Diagnosis of Amantadine Intoxication Presenting Disturbed Consciousness and Myoclonus by Interprofessional Collaboration / 日本プライマリ・ケア連合学会誌

We report a case with disturbed consciousness and myoclonus, diagnosed as amantadine intoxication. Amantadine is widely used in the treatment of Parkinson's syndrome. However, in elderly patients and those with renal dysfunction, amantadine overdose is a rare complication, resulting in symptoms of intoxication such as impaired consciousness and myoclonus. In the present case, multiple amantadines prescribed by several medical institutions may have resulted in the observed intoxication. Our pharmacists and nurses checked the medications and found duplicate amantadine prescriptions.

Evaluating prognostic significance of preoperative C-reactive protein to albumin ratio in older patients with pathological stage II or III colorectal cancer

Purpose@#This study was performed to evaluate the prognostic value of preoperative C-reactive protein to albumin ratio (CAR) in older patients with colorectal cancer (CRC) undergoing curative resection. @*Methods@#We retrospectively analyzed 244 older patients (aged 75 years or higher) with pathological stage II or III CRC who underwent curative surgery between 2008 and 2016. The optimal value of CAR was calculated and its correlation with the clinicopathological factors and prognosis was examined. @*Results@#The optimal cutoff value of the CAR was 0.085. High preoperative CAR was significantly associated with high carcinoembryonic antigen levels (P=0.001), larger tumor size (P<0.001), and pT factor (P=0.001). On multivariate analysis, high CAR was independent prognostic factor for relapse-free survival (P=0.042) and overall survival (P=0.001). @*Conclusion@#Preoperative elevated CAR could be considered as an adverse predictor of both relapse-free survival and overall survival in older patients with CRC undergoing curative surgery.

The Actual Status of Handling Prescription Refills in Community Pharmacies and Pharmacists' Awareness of the Refill-Prescription System / 医薬品情報学

Objectives: A refill-prescription system startedin April, 2022 in Japan. Refill-prescriptions can be usedrepeatedly, but pharmacists are required to check patients' medication and determine whether refills are appropriate. This study aimed to clarify the actual status of community pharmacies' treatment of prescription refills and pharmacists’ concerns about them.Design: Questionnaire survey.Methods: A self-administered questionnaire survey was conducted for pharmacists at community pharmacies from June to July, 2022, shortly after the refill-prescription system was launched, focusing on handling of prescription refills in community pharmacies, and concerns and challenges about refill-prescriptions.Results: Responses were obtainedfrom 377 pharmacists in 34 prefectures throughout Japan. Among them, 30.8% had received refill-prescriptions. Many pharmacists checked medical histories, changes in patients' symptoms, and medication and medical examination status when determining the appropriateness of refills, but few reviewed past laboratory values or laboratory values measuredby patients themselves at the time of their pharmacy visit. Moreover, 34.8% of the pharmacies had internal rules for dealing with refills, and 39.8% had equipment to measure laboratory values. Many pharmacists were concerned about how to share patients’ information with other pharmacies. Challenges that were identified included “Determining whether the refill is appropriate for the patient” and “Establishment of a pharmacy system to receive refill-prescriptions”.Conclusion: This study clarified the actual status of community pharmacies handling of prescription refills, and pharmacists' concerns or challenges about them. Potential improvements include increasing the number of devices that can measure laboratory values at pharmacies, improving home-use measuring devices, creating guidelines to determine the appropriateness of prescription refills and improving pharmacists' skills.

