Hiroshi Saito, Makoto Shoji, Iori Taki, Remi Murase, D. Kamei, T. Shinke, S. Iwai
: Heart failure （ HF ） is a common disease in elderly patients, particularly in those presenting as readmission for worsening HF. While recent studies have revealed mortality-associated factors in this population, little is known about prognostic factors associated with worsening HF. To investigate this clinical evidence gap in patients aged over 75 years, we retrospectively investigated 165 patients hospitalized for HF at Showa University Hospital, of whom 65 （ 39.4 ％） were readmitted for worsening HF. We extracted the candidate variables based on univariate analysis, and then elucidated the independent prognostic factors by multivariate analysis. Compared with non-readmitted patients, readmitted patients with worsening HF had lower left ventricular ejection fraction （ LVEF ） （ 39 ％ vs. 50 ％ , P ＝ 0.002 ） and body mass index （ BMI ） （ 19.9 kg/m 2 vs. 21.4 kg/m 2 , P ＝ 0.007 ） , higher levels of B-type natriuretic peptide （ BNP ） （ 478 pg/ml vs. 198 pg/ml, P ＜ 0.001 ） , and heart rate （ HR ） （ 71.0 beats/min vs. 67.0 beats/min, P ＝ 0.021 ） upon discharge during the primary admission. Multivariate logistic analysis identified LVEF ＜ 40 ％ , BMI ＜ 21 kg/m 2 , BNP ≥ 500 pg/ml, Charlson score ≥ 3, and HR ≥ 70 beats/min upon initial discharge as independent prognostic factors. Based on these factors, readmission for worsening HF was more frequent in those with our proposed risk score of ≥ 3.0 than in those with a risk score ＜ 3.0 （ P ＜ 0.001 ） , and we suggested five prognostic factors for HF patients over 75 years old. Our proposed risk score combines these factors and might predict readmission for worsening HF in the elderly population.
{"title":"Five Prognostic Factors for Readmission in Patients Over 75 Years Old with Worsening Heart Failure","authors":"Hiroshi Saito, Makoto Shoji, Iori Taki, Remi Murase, D. Kamei, T. Shinke, S. Iwai","doi":"10.15369/sujms.32.33","DOIUrl":"https://doi.org/10.15369/sujms.32.33","url":null,"abstract":": Heart failure （ HF ） is a common disease in elderly patients, particularly in those presenting as readmission for worsening HF. While recent studies have revealed mortality-associated factors in this population, little is known about prognostic factors associated with worsening HF. To investigate this clinical evidence gap in patients aged over 75 years, we retrospectively investigated 165 patients hospitalized for HF at Showa University Hospital, of whom 65 （ 39.4 ％） were readmitted for worsening HF. We extracted the candidate variables based on univariate analysis, and then elucidated the independent prognostic factors by multivariate analysis. Compared with non-readmitted patients, readmitted patients with worsening HF had lower left ventricular ejection fraction （ LVEF ） （ 39 ％ vs. 50 ％ , P ＝ 0.002 ） and body mass index （ BMI ） （ 19.9 kg/m 2 vs. 21.4 kg/m 2 , P ＝ 0.007 ） , higher levels of B-type natriuretic peptide （ BNP ） （ 478 pg/ml vs. 198 pg/ml, P ＜ 0.001 ） , and heart rate （ HR ） （ 71.0 beats/min vs. 67.0 beats/min, P ＝ 0.021 ） upon discharge during the primary admission. Multivariate logistic analysis identified LVEF ＜ 40 ％ , BMI ＜ 21 kg/m 2 , BNP ≥ 500 pg/ml, Charlson score ≥ 3, and HR ≥ 70 beats/min upon initial discharge as independent prognostic factors. Based on these factors, readmission for worsening HF was more frequent in those with our proposed risk score of ≥ 3.0 than in those with a risk score ＜ 3.0 （ P ＜ 0.001 ） , and we suggested five prognostic factors for HF patients over 75 years old. Our proposed risk score combines these factors and might predict readmission for worsening HF in the elderly population.","PeriodicalId":23019,"journal":{"name":"The Showa University Journal of Medical Sciences","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75067782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Kijima, J. Tanaka, Shiori Shibata, Hideyuki Oyama, Toshimitsu Shiozawa, Yuki Takahashi, Tetsuji Wakabayashi, Ryuichi Sekine, Y. Harada, T. Uchida, T. Umemoto, G. Kigawa, K. Matsuo, Kuniya Tanaka
