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  1. Fulltext Influence of early clinical exposure for undergraduate students on self-perception of different aspects of geriatric dental care: Pilot study between two colleges from Japan and India
    Patil PG, Ueda T, Sakurai K
    J Indian Prosthodont Soc, 2018 Jul-Sep;16(3):288-93.
    PMID: 27621550 DOI: 10.4103/0972-4052.186402
    OBJECTIVE: The objective of this study is to identify the influence of early clinical exposure for undergraduate students on self-perception of different aspects of geriatric dental care.

    MATERIALS AND METHODS: We have selected two different colleges from Japan and India, namely, Tokyo Dental College (TDC), Tokyo, and Government Dental College (GDC), Nagpur, respectively. The GDC students exposed to patients in a 3(rd) year and TDC in the 5(th) year of course. Survey of 74 undergraduate students GDC and 95 of TDC was conducted. The questionnaire was developed based on to the 50 points undergraduate curriculum by European College of Gerodontology. The questionnaire categorized into four parts; Part I (15 questions) on aging and medicine, Part II (15 questions) on communication skills, Part III (15 questions) on diagnosis/treatment, and Part IV (5 questions) on need of more training in Gerodontology. Their own-perception on self-knowledge and competency was scored on 4 level scale as 3, 2, 1, and 0 for response yes, rather yes, rather no, and no, respectively. Average scores were calculated and presented.

    RESULTS: The differences of the opinions as per students' perception level were found to be slightly more affirmative in GDC students (1.9 for the 4(th) year and 2 for the 5(th) year) than TDC students (1.1 for 5(th) grade and 1.5 for 6(th) grade). Both clinical and didactic hours should be increased in curriculum according to the TDC (89%) and GDC (79%) students. Separate gerodontology subject is suggested from TDC (76%) to GDC (81%) students.

