Background: Fall risk assessment and preventive interventions are important for preventing secondary fractures after hip fracture. The aim of this study was to investigate the distribution and characteristics of Fall Risk Index-21 (FRI-21) scores based on prefracture living conditions in patients with fall-related unilateral hip fracture. Methods: This study included 95 people who had suffered a hip fracture after a fall and had undergone surgery. FRI-21, dual energy X-ray absorptiometry (DXA), and hip structure analysis/trabecular bone score based on DXA were performed within 1 week after surgery. We compared bone parameters between the two groups, which were divided according to the cutoff value of the FRI-21. We also performed cluster analysis on the components of the FRI-21 and compared the characteristics of the subgroups via analysis of variance and multiple comparison tests. Results: All participants had experienced a fall-related fracture, but 47 (49.5%) of the patients were judged to have low scores (<10) on the FRI-21. Moreover, cluster analysis revealed that the subjects were classified into three subgroups, and the characteristics of the items that constitute fall risk, namely, physical function, disease or geriatric syndrome, and environmental factors, were diverse. Conclusions These results suggest that caution is needed when interpreting the FRI-21 total score based on preoperative living conditions in post-fracture patients, as it may not adequately reflect fall risk. Considering the characteristics of the FRI-21 score in patients with hip fractures, identifying appropriate fall prevention strategies and healthcare professionals involved may be important for preventing future re-fractures.

Objectives: The relationship between weight-related load and bone mineral density (BMD)/bone microstructure under normal load conditions using high-resolution peripheral quantitative computed tomography (HR-pQCT) remains unconfirmed. The study aims to investigate the differences in effect of body mass index (BMI) on BMD/bone microstructure of loaded and unloaded bones, respectively, in Japanese postmenopausal women. Methods: Fifty-seven postmenopausal women underwent HR-pQCT on the tibia and radius. Correlation analysis, principal component (PC) analysis, and hierarchical multiple regression were performed to examine the relationship between BMI and HR-pQCT parameters. Results: Several microstructural parameters of the tibia and radius correlated with BMI through a simple correlation analysis, and these relationships remained unchanged even with an age-adjusted partial correlation analysis. PC analysis was conducted using seven bone microstructure parameters. The first PC (PC1) reflected all parameters of trabecular and cortical bone microstructures, except for cortical porosity, whereas the second PC (PC2) reflected only cortical bone microstructure. Hierarchical multiple regression analysis indicated that BMI was more strongly related to BMD/bone microstructure in the tibia than in the radius. Furthermore, BMI was associated with trabecular/cortical BMD, and PC1 (not PC2) of the tibia and radius. Thus, BMI was strongly related to the trabecular bone microstructure rather than the cortical bone microstructure. Conclusions Our data confirmed that BMI is associated with volumetric BMD and trabecular bone microstructure parameters in the tibia and radius. However, although BMI may be more related to HRpQCT parameters in the tibia than in the radius, the magnitude of association is modest.

Objectives: The relationship between weight-related load and bone mineral density (BMD)/bone microstructure under normal load conditions using high-resolution peripheral quantitative computed tomography (HR-pQCT) remains unconfirmed. The study aims to investigate the differences in effect of body mass index (BMI) on BMD/bone microstructure of loaded and unloaded bones, respectively, in Japanese postmenopausal women. Methods: Fifty-seven postmenopausal women underwent HR-pQCT on the tibia and radius. Correlation analysis, principal component (PC) analysis, and hierarchical multiple regression were performed to examine the relationship between BMI and HR-pQCT parameters. Results: Several microstructural parameters of the tibia and radius correlated with BMI through a simple correlation analysis, and these relationships remained unchanged even with an age-adjusted partial correlation analysis. PC analysis was conducted using seven bone microstructure parameters. The first PC (PC1) reflected all parameters of trabecular and cortical bone microstructures, except for cortical porosity, whereas the second PC (PC2) reflected only cortical bone microstructure. Hierarchical multiple regression analysis indicated that BMI was more strongly related to BMD/bone microstructure in the tibia than in the radius. Furthermore, BMI was associated with trabecular/cortical BMD, and PC1 (not PC2) of the tibia and radius. Thus, BMI was strongly related to the trabecular bone microstructure rather than the cortical bone microstructure. Conclusions Our data confirmed that BMI is associated with volumetric BMD and trabecular bone microstructure parameters in the tibia and radius. However, although BMI may be more related to HRpQCT parameters in the tibia than in the radius, the magnitude of association is modest.

