The global cost of medications, including anticancer drugs, is rapidly increasing. However, the relationship between the pharmacological mechanisms of anticancer drugs and the percentage of patients who prefer brand-name drugs remains largely unexplored. This study aimed to assess the proportion of patients who chose brand-name drugs based on the type of oral anticancer drug prescribed and patient background factors that may influence generic drug use. We extracted data from patients who received oral anticancer drugs at a QOL pharmacy between April 1, 2019, and March 31, 2021. Patient characteristics included age, sex, percentage of health insurance co-payment percentage, presence of a home pharmacist, prescribing healthcare provider, and specific oral anticancer drug prescribed. A total of 17,746 patients with prescriptions for oral anticancer drugs that had generic alternatives were included in the study. Among them, 26.4％ （n＝4,682） opted for brand-name drugs. Our results showed that molecularly targeted drugs had higher brand-name preference rates, with imatinib （73.5％） and gefitinib （62.8％） showing the highest selection rates. Furthermore, Patient characteristics such as sex, age, type of medical institution, and drug type influenced the decision to use brand-name drugs instead of generics. Our findings suggest that targeted educational strategies based on the pharmacologic mechanisms of drugs, rather than a one-size-fits-all approach to promoting generics, may be more effective in encouraging the use of generic anticancer drugs.

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Reduced adenosine triphosphate （ATP） levels due to mitochondrial dysfunction induces lung injury in acute respiratory distress syndrome （ARDS）. Considering that febuxostat improves mitochondrial dysfunction and reduces ATP consumption, its effects were investigated in a mouse model of lipopolysaccharide （LPS） -induced lung injury. Male C57BL/6 mice were intratracheally stimulated with LPS. Febuxostat was administered for 4 or 10 days, and LPS stimulation was performed on Day 3 of febuxostat treatment. At 24 h or 7 days after LPS stimulation, we collected mouse bronchoalveolar lavage fluid （BALF） for determination of cell count and inflammatory cytokine levels and lung tissue for histopathological analysis of fibrosis. BALF total cell and neutrophil counts were significantly lower in the LPS＋febuxostat group than in the LPS-only group at 24 h after LPS stimulation and returned to the same levels as those in the control group in both the LPS-only and LPS＋febuxostat groups at 7 days after LPS stimulation. In addition, the percentage of collagen deposition areas in the entire lung field was greater in the LPS-only group than in the control group. Notably, febuxostat treatment reduced lung fibrosis in the LPS-stimulated group. Seven days after LPS stimulation, interleukin （IL） -8 production in the BALF was suppressed in the LPS＋febuxostat group but not in the LPS-only group. Febuxostat suppressed lung inflammation and prevented lung fibrosis by reducing IL-8 involvement in fibrosis in a mouse model of LPS-induced lung injury. These findings suggested that febuxostat may improve ARDS-associated lung injury.

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Patients in intensive care units （ICUs） are at a significant risk of developing complications, including ICU-acquired weakness and post intensive care syndrome （PICS）, which impede recovery to pre illness functional levels. Occupational therapy （OT） is gaining recognition for its potential to alleviate PICS symptoms by addressing physical, cognitive, and psychological challenges. However, OT remains underutilized in ICU settings, necessitating further research to establish standardized practices. This study aimed to investigate current OT practices in ICUs, identify barriers, and propose strategies for improving patient outcomes. A convergent mixed methods design was employed. Quantitative data were collected through surveys of occupational therapists （OTRs） at Showa University-affiliated hospitals to evaluate their practices and perceived effectiveness. Qualitative data were gathered via focus group interviews （FGIs） to explore OTR experiences, challenges, and their integration into multidisciplinary teams. Data analysis combined descriptive statistics with inductive thematic analysis. Quantitative findings revealed widespread implementation of cognitive, physical, and functional assessments; however, psychological assessments and family education interventions were less frequent. OTRs with more ICU experience reported higher perceived effectiveness. Qualitative analysis identified themes, including understanding patient backgrounds, fostering autonomy, and challenges such as insufficient training and limited recognition of the OT role. Multidisciplinary integration of OT was limited but deemed essential. This study highlights the significance of standardized OT practices in ICUs to effectively address patients’ physical, cognitive, and psychological needs. Enhancing education, in­ter­dis­ci­pli­nar­y collaboration, and evidence-based approaches may improve patient recovery and alleviate PICS symptoms.

