Yonago acta medica最新文献

Vitamin E (VE) is a fat-soluble vitamin and well-known as an antioxidant. VE deficiency is associated with various oxidative stress- and aging-related pathologies and sufficient VE intake is thought to help prevent these conditions. However, it has been unclear how VE deficiency in the pre-aging stage affects the liver. In the present study, 11-month-old mice were fed a VE-restricted diet for 3 months, when age-related changes began to appear, to examine the effects of VE deficiency on the liver. Compared to the livers of mice fed a standard diet, those fed a VE-deficient diet showed metabolic dysfunction-associated steatohepatitis (MASH)-like findings including fibrosis. Mice fed the VE-deficient diet mixed with 2% rice bran (RB) showed milder fibrosis than those fed the VE-deficient diet alone. These results suggest that VE deficiency in the pre-aging stage may cause MASH-like changes in the liver, particularly fibrosis, and that RB is an effective means of supplying VE.

Background: Performance status is a useful prognostic index in palliative care. The objectives of this study were to investigate the prognosis of near-end-of-life patients with advanced lung cancer admitted due to deteriorated performance status, evaluate the utility of performance status measurement in predicting life expectancy, and identify prognostic factors using Bayesian proportional hazards models.

Methods: This prospective observational cohort study measured at admission, the Performance status, Palliative Performance Scale, Karnofsky Performance Status (KPS), Palliative Prognostic Index scores, and clinical biochemistry parameters of the included patients. Ninety-two patients with advanced lung cancer and deteriorated performance status admitted to our department at the NHO Yonago Medical Center between January 2016 and December 2018 were analyzed. Bayesian proportional hazards models were employed to classify remaining life prognoses. The Watanabe-Akaike information criteria (WAIC) with the lowest score was used to choose the final model.

Results: The median survival time was 25 (range, 1-107) days. The final prognostic model for the dying trajectory of patients was selected as an M-spline proportional hazards model according to the least WAIC. Independent prognostic factors for shorter remaining life were hypercalcinemia [hazard ratio (HR) 5.37, 95% confidence interval (CI) 2.11-12.9] and low KPS (HR 1.77, 95%CI 1.30-2.46).

Conclusion: Assessing hypercalcinemia and KPS can be advantageous for predicting near-end-of-life prognosis in terminally ill patients with advanced lung cancer.

Background: The prevalence of underweight among young adults in Japan is approximately 20% in both males and females. Despite its potential health risks, underweight in males has received limited attention. Social jet lag (SJL), the misalignment between biological and social time, has recently been associated with various health outcomes, including obesity and circadian rhythm disturbance. However, evidence on the relationship between SJL and underweight, particularly regarding gender differences, remains limited. This study aimed to examine the association between SJL, lifestyle factors including internet use, and underweight status among university students, focusing on sex-specific differences.

Methods: A cross-sectional study was conducted among 3,102 students (54.6% male) at Shimane University in 2022. Participants were classified into underweight (< 18.5 kg/m²) and non-underweight groups. Lifestyle data, including sleep patterns, diet, physical activity (PA), internet use, and gaming time, were obtained from health examinations and questionnaires. SJL was calculated as the difference in sleep midpoint between weekdays and weekends.

For multivariate analysis, logistic regression was performed with underweight as the dependent variable. Age was included as a covariate, and variables significant in univariate analyses were entered into sex-stratified models.

Results: The prevalence of underweight was similar in males and females (17.2% vs. 17.3%). In both sexes, underweight students exhibited lower systolic blood pressure, higher resting heart rate, and lower PA than their non-underweight counterparts. Among males, the underweight group exhibited a greater median SJL (1h) and a higher prevalence of internet addiction (17.1%). Multivariate analysis revealed that SJL was independently associated with underweight only in males (OR = 1.14, P < 0.05).

Conclusion: Although underweight university students exhibited similar physiological characteristics across sexes, SJL was independently associated with underweight only in males, suggesting that irregular sleep-wake patterns may constitute a novel behavioral risk factor for underweight in this population.

Background: Obturator hernias are a relatively rare condition that predominantly occurs in thin elderly women and are frequently associated with bowel incarceration. Therefore, early diagnosis and appropriate treatment are vital. This study aimed to identify risk factors for bowel resection in patients with incarcerated obturator hernias and evaluate the clinical benefits of laparoscopic transabdominal preperitoneal repair (TAPP).

Methods: This retrospective study included 32 female patients diagnosed with incarcerated obturator hernias at our institution between January 2008 and June 2025. The patients were classified into bowel resection (n = 8) and non-resection (n = 24) groups. The clinical and radiological characteristics were compared. Furthermore, surgical outcomes were compared between the laparotomy (n = 18) and TAPP groups (n = 11).

