Current Situation Of Treatment Research Articles

Hypercholesterolemia diagnosis, treatment patterns and target achievement in patients with acute coronary syndromes in Germany.

Patients who experience an acute coronary syndrome (ACS) are at high risk of further cardiovascular events. Long-term treatment of cardiovascular risk factors, such as hyperlipidemia, is critical to prevent progression of coronary heart disease. However, many patients do not reach recommended target levels for low-density lipoprotein (LDL) cholesterol, despite receiving lipid-lowering therapy. To obtain an insight into the current treatment situation for very high-risk patients after an initial ACS in Germany. The multicenter HYDRA-ACS registry study was initiated to document the clinical characteristics of very high-risk patients with ACS and hyperlipidemia in clinical practice. In addition, lipid profiles, lipid-lowering therapy, and lipid target achievement during treatment were documented over 1 year. 353 patients who were documented had a mean age of 57.3years, mean body mass index was 28.6kg/m2, and 73.4% were male; 52.4% had a family history of myocardial infarction (MI) and 32.6% a family history of coronary heart disease (CHD). Patients' medical histories commonly included CHD (32.9%), percutaneous coronary intervention (PCI; 25.5%), and previous ACS (23.0%). Common comorbidities included hypertension (68.6%), diabetes (17.3%), heart failure (16.7%), and stable angina pectoris (15.9%). The proportion of patients receiving lipid-lowering therapy increased from 65.7% at baseline to 100% at the 12-month follow-up (p < 0.0001). Substantial increases in use were seen for statins (85.0% vs. 36.5%, p = 0.0002) and cholesterol resorption inhibitors (32.9% vs. 8.6%, p = 0.0003). Use of combination therapy increased. The proportion of patients undertaking physical exercise increased (p < 0.0001), as did consumption of fruit and vegetables (p = 0.0222) and fish (p = 0.0162), while alcohol consumption decreased (p = 0.0019). Median LDL cholesterol level decreased significantly from baseline (87 vs. 166mg/dL, p < 0.0001), and the proportion of patients with a level < 70mg/dL increased (50.0% vs. 5.7%, p < 0.0001). Median HDL cholesterol increased (47 vs. 45mg/dL, p = 0.0235) and median triglyceride level decreased (119 vs. 148mg/dL, p = 0.0080). The proportion of patients receiving antihypertensive drugs and platelet aggregation inhibitors increased. The most frequent cardiovascular events during the 12-month follow-up were PCI (25.9%) and cardiac catheterization without PCI (12.9%); MI occurred in 2.4% of patients; no deaths were reported. This study provides a contemporary picture of the treatment of hyperlipidemia after ACS in patients in Germany. Despite treatment with lipid-lowering therapy, many patients did not achieve recommended lipid targets by 12months after an ACS event.

Descriptive epidemiology of soft tissue sarcomas and gastrointestinal stromal tumors in Thailand

This study aimed to analyze burden of STS and GIST in population and survival rate which represented the current situation of treatment in Thailand. The data was collected from five population-based cancer registries around the country for the period 2001 through 2015. The Segi world standard population was used to calculated age-standardized incidence rates (ASR). Standardized rate ratios (SRR) were used to compare populations. Joinpoint Trend Analysis was used to assess changes in incidence. STATA was used to examine patient survival rates. During the study period, 4080 cases of STS and 457 cases of GIST were reported. The ASR of STS and GIST was 2.14/100,000 person-years and 0.22/100,000 person-years, respectively. The most common histological types of STS were unspecified sarcoma (24.8%), leiomyosarcoma (19.0%) and liposarcoma (11.4%). The overall ASR of STS in Thailand was relatively low compared to Western countries. The five-year survival rate was 62.6% for STS and 63.4% for GIST, which was comparable to the rates reported in other countries. This is the first report of STS and GIST from PBCRs in Thailand. Based on current healthcare service, an overall survival rates of STS and GIST are comparable to those reported from others.