Consideration of Definition of Solitary Death, and Changes before and after Coronavirus Pandemic: A Survey of Post-mortem Examination Cases in Shizuoka City / 日本プライマリ・ケア連合学会誌

Introduction: The aim of this study was to consider the definition of solitary death by examining characteristics of cases, and to explore the impact of the coronavirus pandemic.Methods: Subjects were individuals with post-mortem examination and autopsy imaging data recorded between 2017 and 2022. Subjects were classified by whether they passed away at home (solitary). We investigated differences between groups in their causes of death, time elapsed between death and discovery, presence or absence of housemates, and prior symptoms.Results: There were 129 cases (79.9%) of solitary death and 41 cases (24.1%) of death outside the home. Solitary death cases were significantly younger. Among these, less than half were discovered more than a day after death, lived alone, or were older adults. Older adults and those discovered more than a day after death were more likely to have trauma as their official cause of death. The frequency and characteristics of solitary death did not change before or after the coronavirus pandemic.Conclusion: Preventive measures for solitary death should not be limited to older adults or those living alone. In particular, deaths from diseases other than sudden death, trauma in older adults, and cases where symptoms were present or medical attention was sought before death are potentially preventable. Countermeasures for solitary death are important in the post-coronavirus pandemic period.

A study on risk factors inducing stress fractures in young Japanese long-distance runners -effects of training distance and intensity- / 体力科学

The purpose of this study was to examine the risk factors of stress fractures in terms of training distance and intensity in young male Japanese high school long-distance runners. Nine hundred and twenty-five runners from high schools, colleges, and work teams responded to our questionnaire. Our analysis of the questionnaire found that the onset rates of stress fractures in males were 25.0%, 40.2%, and 55.3% in high school runners, collegiate runners, and work team runners, respectively, suggesting that young Japanese long-distance runners are more likely to suffer from stress fractures than European and American runners. Stress fractures occurred in male high school and collegiate runners after training that had increased running distance (24.7% and 33.1%, respectively) or running intensity (17.0% and 9.6%), or both increased running distance and increased running intensity (29.8% and 34.6%), suggesting that an increase in running distance at moderate intensity might be a major risk factor in stress fractures in young male long-distance runners. Data from college and work team runners that ran all three years of high school show that stress fractures are most likely to occur in May of the high school freshman year. These results suggested a need to reconsider training programs for freshmen to prevent stress fractures in young runners.

A Case of Adult Hypophosphatasia with Non-specific Symptoms / 日本プライマリ・ケア連合学会誌

A 40-year-old female visited our hospital because of malaise. She had no history of early loss of primary teeth nor family history of skeletal dysplasia. Laboratory examination showed low serum alkaline phosphatase levels of 18 U/L. In addition, hypozincemia was also observed, but alkaline phosphatase level did not increase after zinc replacement. Mediators, including calcium and phosphorus metabolism, were within normal range. X-ray examination showed no evidence of osteomalacia, but mineral bone density was slightly decreased compared with the young adult mean. Urine phosphoethanolamine level was increased, and we then suspected hypophosphatasia. Genetic tests detected ALPL gene heterozygous missense mutation (c.529G>A p.Ala177Thr and c.670A>G p.Lys224Glu) and adult-onset hypophosphatasia was finally diagnosed. It is important to evaluate alkaline phosphatase levels in the screening of patients with non-specific symptoms.

Antiepileptic Drug Adherence and Its Associated Factors among Epilepsy Patients on Follow-ups at Emanuel Mental Specialized Hospital, Ethiopia

Medication adherence is a fundamental determinant of effective treatment. However, people with epilepsy have poor compliance with their treatment because of the chronic nature of the disease. Limited studies have been conducted to address antiepileptic medication adherence in Africa, including Ethiopia. Thus, the aim of this study was to assess antiepileptic drug adherence and its asociated factors among patients with epilepsy attending outpatient department of Amanuel Mental Specialized Hospital. METHODS: A cross-sectional study design was conducted on 439 patients with epilepsy in Amanuel Mental Specialized Hospital. Medication adherence reporting scale-5 (MARS-5) was used to assess adherence to antiepileptic drugs. The Oslo social support, Jacob perceived stigma scale, and hospital anxiety and depression scale (HADS) were the instruments used to assess associated factors. Simple and multiple linear regression analysis models were fitted. Then, the adjusted unstandardized beta (ß) coefficient at a 95% confidence level was used. RESULTS: The mean (SD) score of antiepileptic medication adherence was 16.38(±3.76) with 95%CI:(16.03, 16.72). Depressive symptoms (ß= -1.35, 95% CI: (-2.04, -0.65)), anxiety symptoms (ß=-1.12,95%CI:(-1,79, -0.44), perceived stigma (ß= -1.64, 95% CI: -2.16, -1.12), being single (ß=-0.67, 95%CI: -1.20, -0.14), presence of seizure per month (ß=-2.11,95% CI: (-2.81, -1.41) and antiepileptic drug adverse effect (ß=-0.07,95%CI: -0.11, -0.03) were factors associated with anti-epileptic medication adherence. CONCLUSION: The results suggest that the mean score of adherences to antiepileptic drugs was poor as compared to other settings. Antiepileptic medication adherence screening tool should be included in the patient's treatment protocol

