Atrial fibrillation (AF) is the most common cardiac arrhythmia that is associated with increased morbidity and mortality. AF and heart failure (HF) frequently coexist and confer an adverse prognosis. It is known that incident AF is strongly associated with HF with preserved ejection fraction, indicating that left ventricular (LV) diastolic function plays an important role in the genesis of AF. Two types of LV diastolic dysfunction (i.e., abnormal relaxation during early-diastole, and increased stiffness during mid- to late-diastole) differently affect LV diastolic pressure and might result in different clinical outcomes. Previous studies showed that abnormal relaxation and left atrial (LA) volume were associated with incident AF. We measured diastolic wall strain (DWS), a noninvasive direct measure of LV stiffness by M-mode echocardiography, and studied the role of LV stiffness in the genesis of paroxysmal AF. We found that a low DWS (<0.38) (i.e., increased LV stiffness) was the strongest indicator of AF (odds ratio: 6.22 in a multivariate model). Furthermore, we studied the role of LV stiffness in the progression of paroxysmal AF to persistent AF by measuring DWS, since AF progression is related to worse morbidity and mortality, and poorer outcomes of radiofrequency catheter ablation (RFCA). During a mean follow-up of 35 months, AF progression occurred in 60 of 172 (35%) patients treated with medications only (medication group), and 3 of 134 (2%) who underwent RFCA (RFCA group). In the medication group, patients with a low DWS (<0.38) had a higher incidence of AF progression than those without, while the AF progression rate was low irrespective of the DWS in the RFCA group. In a multivariate analysis, the DWS and LA volume index were independent predictors of AF progression in the medication group (hazard ratio, 1.13 per 0.01 decrease for DWS; 1.04 per 1 mL/m² increase for LA volume index). The DWS would be useful to stratify patients at risk of AF progression who could benefit from an earlier RFCA intervention.

In the authors' hospital, one pharmacist contributes to the outpatient cancer chemotherapy clinic as a full-time staff member. To strengthen cooperation with doctors, pharmacists have, since October 2016, been giving advice during outpatient medical examinations on prescriptions, treatment policy, and supportive therapy. Of the 219 suggestions given so far on prescriptions, 215 (98.2%) were adopted; the corresponding figures for proposed treatment policy are 41/41 (100%), and for proposed supportive therapy 162/166 (97.6%). Because the pharmacists attended the medical examinations, they were able to work with the doctors to gain clear understanding of the patients' situations and problems within the limited examination time, facilitating not only supportive therapy but also treatment policy. This prescription support system has led to higher-quality treatment.

We report a case of penile strangulation in an 82-year-old man who inserted the penis up to the penile base into a plastic bottle to obtain sexual pleasure and prolonged erection. He developed edema of the distal penis, which resulted in penile entrapment at the neck of the bottle. He was unable to remove the penis from the bottle and presented to our hospital 3 days after this event. On examination, the penis was edematous with foul odor, and the penile skin appeared black. He was diagnosed with penile strangulation and suspected sepsis. The neck of the plastic bottle strangled the penile root, and we could not manually release the penile strangulation. The patient was transferred to the operating room, and an orthopedic ring cutter was used to cut the neck of the plastic bottle. We observed necrosis at the distal penile root and performed emergency total penectomy. The patient was administered postoperative antibiotics; however, his general condition did not improve, necessitating additional debridement and removing residual urethra for management of the skin infection. The patient recovered completely following this multidisciplinary treatment approach.