1.Effects of background factors on subjective health and survival rate among community-dwelling persons
Shu Koito ; Ryuichi Kawamoto ; Moeko Suzuki ; Asuka Uemoto ; Teru Kumagi ; Daisuke Ninomiya ; Masanori Abe
An Official Journal of the Japan Primary Care Association 2015;38(3):214-220
Background : With the recent progression of the aging society in Japan, what is now seen as important is not simply treatment of disease alone, but also increased quality of life. We have investigated the correlation between the feeling of subjective health and mortality after mean 3.8 year among local residents.
Methods : In fiscal 2008, a self-recording questionnaire survey was conducted by mailing the questionnaire to 2,657 local residents. Correlation with deaths after mean 3.8 years was investigated based on the Resident Register. With regard to the evaluation items, as background factors related to death, social life conditions (gender·age), health conditions (history of cardiovascular disease, state of depression, subjective happiness, subjective health)and basic activities of daily living (BADL : walking, diet, excretion, bathing, dressing, and ambulation)were evaluated using a 4-point scale ranging from total assistance to completely independent. The Tokyo Metropolitan Institute of Gerontology (TMIG : instrumental independence, intellectual activity, and social role)was used to evaluate the lifestyle factors.
Results : Of 1825 subjects, 767 males (mean age : 67±13 years)and 1058 females (mean age : 68±11 years), could be analyzed. There were 91 deaths from 2008 to 2012. Investigation of factors that increased subjective health revealed that age, cardiovascular disease, state of depression, intellectual activities, and subjective happiness were items that showed significant correlation. Multivariate logistic regression analysis revealed that subjective health was a significant explanatory variable of death.
Conclusion : How one personally feels about one's state of health and how one recognizes that, are important. Though not seen physically, they can be considered as important parameters that predict prognosis.
2.Rectosigmoid Localization of Radiopaque Markers for Identifying Defecation Disorders in Patients With Chronic Constipation: A Retrospective Cohort Study
Tatsuya ABE ; Masao KUNIMOTO ; Yoshikazu HACHIRO ; Kei OHARA ; Mitsuhiro INAGAKI ; Masanori MURAKAMI
Journal of Neurogastroenterology and Motility 2021;27(3):419-425
Background/Aims:
Defecation disorders (DD) are part of the spectrum of chronic constipation with outlet obstruction. Although anorectal physiologic tests are required for the diagnosis of DD, these tests are not available in many institutions. This study aims to investigate the predictivity of DD using rectosigmoid localization of radiopaque markers in a colonic transit study.
Methods:
A total of 169 patients with refractory constipation with a mean age of 67 years were studied. All patients underwent anorectal manometry, a balloon expulsion test, and a colonic transit study. Barium defecography was performed if needed. The relationship between DD diagnosed by these anorectal tests and the rectosigmoid accumulation of markers was examined.
Results:
Seventy-nine (46.7%) patients were identified to have DD based on anorectal test combinations. Rectosigmoid accumulation of markers was observed in 39 (23.1%) patients. The sensitivity and positive predictive value of rectosigmoid accumulation for identifying DD were 31.6% and 64.1%, respectively. Rectosigmoid accumulation provided poor discrimination of DD from normal transit constipation, at a specificity of 82.1% but with a sensitivity of only 10.6%. In discriminating DD from slow transit constipation, rectosigmoid accumulation was found to be useful with a positive likelihood ratio of 5.3.
Conclusions
Rectosigmoid accumulation of markers can differentiate DD from slow transit constipation. However, non-rectosigmoid accumulation does not exclude the presence of DD.
3.Rectosigmoid Localization of Radiopaque Markers for Identifying Defecation Disorders in Patients With Chronic Constipation: A Retrospective Cohort Study
Tatsuya ABE ; Masao KUNIMOTO ; Yoshikazu HACHIRO ; Kei OHARA ; Mitsuhiro INAGAKI ; Masanori MURAKAMI
Journal of Neurogastroenterology and Motility 2021;27(3):419-425
Background/Aims:
Defecation disorders (DD) are part of the spectrum of chronic constipation with outlet obstruction. Although anorectal physiologic tests are required for the diagnosis of DD, these tests are not available in many institutions. This study aims to investigate the predictivity of DD using rectosigmoid localization of radiopaque markers in a colonic transit study.