Objective: We have developed an automatic vigilance system (AVS) that automatically reports adverse drug reactions (ADR) based on laboratory finding abnormalities and symptom keywords in electronic medical records.　In this study, we aimed to evaluate the impact of detecting ADR using AVS on medical treatment.Methods: In AVS, drugs and their ADR signals, which would be detected and reported by AVS to pharmacists, were defined.　Pharmacists evaluated the severity of these signals to identify whether these signals should be discussed with the doctor, continued to be followed up, or ignored.　We investigated detection of ADR at University of Fukui Hospital between April 2016 and March 2017 along with whether prescriptions were modified because of ADR and the contribution of AVS.　Assuming that ADR had worsened without appropriate treatment, medical expenses needed for treating severe ADR were calculated.Results: In total, 325 signals were defined for 146 drugs.　There were 9,103 ADR signals confirmed by pharmacists for 8,531 subjects.　Of these, 12 and 164 signals were discussed with the doctor and continuously observed, respectively.　The pharmacist's suggestions based on AVS led to prescription modifications in 10 cases, corresponding to a reduction of 2.56 million yen in medical expenses in the event that these cases become severe.Conclusion: AVS assisted prescription revisions because of ADR and is thought to contribute to the prevention of worsening of ADR and reduction of medical expenses.

BACKGROUND/AIMS: The ability of endoscopic submucosal dissection (ESD) to resect large early gastric cancers (EGCs) results in the need to treat large artificial gastric ulcers. This study assessed whether the combination therapy of rebamipide plus a proton pump inhibitor (PPI) offered benefits over PPI monotherapy. METHODS: In this prospective, randomized, multicenter, open-label, and comparative study, patients who had undergone ESD for EGC or gastric adenoma were randomized into groups receiving either rabeprazole monotherapy (10 mg/day, n=64) or a combination of rabeprazole plus rebamipide (300 mg/day, n=66). The Scar stage (S stage) ratio after treatment was compared, and factors independently associated with ulcer healing were identified by using multivariate analyses. RESULTS: The S stage rates at 4 and 8 weeks were similar in the two groups, even in the subgroups of patients with large amounts of tissue resected and regardless of CYP2C19 genotype. Independent factors for ulcer healing were circumferential location of the tumor and resected tissue size; the type of treatment did not affect ulcer healing. CONCLUSIONS: Combination therapy with rebamipide and PPI had limited benefits compared with PPI monotherapy in the treatment of post-ESD gastric ulcer (UMIN Clinical Trials Registry, UMIN000007435).
Adenoma ; Cicatrix ; Cytochrome P-450 CYP2C19 ; Endoscopy ; Genotype ; Humans ; Multivariate Analysis ; Prospective Studies ; Proton Pump Inhibitors ; Proton Pumps* ; Protons* ; Rabeprazole ; Stomach Neoplasms ; Stomach Ulcer* ; Ulcer

BACKGROUND/AIMS: The ability of endoscopic submucosal dissection (ESD) to resect large early gastric cancers (EGCs) results in the need to treat large artificial gastric ulcers. This study assessed whether the combination therapy of rebamipide plus a proton pump inhibitor (PPI) offered benefits over PPI monotherapy. METHODS: In this prospective, randomized, multicenter, open-label, and comparative study, patients who had undergone ESD for EGC or gastric adenoma were randomized into groups receiving either rabeprazole monotherapy (10 mg/day, n=64) or a combination of rabeprazole plus rebamipide (300 mg/day, n=66). The Scar stage (S stage) ratio after treatment was compared, and factors independently associated with ulcer healing were identified by using multivariate analyses. RESULTS: The S stage rates at 4 and 8 weeks were similar in the two groups, even in the subgroups of patients with large amounts of tissue resected and regardless of CYP2C19 genotype. Independent factors for ulcer healing were circumferential location of the tumor and resected tissue size; the type of treatment did not affect ulcer healing. CONCLUSIONS: Combination therapy with rebamipide and PPI had limited benefits compared with PPI monotherapy in the treatment of post-ESD gastric ulcer (UMIN Clinical Trials Registry, UMIN000007435).
Adenoma ; Cicatrix ; Cytochrome P-450 CYP2C19 ; Endoscopy ; Genotype ; Humans ; Multivariate Analysis ; Prospective Studies ; Proton Pump Inhibitors ; Proton Pumps* ; Protons* ; Rabeprazole ; Stomach Neoplasms ; Stomach Ulcer* ; Ulcer

BACKGROUND/AIMS: Antithrombotic/nonsteroidal antiinflammatory drug (NSAID) therapies increase the incidence of upper gastrointestinal bleeding. The features of hemorrhagic peptic ulcer disease in patients receiving antithrombotic/NSAID therapies were investigated. METHODS: We investigated the medical records of 485 consecutive patients who underwent esophagogastroduodenoscopy and were diagnosed with hemorrhagic gastroduodenal ulcers. The patients treated with antithrombotic agents/NSAIDs were categorized as the antithrombotic therapy (AT) group (n=213). The patients who were not treated with antithrombotics/NSAIDs were categorized as the control (C) group (n=263). The clinical characteristics were compared between the groups. RESULTS: The patients in the AT group were significantly older than those in the C group (p<0.0001). The hemoglobin levels before/without transfusion were significantly lower in the AT group (8.24+/-2.41 g/dL) than in the C group (9.44+/-2.95 g/dL) (p<0.0001). After adjusting for age, the difference in the hemoglobin levels between the two groups remained significant (p=0.0334). The transfusion rates were significantly higher in the AT group than in the C group (p=0.0002). However, the outcome of endoscopic hemostasis was similar in the AT and C groups. CONCLUSIONS: Patients with hemorrhagic peptic ulcers receiving antithrombotic/NSAID therapies were exposed to a greater risk of severe bleeding that required transfusion but were still treatable by endoscopy.
Anti-Inflammatory Agents, Non-Steroidal ; Endoscopy ; Endoscopy, Digestive System ; Hemoglobins ; Hemorrhage ; Hemostasis, Endoscopic ; Humans ; Incidence ; Medical Records ; Peptic Ulcer