Results: The median age was 86 years and the median body mass index (BMI) was 17.1. The bowel resection group had a significantly longer symptom duration (P < 0.001), a higher incidence of ileus on computed tomography (P = 0.041), and a significantly smaller bowel diameter at the obturator canal (P = 0.031). Cutoff values predictive of resection were identified as 36 h and 10.0 mm for the duration of symptoms and bowel diameter at the obturator canal, respectively. Multivariate analysis demonstrated that both factors were independent predictors of bowel resection (P = 0.045 and 0.040, respectively). Compared to laparotomy, TAPP resulted in significantly lower blood loss (P < 0.001) and shorter postoperative hospital stay (P < 0.001). In the TAPP group, contralateral obturator hernias were identified and simultaneously repaired in six patients (54.5%).

Conclusion: Symptom duration and bowel diameter at the obturator canal may serve as useful predictive factors for bowel resection in patients with incarcerated obturator hernias. TAPP is a minimally invasive and effective surgical strategy with favorable postoperative outcomes and the added advantage of bilateral hernia management.

Background: Medical uncertainty is inherent in clinical practice, especially in primary care where clinicians regularly face multimorbidity, ambiguous symptoms, and unpredictable care courses. Although tolerance of uncertainty (TU) has been associated internationally with resilience, job satisfaction, and decision-making, little is known about its relationship to physician well-being in Japan. In a medical culture that emphasizes precision and decisiveness, navigating uncertainty may be psychologically challenging. This study examined the association between TU and two dimensions of well-being-subjective well-being (SWB) and eudaimonic well-being (EWB)-among Japanese primary care physicians.

Methods: We conducted a cross-sectional online survey from March 1 to 31, 2023, targeting physicians on the Japan Primary Care Association mailing list (N = 4,207). The questionnaire included demographic items and three validated scales: the Short Intolerance of Uncertainty Scale (SIUS), the Subjective Well-Being Scale (SWBS), and the Eudaimonic Well-Being Scale (EWBS). One free-text item explored emotional responses to high-uncertainty situations. Quantitative data were analyzed using correlation analysis and structural equation modeling (SEM), and qualitative responses underwent thematic analysis.

Results: Out of 152 responses, 150 were valid. The SIUS score showed a significant negative correlation with both SWBS (r = -0.433, P < 0.001) and EWBS (r = -0.259, P = 0.001). SEM confirmed these associations, with path coefficients of -0.420 (SWBS) and -0.256 (EWBS), both P < 0.001. Taken together, these results indicate that higher intolerance of uncertainty was associated with lower well-being; conversely, greater tolerance of uncertainty (TU) was positively associated with both subjective and eudaimonic aspects of well-being. Thematic analysis of free-text responses revealed four themes: (1) Positive recognition of uncertainty, (2) Acceptance of uncertainty, (3) Coping strategies, and (4) Growth through uncertainty.

Conclusion: Higher tolerance of uncertainty is positively associated with both subjective and eudaimonic well-being among Japanese primary care physicians. These findings suggest that fostering TU may enhance psychological health and support professional development.

Background: Collaboration between hematologists and primary care physicians (PCPs) is crucial for managing hematologic diseases, particularly malignancies. However, the specific challenges PCPs face in such coordination remain underexplored in Japan. The aim of this study was to investigate the difficulties and questions encountered by PCPs when providing care to patients with hematologic diseases and to identify potential barriers to effective collaboration with hematologists.

Methods: We conducted a web-based, self-administered questionnaire survey among 4,207 physicians listed on the Japan Primary Care Association mailing list. Respondents with at least three years of clinical experience were eligible. The questionnaire covered demographics, involvement in home care, and challenges in referral and follow-up related to hematologic diseases. Quantitative data were analyzed using descriptive statistics; free-text responses were thematically analyzed using NVivo.

Results: A total of 90 PCPs responded. The most frequently referred conditions were malignant lymphoma, bone marrow failure, and myeloproliferative neoplasms. Common follow-up challenges included limited access to hematologists, role ambiguity, and inadequate communication. Thematic analysis revealed key difficulties: a shortage of specialists, complex treatment decisions for elderly patients, and psychological barriers in initiating consultations with hematologists.

Conclusion: PCPs in Japan face both structural and psychological barriers when managing hematologic diseases, particularly in collaboration with hematologists. Enhancing bidirectional communication and addressing these barriers may improve continuity and quality of care.

Kimura disease is a chronic inflammatory disorder characterized by peripheral eosinophilia, elevated serum IgE levels, and a painless mass. Although it predominantly affects adult males, pediatric cases have also been reported. We report two pediatric cases of Kimura disease diagnosed after adverse events following vaccination, presenting with swollen lymph nodes of the neck and upper limbs. Since children are vaccinated more often than adults, a painless mass following vaccination may constitute an important clinical clue in the diagnosis of Kimura disease. Attention should be paid to the differentiation between Kimura disease and immunoglobulin G4-related disease (IgG4-RD) owing to its similarities. This report provides valuable insights into the link between vaccination and Kimura disease, and emphasizes the importance of early diagnosis, especially in children, to ensure timely treatment and appropriate management.

