Background: Endoscopic ultrasound-guided drainage (EUSD) is an effective treatment for postoperative pancreatic fluid collections (POPFCs); however, standards regarding stents used for EUSD have not been established. This study analyzed the outcomes of EUSD of POPFCs at our hospital and examined the safety and effectiveness of plastic stents/tubes. Methods: This retrospective, single-center study focused on EUSD of POPFCs performed at our hospital. We examined the rates of technical success, clinical success, adverse events, and recurrence. Results: Twenty-seven patients were included in this study. The initial drainage methods comprised one nasocystic plastic tube (NPT) and one double-pigtail plastic stent (DPS) for 19 (70.4%) patients, two DPS for four (14.8%) patients, one NPT for three (11.1%) patients, and one lumen-apposing metal stent for one (3.7%) patient. The technical success and clinical success rates were both 100%. Fourteen of the 19 patients with one NPT and one DPS improved, but five patients required additional interventions and improved with fistula site dilation. Although recurrence occurred in one patient, improvement was achieved with second EUSD. Early adverse events comprised one case of bleeding for which hemostasis was achieved by performing coil embolization. Late adverse events comprised three cases of DPS migration; however, no additional intervention was required. Conclusion The use of plastic tubes/stents is safe and effective for EUSD of POPFCs.

Background: Endoscopic ultrasound-guided drainage (EUSD) is an effective treatment for postoperative pancreatic fluid collections (POPFCs); however, standards regarding stents used for EUSD have not been established. This study analyzed the outcomes of EUSD of POPFCs at our hospital and examined the safety and effectiveness of plastic stents/tubes. Methods: This retrospective, single-center study focused on EUSD of POPFCs performed at our hospital. We examined the rates of technical success, clinical success, adverse events, and recurrence. Results: Twenty-seven patients were included in this study. The initial drainage methods comprised one nasocystic plastic tube (NPT) and one double-pigtail plastic stent (DPS) for 19 (70.4%) patients, two DPS for four (14.8%) patients, one NPT for three (11.1%) patients, and one lumen-apposing metal stent for one (3.7%) patient. The technical success and clinical success rates were both 100%. Fourteen of the 19 patients with one NPT and one DPS improved, but five patients required additional interventions and improved with fistula site dilation. Although recurrence occurred in one patient, improvement was achieved with second EUSD. Early adverse events comprised one case of bleeding for which hemostasis was achieved by performing coil embolization. Late adverse events comprised three cases of DPS migration; however, no additional intervention was required. Conclusion The use of plastic tubes/stents is safe and effective for EUSD of POPFCs.

Background: Endoscopic ultrasound-guided drainage (EUSD) is an effective treatment for postoperative pancreatic fluid collections (POPFCs); however, standards regarding stents used for EUSD have not been established. This study analyzed the outcomes of EUSD of POPFCs at our hospital and examined the safety and effectiveness of plastic stents/tubes. Methods: This retrospective, single-center study focused on EUSD of POPFCs performed at our hospital. We examined the rates of technical success, clinical success, adverse events, and recurrence. Results: Twenty-seven patients were included in this study. The initial drainage methods comprised one nasocystic plastic tube (NPT) and one double-pigtail plastic stent (DPS) for 19 (70.4%) patients, two DPS for four (14.8%) patients, one NPT for three (11.1%) patients, and one lumen-apposing metal stent for one (3.7%) patient. The technical success and clinical success rates were both 100%. Fourteen of the 19 patients with one NPT and one DPS improved, but five patients required additional interventions and improved with fistula site dilation. Although recurrence occurred in one patient, improvement was achieved with second EUSD. Early adverse events comprised one case of bleeding for which hemostasis was achieved by performing coil embolization. Late adverse events comprised three cases of DPS migration; however, no additional intervention was required. Conclusion The use of plastic tubes/stents is safe and effective for EUSD of POPFCs.

We investigated the history and indications of Toenho, Kinseiho, and Cho-Sanshaku-Shinteiho, which are different formulae with the same name of seishoekkito. According to the description in “Futsugoyakushitsuhokankuketsu” written by Sohaku Asada, Kinseiho exhibits an immediate effect, while Toenho has preventive effects. However, according to the original text, Kinseiho was formulated such that it could be administered regularly in the summer for prophylaxis. Furthermore, Kinseiho is regarded as a simplified formula with the central structure of Toenho. This implies that Kinseiho is composed of selected crude drugs used in Toenho that are responsible for the main effects of Toenho, such as invigorating spleen energy, clearing fever and generating body fluids. Moreover, there is an instruction to arrange Kinseiho to fit each patient’s condition. In this study, it was found that Cho-Sanshaku-Shinteiho described in “Futsugoyakushitsuhokankuketsu” is a modification of Kinseiho prescribed by Katsuki Gyuzan for patients with fever, consistent with the concept of personalized medicine. The medical extract preparation seishoekkito, which is currently widely used, is Kinseiho. We may use it with heat-clearing formula, fluid-regulating formula or some modifications to make the appropriate formulation based on the patient's symptoms.