Methods:
A total of 169 patients with refractory constipation with a mean age of 67 years were studied. All patients underwent anorectal manometry, a balloon expulsion test, and a colonic transit study. Barium defecography was performed if needed. The relationship between DD diagnosed by these anorectal tests and the rectosigmoid accumulation of markers was examined.
Results:
Seventy-nine (46.7%) patients were identified to have DD based on anorectal test combinations. Rectosigmoid accumulation of markers was observed in 39 (23.1%) patients. The sensitivity and positive predictive value of rectosigmoid accumulation for identifying DD were 31.6% and 64.1%, respectively. Rectosigmoid accumulation provided poor discrimination of DD from normal transit constipation, at a specificity of 82.1% but with a sensitivity of only 10.6%. In discriminating DD from slow transit constipation, rectosigmoid accumulation was found to be useful with a positive likelihood ratio of 5.3.
Conclusions
Rectosigmoid accumulation of markers can differentiate DD from slow transit constipation. However, non-rectosigmoid accumulation does not exclude the presence of DD.
4.How should we treat acute kidney injury caused by renal congestion?
Masanori ABE ; Seiichiro HEMMI ; Hiroki KOBAYASHI
Kidney Research and Clinical Practice 2023;42(4):415-430
Decreased kidney function is associated with increased risk of cardiovascular events and mortality, and heart failure (HF) is a wellknown risk factor for renal dysfunction. Acute kidney injury (AKI) in patients with HF often is attributed to prerenal factors, such as renal hypoperfusion and ischemia as a result of decreased cardiac output. Another such factor is reduction of absolute or relative circulating blood volume, with the decrease in renal blood flow leading to renal hypoxia followed by a decrease in the glomerular filtration rate. However, renal congestion is increasingly being recognized as a potential cause of AKI in patients with HF. Increased central venous pressure and renal venous pressure lead to increased renal interstitial hydrostatic pressure and a reduction of the glomerular filtration rate. Both decreased kidney function and renal congestion have been shown to be important prognostic factors of HF, and adequate control of congestion is important for improving kidney function. Loop and thiazide diuretics are recommended as standard therapies to reduce volume overload. However, these agents are associated with worsening renal function even though they are effective for improving congestive symptoms. There is growing interest in tolvaptan, which can improve renal congestion by increasing excretion of free water and decreasing the required dose of loop diuretic, thereby improving kidney function. This review summarizes renal hemodynamics, the pathogenesis of AKI due to renal ischemia and renal congestion, and diagnosis and treatment options for renal congestion.
5.Common Postmortem Computed Tomography Findings Following Atraumatic Death: Differentiation between Normal Postmortem Changes and Pathologic Lesions.
Masanori ISHIDA ; Wataru GONOI ; Hidemi OKUMA ; Go SHIROTA ; Yukako SHINTANI ; Hiroyuki ABE ; Yutaka TAKAZAWA ; Masashi FUKAYAMA ; Kuni OHTOMO
Korean Journal of Radiology 2015;16(4):798-809
Computed tomography (CT) is widely used in postmortem investigations as an adjunct to the traditional autopsy in forensic medicine. To date, several studies have described postmortem CT findings as being caused by normal postmortem changes. However, on interpretation, postmortem CT findings that are seemingly due to normal postmortem changes initially, may not have been mere postmortem artifacts. In this pictorial essay, we describe the common postmortem CT findings in cases of atraumatic in-hospital death and describe the diagnostic pitfalls of normal postmortem changes that can mimic real pathologic lesions.