    CONCLUSION: Average scores about own-perception of knowledge and competency about aging, medicine, and communication skills were almost same in both GDC and TDC students. With early clinical exposure, GDC students appear have better self-perception regarding the different aspects of the geriatric dental care including subject knowledge, communications, diagnosis, and treatment planning than TDC students with late clinical exposure.
    Matched MeSH terms: Tokyo
  2. Neutron activation analysis and assessment of trace elements in fingernail from residents of Tokyo, Japan
    Wee B, Ebihara M
    Sains Malaysiana, 2017;46:605-613.
    We report herewith the study of fingernail clippings obtained from the residents of Tokyo, Japan. A total of 18 participants with no health problems and occupational exposure to metals were recruited to provide fingernails samples for this study. Through the use of instrumental neutron activation analysis (INAA), 18 elements (Ag, Al, As, Ca, Cl, Co, Cu, Fe, Hg, K, Mg, Mn, Na, S, Sb, Se, V, and Zn) were determined. The results showed that the toxic elements in the fingernails are in the lower range when compared to literature values. There were no chronic exposures to toxic elements such as As and Hg found. The level of Hg found is lower than that reported 20 years ago, possibly due to the strict regulation control in Japan on the release of Hg to the environment. The elements Se and Zn are found to be rather uniformly distributed among participants and are in agreement with results from other countries. There were no significant differences in elemental concentrations due to genders and smoking habits. The overall data from this study showed similar concentrations to those of healthy participants from other countries. Thus, the current data could represent the background level of elemental concentrations in fingernails of residents in Tokyo, which could serve as reference values for future study.
    Matched MeSH terms: Tokyo
  3. Fulltext Prevalence of bimaxillary protrusion among UiTM orthodontic patients
    Ruqoyyah Muslimat Othman, Noor Airin Aidil Koay, Sarah Haniza Abdul Ghani, Noraina Hafizan Norman
    Compendium of Oral Science, 2019;6(1):1-8.
    MyJurnal
    Objective: To determine the prevalence of bimaxillary protrusion in general and the prevalence of skeletal Class I and dental Class I bimaxillary protrusion/ proclination among orthodontic patients attending postgraduate orthodontic clinic at Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Malaysia. Materials and Methods: This is a cross sectional study which was carried out in two stages. The first part involves a random selection of 100 extra-oral profile photographs taken from postgraduate orthodontic residents’ patient list. The photographs were taken using Canon digital SLR camera EOS 70D with macro lens EF 100mm (Canon Inc., Tokyo, Japan) with patients in natural head position. The photographs were visually analysed for its bimaxillary protrusion features by two operators. The second part comprises of analyses of extra-oral profile photographs as well as intra-oral photographs of right buccal segment view which was conducted in two separate sittings. In the first sitting, five assessors analysed 259 extra - and intra-oral photographs followed by 40 photographs assessed in the second sitting for skeletal and dental Class I bimaxillary protrusion/ proclination. Statistical analysis for Kappa score was performed to assess the agreement between assessors using SPSS version 23 and Stata version 13. Results: The first part of the study showed an average prevalence of 34% with bimaxillary protrusion in 100 orthodontic patients. Whilst in the second part, prevalence of skeletal and dental Class I bimax ranging from 28 -33 per cent and 38-40 per cent respectively with very good and good inter-reliability agreement for both component. Conclusion: The prevalence of bimaxillary protrusion in general among UiTM orthodontic patients was found to range from 31 per cent to 37 per cent. Whilst the prevalence of skeletal and dental Class I bimax ranging from 28-33 per cent and 38-40 per cent respectively.
    Matched MeSH terms: Tokyo
  4. Fulltext Public health experience in the ‘Snow Country’ Niigata, Japan
    Syaqirah Akmal, Nizam Baharom
    Int J Public Health Res, 2012;2(2):184-191.
    MyJurnal
    In the cold winter month of January 2012, two post graduate students from the Department of Community Health, Universiti Kebangsaan Malaysia (UKM), went on a two weeks field attachment with the Division of International Health (Public Health), Niigata University Graduate School of Medical & Dental Sciences (NU). This report is an account of our first hand learning experience about the public health system and culture in Niigata, Japan. Famously known as the 'Snow Country', Niigata prefecture is approximately 350 kilometers north of Tokyo, in the middle of the west coast of Honshu island, facing the Sea of Japan. It borders on the east with Fukushima prefecture, which was badly affected by the great tsunami disaster in March 2011. Niigata has a population of two and a half million, of which 21.3% is above the age of 65. Niigata University is located in Niigata City, the capital of Niigata prefecture. This attachment was under the UKM-Global Student Mobility Programme (Outbound) and it was taken as an opportunity to improve the memorandum of understanding between UKM and NU. The objectives were to gain knowledge and experience in various public health issues in a developed nation like Japan. Specifically, we were interested to learn about the local public health programmes, the influenza surveillance system, public health programmes for the elderly population, the Geographical Information System (GIS) and the Japanese culture in general. (Copied from article).
