Objective: We experienced a case with recurring constipation and diarrhea caused by morphine for relieving cancer pain, who were well managed with oral administration of misoprostol. Subject: The patient was a male in his 70s with recurrent bladder cancer following primary surgery, developed bone metastasis to right side pelvis and exhibited cancer-related pain. To alleviate the resting pain, he underwent radiotherapy and received a sustained preparation of morphine sulfate, that lead to difficulty in bowel movements (repeated constipation and diarrhea) and abdominal distension which was intractable with routine administration of laxatives. Misoprostol, a prostaglandin E1 derivatives, which was reported to have an ability to control the bowel movement was administered at a dose of 800μg/day, and the patient subsequently achieved the improvement of bowel dysfunction and resumed regular self-defecation. Discussion: Misoprostol do not only accelerate small intestine movement but also inhibits water and sodium absorption. In this case, it is suggested that the pharmacological properties of misoprostol enabled to improve bowel movement. We consider that misoprostol is useful as one of the medications for refractory constipation caused by opioid administration. Palliat Care Res 2008:3(1);301-304

Purpose: The effectiveness of a flow chart of medication for cancer pain treatment was investigated. This flow chart was developed at Sasebo Chuo Hospital, and calls for the early introduction of controlled-release oxycodone tablets in combination with prescribing of a rescue dose and agents to prevent adverse reactions such as nausea, vomiting, and constipation. Method: The flow chart was used with a group of 29 patients (FC group), but not with a group of 35 patients (non-FC group). The rate of titration, which was adjustment of opioid dosage to achieve cancer pain control, and time required to achieve titration were compared between these two groups. Results: The titration rate of the FC group was 93.1% and that of the non-FC group was 80.0%. Medication was changed to another opioid for 4 patients in the non-FC group because of nausea and vomiting. The time required to achieve titration was 3.8±2.2 days in the FC group and 5.3±3.0 days in the non-FC group, and a significant difference was noted (p=0.048). Conclusion: The use of this flow chart with its early introduction of opioid controlled-release oxycodone tablets appears to be effective in achieving cancer pain control at an early stage.

We examined pharyngeal nerve courses in paraffin-embedded sagittal sections from 10 human fetuses, at 25-35 weeks of gestation, by using S100 protein immunohistochemical analysis. After diverging from the glossopharyngeal and vagus nerves at the level of the hyoid bone, the pharyngeal nerves entered the constrictor pharyngis medius muscle, then turned upward and ran superiorly and medially through the constrictor pharyngis superior muscle, to reach either the levator veli palatini muscle or the palatopharyngeus muscle. None of the nerves showed a tendency to run along the posterior surface of the pharyngeal muscles. Therefore, the pharyngeal nerve plexus in adults may become established by exposure of the fetal intramuscular nerves to the posterior aspect of the pharyngeal wall because of muscle degeneration and the subsequent rearrangement of the topographical relationship between the muscles that occurs after birth.
Adult ; Fetus ; Glossopharyngeal Nerve ; Humans ; Hyoid Bone ; Muscles ; Parturition ; Pharyngeal Muscles ; Pregnancy ; Vagus Nerve

Objective: This study aims to investigate the drinking behavior on the remote islands of Okinawa Prefecture.Patients/Materials and Method: This was a cross-sectional study conducted with residents of Okinawa Prefecture’s small, isolated islands. Between October 1 and December 3, 2014, island residents over 20 years of age who visited island clinics for an annual health checkup or influenza vaccination were recruited. An anonymous entry survey was administered to those who provided their consent. The survey included information on age, sex, presence or absence of drinking, age at drinking initiation, smoking status, comorbidities, and family and social background. The Alcohol Use Disorder Identification Test (AUDIT) was used to assess alcohol consumption. Participant characteristics were analyzed descriptively, and logistic regression analysis was conducted to assess relationships between the high-risk drinking group (AUDIT score ≥10 points) and other measured variables (age, sex, age at drinking initiation, smoking, residence, and employment status).Results: Compared to the results of a national survey in 2013, there was a significantly higher prevalence of male island residents who drank ≥40 g of alcohol per day and female island residents who drank ≥20 g/day, levels which are considered risk factors for lifestyle diseases. Among both male and female island residents, there were significantly higher proportions of those with AUDIT scores ≥8 points, referred to as high-risk drinkers, and those with AUDIT scores ≥20, individuals considered to have probable alcohol dependence, as compared to the results of the national survey. In a logistic regression analysis, factors related to high-risk drinking included younger age, male sex, smoking history, inoccupation, and underage drinking initiation.Conclusion: This is the first report on drinking behavior among inhabitants of Okinawa’s remote islands. The degree of alcohol consumption is serious and must be recognized as a regional health problem.

