Ebstein's anomaly is a rare congenital heart disease. A 51-year-old man was hospitalized due to Ebstein's anomaly with severe congestive heart failure. He underwent Hetzer's procedure for tricuspid valve incompetence and right atrial isolation technique to restore the sinus rhythm. The postoperative course was uneventful, he was discharged from the hospital on the 21st day after the operation. The cardiothoracic ratio reduced from 74% before the operation to 60%. And his New York Heart Association functional class also improved from III to I after discharge. Hetzer's procedure for tricuspid valve repair in Ebstein's anomaly restructures the valve mechanism at the level of the true tricuspid annulus by using the most mobile leaflet for valve closure without placation of the atrialized chamber. We thus conclude that Hetzer's procedure, with anatomical evaluation of the malformed tricuspid valves before or during the operation, is beneficial as a simple and reproducible method for the repair of certain cases of Ebstein's anomaly.

We describe an extremely rare case of advanced pure primary ovarian squamous cell carcinoma (SCC), treated by adjuvant chemotherapy with dose-dense paclitaxel combined with carboplatin (dd-TC) plus the combination chemotherapy with irinotecan and cisplatin (CPT-P), with long-term recurrence-free survival. A 71-year-old woman complaining of lower abdominal pain was referred to our hospital and a 7-cm-diameter solid tumor was identified. She was diagnosed with a left ovarian tumor that was highly suspicious for malignancy based on ultrasonography, magnetic resonance imaging, and contrast-enhanced computed tomography. Bilateral salpingo-oophorectomy, low-anterior colon resection, and colostomy were performed. Intra- and post-operative histopathological diagnosis revealed International Federation of Gynecology and Obstetrics stage IIIc well-differentiated pure ovarian SCC. As adjuvant chemotherapy, 2 courses of dd-TC were administered, followed by 3 courses of CPT-P; the patient then underwent 4 additional courses of dd-TC. Both regimens were effective and there has been no recurrence or metastasis thus far in the 5 years since the operation.
Abdominal Pain ; Aged ; Carboplatin* ; Carcinoma, Squamous Cell* ; Chemotherapy, Adjuvant ; Cisplatin ; Colon ; Colostomy ; Diagnosis ; Drug Therapy, Combination ; Epithelial Cells* ; Female ; Gynecology ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Obstetrics ; Ovarian Neoplasms ; Paclitaxel* ; Recurrence ; Ultrasonography

In order to assess the prevalence of carotid artery disease in patients with arteriosclerosis obliterans (ASO) or aortic aneurysm, 142 patients underwent screening for the presence of carotid atherosclerosis (plaque) with B-mode ultrasonography. Seventy-four (87.1%) of the 85 patients with ASO and 37 (64.9%) of the 57 patients with aortic aneurysm had carotid artery lesions. Of these patients, about half had bilateral lesions. The differences in the prevalence of carotid lesions were not significantly related to age or sex. Prevalence did not differ in relation to the severity or location of the primary lesions. The majority of the carotid lesions were located in the internal carotid arteries. The prevalence of carotid lesions was higher among patients with cerebral infarction than in those without any lesions on computed tomography. These results showing high prevalence of carotid lesions in ASO and aortic aneurysm suggest the usefulness of routine carotid ultrasonographic screening and also that it is important in order to determine the correct treatment for these cases.

The purpose of this cross-sectional study is to investigate the difference in physical activity among elderly living in different areas in Japan (“Bunkyo Ward in Tokyo” (Bunkyo) and “Fuchu City in Tokyo” (Fuchu) as urban areas, and “Oyama Town in Shizuoka” (Oyama) as a non-urban area). Participants were 1859 community-dwelling residents aged 65-74 years, randomly selected from the residential registry (response rate: 68.9%). A mail survey using self-administered questionnaires was conducted. Multivariate logistic regression analyses were used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (95% CI) of various types of physical activity (eg, walking (Walking), going out (Going-out), bicycling (Bicycling), exercise habits (Exercise)), according to residential areas (reference category: Fuchu), stratified by gender, adjusting for socio-demographic variables. There was a significant difference in Going-out (ORs = 0.61 (95% CI: 0.44-0.86) for men, 0.48 (0.33-0.69) for women)), and Bicycling (0.04 (0.03-0.07) for men, 0.04 (0.02-0.07) for women) in Oyama compared to Fuchu. Furthermore, for women, there was a significant difference in Walking (0.56 (0.38-0.81)) and Exercise (0.59 (0.41-0.85)) in Oyama compared to Fuchu. There was a significant difference in Bicycling and Going-out for men in Bunkyo compared to Fuchu, but there was not a significant difference in other items. Low physical activity levels were observed in the elderly in the non-urban area compared to urban areas. The association was stronger in women. Regional difference might need to be taken into account for an effective physical activity intervention.

