PURPOSE : The purpose of this study is to compare sagittal spinal alignment and mobility among standing and sitting (which are fundamental postures in daily activities), and four point kneeling (FPK: the imitation of quadrupedal animal posture).METHODS : Fifty three healthy young men have participated in this study. Spinal alignment is measured using a non-invasive skin surface measurement device (Spinal Mouse®: Index Ltd, Japan). The spinal alignment is measured in 3 positions: upright, flexion, and extension, in each posture (standing, sitting, and FPK), and then the thoracic and lumbar curvature and sacral slope are analyzed.RESULTS : Even between 2 fundamental positions, upright standing and sitting, the lumbar lordosis is statistically different (17.1±8.9° at upright standing, 3.5±10.0° at upright sitting, p<0.001). But the sacral slope is not different between those 2 positions. The lumbo-pelvic rhythm (lumbar-hip or lumbar-pelvis flexion ratio) is also different among the 3 postures, especially in FPK posture. In this posture the lumbar spine and pelvis (sacrum) move to opposite direction each other; this phenomenon is not observed at standing and sitting postures. CONCLUSION : The spinal alignment and mobility are different in many segments among standing, sitting, and FPK.

We report a patient with gingival metastasis of lung cancer in whom the use of sedatives was successfully avoided by employing holistic care approaches. A 64-year-old man had been receiving chemotherapy with the diagnosis of advanced lung cancer. Eighteen months later, a rapidly growing gingival metastasis was observed. Arterial embolization was performed, but it failed to control the bleeding. No active treatment was performed, and he was subsequently transferred to our hospital. He desired death, with markedly pessimistic views, and wished to undergo deep and continuous palliative sedation (DCPS) due to severe total pain (particularly psychological and spiritual) from the beginning. However, he died peacefully before receiving DCPS. We present a literature review of gingival metastasis from lung cancer, as well as our assessment and palliative care for the total pain of this patient.

Purpose: Escitalopram has been inadequately evaluated in cancer patients. Here, we report two patients with advanced cancer who benefited from escitalopram for depression. Case 1: A man aged in his 50s had postoperative recurrence of rectal cancer. He was diagnosed with a major depressive episode according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). The score of the Hamilton Rating Scale for Depression (HAMD-17) was 20 points. He began treatment with 10 mg/day of escitalopram. His symptoms began to improve at about 14 days, and the HAMD-17 score was 4 points at 23 days, suggesting a marked improvement. Case 2: A woman aged in her 50s had cancer of the external auditory canal. She was diagnosed with a major depressive episode according to DSM-IV-TR. The score of HAMD-17 was 26 points. She began treatment with 10 mg/day of escitalopram. Her symptoms began to improve at 15 days, and the HAMD-17 score at 28 days was 13 points, suggesting a marked improvement. In both cases, serious side effects, clear exacerbation of depression, and withdrawal syndrome due to acute drug deprivation associated with worsening of the symptoms were not noted. Conclusion: Escitalopram is considered a useful drug for depression in patients with advanced cancer.

　　The platelet counts documented in most of the studies using the fully automated hematology analyzer XE-5000 are values measured by impedance technology (PLT-I). If blood specimens showing an anomalous particle-size distribution curve in the area where platelet counts are low are used (exceptionally low platelet count samples), the counting method is automatically switched over to an optical method (PLT-O). In the present study, we examined the usefulness of the XE-5000 by comparing PLT-I with PLT-O, using blood samples with low platelet counts collected from patients who visited our hospital between January 1 and March 31, 2012. Dilution linearity left nothing to be desired in either of the two, but simultaneous reproducibility was higher in PLT-O than in PLT-I. The correlations of PLT-I and PLT-O with visual counts were high, working out at r＝0.889～0.984. In the exceptionally low platelet count samples, the correlation coefficient was high in PLT-O than in PLT-I. The cases showing low platelet counts frequently presented giant platelets and/or red cell fragments. Therefore, measuring the samples with low platelet counts requires a high degree of precision. In the samples with exceptionally low platelet counts, PLT-O exceeded PLT-I in simultaneous reproducibility and correlation with visual counts. Thus, our study demonstrated the usefulness of the XE-5000 that could enumerate PLT-O automatically and speedily.

