REVIEW ARTICLE
Real-world effectiveness of ustekinumab for patients with
ulcerative colitis: a systematic review and meta-analysis
Genta Uchida, Masanao Nakamura, Takeshi Yamamura,
Tomoyuki Tsuzuki and Hiroki Kawashima
pg(s) 402 - 427
<Abstract> - < PDF >
Ustekinumab has recently been approved for the treatment of ulcerative colitis (UC) based on data
from clinical trials. However, the effectiveness of ustekinumab in patients with UC in a real-world setting
remains unclear. Hence, in this meta-analysis, we aimed to evaluate the effectiveness of ustekinumab in a
real-world setting and to investigate the predictors of its effectiveness. A comprehensive literature search
was performed to examine the effectiveness of ustekinumab in UC patients admitted between January 2019
and December 2021. Data on clinical remission, response, and corticosteroid-free clinical remission rates
were extracted, pooled, and analyzed. Meta-regression analysis was performed to investigate the source of
heterogeneity and the impact of moderators on the outcomes of interest. A total of 14 eligible studies were
identified. The pooled clinical remission rate was 55.0% at week 8, 36.1% at week 16, 46.6% at month 6,
and 38.6% at month 12. The meta-regression analysis showed that prior use of anti-tumor necrosis factor
(TNF) agents and vedolizumab and the publication style were significant moderators. Additionally, out of
258 patients, there were 28 adverse events (AEs) (10.9%). The effectiveness of ustekinumab in real-world
patients with UC was consistent with the results clinical trials. Moreover, previous treatment with anti-TNF
agents and vedolizumab might have affected the effectiveness of ustekinumab.
ORIGINAL PAPERS
Association between National Institutes of Health Stroke
Scale and Functional Independence Measure
scores in patients with ischemic stroke from
convalescent rehabilitation outcomes
Joe Senda, Keiichi Ito, Tomomitsu Kotake, Masanori Mizuno,
Hideo Kishimoto, Keizo Yasui, Hiroko Nakagawa-Senda,
Masahisa Katsuno, Yoshihiro Nishida and Gen Sobue
pg(s) 428 - 443
<Abstract> - < PDF >
We investigated the associations among neurological severity, activities of daily living (ADLs), and
clinical factors in patients with ischemic stroke in convalescent rehabilitation outcome. The study sample
included 723 patients with ischemic stroke (484 men and 239 women; mean age, 73.2 ± 8.5 years) for
inpatient convalescent rehabilitation. National Institutes of Health Stroke Scale (NIHSS) was used to
measure the neurological severity, and Functional Independence Measure (FIM) was used to assess ADLs
at discharge. Leukoaraiosis was graded based on periventricular hyperintensity (PVH) and deep white
matter hyperintensity (DWMH) on magnetic resonance imaging. The correlations between NIHSS scores
and total FIM scores were significant but relatively mild (r = –0.684, P < 0.001). Multiple regression
analysis revealed that age and PVH grade significantly decreased their total FIM scores and affected the
discrepancies between NIHSS scores at discharge (P < 0.001), but DWMH scores did not affect these
results. Factors such as positive history of heart disease (P = 0.008) and bilateral infarction (P = 0.038)
additionally decreased their total FIM scores and affected the discrepancies between NIHSS scores. These
findings suggest that age, PVH, history of heart disease positive, and bilateral infarction in patients with
ischemic stroke affected their performance of ADLs and the discrepancies between their neurological
severities in convalescent rehabilitation outcomes, probably because the pathophysiological background of
leukoaraiosis and these factors strongly decrease their ADL performance in post-phase ischemic stroke.
