Percutaneous transluminal recanalization for acute large vessel occlusion stroke has been performed more than 30 years and progressing along with development of endovascular device. The treatment started with local injection of urokinese through simple microcatheter and guiding catheter system. In those days, single lumen balloon catheter was developed and it allowed us to navigate balloon catheter to the intracranial large arteries and the thrombus was crashed with balloon to reanalyze. In Japan, mechanical thrombectomy device approved in 2010 and the occlusion has been effectively reanalyzed. Furthermore, aspiration of thrombus using larger lumen catheter combination with vacuum system was introduced in 2011. Stent retriever has been available from 2014, and making the procedure more straightforward and successful. Romanized control studies proved the effects of mechanical thrombectomy and the treatment is becoming standard treatments for acute ischemic stroke.

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Societal needs for general physicians are increasing, and medical universities are responsible for meeting such demands by providing opportunities for medical students and clinical residents to experience the clinical practice of generalists, so that they become more aware of what it involves and might be inclined to become generalists in future. Our department runs a satellite campus at Oda City Hospital, called ‘Oda Training Center of General Practice’, where young trainees can experience general practice under the supervision of attending physicians. In addition, we are involved in several initiatives at Shimane University hospital, including collaboration with the Emergency Medical Center (EMC) and revamping of our clinical clerkship program, such as involving medical students in morning bedside-rounds, effective communication using a business chat-tool, and a joint conference with the EMC. We believe that these initiatives at Shimane University will contribute to fostering more general physicians in the years to come.

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Chronic diarrhea is a symptom frequently noted in patients with various diseases. In addition to organic conditions, such as inflammatory bowel and neoplastic diseases, functional diseases including irritable bowel syndrome are important etiological factors related to chronic diarrhea. According to recent reports, approximately one-third of cases with suspected irritable bowel syndrome are actually diagnosed as bile acid diarrhea, which is characterized by decreased absorption of bile acids from the terminal ileum as well as their hepatic overproduction. Clinical signs and symptoms of bile acid diarrhea do not differ from those of other diseases complicated with chronic diarrhea, and reliable laboratory tests for proper diagnosis are not available in Japan. On the other hand, effective treatment is possible with oral administration of bile acid sequestrants. Therefore, in cases of irritable bowel syndrome with diarrhea and functional diarrhea, the possibility of bile acid diarrhea should always be considered, with a treatment trial with bile acid sequestrants discussed herein as an option.

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We have reported three cases in which switching from hydromorphone to oxycodone provided effective analgesia for neuropathic pain caused by cancer. Case 1 was ovarian cancer, case 2 was lung cancer and case 3 was carcinoma of unknown origin. We diagnosed parts of the pain were neuropathic pain caused by lymph node metastasis or bone metastasis of cancer in flow chart of grading system for neuropathic pain diagnosis chart. There are few reports on the effect of hydromorphone on neuropathic pain, the efficacy of oxycodone has been reported in a comparison of hydromorphone-induced morphine and oxycodone. It has been suggested that different effects for neuropathic pain between hydromorphone and oxycodone are due to the activation of GIRK1/KIR3 channels in the ventrolateral periaqueductal gray matter region. The activation mechanism induces antinociceptive effects by suppressing gamma-aminobutyric acid release. In our experience, oxycodone seemed to have a better effect on neuropathic pain than hydromorphone. Therefore, we believe that early use of oxycodone for cancer pain, in which activation-mediated neuropathic pain is considered to predominate in clinical practice, is likely to provide effective pain relief and improve patients' QOL.

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After publication of above article, the authors realized some errors. The authors correct the errors as follows.

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