Purpose: We identified the risk factors for remnant gastric cancer (RGC) based on remnant gastric mucosal characteristics and gastritis morphology in patients undergoing distal gastrectomy. Materials and Methods: This multicenter retrospective study included 100 patients with RGC after distal gastrectomy and 550 patients without RGC treated between 2013 and 2020.Endoscopic findings, including anastomotic redness, red streaks, enlarged folds, bile reflux as anastomotic findings, as well as disappearance of the regular arrangement of collecting venules (RAC), atrophic gastritis, and intestinal metaplasia as background gastric mucosal findings, were evaluated. Disease risk score matching (1:1) was adjusted for baseline characteristics. Logistic regression analysis was used to develop a risk score model to stratify RGC risk into low, moderate, and high categories. Results: After matching, 96 patients with RGC and 96 controls were analyzed. Anastomotic redness and red streaks, as well as the disappearance of RAC and atrophic gastritis, were significantly more frequent in the RGC group than in the control group, whereas enlarged folds and bile reflux showed no significant differences. Risk scores were assigned as follows:anastomotic redness, 2; red streaks, 3; disappearance of RAC, 7; and atrophic gastritis, 3. The total score stratified patients into high (≥15), moderate (7–14), and low risk (≤6). The positive and negative predictive values were 67.7% and 83.3%, respectively. Conclusions The endoscopic findings of anastomotic redness, red streaks, RAC disappearance, and atrophic gastritis were significantly associated with RGC development.The proposed risk-scoring model could serve as a stratification tool for RGC surveillance.

Background: This study aimed to evaluate the differences in common types of epidermal growthfactor receptor (EGFR) mutations in non-small cell lung cancer (NSCLC) with brain metastasis (BM) treated using linear accelerator-based stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (fSRT). Methods: Between January 2011–December 2023, among 294 consecutive patients with BMfrom NSCLC, 84 patients with EGFR-mutated NSCLC were enrolled in this study. Results: The median follow-up time after SRS/fSRT was 20.1 months (range: 0.6–109.7months), while the median overall survival (mOS) after SRS/fSRT was 25.1 months (95% confidence interval [CI]: 18.4–33.5 months). The mOS after initial treatment for NSCLC was 56.2 months (95% CI:41.7–77.0 months). The mOS after SRS/fSRT in 34 patients with exon 19 deletions and 45 patients with exon 21 mutations with L858R was 20.4 months (95% CI: 13.6–55.9 months) and 28.5 months (95% CI: 16.2–33.5). The two groups showed no difference in the mOS. In univariate analyses using the Cox proportional hazards model, no prognostic factors associated with prolonged survival were identified except for good pretreatment Karnofsky Performance Status score and no prior tyrosine kinase inhibitor use before SRS/fSRT in EGFR-mutated NSCLC. There was no difference in both distant failure and local control in the two groups. Conclusion The difference in survival between EGFR subtypes (exon 21 L858R mutations vs.exon 19 deletion) was not observed after SRS/fSRT in NSCLC.

BACKGROUND: Low-density lipoprotein cholesterol (LDLc) is regarded as a risk factor for endothelial dysfunction. However, LDLc stimulates the proliferation of hematopoietic stem cells (CD34-positive cells), which contribute to endothelial repair. Therefore, LDLc may have a beneficial influence on the endothelium of individuals with lower endothelial repair activity. METHODS: This cross-sectional study included 245 men aged 60-69 years. Endothelial repair activity was categorized by the circulating levels of CD34-positive cells based on median values. The status of endothelium was evaluated using the cardio-ankle vascular index (CAVI). RESULTS: Among individuals with low levels of circulating CD34-positive cells, LDL-c levels were significantly inversely correlated with CAVI and positively correlated with circulating CD34-positive cells. No significant correlations were observed among the participants with high levels of circulating CD34-positive cells. Among low levels of CD34-positive cells, the adjusted standardized parameter (β) and p value were -0.24 (p = 0.021) for CAVI and 0.41 (p < 0.001) for CD34-positive cells, whereas among high levels of CD34-positive cells, the corresponding values were 0.03 (p = 0.738) and -0.09 (p = 0.355). CONCLUSION LDLc has a beneficial influence on endothelial health among individuals with low endothelial repair activity, possibly by stimulating the proliferation of hematopoietic stem cells.
Humans ; Middle Aged ; Male ; Aged ; Cross-Sectional Studies ; Cholesterol, LDL/blood* ; Endothelium, Vascular/physiology* ; Antigens, CD34/blood* ; Hematopoietic Stem Cells