Job satisfaction among Myanmar working population,
a cross-sectional study
Pa Pa Soe, Su Yi Toe, Zar Lwin Hnin, Ma Ma Thant,
Nyi Nyi Latt, Nang Hla Hla Htay, Than Than Aung,
Myint Sann and Nang Hla Hla Win
pg(s) 444 - 454
<Abstract> - < PDF >
The gap between expectations and reality could lead to low job satisfaction. Although much literature
has been described on job satisfaction among different categories of people, more research is needed to
acknowledge the judgment of job satisfaction among some of the Myanmar working population. The study
aims to find out the satisfaction level of a job and the factors related to it. The cross-sectional study was
conducted in January 2019 by calling for face-to-face interviews with 536 respondents selected using a
convenient sampling technique using a pre-tested questionnaire. The highest satisfied respondents were >50
years age group (86.11%), females (71.89%), higher officials (90.53%), and more than three years of service
(78.35%). In the adjusted analysis, having 41–50 year age group (AOR 2.72; 95% CI: 1.08–6.83), part-time
job nature (AOR 2.16; 95% CI: 1.17–3.99), and the higher official (AOR 5.71; 95% CI: 2.48–13.13) were
significantly associated with job satisfaction. Relationships with the direct executive and, organization and
management were the main determinants of job satisfaction. Moreover, the respondents with higher positions
were more likely to have higher job satisfaction in the study.
The association between early rehabilitation and ambulatory
ability at discharge in patients with hip fractures
at acute-phase rehabilitation wards:
a survey of the Japan Association of Rehabilitation Database
Koji Hattori, Hiroko Kamitani, Yusuke Suzuki, Nariaki Shiraishi,
Takahiro Hayashi, Daisuke Matsumoto, Motoya Sugiyama,
Hitoshi Komiya and Masafumi Kuzuya
pg(s) 455 - 464
<Abstract> - < PDF >
This study aimed to examine the effectiveness of early rehabilitation in patients with femoral neck
fractures admitted to acute care settings in Japan using the data registered with the Japan Association
of Rehabilitation Databases (JARD). We included data for 401 patients (out of 3088 patients) aged ≥ 65
years (85 males, 316 females) from nine hospitals who sustained a femoral neck fracture between July
2005 and September 2015. Using the number of days until surgery or the number of days until the start
of rehabilitation or both as the explanatory variables, and the indoor mobility at discharge as the outcome
variable, we calculated the adjusted rate ratio (ARR) and 95% confidence interval (CI) using Poisson
regression analysis (age, sex, cognitive impairment, concurrent symptoms, and previous history of fracture
adjusted as covariates). The ARR for independent walking at the discharge of the early-rehabilitation
group (starting rehabilitation within two days after the injury) was significantly higher (ARR: 2.01, 95%
CI: 1.34–3.02) than that of the non-early rehabilitation group. These results suggest that early acute-phase
rehabilitation after a femoral neck fracture in older patients allows for better ambulatory ability at discharge,
regardless of the time to surgery.
Correlations of high molecular weight adiponectin, tumor
necrosis factor-alpha and vascular endothelial growth factors
with occurrence of colonic polyps in the prediabetic population
Huafen Zhang, Lilan Zhou and Junjun Zhu
pg(s) 465 - 475
<Abstract> - < PDF >
We aimed to explore the correlations of high molecular weight adiponectin (HMW-ADP), tumor
necrosis factor-alpha (TNF-α) and vascular endothelial growth factors (VEGFs) with the occurrence of
colonic polyps in the prediabetic population. Two hundred patients with prediabetes were enrolled, and
their clinical data were retrospectively analyzed. They were divided into group A (75 patients with colonic
polyps) and group B (125 patients without colonic polyps). Eighty patients with normal glucose tolerance
in the same period were divided into group C (32 patients with normal glucose tolerance and colonic
polyps) and group D (48 patients with normal glucose tolerance but no colonic polyps). The correlations
of serum HMW-ADP, TNF-α and VEGF levels with plasma glucose and insulin levels were explored by
Pearson’s analysis. The factors influencing the occurrence of colonic polyps were determined by logistic
regression analysis. Serum HMW-ADP was negatively correlated with TNF-α, VEGFs, FPG, 2hPG, FI and
HOMA-IR (r<0, P<0.05), whereas serum TNF-α and VEGFs were positively correlated with FPG, 2hPG,
FI and HOMA-IR (r>0, P<0.05). Age, body mass index, waist-to-hip ratio, history of smoking, history
of drinking, family history of colon cancer, TNF-α and VEGF were independent risk factors [odds ratio
(OR) >1, P<0.05], and HMW-ADP was a protective factor (OR<1, P<0.05). The areas under the curves of
serum HMW-ADP, TNF-α, VEGFs and their combination for predicting the occurrence of colonic polyps
were 0.899, 0.787, 0.908 and 0.922, respectively. The combination of HMW-ADP, TNF-α and VEGFs can
effectively predict the occurrence of colonic polyps in prediabetic patients.