    Matched MeSH terms: Tokyo
  5. Microplastics in Sediment Cores from Asia and Africa as Indicators of Temporal Trends in Plastic Pollution
    Matsuguma Y, Takada H, Kumata H, Kanke H, Sakurai S, Suzuki T, et al.
    Arch Environ Contam Toxicol, 2017 Aug;73(2):230-239.
    PMID: 28534067 DOI: 10.1007/s00244-017-0414-9
    Microplastics (<5 mm) were extracted from sediment cores collected in Japan, Thailand, Malaysia, and South Africa by density separation after hydrogen peroxide treatment to remove biofilms were and identified using FTIR. Carbonyl and vinyl indices were used to avoid counting biopolymers as plastics. Microplastics composed of variety of polymers, including polyethylene (PE), polypropylene (PP), polystyrene (PS), polyethyleneterphthalates (PET), polyethylene-polypropylene copolymer (PEP), and polyacrylates (PAK), were identified in the sediment. We measured microplastics between 315 µm and 5 mm, most of which were in the range 315 µm-1 mm. The abundance of microplastics in surface sediment varied from 100 pieces/kg-dry sediment in a core collected in the Gulf of Thailand to 1900 pieces/kg-dry sediment in a core collected in a canal in Tokyo Bay. A far higher stock of PE and PP composed microplastics in sediment compared with surface water samples collected in a canal in Tokyo Bay suggests that sediment is an important sink for microplastics. In dated sediment cores from Japan, microplastic pollution started in 1950s, and their abundance increased markedly toward the surface layer (i.e., 2000s). In all sediment cores from Japan, Thailand, Malaysia, and South Africa, the abundance of microplastics increased toward the surface, suggesting the global occurrence of and an increase in microplastic pollution over time.
    Matched MeSH terms: Tokyo
  6. Fulltext Report of the third Asian Prostate Cancer study meeting
    Lojanapiwat B, Lee JY, Gang Z, Kim CS, Fai NC, Hakim L, et al.
    Prostate Int, 2019 Jun;7(2):60-67.
    PMID: 31384607 DOI: 10.1016/j.prnil.2018.06.001
    The Asian Prostate Cancer (A-CaP) study is an Asia-wide initiative that was launched in December 2015 in Tokyo, Japan, with the objective of surveying information about patients who have received a histopathological diagnosis of prostate cancer (PCa) and are undergoing treatment and clarifying distribution of staging, the actual status of treatment choices, and treatment outcomes. The study aims to clarify the clinical situation for PCa in Asia and use the outcomes for the purposes of international comparison. Following the first meeting in Tokyo in December 2015, the second A-CaP meeting was held in Seoul, Korea, in September 2016. This, the third A-CaP meeting, was held on October 14, 2017, in Chiang Mai, Thailand, with the participation of members and collaborators from 12 countries and regions. In the meeting, participating countries and regions presented the current status of data collection, and the A-CaP office presented a preliminary analysis of the registered cases received from each country and region. Participants discussed ongoing challenges relating to data input and collection, institutional, and legislative issues that may present barriers to data sharing, and the outlook for further patient registrations through to the end of the registration period in December 2018. In addition to A-CaP-specific discussions, a series of special lectures were also delivered on the situation for health insurance in the United States, the correlation between insurance coverage and PCa outcomes, and the outlook for robotic surgery in the Asia-Pacific region. Members also confirmed the principles of authorship in collaborative studies, with a view to publishing original articles based on A-CaP data in the future.
    Matched MeSH terms: Tokyo
  7. Fulltext Heat alleviation strategies for athletic performance: A review and practitioner guidelines
    Gibson OR, James CA, Mee JA, Willmott AGB, Turner G, Hayes M, et al.
    Temperature (Austin), 2020;7(1):3-36.
    PMID: 32166103 DOI: 10.1080/23328940.2019.1666624