: Standard laparoscopic colorectal surgery requires additional incision or enlargement of the trocar incision for the retrieval of the surgical specimen. A natural orifice specimen extraction （ NOSE ） procedure, in which the specimen is retrieved through the anus or vagina without any additional skin incision, requires purse-string suture （ PSS ） of the rostral intestinal segment in order to fix the anvil head of the stapler and perform extracorporeal mechanical anastomosis. Colorectal surgery has a limited NOSE in cases where the end of the rostral segment could be pulled through the anus. Broader application of NOSE depends on intracorporeal PSS. We developed a new forceps for intracorporeal PSS during NOSE and evaluated its efficacy. The PSS instrument was refined to pass through a 12-mm trocar in an intracorporeal PSS and achieve anastomosis using double stapling. In trials utilizing an endoscopic practice box, regular spacing of stitches during PSS were consistent （ n ＝ 10 ） , and tight intracorporeal anastomosis of the porcine colon was successfully performed （ n ＝ 2 ） . We then confirmed efficacy through an operation on a pig. Our novel PSS device will help us perform NOSE not only in laparoscopic colorectal surgery but also in any operation requiring intracorporeal PSS, which should contribute to further advances in endoscopic digestive
{"title":"A New Device Facilitating Intracorporeal Purse-string Suture during Endoscopic Surgery","authors":"K. Kijima, J. Tanaka, Shiori Shibata, Hideyuki Oyama, Toshimitsu Shiozawa, Yuki Takahashi, Tetsuji Wakabayashi, Ryuichi Sekine, Y. Harada, T. Uchida, T. Umemoto, G. Kigawa, K. Matsuo, Kuniya Tanaka","doi":"10.15369/sujms.32.173","DOIUrl":"https://doi.org/10.15369/sujms.32.173","url":null,"abstract":": Standard laparoscopic colorectal surgery requires additional incision or enlargement of the trocar incision for the retrieval of the surgical specimen. A natural orifice specimen extraction （ NOSE ） procedure, in which the specimen is retrieved through the anus or vagina without any additional skin incision, requires purse-string suture （ PSS ） of the rostral intestinal segment in order to fix the anvil head of the stapler and perform extracorporeal mechanical anastomosis. Colorectal surgery has a limited NOSE in cases where the end of the rostral segment could be pulled through the anus. Broader application of NOSE depends on intracorporeal PSS. We developed a new forceps for intracorporeal PSS during NOSE and evaluated its efficacy. The PSS instrument was refined to pass through a 12-mm trocar in an intracorporeal PSS and achieve anastomosis using double stapling. In trials utilizing an endoscopic practice box, regular spacing of stitches during PSS were consistent （ n ＝ 10 ） , and tight intracorporeal anastomosis of the porcine colon was successfully performed （ n ＝ 2 ） . We then confirmed efficacy through an operation on a pig. Our novel PSS device will help us perform NOSE not only in laparoscopic colorectal surgery but also in any operation requiring intracorporeal PSS, which should contribute to further advances in endoscopic digestive","PeriodicalId":23019,"journal":{"name":"The Showa University Journal of Medical Sciences","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78000299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tianpeng Wang, M. Sakaki, Yuki Ichikawa, Y. Otoyama, Y. Nakajima, Ikuya Sugiura, Jun Arai, Atsushi Kajiwara, Shojiro Uozumi, Yuu Shimozuma, Manabu Uchikoshi, Hitoshi Yoshida
Reports on surveillance systems useful for determining the risk of developing hepatocellular carcinoma (HCC) after direct-acting antiviral (DAA) treatment for hepatitis C have been published. Liver cirrhosis (LC) is a high-risk factor for HCC, but the evaluation frequency necessary for patients with chronic hepatitis (CH) remains unknown. Here, we aimed to identify how frequent CH patients should be evaluated for HCC, with particular emphasis on patients achieving a sustained virological response (SVR) with DAA treatment. Data were collected pre-treatment (Pre) and at the time of SVR for 141 patients with hepatitis C receiving DAA treatment. We de ned LC by a platelet (PLT) count ≤ 10×10/ μl, and CH was de ned by a PLT count of > 10×10/μl. The incidence of HCC in patients with CH after achieving SVR was retrospectively evaluated. In total, 128 patients (CH, n=102; LC, n=26) achieved SVR, and 13 developed HCC after SVR during the follow-up period (mean, 748 days). Although fibrosis-4 (FIB-4) index, the presence of α -fetoprotein, and prothrombin time were signi cant risk factors for HCC in patients with CH in the univariate analysis, only the Pre-FIB-4 index was an independent predictive factor for HCC development in the multivariate analysis (p=0.04). An FIB-4 index ≥ 3 was a signi cant risk factor for HCC (p=0.005). The cumulative risk for HCC at 1000 days was 2.6% and 24.2% in the FIB-4 index <3 and FIB-4 index ≥ 3 groups, respectively (p=0.004). Frequent HCC examination is recommended for FIB-4 index ≥ 3 CH patients who obtain SVR after DAA treatment.