Background: Severe short bowel syndrome (SBS) frequently leads to intestinal failure-associated liver disease (IFALD); nonetheless, the mechanisms underlying early hepatic changes remain unclear. Existing SBS rodent models involving ≥ 90% small bowel resection often exhibit high postoperative mortality, limiting the ability to evaluate subacute liver injury independent of parenteral nutrition.

Methods: We established a severe SBS murine model by performing 90% small bowel resection (SBS90) in young C57BL/6 mice using a standardized Albert-Lembert anastomotic technique and optimized perioperative management, allowing survival to postoperative day (POD) 14 or longer without parenteral nutrition. Serum biochemistry and liver histology were compared between the Sham, SBS50 (SBS murine model by performing 50% small bowel resection), SBS75 (SBS murine model by performing 75% small bowel resection), and SBS90 groups.

Results: SBS90 mice exhibited significantly higher serum ALT and T-bil levels than did controls. At POD14, the liver histology demonstrated macrovesicular steatosis with minimal inflammatory infiltration, whereas SBS90 mice evaluated on POD28 exhibited macrovesicular steatosis together with severe portal and periportal inflammatory cell infiltration.

Conclusion: This reproducible severe SBS mouse model enabled early and time-dependent hepatic injury evaluation following massive intestinal resection, providing a platform for studying IFALD-contributing mechanisms.

Background: Obstructive sleep apnea syndrome is a common disorder characterized by repeated upper airway obstruction during sleep. Oral appliance therapy is a noninvasive treatment option commonly recommended for patients who are intolerant to continuous positive airway pressure. This study aimed to evaluate the treatment outcomes of oral appliance therapy in patients with obstructive sleep apnea syndrome and to examine the relationship between therapeutic effectiveness and patient characteristics, including age, disease severity, and body mass index.

Methods: A total of 42 patients diagnosed with obstructive sleep apnea syndrome and treated with oral appliance therapy were retrospectively analyzed. The treatment effect was assessed using the apnea-hypopnea index measured before and after therapy (by polysomnography or portable monitoring). Effective treatment was defined as a post-treatment apnea-hypopnea index of <15 events per hour and a ≥ 50% reduction from baseline.

Results: The mean apnea-hypopnea index decreased significantly from 27.6 ± 15.7 to 10.3 ± 8.7 events per hour following oral appliance therapy, with a mean improvement in AHI of 59.6%. Effectiveness was achieved in 66.7% of patients. A significant overall improvement was observed. Reductions in the apnea-hypopnea index were seen across age, severity, and body mass index (BMI) strata. However, only three patients had BMI ≥30 kg/m²; hence, BMI-stratified findings for this subgroup are descriptive and no inferential testing was conducted.

Conclusion: Oral appliance therapy was effective in reducing the apnea-hypopnea index in a broad range of patients, including those traditionally considered less responsive because of advanced age, obesity, or severe disease. These findings suggest a potential role for oral appliance therapy as an alternative to continuous positive airway pressure treatment within the examined strata (age, severity, and BMI), particularly when continuous positive airway pressure therapy is not feasible. Larger prospective studies are warranted.

Background: In Indonesia, stunting remains a health issue among children aged < 5 years, with a prevalence of 36.8% in 2021, the highest prevalence of malnutrition in the said age group, and the quality of drinking water consumed being one of the main causes. This study aimed to identify the quality of drinking water and determine the risk factors for stunting.

Methods: This study was conducted at four Primary Health Care work areas in an urban city between July and October 2022 using a cross-sectional study design with 172 under-fives, 106 of whom had drinking water-related stunting. The sampling methods employed were two-stage, including cluster and purposive sampling. Data collection included anthropometric measurements, interviews, and collecting drinking water samples. This study used the logistic regression test for multivariate analysis.

Results: The results showed that 93.6% of the drinking water was positive for microbiological agents, whereas analysis of heavy metals in drinking water revealed concentrations within acceptable limits as defined by standard drinking water quality regulations. Multivariate analysis showed that exposure to microbiologically contaminated drinking water was significantly associated with a higher risk of stunting. Children exposed to contaminated drinking water had a 3.3 times higher risk of stunting (OR 3.328; 95% CI 1.681-6.587). Additional confounding factors such as children over 23 months of age, history of infectious disease, low birth weight, and poor hygiene practices also contributed to increased stunting risk.

Conclusion: This study highlights the significant role of drinking water quality in the incidence of stunting among children under five. The high prevalence of microbiological contamination in household drinking water was strongly associated with increased stunting risk. Children exposed to contaminated water were over three times more likely to experience stunting. While concentrations of heavy metals remained within safe limits, additional confounding factors including child age, history of infectious disease, low birth weight, and poor hygiene practices further exacerbated the risk. These findings underscore the urgent need for integrated public health interventions focusing on water safety, hygiene education, and early childhood care to effectively reduce stunting prevalence in urban communities.