Background/Aims: The frequency and details of nonalcoholic fatty liver disease (NAFLD) complications in patients with inflammatory bowel disease (IBD) remain unclear. This study aimed to clarify characteristics of NAFLD in patients with IBD. Methods: We retrospectively identified and enrolled patients with IBD diagnosed with or without NAFLD by undergoing abdominal computed tomography (CT) at our institution between 2005 and 2020. The primary endpoint was the complication rate of NAFLD in patients with IBD. Secondary endpoints were the clinical characteristics of nonobese patients with IBD and comorbid NAFLD and their association with nutritional and inflammatory parameters. Results: Twenty-one (21.9%) of 96 eligible patients with IBD also had NAFLD. In nonobese patients (defined as patients with a body mass index <25 kg/m2), C-reactive protein (CRP; P<0.001) and alanine aminotransferase (P=0.018) levels were higher and the albumin level (P=0.005) and prognostic nutritional index (PNI; P=0.002) values were lower in patients with NAFLD than in those without NAFLD. The PNI value was positively correlated (P<0.001) and the CRP level was negatively correlated (P=0.001) with the hepatosplenic ratio. However, in the NAFLD combined group, PNI (P<0.05) and CRP values (P<0.001) were improved over time after CT imaging by continuing IBD treatment. Conclusions Worsening nutritional and inflammatory status in IBD patients is associated with complications of NAFLD. Diagnosis of NAFLD in IBD patients using CT imaging might be useful not only for early detection of NAFLD but also in assessing the need for therapeutic intervention for IBD.

Background/Aims: To date, only thinner-diameter metal stents have been evaluated for unresectable malignant distal biliary obstruction (UR-MDBO). This study investigated the outcomes and optimal cohorts for a 6-mm-diameter fully covered self-expandable metal stent (FCSEMS) compared with those for a 10-mm-diameter FCSEMS. Methods: This single-center retrospective cohort study included patients who underwent initial transpapillary metal stenting for UR-MDBO. Propensity score matching (1:1) analysis was performed. Results: Of 133/68 patients who underwent 6-mm/10-mm-diameter FCSEMS deployment, 59 in each group were selected. The median time to recurrent biliary obstruction was not significantly different between the groups (p=0.46). In contrast, use of the 6-mm-diameter FCSEMS resulted in a significantly reduced incidence of stent-related adverse events (AEs) (p=0.016), especially cholecystitis (p=0.032), and patients aged <70 years were particularly affected by this significant reduction. Among the patients in the end-stage cohort who were unable to continue chemotherapy after FCSEMS deployment, the free rate of stent-related events, including recurrent biliary obstruction and stent-related AEs, was significantly higher in the 6-mm group (p=0.027). Conclusions For UR-MDBO, a 6-mm-diameter FCSEMS can be an optimal and safe option in the younger cohort with a relatively high risk of AEs and in the end-stage cohort requiring safer drainage without interference from stent-related events during times of poor prognosis.

Background/Aims: To date, only thinner-diameter metal stents have been evaluated for unresectable malignant distal biliary obstruction (UR-MDBO). This study investigated the outcomes and optimal cohorts for a 6-mm-diameter fully covered self-expandable metal stent (FCSEMS) compared with those for a 10-mm-diameter FCSEMS. Methods: This single-center retrospective cohort study included patients who underwent initial transpapillary metal stenting for UR-MDBO. Propensity score matching (1:1) analysis was performed. Results: Of 133/68 patients who underwent 6-mm/10-mm-diameter FCSEMS deployment, 59 in each group were selected. The median time to recurrent biliary obstruction was not significantly different between the groups (p=0.46). In contrast, use of the 6-mm-diameter FCSEMS resulted in a significantly reduced incidence of stent-related adverse events (AEs) (p=0.016), especially cholecystitis (p=0.032), and patients aged <70 years were particularly affected by this significant reduction. Among the patients in the end-stage cohort who were unable to continue chemotherapy after FCSEMS deployment, the free rate of stent-related events, including recurrent biliary obstruction and stent-related AEs, was significantly higher in the 6-mm group (p=0.027). Conclusions For UR-MDBO, a 6-mm-diameter FCSEMS can be an optimal and safe option in the younger cohort with a relatively high risk of AEs and in the end-stage cohort requiring safer drainage without interference from stent-related events during times of poor prognosis.

