Background: and Purpose Neuropsychiatric symptoms (NPS) are frequent in dementia and mild cognitive impairment (MCI), yet their reported associations with white matter hyperintensities (WMHs) remain inconsistent. We examined item-level associations between WMHs and NPS across Alzheimer’s disease dementia (ADD), dementia with Lewy bodies (DLB), and amnestic MCI (aMCI). Methods: This multicenter retrospective study involved 523 patients: 276 with ADD, 67 with DLB, and 180 with aMCI. Three-dimensional T1-weighted and T2–fluid-attenuated inversion recovery magnetic resonance images were processed with BAAD (Brain Anatomical Analysis using Diffeomorphic Deformation) software to quantify WMH volume (WMHV) and gray matter volume (GMV), normalized to total intracranial volume (TIV). NPS were assessed using the Neuropsychiatric Inventory. Multiple regression analyses were performed within each group, adjusting for GMV/TIV, age, sex, years of education, Clinical Dementia Rating–Sum of Boxes score, and institution. Results: In the aMCI group, higher WMHV/TIV was positively associated with depression, apathy, and disinhibition, and negatively with delusions. Subregional analyses revealed NPSspecific topographic patterns. No significant associations were detected in the ADD or DLB group. GMV/TIV was positively associated with delusions in the ADD group, but negatively associated with hallucinations in the DLB group. Conclusions Associations between WMHs and NPS were evident in the aMCI group but absent in the ADD and DLB groups, suggesting a stage-dependent effect. WMHs may contribute to NPS primarily in prodromal stages, whereas their influence may be overshadowed by neurodegenerative pathology in dementia. Clarifying the mechanisms underlying WMHs is critical for evaluating their potential as intervention targets.

Objective: The incidence and mortality rates of endometrial cancer are increasing globally, including in Japan. Quality of cancer care is promoted through guideline adherence. This study aimed to establish quality indicators (QIs) for endometrial cancer and explore the factors contributing to treatment nonadherence. Methods: QIs and pattern-of-care indicators (PCIs) were developed using the Research and Development/University of California Los Angeles modified Delphi method. QIs reflect desirable healthcare patterns, whereas PCIs address treatment areas with lacking evidence.Data from the Hospital-Based Cancer Registry and Diagnosis Procedure Combination Survey were used. Patients diagnosed or treated between January 1 and December 31, 2020 were included. The reasons for nonadherence were collected. Logistic regression was used to analyze the factors influencing adherence, including age, body mass index, comorbidities, facilities, and recurrence risk. Results: Of the 35 proposed QI candidates, 8 QIs and 9 PCIs were selected, predominantly focusing on surgical aspects. Adherence rates varied, with peritoneal lavage cytology being the highest (93.1%), and postoperative hormone replacement therapy (HRT) for patients aged <45 years being the lowest (30.9%), when focusing on process indicators. Reasons for nonadherence included patient preference and medical comorbidities as significant factors. Multivariate analysis highlighted age, clinical stage, and Barthel index as significant contributors to nonadherence. Conclusion We developed QIs to comprehensively assess endometrial cancer treatment.Adherence rates are favorable; however, HRT has a low adherence rate. Factors leading to nonadherence include advanced age and incomplete activities of daily living, particularly in advanced stages.

Background/Aims: Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis and handsewn anastomosis for ulcerative colitis requires pulling down of the ileal pouch into the pelvis, which can be technically challenging. We examined risk factors for the pouch not reaching the anus. Methods: Clinical records of 62 consecutive patients who were scheduled to undergo RPC with handsewn anastomosis at the University of Tokyo Hospital during 1989–2019 were reviewed. Risk factors for non-reaching were analyzed in patients in whom hand sewing was abandoned for stapled anastomosis because of nonreaching. Risk factors for non-reaching in laparoscopic RPC were separately analyzed. Anatomical indicators obtained from presurgical computed tomography (CT) were also evaluated. Results: Thirty-seven of 62 cases underwent laparoscopic procedures. In 6 cases (9.7%), handsewn anastomosis was changed to stapled anastomosis because of non-reaching. Male sex and a laparoscopic approach were independent risk factors of non-reaching. Distance between the terminal of the superior mesenteric artery (SMA) ileal branch and the anus > 11 cm was a risk factor for non-reaching. Conclusions Laparoscopic RPC with handsewn anastomosis may limit extension and induction of the ileal pouch into the anus. Preoperative CT measurement from the terminal SMA to the anus may be useful for predicting non-reaching.