Adult
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Aged
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Autopsy/instrumentation/*methods
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Brain/pathology/radiography
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Female
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Forensic Medicine/instrumentation/*methods
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Gastrointestinal Tract/pathology/radiography
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Heart/radiography
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Humans
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Lung/pathology/radiography
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Male
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Middle Aged
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Myocardium/pathology
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Postmortem Changes
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Tomography, X-Ray Computed/*methods
6.Adrenal Venous Sampling for Subtype Diagnosis of Primary Hyperaldosteronism
Mitsuhide NARUSE ; Akiyo TANABE ; Koichi YAMAMOTO ; Hiromi RAKUGI ; Mitsuhiro KOMETANI ; Takashi YONEDA ; Hiroki KOBAYASHI ; Masanori ABE ; Youichi OHNO ; Nobuya INAGAKI ; Shoichiro IZAWA ; Masakatsu SONE
Endocrinology and Metabolism 2021;36(5):965-973
Adrenal venous sampling (AVS) is the key procedure for lateralization of primary hyperaldosteronism (PA) before surgery. Identification of the adrenal veins using computed tomography (CT) and intraoperative cortisol assay facilitates the success of catheterization. Although administration of adrenocorticotropic hormone (ACTH) has benefits such as improving the success rate, some unilateral cases could be falsely diagnosed as bilateral. Selectivity index of 5 with ACTH stimulation to assess the selectivity of catheterization and lateralization index (LI) >4 with ACTH stimulation for unilateral diagnosis is used in many centers. Co-secretion of cortisol from the tumor potentially affects the lateralization by the LI. Patients aged <35 years with hypokalemia, marked aldosterone excess, and unilateral adrenal nodule on CT have a higher probability of unilateral disease. Patients with normokalemia, mild aldosterone excess, and no adrenal tumor on CT have a higher probability of bilateral disease. Although no methods have 100% specificity for subtype diagnosis that would allow bypassing AVS, prediction of the subtype should be considered when recommending AVS to patients. Methodological standardization and strict indication improve diagnostic quality of AVS. Development of non-invasive imaging and biochemical markers will drive a paradigm shift in the clinical practice of PA.
7.Glycemic Control Is Associated with Histological Findings of Nonalcoholic Fatty Liver Disease
Teruki MIYAKE ; Shinya FURUKAWA ; Bunzo MATSUURA ; Osamu YOSHIDA ; Masumi MIYAZAKI ; Akihito SHIOMI ; Ayumi KANAMOTO ; Hironobu NAKAGUCHI ; Yoshiko NAKAMURA ; Yusuke IMAI ; Mitsuhito KOIZUMI ; Takao WATANABE ; Yasunori YAMAMOTO ; Yohei KOIZUMI ; Yoshio TOKUMOTO ; Masashi HIROOKA ; Teru KUMAGI ; Eiji TAKESITA ; Yoshio IKEDA ; Masanori ABE ; Yoichi HIASA
Diabetes & Metabolism Journal 2024;48(3):440-448
Background:
Poor lifestyle habits may worsen nonalcoholic fatty liver disease (NAFLD), with progression to nonalcoholic steatohepatitis (NASH) and cirrhosis. This study investigated the association between glycemic control status and hepatic histological findings to elucidate the effect of glycemic control on NAFLD.
Methods:
This observational study included 331 patients diagnosed with NAFLD by liver biopsy. Effects of the glycemic control status on histological findings of NAFLD were evaluated by comparing the following four glycemic status groups defined by the glycosylated hemoglobin (HbA1c) level at the time of NAFLD diagnosis: ≤5.4%, 5.5%–6.4%, 6.5%–7.4%, and ≥7.5%.
Results:
Compared with the lowest HbA1c group (≤5.4%), the higher HbA1c groups (5.5%–6.4%, 6.5%–7.4%, and ≥7.5%) were associated with advanced liver fibrosis and high NAFLD activity score (NAS). On multivariate analysis, an HbA1c level of 6.5%– 7.4% group was significantly associated with advanced fibrosis compared with the lowest HbA1c group after adjusting for age, sex, hemoglobin, alanine aminotransferase, and creatinine levels. When further controlling for body mass index and uric acid, total cholesterol, and triglyceride levels, the higher HbA1c groups were significantly associated with advanced fibrosis compared with the lowest HbA1c group. On the other hand, compared with the lowest HbA1c group, the higher HbA1c groups were also associated with a high NAS in both multivariate analyses.
Conclusion
Glycemic control is associated with NAFLD exacerbation, with even a mild deterioration in glycemic control, especially a HbA1c level of 6.5%–7.4%, contributing to NAFLD progression.
8.Glycemic Control Is Associated with Histological Findings of Nonalcoholic Fatty Liver Disease
Teruki MIYAKE ; Shinya FURUKAWA ; Bunzo MATSUURA ; Osamu YOSHIDA ; Masumi MIYAZAKI ; Akihito SHIOMI ; Ayumi KANAMOTO ; Hironobu NAKAGUCHI ; Yoshiko NAKAMURA ; Yusuke IMAI ; Mitsuhito KOIZUMI ; Takao WATANABE ; Yasunori YAMAMOTO ; Yohei KOIZUMI ; Yoshio TOKUMOTO ; Masashi HIROOKA ; Teru KUMAGI ; Eiji TAKESITA ; Yoshio IKEDA ; Masanori ABE ; Yoichi HIASA
Diabetes & Metabolism Journal 2024;48(3):440-448
Background:
Poor lifestyle habits may worsen nonalcoholic fatty liver disease (NAFLD), with progression to nonalcoholic steatohepatitis (NASH) and cirrhosis. This study investigated the association between glycemic control status and hepatic histological findings to elucidate the effect of glycemic control on NAFLD.