Antibiotics and antibiotic-resistant bacteria in greywater: Challenges of the current treatment situation and predictions of future scenario

The current work reviews the quantitative microbiological risk assessment of antibiotic-resistant bacteria (ARB) in greywater and discusses the international strategies currently used for reducing antimicrobial resistance. The work highlights the countries that have a plan for the treatment and reuse of greywater and the current guidelines used in these countries. The paper also investigates the role of greywater in the distribution of antimicrobial resistance because of antibiotics and ARB. A bibliometric analysis was conducted for the studies on greywater, pathogenic bacteria, and antibiotics. The studies obtained from Scopus database were screened and compared to obtain the data for global antimicrobial resistance in 2000 and 2021. The strategies used by developed countries that led to the reduction in the recorded antimicrobial resistance are also listed. The challenges and limitations associated with the current plans adopted by several countries to minimise the spreading of the antimicrobial resistance are highlighted, while proposed solutions are provided. Two main issues associated with the distribution of antimicrobial resistance are (1) the absence of a plan in developing counties and presence of antimicrobial agents and ARB in the environment and (2) the difficulties in the current treatment technologies used for the removal of these antimicrobial agents from the water and wastewater. Based on the review and discussion, it was concluded that more advanced technologies are required to ensure total elimination of the antimicrobial agents and ARB from the environment. In addition, a new international standard should be drafted for the ARB in the environment, as they differ from the one currently used for medical applications.

Management of immune thrombocytopenia: 2022 update of Korean experts recommendations

Despite the availability of therapies to treat patients with immune thrombocytopenia (ITP), there is currently little data from randomized trials to assist clinicians in managing patients. The evidence-based guidelines of the Korean Society of Hematology Aplastic Anemia Working Party (KSHAAWP) are intended to support patients and physicians in the management of ITP. Experts from the KSHAAWP discussed and described this guideline according to the current treatment situation for ITP in Korea and finalized the guidelines. The expert panel recommended the management of ITP in adult and pediatric patients with newly diagnosed, persistent, and chronic disease refractory to first-line therapy with minor bleeding. Management approaches include observation and administration of corticosteroids, intravenous immunoglobulin, anti-D immunoglobulin, and thrombopoietin receptor agonists. Currently, evidence supporting strong recommendations for various management approaches is lacking. Therefore, a large focus was placed on shared decision-making, especially regarding second-line treatment.

Current Situation of Treatment of Melasma TCM

Melasma is a kind of coloring disease which shows the plaque of the face from tan to dark brown. At present, there are many western medicine treatment methods, but the effect is not exact. The methods of TCM syndrome differentiation and treatment reflect the therapeutic value more and more. Clinicians explore the treatment of melasma from different angles and ideas of TCM treatment, and many of them have remarkable effects.

IMUP and GPRC5A: two newly identified risk score indicators in pancreatic ductal adenocarcinoma