{"title":"Simple Stratification of Hepatocellular Carcinoma Surveillance after Direct-acting Antiviral Therapy for Chronic Hepatitis C","authors":"Tianpeng Wang, M. Sakaki, Yuki Ichikawa, Y. Otoyama, Y. Nakajima, Ikuya Sugiura, Jun Arai, Atsushi Kajiwara, Shojiro Uozumi, Yuu Shimozuma, Manabu Uchikoshi, Hitoshi Yoshida","doi":"10.15369/sujms.32.125","DOIUrl":"https://doi.org/10.15369/sujms.32.125","url":null,"abstract":"Reports on surveillance systems useful for determining the risk of developing hepatocellular carcinoma (HCC) after direct-acting antiviral (DAA) treatment for hepatitis C have been published. Liver cirrhosis (LC) is a high-risk factor for HCC, but the evaluation frequency necessary for patients with chronic hepatitis (CH) remains unknown. Here, we aimed to identify how frequent CH patients should be evaluated for HCC, with particular emphasis on patients achieving a sustained virological response (SVR) with DAA treatment. Data were collected pre-treatment (Pre) and at the time of SVR for 141 patients with hepatitis C receiving DAA treatment. We de ned LC by a platelet (PLT) count ≤ 10×10/ μl, and CH was de ned by a PLT count of > 10×10/μl. The incidence of HCC in patients with CH after achieving SVR was retrospectively evaluated. In total, 128 patients (CH, n=102; LC, n=26) achieved SVR, and 13 developed HCC after SVR during the follow-up period (mean, 748 days). Although fibrosis-4 (FIB-4) index, the presence of α -fetoprotein, and prothrombin time were signi cant risk factors for HCC in patients with CH in the univariate analysis, only the Pre-FIB-4 index was an independent predictive factor for HCC development in the multivariate analysis (p=0.04). An FIB-4 index ≥ 3 was a signi cant risk factor for HCC (p=0.005). The cumulative risk for HCC at 1000 days was 2.6% and 24.2% in the FIB-4 index <3 and FIB-4 index ≥ 3 groups, respectively (p=0.004). Frequent HCC examination is recommended for FIB-4 index ≥ 3 CH patients who obtain SVR after DAA treatment.","PeriodicalId":23019,"journal":{"name":"The Showa University Journal of Medical Sciences","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86000274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hiroki Tanisawa, Y. Akutsu, Hiroyuki Ito, K. Nomura, T. Sekimoto, K. Kaneko, Yusuke Kodama, K. Arai, Toshihiko Gokan, Yoshimi Onishi, Akinori Ochi, Y. Munetsugu, Tatsuya Onuki, Y. Ohgiya, Hidenari Matsumoto, Mitsuharu Kawamura, T. Shinke
An increase in epicardial adipose tissue(EAT)in the left atrium(LA) predicts the progression of atrial brillation(AF)and AF recurrence after pulmonary vein catheter ablation(CA). We hypothesized that EAT in the right atrium (RA)is also associated with the progression of AF and post-CA AF recurrence. Using 128-slice multidetector computed tomography, EAT volume and atrial volume were measured 3-dimensionally before CA in 68 patients who had proven AF(paroxysmal AF, 42; persistent AF, 26; mean age, 65±11 years; 42.6% female)with successful CA and 21 volunteers with sinus rhythm(age, 63±13 years; 52.3% female). In both atria, EAT and atrial volumes were largest in patients with persistent AF, followed, in order, by those with paroxysmal AF, and then healthy volunteers(P <0.001). Increased EAT and atrial volumes in both atria predicted persistent AF (P<0.001). Fifteen patients had AF recurrence(22.1%)during the 2-year period after CA. Increased EAT volume in both atria were independent predictors for AF recurrence, and a RA EAT volume ≥ 6.2ml was an independent predictor, with a hazard ratio of 5.47(95% con dence interval, 1.2-24.3; P=0.03). The combination of EAT and atrial volume in both atria was a more powerful independent prognostic factor, with a hazard ratio of 4.8(95% confidence interval, 1.7-3.7; P=0.003), and a sensitivity of 60% in 9 of 15 patients, and speci city of 81.1% in 43 of 53 patients,(P=0.003). RA EAT is associated with the progression of AF and post-CA AF recurrence.
