Nagoya Journal of Medical Science最新文献

International guidelines suggested that overweight and underweight are risk factors for frailty. However, body composition, which directly affects body weight, was not mentioned as a risk factor. We aimed to investigate whether the body composition, including muscle, fat, bone, and body water, is a risk factor for frailty. MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and Scopus were searched up to June 03, 2022. We included cohort studies or observational studies using a cross-sectional design that reported an association between body composition and frailty. Two reviewers assessed the quality of the included cohort studies. Furthermore, we examined whether body composition as a risk factor for frailty varies depending on the participant's place of residence. Of the 3871 retrieved studies, 77 were ultimately included, 7 of which were cohort studies. The risk-of-bias evaluation in each cohort study showed that all studies had at least one concern. Low lean mass, waist circumference-defined abdominal obesity, and bone mineral density were significantly associated with frailty in the cohort studies. The results of bone mineral density were conflicted in the cross-sectional studies. Considering the participants' place of residence, a significant association between lower-extremity muscle mass and frailty was demonstrated, particularly among Asian residents. Low lean mass and abdominal obesity were likely risk factors for frailty. These results could be useful for developing frailty prevention strategies and could have a positive impact on individual health management. Further, future studies are needed because body composition affecting frailty may differ by race.

Heparinized saline is used to prevent catheter obstruction; however, it is associated with concerns regarding the incidence of heparin-induced thrombocytopenia and the accuracy of the blood test results. This study compared the impact of saline with and without heparin on central venous catheter occlusion rates in post-surgical intensive care unit patients using a prospective, double-blinded, randomized, controlled design. Patients aged 20-90 years planned to experience central venous catheter insertion and postoperative intensive care unit admission were enrolled and were randomly assigned to either the heparin group (administered normal saline with heparin) or the control group (administered normal saline alone), based on a 1:1 ratio. Nurses blinded to patient allocation performed the occlusion assessment (every 24 h). The Kaplan-Meier curve was used to assess the time to occlusion or removal of each catheter. Central venous catheter insertion results of 136 patients showed no significant variation in occlusion rates between the heparin and control groups within the first 3 days. There was no significant difference between normal saline with and without heparin in preventing central venous occlusion in the intensive care unit up to 3 days post-surgery. The results of this study suggest that it is not necessary to use normal saline with heparin in the management of central venous catheter occlusion, at least when moving from the operating room to the intensive care unit.

Chronic obstructive pulmonary disease is one of the leading causes of death worldwide and in Japan. This study aimed to detect the location and area of spatial clusters with high chronic obstructive pulmonary disease mortality rates in Japan during 2017-2021. Age-standardized numbers of expected chronic obstructive pulmonary disease deaths by sex and municipality were estimated from publicly available data from 1,895 municipalities in Japan. We performed flexible spatial scan statistics to detect the clusters with significantly high risk of chronic obstructive pulmonary disease death using the expected and observed cumulative mortality. During 2017-2021, the cumulative expected number of chronic obstructive pulmonary disease deaths was 87,450 (72,551 males and 14,899 females). There were 23 significant spatial clusters for males and 14 for females. The 23 clusters were scattered in 251 municipalities of 27 prefectures for males, while the 14 clusters for females were localized in 105 municipalities of 12 prefectures. The primary cluster for both sexes was detected in the Osaka Prefecture (males: log-likelihood ratio [LLR] = 188.23, relative risk [RR] = 1.46, p = 0.001; females: LLR = 106.42, RR = 1.95, p = 0.001). We found 23 significant spatial clusters for males and 14 for females. There were obvious sex differences in the distribution of the clusters. Our findings provide supporting evidence to discuss the prioritized areas in the allocation of health care resources to prevent and control the deaths associated with chronic obstructive pulmonary disease.

