This study aimed to determine the safety of antithrombotic therapy in children after Fontan surgery and the relationship between bleeding events, blood coagulability, and antithrombotic therapy dosage. We retrospectively evaluated 22 pediatric patients after Fontan surgery at Showa University Hospital and Showa University Northern Yokohama Hospital from March 2011 to September 2020. Patient background, antithrombotic therapy initiation and dosage, and blood coagulability 1 year after surgery were compared between the bleeding and the nonbleeding groups. The median age at the time of Fontan surgery was 36 months （22-164months）. After Fontan surgery, 21 patients underwent warfarin treatment with a median dose of 0.08 mg/kg/day （0.03-0.16mg/kg/day）. Nine patients （41％） experienced bleeding, with median onset at 10 days （1-127） after initiation of antithrombotic therapy. In four cases, antithrombotic therapy was started within 4 days of surgery. Of 11 cases with a prothrombin time and international normalized ratio （PT-INR） ＞ 2 within 4 weeks after initiation of antithrombotic therapy, 4 had bleeding events and 7 cases did not. Among nine patients with bleeding events who were treated with warfarin, six received a dose of ＜0.1mg/kg/day and three received a dose of ＞0.1 mg/kg/day. There was no significant difference between the warfarin dose at antithrombotic therapy initiation and that at the time of bleeding. Additionally, patient without any bleeding event had a PT-INR ＞ 5. The warfarin dose in this case was ＜ 0.1mg/kg/day. There was no relationship between warfarin dose, PT-INR, and bleeding in pediatric patients after Fontan surgery However, PT-INR was unstable during the perioperative period, and some cases exhibited supratherapeutic PT-INR. Therefore, it is crucial to monitor the factors affecting PT-INR （warfarin dosage, combined use of aspirin, postoperative hemodynamics, drug interaction）, particularly for 2 weeks after the initiation of antithrombotic therapy in pediatric patients after Fontan surgery.

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Medical education is a domain that entails fast-changing knowledge, its application, and a higher level of thinking; therefore, implementing effective teaching is crucial in this domain. In the field of occupational therapy education, both knowledge and skills occupy a large part of the curriculum, with a high need for improvement. Therefore, a number of studies have revealed that flipped classrooms have a positive impact on educational outcomes.
This study proposes flipped classrooms as an instructional strategy, which aims to create video materials to facilitate learning, and examines how this strategy was accepted by learners and instructors through peer review. Fifteen students who already completed the “Range of Motion Test” course using the conventional teaching method and six occupational therapy teachers who supervised clinical practice were asked to participate in the experiment. The video materials were used for the Range of Motion Test tasks in occupational therapy evaluation. The tasks require frequent training and acquisition of higher level of skills. A questionnaire regarding the actual use and content of the video materials was developed.
The items regarding the use of symbols, lines, and narration in the videos were evaluated as good. The students responded that they “would like to use” such materials in the future, and the instructors indicated that they found the materials helpful for students’ understanding. Additionally, specific opinions from the students and instructors regarding the improvement of the video materials were gathered. These points were expressed by both students and instructors, and future improvements would further enhance the educational effectiveness of video materials. However, this study is limited in terms of the opinions gathered. Therefore, further research on the quality and satisfaction levels of advanced learning materials and educational effectiveness of flipped classrooms must be conducted in the future.

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It is necessary to use enough antiplatelet treatment for treating acute coronary syndrome. There are few studies that consider the connection between platelet function and late lumen loss （LLL）. This study aimed to investigate the relationship between major adverse cardiac and cerebrovascular events （MACCE） and LLL. Platelet reactivity units （PRU） 2-4 weeks after percutaneous coronary intervention were evaluated using a VerifyNow system （PCI）. Twelve months following PCI, a follow-up coronary angiography was conducted. PRU patients＜221 were classified into low platelet reactivity （LPR） and high platelet reactivity （HPR） groups. The study enrolled 138 patients who received PCI and implantation of everolimus-eluting stents （EES） or biolimus-eluting stents （BES）; 83 and 51 patients were in the LPR and HPR groups, respectively. There was no considerable difference in MACCE between LPR and HPR groups （1% vs. 5%, P＝0.15）. LLL was substantially higher in the HPR group compared to the LPR in quantitative coronary angiography （QCA） （0.04 ± 0.37 vs. 0.19±0.38, P＝0.02）. In addition, in BES, but not in EES, LLL was considerably higher in the HPR group compared to the LPR group （0.03±0.57 vs. 0.30±0.72, P＝0.004）. When the risk of LLL ≧0.5mm was evaluated, HPR was found to be a risk factor in both univariate and multivariate analyses （Odds ratio 3.34, 95% CI：1.21-9.16, P＝0.01） （Odds ratio 4.42, 95% CI：1.48-13.22, P＝0.007）. One year after PCI, HPR and MACCE were unrelated. In the HPR group, LLL rose, and HPR was the sole risk factor for LLL ≧0.5mm. It was indicated that HPR is a risk factor for clinical results.