{"title":"Epicardial Adipose Tissue in the Right Atrium Is Associated with Progression of Atrial Fibrillation and Recurrence after Pulmonary Vein Catheter Ablation in Patients with Atrial Fibrillation","authors":"Hiroki Tanisawa, Y. Akutsu, Hiroyuki Ito, K. Nomura, T. Sekimoto, K. Kaneko, Yusuke Kodama, K. Arai, Toshihiko Gokan, Yoshimi Onishi, Akinori Ochi, Y. Munetsugu, Tatsuya Onuki, Y. Ohgiya, Hidenari Matsumoto, Mitsuharu Kawamura, T. Shinke","doi":"10.15369/sujms.32.11","DOIUrl":"https://doi.org/10.15369/sujms.32.11","url":null,"abstract":"An increase in epicardial adipose tissue(EAT)in the left atrium(LA) predicts the progression of atrial brillation(AF)and AF recurrence after pulmonary vein catheter ablation(CA). We hypothesized that EAT in the right atrium (RA)is also associated with the progression of AF and post-CA AF recurrence. Using 128-slice multidetector computed tomography, EAT volume and atrial volume were measured 3-dimensionally before CA in 68 patients who had proven AF(paroxysmal AF, 42; persistent AF, 26; mean age, 65±11 years; 42.6% female)with successful CA and 21 volunteers with sinus rhythm(age, 63±13 years; 52.3% female). In both atria, EAT and atrial volumes were largest in patients with persistent AF, followed, in order, by those with paroxysmal AF, and then healthy volunteers(P <0.001). Increased EAT and atrial volumes in both atria predicted persistent AF (P<0.001). Fifteen patients had AF recurrence(22.1%)during the 2-year period after CA. Increased EAT volume in both atria were independent predictors for AF recurrence, and a RA EAT volume ≥ 6.2ml was an independent predictor, with a hazard ratio of 5.47(95% con dence interval, 1.2-24.3; P=0.03). The combination of EAT and atrial volume in both atria was a more powerful independent prognostic factor, with a hazard ratio of 4.8(95% confidence interval, 1.7-3.7; P=0.003), and a sensitivity of 60% in 9 of 15 patients, and speci city of 81.1% in 43 of 53 patients,(P=0.003). RA EAT is associated with the progression of AF and post-CA AF recurrence.","PeriodicalId":23019,"journal":{"name":"The Showa University Journal of Medical Sciences","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76614616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Noriko Wada, Satoko Handa, Hitomi Yamamoto, Hitomi Higuchi, K. Okamoto, Tadanori Sasaki, Y. Kato
A patient’s pain intensity rating alone is insuf cient grounds for determining the pain medication and dosage to administer daily. This study aimed to investigate whether a convenient assessment method could be developed that would reflect the effectiveness of an opioid analgesic on cancer patients’ pain management. We investigated pain intensity (worst, least, average, current) and the effectiveness of the opioid rescue medication in terms of patient satisfaction. This study used Spearman’s rank correlation coefficients to evaluate the relationships between patient satisfaction with rescue medication and both pain intensity and the medication’ s perceived effectiveness. Data from 60 participants with a mean age of 60.5± 11.4 years (range: 31-79 years) were analyzed. Thirty-eight (63.3%) participants were male, and 22 (36.7%) were female. The correlations found between rescue medication satisfaction and both the worst numerical rating scale (NRS) rating (r =-0.15, P=0.16) and the average NRS rating (r=-0.13, P=0.13) were not statistically signi cant. A signi cant positive correlation was observed between rescue medication satisfaction and the medication’s perceived effectiveness (r=0.79, P< 0.0001). Patient satisfaction with their rescue medication can be routinely assessed without imposing a signi cant burden on the patient. A new assessment method incorporating rescue medication satisfaction and pain intensity measures could allow routine pain assessments to re ect both pain intensity and the effectiveness of opioid analgesics. This new assessment method is potentially preferable to selfreported pain intensity and can identify patients for whom treatment is a priority. It also facilitates rapid dose adjustments and reduces the side effects of overdose due to unnecessary increases in opioid analgesics..
