Background: This study aimed to demonstrate the effectiveness of a percutaneous method for treating intra-abdominal abscesses caused by gastrointestinal anastomotic leakage using tandem catheter placement for simultaneous drainage. Methods: This retrospective study involved 12 patients with intra-abdominal abscesses from anastomotic leakage who underwent image-guided percutaneous drainage. In the tandem drainage technique, one or more catheters were inserted into the abscess while an additional catheter was advanced into the gastrointestinal tract through the anastomotic dehiscence to decompress the tract and prevent further leakage. The study evaluated the technical and clinical success rates of this approach. Results: Technical success was achieved in nine of 12 patients (75.0%), with clinical success in eight of these nine patients (88.9%). The mean overall drainage duration after tandem placement was 65.0 days (range, 6–154 days), and the mean hospitalization duration for patients with clinical success was 66.7 days (range, 10–156 days). Conclusion Simultaneous tandem drainage is a feasible treatment for intra-abdominal abscesses caused by anastomotic leakage and may be a viable option for patients who are not candidates for surgery.

Background: This study aimed to demonstrate the effectiveness of a percutaneous method for treating intra-abdominal abscesses caused by gastrointestinal anastomotic leakage using tandem catheter placement for simultaneous drainage. Methods: This retrospective study involved 12 patients with intra-abdominal abscesses from anastomotic leakage who underwent image-guided percutaneous drainage. In the tandem drainage technique, one or more catheters were inserted into the abscess while an additional catheter was advanced into the gastrointestinal tract through the anastomotic dehiscence to decompress the tract and prevent further leakage. The study evaluated the technical and clinical success rates of this approach. Results: Technical success was achieved in nine of 12 patients (75.0%), with clinical success in eight of these nine patients (88.9%). The mean overall drainage duration after tandem placement was 65.0 days (range, 6–154 days), and the mean hospitalization duration for patients with clinical success was 66.7 days (range, 10–156 days). Conclusion Simultaneous tandem drainage is a feasible treatment for intra-abdominal abscesses caused by anastomotic leakage and may be a viable option for patients who are not candidates for surgery.

Background: This study aimed to demonstrate the effectiveness of a percutaneous method for treating intra-abdominal abscesses caused by gastrointestinal anastomotic leakage using tandem catheter placement for simultaneous drainage. Methods: This retrospective study involved 12 patients with intra-abdominal abscesses from anastomotic leakage who underwent image-guided percutaneous drainage. In the tandem drainage technique, one or more catheters were inserted into the abscess while an additional catheter was advanced into the gastrointestinal tract through the anastomotic dehiscence to decompress the tract and prevent further leakage. The study evaluated the technical and clinical success rates of this approach. Results: Technical success was achieved in nine of 12 patients (75.0%), with clinical success in eight of these nine patients (88.9%). The mean overall drainage duration after tandem placement was 65.0 days (range, 6–154 days), and the mean hospitalization duration for patients with clinical success was 66.7 days (range, 10–156 days). Conclusion Simultaneous tandem drainage is a feasible treatment for intra-abdominal abscesses caused by anastomotic leakage and may be a viable option for patients who are not candidates for surgery.

Methadone is a difficult medicine to assess the efficacy at an initial stage because the blood concentration of it varies greatly among individuals and it takes days to reach a steady state and cannot be increased for 7 days. Nevertheless, there are few reports of blood concentration together with effects after administration of methadone about Japanese cancer patients. In this study, we investigated changes in blood concentration and pain score (NRS), and factors that affect blood concentration. Dose per body weight was only correlated with blood concentration of methadone. In the effective cases, NRS decreased chronologically until the 7th day after treatment initiation, and significantly decreased from the 1st day compared to before treatment initiation, but in the ineffective cases, it tended to decrease until the 3rd day, but there was no change thereafter. The blood concentration increased to 110 ng/ml on the 7th day in the effective cases, and in the ineffective cases, it reached the concentration on the 3rd day. Thus there was no correlation between the blood concentration and the drug efficacy. The individual blood concentrations tended to increase slightly or decrease after the 3rd day, but in only one case, it continued to increase. From the above-mentioned, it was shown that the effect could be judged at an early stage, however, since there was a case in which the blood concentration continued to rise until the 7th day, it was considered that the early dose increase within 7 days after initiation should be performed carefully.