We are planning a study focused on the gathering of clinical data for the purpose of formalizing diagnostic logic at 6 institutions specialized in Kampo-based medical examinations. However, during the planning stage, it has been recognized that there are a large number of Kampo formulas to be studied, and differences among faculties and individuals exist regarding how to identify each Kampo formula, methods of gathering findings, and the evaluation of efficacy. Here we report the solution proposal reached after building consensus among all participating faculties on these issues. After raising the issues, conferences were held for each of them, until a unanimous consensus was obtained. As a result, the following conclusions were reached. Thirty-three Kampo formulas were selected as targets for the formalization of diagnostic logic. In addition, the range of dosage forms, crude drug ingredients, and permissible dosages for each Kampo formula were determined. Regarding clinical findings for these Kampo medicines, the items to be collected and evaluation criteria were also established. The criteria for evaluating the validity and safety of each Kampo medicine were decided, together with the grading and timing of evaluation. We hope that our solution proposal reached after building consensus becomes the basis for Kampo research in the future.

A 57-year-old man, who had suffered chest, back and right leg pain about 10 years before, underwent CT and was found a chronic type B aortic dissection with an enlarged false lumen and a narrowed true lumen that was occluded at the infrarenal abdominal aorta. A conventional surgical repair seemed to be too high risk considering his comorbidities, thus we chose a staged hybrid repair. First, surgical repair of the abdominal aorta with an abdominal aortic fenestration was performed. Then, one month after the first operation, zone 2 thoracic endovascular aortic repair with left carotid-axillary artery bypass was performed. At the second operation, the stent graft was purposely deployed from zone 2 into Th12 level of a false lumen through the fenestration followed by coil embolization of a true lumen just distal to the entry tear. The postoperative course was uneventful and he had no complications at 6 months follow-up. Deploying stent graft into a false lumen could be a feasible option in case deploying into a true lumen is not suitable if the anatomical condition permits.

BACKGROUND: The dietary pattern of pregnant women is known to be associated with preterm birth (PTB). We investigated whether PTB was associated with intake of fermented food by using data from the Japan Environment and Children's Study. METHODS: From a data set of 103,099 pregnancies, 77,667 cases at low risk for PTB were analyzed. The primary outcome measurements were based on PTB. Fermented food (miso soup, yogurt, cheese, and fermented soybeans) consumption was assessed by using a semi-quantitative food frequency questionnaire. RESULTS: Intake of miso soup, yogurt, and fermented soybeans before pregnancy significantly reduced the risk of early PTB (< 34 weeks). The adjusted odds ratio (OR) for early PTB in women who had miso soup 1-2 days/week, 3-4 days/week, or ≥ 5 days/week were 0.58, 0.69, and 0.62, respectively, compared with those who had miso soup < 1 day/week (95% confidence interval (CI) 0.40-0.85, 0.49-0.98, and 0.44-0.87). The adjusted OR for early PTB in women who ate yogurt ≥ 3 times/week was 0.62 (95% CI, 0.44-0.87) compared to those who ate yogurt < 1 time/week. The adjusted OR for early PTB in women who ate fermented soybeans ≥ 3 times/week was 0.60 (95% CI, 0.43-0.84) compared to those who ate < 1 time/week. However, the incidence of overall PTB and late PTB (34-36 weeks) was not associated with fermented food intake. CONCLUSION PTB low-risk women with a high consumption of miso soup, yogurt, and fermented soybeans before pregnancy have a reduced risk of early PTB.
Adult ; Cohort Studies ; Diet ; statistics & numerical data ; Feeding Behavior ; Female ; Fermented Foods ; analysis ; Gestational Age ; Humans ; Japan ; epidemiology ; Odds Ratio ; Pregnancy ; Premature Birth ; epidemiology ; Protective Factors ; Surveys and Questionnaires

