Objective: The package inserts are official clinical decision-making documents that provide pharmacological treatment information. However, it has been noted that package inserts on perinatal drug usage differ greatly from expert opinions. This study identified Japanese package insert drugs that are contraindicated for pregnant women and compared them to foreign risk categories.Methods: The survey included 19,022 drugs on the drug pricing list as of April 2022, with package inserts available on the Pharmaceuticals and Medical Devices Agency website. We retrieved the package inserts with the word “pregnant” in the “Contraindications” section and reviewed the descriptions to exclude those that satisfied the exclusion criteria. We also checked the foreign risk categories of contraindicated ingredients for pregnant women. This study used the Australian Therapeutic Goods Administration’s categorization for prescribing medicines in pregnancy (the TGA classification).Results: Of the 19,022 medicines studied, 4,111 (21.6%) were contraindicated for pregnant women. Conversely, 19 (5.1%) ingredients categorized under the relatively safe TGA classifications A, B1, and B2 were also contraindicated for pregnant Japanese women.Conclusion: This study revealed that Japanese package inserts contraindicate over 20% of drugs for pregnant women. On the other hand, some forbidden ingredients did not match the foreign risk categories. Therefore, healthcare professionals should be aware of the limitations of Japanese package inserts concerning pregnant women and make careful decisions based on both package inserts and additional drug information.

Background/Aims: Immune checkpoint blockade has recently been reported to be effective in treating microsatellite instability (MSI)-high tumors. Therefore, sufficient sampling of histological specimens is necessary in cases of unresectable pancreatic cancer (UR-PC). This multicenter study investigated the efficacy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) using a Franseen needle for MSI evaluation in patients with UR-PC. Methods: A total of 89 patients with UR-PC who underwent endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) or EUS-FNB using 22-G needles at three hospitals in Japan (2018–2021) were enrolled. Fifty-six of these patients (FNB 23 and FNA 33) were followed up or evaluated for MSI. Patient characteristics, UR-PC data, and procedural outcomes were compared between patients who underwent EUS-FNB and those who underwent EUS-FNA. Results: No significant difference in terms of sufficient tissue acquisition for histology was observed between patients who underwent EUS-FNB and those who underwent EUS-FNA. MSI evaluation was possible significantly more with tissue samples obtained using EUS-FNB than with tissue samples obtained using EUS-FNA (82.6% [19/23] vs. 45.5% [15/33], respectively; p<0.01). In the multivariate analysis, EUS-FNB was the only significant factor influencing the possibility of MSI evaluation. Conclusions EUS-FNB using a Franseen needle is desirable for ensuring sufficient tissue acquisition for MSI evaluation.

The purpose of this study was to clarify the changes in the sense of difficulty hospital staff felt toward palliative care before and after a palliative care team of the pediatric hospital started in-hospital consultation. A self-administered questionnaire about the difficulty, consisting of 21 items in five areas, was used to conduct a survey in 2015 for the pre-consultation period, and in 2018 for the post-consultation period. Responses were obtained from 222 people in the pre-consultation period (response rate of 70.9%) and from 384 people in the post-consultation period (response rate of 87.3%). Over 70% of the respondents were nurses and midwives. A lower sense of difficulty was observed in three of the items including “relief of painful symptoms”, “family care during caregiving”, and “support when oneself and surrounding staff feeling inadequate and lost”. Further, a significant decrease was observed in the sense of difficulty in six items reported by nurses and midwives in departments receiving the interventions. Eleven of the 16 cases in which the palliative care team intervened involved multiple requests for intervention for 2 patients with pain control difficulties, suggesting that the consultation activities contributed to the decrease in the sense of difficulty experienced by nurses and midwives.