BackgroundPancreatic cancer has been a threateningly lethal malignant tumor worldwide. Despite the promising survival improvement in other cancer types attributing to the fast development of molecular precise medicine, the current treatment situation of pancreatic cancer is still woefully challenging since its limited response to neither traditional radiotherapy and chemotherapy nor emerging immunotherapy. The study is to explore potential responsible genes during the development of pancreatic cancer, thus identifying promising gene indicators and probable drug targets.MethodsDifferent bioinformatic analysis were used to interpret the genetic events in pancreatic cancer development. Firstly, based on multiple cDNA microarray profiles from Gene Expression Omnibus (GEO) database, the genes with differently mRNA expression in cancer comparing to normal pancreatic tissues were identified, followed by being grouped based on the difference level. Then, GO and KEGG were performed to separately interpret the multiple groups of genes, and further Kaplan–Meier survival and Cox Regression analysis assisted us to scale down the candidate genes and select the potential key genes. Further, the basic physicochemical properties, the association with immune cells infiltration, mutation or other types variations besides expression gap in pancreatic cancer comparing to normal tissues of the selected key genes were analyzed. Moreover, the aberrant changed expression of key genes was validated by immunohistochemistry (IHC) experiment using local hospital tissue microarray samples and the clinical significance was explored based on TCGA clinical data.ResultsFirstly, a total of 22,491 genes were identified to express differently in cancer comparing to normal pancreatic tissues based on 5 cDNA expression profiles, and the difference of 487/22491 genes was over eightfold, and 55/487 genes were shared in multi profiles. Moreover, after genes interpretation which showed the > eightfold genes were mainly related to extracellular matrix structural constituent regulation, Kaplan–Meier survival and Cox-regression analysis were performed continually, and the result indicated that of the 55 extracellular locating genes, GPRC5A and IMUP were the only two independent prognostic indicators of pancreatic cancer. Further, detailed information of IMUP and GPRC5A were analyzed including their physicochemical properties, their expression and variation ratio and their association with immune cells infiltration in cancer, as well as the probable signaling pathways of genes regulation on pancreatic cancer development. Lastly, local IHC experiment performed on PAAD tissue array which was produced with 62 local hospital patients samples confirmed that GPRC5A and IMUP were abnormally up-regulated in pancreatic cancer, which directly associated with worse patients both overall (OS) and recurrence free survival (RFS).ConclusionsUsing multiple bioinformatic analysis as well as local hospital samples validation, we revealed that GPRC5A and IMUP expression were abnormally up-regulated in pancreatic cancer which associated statistical significantly with patients survival, and the genes’ biological features and clinical significance were also explored. However, more detailed experiments and clinical trials are obligatory to support their further potential drug-target role in clinical medical treatment.

Treatment status of extremely premature infants with gestational age\u2009

BackgroundThere is a paucity of studies conducted in China on the outcomes of all live-birth extremely premature infants (EPIs) and there is no unified recommendation on the active treatment of the minimum gestational age in the field of perinatal medicine in China. We aimed to investigate the current treatment situation of EPIs and to provide evidence for formulating reasonable treatment recommendations.MethodsWe established a real-world ambispective cohort study of all live births in delivery rooms with gestational age (GA) between 24+0 and 27+6 weeks from 2010 to 2019.ResultsOf the 1163 EPIs included in our study, 241 (20.7%) survived, while 849 (73.0%) died in the delivery room and 73 (6.3%) died in the neonatal intensive care unit. Among all included EPIs, 862 (74.1%) died from withholding or withdrawal of care. Regardless of stratification according to GA or birth weight, the proportion of total mortality attributable to withdrawal of care is high. For infants with the GA of 24 weeks, active treatment did not extend their survival time (P = 0.224). The survival time without severe morbidity of the active treatment was significantly longer than that of withdrawing care for infants older than 25 weeks (P < 0.001). Over time, the survival rate improved, and the withdrawal of care caused by socioeconomic factors and primary nonintervention were reduced significantly (P < 0.001).ConclusionsThe mortality rate of EPIs is still high. Withdrawal of care is common for EPIs with smaller GA, especially in the delivery room. It is necessary to use a multi-center, large sample of real-world data to find the survival limit of active treatment based on our treatment capabilities.

Current status and progress of locking plate in the treatment of distal femoral comminuted fracture

To review the current status and progress of locking plate for the treatment of distal femoral comminuted fractures. The related literature was extensively reviewed to summarize the current status and progress in the treatment of distal femoral comminuted fracture with locking plate from four aspects: the current treatment situation, the shortcomings of locking plate and countermeasures, the progress of locking technology, locking plate and digital orthopedic technology. Treatment of distal femoral comminuted fractures is challenging. Locking plates, the most commonly used fixation for distal femoral comminuted fractures, still face a high rate of treatment failure. Double plates can improve the mechanical stability of comminuted fractures, but specific quantitative criteria are still lacking for when to choose double plates for fixation. The far cortial locking screw has shown good application value in improving the micro-movement and promoting the growth of callus. The biphasic plating is a development of the traditional locking plate, but needs further clinical examination. As an auxiliary means, digital orthopedic technology shows a good application prospect. The inherent defect of locking plate is a factor that affects the prognosis of distal femoral comminuted fracture. The optimization of locking technology combined with digital orthopedic technology is expected to reduce the failure rate of treatment of distal femoral comminuted fracture.

