Kitasato University Medical Center

BackgroundThis study aimed to determine whether community pharmacists perceive barriers to providing medication guidance for gender-specific diseases and to clarify whether these perceived barriers are influenced by pharmacist and patient gender concordance or discordance.MethodsA web-based survey was conducted with pharmacists from five pharmacy groups in Japan. The questionnaire evaluated pharmacists' hesitancy and uncertainty in knowledge using a 7-point Likert scale across 10 gender-specific and three nongender-specific diseases. Each disease was examined under conditions of gender concordance and discordance between a pharmacist and patient. Results were visualized using scatter plots, and the factors contributing to barriers were examined using multivariable logistic regression.ResultsA total of 1315 responses were obtained, including 696 from female pharmacists and 583 from male pharmacists. Among the 10 gender-specific diseases, 9 were in the first quadrant, indicating high hesitancy and uncertainty under gender discordance. However, some diseases exhibited high perceived barriers even under gender concordance. Multivariate logistic regression analysis revealed that pharmacists' implicit assumptions, such as perceiving patients' unwillingness to receive guidance, significantly contributed to stronger perceived barriers. Furthermore, neither years of professional experience nor medication guidance frequency was associated with reduced barriers.ConclusionCommunity pharmacists perceived significant barriers to providing medication guidance for certain gender-specific diseases. These barriers existed in cases of gender discordance and concordance with patients. Pharmacists' experience alone is insufficient to reduce these perceptions, highlighting the need for educational interventions addressing implicit assumptions related to gender-specific care.

Corynebacterium mucifaciens, usually isolated from sterile human specimens, is a rare Corynebacterium species. We describe a blood-origin C. mucifaciens isolate that was resistant to macrolides/lincosamides and had been isolated from a patient with diabetic gangrene. This isolate formed mucoid colonies harboring a fragment of erm(X). As an initial antimicrobial, piperacillin/tazobactam was intravenously administered to the patient for two weeks. Gangrene debridement resulted in good local management. The clinical course was uneventful. The subculture from blood on a blood agar plate revealed mucoid colonies with a positive string test. Gram staining revealed the presence of a mucoid layer around the coryneform. The minimum inhibitory concentrations determined using the broth microdilution method indicated resistance to erythromycin/clindamycin. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS), 16S rRNA gene sequencing, and antimicrobial resistance (AMR) gene profiling were performed. MALDI-TOF-MS identified this isolate as C. mucifaciens based on its high score (2.22). 16S rRNA gene sequencing revealed 99.3% similarity with DMMZ 2278(T) 16S rRNA gene sequence. AMR gene profiling revealed that this isolate possessed a fragment identical to that of erm(X) from Actinotignum schaalii. MALDI-TOF-MS with 16S rRNA gene sequencing can make it easier to identify C. mucifaciens when the coryneform has a mucoid colony appearance with hyperviscosity.

Kita-kyushu lung cancer antigen-1 (KK-LC-1), a cancer/testis antigen (CTA), is frequently expressed in tumor and non-tumor sites of the stomach in patients with gastric cancer (GC). Additionally, KK-LC-1 has been associated with Helicobacter pylori (Hp) infection. Currently, the association between Hp eradication and GC incidence is unclear. This study aimed to investigate the association between KK-LC-1 expression and Hp eradication in GC. This study included 124 patients treated for gastric cancer. Pathological tissue from resected specimens was used to investigate KK-LC-1 expression in tumor and non-tumor sites. The association between 14 clinicopathological factors, including Hp infection and eradication, and KK-LC-1 expression was investigated and analyzed by Fisher's exact test and multivariable regression analysis. KK-LC-1 expression rate in cancerous tissues from patients with GC was 74.2%. The expression of KK-LC-1 was associated with older age, mucosal layer depth of invasion, differentiated type, no lymph node metastasis, Hp eradication, previous Hp infection, and multiple cancers. KK-LC-1 expression was high in GC cases with previous Hp infection and successful eradication. KK-LC-1 expression pattern suggests that it may be associated with GC independently of Hp infection.

