The rarity of pediatric rheumatic disease and scarcity of pediatric rheumatologists can lead to delayed diagnosis and initiation of treatment, which for patients with this chronic disease can have a significant impact on prognosis. On the other hand, recent advances in molecular targeted therapies with biologics and small molecule drugs have contributed to dramatic improvements in controlling the disease. Furthermore, treatment efficacy is now based not only on the scoring of symptoms and clinical examination findings, but also on quality of life (QoL) and patient-reported outcomes (PRO). Various QoL/PRO assessment questionnaires have been developed in Europe and the US, and translated versions are now in clinical use for adult patients in Japan. However, self-assessment is difficult for children, and their understanding and perception of health, illness, and treatment differ from those of adults. Therefore, age-appropriate questionnaires have been developed for children and their guardians, but they have not yet been fully validated for use in Japan. Thanks to improvements in diagnosis and treatment, more patients are now living with the disease into adulthood, focusing attention on the issue of how to support patients through this transition to adulthood and help them understand their own abilities and limitations so that they can become more independent. To improve care for patients with pediatric rheumatic disease and their families, the Pediatric Rheumatology Association of Japan, with the support of a Health and Labor Sciences Research Grant, is conducting registry surveys, developing appropriate pediatric clinical outcome assessments (COAs), seeking approval of drugs and examinations not yet permitted in Japan and increased medical subsidies, and developing systems to support patients in the transition to adulthood.

At present, chemotherapy for cancer is mainly administered on an outpatient basis, and prescriptions for some oral anticancer drugs and drugs to manage side effects are regularly filled at dispensing pharmacies. Therefore, collaboration between medical institutions and dispensing pharmacies is becoming ever more important. We have now started calculating the costs of the additional fee for collaboration enhancement that was newly established in the April 2020 revision of medical fees. As a tool for sharing information with dispensing pharmacies, we use regimen collaboration sheets and tracing reports. In the year since medical fees were revised, we have calculated a total of 666 additional fees for collaboration enhancement, and we have received 225 tracing reports from dispensing pharmacies. The challenge for the future will be to further increase the number of calculations and strengthen collaboration by improving information sharing tools.

A 49-year-old man living on an island was admitted to our hospital in January with antibiotic-resistant intermittent fever, cough, and hypoxemia. Based on his medical history, imaging findings, and a positive test for anti-Trichosporon asahii antibody, we diagnosed summer-type hypersensitivity pneumonitis. A literature review of reported cases of summer-type hypersensitivity pneumonitis diagnosed in seasons other than summer showed that it is common in hot and humid environments as well as in warm regions. The possibility of summer-type hypersensitivity pneumonitis should be considered even in winter.

A 72-year old woman was transferred to our emergency department for evaluation of chest and back pain. She was diagnosed with Stanford type A aortic dissection based on computed tomography findings, and we performed emergency partial arch graft replacement on the same day. The patient was extubated the day following surgery, and oral intake was resumed on the second postoperative day. We observed cloudy drainage in the pericardial drain following the first feed and diagnosed the patient with chylopericardium based on biochemical evaluation findings. Continued drainage necessitated lymphangiography, which was performed on the 7^th postoperative day and revealed lymphatic outflow on the aortic arch lesser curvature side. The volume of drainage decreased subsequently and did not increase thereafter following resumption of oral intake. The patient was discharged on the 27^th postoperative day without any additional treatment.

Delayed diagnosis of bacterial meningitis has a significant impact on prognosis and should not be overlooked. Cases of recurrent bacterial meningitis in infancy may be associated with underlying diseases such as immunodeficiencies and congenital deformities, including those of the inner ear. Streptococcus pneumoniae is a highly invasive causative agent, but the number of patients with meningitis has decreased dramatically in recent years due to the widespread use of the 13-valent pneumococcal conjugate vaccine. However, cases of vaccinated patients having invasive pneumococcal infection have been reported due to serotypes changing. We report a case of recurrent bacterial meningitis in an infant. The second occurrence was associated with Mondini deformity, for which surgical treatment was planned. The third was observed while the patient was awaiting surgery, and the fourth postoperatively. This study presents the clinical course of the Mondini deformity in this patient, which was difficult to manage due to the recurrent bacterial meningitis, and draws on epidemiological data concerning invasive pneumococcal infections occurring between April 2013 and March 2021 in Kawasaki City, Kanagawa Prefecture, Japan.