Respiratory syncytial virus (RSV) is a leading cause of hospitalization in infants and young children worldwide. Although most RSV hospitalizations occur at secondary hospitals, information on RSV-related healthcare costs in these settings is limited. A retrospective analysis of RSV-related hospitalizations was conducted at Saitama City Hospital, a secondary hospital, between April 2018 and May 2024. Patients with laboratory-confirmed RSV infection were included. The study period was divided into three phases based on revisions of the national medical reimbursement schedule. Hospitalization costs were calculated, and high-cost outliers were identified using the interquartile range (IQR) method. A total of 345 patients were hospitalized for RSV, with a marked reduction in Phase II admissions corresponding to the early COVID-19 pandemic. Median hospitalization costs per episode increased in all three phases, from JPY 318,930 to JPY 393,930. Eighteen admissions were identified as cost outliers and classified into three subgroups: (1) children with airway or neurologic disorders, often older than 24 months; (2) otherwise healthy infants under 12 months; and (3) children eligible for palivizumab who contracted RSV before or after the recommended prophylaxis period. Our findings emphasize the existence of high-cost RSV cases outside the currently recognized high-risk groups, including older children with chronic airway disease and healthy young infants. Clinical burden and healthcare costs may be reduced by refining prophylaxis strategies and early intervention in Japan.

Digital therapeutics (DTx) have demonstrated promising potential as a novel therapeutic approach, with their clinical development gaining momentum. Comparison of DTx development between Japan, a relative newcomer, and Germany and the U.S., known for favorable circumstances, is a topic of interest. DTx developed in Japan as of November 2023 were identified on the Pharmaceuticals and Medical Devices Agency (PMDA) website and in the literature. Similar DTx available in the U.S. and Germany were identified in the databases maintained by the U.S. Food and Drug Administration (USFDA) and Federal Institute for Drugs and Medical Devices (BfArM). Data on their clinical trials and regulatory status were obtained from these databases and their respective national clinical trial registries. The data obtained were compared and analyzed. By November 2023, Japan had developed DTx, encompassing 11 therapeutic areas. Seven DTx had reached or completed the confirmatory study stage, whereas five DTx were in the exploratory phase. Twenty DTx in the therapeutic areas were selected from the U.S. and Germany. A total of 27 DTx were reviewed regarding the designs of confirmatory studies and regulatory actions taken. Trial designs demonstrated more similarities than differences across the countries and therapeutic areas. Placebo trial design-associated difficulties were conspicuous. Although regulatory actions to place DTx in the market differed across countries, they effectively ensured the efficacy and safety of DTx that were suitable for marketing considering the most current science. The regulatory measures in the three countries seem to have positively impacted DTx development.

Colorectal large villous adenomas are sometimes associated with McKittrick-Wheelock syndrome, a condition characterized by severe diarrhea leading to dehydration, electrolyte depletion, and acute renal failure, which can be life-threatening in some cases. The efficacy of radiotherapy for colorectal villous adenoma has rarely been reported. We present a rare case of McKittrick-Wheelock syndrome in an older man caused by a large colorectal villous adenoma. This case is notable because palliative external beam radiotherapy of 30 Gy in 10 fractions not only reduced the tumor size but also resulted in significant symptom relief. This report demonstrates the efficacy of palliative radiotherapy for severe colorectal villous adenomas as a valid treatment option, particularly in older patients with complications.

Evidence-based practice (EBP) plays a crucial role in improving healthcare quality; however, there is still a lack of insight into EBP education for nursing in Japan. We aimed to evaluate the acceptability and preliminary effects of an online EBP education program on undergraduate nursing students in Japan. A pilot, single-armed, pre- and post-intervention design study using mixed methods was conducted with 11 nursing students. Participants completed an 8-h EBP education program over a 2-day period, which provided introductory knowledge and skills based on the five steps of EBP. The total score of the Student-Evidence-Based Practice Questionnaire showed a trend toward improvement with a medium effect size (P = 0.06, d =0.51). The following subscales displayed improvement with small to medium effect sizes: "frequency of practice" (P = 0.14, d =0.34), "retrieving/reviewing evidence" (P = 0.04, d = 0.59), and "sharing and applying EBP" (P = 0.13, d = 0.36). The focus group interviews revealed an enhanced understanding of EBP, improved skills for reading articles, and highlighted the importance of interactive teaching and access to on-demand learning materials. Our results suggested that the online EBP education program was acceptable and demonstrated preliminary effects in enhancing the skills of undergraduate nursing students in retrieving and reviewing evidence and results in thematic analysis. Further research such as a controlled trial including a more diverse sample with longer follow-up should be conducted to validate our findings and examine the program's long-term effects on clinical practice.

It is desirable for community pharmacists to be involved in promoting and maintaining the oral health of local residents. In this study, we conducted a questionnaire survey of Japanese community pharmacists to understand the actual conditions and the attitudes of these pharmacists regarding oral healthcare advice. A web-based anonymous self-administered questionnaire survey was completed by community pharmacists from March 26 to 29, 2021. We received responses from 324 pharmacists. A majority of respondents (66.0%) regarded dealing with "daily oral health issues and oral care" as a role of community pharmacists. Respondents also reported being consulted by patients or customers about mouth ulcers (70.1%) and xerostomia (54.6%). However, the frequency of consumer inquiries about these oral conditions was less than once per week. Just over half of the respondents (52.2%) said they were confident about dealing with mouth ulcers, whereas less than 40% were confident about handling other oral problems. The most common anxiety was a "lack of knowledge about appropriate responses to oral symptoms" (60.2%). The respondents desired education and training (75.6%) to better promote oral health-related activities. Japanese community pharmacists believe that they have a role to play in oral health issues and oral care, but their level of confidence in their ability to respond to oral health issues is low. Pharmacists are concerned about their lack of knowledge about oral healthcare and they desire more opportunities for education and training so that they can perform pharmacy-based maintenance and promotion of oral healthcare for local residents.

