Purpose: This study investigated the relationship between the number of days that hospital visits were postponed and changes in clinical parameters due to the spread of coronavirus disease 2019 (COVID-19), after the Japanese government declared a state of emergency in April 2020. Methods: Regarding the status of postponement of appointments, we analyzed the patients who had visited the Nihon University Hospital at Matsudo for more than 1 year for supportive periodontal therapy (SPT) and classified them into low-, moderate- and high-risk subgroups according to the periodontal risk assessment (PRA). Clinical parameters for periodontal disease such as probing depth (PD), full-mouth bleeding score (FMBS), full-mouth plaque score, periodontal inflamed surface area (PISA), and periodontal epithelial surface area (PESA) were analyzed in 2 periods, from October 2019 to March 2020 and after April 2020.Correlation coefficients between days of deferral and the degree of changes in clinical parameters were calculated. Results: The mean age of the 749 patients was 67.56±10.85 years, and 63.82% were female.Out of 749 patients, 33.24% deferred their SPT appointments after April 2020. The average total of postponement days was 109.49±88.84. The number of postponement days was positively correlated with changes in average PD (rs=0.474) and PESA (rs=0.443) in the high-risk subgroup of FMBS, and average PD (rs=0.293) and PESA (rs=0.253) in the highrisk subgroup of tooth number (TN). Patients belonging to the high-risk subgroups for both FMBS and TN had a positive correlation between postponement days and PISA (rs=0.56). Conclusions The findings, the spread of COVID-19 appears to have extended the visit interval for some SPT patients. Moreover, longer visit intervals were correlated with the worsening of some clinical parameters for SPT patients with high PRA.

OBJECTIVES: Sarcopenia and osteoporosis affects activities of daily living and quality of elderly people. However, little is known about its impact on elderly locomotor diseases, such as osteoporotic vertebral fracture (OVF). There is no report investigating the influence of both sarcopenia and osteoporosis on outcomes of OVF. This study aimed to evaluate the clinical outcomes of OVF in elderly patients from sarcopenic perspectives. METHODS: This prospective study was conducted with 396 patients, aged 65 years or more, hospitalized for the treatment of OVF (mean age, 81.9 ± 7.1 years; 111 males, 285 females). The primary outcome was the Japanese Orthopaedic Association (JOA) score for lumbar disease (at first visit, hospital discharge, and 1 year after treatment) and Barthel index (at the same time and before hospitalization). The second outcome was living place after discharge. Susceptibility to sarcopenia and osteoporosis were evaluated and clinical results of conservative treatment were compared. RESULTS: Sarcopenia significantly affected Barthel index at first visit and discharge. Sarcopenia patients had significantly higher rate for discharge to nursing home and living in nursing home after 1 year than patients without sarcopenia. Osteoporosis significantly affected the JOA score at the first visit and the Barthel index before hospitalization, at the first visit, discharge, and after 1 year. Osteoporosis did not affect the living place at discharge and after 1 year. CONCLUSIONS: Sarcopenia and osteoporosis affected outcomes of conservative treatment for OVF; moreover, sarcopenia affected the living place of OVF patients at discharge and after 1 year.
Activities of Daily Living ; Aged ; Asian Continental Ancestry Group ; Hospitalization ; Humans ; Male ; Nursing Homes ; Osteoporosis ; Prospective Studies ; Sarcopenia

Endoscopic ultrasound-guided biliary drainage (EUS-BD), EUS-guided choledochoduodenostomy (EUS-CDS), and EUS-guided hepaticogastrostomy (EUS-HGS) can effectively palliate obstructive jaundice, but have not been well established yet. The incidence of complications is about 30% in EUSBD and higher for EUS-HGS. Several complications have been reported such as bleeding, perforation and peritonitis. Bleeding occurs due to puncture of portal vein, hepatic vein and artery, and we should use color Doppler. When a cautery dilator is used for fistula dilation, burn effects may cause delayed bleeding. Endoscopic hemostasis is only effective for anastomotic bleeding and embolization with interventional radiology technique is required for pseudo aneurysm. There are some types of perforation: failed stent placement after puncture or fistula dilation, double puncture during CDS procedure, and stent migration. Peritonitis with perforation requires surgery and can be fatal. Stent migration before mature fistula formation causes severe peritonitis because EUS-BD makes fistula between two unattached organs. Stents with flaps or long covered self-expandable metallic stents (cSEMSs) are effective to prevent migration. Recent development of lumen apposing stents may reduce early migration in EUS-CDS. Peritonitis without migration can be due to 1) leakage of bile juice or gastric/duodenal contents during EUS-BD or 2) leakage along the placed stent. We should make procedure time as short as possible, and cSEMSs reduce bile leak along the stent by occluding the dilated fistula. In summary, we should understand the mechanism of complications and the technique to prevent and manage complications. Development of dedicated devices to increase the success rate and reduce complications is required.
Aneurysm ; Arteries ; Bile ; Burns ; Cautery ; Choledochostomy ; Drainage* ; Fistula ; Hemorrhage ; Hemostasis, Endoscopic ; Hepatic Veins ; Incidence ; Jaundice, Obstructive ; Peritonitis ; Portal Vein ; Punctures ; Radiology, Interventional ; Stents