The Understanding of “Group Home” in Pharmacy Students, and the Impact of Test-linked Video Lectures: A Survey / 社会薬学

To acquire “practical abilities in community health and medical care”, it is necessary to understand the work tasks in the context of welfare and working care facilities and smoothly promote inter-professional work. It is considered that the time when pharmacy students fully understand the outline of “group home”, which is one of the working care facilities, is during the class or practical training period. Therefore, we conducted a questionnaire survey in the context of 4-6th grade students. In addition, to improve the knowledge of students with insufficient comprehension, video lectures were created; comprehension was evaluated in both pre-post-tests. Furthermore, the effectiveness of the video lecture was evaluated based on the analysis of the students’ understanding. The most common cognitive methods and periods for both 4th and 6th graders were “friends/family” and “before entering university”, respectively. As a result of the pre-test, the correct answer rate of each item and the total average score （50.0% and less than 50.0 points, respectively） suggested a low level of understanding regardless of the grade. On the other hand, the correct answer rate of each item and the total average score （70.0% and 70.0 points or more, respectively） in the post-test showed a high degree of understanding; further, they were significantly increased compared to those with respect to the pre-test, indicating the effectiveness of the video lecture. From the above results, we devised a test-linked video lecture that can be used as an effective tool for the understanding of the outline of “group home”.

Survey of Adverse Events and Continuity of Treatment in Old-Old Patients Treated With Trifluridine / Tipiracil Hydrochloride for Colorectal Cancer / 日本農村医学会雑誌

Trifluridine (FTD) / tipiracil hydrochloride (TPI) has been approved for the treatment of colorectal cancer, but its dose-limiting toxicity is neutropenia. Elderly patients are at high risk of febrile neutropenia and should be monitored carefully when administering FTD / TPI. In this study, we retrospectively investigated the incidence of adverse events, dose reduction, and number of administered courses in 8 old-old patients treated with FTD / TPI for colorectal cancer. The results showed that severe neutropenia of Grade 3 or higher occurred in 5 of the 8 patients. Six patients had a dose reduction, but 5 of them were able to continue treatment for at least 3 courses. The frequency and severity of adverse events, including neutropenia, appears to be higher in old-old patients, so it is important to take appropriate measures.

Effect of temporary school closure due to COVID-19 on musculoskeletal function in elementary school children / Journal of Rural Medicine

Objective: In 2020, coronavirus disease-2019 (COVID-19) became the cause of a pandemic. In response, the Japan Sports Agency issued warnings about secondary damage to health, such as the threat to physical and mental well-being due to the lack of exercise in this situation. In this study, we report on cross-sectional and longitudinal examinations of standing trunk flexion to evaluate how temporary long-term school closures affected musculoskeletal function in elementary school students.Patients and Methods: All children in one public elementary school in T-city during the school years 2019 and 2020 were included in this study. A digital forward flexion meter was used to measure standing trunk flexion.Results: In this study, 284 (284/289: 98.3%) and 266 (266/274: 97.1%) children in school years 2020 and 2019, respectively, were found to have valid data for cross-sectional analysis. The standing trunk flexion did not show significant differences between grades or sexes. In the longitudinal analysis, the results of the comparison of standing trunk flexion in children for two consecutive years revealed significant differences only between grades 3 and 4 (P<0.05) and between girls in grades 3 and 4 (P<0.01), but no significant differences in other grades or among boys or girls were observed.Conclusion: Initially, we expected that there would be a difference in the results of functional assessment using standing trunk flexion depending on the period of absence from school. However, the results of this study showed no significant changes in standing trunk flexion. Moreover, since children’s musculoskeletal functions may be affected by various factors during the COVID-19 pandemic, they should be carefully monitored in the future.