Background/Aims: To date, only thinner-diameter metal stents have been evaluated for unresectable malignant distal biliary obstruction (UR-MDBO). This study investigated the outcomes and optimal cohorts for a 6-mm-diameter fully covered self-expandable metal stent (FCSEMS) compared with those for a 10-mm-diameter FCSEMS. Methods: This single-center retrospective cohort study included patients who underwent initial transpapillary metal stenting for UR-MDBO. Propensity score matching (1:1) analysis was performed. Results: Of 133/68 patients who underwent 6-mm/10-mm-diameter FCSEMS deployment, 59 in each group were selected. The median time to recurrent biliary obstruction was not significantly different between the groups (p=0.46). In contrast, use of the 6-mm-diameter FCSEMS resulted in a significantly reduced incidence of stent-related adverse events (AEs) (p=0.016), especially cholecystitis (p=0.032), and patients aged <70 years were particularly affected by this significant reduction. Among the patients in the end-stage cohort who were unable to continue chemotherapy after FCSEMS deployment, the free rate of stent-related events, including recurrent biliary obstruction and stent-related AEs, was significantly higher in the 6-mm group (p=0.027). Conclusions For UR-MDBO, a 6-mm-diameter FCSEMS can be an optimal and safe option in the younger cohort with a relatively high risk of AEs and in the end-stage cohort requiring safer drainage without interference from stent-related events during times of poor prognosis.

BACKGROUND: School teachers have a possibility toward at-risk Internet addiction (IA) due to increased opportunities to use the Internet, along with the spread of the Internet in recent years. Burnout syndrome (BOS) is found to be one of the symptoms related to unhealthy mental health, especially among teachers. This study aims to research the relationship between at-risk IA and the Internet usage or BOS by conducting a nationwide cross-sectional survey and examining the factors associated with IA. METHOD: This study was a cross-sectional survey by anonymous questionnaire. This survey was a random sampling survey of junior high schools across Japan in 2016. The participants were 1696 teachers at 73 schools (response rate in teachers 51.0%). We asked participants for details of their backgrounds, Internet usage, the Internet Addiction Test (IAT) by Young, and the Japanese Burnout Scale (JBS). We divided the participants into either the at-risk IA group (IAT score ≧ 40, n = 96) or the non-IA group (IAT score < 40, n = 1600). To compare the difference between at-risk IA and non-IA, we used nonparametric tests and t test according to variables. To analyze the relationship between the IAT score and the scores of three factors of the JBS (emotional exhaustion, depersonalization, and personal accomplishment), we used both ANOVA and ANCOVA, adjusted by relevant confounding factors. To clarify the contribution of each independent variable to IAT scores, we used multiple logistic regression analysis. RESULTS: In our study, at-risk IA was associated with using the internet many hours privately, being on the Internet both on weekdays and weekends, playing games, and surfing the Internet. In the relationship between IAT score and BOS factor score, a higher score for "depersonalization" had a positive relationship with at-risk IA, and the highest quartile for "decline of personal accomplishment" had a lower odds ratio with at-risk IA by multiple logistic regression analysis. CONCLUSION We clarified there is a significant relationship between at-risk IA and BOS among junior high school teachers in a nationwide survey. Our results suggest that finding depersonalization at the early stage may lead to the prevention of at-risk IA among teachers. Those who are at-risk of IA may feel personal accomplishment through use of the Internet.
Adult ; Analysis of Variance ; Behavior, Addictive ; psychology ; Burnout, Psychological ; psychology ; Cross-Sectional Studies ; Humans ; Internet ; Japan ; Male ; Middle Aged ; Personal Satisfaction ; Risk Factors ; School Teachers ; psychology ; Schools ; Surveys and Questionnaires

BACKGROUND: We reported that human T cell leukemia virus 1 (HTLV-1) infection is positively associated with atherosclerosis. Recent evidence has revealed a close association of periodontitis with atherosclerosis, endothelial dysfunction, and disruption of the microcirculation. However, the association between HTLV-1 and advanced periodontitis has not been investigated to date. Since hematopoietic activity is closely linked to endothelial maintenance activity and is known to decline with age, we hypothesized that the state of hematopoietic activity influenced the association between HTLV-1 and advanced periodontitis in elderly participants. METHODS: A cross-sectional study was performed including 822 elderly participants aged 60-99 years who participated in a dental health check-up. Advanced periodontitis was defined as a periodontal pocket ≥ 6.0 mm. Participants were classified as having low or high hematopoietic activity according to the median values of reticulocytes. RESULTS: HTLV-1 infection was positively related to advanced periodontitis among participants with lower hematopoietic activity (lower reticulocyte count), but not among participants with higher hematopoietic activity (higher reticulocyte count). The adjusted odds ratio (95% confidence interval) considering potential confounding factors was 1.92 (1.05-3.49) for participants with a lower reticulocyte count and 0.69 (0.35-1.36) for participants with a higher reticulocyte count. CONCLUSIONS Among elderly participants, the association between HTLV-1 infection and advanced periodontitis is influenced by hematopoietic activity. Since hematopoietic activity is associated with endothelial maintenance, these findings provide an efficient tool for clarifying the underlying mechanism of the progression of periodontitis among elderly participants.
Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Female ; HTLV-I Infections ; physiopathology ; Hematopoiesis ; physiology ; Human T-lymphotropic virus 1 ; physiology ; Humans ; Japan ; epidemiology ; Male ; Middle Aged ; Odds Ratio ; Periodontitis ; epidemiology ; virology ; Prevalence ; Risk Factors