BACKGROUND: Epstein-Barr (EB) virus infection stimulates the production of vascular endothelial growth factor (VEGF), which contributes to the progression of angiogenesis. Angiogenesis plays an important role in the development of atherosclerosis. Since serum anti-early antigen EB virus IgG (EBV EA-IgG) titer is a sign of active EB virus infection, EBV EA-IgG titer could be associated with atherosclerosis. The number of minor (T) alleles in VEGF polymorphism rs3025039 has been reported to be inversely associated with serum VEGF concentration, suggesting that rs3025039 might have a strong influence on the association between EBV EA-IgG titer and atherosclerosis. By focusing on the role of VEGF in the development of atherosclerosis, this study aimed to investigate the association between active EB virus infection and atherosclerosis. METHODS: A cross-sectional study of 2,661 older Japanese individuals aged 60-89 years who participated in annual health check-ups during 2017-2019 was conducted. Logistic regression was used to evaluate the association between EBV EA-IgG titer and atherosclerosis in relation to rs3025039 genotype. The influence of rs3025039 (T) allele carrier status on the association between EBV EA-IgG titer and atherosclerosis was also evaluated by using logistic regression. RESULTS: Among rs3025039 CC-homozygotes, with the lowest EBV EA-IgG titer tertile as the reference, the multivariable odds ratio (95% confidence interval) was 1.11 (0.82, 1.50) for the medium tertile and 1.07 (0.78, 1.47) for the high tertile. Among rs3025039 (T) allele carriers, the corresponding values were 1.44 (0.88, 2.36) and 1.88 (1.15, 3.05), respectively. There was a significant interaction between rs3025039 (T) allele carrier status and the association between EBV EA-IgG titer and atherosclerosis (adjusted p = 0.0497). CONCLUSION EBV EA-IgG titer was significantly positively associated with atherosclerosis only among participants who are genetically less likely to have progressive angiogenesis. An angiogenesis-related genetic factor was revealed as a determinant of the association between EBV EA-IgG titer and atherosclerosis. These findings introduce a novel concept that could explain the association between viral infection and atherosclerosis.
Humans ; Aged ; Male ; Middle Aged ; Female ; Japan/epidemiology* ; Atherosclerosis/virology* ; Aged, 80 and over ; Vascular Endothelial Growth Factor A/genetics* ; Epstein-Barr Virus Infections/virology* ; Polymorphism, Single Nucleotide ; Cross-Sectional Studies ; Herpesvirus 4, Human ; Antigens, Viral/immunology* ; Antibodies, Viral/blood* ; Immunoglobulin G/blood* ; Genotype ; East Asian People

BACKGROUND: Subclinical hypothyroidism (SCH) has been reported to be associated with lower endothelial progenitor (CD34-positive) cell count, whereas an inverse association between circulating CD34-positive cell count and height loss is documented. Reports indicate height loss to be associated with all-cause mortality, and a higher CD34-positive cell count has been shown to predict longer life. Therefore, evaluating the association between SCH and height loss provides mechanistic insights underlying the association between height loss and mortality risk. METHODS: A prospective study involving 1,599 participants with normal free triiodothyronine (T3) and free thyroxine (T4) levels was conducted to determine the association between SCH and height loss.Since the free T4 level influences the supply of active thyroid hormone (free T3), the analysis was stratified by the median free T4 level. Height loss was defined as the highest quintile of annual height decrease. RESULTS: SCH was positively associated with height loss in participants with low-normal free T4 levels (below the median), but not in those with high-normal free T4 levels (at or above the median). After adjusting for sex, age, free T3 level, atherosclerosis, and known cardiovascular risk factors, the adjusted odds ratios (95% confidence interval) for height loss were 1.88 (1.02, 3.47) and 1.92 (1.02, 3.62) in the low-normal free T4 group. The corresponding values in the high-normal free T4 group were 0.37 (0.08, 1.69) and 0.43 (0.09, 1.97). CONCLUSION SCH could influence height loss, and free T4 might influence the association between SCH and height loss in euthyroid individuals. These results clarify the mechanisms underlying the association between height loss and mortality risk.
Humans ; Hypothyroidism/epidemiology* ; Thyroxine/blood* ; Male ; Female ; Prospective Studies ; Middle Aged ; Body Height ; Adult ; Aged ; Risk Factors