Objective: “Housing for the elderly” is a type of facility where a few healthcare staff and care workers provide long-term care to residents. This study aimed to explore the infection control measures promoted by the public health centers (PHC) when a cluster of norovirus cases occurred in this type of facility.Materials and Methods: This study involved a prefectural office in Japan and collected the records of PHC surveys/instructions of norovirus cluster cases that occurred in “housing for the elderly” facilities between 2017 and 2019. The records provided information about the case characteristics (cluster periods and number of infected individuals) and instructions for infection control by the PHC. We tabulated the case characteristics and performed a descriptive qualitative analysis to extract the instructions from the PHC.Results: Twelve clusters of cases were included in the study. Approximately 16% of the residents and care workers in each facility were infected, and it took an average of 23 days from the start of the outbreak to the end. Nine categories of PHC instructions emerged after the data analysis. “Collaboration with community healthcare workers” included instructions by the PHC to share information with external physicians and home-visiting nurses. In “precautions when caring for elderly residents with functional decline”, the procedure for changing diapers and infection control measures considering the behavior of residents with dementia were advised. If the contents of the infection control manuals were deemed to be inadequate, an “improvement of the infection control manuals” was instructed.Conclusion: To implement effective infection control by care workers at “housing for the elderly” facilities, the PHC should promote the involvement of community physicians and nurses and advise on clear procedures based on residents’ functional decline.

Clarifying the current state of ophthalmic solutions and the handling of eye drops is important for the proper use of ophthalmic solutions. In this study, a questionnaire survey was conducted from May 2018 to February 2019 on 200 ophthalmic inpatients who provided consent. In total, 36.5% of the patients were dissatisfied with the usability of ophthalmic containers due to their hard material andthe difficulty of releasing the ophthalmic solution. In addition, 43.0% of the patients repliedthat they hadlearnedfrom medical professionals, such as doctors and pharmacists, about the handling of eye drops, whereas 45.0% reported failing to apply ophthalmic solutions onto their eyes correctly. Only 2.0% of the respondents answeredthat they hadconsulteddoctors or pharmacists about the use of ophthalmic solutions. These findings underscore the current problems about patients’ satisfaction with ophthalmic solutions andhandling of eye drops. Therefore, pharmacists may needto be actively involvedin patients’ selection of ophthalmic solutions andinstruct them regarding usage.

  Using healthy volunteers, we examined the influence of emulsified oil and a low concentration of CO2 gas on cutaneous blood flow in the forearm. The forearm of each subject was immersed in 25 liters of warm water containing either 10 ppm emulsified oil or 60 ppm CO2 gas or both. Forearm cutaneous blood flow was measured for 20 minutes. Emulsified oil had no effect on cutaneous blood flow, whereas CO2 gas caused a gradual and significant increase. When CO2 gas was used with emulsified oil, cutaneous blood flow was significantly increased in comparison to CO2 alone, suggesting that emulsified oil enhances the vasodilation caused by CO2. We then prepared bath salts releasing CO2 and emulsified oil, and tested for their influence on sweating function in sixteen healthy adults. Each subject bathed daily 10 minutes either in tap water (control group) or in tap water dissolving bath salts releasing CO2 and emulsified oil (bath-salts group) at 40°C for successive 14 days. A sweating test was performed before and after the session of bathing. In the bath-salts group, the baseline tympanic temperature after successive bathing tended to be lower than that before successive bathing. Although the rise of body temperature during the heat exposure was not different between the groups, sweating rate was significantly greater after successive bathing. The analysis of the rate of sweat expulsion suggested that the greater sweat rate after the successive bathing is mediated by the central mechanism for sweating. Such changes were not observed in the control group. Thus, successive bathing using bath salts that release CO2 and emulsified oil may have a beneficial effect on sweating function.

Objective  Preterm birth is the major cause for neonatal deaths in low and middle income countries. The aim of this report is to evaluate the proportions of deaths of moderate to late preterm infants born at 32 to 36 weeks of gestations as well as the neonates with low birth weights weighing from 1500g to 2499g among the total neonatal deaths and analyze their causes of deaths in Lempira province, the Republic of Honduras. Study design  A secondary analysis based on the data sets from the regional office of Ministry of Health.Methods  We obtained data sets on infant mortality from January 2015 to June 2017 compiled by a regional office of Ministry of Health in Lempira province. We then calculated proportions of each cause of death in the groups of newborn infants stratified by gestational weeks and birth weights.Results  During the study period, a total of 253 neonatal deaths were recorded, comprising 66.9% of the total infant deaths (n=378). The number of the newborn infants who died during early neonatal period was 201 (79.4%). The number of preterm newborn infants who died during neonatal period was 146 (57.7%) and 70 (27.6%) were born at moderate to late preterm periods. 103 (40.7%) were born with their birth-weights below 2500g, and the number of those weighing from 1500g to 2499g were 61 (24.1%). The leading cause of deaths of moderate to late preterm infants was hyaline membrane disease (n=25/48: 52.1%), as was the case with low birth weight infants weighing from 1500g to 2499g. Conclusion  It was shown that approximately one fourths of neonatal deaths occurred in moderate to late preterm infants in Lempira province during the study period. Approximately half of these preterm infants died of hyaline membrane disease, who could have been saved with simple and low-cost equipment such as bubble continuous positive airway pressure.