Zebrafish Vascular Development: General and Tissue-Specific Regulation

Circulation is required for the delivery of oxygen and nutrition to tissues and organs, as well as waste collection. Therefore, the heart and vessels develop first during embryogenesis.The circulatory system consists of the heart, blood vessels, and blood cells, which originate from the mesoderm. The gene expression pattern required for blood vessel development is predetermined by the hierarchical and sequential regulation of genes for the differentiation of mesodermal cells. Herein, we review how blood vessels form distinctly in different tissues or organs of zebrafish and how vessel formation is universally or tissue-specifically regulated by signal transduction pathways and blood flow. In addition, the unsolved issues of mutual contacts and interplay of circulatory organs during embryogenesis are discussed.

Zebrafish Vascular Development: General and Tissue-Specific Regulation

Circulation is required for the delivery of oxygen and nutrition to tissues and organs, as well as waste collection. Therefore, the heart and vessels develop first during embryogenesis.The circulatory system consists of the heart, blood vessels, and blood cells, which originate from the mesoderm. The gene expression pattern required for blood vessel development is predetermined by the hierarchical and sequential regulation of genes for the differentiation of mesodermal cells. Herein, we review how blood vessels form distinctly in different tissues or organs of zebrafish and how vessel formation is universally or tissue-specifically regulated by signal transduction pathways and blood flow. In addition, the unsolved issues of mutual contacts and interplay of circulatory organs during embryogenesis are discussed.

Method to prevent cheek depression using an island sternocleidomastoid muscle flap with the middle pedicle as a feeding vessel in immediate reconstruction of the facial nerve with the sural nerve following resection of a parotid gland tumor

Many surgeons have demonstrated the validity of sternocleidomastoid muscle flaps for the reconstruction of head and neck tumors. We present a case in which we used an island sternocleidomastoid muscle flap to reconstruct a cheek depression after excision of a malignant parotid tumor. A 44-year-old woman presented with a right malignant parotid tumor. We performed total resection of the parotid gland and facial nerve with the sural nerve and reconstructed the facial nerve and cheek depression with an island sternocleidomastoid muscle flap. The sternal head of the right sternocleidomastoid muscle was cut at the cranial and caudal segments to elevate it as an island flap. We used the superior thyroid artery as the sole pedicle for the island muscle flap. At 1 year and 3 months after the operation, the mimic muscles had gradually recovered and progressed without complications such as Frey syndrome, cervical motor dysfunction, or concave deformation of the neck and cheeks.

The Learning of Bereavement Care by Family Physicians: A Qualitative Study / 日本プライマリ・ケア連合学会誌

Introduction: The learning and practice of bereavement care by Japanese family practitioners has largely been unexplored. The purpose of this study was to clarify what family doctors thought they learned by providing care for bereaved families and how they changed because of it.Methods: Semi-structured interviews were conducted with seven family practitioners working in bereaved family outpatient care at the researcher's hospital. A modified grounded theory approach was used for the analysis.Results: The analysis identified five thematic categories: 1) the doctor's feelings and thoughts before learning about bereavement care, 2) things they learned from providing bereavement care, 3) things they learned by interacting with the families and things they learned upon reflections afterward, 4) changes in themselves, and 5) changes in their feelings after learning about bereavement care.Conclusion: The doctors learned to provide bereavement care by directly interacting with families and by reflecting on those experiences; for example, they learned to listen and be empathetic, and to understand individuals' personal responses to grief. As a result, they may have gained the ability to have a more rounded view of life and death and of their role in helping families adjust to the death of a family member.