When examining patients with vertigo, it is essential to differentiate between central and peripheral causes. We report on a patient who had been treated as a case of benign paroxysmal positional vertigo (BPPV), but was eventually diagnosed as having cerebellar nodulus infarction. The patient visited our hospital complaining of rotatory vertigo, and we diagnosed and treated the patient as a case of BPPV. He was able to walk, but the dizziness changed from rotatory vertigo persisted. Computed tomography angiography (CTA) revealed obstruction of the right vertebral artery, and the patient was eventually diagnosed as having cerebellar nodulus infarction. Infarction in the lower cerebellum is characterized by vertigo without cerebellar ataxia, and the clinical picture may resemble that of vestibular neuritis or BPPV. We should be aware of cases of cerebellar infarction in which nystagmus can mimic that in BPPV.

Abstract Actinomycetes, rich in biosynthetic gene clusters (BGCs), are important sources of natural products (NPs). However, the rate of discovering novel NPs from actinomycetes has declined, indicating the need for a new strategy to obtain NPs. Herein, we present a strategy for the efficient discovery of novel NPs. First, we performed a comprehensive analysis of BGCs in actinomycetes, evaluating the average number and types of BGCs per genus to identify prolific NP producers. Our analysis revealed that certain actinomycetes strains, such as those in the familyPseudonocardiaceae, possess a greater number of BGCs thanStreptomyces. In addition, these strains tend to possess strain-specific BGCs compared with others. To facilitate the identification of strain-specific compounds, we developed a comparative metabolic analysis method using molecular networking. Applying this method to eightPseudonocardiaceaestrains, we successfully discovered two novel peptides, lentindoles A (1) and B (2), featuring a 6/5/6 and 6/5/5 tricyclic ring system, respectively, along with their possible biosynthetic precursor, lentindole C (3). Our result demonstrates that the effectiveness of our developed strategy, which is expected to accelerate the discovery of novel NPs.

Society is aging, and the proportion of older patients with lung cancer is increasing. However, the treatment choices and prognoses for older patients with cancer recurrence remain unclear. We retrospectively investigated the treatment choices and prognoses of older patients with recurrence. We conducted a retrospective review of 1100 patients who underwent complete resection for non-small cell lung cancer at Kitasato University Hospital between 2004 and 2017. Patients of ≥75years of age were defined as older patients, and the prognosis and prognostic factors of these patients upon recurrence were examined. Among the 290 patients who developed recurrence, 106 experienced recurrence at an older age. The factors associated with survival after recurrence included sex, time to recurrence, number of recurrences, performance status at recurrence, and active treatment. As the age at recurrence increased, the proportion of patients who did not receive active treatment increased, as did the proportion for whom the reason was the patient's and family's preferences. A considerable number of older patients who experience recurrence do not wish to receive active treatment. However, the prognosis can be improved by aggressive treatment for recurrence.

Oligo-recurrence refers to the presence of a limited number of metachronous recurrences that can be treated with radical local therapy, and most patients have a good prognosis. However, the clinical course after local therapy for oligo-recurrence of non-small cell lung cancer (NSCLC) varies, and the prognostic factors are unclear. The aim of this study was to elucidate the prognostic factors of patients with oligo-recurrence of NSCLC who underwent radical local therapy. Between 2004 and 2015, 901 patients who underwent complete resection for NSCLC were included. We defined oligo-recurrence as two or fewer recurrences and retrospectively examined the factors that affected post-recurrence survival in patients who underwent radical local therapy for oligo-recurrence. Recurrence was confirmed in 267 patients, and among them, 125 experienced oligo-recurrence. Eighty-five patients with oligo-recurrence received local therapy, and their 5-year post-recurrence survival rate was 42.8%. Multivariable analysis of the prognostic factors of these patients revealed that single recurrence (hazard ratio = 2.19, P = 0.005) and systemic therapy (hazard ratio = 1.75, P = 0.043) were significant favorable prognostic factors associated with post-recurrence survival. However, the presence or absence of epidermal growth factor gene mutations, which is generally a prognostic factor for NSCLC recurrence, did not affect the prognosis of these patients. The number of recurrences and receiving systemic therapy are important prognostic factors for patients with oligo-recurrence who undergo radical local therapy, and these patients have a particularly favorable prognosis.