The number of molecular-targeted drugs available for breast cancer therapy has steadily increased in recent years and plays a central role in the systemic treatment of breast cancer.

Apart from endocrine drugs, trastuzumab, an anti-human epidermal growth factor receptor 2 (HER2) drug for treating HER2 overexpressing breast cancer, available since April 2001 in Japan, is well-known in the field of breast cancer. However, there are five types of anti-HER2 drugs available as of January 2022, with expanded indications ranging from treatment for metastatic breast cancer to postoperative adjuvant therapy and preoperative medication. Other molecular-targeted drugs, such as angiogenesis inhibitors, mammalian target of rapamycin inhibitors, cyclin-dependent kinase 4/6 inhibitors, poly adenosine diphosphate (ADP) ribose polymerase inhibitors, and immunological checkpoint inhibitors, have been used in clinical practice based on the results of numerous clinical trials. In December 2021, a new option to use a molecular-targeted drug as an insured medical treatment was added to postoperative adjuvant therapy for hormone receptor-positive and HER2-negative breast cancer, an alteration after approximately 20 years since the introduction of aromatase inhibitors.

As described above, molecular-targeted drugs are being developed yearly, but there remain limitations to drugs that can be used to treat each breast cancer subtype. Therefore, it is necessary to appropriately select and use therapeutic agents based on subtype and time of introduction.

Respiratory syncytial virus (RSV) is a common cause of lower respiratory tract infections (LRIs) in infants and young children and may be accompanied by T helper type (Th) 1/Th2 imbalance. Leukotriene receptor antagonists improve the long-term prognosis of patients with RSV-induced LRIs, but the long-term effects have not yet been investigated. In this study, we measured the long-term effects of pranlukast, a cysteinyl leukotriene receptor 1 antagonist, in hospitalized patients (aged <2 years) with RSV-induced LRIs. Participants were randomized into two groups: the pranlukast group (group P, n = 9) and the control group (group C, n = 11), which received placebo. Both groups were unblinded for prescription at discharge. Group P continued to take pranlukast for 6 months, and group C took nothing after discharge. Serum levels of interferon gamma and interleukin-4 were measured, and Th1 and Th2 cell counts and Th1/Th2 ratio were analyzed by flow cytometry upon hospitalization, at discharge, and 6 months post-discharge. Notably, at 6 months post-discharge, the Th1/Th2 ratio was significantly higher in group C than in group P (p < 0.05). Although these results suggest that long-term pranlukast administration suppresses Th1 response, no side effects or other diseases were noted. Our study included a small number of patients; therefore, large-scale trials are required.

Introduction: This study aimed to determine the differences in risk factors for patients with delirium in the general wards and intensive care units of a university hospital.

Materials and Methods: The participants were inpatients at an acute care university hospital, excluding obstetrics and pediatrics patients. Delirium was diagnosed using Delirium Rating Scale-Revised-98 (DRS-R-98) in the general ward and using Intensive Care Delirium Screening Checklist (ICDSC) in the intensive care unit. A logistic analysis was performed using the statistical analysis program package SAS Ver. 9.4 (SAS Institute, Cary, NC, USA) to investigate the factors that influence the development of delirium.

Results: A total of 1,420 patients were included in the study. Delirium developed in 36 (5.1%) of the 707 patients who underwent DRS-R-98 in the general ward. Of the 207 patients who underwent ICDSC in the intensive care unit, 57 (27.5%) developed delirium. The risk factors for patients with delirium in the general ward were dementia (34.8%, odds ratio [OR]: 12.13) and respiratory distress (11.4%, OR: 8.53). In the intensive care unit, the risk factors were dementia (75.0%, OR: 9.65), non-benzodiazepine sleeping pills (77.8%, OR: 8.79), and history of delirium (72.7%, OR: 9.45). The OR of dementia as a factor for delirium was the highest in both general wards (OR: 12.13) and intensive care units (OR: 9.65).

Conclusion: Cognitive impairment was associated with the development of delirium in patients in both general wards and intensive care units, and non-benzodiazepine sleeping pills were risk factors delirium development in intensive care units.