Background : The improvement in surgical results for congenital heart disease has resulted in an increase in the number of adult congenital heart disease (ACHD) cases. Some ACHD patients are known to develop thoracic aortic aneurysm (TAA) at a young age, so we examined TAA in ACHD patients presenting at our institute over a 10-year interval. Methods : From 2002 to 2011, we performed 32 cases of surgery for TAA in ACHD patients. We excluded 5 cases of adult bicuspid aortic valve, 2 of TAA with untreated congenital heart disease (CHD), 1 of Marfan syndrome with CHD, and 9 of coarctation of the aorta (CoA) repair for the same site ; 15 patients were included. Results : The male/female ratio was 13/2, and the age of reoperation was 33.3±10.8 years. The 15 ACHD patients included 5 cases of the tetralogy of Fallot (TOF), 4 of congenital aortic stenosis (AS), 3 of ventricular septal defect (VSD), and 1 of each CoA complex, polysplenia/double outlet right ventricle (DORV), and polysplenia/corrected transposition of the great arteries (cTGA). Twelve cases of root dilatation and 2 of ascending aortic aneurysm were observed and 10 cases were concomitant with moderate to severe aortic regurgitation. Thirteen cases underwent elective surgery and the other two cases were emergency surgeries : a Bentall procedure for type 2 acute aortic dissection of polysplenia/DORV, and a Bentall and right ventricular outflow reconstruction (RVOTR) for ascending aorta/right ventricle rupture due to Konno patch detachment in congenital AS. The 13 elective cases included 11 cases of Bentall procedure, 1 of ascending aorta/hemi arch replacement, and 1 of ascending aorta replacement. Concomitant procedures were 1 case of aortic valve replacement, 1 of mitral valve replacement, 1 of subaortic stenosis release, and 2 of RVOTR. Operation time was 572.8+/-101.4 min, cardiopulmonary bypass time was 295.8+/-100.2 min, and aorta clamp time was 188.1+/-58.8 min. One hospital death was observed in 1 emergency case due to methicillin-resistant Staphylococcus aureus (MRSA) sepsis, but no 30-day mortality was observed. Intensive care unit (ICU) stay was 9.4+/-10.1 days and hospital stay was 34.4+/-18.2 days. Conclusion : The most common ACHD found during TAA surgery in our institute was Tetralogy of Fallot. ACHD had various complications and restrictions for surgery but TAA surgery in ACHD patients was safe and feasible.

Double product (DP, heart rate × systolic blood pressure) during an incremental exercise test has been known to start to increase steeply at a workload, i. e. double product break point (DPBP), which corresponds to the blood lactate threshold. The study was to investigate the relationship between DP transition and ST segment depression in electrocardiogram during exercise. Thirty-one patients of angina pectoris of effort and 140 elderly persons performed a continuous incremental exercise test using a stationary bicycle ergometer. During the entire test, HR and blood pressure were measured every 15 seconds and an electrocardiogram was recorded continuously. DPBP was then calculated. In ten of the 31 patients, ST level depression above -0.1 mV with a typical ischemic form in lead V 5 was observed during the test. However, workload at the DPBP was significantly lower than that of the ischemic threshold on the electrocardiogram (i. e. -0.1mV of ST depression) in relation to work load (46+/-16 vs. 78+/-20 watts), HR (96+/-13 vs. 117+/-13 bpm), SBP (160+ /-20 vs. 199+/-31 mmHg) and DP (15400+/-3400 vs. 23400+/-4900 bpm × mmHg) . In elderly persons, DPBP could be determined without the ischemic ST depression in 96% of 327 tests. This study indicated that the DPBP would be an objective index of exercise intensity with lower risk for exercise prescription in cardiac patients and elderly persons.