  To the best of our knowledge, there are few reports on acquirement of medical skills of infection control using a scenario simulation program. We report the development of a education program using scenario-based simulation named Infection Control Training Course （ICTC）. The three main aims of this course are basic comprehension of standard precautions and contact precautions, acquirement of skills for wearing and removal of personal protective equipment （PPE）, and precise selection of PPE for various situations.
・For the materials and methods, 225 medical staff members taking part in the ICTC at TMU participated in the study. Investigations using a questionnaire about standard precaution, contact precaution and PPE selection were carried out for the pre-course and post-course of the day. In addition, the satisfaction level was evaluated using free score text.
・The return rates of the completed questionnaire for investigating these areas were 88.4% （pre-course） and 95.1% （post-course）. Among all the items investigated, improvements were verified statistically （Wilcoxon signed-rank test）. The satisfaction level was 94.7 ± 9.4 points.
・In conclusion, the ICTC was considered to be effective for acquiring medical skills of infection control, particularly basic comprehension regarding standard precaution, contact precaution and precise PPE selection using a scenario simulation program.

Three patients with hypersensitivity pneumonitis caused by inhalation of spores of Cortinus shiitake (Lentinus edodes) cultivated in vinyl houses were observed. These three patients developed the disease after harvesting shiitake for several hours in closed frame houses with a heater in the autum and winter. The frames were full of spores of shiitake and the patients suffered from a discordant feeling, systemic weakness, a feeling of cold, fever (over 38 C), a feeling of airway occlusion, a slight cough and sputum. These symptoms disappeared during rest the next day.
Case 1 was examined by the inhalation provocation test with a suspension of shiitake spores and spore-allergen. This test caused several clinical symptoms (fever, airway occlusion and various symptomatic feelings), leucocytosis, decrease of PaO₂ a positive reaction of CRP and X-ray findings (appearance of interstitial pneumonitis shadows).
The 3 patients were considered to be suffering from allergic hypersensitivity pneumonitis due to inhalation of spores of Cortinus shiitake, because of their work, the development of symptoms after work in specific occupational conditions, a positive reaction to precipitating antibody against spore-allergen of shiitake, negative reactions to precipitation antibodies to 11 molds-allergens, various abnormal values in immunological tests and a positive reaction in a provocation test in one case.
In a survey of 45 shiitake-grower, it was found that 6 (13.3%) suffered from respiratory disease. No difference was found in the incidence of intracutaneous reactions to spore-allergen or allergen of dried shiitake in non-farm workers. Among 31 growers of shiitake a precipitation antibody to spore-allergen was observed only in these three patients. These results indicate that an allergic disposition is very important for development of hypersensitivity pneumonitis.

Background/Aims: Immune checkpoint blockade has recently been reported to be effective in treating microsatellite instability (MSI)-high tumors. Therefore, sufficient sampling of histological specimens is necessary in cases of unresectable pancreatic cancer (UR-PC). This multicenter study investigated the efficacy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) using a Franseen needle for MSI evaluation in patients with UR-PC. Methods: A total of 89 patients with UR-PC who underwent endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) or EUS-FNB using 22-G needles at three hospitals in Japan (2018–2021) were enrolled. Fifty-six of these patients (FNB 23 and FNA 33) were followed up or evaluated for MSI. Patient characteristics, UR-PC data, and procedural outcomes were compared between patients who underwent EUS-FNB and those who underwent EUS-FNA. Results: No significant difference in terms of sufficient tissue acquisition for histology was observed between patients who underwent EUS-FNB and those who underwent EUS-FNA. MSI evaluation was possible significantly more with tissue samples obtained using EUS-FNB than with tissue samples obtained using EUS-FNA (82.6% [19/23] vs. 45.5% [15/33], respectively; p<0.01). In the multivariate analysis, EUS-FNB was the only significant factor influencing the possibility of MSI evaluation. Conclusions EUS-FNB using a Franseen needle is desirable for ensuring sufficient tissue acquisition for MSI evaluation.

Evidence is growing on adverse health outcomes associated with less physical activity (PA) and more sedentary behavior (SB). As most workers generally spend approximately one-third of the day at work, measuring the amount of occupational PA/SB time would contribute to understanding the health risks of physical inactivity and SB among workers. In this review article, we describe the amount of time spent in different intensities of activity (moderate-to-vigorous PA [MVPA]; light PA [LPA]; and SB), on work and non-work days, while at work and outside working hours among workers. The review used objective measurements made by an accelerometer and showed the proportion of MVPA that office workers engaged in on work and non-work days accounted for 3-5% and 2-4% of accelerometer wear time, respectively. Moreover, office workers spent more time in SB and less time in LPA on work days than non-work days (SB, 66-76% vs. 60-69%; LPA, 20-28% vs. 23-36%). Especially on work days, office workers spent the greatest proportion of the day in SB during working hours (71-82%), compared with that outside working hours (63-67%). The proportion of MVPA accounted for 2-5% during working hours and 3-7% outside working hours. In addition, there were considerable differences in the proportions of LPA and SB between white-collar and blue-collar workers during working hours (SB, 73 vs. 55%; LPA; 22 vs. 40%), whereas the MVPA time was similar (5 vs. 5%). Some occupational exposure to unfavorable PA/SB at work might be unavoidable; however, inadequate PA/SB during working hours should be corrected.