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To investigate the association between lesion orientation on the endoscopic monitor and colorectal endoscopic submucosal dissection （ESD） difficulty. We performed ESD for 406 consecutive colorectal tumors between January 2019 and August 2024. Multivariate logistic regression analysis was conducted on the following factors related to difficult ESD and incomplete ESD: tumor size （≥40mm or ＜40mm）, lesion location （right or left colon）, lesion orientation on the endoscopic monitor （upward or downward）, submucosal fibrosis （F0/1 or F2）, tumor invasion depth （Tis, T1a, or T1b）, and operator’s experience in colorectal ESD （beginner ［＜20 cases］ or nonbeginner ［≥20 cases］）. Procedures requiring ≥120min indicated difficult colorectal ESDs. The mean tumor size was 28.9±15.4mm, and the mean procedure time was 82.6±64.1min. Tumor size≥40mm （odds ratio ［OR］, 9.30; 95％ confidence interval ［CI］, 4.93-18.00; p＜0.001）, upward lesion orientation on the endoscopic monitor （OR, 3.79; 95％ CI, 2.06-7.04; p＜0.001）, and severe fibrosis （OR, 7.42; 95％ CI, 2.97-19.00; p＜0.001） were independent factors that increased colorectal ESD difficulty. Meanwhile, severe fibrosis （OR, 3.52; 95％ CI, 1.11-10.45; p＝0.033）, T1b invasion depth （OR, 3.30; 95％ CI, 1.07-9.34; p＝0.039）, and beginner operator （OR, 2.97; 95％ CI, 1.25-7.25; p＝0.035） were independent factors contributing to incomplete ESD. In addition to known intrinsic factors, such as large tumor size and fibrosis, the upward orientation of the lesion on the endoscopic monitor was identified as an independent factor that increased the difficulty of colorectal ESD.

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Previous studies suggest that the gut microbiota may contribute to the onset of depression and that dairy consumption may affect the gut microbiota and alleviate depressive symptoms. This study aimed to investigate the relationship between dairy consumption, gut microbiota composition, and its metabolites in patients with major depressive disorder （MDD）. Fecal samples were collected from 32 participants with MDD and 34 age- and sex-matched healthy controls （HCs）. The gut microbiota composition and its metabolites were analyzed. Dairy intake was evaluated using the Brief-Type Self-Administered Dietary History Questionnaire. Depression severity was assessed using the Hamilton Depression Rating Scale （HDRS）. The effects of depression status （MDD versus HC groups） and dairy intake on the gut microbiota were examined using a two-way analysis of variance. We found interactions between the effects of depression status and dairy intake on the abundance of the family Lactobacillaceae （F ［1,62］＝4.265, uncorrected p＝0.043） and the genera Lactobacillus （F ［1,62］＝4.044, uncorrected p＝0.049） and Megasphaera （F ［1,62］＝ 5.739, uncorrected p＝0.020）. Additionally, pelargonate concentrations were correlated with depression severity （HDRS score: rs＝−0.375, uncorrected p＝0.034） and dairy intake （rs＝ 0.363, uncorrected p＝0.041）. Dairy consumption may be associated with specific gut microbiota and its metabolites in patients with MDD. Further large-scale studies are required for in-depth char­ac­ter­i­za­tion of the relationship between dairy intake and gut microbiota and its metabolomes in patients with MDD.

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In Japan, medical and long-term care services are provided by separate insurance systems. The elderly have multifaceted needs, and this study aims to identify gaps in services not adequately covered by these insurance policies and assess user satisfaction with the available services. A cross-sectional survey was conducted between April 2014 and December 2017, targeting 251 home healthcare service users in Japan. After excluding those with severe dementia or impairments, 95 service users and 156 caregivers participated. The survey included questions on service usage, satisfaction levels, unmet needs, and household information. Additionally, three care managers from different facilities were interviewed. The survey revealed a mismatch between the services provided and the needs of users. The most desired services were shopping for non-daily necessities and support for general outings, both of which were inadequately covered by the current insurance systems. Care managers noted that although no deficiencies were officially admitted, a more timely offering of household-specific services could prevent hospitalization due to declines in activities of daily living （ADL）. Certain home-based services desired by users are not fully covered by Japan’s long-term care or medical insurance systems. Addressing these gaps could improve the wellbeing of care recipients and caregivers while potentially reducing healthcare costs. However, delays in service provision due to the lack of a centralized system may decrease ADLs, increasing the risk of hospitalization.

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This case report highlights our experience implementing a procedure aimed at enhancing the ability of older patients with limited comprehension to engage in activities of daily living （ADLs） through respiratory rehabilitation involving optimized management of chronic obstructive pulmonary disease （COPD）. A 72-year-old man was admitted to Fujigaoka Rehabilitation Hospital for rehabilitation after sustaining with multiple fractures sustained after falling down an approximately 4-m flight of stairs. On admission, he presented with exertional dyspnea attributable to heart failure and pneumothorax. For inhalation therapy, umeclidinium bromide （UMEC, 62.5µg/day）/vilanterol trifenatate （VI, 25µg/day） was initially prescribed because of its simplicity and ease of use. However, the patient did not achieve an adequate inspiratory volume with this treatment. Consequently, the inhalation therapy was switched to tiotropium bromide hydrate （TIO, 5.0µg/day）/olodaterol hydrochloride （OLO, 5.0µg/day）, which despite being less userfriendly, required less inspiratory effort. During this period, inhalation exercises were administered under the direction of a physical therapist. On day 42 of hospitalization, the patient demonstrated sufficient respiratory capacity to transition back to UMEC/VI. In postdischarge followup, the patient reported no difficulties with inhaler use and no adverse effects such as tremors or palpitations related to the medication. This case underscores the importance of individualized inhalation device selection and respiratory training in the rehabilitation of older patients with complex comorbidities.

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