O-035 Searching for the perfect country - mapping out differences in fertility treatments and access to treatments across Europe

Abstract text Fertility Europe has established a working group that is examining secondary data on legislation, regulation and funding of fertility treatment across Europe. The data has been mapped in order to easily visualize the “perfect country” in terms of fertility treatments[Vi1] . The map will be updated every two years in order to show progress towards more countries reaching the status of “perfect country”. As the map provides a clear picture on the differences in access to treatments[Vi2] across Europe, it is expected to be a useful advocacy tool for patient[Vi3] associations working to influence the current treatment situation in their country. This talk focuses on the work that has been done by the Fertility Europe working group to date, to create the map of the “perfect country”, and the possibilities that such a map represents from a patient advocacy perspective. treatmentS [Vi1] [Vi1] treatmentS [Vi2] [Vi2] patient associations’ [Vi3] [Vi3]

非增殖性糖尿病视网膜病变的治疗现状

非增殖性糖尿病视网膜病变的治疗现状

Hepatitis C management and treatment among people who inject drugs in Italy: an exploratory pilot survey.

BackgroundPeople Who Use Drugs (PWID) play a crucial role in the goal of eradicating hepatitis C and, despite the high efficacy and tolerability of Direct Acting Antivirals, many PWID still have to be treated and there are many barriers that slow down the process. An exploratory pilot survey was conducted to determine service providers' current condition and the barriers experienced by&amp;nbsp;PWID&amp;nbsp;in accessing HCV&amp;nbsp;treatment.&amp;nbsp;&amp;nbsp;MethodsSeven selected&amp;nbsp;clinical centres completed a 27-item online&amp;nbsp;survey addressing the current treatment situation in PWID hepatitis C treatment, related barriers and linkage to care.&amp;nbsp;&amp;nbsp;ResultThe survey mainly involved central-northern Italian clinical centres (71.4%), with less than 4 prescribers (71.4%) despite they are currently treating around 500-1000 patients for Hepatitis C (&amp;amp;gt;50% current or former PWID). In most cases, they carried out the necessary checks (100% blood sample, 85.7% fibroscan and 43% ultrasound) in few visits (85.7%) to deliver drugs in about one month (71.4%). They all agree on the need for fast-track for PWID and therefore they are all engaged in dedicated projects. The commitment to eradication is, in most cases, based on personal efforts, which despite the few prescribers, the lack of institutional support (85.7%) and the impossibility to use simplification scores since prescription and drug delivery portals (AIFA and regional) still require a lot of information. Although the centres questioned express the need for a simplification of the bureaucratic processes, however, they scrupulously follow PWID. For 57.4% of the centres, Linkage to Care remains the most problematic moment, to follow equally the lack of a correct epidemiological estimate and the implementation of the harm reduction policies. Finally, most of the centres don't find particular barriers related to PWID's features, but analysing them individually the main ones are: the difficult social background, the reinfection risk and the patient's poor motivation.&amp;nbsp;ConclusionsThe needs emerged from this survey are: to work on PWID de-stigmatization, to simplify the prescription/drug delivery portals in order, to increase PWID social assistance network and institutions support in HCV eradication programs.&amp;nbsp;&amp;nbsp;

Current Situation of Treatment and Follow-up Re-examination of Children with Epilepsy at Vietnam National Children’s Hospital

