Kuo General Hospital

The efficacy, safety, and clinical outcomes in patients switching to generic rosuvastatin compared to those taking other brand-name atorvastatin are unclear. Electronic medical records were retrospectively collected from January 1, 2013 to December 31, 2020 of patients who switched medication because of hospital policy from brand-name to generic rosuvastatin after March 14, 2018. Only patients who had taken the medication for at least 1 year prior to and 1 year after that date were enrolled. The records of patients who consistently used brand-name atorvastatin during the same period were also collected. The efficacy of lipid control, potential adverse effects, clinical outcomes of major cardiovascular events (MACE), and medical expenses were compared between the 2 groups. Propensity score matching (PSM) was conducted to balance potential cofounders. After 1:1 PSM, 592 patients were enrolled in the rosuvastatin and atorvastatin groups, respectively. No significant differences were observed in total cholesterol level (-4.38 ± 23.0 vs. -3.72 ± 26.95 mg/dL, p = 0.702), low-density lipoprotein (-2.38 ± 19.89 vs. -2.42 ± 23.63 mg/dL, p = 0.976), or glycated hemoglobin (-0.05% ± 0.7% vs. -0.08% ± 0.76%, p = 0.543). No significant difference was noted in cumulative MACE rate (2.70% vs. 3.89%, log-rank p = 0.265) after the switch date, and each person in the generic group had a 16% average reduction in medical expenses. Switching to generic rosuvastatin led to comparable lipid-lowering efficacy, safety, and clinical outcomes and lower medical expenses compared with consistently using brand-name atorvastatin.

Physical therapy for mobilization after a hip fracture is effective in improving muscle strength and balance training of the lower extremities; however, effective interventions targeting the trunk muscles remain to be established. The efficacy of virtual reality (VR)-based exercise therapy has been recently reported. This case report demonstrates the effectiveness of VR-based intervention in improving the gait of a female patient in her 90s with a femoral neck fracture who had difficulty in independent gait postoperatively due to trunk dysfunction. The patient had undergone bipolar hip hemiarthroplasty for a right femoral neck fracture sustained via a fall at home. Standard physical therapy, including range of motion exercises, resistance training, and gait training, was commenced gradually the day after surgery. An improvement in lower extremity pain was reported at the two-month follow-up visit but without any improvement in the gait ability. Trunk flexion was observed during gait, and the patient had difficulty in independent gait and walking without upper limb support. Withdrawal and reversal designs (BAB) were employed, and each period lasted one week. Standard physiotherapy supplemented with trunk reach training in a seated position using VR equipment was commenced subsequently. An improvement in the maximum anterior pelvic tilt angle and sitting and standing postures, increased hip extension range of motion and step length during gait, and decreased gait speed were observed during the intervention phase. These results highlight the importance of physiotherapy interventions targeting the trunk muscle and the effectiveness of VR-guided trunk training in patients with femoral neck fractures.

Tissue inhibitor of metalloproteinases-3 (TIMP3) is vital in regulating several biological processes. TIMP3 exerts antitumour effects via matrix metalloproteinase (MMP)-dependent and MMP-independent pathways. Due to promoter methylation and miRNA binding, TIMP3 expression has been observed to decrease in various cancers. Consequently, the migration and invasion of cancer cells increases. Conflicting results have reported that expression levels of TIMP3 in primary and advanced cancers are higher than those in healthy tissues. Therefore, the role of TIMP3 in cancer biology and progression needs to be elucidated. This review provides an overview of TIMP3, from its biological function to its effects on various cancers. Moreover, gynaecological cancers are discussed in detail. TIMP3 has been associated with cervical adenocarcinoma as well as cancer development in serous ovarian cancer and breast cancer metastasis. However, the relationship between TIMP3 and endometrial cancers remains unclear. TIMP3 may be a useful biomarker for gynaecological cancers and is a potential target for future cancer therapy.

To the Editor, Burnout is a syndrome conceptualized by emotional exhaustion, depersonalization, and a diminished sense of personal achievement.1, 2 Physician burnout has several negative effects, including medical errors and mental ill health.2, 3 It is worth addressing that the prevalence of burnout among resident physicians in Japan is high at approximately 30%.4 Herein, we, the members of the American College of Physicians Japan Chapter Physicians' Well-being Committee, report factors contributing to burnout of Japanese resident physicians and propose specific countermeasures (Table 1). Our recommendations are the result of focus group discussions with individuals of broad expertise and recent evidence, ensuring that they are grounded and directly relevant to the current challenges faced by resident physicians in Japan. Poor communication and stress in relationships with medical staff and patients may contribute to burnout among resident physicians.2, 3 Because most physicians in Japan start their careers without previous work experience, their communication skills with medical staff and patients may be underdeveloped. Mentoring, sharing plans within the medical team, and changing the teams may improve Communication with other medical staff. Resident physicians should also learn skills for coping with difficult patients who display strong negative feelings toward the physician.5 To cope with difficult patient encounters, metacognition of their own feelings, analysis on factors of difficult situations, and improvement in the capacity to empathize are important.5 Long working hours, increased workload, sleep deprivation owing to duty shifts, and increased burden of COVID-19 treatment are also risk factors for burnout.2, 3 Measures in line with the work reform of physicians in Japan, such as limiting or reducing work, introducing night flow, and mandatory rest after shifts, may be effective. Resilience can be improved by addressing “motivation” through coaching, setting incremental goals, building on successes to increase confidence, and setting new goals.1 In Japan, factors contributing to burnout among resident physicians include rotations through multiple departments and affiliated hospitals and changes in the environment, including community medicine and “tasuki-gake” training (clinical training in which resident physicians work alternately between primary hospitals and external hospitals/clinics on a 1 year basis). It may be important to limit the number of patients to be assigned at the beginning of the rotation and to simultaneously assess the resident physician's performance. In addition, although changes in the environment increase the number of tasks to be acquired, it is important to modify one's mindset, for example, to recognize that the speed of acquiring new skills varies among individuals and to regard environmental changes as steps in career development.1, 3 Among resident physicians, a lack of meaning in work, a lack of job autonomy, and a sense of helplessness contribute to burnout. To address low job satisfaction, it is important to focus, through coaching, on parts of the job that provide autonomy and enjoyment.1, 3 Furthermore, it is important to create a platform that enables clinical residents to actively interact with role models of a close generation to address low job satisfaction. Identifying causes of burnout and providing specific countermeasures could help prevent burnout among resident physicians. Additional problems related to burnout among resident physicians should be identified, and interventions to reduce their burnout need to be sought. All authors had access to the data and a role in writing the manuscript. None. None. None.