Although the physical activity reference value for older adults (10 METs*hour/week) has been promoted by Japan Ministry of Health, Welfare, and Labour since 2013, little is known about how many steps/day cut-off values that optimally identify meeting the reference value according to the differences of age, sex, medical history, and joint pain. The purpose of this study were 1) to determine the steps/day that optimally identify meeting the reference value, and 2) to identify the differences by the effects of age, sex, medical history, and joint pain on cut-off values. This study included 583 community-dwelling older Japanese adults (aged 73.2 ± 5.4 years; 153 men, 430 women). A uniaxial accelerometer survey was conducted to estimate the total physical activity volume and steps/day. Receiver operating characteristic (ROC) analyses were used to detect steps/day cut-off values for meeting the reference value among all participants and stratified by age, sex, medical history, and joint pain. The optimal cut-off value (AUC (area under the ROC curve), sensitivity, and specificity) for the reference value was 4376 steps/day (0.99, 95.2%, and 97.2%) in all participants. Differences among the cut-off values according to age, sex, medical history, and joint pain ranged from 39 to 169 steps/day. These results suggest that step counts has satisfactory validity to represent the reference value in older adults, and the effects of age, sex, medical history, and joint pain on cut-off values were considerably small. Therefore, this step-count level may be a useful indicator for modifying the daily-life activities of older adults.

Habitual moderate- to vigorous-intensity physical activity positively impacts lower extremely performance in older adults. However, little is known whether habitual sedentary behaviour time independently impacts lower extremity performance. The purpose of this cross-sectional study was to identify whether sedentary behaviour time is associated with lower extremity performance independent of moderate- to vigorous-intensity physical activity time in older adults. Eight-hundred-and-two community-dwelling older Japanese adults (72.5 ± 5.9 years) participated in this study. Sedentary behavioir time and moderate- to vigorous-intensity physical activity time were assessed using a uniaxial accelerometer. Lower extremity performance was assessed by repeated chair stand, single leg stance, and timed up and go tests. Jonckheere terpstra trend test and Spearman rank correlation coefficient were used to identify the single relation between sedentary behaviour time and lower extremity performance. A hierarchical multiple regression analysis was used to identify whether sedentary behaviour time is associated with lower extremity performance independent of moderate- to vigorous-intensity physical activity time. Results of single relation analysis showed there were negative associations between sedentary behaviour time and all lower extremity performance tests. Multivariable analysis indicated that sedentary behaviour time was not significantly associated with any lower extremity performances but moderate- to vigorous-intensity physical activity time was positively associated with all lower extremity performance tests. In conclusion, sedentary behaviour time would be less useful than moderate- to vigorous-intensity physical activity time as an indicator for modifying habitual behavior to maintain good lower extremity performance in community-dwelling older adults.

The purpose of this study was to retrospectively examine the association of habitual exercise with “single fall (= 1)”, “multiple falls (≥ 2)”, and “injurious falls (≥ 1)” among community-dwelling older adults. A total of 1,683 community-dwelling older adults, aged 60-97 years (72.6 +/- 6.6 yr, 512 men and 1,171 women) were included in this study. Habitual exercises continued one year or longer (6.4 +/- 9.5 yr) were classified into twelve types. Exercise components (time, quantity, period of continuity, and number of exercises) were divided with median or tertiles. To assess the association between habitual exercises and fall status, multivariable logistic regression analyses with stepwise selection method, were applied. The multivariable logistic regression analyses showed that dance (odds ratio (OR): 0.30, 95% confidence interval (CI): 0.09-0.96) was negatively associated with “single fall”. Bicycling (OR: 3.72, 95% CI: 1.32-10.77) was positively associated with “multiple falls”, and the period of continuity (OR: 0.74, 95% CI: 0.60-0.91) was negatively associated with “multiple falls”. None of the exercise components were selected with regard to “injurious falls”. Results indicate that dance may be an effective type of exercise for fall prevention among community-dwelling older adults. However, caution about falling is warranted toward bicycling as an exercise. Moreover, a longer period of continuity (≥ 4 years) appears to be a positive factor of habitual exercise for fall prevention.