Purpose: To assess treatment compliance and follow-up appointment of children with epilepsy at the Vietnam National Children’s Hospital in 2019.&#x0D; Method: A cross-sectional descriptive study was conducted on pediatric patients and primary caregivers came for examination and treatment at the Neurology Department, Vietnam National Children’s Hospital from January 2019 to December 2019.&#x0D; Results: Mean age was 74.3 ± 45.1 (month age). The most common age group was the 2-6 year old group (40.5%), the lower rate was the 6-12 year old group (30.0%), and rest groups was the low rate. The male: female ratio is 1.43:1. Most of the main caregivers are parents (92.5%). Average treatment time was 20.4 ± 15.7 months, the rate of good adherence to treatment 43.5%, 31.5% of children had moderated adhering to treatment and 25.0% had poor adhering to treatment. Within 6 months, 40.5% of children re-examined on time. The reasons for not complying with on-time re-examination were mainly due to the caregiver's busy work or the child was busy at school (37.8%) and the distance from home to hospital (26.1%).&#x0D; Conclusions: The percentage of patients who complied with treatment and re-examination was not high. Factors that were statistically significant for children's non-compliance were: health insurance level, age of onset, duration of treatment, and frequency of attacks following treatment.

Mobile Health Usage, Preferences, Barriers, and eHealth Literacy in Rheumatology: Patient Survey Study.

BackgroundMobile health (mHealth) defines the support and practice of health care using mobile devices and promises to improve the current treatment situation of patients with chronic diseases. Little is known about mHealth usage and digital preferences of patients with chronic rheumatic diseases.ObjectiveThe aim of the study was to explore mHealth usage, preferences, barriers, and eHealth literacy reported by German patients with rheumatic diseases.MethodsBetween December 2018 and January 2019, patients (recruited consecutively) with rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis were asked to complete a paper-based survey. The survey included questions on sociodemographics, health characteristics, mHealth usage, eHealth literacy using eHealth Literacy Scale (eHEALS), and communication and information preferences.ResultsOf the patients (N=193) who completed the survey, 176 patients (91.2%) regularly used a smartphone, and 89 patients (46.1%) regularly used social media. Patients (132/193, 68.4%) believed that using medical apps could be beneficial for their own health. Out of 193 patients, only 8 (4.1%) were currently using medical apps, and only 22 patients (11.4%) stated that they knew useful rheumatology websites/mobile apps. Nearly all patients (188/193, 97.4%) would agree to share their mobile app data for research purposes. Out of 193 patients, 129 (66.8%) would regularly enter data using an app, and 146 patients (75.6%) would welcome official mobile app recommendations from the national rheumatology society. The preferred duration for data entry was not more than 15 minutes (110/193, 57.0%), and the preferred frequency was weekly (59/193, 30.6%). Medication information was the most desired app feature (150/193, 77.7%). Internet was the most frequently utilized source of information (144/193, 74.6%). The mean eHealth literacy was low (26.3/40) and was positively correlated with younger age, app use, belief in benefit of using medical apps, and current internet use to obtain health information.ConclusionsPatients with rheumatic diseases are very eager to use mHealth technologies to better understand their chronic diseases. This open-mindedness is counterbalanced by low mHealth usage and competency. Personalized mHealth solutions and clear implementation recommendations are needed to realize the full potential of mHealth in rheumatology.

Subtrochanteric femur fractures-epidemiology, surgical procedures, influence of time to surgery and comorbidities on complications : A risk-adjusted regression analysis of routine data from 2124cases

There are approximately 12,000 subtrochanteric femur fractures in Germany per year with a rising trend but studies about the epidemiology and the surgical outcome are rare. Furthermore, there are no guidelines from expert societies and there is no adequate quality assurance. Presentation of the epidemiology and the current treatment situation with respect to the patient collective, comorbidities, time to surgery and surgical procedures used as well as the identification of modifiable risk factors with respect to complications. Analysis of routine data based on an established data model in 2124 cases. The descriptive statistics contain data on basic patient characteristics, such as age, comorbidities, surgical procedure, time to surgery and mortality. In the analytical statistics the impact of risk factors (surgical procedure, time to surgery etc.) on the endpoints mortality, complications and decubitus was investigated by logistical regression analyses. Of the patients 55% were operated on within the first 24h. Intramedullary osteosynthesis (89%) is the most frequently used surgical method (prostheses 2%, extramedullary procedures 5%). Within the first postoperative year 37% of the patients received a higher level of care, where the care was moved from outpatient to inpatient treatment. The mortality in the first postoperative year was 26%, while early complications were observed in 6%. Adelay in surgical treatment was associated with an increased mortality and intrinsic factors, which were difficult to influence. Intramedullary osteosynthesis had the lowest mortality and revision rates. Concerning the epidemiological data, the patient collectives of subtrochanteric fractures and femoral neck or pertrochanteric fractures were very similar. Major delays in the time to surgery of subtrochanteric fractures can be associated with increased complication rates and mortality. Therefore, programs to prevent older patients from falling have a high priority.

