Brexpiprazole （BREX）, a serotonin-dopamine activity modulator, was launched in Japan in 2018. The medium- to long term adherence to this medication and the incidence of side effects are not well characterized. BREX is also a potent partial agonist of human serotonin 5-HT1A, which produces anxiolytic effects. Therefore, we retrospectively examined the treatment persistence, the incidence of adverse effects, and the pre and posttreatment changes in the dose of benzodiazepines （BZDs） in patients with acute schizophrenia treated with BREX. This was an observational, retrospective study based on the medical records of patients hospitalized at Showa University Karasuyama Hospital between August 2018 and December 2021. Eighty-six patients who were diagnosed with schizophrenia based on the International Classification of Diseases and Related Health Problems, 10th Revision （ICD-10） definition and were prescribed BREX for the first time were included in the study. The mental status was assessed by clinicians using the Clinical Global Impression-Severity of Illness （CGI-S） scale. The continuation rate for BREX treatment during the first 24 weeks was 46.5％. Patients receiving BREX monotherapy at 24 weeks and those with a CGI-S score ≤ 5 at the start of BREX treatment had a higher persistence rate of BREX at 24 weeks. There were no significant differences between the BREX continuation and BREX discontinuation groups with respect to the dose change of BZDs. BREX monotherapy and mild-moderate mental status at initiation are potential predictors of BREX treatment persistence. Prospective studies are required to confirm these findings.

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Pancreatic cancer is a malignant tumor with a poor prognosis, and the incidence rate of pancreatic cancer-related morbidity and the rate of mortality are increasing. Abdominal ultrasonography is recommended as a screening tool for pancreatic cancer. High echogenicity （brightness） of the pancreas has attracted attention in recent years. However, its significance is unknown. An association was found between strong echogenicity of the pancreas and lifestyle-related diseases. However, the background pancreatic parenchyma （“background pancreas”） in pancreatic diseases has not been analyzed extensively with endoscopic ultrasonography （EUS）. For the early detection of pancreatic cancer, we EUS was used to analyze the background pancreas in cases of pancreatic ductal adenocarcinoma （PDAC） and intraductal papillary mucinous tumor （IPMN）. The association between the background pancreas and PDAC/IPMN and between the background pancreas and life history of the patients was investigated. The current study enrolled 42 patients with PDAC and 40 with IPMN who underwent EUS at Showa University Hospital from August 1, 2021, to July 31, 2023. To measure the pancreas-kidney brightness ratio, the echogenicity （brightness） of the background pancreas of the patients was compared using the ImageJ software. The association between the appearance of the background pancreas and patients’ health-related habits was analyzed. The background pancreas was relatively dim in patients with PDAC. However, it was relatively bright in patients with IPMN. Further, the brightness of the background pancreas of was correlated with body mass index, hemoglobin A1c level, and serum triglyceride level in patients with IPMN. In terms of EUS and histopathological findings, patients with IPMN presented with fat deposition. Further, patients with PDAC exhibited parenchymal atrophy and fibrosis in the background pancreas. Analyzing the background pancreas on EUS may identify an association between lifestyle-related diseases and the diagnosis of pancreatic tumors.

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The present study analyzed the effects of online gambling on patients with gambling disorder, with special focus on their financial status and psychological characteristics, and investigated the mechanisms that changed the type of gambling. Overall, 41 patients were divided into three groups by online experience （no online, partially online, and mostly online）, and were analyzed retrospectively. In addition, results of Wechsler Adult Intelligence Scale （WAIS）, Wender Utah rating scale （WURS）, Autism-Spectrum Quotient （AQ test）, and South Oaks Gambling Screen （SOGS）, were assessed to elucidate their psychological characteristics. The main gambling gateways were pachinko （41.5％）, pachislot （29.3％）, and horse racing （12.2％）. Moreover, 29.2％ patients participated in online gambling. The total SOGS score was 11.4 （SD＝3.1）, exceeding the cutoff value of 5/6 with no observed difference among the three groups. The total amount of money invested was highest in the “mostly online” group, followed by the “no online” and “partially online” groups （P＜0.05 between “mostly online” and “partially online” groups）. Number of gambles was highest in the “partially online” group, followed by the “mostly online” and “no online” groups （P＜0.01 between “partially online” and “no online” groups）. In WURS, 30.0％ of the respondents exceeded the attention-deficit/hyperactivity disorder （ADHD） trend cutoff. The highest working memory （WM） of 103.5 （SD＝15.0） was observed in WAIS-IV （P＜0.001 between WM and processing speed）. WAIS WM scores revealed that the “mostly online” group had the highest WM of 106.1 （SD＝11.3）, followed by the “partially online” group with 101.2 （SD＝13.3） and the “no online” group with 99.5 （SD＝18.6）. Pachinko and pachislot were the gambling gateways, and online gambling increased total debt. ADHD screening is crucial in treatment of patients with gambling disorders, and higher WM may be associated with a greater tendency of online gambling.

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Uniform placement of SpaceOAR is useful in radiation therapy because it reduces the radiation dose to the rectum. We evaluated the placement patterns of the SpaceOAR system along with permanent prostate brachytherapy in patients with prostate cancer and investigated patient factors that influenced placement morphology. We examined 360 cases of prostate cancer to identify patient factors that affected the distribution of SpaceOAR injections in our hospital between April 2018 and April 2021. The uniformity of placement morphology （homogeneous or heterogeneous） was assessed based on T2-weighted magnetic resonance images obtained the day after SpaceOAR implantation. We identified the following as influencing factors: age, initial prostate-specific antigen level, prostate volume, clinical T stage, Gleason score, National Comprehensive Cancer Network risk classification, and duration of neoadjuvant hormonal therapy. Multivariate analysis of patient characteristics and SpaceOAR placement morphology showed statistically significant differences in the National Comprehensive Cancer Network risk classification （p＝0.02） and neoadjuvant hormonal therapy duration （p＝0.004）. The cutoff value of the receiver operating characteristic curve for SpaceOAR homogeneity and neoadjuvant hormonal therapy duration, performed as a subgroup analysis, was 3 months, with a sensitivity of 0.83 and specificity of 0.52. Patients classified as high risk according to the National Comprehensive Cancer Network guidelines and those with a longer neoadjuvant hormonal therapy period may exhibit less uniform SpaceOAR system placements. Furthermore, a neoadjuvant hormonal therapy duration of 3 months seems to be a suitable duration for achieving uniformity.

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