　　Chronic kidney disease (CKD) has recently been reported to be an independent risk factor for stroke. However, a detailed analysis was yet to be conducted according to stroke subtype. We attempted to determine the risk factors for stroke using data from the “specific health checkup” for metabolic syndrome conducted by the 9 hospitals affiliated with the Akita Prefectural Federation of Agricultural Cooperatives, and evaluate and determine the risk factors for stroke. There were 401 patients who had undergone metabolic syndrome checkups from 2007 and 2010 and suffered from stroke afterwards within 3 years after the screening. The controls were all 69,407 subjects who were screened during the same period. The predictors examined were sex, age, blood pressure, BMI, cholesterol values (HDL・LDL), history of diabetes mellitus, presence of atrial fibrillation, CKD, and drinking and smoking habits. Analysis was conducted using logistic regression. The risk factors for stroke as a whole were male sex, age, blood pressure, diabetes, atrial fibrillation, CKD, and smoking history. For cerebral infarction, the risk factors were male sex, age, blood pressure, diabetes, atrial fibrillation, CKD, and smoking habit. The risk factors for cerebral hemorrhage were age, blood pressure, and CKD. For subarachnoid hemorrhage, the risk factors were female sex, age, blood pressure, low HDLemia, and CKD. In conclusion, CKD is an independent risk factor for the 3 subtypes of stroke, and in particular plays an important role as a higher risk factor for cerebral hemorrhage. Smoking cessation and controls of blood pressure, diabetes and atrial fibrillation are the important measures for stroke prevention. In addition, the further intervention should also be targeted to those with the result of CKD revealed by specific health checkups.

This study aimed to examine the association between body mass index (BMI) and muscle strength, and mobility limitation (ML). A cross-sectional analysis was conducted on data from 570 community-dwelling older Japanese women aged 65-91 years [mean age, 73.9 ± 5.8 (SD) years]. Muscle strength was assessed by hand-grip strength (HGS). ML was assessed using self-reported difficulty level in walking 400 m and ascending 10 steps without resting. BMI and muscle strength were divided into tertiles (high: BMI ≧ 25.1 kg/m², HGS ≧ 22.5 kg; middle: BMI 22.4-25.0 kg/m², HGS 18.8-22.4 kg; low: BMI ≦ 22.3 kg/m², HGS ≦ 18.7 kg) respectively, and logistic regression analysis was used to determine the association between BMI and muscle strength with ML. 256 participants (44.9%) were identified as having ML. Adjusted odds ratios of BMI for ML were 1.64 (95% confidence interval (CI): 1.00-2.68) in the middle group and 1.89 (95% CI: 1.15-3.12) in the high group when compared to the low group. Adjusted odds ratios of muscle strength for ML were 1.25 (95% CI: 0.77-2.04) in the middle group and 1.85 (95% CI: 1.11-3.09) in the low group when compared to the high group. Compared to the low BMI plus high muscle strength group, adjusted odds ratio for ML was significantly higher in the high BMI plus low muscle strength group (2.65, 95% CI: 1.02-6.87) and the high BMI plus middle muscle strength group (3.09, 95% CI: 1.25-7.61). Our findings indicate that the combination of overweight plus muscle weakness is more predictive for having ML than overweight or muscle weakness alone.

Borderline personality disorder (BPD) is often manifested by maladaptive behaviours such as self-injury. The interpersonal style characteristic of BPD makes it difficult to maintain stable therapeutic relationships, with the patient often discontinuing treatment. Although dialectical behavior therapy (DBT) has been reported to benefit patients with BPD, reports in Asian countries have been few. We herein describe a 22-year-old female with BPD and a history of attempted suicide and self-injury who underwent DBT at our hospital. Methods: Our 6-month DBT consists of 4 parts: weekly psychotherapy by a psychiatrist, weekly skills training by a clinical psychologist and nurse, emergency consultations, and supervision/consultation meetings. Individual psychotherapy and skills training sessions, respectively, were conducted for this patient 24 times. Results: After completing DBT, the number of self-injuries and frequency of suicidal ideation in our patient decreased. Conclusion: Although more costly than standard treatment for BPD, a trial of DBT might be worthwhile in Japanese patients.