Current Situation and Problems of MBR Treatment Process in Dye Wastewater

In most areas in China, the poor quality of printing and dyeing wastewater discharged from dyeing, papermaking and silk factories have caused a series of environment pollution and health problems. So the optimization of the dyeing wastewater effluent process has become imminent. MBR is a new type of wastewater treatment technology in recent years, MBR can efficiently treatment printing and dyeing wastewater. The paper introduces several basic types of MBR treatment process in terms of the working principle, advantages and current situation of treatment in the dye wastewater applications, including AO-MBR Process, Coagulation Sedimentation-Micro electrolysis-MBR Process, MBR-RO Process, MBR Gravity Drain Process, Submerged Membrane Bioreactor (SMBR) Process and Direct Contact Membrane Distillation Process. Through analysis and summary, the MBR treatment process in dye wastewater should focus on solving the problem of removal of the final product. The effective combination of MBR technology and other chemical and physical treatment processes can provide important guiding significance for the future dye wastewater from the end treatment to the control of source pollution.

Epidemiology and health care utilization of patients suffering from Huntington\u2019s disease in Germany: real world evidence based on German claims data

BackgroundHuntington’s disease (HD) is a rare, genetic, neurodegenerative and ultimately fatal disease with no cure or progression-delaying treatment currently available. HD is characterized by a triad of cognitive, behavioural and motor symptoms. Evidence on epidemiology and management of HD is limited, especially for Germany. This study aims to estimate the incidence and prevalence of HD and analyze the current routine care based on German claims data.MethodsThe source of data was a sample of the Institute for Applied Health Research Berlin (InGef) Research Database, comprising data of approximately four million insured persons from approximately 70 German statutory health insurances. The study was conducted in a retrospective cross-sectional design using 2015 and 2016 as a two-year observation period. At least two outpatient or inpatient ICD-10 codes for HD (ICD-10: G10) during the study period were required for case identification. Patients were considered incident if no HD diagnoses in the 4 years prior to the year of case identification were documented. Information on outpatient drug dispensations, medical aids and remedies were considered to describe the current treatment situation of HD patients.ResultsA 2-year incidence of 1.8 per 100,000 persons (95%-Confidence interval (CI): 1.4–2.4) and a 2-year period prevalence of 9.3 per 100,000 persons (95%-CI: 8.3–10.4) was observed. The prevalence of HD increased with advancing age, peaking at 60–69 years (16.8 per 100,000 persons; 95%-CI: 13.4–21.0) and decreasing afterwards.The most frequently observed comorbidities and disease-associated symptoms in HD patients were depression (42.9%), dementia (37.7%), urinary incontinence (32.5%), extrapyramidal and movement disorders (30.5%), dysphagia (28.6%) and disorders of the lipoprotein metabolism (28.2%).The most common medications in HD patients were antipsychotics (66.9%), followed by antidepressants (45.1%). Anticonvulsants (16.6%), opioids (14.6%) and hypnotics (9.7%) were observed less frequently.Physical therapy was the most often used medical aid in HD patients (46.4%). Nursing services and speech therapy were used by 27.9 and 22.7% of HD patients, respectively, whereas use of psychotherapy was rare (3.2%).ConclusionsBased on a representative sample, this study provides new insights into the epidemiology and routine care of HD patients in Germany, and thus, may serve as a starting point for further research.