OBJECTIVE: We conducted a retrospective, multi-institutional, collaborative study to accumulate cases of neuroendocrine carcinoma of the endometrium, to clarify its clinicopathologic features, treatment, prognosis and prognostic factors to collate findings to establish future individualized treatment regimens. To our knowledge, this is the largest case study and the first study to statistically analyze the prognosis of this disease. METHODS: At medical institutions participating in the Kansai Clinical Oncology Group/Intergroup, cases diagnosed at a central pathologic review as neuroendocrine carcinoma of the endometrium between 1995 and 2014 were enrolled. We retrospectively analyzed the clinicopathologic features, treatment, prognosis and prognostic factors of this disease. RESULTS: A total of 65 cases were registered from 18 medical institutions in Japan. Of these, 42 (64.6%) cases were diagnosed as neuroendocrine carcinoma of the endometrium based on the central pathological review and thus included in the study. Advanced International Federation of Gynecology and Obstetrics stages (stage III and IV) and pure type small cell neuroendocrine carcinoma cases had a significantly worse prognosis. Upon multivariate analysis, only histologic subtypes and surgery were significant prognostic factors. Pure type cases had a significantly worse prognosis compared to mixed type cases and complete surgery cases had a significantly better prognosis compared to cases with no or incomplete surgery. CONCLUSION: Our findings suggest that complete surgery improves the prognosis of neuroendocrine carcinoma of the endometrium. Even among cases with advanced disease stages, if complete surgery is expected to be achieved, clinicians should consider curative surgery to improve the prognosis of neuroendocrine carcinoma of the endometrium.
Carcinoma, Large Cell ; Carcinoma, Neuroendocrine ; Carcinoma, Small Cell ; Endometrial Neoplasms ; Endometrium ; Female ; Gynecology ; Japan ; Medical Oncology ; Multivariate Analysis ; Obstetrics ; Prognosis ; Retrospective Studies

BACKGROUND: Osteoporosis is considered a public health problem with high worldwide prevalence. One approach to prevention is through the promotion of physical activity, especially exercise, during adolescence. METHODS: This study compared bone variables in different body segments in adolescents according to participation in track and field. The study included 34 adolescents (22 boys), of whom 17 were track and field athletes and 17 were control subjects. Bone mineral density (BMD, g/cm2) and bone mineral content (BMC, g) were analyzed using dual energy X-ray absorptiometry (total body stratified by body segments). Peak height velocity was used to estimate somatic maturation. RESULTS: Athletes had higher BMD (P=0.003) and BMC (P=0.011) values in the lower limbs and higher whole body BMD (P=0.025) than the control group. However, when adjusted for confounding factors, the difference was not maintained. The groups had similar lean soft tissue values (P=0.094). Training overload was positively correlated with BMD in the upper limbs (r=0.504; 95% confidence interval, 0.031-0.793). Although track and field athletes had higher BMD and BMC values in the lower limbs, these differences were not significant when adjusted for confounding factors. CONCLUSIONS: Track and field participation in adolescence appears to influence BMD and BMC in lower limbs, and fat-free mass seems to mediate this effect. Also, higher training loads were found to be positive for bone health in upper limbs.
Absorptiometry, Photon ; Adolescent ; Athletes ; Bone and Bones ; Bone Density ; Child ; Humans ; Lower Extremity ; Motor Activity ; Osteoporosis ; Pilot Projects ; Prevalence ; Public Health ; Sports ; Track and Field ; Upper Extremity

Soshikokito has long been used to treat cough in frail patients with cold sensation in their feet, based on the Japanese traditional Kampo textbook “Iryo-Shuhou-Kiku”. In many old documents including “Wazai-Kyokuho,” where soshikokito was first described, it is suggested that airways obstructed by a large quantity of watery expectoration should be the proper indication for the use of this formula. However, in the five cases that we successfully treated, the quantity of sputum was relatively small. To determine the practical indications for this, we examined their abdominal strength and the presence or absence of “cold feet” sensation. In addition, we investigated the nature of sputum in the past clinical reports in which successful treatment using soshikokito was described. It has become clear that we can prescribe soshikokito as an antitussive regardless of the patients' physical fitness as deduced from the abdominal strength. The “cold feet” sensation was not an essential symptom and was regarded as one of the symptoms of qi counterflow. Regarding the properties of sputum, it was viscous and small in quantity. In the cases where soshikokito was effective, it was speculated that viscous sputum would result in airway obstruction, coughing, and wheezing. These conditions will be ameliorated by the antitussive and expectorant effect of this formula, which improves qi counterflow and mildly tonifies water. In the treatment of cough with respiratory distress, “sputum with high viscosity and hard to discharge” is considered to be the targeted symptom in the practical usage of soshikokito.