People with high health knowledge tend to use information and communication technology (ICT) to obtain, maintain, and promote information necessary for health management. Therefore, experts hypothesize that improving health knowledge will increase the use of online medication guidance via ICT. In this study, we investigated the relationship between health knowledge and willingness to use online medication guidance among Iwaki Health Promotion Project health checkup subjects. The 736 examinees participating in this project in 2022 were surveyed on age, gender, number of people living with them, whether they exercise, drink alcohol, or smoke, whether they use smartphones, whether they use medication registers, their health knowledge score, and whether they take any medications. The presence/absence of desire for online medication guidance (1/0) was used as the objective variable to identify influencing factors. Univariate and multivariate analyses showed that independence was found for four factors: age (OR: 0.975, P<0.001), gender (male) (OR: 1.914, P<0.001), smartphone use (OR: 2.156, P＝0.004) and health knowledge score (OR: 1.405, P<0.001). This study found that health knowledge plays a role in the intention to use online medication guidance. In order to improve health knowledge, it will be necessary to enhance skills to obtain and use high-quality health information and to improve the environment for using ICT-based communication devices.

A 57-year-old man presented with a one-month history of dyspnea. Computed tomography revealed a pulmonary embolism, and echocardiography revealed multiple linear floating thrombi in the right atrium. An urgent surgical thrombectomy was performed, and most of the thrombi in the right atrium and bilateral pulmonary arteries were removed under cardiopulmonary bypass. The thrombi in the right atrium adhered to the linear Chiari networks. The patient was treated with rivaroxaban uneventfully and subsequently discharged on postoperative day 26. Herein, we report a case of right atrial thrombi and pulmonary embolism likely augmented by the Chiari network, which was successfully treated with surgical thrombectomy.

A 74-year-old man having a right refractory foot ulcer was referred to our hospital with a diagnosis of arteriosclerosis obliterans. Angiography of the lower extremities showed occlusive lesions in the middle popliteal artery and lower-leg arteries. Preoperative examination revealed decreased cardiac function and severe stenosis of the left and right coronary arteries. Therefore, we first performed coronary artery bypass grafting, followed by revascularization of the lower limbs at a later date. Owing to the lack of suitable autologous vein grafts, our procedure of choice was popliteal endarterectomy via a posterior approach with short saphenous vein angioplasty. The patient's foot ulcer healed completely following surgery. His postoperative course was uneventful, and he remained symptom-free during a 1-year follow-up.

Background/Aims: The Heart Failure Association (HFA)-PEFF score is recognized as a simple method to diagnose heart failure (HF) with preserved ejection fraction (HFpEF). This study aimed to evaluate the relationship between HFA-PEFF scores and cardiovascular outcomes in HFpEF patients. Methods: A total of 502 consecutive HFpEF patients were prospectively observed for up to 1,500 days. Cardiovascular outcomes were compared between two groups of patients, defined by their HFA-PEFF scores: those who scored 2–4 (the intermediate-score group) and those who scored 5–6 group (the high-score group). Overall, 236 cardiovascular events were observed during the follow-up period (median, 1,159 days). Results: Kaplan-Meier analysis showed that there were significant differences in composite cardiovascular events and HF-related events between the intermediate-score group and the high-score group (p = 0.003 and p < 0.001, respectively). Multivariate Cox proportional hazards analysis showed that the HFA-PEFF scores significantly predicted future HF-related events (hazard ratio, 1.66; 95% confidence interval [CI], 1.11 to 2.50; p = 0.014); receiver operating characteristic analysis confirmed this relationship (area under the curve, 0.633; 95% CI, 0.574 to 0.692; p < 0.001). The cutoff HFA-PEFF score for the identification of HF-related events was 4.5. Decision curve analysis revealed that combining the HFA-PEFF score with conventional prognostic factors improved the prediction of HF-related events. Conclusions HFA-PEFF scores may be useful for predicting HF-related events in HFpEF patients.

Objective：Patients with vertebral compression fracture first visit the acute care hospital for a diagnosis, but cannot be admitted and return home with a corset and analgesics. Because of severe lower back pain, they stay in bed for a significant period of time, and their skeletal muscles suffer from disuse atrophy. We aimed to actively admit these patients for recovery phase rehabilitation by setting up a hotline.Methods：The backgrounds of each case including the major laboratory findings were investigated for 1 year. Health professionals were able to use the hotline to request admission for the patients.Results：One hundred twenty-seven patients (38 males and 89 females, aged 84±7.5 years) were admitted. The percentages of phone calls from acute-care hospitals, clinics, and regional care managers were 46%, 31%, and 20%, respectively. With regard to degree of disability 36％ of the patients were at C1, 31% were at B2, and 20% were at C2 indicating that they needed almost complete assistance. Fifty one percent of the patients lived alone, and 20% were couples without assistance from others. Because they were elderly patients with many complications, more than six agents had been prescribed on average. However, osteoporosis medication had been prescribed to only 23%. The prognosis was favorable with ratio of returned home being 91%, even though the outcome of rehabilitation is limited by ageing and deteriorated cardiac and renal functions in these patients.Conclusion：Services to support these patients during the recovery phase of rehabilitation is crucial, in order to improve community-based health care.

Objective：Patients with vertebral compression fracture first visit the acute care hospital for a diagnosis, but cannot be admitted and return home with a corset and analgesics. Because of severe lower back pain, they stay in bed for a significant period of time, and their skeletal muscles suffer from disuse atrophy. We aimed to actively admit these patients for recovery phase rehabilitation by setting up a hotline.Methods：The backgrounds of each case including the major laboratory findings were investigated for 1 year. Health professionals were able to use the hotline to request admission for the patients.Results：One hundred twenty-seven patients (38 males and 89 females, aged 84±7.5 years) were admitted. The percentages of phone calls from acute-care hospitals, clinics, and regional care managers were 46%, 31%, and 20%, respectively. With regard to degree of disability 36％ of the patients were at C1, 31% were at B2, and 20% were at C2 indicating that they needed almost complete assistance. Fifty one percent of the patients lived alone, and 20% were couples without assistance from others. Because they were elderly patients with many complications, more than six agents had been prescribed on average. However, osteoporosis medication had been prescribed to only 23%. The prognosis was favorable with ratio of returned home being 91%, even though the outcome of rehabilitation is limited by ageing and deteriorated cardiac and renal functions in these patients,Conclusion：Services to support these patients during the recovery phase of rehabilitation is crucial, in order to improve community-based health care.

A 57-year-old man was admitted with high fever and chest discomfort associated with aortic valve infective endocarditis. An echocardiogram showed severe aortic valve regurgitation. An emergent operation was performed. The aortic valve was destroyed and an annulus abscess was observed. Aortic valve replacement was performed. There was a large amount of pleural effusion in both chest cavities. Bilateral chest drainage was performed. Cardiopulmonary bypass weaning was performed uneventfully. The operation was finished without any mechanical support required. However, respiratory failure was observed to progress rapidly immediately after the operation. A postoperative X-ray showed bilateral pulmonary edema. Re-expansion pulmonary edema was diagnosed. Because oxygenation was not improved in ventilator settings, venovenous extracorporeal membrane oxygenation (V-V ECMO) was installed. Respiratory support with V-V ECMO was needed for 17 days postoperatively. It took 36 days before the patient was removed from the ventilator. V-V ECMO successfully managed bilateral re-expansion pulmonary edema.

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

No abstract available.
Endoscopic Mucosal Resection ; Gastroscopy ; Dissection

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