Associations between changes in social contact pattern
and the mental health status of Chinese adults:
cross-sectional findings
Jingya Zhang, Shuai Zhou, Qiong Wang, Fangfang Hou, Xiao Han,
Guodong Shen, Chifa Chiang, Hiroshi Yatsuya and Yan Zhang
pg(s) 476 - 489
<Abstract> - < PDF >
The study aims to examine the associations between social contact pattern changes and mental health
status, including depression, anxiety, and loneliness, among Chinese adults in the context of coronavirus
disease 2019 (COVID-19). Data on social contact patterns before and after the outbreak of COVID-19
were obtained from 3511 participants. Mental health (ie, depression, anxiety, and loneliness) was assessed
by the 9-item Patient Health Questionnaire, Dark Future Scale, and the 9-scale Three-Item Loneliness
Scale, respectively. Poisson regression analyses revealed that the participants who had increased in-person
communication were more likely to have mental disorders [depression: prevalence ratio (PR)=1.13, 95%
confidence interval (CI): 1.02, 1.26; anxiety: PR=1.15, 95% CI: 1.01, 1.30]. The current study concluded
that the in-person communication increase before and after the outbreak of COVID-19 was associated with
mental disorders among Chinese adults.
The study of exercise therapy using a virtual reality system
on healthy subjects assuming hospital use
and intradialytic exercise
Ren Takahashi, Hiroki Yabe, Takashi Hibino, Sayumi Morishita,
Mina Watanabe, Katsumasa Nishioka and Hideaki Ishikawa
pg(s) 490 - 503
<Abstract> - < PDF >
This study aimed to investigate the basic data on the effectiveness and safety of the system in healthy
subjects using an immersive virtual reality (VR) exercise system specialized for therapeutic exercise therapy
during dialysis or hospital use. A total of 15 healthy adult subjects performed four exercises, namely lifting
and rowing exercises using VR and each movement exercise without VR (control). The simulator sickness
questionnaire (SSQ) was administered pre- and post-operatively to assess for VR sickness. Blood pressure,
heart rate (HR), rating of perceived exhaustion, Profile of Mood States 2nd Edition Japanese version, and
muscle activity (iEMG) were measured using electromyography. The correlation between changes in mood
states and HR or iEMG results was examined. The SSQ measured post-VR exercise was 11.2 (18.7–7.5)
and 11.2 (7.5–29.9) points in the lifting and rowing VR, respectively. The HR in lifting (VR, 82.5 ± 12.7
vs control, 71.6 ± 10.6 bpm, P<0.05) and rowing (VR, 94.2 ± 13.1 vs control, 83.5 ± 12.0, P<0.05) with
VR exercise was significantly higher than in control. No significant differences were observed between
the other variables. There was a positive correlation between HR and negative mood in the lifting VR
condition (r=0.64, P<0.05), but not in the control group. Contrastingly, there was a positive correlation
between iEMG and negative mood in rowing control (r=0.56), but not VR. Safety was confirmed, with
no VR sickness or discontinuation of the system. Exercise therapy using VR resulted in a higher exercise
load. This VR system has the potential for additional effective intradialytic exercises and hospital use.