Association between Asian dust exposure and respiratory function in children with bronchial asthma in Nagasaki Prefecture, Japan

BACKGROUND@#Studies on the adverse effects of Asian dust (AD) on respiratory function in children are scarce. The objective of this study was to examine the association between AD and respiratory function by measuring peak expiratory flow rates (PEFRs) in asthmatic children.@*METHODS@#The study was carried out from March to May from 2014 through 2016. One hundred ten children with bronchial asthma were recruited from four hospitals in the Goto Islands and south Nagasaki area in Nagasaki prefecture. The parents were asked to record their children's PEFRs every morning/evening and clinical symptoms in an asthma diary. AD was assessed from light detection and ranging data, and a linear mixed-effects model was used to estimate the effects of AD on daily PEFR. Time-stratified case-crossover analyses were performed to examine the association between AD and asthma attacks defined by reduction levels in PEFR.@*RESULTS@#AD was detected on 11 days in the Goto Islands, and on 23 days in the south Nagasaki area. After adjusting for age, sex, temperature, and daily oxidants, we found a consistent association between AD and a 1.1% to 1.7% decrease in PEFR in the mornings and a 0.7% to 1.3% decrease in the evenings at a lag of 0 to 5 days. AD was not associated with the number of asthma attacks, respiratory symptoms, or other symptoms at any lag days examined.@*CONCLUSIONS@#Exposure to AD was associated with reduced PEFR, although the effects were not large enough to induce clinically apparent symptoms, in clinically well-controlled asthmatic children.

Active Tuberculosis With Rapidly-Growing Pulmonary Lesion in a Hospitalized Dermatomyositis Patient Below Age 40 / 日本農村医学会雑誌

A 38-year-old man was admitted to our hospital with fever and skin rash, and he was diagnosed as having dermatomyositis. He was treated with anti-inflammatory steroid and immunosuppressive agents. On hospital day 48, chest computed tomography (CT) revealed a nodule measuring approximately 2 cm in size in the lower lobe of the right lung (S9). Bacterial and/or fungal infection was suspected, but there was no response to antibiotic or antifungal treatment. A week later, repeat chest CT revealed the tumor now measuring approximately 6 cm in size in the lower lobe of the right lung. We performed bronchoscopy, and bacteriological examination of the transbronchial biopsy specimen revealed pulmonary tuberculosis. Interferongamma release assay (IGRA) before the initiation of immunosuppressive treatment was negative, so we did not administer treatment for latent tuberculosis infection. He was, however, treated with isoniazid, rifampicin, ethambutol, and pyrazinamide for 9 months, following which radiological features improved gradually. Here we describe in detail this rare case of a negative IGRA result before immunosuppressive therapy in a relatively young Japanese man who went on to develop active tuberculosis with a rapidly-growing pulmonary lesion during hospitalization.

Effects of the movement velocity training on sprint performance / 体力科学

To investigate the effects of training focused on the movement velocity of the lower limbs (movement velocity training) on short sprint performance in young female non-athletes. Twenty-nine healthy young females (mean age: 20.1 ± 0.9 years) participated in this study. The subjects were randomized into a movement velocity training group (MV group, n=15) and a resistance training group (R group, n=14). MV group performed six lower limb exercises at high velocity (as fast as possible) with no load. R group performed five lower limb strength exercises using a resistance band. Both training programs were applied for 20 minutes per session, 5 days a week for 6 weeks. The following outcomes were measured at baseline and after 6 weeks of training: 30 m sprint time, 20- 26m running velocity, step length, step frequency, and muscle strength and movement velocity of knee extension. Significant group × time interactions were observed for the 30-m sprint time with the MV group exhibiting a significant improvement on simple main effect analysis. For the other parameters (step length, step frequency, and muscle strength and movement velocity of knee extension), group × time interactions were not observed and a significant main effect was observed. These findings suggest that training focused on the movement velocity of the lower limbs can be effective for improving sprint performance.

