Introduction: We aimed to evaluate the impact of lifestyle modifications on the risk of eradication failure in patients undergoing first-line therapy for Helicobacter pylori infection.Methods: A survey was conducted in a community pharmacy to assess changes in alcohol consumption, smoking, and high-fat diet intake before, during, and after first-line therapy for H. pylori infection in enrolled patients.Results: A total of 100 patients (response rate: 3.4%) were included in the analysis. Before therapy, 20 patients (20%) smoked, 35 patients (35%) consumed alcohol, and 91 patients (91%) had a high-fat diet. During therapy, the proportion of patients who changed their habits was 15.0% (3/20) for smoking, 71.4% (25/35) for alcohol consumption, and 28.6% (26/91) for high-fat diet. However, the continuation of these changes post-therapy was minimal.Conclusion: Among patients undergoing first-line therapy for H. pylori infection, lifestyle habits that increase the risk of eradication failure were prevalent, with many patients maintaining their habits during therapy except for alcohol consumption. These findings provide fundamental data for lifestyle counselling during eradication therapy.

Objective: In Sweden, primary healthcare centers play an important role in the performance of general practice, education, and clinical research. In Japan, general physicians or general practitioners are expected to be more active in the small-scale hospitals and clinics in rural areas. This study aimed to explore the differences in attitudes toward general practice and clinical research among medical students in Japan and Sweden to present solutions to help doctors stay in rural areas of Japan.Materials and Methods: This cross-sectional study was conducted at two medical schools in Japan and Sweden in 2018, using an anonymous and self-administered questionnaire survey that comprised 16 items including 9 items on clinical research.Results: Participants were 154 medical students (response rate: 69.4% for 222 students) in Japan and 56 (27.1% for 201 students) in Sweden. The proportion of medical students who wanted to become general physicians was greater in Japan than in Sweden (Japan:Sweden=36.4%:17.9%; P=0.012). Although fewer Japanese students wanted to conduct research in rural areas than Swedish students (43.5%:57.1%; P<0.001), the positive proportion of Japanese students working in clinical research and/or taking an academic degree in rural areas was greater than that of Swedish students (52.0%:23.2%; P=0.032).Conclusion: As Swedish medical students and young doctors learn considerably from primary healthcare centers, their attitudes toward clinical research are more developed than those of their Japanese counterparts. However, more Japanese medical students than Swedish students wish to become general practitioners, and they are likely to strive to conduct clinical research at small-scale hospitals/clinics in rural areas. Therefore, the improvement of the clinical research environment in small-scale hospitals and clinics in rural areas is needed at the earliest in Japan.

Objective: To determine the extent of pharmacists’ burden of inquiries from healthcare professionals in community pharmacies. Design: A descriptive cross-sectional study. Methods: A web-based survey was administered to pharmacists affiliated with Medical System Network Group, Inc.’s community pharmacies in Japan. The survey was conducted from February 15 to March 31, 2022. The primary outcome was the burden of inquiries from healthcare professionals and the secondary outcome was the level of burden by job category. Healthcare professionals were defined as physicians, nurses, pharmacists, administrators, care managers, and nursing home staff. To assess the degree of burden, participants were asked “Do you feel burdened by inquiries from health care professionals ? ” and their response was rated on a 5-point Likert scale (not at all, slightly, a little, a lot, and very much). The responses “a lot” and “very much” were combined and defined as “burdened.” To identify the causes of burden, factors of burden and inquiries were investigated. Results: Totally, 1,667 participants were recruited, of which 915 (54.9%) were included in the analysis (women: 62.6%). The participants had a median age of 38 years (interquartile range 31, 48), and worked as pharmacists for 12 years (interquartile range 5, 20). Nearly 13.5% of the respondents felt burdened by inquiries from healthcare professionals and 34.7% reported that physician inquiries were burdensome. The most common reason for feeling burdened was a lack of knowledge about the inquiries (77.3%). Conclusion: It was found that 13.5% of respondents felt burdened when dealing with inquiries from healthcare professionals to pharmacists. In particular, a high percentage of respondents felt burdened by inquiries from physicians. Further research is needed to clarify whether the introduction of a tool that matches the results of this study will reduce the burden of responding to inquiries.