Urethral identification using three-dimensional magnetic
resonance imaging and interfraction urethral motion
evaluation for prostate stereotactic body radiotherapy
Yutaka Kato, Shintaro Okumiya, Kuniyasu Okudaira, Junji Ito,
Motoki Kumagai, Takeshi Kamomae, Yumiko Noguchi,
Mariko Kawamura, Shunichi Ishihara and Shinji Naganawa
pg(s) 504 - 517
<Abstract> - < PDF >
Prostatic urethra identification is crucial in prostate stereotactic body radiotherapy (SBRT) to reduce
the risk of urinary toxicity. Although computed tomography (CT) with a catheter is commonly employed,
it is invasive, and catheter placement may displace the urethral position, resulting in possible planning
inaccuracies. However, magnetic resonance imaging (MRI) can overcome these weaknesses. Accurate
urethral identification and minimal daily variation could ensure a highly accurate SBRT. In this study, we
investigated the usefulness of a three-dimensional (3D) T2-weighted (T2W) sequence for urethral identification,
and the interfractional motion of the prostatic urethra on CT with a catheter and MRI without a
catheter for implementing noninvasive SBRT. Thirty-two patients were divided into three groups. The first
group underwent MRI without a catheter to evaluate urethral identification by two-dimensional (2D)- and
3D-T2W sequences using mean slice-wise Hausdorff distance (MSHD) and Dice similarity coefficient (DSC)
of the contouring by two operators and using visual assessment. The second group provided 3-day MRI
data without a catheter using 3D-T2W, and the third provided 3-day CT data with a catheter to evaluate
the interfractional motion using MSHD, DSC, and displacement distance (Dd). The MSHD and DSC for
the interoperator variability in urethral identification and visual assessment were superior in 3D-T2W than
in 2D-T2W. Regarding interfractional motion, the Dd value for prostatic urethra was smaller in MRI than
in CT. These findings indicate that the 3D-T2W yielded adequate prostatic urethral identification, and
catheter-free MRI resulted in less interfractional motion, suggesting that 3D-T2W MRI without a catheter
is a feasible noninvasive approach to performing prostate SBRT.
Preoperative frailty as a predictive factor for postoperative
complications in patients with pancreatic cancer
Makoto Onji, Shinji Kakizoe, Koichi Naito, Kenjiro Date, Asuka Nakai,
Kanami Shimizu, Masatake Suyama, So Nakamura,
Hirotaka Kuga and Kazuyoshi Nishihara
pg(s) 518 - 527
<Abstract> - < PDF >
Frailty is considered one of the most important indicators of a patient’s general condition. However, only
a few studies have investigated the association between preoperative frailty and postoperative complications
in pancreatic cancer. Therefore, this study aimed to examine this association in patients with pancreatic
cancer. We retrospectively reviewed 52 consecutive patients who underwent pancreatectomy for pancreatic
cancer between July 2019 and March 2021. Patients were classified into two groups according to the
presence of postoperative complications. Their characteristics and clinical parameters, including physical
function, were analyzed. Patients with postoperative complications had a higher prevalence of frailty
(58.8% vs 14.3%, p = 0.003) and a shorter 6-min walk distance (380 m vs 436 m, p = 0.020) than those
without postoperative complications. Logistic regression analysis identified preoperative frailty as the only
independent risk factor for complications after pancreatectomy (p = 0.002). Preoperative frailty is associated
with postoperative complications of pancreatectomy. Since preoperative frailty can be easily evaluated, it
is a useful predictor of postoperative complications after pancreatectomy.
Editors' Choice
Supernatant from activated omentum accelerates
wound healing in diabetic mice wound model
Yu Li, Kazunobu Hashikawa, Katsumi Ebisawa, Miki Kambe,
Shinichi Higuchi and Yuzuru Kamei
pg(s) 528 - 541
<Abstract> - < PDF >
Diabetic wounds are considered one of the most frequent and severe complications of diabetes mellitus.
Recently, the omentum has been used in diabetic wound healing because of its tissue repair properties.
The activated omentum is richer in growth factors than the inactivated, thereby contributing to the wound
healing process. To further investigate the effect of activated omentum conditioned medium (aOCM) on
diabetic wound healing, we injected supernatant from aOCM, saline-OCM (sOCM), inactivated-OCM
(iOCM), and medium (M) subcutaneously upon creation of a cutaneous wound healing model in diabetic
mice. Wound area (%) was evaluated on days 0, 3, 5, 7, 9, 11, 14, 21, and 28 post-operation. At 9 and
28 d post-operation, skin tissue was harvested and assessed for gross observation, neovascularization,
peripheral nerve fiber regeneration, and collagen deposition. We observed that aOCM enhanced the wound
repair process, with significant acceleration of epidermal and collagen deposition in the surgical lesion
on day 9. Additionally, aOCM displayed marked efficiency in neovascularization and peripheral nerve
regeneration during wound healing. Thus, aOCM administration exerts a positive influence on the diabetic
mouse model, which can be employed as a new therapy for diabetic wounds.