    International competition inevitably presents logistical challenges for athletes. Events such as the Tokyo 2020 Olympic Games require further consideration given historical climate data suggest athletes will experience significant heat stress. Given the expected climate, athletes face major challenges to health and performance. With this in mind, heat alleviation strategies should be a fundamental consideration. This review provides a focused perspective of the relevant literature describing how practitioners can structure male and female athlete preparations for performance in hot, humid conditions. Whilst scientific literature commonly describes experimental work, with a primary focus on maximizing magnitudes of adaptive responses, this may sacrifice ecological validity, particularly for athletes whom must balance logistical considerations aligned with integrating environmental preparation around training, tapering and travel plans. Additionally, opportunities for sophisticated interventions may not be possible in the constrained environment of the athlete village or event arenas. This review therefore takes knowledge gained from robust experimental work, interprets it and provides direction on how practitioners/coaches can optimize their athletes' heat alleviation strategies. This review identifies two distinct heat alleviation themes that should be considered to form an individualized strategy for the athlete to enhance thermoregulatory/performance physiology. First, chronic heat alleviation techniques are outlined, these describe interventions such as heat acclimation, which are implemented pre, during and post-training to prepare for the increased heat stress. Second, acute heat alleviation techniques that are implemented immediately prior to, and sometimes during the event are discussed. Abbreviations: CWI: Cold water immersion; HA: Heat acclimation; HR: Heart rate; HSP: Heat shock protein; HWI: Hot water immersion; LTHA: Long-term heat acclimation; MTHA: Medium-term heat acclimation; ODHA: Once-daily heat acclimation; RH: Relative humidity; RPE: Rating of perceived exertion; STHA: Short-term heat acclimation; TCORE: Core temperature; TDHA: Twice-daily heat acclimation; TS: Thermal sensation; TSKIN: Skin temperature; V̇O2max: Maximal oxygen uptake; WGBT: Wet bulb globe temperature.
    Matched MeSH terms: Tokyo
  8. No promising antidote 25 years after the Tokyo subway sarin attack: A review
    Sakurada K, Ohta H
    Leg Med (Tokyo), 2020 Nov;47:101761.
    PMID: 32702607 DOI: 10.1016/j.legalmed.2020.101761
    On the battlefields of Syria, many innocent civilians have been killed or injured by sarin poisoning. In Malaysia in February 2017, a North Korean man was assassinated with VX at Kuala Lumpur International Airport. In the face of such threats, a more effective antidote against organophosphonate acetylcholinesterase (AChE) inhibitors is needed, one that can freely penetrate into the central nervous system (CNS) through the blood-brain barrier (BBB). In the 1995 Tokyo subway sarin attack, which produced more than 6,000 victims, 2-pyridinealdoxime methiodide was the most commonly used antidote in hospitals, but it was unable to prevent CNS damage and no other oximes have been approved for use in Japan. Ultimately, 12 people died, and many victims had severe neurological injuries or sequelae. Although more than 25 years have passed since the incident, progress has been slow in the development of a new antidote that can penetrate the BBB, restore AChE activity in the CNS, and definitely prevent brain injury. From the perspectives of countering terrorism and protecting innocent people from nerve agent attacks, the search for nerve agent antidotes should be accelerated with the goals of improving both survival and quality of life. This review gives an overview of a series of our studies on the development of a new antidote since the Tokyo subway sarin attack and emphasizes that there is unfortunately still no promising antidote for saving the CNS in Japan.
    Matched MeSH terms: Tokyo
  9. Fulltext SINGLE NUCLEOTIDE POLYMORPHISM OF ECCB5 GENE OF MYCOBACTERIUM TUBERCULOSIS COMPLEX ISOLATES FROM SUSPECTED PULMONARY TB PATIENTS IN SURABAYA INDONESIA
    Kurniawati S, Soedarsono S, Aulanni'am A, Mertaniasih NM
    Afr J Infect Dis, 2018;12(2):37-42.
    PMID: 30109284 DOI: 10.21010/ajid.v12i2.6
    Background: Mycobacterium tuberculosis Complex (MTBC) is a group of Mycobacterium that causes tuberculosis (TB). TB is an infectious disease that remains a global health problem. Indonesia is one of the five countries in the world where TB is the most prevalent and became the country with tle second largest rate of TB in 2014 and 2015. MTBC has high pathogenicity that can cause infections in animals and humans. The most common route of transmission is via airborne droplet nuclei and contact with animals or humans infected with TB. MTBC has many virulence factors. One of these factors is EccB5 that is encoded by eccB5 gene. EccB5 is a transmembrane protein-conserved membrane protein and could play a role in inducing damage in host cells, macrophage infection, and may correlate with active disease. The characterization of eccB5 gene needs to be studied to determine the nucleotide sequences, which may be associated with active disease. The aim of this research was to analyze the nuclotide sequences of eccB5 gene of MTBC from suspected pulmonary tuberculosis patients, SNPs of eccB5 gene and possible correlation with the disease, especially in Indonesia.