Efficacy and safety of cold forceps polypectomy utilizing the jumbo cup: a prospective study

BACKGROUND/AIMS: There are few prospective studies on cold forceps polypectomy (CFP) using jumbo cup forceps. Therefore, we examined patients with diminutive polyps (5 mm or smaller) treated with CFP using jumbo cup forceps to achieve an adenoma-free colon and also assessed the safety of the procedure and the recurrence rate of missed or residual polyp after CFP by performing follow-up colonoscopy 1 year later. METHODS: We included patients with up to 5 adenomas removed at initial colonoscopy and analyzed data from a total of 361 patients with 573 adenomas. One-year follow-up colonoscopy was performed in 165 patients, at which 251 lesions were confirmed. RESULTS: The one-bite resection rate with CFP was highest for lesions 3 mm or smaller and decreased significantly with increasing lesion size. Post-procedural hemorrhage was observed in 1 of 573 lesions (0.17%). No perforation was noted. The definite recurrence rate was 0.8% (2/251 lesions). The probable recurrence rate, which was defined as recurrence in the same colorectal segment, was 17%. Adenoma-free colon was achieved in 55% of patients at initial resection. Multivariate analysis revealed that achievement of an adenoma-free colon was significantly associated with number of adenomas and years of endoscopic experience. CONCLUSIONS: CFP using jumbo biopsy forceps was safe and showed a high one-bite resection rate for diminutive lesions of 3 mm or smaller. The low definite recurrence rate confirms the reliability of CFP using jumbo biopsy forceps. Number of adenomas and years of endoscopic experience were key factors in achieving an adenoma-free colon.

What are the FIM Sub-items Related to Institutionalization in Patients With Disuse Syndrome? / 日本農村医学会雑誌

The objective of this study was to determine whether a decrease in the score for any of the Functional Independence Measure (FIM) domains at discharge compared to before admission (decreased FIM) is associated with increased risk of facility admission. Patients were divided into those discharged to a care facility (facility group) and those discharged home (home group). Patients in the home group were selected so as to match those in the facility group. A total of 36 patients were included in each group. Mean ages of patients in the home and facility groups were 88.9 ± 7.9 and 89.1 ± 7.6 years, respectively, and mean pre-admission total FIM scores were 77.1 ± 29.8 and 78.5 ± 30.3, respectively. When each FIM subdomain was examined for correlation between decreased score and post-discharge destination, bowel management (odds ratio, 4.5), bladder management (3.9), social interaction (3.5), problem solving (3.5), and walking (2.5) were identified as being significantly associated with increased risk of facility admission. A limitation was that this study did not consider the care-giving capacity of families. Further studies are needed to identify additional potential factors affecting post-discharge destination, including care-giving capacity of families and other social factors.

Questionnaire results on exposure characteristics of pregnant women participating in the Japan Environment and Children Study (JECS)

BACKGROUND@#The Japan Environment and Children's Study (JECS) is a nation-wide birth cohort study investigating environmental effects on children's health and development. In this study, the exposure characteristics of the JECS participating mothers were summarized using two questionnaires administered during pregnancy.@*METHODS@#Women were recruited during the early period of their pregnancy. We intended to administer the questionnaire during the first trimester (MT1) and the second/third trimester (MT2). The total number of registered pregnancies was 103,099.@*RESULTS@#The response rates of the MT1 and MT2 questionnaires were 96.8% and 95.1%, respectively. The mean gestational ages (SDs) at the time of the MT1 and MT2 questionnaire responses were 16.4 (8.0) and 27.9 (6.5) weeks, respectively. The frequency of participants who reported "lifting something weighing more than 20 kg" during pregnancy was 5.3% for MT1 and 3.9% for MT2. The Cohen kappa scores ranged from 0.07 to 0.54 (median 0.31) about the occupational chemical use between MT1 and MT2 questionnaires. Most of the participants (80%) lived in either wooden detached houses or steel-frame collective housing. More than half of the questionnaire respondents answered that they had "mold growing somewhere in the house". Insect repellents and insecticides were used widely in households: about 60% used "moth repellent for clothes in the closet," whereas 32% applied "spray insecticide indoors" or "mosquito coil or an electric mosquito repellent mat."@*CONCLUSIONS@#We summarized the exposure characteristics of the JECS participants using two maternal questionnaires during pregnancy.