{"title":"Integrating Cancer Patients’ Satisfaction with Rescue Medication in Pain Assessments","authors":"Noriko Wada, Satoko Handa, Hitomi Yamamoto, Hitomi Higuchi, K. Okamoto, Tadanori Sasaki, Y. Kato","doi":"10.15369/sujms.32.181","DOIUrl":"https://doi.org/10.15369/sujms.32.181","url":null,"abstract":"A patient’s pain intensity rating alone is insuf cient grounds for determining the pain medication and dosage to administer daily. This study aimed to investigate whether a convenient assessment method could be developed that would reflect the effectiveness of an opioid analgesic on cancer patients’ pain management. We investigated pain intensity (worst, least, average, current) and the effectiveness of the opioid rescue medication in terms of patient satisfaction. This study used Spearman’s rank correlation coefficients to evaluate the relationships between patient satisfaction with rescue medication and both pain intensity and the medication’ s perceived effectiveness. Data from 60 participants with a mean age of 60.5± 11.4 years (range: 31-79 years) were analyzed. Thirty-eight (63.3%) participants were male, and 22 (36.7%) were female. The correlations found between rescue medication satisfaction and both the worst numerical rating scale (NRS) rating (r =-0.15, P=0.16) and the average NRS rating (r=-0.13, P=0.13) were not statistically signi cant. A signi cant positive correlation was observed between rescue medication satisfaction and the medication’s perceived effectiveness (r=0.79, P< 0.0001). Patient satisfaction with their rescue medication can be routinely assessed without imposing a signi cant burden on the patient. A new assessment method incorporating rescue medication satisfaction and pain intensity measures could allow routine pain assessments to re ect both pain intensity and the effectiveness of opioid analgesics. This new assessment method is potentially preferable to selfreported pain intensity and can identify patients for whom treatment is a priority. It also facilitates rapid dose adjustments and reduces the side effects of overdose due to unnecessary increases in opioid analgesics..","PeriodicalId":23019,"journal":{"name":"The Showa University Journal of Medical Sciences","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89774506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Enami, Takeshi Aoki, T. Kusano, Koji Nogaki, Kazuhiro Matsuda, Kosuke Yamada, T. Koizumi, K. Mitamura, Akira Fujimori, Reiko Koike, S. Goto, Makoto Watanabe, K. Otsuka, M. Murakami
: The fast-track surgery protocol, including perioperative immunonutritional management, is increasingly gaining attention for the prevention of surgical site infections （ SSIs ） . To analyze the association between the fast-track surgery protocol employed at a single center and outcomes, including SSIs and the length of hospital stays. This retrospective analysis included 217 patients who underwent hepatectomy at the study department between January 2009 and February 2014. Patients were divided into two groups : those managed by a conventional protocol （ group C, n ＝ 75 ） and those managed by the fast-track surgery protocol （ group F, n ＝ 142 ） . There were no significant differences in patient characteristics or factors between the two groups. and total cholesterol levels surgery were significantly higher in group F than in group C, and pre-hepatectomy C-reactive protein （ CRP ） levels were lower in group F than in group C. serum CRP The operations group F than in group C （ 312 vs. 286 min ） and blood loss volume was less （ 385 g group F vs. 428 ） . SSI in group F （ 4.2 ％ , n ＝ ） C , , F （ days C （ 25.8 fast-track surgery perioperative strategy may improve preoperative nutritional status and postoperative inflammation, with subsequent reductions in SSI rates and the length of hospital stay in patients undergoing hepatectomy.
快速通道手术方案，包括围手术期免疫营养管理，越来越受到关注，以预防手术部位感染(ssi)。分析单一中心采用的快速通道手术方案与结果(包括ssi和住院时间)之间的关系。这项回顾性分析包括2009年1月至2014年2月期间在研究部接受肝切除术的217例患者。患者分为两组:采用常规方案的患者(C组，n = 75)和采用快速通道手术方案的患者(F组，n = 142)。两组患者的特征或因素无显著差异。F组术后总胆固醇水平明显高于C组，肝切除术前C反应蛋白(CRP)水平明显低于C组，血清CRP低于C组(312 vs 286 min)，出血量小于C组(385 g vs 428)。快速手术围手术期策略可改善术前营养状况和术后炎症，随后可减少肝切除术患者的SSI发生率和住院时间。
