1.Loneliness As an Independent Factor for Health and Disability Regardless of Alcohol Habit, Smoking Habit, and Social Relationships: A Questionnaire-Based Cross-Sectional Study in a Rural Area of Japan
Yoshio HISATA ; Takashi SUGIOKA
Journal of the Japanese Association of Rural Medicine 2022;71(1):1-11
We conducted a questionnaire survey to examine the association between loneliness and health with consideration of lifestyle and social relationships in a mountainous rural area of Japan. We used the Japanese versions of the short-form University of California, Los Angeles Loneliness Scale (UCLA score: 3-9 points) and the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS score: 12-48 points). Among 108 respondents (47 men, 61 women), mean age was 74.1 years, 30 (28%) were obese, 40 (37%) had a smoking habit, and 38 (35.1%) had an alcohol habit. Negative social relationships were reported by5 (4.6%) respondents. Mean UCLA score was 4.08 ± 1.34 and mean WHODAS score was 7.68 ± 8.84. Respondents were classified into the loneliness group if the UCLA score was greater than 4 points (58/108, 53,7%) and into the healthy group if the WHODAS score was 7 points or less (66/108, 61.1%). In univariable analysis, lower health status was significantly associated with age > 75 years (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.11-0.73, p = 0.003), female sex (OR 2.82, 95%CI 1.15-7.09, p = 0.01), living alone (OR 0.44, 95%CI 0.14-1.33, p = 0.01), divorce, separation, or bereavement (OR 0.24, 95%CI 0.09-0.60, p < 0.001), ≤ 9 years of education (OR 0.18, 95%CI 0.07-0.46, p < 0.001), unemployed/looking for work (OR 0.9, 95%CI 0.26-0.27, p < 0.001), no alcohol habit (OR 2.66, 95%CI 1.05-7.05, p = 0.02), and loneliness (OR 0.29, 95%CI 0.11-0.72, p = 0.003). On multivariable analysis, loneliness was identified as an independent risk factor for poorer health status (OR 0.11, 95%CI 0.02-0.43, p =0.002) after adjusting for the other significant items on univariable analysis.
2.Histological Architecture of Gastric Epithelial Neoplasias That Showed Absent Microsurface Patterns, Visualized by Magnifying Endoscopy with Narrow-Band Imaging
Kenta CHUMAN ; Kenshi YAO ; Takao KANEMITSU ; Takashi NAGAHAMA ; Masaki MIYAOKA ; Haruhiko TAKAHASHI ; Kentaro IMAMURA ; Rino HASEGAWA ; Toshiharu UEKI ; Hiroshi TANABE ; Seiji HARAOKA ; Akinori IWASHITA
Clinical Endoscopy 2021;54(2):222-228
Background/Aims:
The objective of this study was to elucidate the histological structure of the absent microsurface patterns (MSPs) that were visualized by magnifying endoscopy with narrow-band imaging (M-NBI).
Methods:
The study included consecutive gastric epithelial neoplasias for which M-NBI findings and histological findings could be compared on a one-to-one basis. The lesions were classified as absent MSPs and present MSPs based on the findings obtained using M-NBI. Of the histopathological findings for each lesion that corresponded to M-NBI findings, crypt opening densities, crypt lengths, crypt opening diameters, intercrypt distances, and crypt angles were measured and compared.
Results:
Thirty-six lesions were included in the analysis; of these, 17 lesions exhibited absent MSP and 19 lesions exhibited present MSP. Comparing the histological measurements for absent MSPs vs. present MSPs, median crypt opening density was 0.9 crypt openings/mm vs. 4.8 crypt openings/mm (p<0.001), respectively. The median crypt length, median crypt opening diameter, median intercrypt distance, and median crypt angle were 80.0 μm vs. 160 μm (p<0.001), 40.0 μm vs. 44.2 μm (p=0.09), 572.5 μm vs. 166.7 μm (p<0.001), and 21.6 degrees vs. 15.5 degrees (p<0.001), respectively.