    Materials and Methods: Samples were collected from the Tuberculosis Laboratory, Clinical Microbiology of Dr. Soetomo Hospital Surabaya Indonesia. DNA extraction used boiling extraction method and continued nucleic acid amplification using PCR techniques. Primer pairs used eccB5 SK.. The positivity of DNA specific revealed amplicon in 1592 bp. PCR product was sequenced by 1st Base (First BASE Laboratories Sdn Bhd, Selangor, Malaysia). The sequence analysis used Genetyx-Win version 10.0 (Genetyx Corporation, Tokyo, Japan).

    Results: Total isolates of Mycobacterium spp. were 28 and those that showed positive MTBC were 24 isolates and 4 nontuberculosis mycobacteria (NTM) using immunochromatographic test (ICT). The amount of homology from MTBC using blast NCBI was 99%-100%. Two SNPs were found in position c.1277 which revealed replacement of amino acid in 426 of codon position.

    Conclusion: The sequence of eccB5 gene of MTBC showed high significant homology, while proposed non-synoymous single nucleotide polymorphisms (nsSNP) may associated with clinical outcomes.

    Matched MeSH terms: Tokyo
  10. Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos)
    Mori Y, Itoi T, Baron TH, Takada T, Strasberg SM, Pitt HA, et al.
    J Hepatobiliary Pancreat Sci, 2018 Jan;25(1):87-95.
    PMID: 28888080 DOI: 10.1002/jhbp.504
    Since the publication of the Tokyo Guidelines in 2007 and their revision in 2013, appropriate management for acute cholecystitis has been more clearly established. Since the last revision, several manuscripts, especially for alternative endoscopic techniques, have been reported; therefore, additional evaluation and refinement of the 2013 Guidelines is required. We describe a standard drainage method for surgically high-risk patients with acute cholecystitis and the latest developed endoscopic gallbladder drainage techniques described in the updated Tokyo Guidelines 2018 (TG18). Our study confirmed that percutaneous transhepatic gallbladder drainage should be considered the first alternative to surgical intervention in surgically high-risk patients with acute cholecystitis. Also, endoscopic transpapillary gallbladder drainage or endoscopic ultrasound-guided gallbladder drainage can be considered in high-volume institutes by skilled endoscopists. In the endoscopic transpapillary approach, either endoscopic naso-gallbladder drainage or gallbladder stenting can be considered for gallbladder drainage. We also introduce special techniques and the latest outcomes of endoscopic ultrasound-guided gallbladder drainage studies. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
    Matched MeSH terms: Tokyo
  11. Fulltext Emergency medicine as a specialty in Asia
    Pek JH, Lim SH, Ho HF, Ramakrishnan TV, Jamaluddin SF, Mesa-Gaerlan FJC, et al.
    Acute medicine & surgery, 2016 04;3(2):65-73.
    PMID: 29123755 DOI: 10.1002/ams2.154
    Aim: We aim to examine the similarities and differences in areas of EM development, workload, workforce, and capabilities and support in the Asia region. Emerging challenges faced by our EM community are also discussed.

    Methods: The National Societies for Emergency Medicine of Hong Kong, India, Japan, Malaysia, Philippines, Singapore, South Korea, Taiwan, Thailand and Turkey participated in the joint Japanese Association of Acute Medicine (JAAM) and Asian Conference of Emergency Medicine (ACEM) Special Symposium held in October 2013 at Tokyo, Japan. The findings are reviewed in this paper.

    Results: Emergency medicine (EM) has over the years evolved into a distinct and recognized medical discipline requiring a unique set of cognitive, administrative and technical skills for managing all types of patients with acute illness or injury. EM has contributed to healthcare by providing effective, safe, efficient and cost-effective patient care. Integrated systems have developed to allow continuity of emergency care from the community into emergency departments. Structured training curriculum for undergraduates, and specialty training programs for postgraduates are in place to equip trainees with the knowledge and skills required for the unique practice of EM.

    Conclusion: The practice of EM still varies among the Asian countries. However, as a region, we strive to continue in our efforts to develop the specialty and improve the delivery of EM.