BACKGROUND/AIMS: In distal malignant biliary obstruction, an antireflux metal stent (ARMS) with a funnel-shaped valve is effective as a reintervention for metal stent occlusion caused by reflux. This study sought to evaluate the feasibility of this ARMS as a first-line metal stent. METHODS: Patients with nonresectable distal malignant biliary obstruction were identified between April and December 2014 at three Japanese tertiary centers. We retrospectively evaluated recurrent biliary obstruction and adverse events after ARMS placement. RESULTS: In total, 20 consecutive patients were included. The most common cause of biliary obstruction was pancreatic cancer (75%). Overall, recurrent biliary obstruction was observed in seven patients (35%), with a median time to recurrent biliary obstruction of 246 days (range, 11 to 246 days). Stent occlusion occurred in five patients (25%), the causes of which were sludge and food impaction in three and two patients, respectively. Stent migration occurred in two patients (10%). The rate of adverse events associated with ARMS was 25%: pancreatitis occurred in three patients, cholecystitis in one and liver abscess in one. No patients experienced non-occlusion cholangitis. CONCLUSIONS: The ARMS as a first-line biliary drainage procedure was feasible. Because the ARMS did not fully prevent stent dysfunction due to reflux, further investigation is warranted.
Arm ; Asian Continental Ancestry Group ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholecystitis ; Drainage ; Humans ; Liver Abscess ; Pancreatic Neoplasms ; Pancreatitis ; Pilot Projects* ; Retrospective Studies ; Sewage ; Stents*

We describe an extremely rare case of advanced pure primary ovarian squamous cell carcinoma (SCC), treated by adjuvant chemotherapy with dose-dense paclitaxel combined with carboplatin (dd-TC) plus the combination chemotherapy with irinotecan and cisplatin (CPT-P), with long-term recurrence-free survival. A 71-year-old woman complaining of lower abdominal pain was referred to our hospital and a 7-cm-diameter solid tumor was identified. She was diagnosed with a left ovarian tumor that was highly suspicious for malignancy based on ultrasonography, magnetic resonance imaging, and contrast-enhanced computed tomography. Bilateral salpingo-oophorectomy, low-anterior colon resection, and colostomy were performed. Intra- and post-operative histopathological diagnosis revealed International Federation of Gynecology and Obstetrics stage IIIc well-differentiated pure ovarian SCC. As adjuvant chemotherapy, 2 courses of dd-TC were administered, followed by 3 courses of CPT-P; the patient then underwent 4 additional courses of dd-TC. Both regimens were effective and there has been no recurrence or metastasis thus far in the 5 years since the operation.
Abdominal Pain ; Aged ; Carboplatin* ; Carcinoma, Squamous Cell* ; Chemotherapy, Adjuvant ; Cisplatin ; Colon ; Colostomy ; Diagnosis ; Drug Therapy, Combination ; Epithelial Cells* ; Female ; Gynecology ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Obstetrics ; Ovarian Neoplasms ; Paclitaxel* ; Recurrence ; Ultrasonography

Percutaneous transhepatic biliary drainage (PTBD) is an established procedure for biliary obstruction. However, duodenobiliary or jejunobiliary reflux of the intestinal contents through a PTBD catheter sometimes causes recurrent catheter obstruction or cholangitis. A 64-year-old female patient with a history of choledochojejunostomy was referred to our department with acute cholangitis due to choledochojejunal anastomotic obstruction. Emergent PTBD was performed, but frequent obstructions of the catheter due to the reflux of intestinal contents complicated the post-PTBD course. We therefore introduced a catheter with an antireflux mechanism to prevent jejunobiliary reflux. A commercially available catheter was modified; side holes were made at 1 cm and 5 to 10 cm (1 cm apart) from the tip of the catheter, and the catheter was ligated with a nylon thread just proximal to the first side hole. Using this novel "antireflux PTBD technique," jejunobiliary reflux was prevented successfully, resulting in a longer patency of the catheter.
Catheter Obstruction ; Catheters ; Cholangitis ; Choledochostomy ; Dioxolanes ; Drainage ; Female ; Fluorocarbons ; Gastrointestinal Contents ; Humans ; Nylons

