The impact of no placement of drains in hemithyroidectomy on the postoperative course: A single-institutional study in Japanese patients

Background: Recently, the placement of drains in thyroidectomy has been debated. In this study, we evaluated the efficacy and safety of no placement of drains in hemithyroidectomy. Methods: After obtaining approval from the Institutional Review Board, we started not placing drains during surgery in adult patients who underwent hemithyroidectomy with or without central neck lymph node dissection for benign thyroid nodules or well-differentiated thyroid cancer, with informed consent being obtained. We compared the clinical data of the patients without drain placement (n=19) to the historical data of consecutive patients with a suction drain (n=20). Results: The operative wound and amount and characteristics of the drainage fluid were monitored every 2 h after the operation until the following morning, in addition to monitoring the oxygen saturation and an electrocardiogram. The proportion of patients undergoing cervical lymph node dissection was identical between the groups. The drain was removed on Day 1 after surgery in 19 patients and on Day 2 after surgery in 1 patient. The patients without a drain showed a significantly shorter postoperative hospital stay than those with a drain (4.0 vs. 4.5 days, respectively, p=0.03). No patients in either group experienced postoperativebleeding or seroma or wound infection. Conclusion: The hemithyroidectomy patients without a drain were able to be discharged earlier than those with a drain and without any adverse events, provided they received close monitoring after surgery

An Evaluation of the Efficacy of Compression Therapy Using Sleeves and Stockings to Prevent Docetaxel-induced Peripheral Neuropathy in Breast Cancer Patients

Taxanes are key drugs for patients with breast cancer. A major adverse effect of taxanes is peripheral neuropathy (PN). To investigate the ability of compression therapy using sleeves and stockings to prevent PN due to the taxane docetaxel, we conducted a single-center historical control trial. Patients receiving docetaxel at 75 mg/m2 every 3 weeks for 4 cycles as first-line chemotherapy for breast cancer were eligible. PN was evaluated using the common terminology criteria for adverse events version 4.0. The primary endpoint was the incidence of allgrade PN until 3 weeks after the fourth docetaxel administration. We evaluated 26 patients in the intervention group and compared their data to those collected retrospectively from 52 patients treated with docetaxel without compression. Neither the incidence of all-grade PN until 3 weeks after the fourth docetaxel administration (63.5% in the control group vs. 76.9% in the intervention group, p=0.31) nor that of PN grade ≥ 2 (13.5% vs. 15.4%, p=0.99) differed between the groups. In this study, the efficacy of compression therapy using sleeves and stockings to prevent PN induced by docetaxel was not demonstrated. Further clinical studies including medications or intervention are needed to reduce the incidence and severity of PN induced by chemotherapy

Study Protocol for Assessing the Efficacy of Compression Therapy Using Stockings and Sleeves to Prevent Docetaxel-Induced Peripheral Neuropathy in Breast Cancer Patients

Taxanes are key drugs for patients with breast cancer. A major adverse effect associated with the administration of the taxane docetaxel is chemotherapy-induced peripheral neuropathy (CIPN). We are conducting a singlecenter, single-arm, open-label historical control trial to evaluate the ability of compression therapy using stockings or sleeves to prevent CIPN due to docetaxel treatment. The primary endpoint is the incidence of all-grade CIPN according to patients’ records until 3 weeks after the fourth docetaxel administration. This study’s results will clarify whether compression therapy using stockings or sleeves can prevent CIPN in breast cancer patients

Complete Dissection of a Hepatic Segment after Blunt Abdominal Injury Successfully Treated by Anatomical Hepatic Lobectomy: Report of a Case

A 21-year-old male patient was transferred to the emergency room of our hospital after suffering seat belt abdominal injury in a traffic accident. Abdominal computed tomography revealed a massive hematoma in the abdominal cavity associated with deep hepatic lacerations in the right lobe. The presence of a solid tissue possibly containing pneumobilia was observed above the greater omentum. These findings were consistent with a tentative diagnosis of hepatic laceration due to blunt trauma; therefore, this prompted us to perform emergency laparotomy. The operative findings revealed a massive hematoma and pulsatile bleeding from the lacerated liver and a retroperitoneal hepatoma, which was most likely due to subcapsular injury of the right kidney. In accordance with the preoperative imaging studies, a pale liver fragment on the greater omentum was observed, which was morphologically consistent with the defect in the posterior segment of the liver. Since the damaged area of the liver broadly followed the course of the middle hepatic vein, we carefully inspected and isolated the inflow vessels and eventually performed a right hepatic lobectomy. The patient's postoperative course was uneventful, and he was doing well at 10 months after surgery

The preoperative thyroid function and perioperative course in patients with Graves\u27 disease