Trends of travel burdens to access cancer care among
children with cancer: analysis of a population-based cancer
registry data in Aichi, Japan
Anna Tsutsui, Natsumiko Ando, Yukari Taniyama, Takako Fujimaki,
Masanori Kawaura, Keitaro Matsuo, Hidemi Ito and Yuko Ohno
pg(s) 542 - 554
<Abstract> - < PDF >
Centralization of childhood cancer treatment in specialized hospitals is necessary for quality treatment
and care, but imposes a time and cost burden for patients and their families. We investigated the 20-year
trend in the patients’ car travel burden to reach cancer-care hospitals in Aichi Prefecture, Japan. From the
Aichi population-based cancer registry data, 1,741 cases diagnosed in 1998–2017 under 15 years of age
were extracted and assigned to three treatment groups: invasive treatment (n = 697), radiotherapy (n =
371), or chemotherapy groups (n = 1,462), allowing for duplicate assignment. Their travels to access each
treatment hospital were estimated and summarized as the estimated travel times (ETT), estimated travel
distances (ETD), and direct distances (DD). The ETTs were compared using the Brunner–Munzel test. The
average cases per year for each hospital were plotted. The annual trends during 1998–2017 on ETT, ETD,
and DD were investigated using Joinpoint regression models. The ETTs were 0.38–0.45 hours on median
for three periods (1998–2005, 2006–2012, and 2013–2017) in three treatment groups and increased by
0.02–0.07 hours from 2006–2012 to 2013–2017, with a statistically significant difference in the radiotherapy
group (0.07 hours, P = 0.037). The average cases per year increased for the top hospital in each group, and
regression model analyses showed no joinpoint on the annual median trend. In conclusion, the increases in
travel times were small and not considered clinically significant, and treatment centralization was observed
from 2006–2012 to 2013–2017.
Development and validation of a professional autonomy scale
for Japanese midwives
Satsuki Obata and Shigemi Iriyama
pg(s) 555 - 568
<Abstract> - < PDF >
Japanese midwives are required to autonomously perform midwifery diagnosis and maternity care.
However, education to promote the professional autonomy of midwives is inadequate, and previous studies
have not been able to identify a measure for it. This study aimed to develop a professional autonomy scale
for midwives, to be used for the education and career advancement of Japanese midwives. The Midwives
Professional Autonomy Scale extracted items from the midwives’ “autonomy” and “specialty” literature,
and 10 professionals verified the surface and content validity of the scale. Overall, 695 Japanese midwives
participated in a survey, of which a sample of 399 was recovered. Exploratory factor analysis was performed
using the sample to confirm the validity of the construct and internal consistency of the scale (Cronbach’s
alpha value 0.95). Additionally, the validity of the criteria was confirmed using the self-efficacy scale, self-esteem
scale, and job satisfaction, and the stability was confirmed by test-retest reliability. Consequently, the
professional autonomy scale for Japanese midwives comprised 24 items and 5 factors. This scale can thus
be used to evaluate the professional autonomy of Japanese midwives and for midwifery education.
A nerve-to-implant distance as a novel predictor
for lateral femoral cutaneous nerve injuries after anterior
subcutaneous pelvic internal fixation
Shinsuke Takeda, Michiro Yamamoto, Yoshihiro Tanaka, So Mitsuya, Ken-Ichi Yamauchi and Hitoshi Hirata
pg(s) 569 - 578
<Abstract> - < PDF >
Although anterior subcutaneous pelvic internal fixation is a valuable tool for the reduction and fixation of
unstable pelvic ring injuries, lateral femoral cutaneous nerve irritation by the implant is the most common
complication. This study aimed to investigate the association between the nerve-to-implant distance and
the postoperative lateral femoral cutaneous nerve symptom. Patients who underwent anterior subcutaneous
pelvic internal fixation between 2016 and 2019 were retrospectively analyzed. Lateral femoral cutaneous
nerve status was defined as follows: not identified, nerve-to-implant distance <13 mm, and ≥13 mm. The
proportion of patients who experienced postoperative nerve disorders was compared using the nerve status.