It has been experienced that Kampo, with its philosophy that every disease is psychosomatic in origin and that herbs affect both the psyche and the soma, sometimes has a dramatic effect on somatoform disorders, though there has been no study examining the effects of Kampo on somatoform disorders. In this preliminary study, the morbidity of somatoform disorders among patients who visited the Keio Kampo Clinic and the patients' psychological well-being were examined.
One hundred patients (17 males and 83 females; mean age [±SD], 39±16) who sought Kampo treatment for the first time at Keio University Hospital participated in this study. A Japanese checklist derived from the somatoform disorders schedule (version 1.1) was used to check the somatoform symptoms. To assess psychological well-being, the subjective well-being inventory (SUBI) was performed. The subjects' clinical records were examined afterwards to rule out symptoms which could be medically explained.
Somatoform patients and medically ill (non-somatoform) patients were 65% and 26% of the total respectively. The somatoform patients showed significantly lower SUBI positive scores than the non-somatoform patients (p=0.042), while SUBI negative scores were significantly higher (p=0.001). Among the somatoform patients, there was a negative correlation between numbers of somatoform symptoms and SUBI positive scores (r=0.267; p=0.032), and a positive correlation between numbers of somatoform symptoms and SUBI negative scores (r=0.337; p=0.006).
Following the SUBI scores through treatment courses may lead to a better understanding of the pathology of somatoform disorders and to more effective use of Kampo.

Indications are that Japan is growing old at a faster pace than in any other nation. In 1993, people aged 65 years and over accounted for 13.5% of the nation's population, and in Nagano Prefecture the rate stood at 17.9%, far higher than the national average. In our district, Minamisaku, it was 22.0%, greater than the prefectural average. As aging goes on at a rapid clip, the number of the bed-ridden is on the upswing.
The Saku Central Hospital has instituted a system of home-visit health care since 1988 with the Department of Internal Medicine playing a pivotal role. The Department of Dentistry and Oral Surgery has also commenced a home-visit dental care program since 1990
The patients to whom home-visit care is delivered have a variety of basic diseases. The attention has focused on their treatment. In many cases, their indifference to oral hygiene was responsible for the ailments. Since the mouth is an inlet for bacteria and other pathogenic microorganisms, it is important to keep the mouth clean so as to prevent the deterioration of basic diseases. That biting may be done with dentures and other prosthetic devices suggests a feasibility of improving quality of life and working for a better health? Because some reports argue that chewing stimulates the brain, thus helpful in preventing senile psychosis, and because eating is one of the pleasures for the bedridden, the role played by us, dentists, is large. Here we report the present status of home-visit dental care delivered by our department from 1990 to 1995

Indications are that Japan is growing old at a faster pace than in any other nation. In 1993, people aged 65 years and over accounted for 13.5% of the nation's population, and in Nagano Prefecture the rate stood at 17.9%, far higher than the national average. In our district, Minamisaku, it was 22.0%, greater than the prefectural average. As aging goes on at a rapid clip, the number of the bed-ridden is on the upswing. The Saku Central Hospital has instituted a system of home-visit health care since 1988 with the Department of Internal Medicine playing a pivotal role. The Department of Dentistry and Oral Surgery has also commenced a home-visit dental care program since 1990 The patients to whom home-visit care is delivered have a variety of basic diseases. The attention has focused on their treatment. In many cases, their indifference to oral hygiene was responsible for the ailments. Since the mouth is an inlet for bacteria and other pathogenic microorganisms, it is important to keep the mouth clean so as to prevent the deterioration of basic diseases. That biting may be done with dentures and other prosthetic devices suggests a feasibility of improving quality of life and working for a better health? Because some reports argue that chewing stimulates the brain, thus helpful in preventing senile psychosis, and because eating is one of the pleasures for the bedridden, the role played by us, dentists, is large. Here we report the present status of home-visit dental care delivered by our department from 1990 to 1995