Graves\u27 disease is an autoimmune disorder that induces increase in thyroid hormone production and release. Although euthyroidshould be desirable to ensure a safe operation, some patients still undergo thyroidectomy with hyperthyroidism. The aimof this study was to evaluate our preoperative strategies in patients with Graves\u27 disease. A total of 186 patients underwent thyroidectomy for Graves\u27 disease between 2003 and 2017. We gave all of these patients potassium iodide (KI) in order todecrease their thyroid hormone levels. We compared the clinical factors among three groups defined by the value of serumfree triiodothyronine (FT3) after the administration of KI: (1) the good control group (n=126) with ?6.0 pg/mL, (2) the fair control group (n=35) with >6.0 but ?10.0 pg/mL, and (3) the poor control group (n=25) with >10.0 pg/mL. KI decreased the serumlevels of thyroid hormone. However, some patients still had hyperthyroidism, and the subsequent administration of corticosteroidreduced FT3 but not thyroxine. Regarding the intraoperative course, the heart rate at 1 h after beginning general anesthesiawas higher in the poor control group than in the good control group (p<0.05), and the proportion of patients givenadrenergic beta-blocker was higher in the poor control group than in the other groups (p<0.01 each). One patient in the faircontrol group experienced suspected thyroid storm after total thyroidectomy. The occurrence rate of other deteriorations wasidentical among the three groups. With preparative KI and corticosteroid administration, almost all patients with Graves\u27 disease were able to undergo thyroidectomy safely

The Efficacy of Software to Help Patients Understand Drug for Adjuvant Treatment for Breast Cancer: A Pilot Randomized Controlled Trial

We assessed the usefulness of ChemoCalc, a software package for calculating drug costs, in helping patients understand these costs. We randomly assigned, in a 1 : 1 ratio, 20 women who had undergone surgery for early breast cancer to a group that discussed adjuvant treatment with their physicians using the ChemoCalc software (ChemoCalc group) or a group that discussed adjuvant treatment without ChemoCalc (Usual Explanation group). The participants completed a five-grade evaluation questionnaire after these discussions. The primary endpoint was the intergroup comparison of the questionnaire scores regarding participants’ understanding of their treatment-associated drug costs. Median age was not significantly different between the ChemoCalc group and Usual Explanation group (57 vs. 50, respectively; p=0.27). Patients in the ChemoCalc group had a significantly higher perceived level of understanding of the drug cost than those in the Usual Explanation group (5 [4-5] vs. 2.5 [1-5], respectively; p=0.002). Scores related to the patients’ perception that understanding drug costs is an important part of breast cancer treatment were also higher in the ChemoCalc group than the Usual Explanation group (5 [2-5] vs. 3 [1-5], respectively; p=0.049). ChemoCalc was found to be useful for understanding drug costs

Is it practical to determine the therapeutic strategy for breast cancer by evaluating pathological findings in core needle biopsy specimens?

Background; Core needle biopsy (CNB) specimens have been widely used not only for the diagnosis of breast cancer, but also for assessing biomarkers, including lymphovascular invasion (ly and v), nuclear grading, the estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2) and Ki-67. We herein compared the pathological biomarkers of ER+/HER2- invasive breast cancers in CNB with those in the subsequent surgical specimens.　Methods; Patients with ER+/HER2- invasive breast cancer who presented to our department from August 2011 to July 2013 who had CNB and subsequent surgery were included. Lymphovascular invasion (ly, v) and nuclear grading were determined by hematoxylin and eosin staining, and the ER, PgR, HER-2, and Ki-67 status were evaluated by immunohistochemistry.　Results; The concordance rates between CNB and surgical specimens for the ly, v, nuclear grading, ER and PgR were 2.4%, 2.9%, 63.0%, 96.4% and 82.1%, respectively. Lymphovascular invasion and nuclear grading tended to be underestimated with CNB in discordant cases. The Ki-67 labeling index in CNB specimens was strongly correlated with that in surgical specimens (correlation coefficient 0.75, p<0.0001). Consequently, there was a reasonable level of agreement between CNB and surgical specimens for surrogate subtyping (82.1%).　Conclusions; CNB provided reliable information on the expression of hormone receptors, Ki-67 in ER+/HER2- invasive breast cancers. However, because of the substantial discordance between CNB and surgical specimens, the status of lymphovascular invasion and nuclear grading should not be concluded based on CNB specimens

Lymphedema After Axillary Lymph Node Dissection in Breast Cancer: Prevalence and Risk Factors—A Single-Center Retrospective Study

