The factors that influence the risk of accidents during the replacement of gastrostomy catheters remain unknown and therefore have not yet been thoroughly investigated. We conducted a nationwide questionnaire survey of 415 rehabilitation-training facilities for the replacement of gastrostomy catheters. We received 221 valid responses. Among the catheter replacement methods submitted, the bumper button replacement method was the most widely chosen, comprising 40% of the valid responses. The measures used to prevent accidental erroneous catheterization included examination of the stomach contents, endoscopic examination of the stomach, and the detection of insufflation sounds, although these measures varied widely among the facilities. Fifty-one out of the 221 facilities that responded to the survey experienced various mishaps, of which 20 were due to erroneous catheterization. In approximately 40% of the facilities, there was no operative manual for the replacement nor was the patient's consent taken before performing the procedure. This investigation elucidates the risks involved in the replacement of gastrostomy catheters. This survey also suggests that the methods used for catheter replacement should be re-examined to prevent accidents during the replacement.

Previous research has demonstrated that the concentric muscle strength of knee extension exerted at slow to medium angular velocities is increased by teeth clenching. This study evaluated the isokinetic eccentric strength of knee extensors at 4 angular velocities (60, 120, 180 and 240 degrees per second) with and without teeth clenching on the Cybex 6000 Extremity Testing and Rehabilitation System. Twelve healthy adult male (26.8±1.8 years) volunteered for the study. Peak torque per body weight and average power per body weight were analyzed. The results demonstrated that peak torque per body weight accompanied by teeth clenching was significantly increased at 60, 120, 180 and 240 deg/s by 9.5%, 8.2%, 8.2% and 9.8%, respectively (p<0.01) . Similarly average power per body weight during teeth clenching was significantly higher at 60, 120, 180 and 240 deg/s by 9.1%, 9.5%, 9.4% and 7.7%, respectively (p<0.05) . These findings suggest that teeth clenching is a factor that leads to augmented eccentric strength of knee extensors. Its effect appears to be independent of angular velocity.

A 61-year-old man was found to have an abdominal aortic aneurysm (AAA) during follow-up for ischemic heart disease. On admission, ultrasonograms and computed tomograms revealed a thickened aortic wall surrounded by a soft tissue (so-called mantle). The obstructive right anterior brain artery and stenotic right internal carotid artery were also detected by angiography. Coronary angiography demonstrated multiple stenotic lesions of the coronary arteries. The excised AAA was replaced with an prosthetic graft. The mobilization of the adjacent viscera was kept as little as possible in order to prevent injury to them. We reported a case of “inflammatory” abdominal aneurysm associated with various atherosclerotic lesions.

OBJECTIVETo examine adaptive changes in the shape of the upper airway during titrated mandibular advancement. Furthermore, to understand the mechanism of mandible-adjustable therapy to improve the ventilation.

METHODSFourteen non-apnea participated in the study. A custom-made oral device was used to keep the mandible in titrated advancement at 0% (F0), 50% (F50), 75% (F75), 100% (F100) of the maximum advancement. Magnetic resonance imaging was used to investigate the difference in the shape of upper-airway in these 4 positions. Changes in the anteroposterior direction (AP), lateral direction (Lat) and its ratio (AP/Lat) were calculated, which were transformed into the percentage of the original ones.

RESULTSThe dose-dependent decrease of AP/Lat was found when the mandible was advanced (P = 0.0001). Lateral change rate in percentage increased by degrees (P = 0.0023), while the increase of anteroposterior change rate in percentage showed no statistical significance.

CONCLUSIONThe shape of upper airway tended to be less round. The enlargement of upper airway during titrated mandibular advancement was mainly the result of enlargement in lateral direction.

Asian Continental Ancestry Group ; Humans ; Magnetic Resonance Imaging ; Male ; Mandible ; anatomy & histology ; Mandibular Advancement ; Palate, Soft ; anatomy & histology ; Pharynx ; anatomy & histology

Purpose: To clarify the family-perceived usefulness of a pamphlet for families of imminently dying patients. Methods: Physicians and/or nurses provided medical and practical information about the dying process using a pamphlet for families of imminently dying patients. We surveyed family members 6 months after the death of the patient about the perceived usefulness. Results: We sent out a questionnaire to 325 bereaved, and obtained an answer from 260 (response rate: 85%). Overall, 81% reported the pamphlet to be “very useful” or “useful”. The experience reported by the bereaved included: “Helped me to understand the dying process” (84%); “Helped me to understand how symptoms and changes occur” (76%), “Useful in preparation for patient's death“ (75%), “Helped me to understand the physical conditions of the patient” (75%), “Helped me to know what I can do for the patient” (74%). Conclusion: “A pamphlet for families of imminently dying patients” may be useful for members of an imminently dying patient's family.

We studied maxillofacial fractures treated by departments of oral and maxillofacial surgery in Tokyo. A retrospective review of records and radiographs for patients admitted during the 5-year period from 2000 to 2004 was conducted at five departments in Tokyo. Date, age, gender, cause of injury, fracture site, concomitant injury, domestic violence against women, and treatment were reviewed. 674 patients with maxillofacial fractures were admitted. Male-to-female ratio was 3.6:1. The most frequent age group was 21-25 years. Fractures of the mandible were most frequent (87%), followed by the maxilla (14%) and the zygomatic bone (12%). Thirty-one percent of fractures were due to traffic accidents, 29% to accidental falls, 23% to violence and 14% to sports. The incidence of maxillofacial fractures caused by traffic accidents was lower, and that caused by falls and violence were higher than in other countries. Seventeen percent of the maxillofacial fracture patients had concomitant injuries. The incidence of domestic violence-related maxillofacial fracture was 1.6% of all cases. These cases were mainly caused by a husband (55%) or a sexual partner (36%). Most patients (67%) were treated by open reduction surgery. However, condylar fracture alone was usually treated by closed reduction surgery.