Methods:
This observational study included 331 patients diagnosed with NAFLD by liver biopsy. Effects of the glycemic control status on histological findings of NAFLD were evaluated by comparing the following four glycemic status groups defined by the glycosylated hemoglobin (HbA1c) level at the time of NAFLD diagnosis: ≤5.4%, 5.5%–6.4%, 6.5%–7.4%, and ≥7.5%.
Results:
Compared with the lowest HbA1c group (≤5.4%), the higher HbA1c groups (5.5%–6.4%, 6.5%–7.4%, and ≥7.5%) were associated with advanced liver fibrosis and high NAFLD activity score (NAS). On multivariate analysis, an HbA1c level of 6.5%– 7.4% group was significantly associated with advanced fibrosis compared with the lowest HbA1c group after adjusting for age, sex, hemoglobin, alanine aminotransferase, and creatinine levels. When further controlling for body mass index and uric acid, total cholesterol, and triglyceride levels, the higher HbA1c groups were significantly associated with advanced fibrosis compared with the lowest HbA1c group. On the other hand, compared with the lowest HbA1c group, the higher HbA1c groups were also associated with a high NAS in both multivariate analyses.
Conclusion
Glycemic control is associated with NAFLD exacerbation, with even a mild deterioration in glycemic control, especially a HbA1c level of 6.5%–7.4%, contributing to NAFLD progression.
9.Glycemic Control Is Associated with Histological Findings of Nonalcoholic Fatty Liver Disease
Teruki MIYAKE ; Shinya FURUKAWA ; Bunzo MATSUURA ; Osamu YOSHIDA ; Masumi MIYAZAKI ; Akihito SHIOMI ; Ayumi KANAMOTO ; Hironobu NAKAGUCHI ; Yoshiko NAKAMURA ; Yusuke IMAI ; Mitsuhito KOIZUMI ; Takao WATANABE ; Yasunori YAMAMOTO ; Yohei KOIZUMI ; Yoshio TOKUMOTO ; Masashi HIROOKA ; Teru KUMAGI ; Eiji TAKESITA ; Yoshio IKEDA ; Masanori ABE ; Yoichi HIASA
Diabetes & Metabolism Journal 2024;48(3):440-448
Background:
Poor lifestyle habits may worsen nonalcoholic fatty liver disease (NAFLD), with progression to nonalcoholic steatohepatitis (NASH) and cirrhosis. This study investigated the association between glycemic control status and hepatic histological findings to elucidate the effect of glycemic control on NAFLD.
Methods:
This observational study included 331 patients diagnosed with NAFLD by liver biopsy. Effects of the glycemic control status on histological findings of NAFLD were evaluated by comparing the following four glycemic status groups defined by the glycosylated hemoglobin (HbA1c) level at the time of NAFLD diagnosis: ≤5.4%, 5.5%–6.4%, 6.5%–7.4%, and ≥7.5%.
Results:
Compared with the lowest HbA1c group (≤5.4%), the higher HbA1c groups (5.5%–6.4%, 6.5%–7.4%, and ≥7.5%) were associated with advanced liver fibrosis and high NAFLD activity score (NAS). On multivariate analysis, an HbA1c level of 6.5%– 7.4% group was significantly associated with advanced fibrosis compared with the lowest HbA1c group after adjusting for age, sex, hemoglobin, alanine aminotransferase, and creatinine levels. When further controlling for body mass index and uric acid, total cholesterol, and triglyceride levels, the higher HbA1c groups were significantly associated with advanced fibrosis compared with the lowest HbA1c group. On the other hand, compared with the lowest HbA1c group, the higher HbA1c groups were also associated with a high NAS in both multivariate analyses.
Conclusion
Glycemic control is associated with NAFLD exacerbation, with even a mild deterioration in glycemic control, especially a HbA1c level of 6.5%–7.4%, contributing to NAFLD progression.