BACKGROUND/AIMS: Stent migration occurs frequently, but the prevention of complications resulting from covered self-expandable metal stents (C-SEMSs) remains unresolved. We prospectively assessed a newly developed C-SEMS, a modified covered Zeo stent (m-CZS), in terms of its antimigration effect. METHODS: Between February 2010 and January 2011, an m-CZS was inserted into 42 patients (31 initial drainage cases and 11 reintervention cases) at a tertiary referral center and three affiliated hospitals. The laser-cut stent was flared for 1.5 cm at both ends, with a 1 cm raised bank located 1 cm in from each flared end. The main outcome of this study was the rate of stent migration, and secondary outcomes were the rate of recurrent biliary obstruction (RBO), the time to RBO, the frequencies of complications, and overall survival. RESULTS: Of the 31 patients with initial drainage, stent migration occurred in four (12.9%, 95% confidence interval, 5.1% to 29.0%), with a mean time of 131 days. RBO occurred in 18 (58%), with a median time to RBO of 107 days. Following previous C-SEMS migration, seven of 10 patients (70%) did not experience m-CZS migration until death. CONCLUSIONS: m-CZSs with antimigration properties effectively, although not completely, prevented stent migration after stent insertion.
Aged ; Aged, 80 and over ; Alloys ; Carcinoma/*complications ; Cholestasis/etiology/*therapy ; Digestive System Neoplasms/*complications ; Drainage ; Equipment Design ; Feasibility Studies ; Female ; Humans ; Kaplan-Meier Estimate ; Lymphatic Metastasis ; Male ; Middle Aged ; *Prosthesis Failure ; Recurrence ; Reoperation ; *Stents/adverse effects ; Time Factors

  The incidence of fever in children admitted to general hospitals is very high. Provision of adequate nutrition and fluid supplements to febrile children is very important, but with some children it is difficult to maintain an adequate intake. To address this problem, we devised a new ‘febrile children's menu’, utilizing preparation methods and foods to produce a palatable menu for patients with fever.
  We introduced this ‘febrile children's menu‘ on January 6, 2011, providing it to 109 patients (age range: 1 to 8 years, average age: 3.3±1.9 years) over the ensuing 3-month period. We provided a mean 4.0±2.9 meals per day to each patient during their febrile stage (≥37.5°C). To evaluate the usefulness of the ‘febrile children's menu’, we investigated eating rates during the febrile period in all patients who had been provided with the menu, and performed a questiomaire survey on their parents/guardians. The mean eating rates during the febrile period were 39±30% for main meals, and 28±22% for side dishes. No significant difference was seen in the eating rates during the febrile period recorded over the 2-month period prior to introduction of the new menu to 112 febrile children (age range: 1 to 8 years, average age: 3.3±2.1 years), 39±30% for main meals, and 29±22% for side dishes. The questionnaire survey was responded by 43 parents/guardians (a recovery rate of 39%). The ‘febrile children's menu’ was assessed as ‘good’ by 67% of respondents, representing an overall favourable impression from the parents/guardians. With reference to the survey results, we will attempt to further improve the ‘febrile children's menu’ with the aim of increasing eating rates during the febrile period.

Objective: The purpose of the present study was to clarify the efficacy of alendronate and raloxifene for preventing bone loss in patients with hip fracture by monitoring bone mineral densities (BMDs) and biochemical markers during the 9-month period after fracture. Patients and Methods: Eighty-two female hip fracture patients from 50 to 99 years old (mean ± SD: 81.6 ± 9.5) were randomly divided into two groups; there were 46 patients in the alendronate-treated group (group ALN) and 36 patients in the raloxifene-treated group (group RLX). Drugs were administered to patients six weeks after their operations. Lumbar spine BMD and neck, trochanter, Ward's and total BMDs of the contralateral proximal femur, serum intact osteocalcin (intact OC), bone-specific alkaline phosphatase (BAP) and urinary N-terminal telopeptide of type I collagen (NTX) were measured just before the start of drug administration and at 9 months thereafter. Results: Twenty-two out of 46 patients in group ALN and 23 out of 36 patients in group RLX completed the study. The most common reason for dropping out was the patient's failure to visit the outpatient clinic. Trochanter BMD in group ALN tended to increase by 8.4% compared with the baseline, and total hip BMD in group RLX showed a significant increase (5.7%), although neck BMD in both groups decreased during the 9 months of treatment (–8.7% for group ALN and –4.2% for group RLX compared with the baseline). Spine BMD did not change significantly in eithr group. Serum BAP and urinary NTX decreased significantly in both groups. Serum intact OC did not change significantly. Conclusions: Both alendronate and raloxifene have a favorable effect on trochanter and total BMDs of the contralateral proximal femur in the short period after hip fracture. However, both drugs could not prevent bone loss in the femoral neck during the 9 months of treatment.

In conventional pharmacological research in the field of mental disorders, pharmacological effect and dose have been estimated by ethological approach and in vitro data of affinity to the site of action. In addition, the frequency of administration has been estimated from drug kinetics in blood. However, there is a problem regarding an objective index of drug effects in the living body. Furthermore, the possibility that the concentration of drug in blood does not necessarily reflect the drug kinetics in target organs has been pointed out. Positron emission tomography (PET) techniques have made progress for more than 20 years, and made it possible to measure the distribution and kinetics of small molecule components in living brain. In this article, we focused on rational drug dosing using receptor occupancy and proof-of-concept of drugs in the drug development process using PET.
Brain ; Central Nervous System ; Drug Evaluation ; Electrons ; Kinetics ; Mental Disorders ; Norepinephrine Plasma Membrane Transport Proteins ; Positron-Emission Tomography ; Receptors, Dopamine D2 ; Serotonin Plasma Membrane Transport Proteins