The patient was a 48-year-old woman who had been taking oral steroids for dermatomyositis since age 39. The patient experienced an episode of sudden chest tightness at age 48, and acute myocardial infarction was suspected. Coronary angiography revealed a right coronary artery occlusion ; emboli (thrombi) were collected from the same site. Left cardiac ventriculography revealed the presence of a mobile thrombotic mass in the ascending aorta. Although heparin therapy was initiated considering the possibility of thrombosis, no shrinkage of the mass was observed, and surgery was planned as per treatment guidelines. The mass was a rod-shaped thrombus measuring 20 mm×7 mm×7 mm attached to the aortic wall, approximately 2.5 cm distal from the entrance to the right coronary artery. Since the aortic wall at the site of the tumor attachment was normal, surgery involved only removal of the mass. A histopathological assessment revealed that the mass was a mixed thrombus containing both white and red thrombotic components. The patient was started on postoperative oral antiplatelet and anticoagulant drug therapy to prevent additional thrombosis, and no recurrence has been noted at 1 year postoperative.

BACKGROUND: Age-related low-grade inflammation causing endothelial disruption influences sarcopenia, hypertension, and atherosclerosis. We reported previously that maintenance of muscle strength in elderly hypertensive men with high platelet levels is positively associated with subclinical atherosclerosis but not in those with low platelet levels. Since reduced tongue pressure is related to sarcopenia, tongue pressure may be associated with subclinical carotid atherosclerosis in hypertensive elderly subjects, and platelet levels may function as an indicator of the association between tongue pressure and subclinical carotid atherosclerosis. METHODS: We conducted a cross-sectional study of 342 hypertensive elderly Japanese men aged 60-89 who participated in an annual health check-up in 2015 and 2016. Subclinical carotid atherosclerosis was defined as a common carotid intima-media thickness (CIMT) of 1.1 mm or more. RESULTS: In the overall study population, 171 subjects demonstrated low platelets (< 21.4 × 10/μL). Tongue pressure was significantly inversely associated with subclinical carotid atherosclerosis in these subjects, but not in subjects with high platelets. The known cardiovascular risk factor adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of subclinical carotid atherosclerosis for a 1 standard deviation (SD) increment in tongue pressure (10.4 kPa) were 0.54 (0.35, 0.85) and 1.31 (0.87, 1.96), respectively. CONCLUSION Tongue pressure is inversely associated with subclinical carotid atherosclerosis in hypertensive elderly men with low platelet levels, but not in those with high levels. This finding may thus constitute an efficient tool for clarifying the background mechanism of age-related diseases such as sarcopenia, hypertension, and atherosclerosis.
Aged ; Aged, 80 and over ; Aging ; blood ; physiology ; Carotid Artery Diseases ; blood ; physiopathology ; Carotid Intima-Media Thickness ; Confidence Intervals ; Cross-Sectional Studies ; Humans ; Hypertension ; blood ; physiopathology ; Japan ; Male ; Middle Aged ; Odds Ratio ; Platelet Count ; Pressure ; Risk Factors ; Tongue ; physiology

　　The Department of Plastic Surgery in our hospital uses compression stockings as a preventive measure against deep venous thrombosis (DVT). Elastic bandages are also used in patients with bone protrusion, skin lesions, or with no size-matched stockings. However, elastic bandages are associated with problems such as inconsistent compression force, ready loss of compression, and local skin lesions due to compression. Therefore, to address these problems, we developed a new bandaging technique by layering different types of bandages (multi-layer bandages), evaluated changes in compression using a measurement device, and examined skin condition after 6 h. On average, the compression of elastic bandages and multi-layer bandages decreased by 52% and 37.4%, respectively, after 6 h (t-test, P = 0.036). Skin wrinkles were finer with the multi-layer bandages. These results suggest that multi-layer bandages are less likely to loosen and that cast paddings prevent bandages from compressing the same local areas. However, because previous research warns of using elastic bandages as an easy way to prevent DVT, it is important to acquire accurate knowledge and master skills for bandaging with proper compression.