Nerve-to-implant distances were compared using the presence or absence of postoperative lateral femoral
cutaneous nerve disorders. The predictive value of a nerve-to-implant distance of 13 mm for postoperative
nerve disorders was assessed. Overall, 26 lateral femoral cutaneous nerves were included. Ten patients
had postoperative nerve disorders, of which seven had an nerve-to-implant distance <13 mm, while the
other three occurred in patients whose nerves were not identified. A nerve-to-implant distance ≥13 mm
was significantly associated with a decreased risk of postoperative nerve disorder compared to a nerve
-to-implant distance <13 mm (p = 0.017). A nerve-to-implant distance ≥13 mm had a perfect sensitivity
(100%) and modest specificity (58.3%). Nerve-to-implant distance was ≥13 mm. Nerve disorders were
frequently observed when the nerve-to-implant distance was <13 mm or the nerve was not identified
intraoperatively. Efforts to identify the lateral femoral cutaneous nerve may be useful to avoid internal
fixation-related nerve disorders.
Propofol elicits apoptosis and attenuates cell growth
in esophageal cancer cell lines
Rui Zhou, Yuko Konishi, Ailing Zhang and Kimitoshi Nishiwaki
pg(s) 579 - 591
<Abstract> - < PDF >
Propofol is a pharmaceutical agent commonly used as an intravenous anesthetic in surgical treatments
and a sedative in intensive care. However, it is largely unknown how exposure to propofol affects the
proliferation, invasion, and apoptosis of neoplastic cells in esophageal cancer. In this study, we sought to
elucidate the impact of propofol exposure on the growth properties of human esophageal cancer cell lines
in vitro. We treated two human esophageal cancer cell lines, KYSE30 and KYSE960, with up to 10 μg/mL
of propofol for 12–36 h. The treated cells were then analyzed by cell proliferation assay, Matrigel
invasion assay, quantification of caspase-3/7 and -9 activities, and cell staining with Annexin V and
7-aminoactinomycin D to detect early apoptosis and cell death, respectively, via flow cytometry. We found
that 3–5 μg/mL propofol reduced the growth and Matrigel invasion of both cell lines in a dose-dependent
manner. Executioner caspase-3/7, but not caspase-9 involved in intrinsic apoptosis pathway, was activated
by cell exposure to 3–5 μg/mL propofol. In addition, 3–5 μg/mL propofol augmented early apoptosis in
both cell lines and increased cell death in the KYSE30 cell line. In summary, exposure to propofol, at
concentrations up to 5 μg/mL, led to the reduction of cell growth and Matrigel invasion, as well as the
augmentation of apoptosis in esophageal cancer cell lines. These data will help define a methodology to
safely utilize propofol, a common general anesthetic and sedative, with esophageal cancer patients.
Role of serum n-6 polyunsaturated fatty acids in
the development of acute coronary syndromes
Naoya Inoue, Shuji Morikawa and Toyoaki Murohara
pg(s) 592 - 601
<Abstract> - < PDF >
n-3 polyunsaturated fatty acids (PUFAs) have an inhibitory effect on the development of coronary artery
disease (CAD). However, whether n-6 PUFAs, dihomo-gamma-linolenic acid (DGLA), and arachidonic
acid (AA) play a role in the development of CAD remains unclear. This study investigated the association
between PUFAs and the risk of developing acute coronary syndrome (ACS) using the lipid and PUFAs
data of patients who received percutaneous coronary intervention (PCI) for either non-emergent conditions
(staged group) or ACS (ACS group). We retrospectively evaluated 433 patients who underwent PCI between
2014 and 2021. The patients were divided into the ACS group (n = 18) and the staged group (n = 132).
The lipid and PUFA values of each patient between the two groups were compared. Moreover, to investigate
the correlation between n-6 PUFA levels and ACS, the effects of confounding factors such as the use of
strong statins and low-density lipoprotein cholesterol (LDL-C) levels were adjusted. The ACS group had
higher n-6 PUFAs levels than the staged group (DGLA: 36.8 μg/mL vs 29.6 μg/mL; AA: 203.3 μg/mL
vs 145.8 μg/mL). Furthermore, the analysis of covariance adjusted for LDL-C levels showed a significant
difference between the two groups in terms of DGLA and AA levels. The n-3 PUFA levels did not
significantly differ between the staged and ACS groups. Moreover, the ACS group had higher DGLA and
AA levels and lower n-3 PUFAs/AA ratios than the staged group. Therefore, excess n-6 PUFAs may be
a risk factor for ACS.