{"title":"Fast-track Surgery Protocol for Hepatectomy and the Rate of Surgical Site Infections: A Single-center Study","authors":"Y. Enami, Takeshi Aoki, T. Kusano, Koji Nogaki, Kazuhiro Matsuda, Kosuke Yamada, T. Koizumi, K. Mitamura, Akira Fujimori, Reiko Koike, S. Goto, Makoto Watanabe, K. Otsuka, M. Murakami","doi":"10.15369/sujms.32.147","DOIUrl":"https://doi.org/10.15369/sujms.32.147","url":null,"abstract":": The fast-track surgery protocol, including perioperative immunonutritional management, is increasingly gaining attention for the prevention of surgical site infections （ SSIs ） . To analyze the association between the fast-track surgery protocol employed at a single center and outcomes, including SSIs and the length of hospital stays. This retrospective analysis included 217 patients who underwent hepatectomy at the study department between January 2009 and February 2014. Patients were divided into two groups : those managed by a conventional protocol （ group C, n ＝ 75 ） and those managed by the fast-track surgery protocol （ group F, n ＝ 142 ） . There were no significant differences in patient characteristics or factors between the two groups. and total cholesterol levels surgery were significantly higher in group F than in group C, and pre-hepatectomy C-reactive protein （ CRP ） levels were lower in group F than in group C. serum CRP The operations group F than in group C （ 312 vs. 286 min ） and blood loss volume was less （ 385 g group F vs. 428 ） . SSI in group F （ 4.2 ％ , n ＝ ） C , , F （ days C （ 25.8 fast-track surgery perioperative strategy may improve preoperative nutritional status and postoperative inflammation, with subsequent reductions in SSI rates and the length of hospital stay in patients undergoing hepatectomy.","PeriodicalId":23019,"journal":{"name":"The Showa University Journal of Medical Sciences","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82997251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: Although antigen-specific T helper （ Th ） cells are developed from naive T cells, human Th17 cells are not derived from naive CD4 + T cells unlike murine cells. Therefore, the source of human Th17 cells has remained unresolved. In this study, we assessed the early differentiation pathway of human Th17 cells from CD31 + thymic naive T cells into stem cell memory CCR6 + Th17 precursors and the regulation of this process by cytokines. Peripheral blood mononuclear cells were isolated from healthy volunteers. We found that only CD31 - CCR6 + naive type CD4 + T cells had the ability to produce IL-17A in response to Th17-inducing stimuli. A cell tracking assay using CD31 + CCR6 - cells labeled with carboxyfluorescein diacetate succinimidyl ester revealed that CD31 - CCR6 + Th17 precursors were derived from CD31 + CCR6 - thymic naive T cells. CD31 is known to suppress IL-17 production by interfering with downstream T cell receptor （ TCR ） signaling molecules including Lck, which is essential for IL-17 production. The inactive form of Lck was much higher in CD31 + T cells than CD31 - T cells after TCR stimulation. cell the conversion of CD31 + CCR6 - naive T cells into CD31 - CCR6 + Th17 precursors by upregulating CD31 expression and suppressing CCR6 expression. In CD31 - CCR6 + Th17 precursors could be sourced from CD31 + CCR6 - naive T cells, and IL-4 the early Th17 findings provide novel insights into the regulation of differentiation of naive CD4 + T cells into Th17 cells in humans. Furthermore, our results may provide hints for further elucidation of the differentiation process of Th17 cells and of the pathology of Th17 cell-related diseases.
{"title":"Regulatory Effect of IL-4 on Early Th17 Differentiation from Naive T Cells into Stem Cell Memory Th17 Precursors via Modulation of CD31 and CCR6 Expression","authors":"Kohei Maeda, T. Tanioka, S. Iwamoto","doi":"10.15369/sujms.32.135","DOIUrl":"https://doi.org/10.15369/sujms.32.135","url":null,"abstract":": Although antigen-specific T helper （ Th ） cells are developed from naive T cells, human Th17 cells are not derived from naive CD4 + T cells unlike murine cells. Therefore, the source of human Th17 cells has remained unresolved. In this study, we assessed the early differentiation pathway of human Th17 cells from CD31 + thymic naive T cells into stem cell memory CCR6 + Th17 precursors and the regulation of this process by cytokines. Peripheral blood mononuclear cells were isolated from healthy volunteers. We found that only CD31 - CCR6 + naive type CD4 + T cells had the ability to produce IL-17A in response to Th17-inducing stimuli. A cell tracking assay using CD31 + CCR6 - cells labeled with carboxyfluorescein diacetate succinimidyl ester revealed that CD31 - CCR6 + Th17 precursors were derived from CD31 + CCR6 - thymic naive T cells. CD31 is known to suppress IL-17 production by interfering with downstream T cell receptor （ TCR ） signaling molecules including Lck, which is essential for IL-17 production. The inactive form of Lck was much higher in CD31 + T cells than CD31 - T cells after TCR stimulation. cell the conversion of CD31 + CCR6 - naive T cells into CD31 - CCR6 + Th17 precursors by upregulating CD31 expression and suppressing CCR6 expression. In CD31 - CCR6 + Th17 precursors could be sourced from CD31 + CCR6 - naive T cells, and IL-4 the early Th17 findings provide novel insights into