Background/Aims: The optimal length of the uncovered portion of partially covered self-expandable metal stents (PCSEMSs) used in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) remains unclear. This study investigated the safety and efficacy of PCSEMSs with different uncovered lengths, with a focus on stent migration and time to recurrent biliary obstruction (RBO). Methods: Outcomes of patients undergoing EUS-HGS using PCSEMSs with 5-mm and 20-mm uncovered portions at our institution from January 2016 to December 2021 were compared. Results: Sixty-two patients underwent EUS-HGS using PCSEMS (5/20-mm uncovered portions: 32/30). Stent migration occurred only in the 5-mm group. There were no differences in RBO rates (28.1% vs. 40.0%) or median time to RBO (6.8 vs. 7.1 months) between the two groups. Median overall survival (OS) was longer in the 20-mm group (3.1 vs. 4.9 months, p=0.037) due to the higher number of patients that resumed chemotherapy after EUS-HGS (56.7% vs. 28.1%, p=0.029). Good performance status, absence of hepatic metastases, and chemotherapy after EUS-HGS were independent predictors of longer OS. Conclusions No migration was observed in patients treated with PCSEMS with 20-mm uncovered portions. Patients treated with PCSEMS with 20-mm uncovered portions performed at least as well as those treated with 5-mm uncovered portions in all material respects.

Objective：We analyzed whether activities of daily living (ADL) had an additive effect on the discharge destination of hospitalized older patients with internal medicine.Methods：Of the 691 patients hospitalized for medical illness aged 65 years or older who received physical therapy during this study period, 186 patients were included in the analysis. The main outcome was the discharge destination. Participants were categorized in the home discharge group and other institution group. The Barthel Index (BI) was used to assess the ADL at the first physical therapy session. Multivariate logistic regression analysis was used to estimate the influence of the BI on determining the discharge destination. The cut-off point of the BI score was evaluated using a receiver operating characteristic curve.Results：During the follow-up period, 17 participants (9.1%) could not be discharged to their homes. Logistic regression analysis showed that the BI influenced discharge destinations (odds ratio：1.54；95% confidence intervals：1.23-1.89). The cut-off point of the BI score for determining home discharge was 72.5 (sensitivity, 0.80；specificity, 0.94；area under the curve, 0.94；positive predictive value：0.99, negative predictive value：0.32).Conclusions：These findings suggest that the BI is a useful predictor for determining the potential destination of hospitalized older patients following discharge. However, the results of this study have limitations such as a low negative predictive value and a limited number of subjects.

Objective：We analyzed whether activities of daily living (ADL) had an additive effect on the discharge destination of hospitalized older patients with internal medicine.Methods：Of the 691 patients hospitalized for medical illness aged 65 years or older who received physical therapy during this study period, 186 patients were included in the analysis. The main outcome was the discharge destination. Participants were categorized in the home discharge group and other institution group. The Barthel Index (BI) was used to assess the ADL at the first physical therapy session. Multivariate logistic regression analysis was used to estimate the influence of the BI on determining the discharge destination. The cut-off point of the BI score was evaluated using a receiver operating characteristic curve.Results：During the follow-up period, 17 participants (9.1%) could not be discharged to their homes. Logistic regression analysis showed that the BI influenced discharge destinations (odds ratio：1.54；95% confidence intervals：1.23-1.89). The cut-off point of the BI score for determining home discharge was 72.5 (sensitivity, 0.80；specificity, 0.94；area under the curve, 0.94；positive predictive value：0.99, negative predictive value：0.32).Conclusions：These findings suggest that the BI is a useful predictor for determining the potential destination of hospitalized older patients following discharge. However, the results of this study have limitations such as a low negative predictive value and a limited number of subjects.

BACKGROUND: To examine changes in psychological distress prevalence among pregnant women in Miyagi Prefecture, which was directly affected by the Great East Japan Earthquake and tsunami, and compare it with the other, less damaged areas of Japan. METHODS: This study was conducted in conjunction with the Japan Environment and Children`s Study. We examined 76,152 pregnant women including 8270 in Miyagi Regional Center and 67,882 in 13 other regional centers from the all-birth fixed data of the Japan Environment and Children's Study. We then compared the prevalence and risk of distress in women in Miyagi Regional Center and women in the 13 regional centers for 3 years after the disaster. RESULTS: Women in the Miyagi Regional Center suffered more psychological distress than those in the 13 regional centers: OR 1.38 (95% CI, 1.03-1.87) to 1.92 (95% CI, 1.42-2.60). Additionally, women in the inland area had a consistently higher prevalence of psychological distress compared to those from the 13 regional centers: OR 1.67 (95% CI, 1.18-2.38) to 2.19 (95% CI, 1.60-2.99). CONCLUSIONS The lack of pre-disaster data in the Japan Environment and Children's Study made it impossible to compare the incidence of psychological distress before and after the March 2011 Great East Japan Earthquake. However, 3 years after the Great East Japan Earthquake, the prevalence of pregnant women with psychological distress did not improve in Miyagi Regional Center. Further, the prevalence of mental illness in inland areas was consistently higher than that in the 13 regional centers after the disaster.
Adolescent ; Adult ; Disasters ; Earthquakes ; Female ; Humans ; Japan/epidemiology* ; Pregnancy ; Pregnancy Complications/psychology* ; Pregnant Women/psychology* ; Prevalence ; Psychological Distress ; Tsunamis ; Young Adult