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

Objective: We present a case of small intestinal perforation within an inguinal hernia following low-energy indirect trauma.Patient: A 55-year-old man with a known right inguinal hernia which had no prior indication for surgery developed acute right groin pain after sudden braking caused his scooter handlebar to strike his right thigh.Results: Physical examination and computed tomography (CT) scan of the abdomen and pelvis revealed multiple pockets of extraluminal air within the hernia sac, as well as gas bubbles in the surrounding intestinal contents. Based on these findings, we made a diagnosis of small intestinal perforation within the inguinal hernia.Conclusion: Small intestinal perforation within an inguinal hernia is an uncommon but potentially life-threatening complication requiring emergent surgical intervention. Delays in diagnosis and management can lead to peritonitis, abscess formation, sepsis, and prolonged hospitalization. Therefore, clinicians should maintain a high index of suspicion for intestinal perforation in patients with inguinal hernias, even in the absence of direct trauma or subsequent low-energy injuries.

Cardiac injuries caused by blunt chest trauma have a high mortality rate, and not only a median sternotomy but also a clamshell thoracotomy can be an alternative approach. In this report, we describe a case in hemostasis was achieved by clamshell thoracotomy in a left atrial appendage injury caused by blunt thoracic trauma. The patient is a 49-year-old woman. After an argument with her husband, she jumped off the balcony of her home on the 6th floor and fell in a supine position. She was brought to the hospital in shock, and pericardial effusion was found on FAST. She had cardiac arrest due to cardiac tamponade, and left anterolateral thoracotomy was performed to open the pericardium. After the removing the hematoma in the pericardial sac was removed, the patient experienced a return of spontaneous circulation, but a large amount of blood was seen spurting out, and the patient was transferred to a clamshell thoracotomy to secure the visual field. An injury of about 8 mm was observed in the left atrial appendage, which was sutured after establishing ECMO. The patient was discharged from the ICU on postoperative day 20 and discharged home unassisted on postoperative day 77. The cause of blunt cardiac injury is often traffic trauma, but this is a very rare case in which the patient suffered a left atrial appendage injury due to a fall trauma and clamshell thoracotomy was able to save her life. Therefore, clamshell thoracotomy is one of the options to open the chest in certain clinical situation.

Introduction: Relieving cancer pain in children poses significant challenges, especially when pharmacological therapies become ineffective or difficult to administer. This case report describes a pediatric patient with renal cancer who experienced severe lumbago and was successfully treated with implanted epidural analgesia. Case: An 11-year-old boy had been diagnosed with left renal cell carcinoma 1 year prior. After a left nephrectomy and postoperative chemotherapy, the patient experienced a local recurrence a few months later. The patient was referred to the palliative care team because of discomfort in the lumbar region. Detailed imaging and medical history strongly suggested cancer-related pain. Opioid therapy was initiated; however, the patient developed increasing difficulties with oral intake due to headache and nausea associated with escalating pain levels. Epidural analgesia was administered, which resulted in pain relief and improved oral intake. Considering the child’s prognosis, a subcutaneous implantable epidural port was placed to facilitate the continuation of treatment. Subsequently, the patient’s quality of life improved, allowing for activities such as outings. Conclusion: When facing the limitations of pharmacological therapies, a nerve block such as an epidural analgesic can be an effective therapeutic option in pediatric cancer treatment.

Among patients with chronic sinusitis with nasal polyps, there are many refractory cases that repeatedly relapse after conventional Western medical treatment. Such patients suffer not only from nasal obstruction, nasal discharge, and posterior rhinorrhea, but also from olfactory disturbances, which have a significant impact on their daily life due to a decrease in quality of life. In this report, we describe six cases of refractory chronic sinusitis with nasal polyps and olfactory dysfunction that were effectively treated with the addition of eppikajutsuto. For patients with chronic sinusitis with nasal polyps and olfactory dysfunction who have difficulty controlling their symptoms with conventional treatment, a Kampo medicine approach may improve not only the coexisting symptoms such as olfactory dysfunction but also nasal obstruction.