Conclusions
Histological findings showed that lesions exhibiting absent MSPs had lower crypt opening density, shorter crypt length, greater intercrypt distance, and larger crypt angle.
3.Histological Architecture of Gastric Epithelial Neoplasias That Showed Absent Microsurface Patterns, Visualized by Magnifying Endoscopy with Narrow-Band Imaging
Kenta CHUMAN ; Kenshi YAO ; Takao KANEMITSU ; Takashi NAGAHAMA ; Masaki MIYAOKA ; Haruhiko TAKAHASHI ; Kentaro IMAMURA ; Rino HASEGAWA ; Toshiharu UEKI ; Hiroshi TANABE ; Seiji HARAOKA ; Akinori IWASHITA
Clinical Endoscopy 2021;54(2):222-228
Background/Aims:
The objective of this study was to elucidate the histological structure of the absent microsurface patterns (MSPs) that were visualized by magnifying endoscopy with narrow-band imaging (M-NBI).
Methods:
The study included consecutive gastric epithelial neoplasias for which M-NBI findings and histological findings could be compared on a one-to-one basis. The lesions were classified as absent MSPs and present MSPs based on the findings obtained using M-NBI. Of the histopathological findings for each lesion that corresponded to M-NBI findings, crypt opening densities, crypt lengths, crypt opening diameters, intercrypt distances, and crypt angles were measured and compared.
Results:
Thirty-six lesions were included in the analysis; of these, 17 lesions exhibited absent MSP and 19 lesions exhibited present MSP. Comparing the histological measurements for absent MSPs vs. present MSPs, median crypt opening density was 0.9 crypt openings/mm vs. 4.8 crypt openings/mm (p<0.001), respectively. The median crypt length, median crypt opening diameter, median intercrypt distance, and median crypt angle were 80.0 μm vs. 160 μm (p<0.001), 40.0 μm vs. 44.2 μm (p=0.09), 572.5 μm vs. 166.7 μm (p<0.001), and 21.6 degrees vs. 15.5 degrees (p<0.001), respectively.
Conclusions
Histological findings showed that lesions exhibiting absent MSPs had lower crypt opening density, shorter crypt length, greater intercrypt distance, and larger crypt angle.
4.Trough level of infliximab is useful for assessing mucosal healing in Crohn's disease: a prospective cohort study.
Akihiro KOGA ; Toshiyuki MATSUI ; Noritaka TAKATSU ; Yasumichi TAKADA ; Masahiro KISHI ; Yutaka YANO ; Takahiro BEPPU ; Yoichiro ONO ; Kazeo NINOMIYA ; Fumihito HIRAI ; Takashi NAGAHAMA ; Takashi HISABE ; Yasuhiro TAKAKI ; Kenshi YAO ; Hirotsugu IMAEDA ; Akira ANDOH
Intestinal Research 2018;16(2):223-232
BACKGROUND/AIMS: Decreased trough levels of infliximab (TLI) and antibodies to infliximab (ATI) are associated with loss of response (LOR) in Crohn's disease. Two prospective studies were conducted to determine whether TLI or ATI better correlates with LOR (Study 1), and whether TLI could become a predictor of mucosal healing (MH) (Study 2). METHODS: Study 1 was conducted in 108 patients, including those with LOR and remission to compare ATI and TLI in discriminating the 2 conditions based on receiver operating characteristic (ROC) curve analyses. Study 2 involved 35 patients who were evaluated endoscopically. RESULTS: In Study 1, there were no differences between the 2 assays in ROC curve analyses; the TLI cutoff value for LOR was 2.6 µg/mL (sensitivity, 70.9%; specificity, 79.2%), and the ATI cutoff value was 4.9 µg/mL (sensitivity, 65.5%; specificity, 67.9%). The AUROC (area under the ROC curve) of TLI was greater than that of ATI. AUROC was useful for discriminating between the 2 conditions. In Study 2, the TLI was significantly higher in the colonic MH group than in the non-MH group (2.7 µg/mL vs. 0.5 µg/mL, P=0.032). CONCLUSIONS: TLI is better than ATI for clinically diagnosing LOR, and a correlation was observed between TLI and colonic MH.