Editors' Choice
Comparison of clinical features between patients with acute
exacerbation of idiopathic interstitial pneumonia and collagen
vascular disease-associated interstitial pneumonia
Yuki Kata, Yu Hara, Kota Murohashi, Yusuke Saigusa, Ryo Nagasawa,
Yoichi Tagami, Hiroaki Fujii, Ayako Aoki, Yurika Nishikawa,
Katsushi Tanaka, Keisuke Watanabe, Nobuyuki Horita,
Nobuaki Kobayashi, Masaki Yamamoto, Makoto Kudo
and Takeshi Kaneko
pg(s) 602 - 611
<Abstract> - < PDF >
Acute exacerbation (AE) of interstitial pneumonia (IP) shows poor prognosis, due to the typical
histological pattern of diffuse alveolar damage superimposed upon lung fibrosis. The previous reports
comparing clinical features between AE of idiopathic interstitial pneumonias (IIPs) and those of IPs with
known etiology are limited. We retrospectively compared clinical parameters including age, sex, Charlson
Comorbidity Index score (CCIS), blood biomarkers at diagnosis of AE, treatment, and 3-month mortality
between patients with AE of IIPs and collagen vascular disease-associated interstitial pneumonia (CVD-IP).
We assessed 85 patients, comprising 66 patients with AE of IIPs (78%) and 19 patients with AE of CVD-IP
(22%). The least absolute shrinkage and selection operator regression selected CCIS (hazard ratio, 1.281;
95% confidence interval, 1.055–1.556; P = 0.012) and log serum lactate dehydrogenase (LDH) (hazard ratio,
6.267; 95% confidence interval, 2.172–18.085; P < 0.001) as significant predictors of 3-month mortality
among these patients. Also, the adjusted survival curves using sex, CCIS, and serum LDH showed no
significant differences between these two groups. In conclusion, among AE patients, CCIS and serum
LDH level may be more important prognostic factors for 3-month mortality rather than two classification
of IP subtypes: IIPs and CVD-IP.
NOTE
The usefulness of the apparent diffusion coefficient value
in diagnosing acute spinal cord ischemia
Norikazu Koori, Joe Senda and Takehiro Naito
pg(s) 612 - 618
<Abstract> - < PDF >
The purpose of our study was to assess the usefulness of the apparent diffusion coefficient (ADC) value
in differentiating between a normal spinal cord and a spinal cord with acute ischemia. Control group of
113 and 8 acute spinal cord ischemia patients were enrolled in this study. The ADC values were measured
when diffusion-weighted imaging was first performed after the onset of acute spinal cord ischemia. The
mean ADC value each of the control group and acute spinal cord ischemia patients was 0.99 ± 0.19
× 10–3 mm2/s and 0.70 ± 0.15 × 10–3 mm2/s. The mean ADC value in patients with acute spinal cord
ischemia was significantly lower than that in patients with a normal spinal cord (P < 0.01). We found the
cutoff ADC value (0.86 × 10–3 mm2/s) to be a useful indicator of acute spinal cord ischemia (sensitivity
= 100.0%, specificity = 71.7%, AUC = 0.92). In conclusions, it is suggested that the ADC value may be
useful in the diagnosis of acute spinal cord ischemia.
CASE REPORTS
A rare case of the axillary necrotizing fasciitis
Hiroki Ito, Shinsuke Takeda, Yuji Matsuno, Hiroshi Takahashi
and Ken-Ichi Yamauchi
pg(s) 619 - 625
<Abstract> - < PDF >
Necrotizing fasciitis is a rapidly progressive, life-threatening soft tissue infection that needs acute
surgical intervention and other types of supportive care. The upper extremities are a less frequent site for
this infection than the lower extremities. Axillary necrotizing fasciitis is quite rare and bears a high risk
of iatrogenic neurovascular injuries. We report a severe case of a 39-year-old man with a right axillary
necrotizing fasciitis caused by Streptococcus pyogenes. While dealing with important nerves and blood
vessels at the initial emergency surgery, we marked and preserved them with vascular tapes. The patient
underwent several surgical interventions for infection control in addition to supportive care to avoid limb
loss and to survive. Intraoperatively, the locations of nerves and vessels could be easily found by checking
the vessel tapes. Twelve months after the initial admission, the patient had no symptoms of nerve injuries
and resumed work. With necrotizing fasciitis, the risk of an iatrogenic nerve injury exists even if limb
amputation is avoided due to repeated debridement. We report that marking and preserving nerves and
blood vessels with vascular tapes at the initial surgery may make the subsequent ones easier and may
reduce iatrogenic neurovascular injury.