Recent studies have indicated that diabetic ketoacidosis (DKA) can be the primary presenting symptom of pancreatic cancer. This comprehensive review assesses the existing research on the incidence of DKA as an initial symptom of pancreatic cancer, including its clinical characteristics, diagnostic challenges, and implications for treatment and prognosis. A comprehensive search was conducted across four electronic databases (PubMed, Scopus, Web of Science, and Cochrane), complemented by a manual search. The search criteria focused on original case reports of pancreatic cancer patients who presented with DKA. Among the 360 studies reviewed, 9 met the eligibility criteria. Among the cases, pancreatic adenocarcinoma was the most common type, followed by somatostatinoma and cystadenocarcinoma. Diagnostic modalities included computed tomography, ultrasound, biopsy, and endoscopic ultrasound. Elevated tumor markers such as CA19-9 were reported in several cases. Most patients presented with gastrointestinal and neurological symptoms, with high levels of glucose and ketone bodies. This review highlights that DKA can serve as a rare but significant initial presentation of pancreatic cancer. Identifying this association is critical for facilitating early diagnosis, which may improve the otherwise poor prognosis of pancreatic cancer. Our findings suggest that clinicians should maintain a high index of suspicion for pancreatic malignancy in patients presenting with unexplained DKA, particularly those without traditional risk factors or precipitating events. Early imaging and multidisciplinary evaluation are essential in such cases.

Invasive urothelial carcinoma (UC) has diverse morphological presentations. Here, we describe the case of a Japanese woman aged in her early 60s with UC with unclear differentiation. The patient presented with distinct glandular differentiation and concurrent cystitis glandularis (CG) and intestinal metaplasia (IM) without a conventional UC component. Up to 2% of patients with bladder cancer develop adenocarcinoma. However, differentiating UC with glandular differentiation (UCg) from adenocarcinoma can be challenging. Although CG and IM are associated with adenocarcinoma, their presence does not necessarily imply that the comorbid cancer is adenocarcinoma. In this case, cytokeratin 7 (CK7) and CK5/6 positivity was assessed to establish the diagnosis of poorly differentiated UCg. A poorly differentiated pure UCg without conventional UC components has not yet been reported, which makes diagnosis extremely difficult. Moreover, because of the highly differentiated glandular structures within poorly differentiated UCs, the mechanism of tumorigenesis remains unclear. Further studies involving a larger case series should be conducted to elucidate the association between CG and IM and investigate the genetic background of these tumors, all of which would improve the accuracy of differentiation between poorly differentiated UC and adenocarcinoma.

Hereditary breast and ovarian cancer syndrome (HBOC) is a hereditary tumor syndrome caused by mutations in BRCA genes. Advances in genetic testing technologies have enabled surveillance and risk-reducing surgeries for carriers of BRCA mutations, allowing for the early detection and prevention of cancer. However, the research and support infrastructure for addressing the psychological and social impacts of genetic diagnostics remain insufficient, and there is a need for mental and psychological support based on the needs of patients and their families. Here, we provide an overview of mindfulness, a psychotherapy that has been demonstrated to be effective in alleviating psychological distress in cancer patients, and we discuss the prospects for mindfulness therapy in HBOC patients.

We describe a case of sarcoidosis in a previously healthy 39-year-old man with the development of an acute kidney injury, requiring renal replacement therapy, as the first manifestation of the disease. The course of the disease was complicated by a сatheter-associated bloodstream infection. According to the histological examination of kidney biopsy samples, granulomatous interstitial nephritis was diagnosed. Extensive examination of the patient revealed persistent hypercalcemia, elevated transaminase levels, intrathoracic lymphadenopathy, and infiltrates in the lungs. Other diseases, such as anti-neutrophil cytoplasmic antibody-associated vasculitis, tuberculosis, autoimmune liver diseases, and systemic lupus erythematosus, were ruled out. The patient was treated with pulse therapy of methylprednisolone, which then switched to oral glucocorticoids (prednisolone 60 mg/day followed by a gradual decrease in the dose). The 9-month follow-up revealed a regression of lung lesions and improvement of the impaired renal function. The prednisolone dose was reduced to 7.5 mg/day, and renal replacement therapy was discontinued.

A 0.04% mitomycin C (MMC) ophthalmic solution is not commercially available and is prepared in hospitals as required. The physical properties and stability of the MMC ophthalmic solution have not been clarified because of a lack of data. This study aimed to assess the stability of the MMC ophthalmic solution under various storage conditions. The MMC ophthalmic solution was prepared by dissolving 2 mg of MMC in 5 mL of saline solution. Each batch of ophthalmic solution was stored under three conditions [cold/shaded light, room temperature/shaded light, and room temperature/scattered light (approximately 4000 lx)], and MMC concentration was determined using high-performance liquid chromatography on days 0, 1, 3, 5, 7, 14, and 21. The expiry date was calculated based on the results of the degradation analysis. pH measurements and bacterial culture tests were conducted for each storage condition. The MMC concentrations on day 21 under cold/shaded light, room temperature/shaded light, and room temperature/scattered light were 340, 287, and 227 µg/mL, respectively. MMC concentrations decreased over time, and the decrease was highest when the samples were stored at room temperature and exposed to light, and lowest under cold conditions and protected from light. The pH of MMC solutions was 5.8 after preparation, which increased to 6.9 with time under all storage conditions. Culture tests did not detect any bacteria under any storage conditions. The MMC ophthalmic solution was most stable under cold/shaded conditions, and our study clarifies its expiry date for clinical use.