    Matched MeSH terms: Tokyo
  12. Fulltext First case of Plasmodium knowlesi infection in a Japanese traveller returning from Malaysia
    Tanizaki R, Ujiie M, Kato Y, Iwagami M, Hashimoto A, Kutsuna S, et al.
    Malar J, 2013;12:128.
    PMID: 23587117 DOI: 10.1186/1475-2875-12-128
    This is the first case of Plasmodium knowlesi infection in a Japanese traveller returning from Malaysia. In September 2012, a previously healthy 35-year-old Japanese man presented to National Center for Global Health and Medicine in Tokyo with a two-day history of daily fever, mild headaches and mild arthralgia. Malaria parasites were found in the Giemsa-stained thin blood smear, which showed band forms similar to Plasmodium malariae. Although a nested PCR showed the amplification of the primer of Plasmodium vivax and Plasmodium knowlesi, he was finally diagnosed with P. knowlesi mono-infection by DNA sequencing. He was treated with mefloquine, and recovered without any complications. DNA sequencing of the PCR products is indispensable to confirm P. knowlesi infection, however there is limited access to DNA sequencing procedures in endemic areas. The extent of P. knowlesi transmission in Asia has not been clearly defined. There is limited availability of diagnostic tests and routine surveillance system for reporting an accurate diagnosis in the Asian endemic regions. Thus, reporting accurately diagnosed cases of P. knowlesi infection in travellers would be important for assessing the true nature of this emerging human infection.
    Matched MeSH terms: Tokyo
  13. Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis
    Mayumi T, Okamoto K, Takada T, Strasberg SM, Solomkin JS, Schlossberg D, et al.
    J Hepatobiliary Pancreat Sci, 2018 Jan;25(1):96-100.
    PMID: 29090868 DOI: 10.1002/jhbp.519
    Management bundles that define items or procedures strongly recommended in clinical practice have been used in many guidelines in recent years. Application of these bundles facilitates the adaptation of guidelines and helps improve the prognosis of target diseases. In Tokyo Guidelines 2013 (TG13), we proposed management bundles for acute cholangitis and cholecystitis. Here, in Tokyo Guidelines 2018 (TG18), we redefine the management bundles for acute cholangitis and cholecystitis. Critical parts of the bundles in TG18 include the diagnostic process, severity assessment, transfer of patients if necessary, and therapeutic approach at each time point. Observance of these items and procedures should improve the prognosis of acute cholangitis and cholecystitis. Studies are now needed to evaluate the dissemination of these TG18 bundles and their effectiveness. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
    Matched MeSH terms: Tokyo
  14. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos)
    Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, et al.
    J Hepatobiliary Pancreat Sci, 2018 Jan;25(1):41-54.
    PMID: 29032636 DOI: 10.1002/jhbp.515
    The Tokyo Guidelines 2013 (TG13) for acute cholangitis and cholecystitis were globally disseminated and various clinical studies about the management of acute cholecystitis were reported by many researchers and clinicians from all over the world. The 1st edition of the Tokyo Guidelines 2007 (TG07) was revised in 2013. According to that revision, the TG13 diagnostic criteria of acute cholecystitis provided better specificity and higher diagnostic accuracy. Thorough our literature search about diagnostic criteria for acute cholecystitis, new and strong evidence that had been released from 2013 to 2017 was not found with serious and important issues about using TG13 diagnostic criteria of acute cholecystitis. On the other hand, the TG13 severity grading for acute cholecystitis has been validated in numerous studies. As a result of these reviews, the TG13 severity grading for acute cholecystitis was significantly associated with parameters including 30-day overall mortality, length of hospital stay, conversion rates to open surgery, and medical costs. In terms of severity assessment, breakthrough and intensive literature for revising severity grading was not reported. Consequently, TG13 diagnostic criteria and severity grading were judged from numerous validation studies as useful indicators in clinical practice and adopted as TG18/TG13 diagnostic criteria and severity grading of acute cholecystitis without any modification. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
    Matched MeSH terms: Tokyo
  15. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis
    Miura F, Okamoto K, Takada T, Strasberg SM, Asbun HJ, Pitt HA, et al.
    J Hepatobiliary Pancreat Sci, 2018 Jan;25(1):31-40.
    PMID: 28941329 DOI: 10.1002/jhbp.509
    The initial management of patients with suspected acute biliary infection starts with the measurement of vital signs to assess whether or not the situation is urgent. If the case is judged to be urgent, initial medical treatment should be started immediately including respiratory/circulatory management if required, without waiting for a definitive diagnosis. The patient's medical history is then taken; an abdominal examination is performed; blood tests, urinalysis, and diagnostic imaging are carried out; and a diagnosis is made using the diagnostic criteria for cholangitis/cholecystitis. Once the diagnosis has been confirmed, initial medical treatment should be started immediately, severity should be assessed according to the severity grading criteria for acute cholangitis/cholecystitis, and the patient's general status should be evaluated. For mild acute cholangitis, in most cases initial treatment including antibiotics is sufficient, and most patients do not require biliary drainage. However, biliary drainage should be considered if a patient does not respond to initial treatment. For moderate acute cholangitis, early endoscopic or percutaneous transhepatic biliary drainage is indicated. If the underlying etiology requires treatment, this should be provided after the patient's general condition has improved; endoscopic sphincterotomy and subsequent choledocholithotomy may be performed together with biliary drainage. For severe acute cholangitis, appropriate respiratory/circulatory management is required. Biliary drainage should be performed as soon as possible after the patient's general condition has been improved by initial treatment and respiratory/circulatory management. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
    Matched MeSH terms: Tokyo
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