the regulation of differentiation of naive CD4 + T cells into Th17 cells in humans. Furthermore, our results may provide hints for further elucidation of the differentiation process of Th17 cells and of the pathology of Th17 cell-related diseases.","PeriodicalId":23019,"journal":{"name":"The Showa University Journal of Medical Sciences","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83520951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: Neuroendocrine ductal carcinoma in situ of the breast （ NE-DCIS ） was recently recognized as a special subtype of DCIS, although the diagnostic criteria for NE-DCIS are yet to be established. DCIS is defined as the immunohistochemical expression of neuroendocrine markers chromogranin A and / or synaptophysin in over 50 ％ of tumor cells. Here, we investigated whether there are significant differences in magnetic resonance imaging （ MRI ） findings between NE-DCIS and non-NE-DCIS. The study sample comprised 8 lesions in 7 patients with breast NE-DCIS and 71 lesions in 69 patients with non-NE-DCIS who underwent preoperative MRI and histopathological diagnosis at our hospital from June 2010 to June 2012. The patients were females aged 34 – 85 years. We examined the lesion type, pattern of time-signal intensity curve （ TIC ） on dynamic contrast-enhanced MRI （ DCE-MRI ） , presence or absence of bloody duct ectasia delineation, and presence or absence of calcification on mammography （ MMG ） . Mass-type lesions were significantly more common in breast NE-DCIS than in non-NE-DCIS on MRI. On DCE-MRI, the TIC washout pattern was more commonly observed in NE-DCIS than in non-NE-DCIS, and although there was no significant difference in the rate of bloody duct ectasia delineation, it was relatively more common in NE-DCIS. MMG revealed a significant difference in calcification between non-NE-DCIS （ 60.1 ％） and NE-DCIS （ 0 ％） . Mass-type lesions TIC washout pattern non-NE-DCIS on MRI and DCE-MRI.
{"title":"Comparison of Magnetic Resonance Imaging Findings of Neuroendocrine and Non-neuroendocrine Ductal Carcinoma in Situ of the Breast","authors":"Kumi Hatano, M. Hirose, Y. Ohgiya, T. Gokan","doi":"10.15369/SUJMS.31.21","DOIUrl":"https://doi.org/10.15369/SUJMS.31.21","url":null,"abstract":": Neuroendocrine ductal carcinoma in situ of the breast （ NE-DCIS ） was recently recognized as a special subtype of DCIS, although the diagnostic criteria for NE-DCIS are yet to be established. DCIS is defined as the immunohistochemical expression of neuroendocrine markers chromogranin A and / or synaptophysin in over 50 ％ of tumor cells. Here, we investigated whether there are significant differences in magnetic resonance imaging （ MRI ） findings between NE-DCIS and non-NE-DCIS. The study sample comprised 8 lesions in 7 patients with breast NE-DCIS and 71 lesions in 69 patients with non-NE-DCIS who underwent preoperative MRI and histopathological diagnosis at our hospital from June 2010 to June 2012. The patients were females aged 34 – 85 years. We examined the lesion type, pattern of time-signal intensity curve （ TIC ） on dynamic contrast-enhanced MRI （ DCE-MRI ） , presence or absence of bloody duct ectasia delineation, and presence or absence of calcification on mammography （ MMG ） . Mass-type lesions were significantly more common in breast NE-DCIS than in non-NE-DCIS on MRI. On DCE-MRI, the TIC washout pattern was more commonly observed in NE-DCIS than in non-NE-DCIS, and although there was no significant difference in the rate of bloody duct ectasia delineation, it was relatively more common in NE-DCIS. MMG revealed a significant difference in calcification between non-NE-DCIS （ 60.1 ％） and NE-DCIS （ 0 ％） . Mass-type lesions TIC washout pattern non-NE-DCIS on MRI and DCE-MRI.","PeriodicalId":23019,"journal":{"name":"The Showa University Journal of Medical Sciences","volume":"95 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83985038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Oshita, Takuma Kuroda, K. Ishikawa, T. Nagai, Keikichi Kawasaki, K. Kanzaki, K. Inagaki
An 82-year-old woman had been taking alendronate for 5 years and 5 months, which had been prescribed for osteoporosis at a local clinic. Severe left thigh pain began without any trauma. X-ray, computed tomography and magnetic resonance imaging findings showed atypical femoral fracture(AFF). Treatment with teriparatide and weight-bearing therapy was selected. Bone union was achieved without surgery. Teriparatide has been reported to promote AFF healing. At four years and 9 months from the beginning of treatment, our patient has no left femoral pain and no impairment to activities of daily living. Careful follow-up will be necessary as long-term outcomes of conservative AFF treatment have not been reported to date.