Background/Aims: Several studies have assessed the effect of cool temperature on colonic peristalsis. Transient receptor potential melastatin 8 (TRPM8) is a temperature-sensitive ion channel activated by mild cooling expressed in the colon. We examined the antispasmodic effect of cool temperature on colonic peristalsis in a prospective, randomized, single-blind trial and based on the video imaging and intraluminal pressure of the proximal colon in rats and TRPM8-deficient mice. Methods: In the clinical trial, we randomly assigned a total of 94 patients scheduled to undergo colonoscopy to 2 groups: the mildly cool water (n = 47) and control (n = 47) groups. We used 20 mL of 15°C water for the mildly cool water. The primary outcome was the proportion of subjects with improved peristalsis after treatment. In the rodent proximal colon, we evaluated the intraluminal pressure and performed video imaging of the rodent proximal colon with cool water administration into the colonic lumen. Clinical trial registry website (Trial No. UMIN-CTR; UMIN000030725). Results: In the randomized controlled trial, after treatment, the proportion of subjects with no peristalsis with cool water was significantly higher than that in the placebo group (44.7% vs 23.4%; P < 0.05). In the rodent colon model, cool temperature water was associated with a significant decrease in colonic peristalsis through its suppression of the ratio of peak frequency (P < 0.05). Cool temperaturetreated TRPM8-deficient mice did not show a reduction in colonic peristalsis compared with wild-type mice. Conclusion For the first time, this study demonstrates that cool temperature-dependent suppression of colonic peristalsis may be associated with TRPM8 activation.

No study has described Streptococcus dysgalactiae subsp. equisimilis (SDSE) isolates that cause repetitive infections (recurrence and reinfection). We compared the microbiological characteristics of SDSE causing repetitive infections with those causing single infections. Three patients with invasive infections were identified based on their medical records, and multiple SDSE isolates were collected at intervals over three weeks, using a laboratory repository. Isolates from 12 patients with single-episode infections served as controls. Six isolates were collected from three patients with first and second episodes of infection. All isolates causing either repetitive or single-episode infection were subjected to emm typing, multilocus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE), and random amplified polymorphic DNA (RAPD) analyses. Amplification of five virulence genes (sicG, prtF1, prtF2, lmb, and cbp), biofilm formation (BF), and cell invasion abilities (CIAs) were measured as virulent phenotypes. We observed close genetic similarities in the data obtained by emm typing, MLST, PFGE, and RAPD in four isolates from two patients, suggesting recurrence, whereas two isolates from one patient indicated genetic differences in these data, suggesting re-infection. The presence of the five virulence genes and the BF and CIA measurements appeared not to contribute to repetitive infections, compared with isolates causing single-episode infection. In conclusion, clinicians encountering patients with repetitive infections should be aware of both possibilities: recurrence with closely related strains and reinfection with different strains.
Biofilms ; DNA ; Electrophoresis, Gel, Pulsed-Field ; Humans ; Medical Records ; Multilocus Sequence Typing ; Phenotype ; Recurrence ; Streptococcus ; Virulence