The CIMH track concept in the treatment of psychotic disorders

The treatment of psychotic disorders and illnesses is achallenge for therapists and institutions due to the heterogeneity of the cause and course, refractory symptoms, lack of therapy adherence and high rates of relapse. These circumstances can be effectively counteracted by the flexibility of therapeutic approaches and settings. Auseful but rarely used concept is the treatment of psychoses within the so-called track unit. Atrack unit is defined as asyndrome-oriented, decentralized, modular unit, adjusted to the patient's individual stage-specific needs across both inpatient and outpatient sectors. The track concept offers afully integrated sector-spanning model of treatment at all stages of psychotic illnesses as well as acontinuity of treatment. Another important goal is the early availability of timely treatment for as many psychotic patients as possible so that the symptoms can be alleviated as soon as possible and the quality of life can be sustainably improved or preserved. The track concept not only improves the current situation of treatment for acutely or chronically psychotic patients but also represents anecessary investment in the future. This treatment model aims to ensure that the good but complex and costly treatment options are available to patients even if inpatient treatment is not favored by the patient.

Questionnaire survey on adjuvant chemotherapy for elderly patients after gastrectomy indicates their vulnelabilities.

In Japan, S-1 adjuvant chemotherapy for 1year is the standard of care for the treatment of stage II and III patients under 80years old with gastric cancer after curative operation. However, the feasibility of S-1 chemotherapy in patients over 80years old has not yet been elucidated. To clarify the current treatment situation and feasibility of S-1 treatment in patients over 80years old, a questionnaire survey of the patients treated from January 2011 to December 2012 was conducted at 58 member institutions of the Stomach Cancer Study Group of the JCOG (Japan Clinical Oncology Group). Gastrectomy was performed in 15,573 patients of all ages, and 1,660 (10.7%) patients were over 80years of age. Of these elderly patients, 661 (4.2%) were diagnosed as stage II and III. While S-1 adjuvant chemotherapy was recommended to 248 (37.5%) of the stageII/III patients, only 99 (15.0%) of them actually received S-1. Interestingly, the creatinine clearance rate was between 30 and 80mL/min in 87 (87.9%) of the patients suggesting that S-1 dose modification should be considered. Moreover, S-1 compliance was poor in patients with more than 15% body weight loss. In general practice, surgery alone can be regarded as the standard of care for stage II and III gastric cancer patients over 80years old. The feasibility and efficacy of S-1 adjuvant chemotherapy should be elucidated in a randomized control trial considering the vulnerabilities of the elderly.

Current Situation of Treatment for Anaphylaxis in a Japanese Pediatric Emergency Center.

Anaphylaxis is a systemic allergic reaction that sometimes requires prompt treatment with intramuscular adrenaline. The aim of the study was to investigate the current situation regarding anaphylaxis treatment in a representative pediatric primary emergency facility in Japan. We retrospectively examined the medical records dating from April 2011 through March 2014 from Kobe Children's Primary Emergency Medical Center, where general pediatricians work on a part-time basis. Clinical characteristics and current treatments for patients with anaphylaxis who presented to the facility were investigated. Furthermore, we compared the clinical characteristics between anaphylaxis patients given intramuscular adrenaline and those not given it. During the study period, 217 patients were diagnosed with anaphylaxis. The median Sampson grade at the time of visit was 2, and 90 patients (41%) were grade 4 or higher. No patients received self-intramuscular injected adrenaline before arrival at our emergency medical center because none of the patients had been prescribed it. Further treatment during the visit was provided to 128 patients (59%), with only 17 (8%) receiving intramuscular adrenaline. Patients given intramuscular adrenaline had significantly lower peripheral saturation of oxygen at the visit (P = 0.025) and more frequent transfer to a referral hospital (P < 0.001) than those not given intramuscular adrenaline. Education for Japanese pediatric practitioners and patients is warranted, because no patients used self-intramuscular injected adrenaline as a prehospital treatment for anaphylaxis, and only severely affected patients who needed oxygen therapy or hospitalization received intramuscular adrenaline in a pediatric primary emergency setting.

Diagnosis and treatment of unexpected gallbladder carcinoma: a multicenter retrospective study (A report of 223 cases)

Diagnosis and treatment of unexpected gallbladder carcinoma: a multicenter retrospective study (A report of 223 cases)