The analgesia, sedation, and delirium management guidelines (PADIS guidelines) for patients in the adult intensive care unit (ICU) published in 2018 mention the need for proper sleep evaluation and management. A web questionnaire survey on sleep evaluation and intervention status in domestic ICUs, based on the PADIS guidelines, was conducted. The majority of the respondents were physicians working in city hospitals. Approximately 70% of the respondents answered that they performed sleep assessments on patients who are hospitalized, undergoing oral or nasotracheal intubation ventilation, undergoing post-tracheostomy ventilation, and undergoing ventilation with noninvasive positive pressure ventilation. Based on the survey, the most common evaluation method was the subjective evaluation done by nurses, rather than using the Richards-Campbell questionnaire recommended by the PADIS guidelines. More than half of the respondents answered that they dim lights in the patient's room at night, administer sleep medication, and adjust the dose of continuous sedation medication day and night to promote sleep in patients undergoing ventilation. Additionally, 40% of the respondents felt that sleep disturbance during ventilation, while in the ICU, may impact the patient's life after the liberation from the mechanical ventilation. Evidence supporting sleep assistance in ventilated patients remains unclear. Further research is necessary.

Fibromuscular dysplasia (FMD) is a type of non-arteriosclerotic, non-inflammatory vascular lesion that occurs mainly in the media of small- and medium-sized arteries. FMD can be diagnosed by cerebral angiography or pathology, and the string-of-beads feature is specific to FMD. FMD is common among middle-aged women, and the incidence is lower in Japan than in Europe and the United States. There is no clear evidence on the benefits of endovascular intervention for acute revascularization of dissecting FMD lesions. Moreover, in Japan, there are no reports of bilateral internal carotid artery (ICA) stenting for progressive dissecting FMD lesions, which occur frequently in the main trunk artery. We report a 50-year-old woman who visited the clinic with a complaint of headache. The patient was referred to our hospital because of right ICA dissection, as identified by head and neck magnetic resonance angiography (MRA). At admission, the patient was conscious, and her only symptom was headache. No neurological dropout was observed. We performed urgent cerebral angiography and observed narrowing of the right ICA at the second cervical vertebra and blood vessel wall irregularity in the third segment of the left vertebral artery. On the seventh day of illness, MRA showed vascular wall irregularity in the left ICA as a new lesion, and left ICA dissection was diagnosed. Progression of the left ICA lesion was observed on the 12th day of illness. We performed left ICA stenting on the 15th day of illness. The patient progressed without postoperative neurological symptoms, and headache improved. No vertebral artery lesion exacerbation was observed. On the 22nd day of illness, preventive stent placement of the right ICA dissection was performed. After surgery, the patient was discharged home on the 31st day of illness without complications. Follow-up imaging is required for suspected FMD, and endovascular treatment may be effective for advanced lesions.

Extracorporeal membrane oxygenation (ECMO) has been as a for lifesaving rescue therapy for patients with severe acute respiratory failure associated with coronavirus disease-2019 unresponsive to mechanical ventilation. Although the broad application of this new technology undoubtedly saves lives in many cases, these innovations have created new ethical issues in intensive care medicine. Intensivists managing patients treated with ECMO should be prepared to deal not only with complex clinical management, but also with ethical issues. For the clinical-ethical case analysis, we used the "four-topic" approach described by Jonsen, et al. This method helped classify all aspects of clinical ethics into four categories and provided a framework for linking the current situation of this case to ethical principles.

An 18-month-old boy developed toxic shock syndrome (TSS) after a minor burn. He sustained a second-degree burn (superficial partial thickness) over 4-5% of the total body surface area on the right upper arm and lateral chest. Four days later, he developed a fever and was brought to the emergency room of our hospital. At presentation, he had tachycardia and peripheral coldness despite the fever. There were no signs of infection at the burn site, but diffuse erythema was observed on the left upper arm and lateral chest. He was admitted to the pediatric intensive care unit for suspected TSS and compensated shock. Gradually, his condition stabilized and he was transferred to the general ward on day 4 of hospitalization. On day 7, desquamation away from the wound was observed. Staphylococcus aureus positive for the TSS toxin-1 gene was detected in the wound culture on admission, and we diagnosed probable TSS. Based on the course and physical examination findings, the patient was treated for TSS and had a good outcome without developing hypotension or multiple organ failure. TSS progresses rapidly and can be fatal, so it is important to be aware of TSS when treating febrile children with burns.