When patients hospitalized in a palliative care unit die, particularly when their deaths were not peaceful ones, we, as health professionals, feel distressed, senses of helplessness and defeat, and even regret. However, busy daily clinical practice usually does not allow us to express these feelings. After going through such an experience repeatedly, your self-efficacy may be reduced and you could feel burned out. In this study, through the experience of coping with the death of a liver cancer patient who died of necrotizing fasciitis resulted from bedsore, a death conference was organized for us, health professionals who had been directly concerned with the patient, to discuss questions, conflicts, and dilemmas that arose when we provided care and express feelings that had been repressed. And other participants in the conference, who had not been directly concerned with the patient, gave their affirmative views. The conferences served to: (1) promote mutual understanding, trustful relationships, and teamwork among us, (2) increase our awareness of palliative care, and (3) allow us to cope with stress and prevent us from feeling burned out. These effects are considered to help implement improved health care. In the former part of the conference remarks were divided into three categories, (1) regret, (2) questions, conflicts, and dilemmas, and (3) senses of helplessness and defeat, and in the latter part affirmative views were mainly stated.

BACKGROUND: We investigated the association between psychological distress and oral health status/oral health-related quality of life (OHQoL) in Japanese community-dwelling people. METHODS: We conducted a cross-sectional study using data from the Nagasaki Islands Study. A total of 1183 (455 men and 728 women) has been analyzed in this study. Psychological distress was measured using the Kessler Psychological Distress Scale (K6). Oral health status was measured by dental examination. The OHQoL was measured using the General Oral Health Assessment Index (GOHAI). We defined the total score of ≥5 points on the K6 as high psychological distress (high-K6 group). RESULTS: The multiple linear regression analysis to identify the GOHAI showed that gender, K6, the total number of teeth, the number of dental caries, and visiting a dental clinic within the past 6 months significantly associated with the GOHAI. Among all of these variables, high-K6 (≥ 5) was a substantial contributing factor of the GOHAI (β = - 0.23, 95% Cl - 2.31 to -1.41, p < 0.0001). CONCLUSIONS It is likely that the individual with high psychological distress was strongly related to poor OHQoL even in the general population.
Aged ; Cross-Sectional Studies ; Dental Caries/epidemiology* ; Female ; Humans ; Independent Living/statistics & numerical data* ; Japan/epidemiology* ; Linear Models ; Male ; Middle Aged ; Oral Health/statistics & numerical data* ; Quality of Life/psychology* ; Sex Factors ; Stress, Psychological/epidemiology*

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

BACKGROUND: Human T cell leukemia virus type-1 (HTLV-1) stimulates inflammation activity. Our previous study revealed a positive association between asymptomatic HTLV-1 infection and advanced periodontitis among elderly Japanese individuals with low levels of hematopoietic activity (reflected by reticulocyte levels). Since low hematopoietic activity has been correlated with low-grade inflammation and low-grade inflammation is associated with atherosclerosis, the status of atherosclerosis could, in turn, determine the nature of this association. METHODS: To this end, a cross-sectional study of 907 elderly Japanese individuals (aged 60-99 years), who had participated in dental health check-up during the period 2016-2018, was conducted. Advanced periodontitis was defined as periodontal pocket ≥ 6.0 mm. RESULTS: Among the study population, 295 (32.5%) were found to have atherosclerosis defined as a carotid intima-media thickness (CIMT) of ≥ 1.1 mm. HTLV-1 infection was positively associated with advanced periodontitis in participants with atherosclerosis, but no significant associations were observed among the participants without atherosclerosis. The known risk factors' (including reticulocyte and CIMT) adjusted odds ratio (OR) and 95% confidence interval (CI) of advanced periodontitis were OR 2.01 and 95% CI 1.06-3.81 for participants with atherosclerosis and OR 0.61 and 95% CI 0.34-1.12 for participants without atherosclerosis. CONCLUSION This study found a significant association between HTLV-1 infection and advanced periodontitis among elderly Japanese with atherosclerosis. However, this association is absent in individuals without atherosclerosis, suggesting that atherosclerosis might act as a determinant in the association between HTLV-1 infection and advanced periodontitis among elderly Japanese.