Cardiac rehabilitation in a heart-failure patient using
customized “cardiac support net” treatment: a case report
Kiyonori Kobayashi, Toshiaki Akita, Sho Akita, Hideki Ito,
Sachie Terazawa, Masato Mutsuga and Akihiko Usui
pg(s) 626 - 634
<Abstract> - < PDF >
At our hospital, we are conducting the “Clinical Study of a Patient-Specific Cardiac Support Net for
Dilated Cardiomyopathy (jRCTs042180025)”, a multi-facility clinical study of a customized cardiac support
net (CSN). Here, we describe the cardiac rehabilitation (CR) of a heart failure (HF) patient after CSN
treatment. The patient was a 65-year-old man who exhibited dilated cardiomyopathy (DCM) because of left
ventricular non-compaction; his New York Heart Association status was class III. In November 2019, he
received CSN treatment. The early CR program was adapted for this patient, and his postoperative course
was uneventful. Functional measurements showed improved leg-muscle strength (before treatment: 61.4%
BW; at discharge: 77.3% BW). During long-term follow-up, the patient’s exercise tolerance increased, as
shown by 6-minute walk distance (before treatment: 576 m; long-term follow-up: 600 m) and peak oxygen
uptake (before treatment: 12.5 mL/kg/min; long-term follow-up: 13.3 mL/kg/min). In the 2 years since
discharge, the patient has not been hospitalized for HF. This report is the first to show that the CSN can
be used to perform a CR program in a DCM patient without significant functional decline.
Vascular perforation of umbilical venous catheter and
awaiting it to be shallow
Akinobu Taniguchi, Masahiro Hayakawa and Yoshiaki Sato
pg(s) 635 - 638
<Abstract> - < PDF >
The patient was a boy born at 23 weeks and 0 days of gestation weighed 401 g at birth. For treatment,
an umbilical venous catheter was placed but the catheter perforated a blood vessel. We thought that
prompt removal of the catheter would lead to massive bleeding, so we kept the catheter in place at the
umbilicus, waited for weight gain, and removed it after confirming that the catheter tip had spontaneously
become shallow and was in the umbilical vein. This procedure allowed us to handle the patient without
major problems.
Local hyperthermia with built-in endoscopy for
radioresistant cervical cancer: a case series
Nobuhisa Yoshikawa, Yoshiyuki Itoh, Tetsuya Matsukawa,
Mariko Kawamura, Keiichiro Yamada, Seiji Nakamura
and Hiroaki Kajiyama
pg(s) 639 - 647
<Abstract> - < PDF >
We evaluated the efficacy and safety of an endoscope-embedded transvaginal laser hyperthermia system
for superficial cervical cancer that remained in the cervix after radiotherapy. We developed an innovative
endoscope-embedded hyperthermia system consisting of a diode laser device, a temperature control unit,
an endoscope control unit, and a transvaginal probe. Superficial lesions of recurrent or residual cervical
cancer on the uterine cervix or vaginal wall after radiotherapy were eligible for this study. A total of
four cases of three patients were eligible for this treatment. Case 1: The post-chemoradiotherapy residual
tumor of a patient with stage IIB squamous cell carcinoma of the cervix was treated with the device.
Two months after the laser hyperthermia treatment, the tumor’s disappearance was confirmed. Case 2: A
post-hysterectomy persistent tumor on the vaginal stump of a patient with stage IIB adenocarcinoma of
the cervix was subjected to the laser hyperthermia treatment. Two months after the treatment, the stump’s
cytology was false positive. Case 3: As in case 2, this patient’s recurrence in the anterior vaginal wall was
subjected to laser hyperthermia treatment, but the tumor’s growth was not controlled. Case 4: A tumor at
the vaginal margin was identified during a salvage hysterectomy in a patient with stage IIB squamous cell
carcinoma of the cervix who underwent chemoradiotherapy. After laser hyperthermia treatment, the tumor’s
disappearance was confirmed. Our new endoscope-embedded laser hyperthermia system can be a candidate
for treating residual superficial cervical cancer after radiotherapy by accurately capturing superficial lesions.