{"title":"Teriparatide Treatment for An Atypical Fracture of the Femoral Shaft: A Case Report","authors":"Y. Oshita, Takuma Kuroda, K. Ishikawa, T. Nagai, Keikichi Kawasaki, K. Kanzaki, K. Inagaki","doi":"10.15369/SUJMS.31.73","DOIUrl":"https://doi.org/10.15369/SUJMS.31.73","url":null,"abstract":"An 82-year-old woman had been taking alendronate for 5 years and 5 months, which had been prescribed for osteoporosis at a local clinic. Severe left thigh pain began without any trauma. X-ray, computed tomography and magnetic resonance imaging findings showed atypical femoral fracture(AFF). Treatment with teriparatide and weight-bearing therapy was selected. Bone union was achieved without surgery. Teriparatide has been reported to promote AFF healing. At four years and 9 months from the beginning of treatment, our patient has no left femoral pain and no impairment to activities of daily living. Careful follow-up will be necessary as long-term outcomes of conservative AFF treatment have not been reported to date.","PeriodicalId":23019,"journal":{"name":"The Showa University Journal of Medical Sciences","volume":"95 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84914682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eiji Shiotani, S. Kuriyama, H. Ishikawa, Raita Amemiya, K. Inagaki
: Despite many reports describing the surgical procedure for knee ligament reconstruction, especially the anterior cruciate ligament, there have been few reports on infection prevention and none on sterilizing reconstruction materials using povi-done-iodine during surgery. Here we report our surgical techniques for infection prevention. The participants included 522 patients who underwent arthroscopic knee ligament reconstruction at our hospital from April 2001 to October 2005. Despite taking various measures after cases of infection in 2001, such as the selection of sutures and artificial ligaments, and the use of indwelling intra-articular drains, the infection rate was not reduced to zero. Recently, we felt that soaking reconstruction ligaments in povidone-iodine and then washing with saline （“ povidone-iodine pickling ”） immediately prior to burr-hole insertion may prevent bacterial infections caused by surgical instruments and the surgery. in study, we examined the effects of our techniques for intraoperative and postoperative infection prevention, including “ povidone-iodine pickling ” . 100 2001, 3 112 2002, 2 of 121 and 121 2004, when the povidone-iodine, graft on the floor during surgery in a chlorhexidine gluconate or povidone-iodine solution of the graft. of povidone-iodine for mitigate the risk of septic arthritis. Going forward, we need to understand the specific pathologic basis of any cytotoxicity caused by the use of povidone-iodine on reconstructed ligaments.
{"title":"Prevention of Suppurative Knee Arthritis after Knee Ligament Reconstructive Surgery","authors":"Eiji Shiotani, S. Kuriyama, H. Ishikawa, Raita Amemiya, K. Inagaki","doi":"10.15369/SUJMS.31.63","DOIUrl":"https://doi.org/10.15369/SUJMS.31.63","url":null,"abstract":": Despite many reports describing the surgical procedure for knee ligament reconstruction, especially the anterior cruciate ligament, there have been few reports on infection prevention and none on sterilizing reconstruction materials using povi-done-iodine during surgery. Here we report our surgical techniques for infection prevention. The participants included 522 patients who underwent arthroscopic knee ligament reconstruction at our hospital from April 2001 to October 2005. Despite taking various measures after cases of infection in 2001, such as the selection of sutures and artificial ligaments, and the use of indwelling intra-articular drains, the infection rate was not reduced to zero. Recently, we felt that soaking reconstruction ligaments in povidone-iodine and then washing with saline （“ povidone-iodine pickling ”） immediately prior to burr-hole insertion may prevent bacterial infections caused by surgical instruments and the surgery. in study, we examined the effects of our techniques for intraoperative and postoperative infection prevention, including “ povidone-iodine pickling ” . 100 2001, 3 112 2002, 2 of 121 and 121 2004, when the povidone-iodine, graft on the floor during surgery in a chlorhexidine gluconate or povidone-iodine solution of the graft. of povidone-iodine for mitigate the risk of septic arthritis. Going forward, we need to understand the specific pathologic basis of any cytotoxicity caused by the use of povidone-iodine on reconstructed ligaments.","PeriodicalId":23019,"journal":{"name":"The Showa University Journal of Medical Sciences","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81532480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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