Background: Lymphedema may develop when axillary lymph node dissection (ALND) injures and obstructs the lymph ducts in the upper limb. In patients with breast cancer, lymphedema is difficult to treat and can cause arm swelling, heaviness, and restricted movement. We aimed to identify the prevalence and risk factors for lymphedema after ALND in patients with breast cancer.Methods and Results: This retrospective study included 175 patients with breast cancer who underwent ALND in the Nagasaki University Hospital, Japan, between 2005 and 2018. Lymphedema was defined as symptomatic arm swelling with a >2-cm difference in the arm circumference between the affected and contralateral arms. Patients were divided into two groups according to the presence or absence of lymphedema. Surgical and pathological findings were compared between the two groups. Univariate and multivariate analyses were performed, including the chi-square test, Student’s t-test, and logistic regression analysis. Lymphedema was prevalent in 20% of the study participants, and the mean time interval from surgery to development of lymphedema was 479 days. In the univariate analysis, a body mass index of >26 kg/m2, smoking, radiotherapy (RT), and dissection of >18 axillary lymph nodes (ALNs) significantly increased the risk of lymphedema. In the multivariate analysis, smoking, RT, and dissection of >18 ALNs significantly increased the risk of lymphedema.Conclusions: The prevalence of lymphedema in our study was 20%. Our findings suggest that smoking, RT, and dissection of >18 ALNs are risk factors for lymphedema. Aggressive and empiric ALND might be associated with axillary lymph duct damage

Protocol for studying the efficiency of ChemoCalc software in helping patients to understand drug treatment costs for breast cance

Survival of patients with breast cancer can be prolonged by treatment with drugs, particularly new molecular-targeted drugs. However, these agents can be expensive and such treatments can be “an economic burden.” In this ongoing trial, we aim to assess the usefulness of ChemoCalc, a software package for calculating drug costs, to help patients understand the financial outlays. In this multicenter, randomized controlled phase 2 trial, 106 patients with advanced breast cancer will be assigned to either the “ChemoCalc” or “Usual Explanation” group. Treatment using ChemoCalc will be discussed with patients in the ChemoCalc group, whereas standard treatments, without using ChemoCalc, will be discussed with patients in the Usual Explanation group. Subsequently, the participants will decide the treatment and complete a five-grade evaluation questionnaire; those in the Usual Explanation group will receive information about ChemoCalc. Investigators will report if patients subsequently decide to change treatments. The primary endpoint will be the scores of two key questions compared between the groups: “Did you understand the cost of treatment in today\u27s discussion?” and “Do you think the cost of treatment is important in choosing a treatment?“. The secondary endpoints will be to compare discrepancies between treatments recommended by physicians and those selected by patients, the time required for discussion, other questionnaire factors, and the relationship between Comprehensive Score for Financial Toxicity tool and treatment selection. This will be the first randomized controlled trial to assess the efficacy of software to help patients understand drug cost estimates and whether it subsequently affects treatment choice. This study will be conducted according to the CONSORT statement. All participants will sign a written consent form. The study protocol was reviewed and approved by the Clinical Research Review Board of Nagasaki University (19070801). The protocol (version 1) was designed and will be conducted in accordance with the Declaration of Helsinki (1964) and the Ethical Guidelines for Medical and Health Research Involving Human Subjects (2017). The findings will be disseminated through scientific and professional conferences, and in peer-reviewed journals

The linkage between medical student readiness for interprofessional learning and interest in community medicine

Objectives: The purpose of this study is to investigate the relationship between medical student readiness for interprofessional learning and interest in community medicine prior to incorporating community-oriented interprofessional education into the curriculum. Methods: A questionnaire was administered to students at Nagasaki University School of Medicine in Japan during each of three consecutive years (N=2244). The Readiness for Interprofessional Learning Scale (RIPLS) was administered in addition to a questionnaire to evaluate interest in community medicine. The Kruskal-Wallis and Steel-Dwass tests were used to determine differencesbetween school years. Correlation between the RIPLS score and interest in community medicine was evaluated with Spearman\u27s rank correlation coefficient. Relationships between RIPLS score and demographic parameters, and interest in community medicine were evaluated with multiple linear regression analysis. Results: Eighty-four percent (1891/2244) of students responded. The RIPLS score was highest in school year 1, followed by year 6, year 5,year 3, and years 4 and 2. Interest in community medicine correlated with the RIPLS score (rs = 0.332, p < 0.001),but less in year 1 (rs = 0.125, p = 0.002) than in other years. RIPLS score was significantly associated with gender, age, school year, interest in community medicine, but not the year that the survey was conducted. Conclusions: Community-oriented interprofessional education has the potential to improve attitudes towards interprofessional learning. When introducing this promising education into the curriculum from year 1, attracting students\u27 interest in community medicine should be considered