The purpose of this study was to investigate the changes in patellar tendon length during passive knee flexion in the menstrual cycle. The right knee joints of 10 adult women with stable menstrual cycles were evaluated. Measurement of patellar tendon length was performed when the knee joint was bent flexibly at six angles (0°, 30°, 60°, 90°, 110°, and 130°), and the long-axis image of the patellar tendon was transversely superimposed at each angle. A photograph was taken with an ultrasonic device. Measurements were performed once during each of the four phases of the menstrual cycle (menstrual, follicular, ovulatory, and luteal phases) classified by the basal body temperature method. There were no significant differences in patellar tendon length at each knee flexion angle in each phase of the menstrual cycle. In the luteal phase, the patellar tendon was stretched significantly at 90° and 130° compared to knee flexion of 0°.

Background/Aims: Several fine-needle biopsy (FNB) needles are available for endoscopic ultrasound (EUS)-guided tissue acquisition. However, there is disagreement on which type of needle has the best diagnostic yield. The aim of this study was to compare the performance and safety of two commonly used EUS-FNB needles. Methods: We retrospectively analyzed consecutive patients who underwent EUS-FNB between June 2016 and March 2020 in our hospital. Two types of needles were evaluated: a 20-gauge Menghini needle with a lateral forward bevel and a 22-gauge Franseen needle. Rapid on-site evaluation was performed in all the cases. A multivariate analysis was performed to clarify the negative predictive factors for obtaining a histological diagnosis. Propensity score matching was performed to compare the diagnostic yields of these two needles. Results: We analyzed 666 patients and 690 lesions. The overall diagnostic rate of histology alone was 88.8%, and the overall adverse event rate was 1.5%. Transduodenal access and small lesions (≤2 cm) were identified as negative predictive factors for obtaining a histological diagnosis. After propensity score matching, 482 lesions were analyzed. The diagnostic accuracy rates of histology in the M and F needle groups were 89.2% and 88.8%, respectively (p=1.00). Conclusions Both the needles showed high diagnostic yield, and no significant difference in performance was observed between the two.

Background/Aims: Several fine-needle biopsy (FNB) needles are available for endoscopic ultrasound (EUS)-guided tissue acquisition. However, there is disagreement on which type of needle has the best diagnostic yield. The aim of this study was to compare the performance and safety of two commonly used EUS-FNB needles. Methods: We retrospectively analyzed consecutive patients who underwent EUS-FNB between June 2016 and March 2020 in our hospital. Two types of needles were evaluated: a 20-gauge Menghini needle with a lateral forward bevel and a 22-gauge Franseen needle. Rapid on-site evaluation was performed in all the cases. A multivariate analysis was performed to clarify the negative predictive factors for obtaining a histological diagnosis. Propensity score matching was performed to compare the diagnostic yields of these two needles. Results: We analyzed 666 patients and 690 lesions. The overall diagnostic rate of histology alone was 88.8%, and the overall adverse event rate was 1.5%. Transduodenal access and small lesions (≤2 cm) were identified as negative predictive factors for obtaining a histological diagnosis. After propensity score matching, 482 lesions were analyzed. The diagnostic accuracy rates of histology in the M and F needle groups were 89.2% and 88.8%, respectively (p=1.00). Conclusions Both the needles showed high diagnostic yield, and no significant difference in performance was observed between the two.

Objective: In recent years, an association between serum soluble immune checkpoint molecules (sICMs) and malignant tumors has been reported, which may become important biomarkers in the future. Although several reports have suggested a correlation between sICMs and prognosis, their origin is unclear. In this study, changes in serum soluble PD-L1 (sPD-L1) during the perioperative period and its origin were analyzed in patients with lung cancer.Patients and Methods: Patients with lung tumors (n=39) were included. Samples for sPD-L1 measurements were collected at five time points before and after surgery, and their changes over time were analyzed. ELISA was used to measure sPD-L1 levels.Results: Thirty-nine patients with lung tumors (31, males; 8, females; age, 74 (years) ± 7.7 (range: 51–89) years; malignancy/benign, 33/6) were enrolled. Eight cases of driver gene mutation-positive tumors were included. Twenty-eight (72%) patients were smokers, and their performance status was 0-1 in all 39 patients. PD-L1 TPS was ≥50%/1–49%/<1% in 8/10/14 patients. Stage I/II/III/IV/postoperative recurrence of lung cancer was observed in 21/0/6/5/1 patients, respectively. There were no significant correlations between sPD-L1 levels and clinicopathological features and no correlation with PD-L1 TPS. Comparing localized lesions (stages I–III) with advanced lesions (stage IV and postoperative recurrence), the distribution of sPD-L1 was slightly higher in advanced lesions, although the difference was not significant. No obvious changes in sPD-L1 expression were observed before and after surgery.Conclusion: sPD-L1 levels tended to be high in stage III and above lung cancer. There was no change in sPD-L1 levels before and after surgery. sPD-L1 levels did not correlate with the PD-L1 TPS.