Matsuyama Red Cross Hospital

Abstract Introduction Maintaining dose intensity is essential for the efficacy of adjuvant S-1 chemotherapy in gastric cancer. Although pharmacist interventions can reduce toxicity and improve adherence, multicenter evidence regarding their impact on dose maintenance is limited. Aim This study aimed to evaluate the impact of continuous pharmacist intervention on treatment completion and relative performance (RP) value in patients receiving adjuvant S-1 chemotherapy for gastric cancer. Methods This multicenter retrospective study analysed 225 patients across 12 institutions, categorised into continuous intervention (n=97) and non-continuous intervention (n=128) groups. Continuous intervention was defined as systematic monitoring and management for at least 50% of the treatment duration. Inverse probability of treatment weighting adjusted for baseline covariates. The primary and secondary endpoints were the eight-cycle completion rate and the RP value, respectively. Results Eight-cycle completion rate did not differ significantly between the continuous and non-continuous intervention groups (53.0% vs. 55.2%, p = 0.775), nor did the frequency of treatment modification events, including discontinuation or dose reduction. However, the RP value was significantly higher in the continuous intervention group than in the non-continuous intervention group (73.7% vs. 64.9%, p = 0.038), a finding robustly supported by sensitivity analysis between these two groups (75.1% vs. 61.1%, p = 0.0008). The continuous group maintained a high intervention rate (89.1%) throughout the final cycle, providing significantly more supportive care interventions than the non-continuous intervention group (53.2% vs. 4.9%, p < 0.001). Conclusion Although continuous pharmacist intervention did not improve the binary completion rate, it was essential for maintaining RP values above the clinically essential 70% threshold through proactive toxicity management and dynamic dose optimization. These findings suggest that systematic pharmaceutical care contributes significantly to ensuring the quality and intensity of adjuvant chemotherapy.

ABSTRACTINTRODUCTIONSitus inversus totalis (SIT) is a rare congenital anomaly characterized by complete mirror-image transposition of thoracic and abdominal organs. Although laparoscopic colectomy in SIT has been increasingly reported, the reversed anatomy and inherent limitations of laparoscopy make such procedures technically demanding. Robotic-assisted surgery may overcome these issues by providing enhanced ergonomics and intuitive instrument control, yet reports in SIT remain scarce.CASE PRESENTATIONA 51-year-old man with SIT presented with anal bleeding and was diagnosed with sigmoid colon cancer. Preoperative CT confirmed complete visceral inversion without distant metastasis. Robotic-assisted sigmoidectomy with D3 lymphadenectomy was performed using the da Vinci Xi surgical system. A patient-specific port configuration was designed based on preoperative imaging, minimized arm collisions, and optimized instrument mobility. The procedure was uneventful, with an operative time of 232 minutes and minimal blood loss. The patient was discharged on POD 7 without complications. Histopathological examination revealed pT3, pN1a, cM0, Stage IIIB adenocarcinoma.CONCLUSIONSThis case demonstrates that robotic-assisted colectomy can effectively overcome the ergonomic and technical challenges posed by SIT. Patient-specific port mapping, guided by preoperative imaging, is essential to maximize the benefits of robotic technology. Furthermore, this report contributes to the limited evidence supporting robotic colectomy as a feasible and advantageous approach for patients with SIT.

Autonomic dysfunction is recognized as the central mechanism of orthostatic hypotension after microgravity exposure. Because the arterial baroreflex regulates arterial pressure (AP) via sympathetic nerve activity (SNA), we investigated the systematic baroreflex function under simulated microgravity by conducting an open‐loop analysis. We used Sprague–Dawley rats after hindlimb unloading (HU) for 2 weeks. We isolated the carotid sinuses from the systemic circulation, then changed intracarotid sinus pressure (CSP) stepwise and recorded SNA and AP responses. We compared CSP−AP (total loop), CSP−SNA (mechanoneural arc), and SNA−AP (neuromechanical arc) relations between control rats (n = 9) and HU rats (n = 7). The total loop gain at the operating point decreased significantly in HU rats compared with control rats (0.3 ± 0.4 vs. 1.1 ± 0.4 mmHg/mmHg, p < 0.05). In addition to the decrease in the mechanoneural arc gain at the operating point, the neuromechanical arc gain also decreased significantly in HU rats compared with control rats. A numerical simulation experiment showed a greater AP fall with a significant reduction of the total loop gain in response to hypotensive stress in HU rats. Thus, we conclude that simulated microgravity impairs baroreflex sympathetic regulation in the lower AP range, which may play an important role in the pathogenesis of orthostatic hypotension after microgravity exposure.

Abstract Background and Aims Diabetic Kidney Disease (DKD), the leading cause of end-stage renal disease (ESRD) worldwide, must be diagnosed early to allow for timely intervention and prevention of severe progression. Chronic kidney disease (CKD) can be easily diagnosed and its severity determined by estimated glomerular filtration rate (eGFR) and urine protein-creatinine ratio (UPCR) or urine albumin-creatinine ratio (UACR). However, recent studies suggest that efforts to achieve early diagnosis of CKD have been insufficient. We evaluated the accuracy of urine dipstick testing in the early diagnosis of DKD and confirmed the importance of UACR measurement. Method Data were used from 1,323 diabetes education inpatients at our hospital. Results from simultaneous urine dipstick testing and UACR measurement upon admission were analyzed. Results of urine dipstick testing were classified into five levels (−, ±, 1+, 2+, 3+), and results of UACR were categorized into three groups: normoalbuminuria (UACR &amp;lt; 30 mg/gCr), microalbuminuria (30 ≤ UACR &amp;lt; 300 mg/gCr), and macroalbuminuria (UACR ≥ 300 mg/gCr). Urine dipstick testing was considered positive with a result of 1+ or higher, and microalbuminuria or greater was defined as DKD. The accuracy of urine dipstick testing in diagnosing DKD was then evaluated. Results Of the 1,323 cases, there were 202 true positives, 262 false negatives, 13 false positives, and 846 true negatives (Table 1). When diagnosing DKD with urine dipstick testing 1+ or higher, the prevalence was 35.1%, the positive and negative rate was 16.3% and 83.7%, the accuracy was 79.2%, the sensitivity was 43.5%, the specificity was 98.5%, the positive and negative predictive value was 93.9% and 76.3% (Table 1). In addition, when the cut-off for a positive result in urine dipstick testing was set to ± or higher, there were 314 true positives, 150 false negatives, 108 false positives, and 751 true negatives. The prevalence was 35.1%, the positive and negative rate was 31.9% and 68.1%, the accuracy was 80.5%, the sensitivity was 67.7%, the specificity was 87.4%, the positive and negative predictive value was 74.4% and 83.4% (Table 2). Conclusion Urine dipstick testing demonstrated low sensitivity (43.5%) for early DKD diagnosis, with a high risk of misdiagnosing 66.5% of patients with microalbuminuria or higher as normoalbuminuria. Even with a cutoff value adjusted to ± to improve sensitivity, the sensitivity was limited to 67.7%, leaving 32.3% of early cases undetected. These findings highlight the limitations of dipstick testing for early detection of DKD. Regular UACR measurements are essential, as emphasized in the 2024 clinical practice guidebook for the diagnosis and treatment of CKD published by the Japanese Society of Nephrology, to enable early detection and timely intervention in DKD.