Antibodies
;
Cohort Studies*
;
Colon
;
Crohn Disease*
;
Humans
;
Infliximab*
;
Prospective Studies*
;
ROC Curve
;
Sensitivity and Specificity
5.A Case of Blunt Traumatic Aortic Injury with a Pseudoaneurysm in the Aortic Arch between the Brachiocephalic and Left Common Carotid Arteries
Maiko NAGAHAMA ; Kenji MOGI ; Manabu SAKURAI ; Takashi YAMAMOTO ; Yoshiharu TAKAHARA
Japanese Journal of Cardiovascular Surgery 2022;51(5):321-323
A 44-year-old man was injured by concreate boards falling on the left side of his body, and he was transferred to our hospital on suspicion of a blunt traumatic aortic injury. The contrast-enhanced CT axial scan showed the abnormal alignment of the brachiocephalic artery and a mediastinal hematoma. However, a 3D-CT image showed a pseudoaneurysm in the aortic arch between the brachiocephalic and left common carotid arteries. Immediately, partial arch replacement was performed. A 20 mm disruption was detected on the intimal surface of the arch aorta between the brachiocephalic and left common carotid arteries. This case was a very rare condition of blunt traumatic aortic injury.
6.Surgical Treatment for Aseptic Mediastinitis in the Late Phase after Aortic Root and Arch Replacement
Takashi YAMAMOTO ; Kenji MOGI ; Manabu SAKURAI ; Maiko NAGAHAMA ; Yoshiharu TAKAHARA
Japanese Journal of Cardiovascular Surgery 2023;52(3):149-153
Objective: A few cases of an aseptic abscess after thoracic aortic surgery have been reported. However, it sometimes requires surgical treatment because the rapid growth of perigraft fluid collection results in exposure towards the body surface. We discuss the results of our treatment of these cases. Methods: This study was a retrospective analysis. Four of 341 cases who underwent thoracic aortic surgery between April 2013 and March 2020 were included. These cases presented with a bulge of the body surface 10.3 (range, 3-27) months after surgery. Results: Although the fluids looked purulent in all cases, no bacteria were detected. We diagnosed them as aseptic abscess, for which omental implantation was performed. No signs of recurrence have been found in any cases even after 5.4 (range, 1-8.5) years. Conclusions: Omental implantation was effective for controlling aseptic abscess for long-term periods.
7.A Case of Postoperative Pyoderma Gangrenosum after Mitral Valve Replacement
Maiko NAGAHAMA ; Kenji MOGI ; Manabu SAKURAI ; Takashi YAMAMOTO ; Yoshiharu TAKAHARA
Japanese Journal of Cardiovascular Surgery 2023;52(6):392-395
A 47-year-old man had severe mitral regurgitation after severe skin eruption, so mitral valve replacement was electively performed 8 months later. A median sternal wound opened spontaneously and had purulent exudate on the 5th postoperative day (5 POD). We had suspicion of bacterial mediastinitis, so we drained the anterior mediastinum and tried antibiotic treatment. However, the microbiological stains and culture were negative, and adipose tissue was extremely melted with pustules around the wound. Considering other diseases without infection, we consulted to a dermatologist and tried highdose steroid therapy as pyoderma gangrenosum (PG) appeared on the 8 POD. Meanwhile, the sternum was left open and apllied a negative pressure dressing applied with Negative Pressure Wound Therapy (NPWT). The wound responded remarkably to steroid therapy, so we closed the sternum on the 10 POD, and sutured the sternal wound on the 19 POD. We tapered off steroids after the suture. PG can be caused by the trauma of surgery, so we have to make a decision on whether to use high dose steroid therapy in the postoperative period. We report this case as one of the differential diseases that the surgeons must know.