BACKGROUND: The canonical Wnt/β-catenin signaling pathway is a fundamental regulatory system involved in various biological events. ICG-001 selectively blocks the interaction of β-catenin with its transcriptional co-activator cyclic AMP response element-binding protein (CBP). Recent studies have provided convincing evidence of the inhibitory effects of ICG-001 on Wnt-driven disease models, such as organ fibrosis, cancer, acute lymphoblastic leukemia, and asthma. However, the effects of ICG-001 in atopic dermatitis (AD) have not been investigated. OBJECTIVE: To investigate whether β-catenin/CBP-dependent signaling was contributed in the pathogenesis of AD and ICG-001 could be a therapeutic agent for AD. METHODS: We examined the effects of ICG-001 in an AD-like murine model generated by repeated topical application of the hapten, oxazolone (Ox). ICG-001 or vehicle alone was injected intraperitoneally every day during the development of AD-like dermatitis arising from once-daily Ox treatment. RESULTS: Ox-induced AD-like dermatitis characterized by increases in transepidermal water loss, epidermal thickness, dermal thickness accompanied by increased myofibroblast and mast cell counts, and serum levels of thymic stromal lymphopoietin and thymus and activation-regulated chemokine, and decreases in stratum corneum hydration, were virtually normalized by the treatment with ICG-001. Elevated serum levels of periostin tended to be downregulated, without statistical significance. CONCLUSION: These results suggest that β-catenin/CBP-dependent signaling might be involved in the pathogenesis of AD and could be a therapeutic target.
Animals ; Asthma ; Chemokine CCL17 ; Cyclic AMP Response Element-Binding Protein ; Cyclic AMP ; Dermatitis ; Dermatitis, Atopic ; Fibrosis ; Mast Cells ; Mice ; Myofibroblasts ; Oxazolone ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Water

An 83-year-old man who had undergone aortic arch repair using the elephant trunk technique in addition to abdominal aorta repair required surgical intervention for a pseudoaneurysm at the distal anastomosis of the aortic arch graft. Due to marked adhesion around the aneurysm, aortic cross-clamping was not feasible. Thus, under femoro-femoral partial bypass, the arch prosthesis was endoclamped using an aortic occlusion balloon inserted through the left femoral artery into the aortic arch graft and through the elephant trunk, guided by fluoroscopy and transesophageal echocardiography. This allowed descending aorta replacement with minimal bleeding. His postoperative course was uneventful. This technique enabled safe and bloodless clamping of the proximal portion of the aortic arch graft.

It was previously reported the safety and efficacy of oral tapentadol ER switched from other opioids for 8 weeks in subjects with moderate to severe cancer pain, who received opioid analgesics prior to study participation. All treatment emergent adverse events were evaluated in previous safety analysis. In this report, the incidence and timing of opioid specific adverse events related to tapentadol administration were analyzed and compared with those of morphine SR as a reference. Fifty subjects each was randomized to the tapentadol ER group and the morphine SR group. The incidences of major adverse events that are considered related to treatment in the tapentadol ER group and the morphine SR group were nausea (8.0%, 14.0%), vomiting (2.0%, 24.0%), constipation (8.0%, 20.0%), and somnolence (8.0%, 18.0%), the incidences of these events were lower in the tapentadol ER group. These results suggest that tapentadol ER is a orally opioid which has well safety profiles, and is a new option of cancer pain therapy.

The present multicenter, open-label study evaluated the efficacy and safety of tapentadol ER administered at 50 mg/day to 500 mg/day in opioid-naive and opioid-switching subjects with moderate to severe cancer pain. For opioid-naive subjects, the initial dose was tapentadol ER 50 mg/day. For opioid-switching subjects, the initial dose was determined depending on previously used opioid and was dose-adjusted for each subject. The study design consists of two parts of titration period and maintenance period to which a patient who achieves dose adjustment can proceed. The percentage of subjects achieving dose adjustment in the titration period was 93.3% for opioid-naive subjects and 80.6% for opioid-switching subjects. The percentage of subjects who maintained adequate analgesia throughout the maintenance period (primary endpoint) was 89.7% for opioid-naive subjects and 92.9% for opioid-switching subjects. The most frequent adverse events were were nausea, vomiting, somnolence, and constipation, all of which were commonly reported with the use of opioids. These findings showed that tapentadol ER was well tolerated in the dose range of 50 mg/day to 500 mg/day.