Gastric cancer is a common malignancy disease with a poor prognosis. Deficient mismatch repair is a prognostic and predictive marker of response to systemic therapies. However, deficient mismatch repair frequency and the relationship between this status and microscopic characteristics are inconsistent across nations. We aimed to determine the rate of deficient mismatch repair and its association with histopathological features in gastric cancer patients. A cross-sectional study was conducted on 226 gastric cancer patients treated at Hue University of Medicine and Pharmacy Hospital and Hue Central Hospital from June 2020 to January 2024. Mismatch repair protein expression was evaluated using immunohistochemical staining, and any absence of mismatch repair proteins was regarded as deficient mismatch repair. The deficient mismatch repair rate was 12.8%. Deficient mismatch repair appeared to be more frequent in the intestinal subtype of Lauren classification odds ratio (OR) = 4.767 (95% confidence interval [CI], 1.086-20.921; p = 0.039), tubular/papillary adenocarcinoma (OR = 5.25; 95% CI, 1.185-23.251; p = 0.029), mucinous adenocarcinoma (OR = 6.19; 95% CI, 1.113-34.445; p = 0.037), and differentiated type (OR = 3.24; 95% CI, 1.324-7.931; p = 0.01). No statistically significant association was detected with histopathological features according to the Tumor Location-Modified Lauren classification and mucinous secreting morphology. Deficient mismatch repair status was unusual in gastric cancer. The degree of cell differentiation and microscopic characteristics based on the World Health Organization and Lauren classification could all impact the predictive power for microsatellite-instable status.

Intraoperative magnetic resonance imaging (iMRI) plays a crucial role in improving the precision of brain tumor surgeries. However, the use of iMRI can impose certain limitations on intraoperative head positioning. In regular microscopic surgery, head positioning is of utmost importance because an appropriate surgical field is important for the efficacy and safety of surgery. Therefore, in cases where adequate head positioning is difficult, usually, iMRI will not be utilized. Herein, we report an adult case of cerebellar astrocytoma whose tumor extended to the culmen of the cerebellum. Upon surgery via the suboccipital approach, the positional limitations imposed by iMRI led to an insufficient vertex-down position and limited surgical field, which hampered the removal of the upper portion of the tumor. However, this concern could be overcome when used in combination with an endoscope. The potential of iMRI applications is anticipated to be enhanced by overcoming positional limitations through combined endoscopic surgery. The use of multimodality in surgery is an optimal example of how surgical support equipment can also improve surgical outcomes. Here, we report on the new possibilities offered by multimodality.

The number of individuals with age-related mild cognitive impairment and subsequent dementia has inevitably increased with the rise in population aging. It is important to maintain cognitive function or decelerate declines in cognitive function. However, the evidence on lifestyle-based factors associated with this decline is lacking. Here, we investigated modifiable lifestyle-based factors associated with chronological cognitive decline in cognitively healthy adults aged ≥60 years (Mini-Mental State Examination [MMSE] score ≥27). This case-control study enrolled 363 participants who were divided into two groups based on annual declines in MMSE score: 40 cases with an MMSE score decline of ≥0.5 points/year and 323 controls with maintained MMSE scores. Smoking, lower social functioning scores on the 36-Item Short Form Health Survey version 2, higher Pittsburgh Sleep Quality Index (PSQI) global scores, and sleep disorders were significantly associated with a decline in MMSE scores. Multivariate logistic regression analysis revealed higher age, current smoking status, and either higher PSQI global scores or sleep disorders to be independently associated with MMSE score decline. In conclusion, the present study identified aging, smoking, and sleep quality as factors associated with a greater decline in MMSE scores in cognitively healthy individuals. Our findings highlight the potential importance of lifestyle factors in preventing cognitive decline.