Multiple endocrine neoplasia type 1 (MEN1) is an inherited autosomal dominant disease presenting with pancreatic neuroendocrine tumors (pNETs), parathyroid tumors, or pituitary tumors. Using the PubMed database, we reviewed the literature on information regarding the proper diagnosis and treatment of MEN1-associated pNET. Many cases of MEN1-associated pNET are functioning pNETs. Gastrinomas and insulinomas tend to occur frequently in the duodenum and pancreas, respectively. In addition to diagnostic imaging, the selective arterial secretagogue injection test (SASI test) is useful for localizing functioning pNET. The standard treatment is surgical resection. However, in the case of a functioning pNET, the tumor should first be accurately located using the SASI test before an appropriate surgical method is selected. In cases of a MEN1-associated non-functioning pNET that exceeds 2 cm in diameter, the incidence of distant metastasis is significantly increased, and surgery is recommended. In cases of unresectable pNET, a somatostatin analog has been shown to demonstrate antitumor effects and is considered to be a promising treatment. In addition, molecular-targeted drugs have recently been found to be effective in phase III clinical trials.
Diagnostic Imaging ; Duodenum ; Gastrinoma ; Incidence ; Insulinoma ; Multiple Endocrine Neoplasia ; Multiple Endocrine Neoplasia Type 1 ; Neoplasm Metastasis ; Neuroectodermal Tumors, Primitive ; Neuroendocrine Tumors ; Pancreas ; Pituitary Neoplasms ; Somatostatin

BACKGROUND/AIMS: Colonic diverticular bleeding can stop spontaneously or be stopped by endoscopic hemostasis. We analyzed the clinical and colonoscopic features of patients with colonic diverticular bleeding to establish the predictive factors for rebleeding. METHODS: A total of 111 patients (median age, 72 years) with colonic diverticular bleeding in Aso Iizuka Hospital between April 2007 and July 2010 were enrolled. Age, sex, body mass index (BMI), comorbidity, medication, location of bleeding, colonoscopic findings and hemostatic methods were analyzed retrospectively from the hospital records. RESULTS: The most common sites of bleeding were the ascending (39.6%) and sigmoid (29.7%) colon. Overt rebleeding occurred in 30 patients (27.0%). Spontaneous hemostasis was seen in 81 patients (73.0%), and endoscopic hemostatic treatment was performed in 30 patients. The BMI in the patients with colonic diverticular rebleeding was significantly higher than in patients without rebleeding. Colonoscopic findings of actively bleeding or nonbleeding visible vessels in the responsible diverticula were more frequent in the group with rebleeding. CONCLUSIONS: A higher BMI and colonoscopic findings of actively bleeding or nonbleeding visible vessels can be used as predictive factors for colonic diverticular rebleeding. Patients with such findings should be carefully followed up after hemostasis of the initial colonic diverticular bleeding.
Body Mass Index ; Colon ; Colon, Sigmoid ; Comorbidity ; Diverticulum ; Hemorrhage ; Hemostasis ; Hemostasis, Endoscopic ; Humans ; Retrospective Studies

OBJECTIVETo characterize the symptoms of neurogenic intrapelvic syndrome and the pathogenic mechanisms.

METHODSA total of 537 patients with neurogenic intrapelvic syndrome were treated in the Takano Hospital between 2001 and 2005. Clinical data were analyzed retrospectively.

RESULTSThe mean age was 58.5 years old. There were 205 males and 332 females. There were 80 patients(14.9%) who presented with only one symptom with anorectal pain being the most common one (43.8%, 35/80). One hundred and fifty-six(29.1%) patients had two symptoms with anorectal pain and difficult evacuation being the most common combination (26.3%, 41/156). There were 144 patients (26.8%) complained of 3 symptoms and the most common combination was anorectal pain, difficult evacuation, and abdominal discomfort (30.0%, 43/144). A combination of 4 symptoms was reported in 105 patients(19.6%) with the combination of anorectal pain, incontinence, abdominal discomfort, and lumbar discomfort being the most often(65.7%, 69/105). In addition, there were 52 patients(9.7%) who had above 5 symptoms simultaneously. The frequencies of the 5 symptoms were 73.6% for anorectal pain, 27.9% for incontinence, 69.6% for difficult evacuation, 55.3% for abdominal discomfort, and 53.6% for lumbar discomfort.

CONCLUSIONSSymptomatology of neurogenic intrapelvic syndrome is complicated. The pathogenic mechanism may be related to concurrent dysfunction of sacral nerve and pelvic splanchnic nerve.

Encopresis ; etiology ; Female ; Humans ; Male ; Middle Aged ; Pelvic Pain ; etiology ; Retrospective Studies ; Syndrome