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To test the efficacy of direct hemoperfusion using a polymyxin B-immobilized fiber column （PMX-DHP） in collagen disease-related interstitial pneumonia （CVD-IP）. This study examined the underlying disease, prognosis, arterial oxygen partial pressure/inhaled oxygen concentration ratio （P/F ratio）, c-reactive protein （CRP）, computed tomography （CT） pattern, etc., in 12 cases of acute aggravation of CVD-IP who underwent PMX-DHP. The underlying diseases include dermatomyositis （DM） in 5 cases, rheumatoid arthritis （RA） in 5 cases, systemic lupus erythematosus in 1 case, and duplication syndrome in 1 case. There were 7 cases （survival rate of 41.7％）. The survival rate by underlying disease was 80.0％ for DM and 20.0％ for RA. The P/F ratio was increased in all cases by PMX-DHP, which was 320.0mmHg （199.1-364.4） for DM and 90.1mmHg （58.9-140.8） for non-DM before implementation, which were considerably higher in DM. Furthermore, CRP in DM was 1.1mg/dl （0.8-1.7） and 7.1mg/dl （4.1-18.3） in non-DM, which was considerably lower in DM. In contrast, the CT pattern increased the survival rate of nonspecific interstitial pneumonia to 80.0％ （4 out of 5 cases survived）, although there was no significant difference in each item. PMX-DHP treatment for acute CVD-IP exacerbation may have improved oxidative ability by preventing lung fibrosis progression. Particularly, DM is more useful for improving the prognosis of life. In contrast, the P/F ratio improved in all cases, indicating its efficacy regardless of severity. The introduction of PMX-DHP at an early stage in all cases of CVD-IP is expected to improve the prognosis of life. The underlying disease is DM in particular, or the CT pattern is nonspecific interstitial. It is proposed that pneumonia be actively introduced.

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More than 10 years have passed since the Great East Japan Earthquake. In hindsight, it became clear in the days that followed that the nation’s increased awareness of “Kizuna” （Bonds）, which was visible during the earthquake, no longer exists. Historically, this change in mindset us not new. For instance, the Great Genryaku Earthquake is portrayed in Kamono Chomei’s well-known book Hojoki, which was written during the Kamakura period. The change in thinking following the calamity may be summed up in one word: forgetting. In addition, the Great Kanto Earthquake, where Kanzo Uchimura described how the earthquake, which destroyed the imperial capital, was a form of punishment and a means of regaining conscience. However, Japan subsequently expanded its colonies and proceeded to the unprecedented Second World War. Following the earthquake in East Japan, several ideas were expressed in different ways. In addition to being an infectious occurrence, the spread of Kizuna was a historical reenactment of an earlier incident. The limitations of such repetition were proven in this study, as well as the significance of scientific acknowledgment as a factor that transcends such repetition.

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The patient is a 79-year-old woman. Her primary care physician diagnosed her with corrosive esophagitis when she experienced dysphagia after accidentally swallowing alcohol gel from her hand sanitizer around a year ago. She was sent to her healthcare physician approximately 3 months ago after experiencing swallowing difficulties and vomiting. She was examined at our hospital. Upper gastrointestinal endoscopy revealed circumferential stenosis with ulceration at 21-25cm of the incisor row, which did not pass through an oral endoscope （OLIMPUS GIF-XZ1200）. GIF-1200N biopsy revealed no cancerous abnormalities. Because medical treatment, including endoscopic dilatation, had failed to improve her condition, the patient and her family requested surgical intervention. Subsequently, a minimally invasive esophagectomy was conducted. Postoperative pathology revealed no signs of cancer and just a very stenotic region in the upper esophagus. We provide a rare case of successful surgical treatment of a patient with severe stricture after corrosive esophagitis caused by accidental swallowing of alcohol gel from hand sanitizer.

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Malignant struma ovarii is a rare germ cell tumor of the ovary. It accounts for only 2.7％ of all ovarian teratomas and is predominantly found in women aged 40-60 years. A 56-year-old multiparous woman presented with fever. Computed tomography and magnetic resonance imaging revealed a pelvic cystic mass, and a laparoscopic bilateral salpingo-oophorectomy was performed. Histopathology of the left ovary revealed a papillary thyroid carcinoma （PTC） arising within the teratoma. Staging laparotomy involving total hysterectomy, omentectomy, pelvic lymphadenectomy, and para-aortic lymphadenectomy was performed. Postoperative histopathology confirmed the presence of PTC in mature teratoma （stage IA）. The patient did not receive any adjuvant therapies. Malignant struma ovarii cannot be diagnosed preoperatively. There are no imaging features unique to malignant struma ovarii. Even if imaging features suggest a benign solid component mass, it is important to consider the prospect of a malignant tumor.

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