Catheter ablation is the first-line treatment for atrial fibrillation. Although the efficacy and safety of this procedure have been reported in older patients, they might diminish with age. Therefore, this study aimed to determine the safety and effectiveness of atrial fibrillation ablation in patients aged ≥80 years. We retrospectively analyzed the features of the catheter ablation and the subsequent clinical course and outcomes of 100 patients with atrial fibrillation aged ≥80 years who underwent ablation between July 2019 and December 2021 at Tosei General Hospital, Seto, Aichi, Japan. The average duration of atrial fibrillation was 6.0 ± 9.5 months, and 83% of the patients were symptomatic. Approximately 30% of patients developed heart failure, with 15% requiring hospitalization within one year before ablation. After ablation, 93% of patients were atrial fibrillation-free, and none required postoperative hospitalization due to heart failure. However, several complications have been observed, including cardiac tamponade, hematoma at the access site, and postoperative bradycardia. Notably, an enlarged left atrial diameter before ablation is a predictor of complications. In patients aged ≥80 years, atrial fibrillation ablation therapy demonstrated a high non-recurrence rate and may alter the progression of heart failure. Although the incidence of complications was relatively low, caution should be exercised when older patients with enlarged left atrial diameters undergo atrial fibrillation ablation.

Kounis syndrome (KS) manifests as an acute coronary syndrome triggered by allergy, hypersensitivity, or anaphylaxis. It is believed that mast cells and histamine can potentially induce acute cardiac events by activating various inflammatory pathways. Here, we present a case of KS triggered by rifampicin administered during empyema drainage in a young male patient with no history of coronary artery disease. To the best of our knowledge, our case is the first report of rifampicin-induced KS documented in the literature. The wide range of etiological factors complicates the diagnosis of KS. Healthcare professionals should consider KS as a potential diagnosis in patients experiencing angina or similar pain alongside suspected allergic reactions.

Since the COVID-19 pandemic, it has been found that SARS-CoV-2 antecedent infection can cause multisystem inflammatory syndrome in children. However, the frequency of SARS-CoV-2 antecedent infection in Kawasaki disease (KD) is unknown. The purpose of this study was to investigate the frequency of SARS-CoV-2 infection that preceded the onset of KD. This study is a multi-center observational study. The subjects were patients who were diagnosed with KD at 4 hospitals from April 1, 2020 to August 31, 2022. Serum SARS-CoV-2 IgM and total antibody including IgG levels were measured by the chemiluminescence immunoassay method before and after treatment for KD. A total of 55 patients participated in the study. The first antibody measurement before the initial treatment was performed on a median of 4th days of illness and the second antibody measurement was performed after the initial treatment on a median of 12th days of illness. No patient had a significant increase in SARS-CoV-2 IgM levels in two measurements. Only one patient (1.8%) had elevated total antibodies including IgG, and the patient had a history of COVID-19 6 months before the onset of KD. SARS-CoV-2 antecedent infection before the onset of KD was not observed in this study, and strong association between development of KD and SARS-CoV-2 infection was not suggested.

Distinguishing recurrent cholangiocarcinoma lesions from postoperative fibrosis or biliojejunostomy lesions using contrast-enhanced computed tomography (CECT) alone is challenging. This study examined the value of adding diffusion-weighted magnetic resonance imaging (DWI) to CECT for the detection of cholangiocarcinoma recurrence. This single-institution retrospective analysis included 33 patients who underwent cholangiocarcinoma resection between January 2016 and December 2020. Of the patients, 20 were in the recurrence group and 13 were in the non-recurrence group. Two observers independently reviewed the CECT images and subsequently reviewed the combined CECT and DWI images (b-value, 1000 s/mm²), with each image reviewed twice. The diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis. Kappa statistics were used to evaluate agreement. The diagnostic performance (area under the ROC curve [AUC]) of both observers improved after the addition of DWI; the AUC improved from 0.614 to 0.918 (P = 0.003) in the first session and from 0.820 to 0.928 (P = 0.20) in the second session for Observer A, whereas it improved from 0.566 to 0.858 (P < 0.001) in the first session and from 0.753 to 0.930 (P = 0.02) in the second session for Observer B. The intraobserver and interobserver agreements improved after the addition of DWI; the kappa value improved from 0.586 to 0.656 for Observer A, from 0.371 to 0.838 for Observer B, from 0.308 to 0.766 in the first session, and from 0.464 to 0.620 in the second session. Adding DWI to CECT improves the detection of cholangiocarcinoma recurrence compared to CECT alone.