Purpose: Consensus is lacking regarding the optimal antibiotic treatment for pediatric complicated appendicitis. This study determined the optimal first-line antibiotic treatment for pediatric patients with complicated appendicitis based on peritoneal fluid cultures. Methods: This retrospective study examined the cases of pediatric patients who underwent appendectomy for complicated appendicitis at our institution between 2013 and 2019. Peritoneal fluid specimens obtained during appendectomy were cultured for the presence of bacteria. Results: Eighty-six pediatric patients were diagnosed with complicated appendicitis.Of them, bacteria were identified in 54 peritoneal fluid samples. The major identified bacteria were Escherichia coli (n=36 [66.7%]), Bacteroides fragilis (n=28 [51.9%]), α-Streptococcus (n=25 [46.3%]), Pseudomonas aeruginosa (n=10 [18.5%]), Enterococcus avium (n=9 [16.7%]), γ-Streptococcus (n=9 [16.7%]), and Klebsiella oxytoca (n=6 [11.1%]). An antibiotic susceptibility analysis showed E. coli was inhibited by sulbactam/ampicillin in 43.8% of cases versus cefmetazole in 100% of cases. Tazobactam/piperacillin and meropenem inhibited the growth of 96.9-100% of the major identified bacteria. E. coli (100% vs. 84.6%) and P. aeruginosa (100% vs. 80.0%) were more susceptible to amikacin than gentamicin. Conclusion Tazobactam/piperacillin or meropenem is a reasonable first-line antibiotic treatment for pediatric complicated appendicitis. In the case of aminoglycoside use, amikacin is recommended.

Gastric adenocarcinoma of the fundic gland mucosa type (GA-FGM) was proposed as a new variant of gastric adenocarcinoma of the fundic gland type (GA-FG). However, at present, the influence of Helicobacter pylori and the speed of progression and degree of malignancy in GA-FGM remain unclear. Herein, we report the first case of intramucosal GA-FGM that was endoscopically observed before and after H. pylori eradication over 15 years. The lesion showed the same tumor size with no submucosal invasion and a low MIB-1 labeling index 15 years after its detection using endoscopy. The endoscopic morphology changed from 0-IIa before H. pylori eradication to 0-IIa+IIc and then 0-I after H. pylori eradication. These findings suggest that the unaltered tumor size reflects low-grade malignancy and slow growth, and that the endoscopic morphology is influenced by H. pylori eradication.

Purpose: Naldemedine is a peripheral µ-opioid receptor antagonist, including the treatment of opioid-induced constipation (OIC) . However, diarrhea is known as its side effect. We conducted a study focusing on the administration period of opioid analgesics before the start of naldemedine to clear predictors of diarrhea due to Naldemedine. Method: All data were retrospectively collected from the electronic medical record system. We investigated patients who initially administrated naldemedine at Nagasaki University Hospital from June 1 2017 to March 31 2019. Result: One hundred thirty-two patients were subject of investigation. The incidence of diarrhea was 25.0%. The result of the multivariate analysis showed that significant predictors of diarrhea were associated with the opioid analgesics usage period longer than 7 days before naldemedine initiation (odds ratio: 3.76, 95% confidence interval: 1.53-9.20, p=0.004). Discussion: When naldemedine was used for OIC, diarrhea may be avoided by using within 7 days after opioid analgesics.

Strenuous exercise induces upper respiratory tract infection (URTI), whereas moderate exercise prevents URTI. This study aimed to assess the incidence of URTI and the association between URTI episodes and exercise duration in Japanese collegiate athletes. A cross-sectional survey was conducted with 1,740 participants; 1,235 responses were eligible for analysis. Participants were classified into three groups: control group (weekly total exercise duration <60 min, n=405), exercise group (weekly total exercise duration >60 min, n=193), and athlete group (joined a sports club and weekly exercise frequency >5 days, n=637). We requested the following information from participants: basic characteristics, incidence of URTI symptoms (fever, runny or plugged nose, sore throat, and cough) or influenza for each month over the past year, day of the week exercise is typically performed, and duration of exercise per week. The incidence of URTI episodes per year was significantly lower in the athlete group (2.0 ± 2.4 episodes) compared to the control group (2.6 ± 2.4 episodes, p<0.001). The incidence of URTI episodes did not significantly differ between the control group and exercise group (2.9 ± 2.9 episodes, p=0.607). Although the frequency of URTI episodes and exercise duration were not significantly associated among male athletes (p=0.209), they were positively associated in female athletes (p=0.027). These results indicate that Japanese collegiate athletes experience fewer URTI episodes than non-athletes, but athletes who exercise for long durations may frequently experience URTI, particularly female athletes.