The purpose of the present study was to examine the validity and reliability of the stages of change for sedentary behavior scale among workers. The participants were 2400 Japanese workers aged 20-59 years (male: 50.0%, mean age: 40.4±10.8 years) recruited from research company. With an internet-based survey, the stages of change for sedentary behavior, total sitting time (min/day), socio-demographic characteristics, health-related characteristics and work-related characteristics were obtained. “Too much sitting” was defined as sitting or lying down for a total of 8 hours or more per day on average. Participants were categorized into one of 5 stages based on their present status for “too much sitting” and motivational readiness for reducing sedentary behavior. For the criterion validity, a one-way analysis of variance was utilized to compare the total sitting time among the 5 stages. To assess the test-retest reliability, randomly-selected 200 workers answered the scale again two weeks later. Then, the Kappa index (k) was calculated. As results, the means of total sitting time were significantly distinguished across the stages [F (4, 2395) =111.5, p<0.001, η2=0.16]. Participants in early stages (precontemplation, contemplation, preparation) had significantly longer sitting time than those in the Maintenance (Precontemplation>Contemplation, Preparation>Action, Maintenance) (p<0.001). The scale to assess the readiness to reduce sedentary time has shown good 2-week test-retest reliability (k=0.64). These results suggest that the developed scale presented good validity and reliability to assess the motivational readiness for reducing prolonged sedentary behavior among Japanese workers.

Background: Comparative analysis of virulence factors (VFs) between Pasteurella canis and Pasteurella multocida are lacking, although both cause zoonotic infections. We determined the virulence-associated genome sequence characteristics of P. canis and assessed the toxin gene prevalence unique to P. canis among clinical isolates of P. canis and P. multocida. Methods: We selected 10 P. canis and 16 P. multocida whole-genome sequences (WGSs) from the National Center for Biotechnology database. The VFanalyzer tool was used to estimate P. canis-characteristic VFs. Amino acid sequences of VFs were compared with multiple-aligned sequences. The genome structure containing P. canis-characteristic and adjacent loci was compared to the corresponding P. multocida genome structure. After designing primer sequences and assessing their accuracy, we examined the gene prevalence of the P. canis-characteristic VFs using PCR among clinical isolates of P. multocida and P. canis. Results: Using VFanalyzer, we found virulence-associated cytolethal distending toxin (cdt)A–cdtB–cdtC loci common to all P. canis WGSs that were not found in P. multocida WGSs. Similarities in the multiple alignments of CdtA–CdtB–CdtC amino acid sequences were found among the 10 P. canis WGSs. Shared or similar loci around cdtA–cdtB–cdtC were identified between the P. canis and P. multocida genome structures. The PCR-based cdtA–cdtB–cdtC prevalence differed for P. canis and P. multocida clinical isolates. Conclusions P. canis-specific cdtA–cdtB–cdtC prevalence was identified among clinical isolates. These three loci may be unique toxin genes and promising targets for the rapid identification of P. canis in clinical settings.

Background/Aims: Empiric antibiotics are given in combina-tion with biliary drainage for acute cholangitis but sometimes turn out to be insensitive to microorganisms in blood and bile. Clinical outcomes were compared according to sensitiv-ity to microorganisms detected in blood and bile culture to evaluate the impact of sensitivity to empiric antibiotics in cholangitis. Methods: Consecutive patients who underwent biliary drainage for acute cholangitis were retrospectively studied. Clinical outcomes such as 30-day mortality, length of hospital stay and high care unit stay, organ dysfunction and duration of fever were compared in three groups: group A (sensitive to both blood and bile culture), group B (sensitive to blood culture alone) and group C (insensitive to both blood and bile culture). Results: Eighty episodes of cholangitis were classified according to sensitivity results: 42, 32 and six in groups A, B and C. Escherichia coli and Klebsiella were two major pathogens. There were no significant differences in 30-day mortality rate (7%, 0%, and 0%, p=0.244), length of hospital stay (28.5, 21.0, and 20.5 days, p=0.369), organ dysfunc­tion rate (14%, 25%, and 17%, p=0.500), duration of fever (4.3, 3.2, and 3.5 days, p=0.921) and length of high care unit stay (1.4, 1.2, and 1.7 days, p=0.070) in groups A, B and C. Empiric antibiotics were changed in 11 episodes but clinical outcomes appeared to be non-inferior even in 31episodes of cholangitis who were on inadequate antibiotics throughout the course. Conclusions Sensitivity of empiric antibiotics was not associated with clinical outcomes in acute cholangitis.

Objective: The impact of systematic retroperitoneal lymphadenectomy (SRL) remains controversial in patients with advanced ovarian clear-cell carcinoma (CCC) who are optimally debulked. Methods: Between 1986 and 2017, a total of 3,227 women with epithelial ovarian carcinoma were analyzed in a multi-institutional study. Among them, 166 optimally debulked women with stage IIB–IV CCC were collected (residual tumor of <1 cm). All patients were divided into 2 groups: 1) Group I (n=112): underwent standard radical surgery with SRL, 2) Group II (n=54):underwent non-staging limited surgery. The pathological slides were assessed based on central pathological review. Oncologic outcomes were compared between the two groups using a propensity score (PS)-matching technique to adjust for various clinicopathologic factors. Results: The median follow-up duration of all surviving women was 52.8 (1.6–184.2) months.Overall, 88 patients (53.0%) experienced recurrence and 68 patients (41.0%) died of the disease. In the original cohort, the 5-year overall survival (OS) rates of groups I and II were 57.9 and 64.9%, respectively (log-rank p=0.415). In the PS-adjusted cohort, the 5-year OS rates were 64.9 and 58.8% in women in groups I and II, respectively (p=0.453). Furthermore, in the PS-matched cohort after adjustment for multiple clinicopathologic factors, there was no significant difference in OS between the 2 groups (group I vs. group II; hazard ratio=1.170;95% confidence interval=0.633–2.187; p=0.615). Conclusions This study suggests that the performance of SRL including radical surgery may not lead to a significant improvement in the oncologic outcome of advanced CCC patients with optimal cytoreduction.

The purpose of this study was to consider the validity of measuring the Star Excursion Balance Test (SEBT), which has been used as a measure of balance ability in athletes, for community-dwelling elderly people. To achieve this purpose, we examined the relationship between the existing balance ability measures, leg strength, and the SEBT. The subjects were 36 elderly people (mean age: 71.1 years). We used the SEBT, functional reach test (FRT), timed up-and-go test (TUG), and Mini-BESTest to evaluate balance ability and the 30-second chair-stand test (CS-30) to assess leg strength; we also assessed the 10-m walk time. The correlation coefficient with the SEBT was calculated. The significant level was 5%. A significant positive correlation was observed between the total score of Mini-BESTest and the SEBT reach distance in the anterior direction (r = 0.364, p < 0.05) and the posteromedial direction (r = 0.407, p < 0.05). A significant positive correlation was observed between anticipatory postural control and the SEBT reach distance in the anterior directions (r = 0.403, p < 0.05), and postural responses and SEBT reach distance in the posterolateral direction (r = 0.360, p < 0.05), which were subsystem category of Mini-BESTest. No significant correlation was found in the other items. The correlation with Mini-BESTest indicates that SEBT might be a valid tool to evaluate the dynamic balance ability of community-dwelling elderly people. However, their correlation coefficient is not high, suggesting that SEBT can evaluate elements different from Mini-BESTest.

BACKGROUND/AIMS: There is a controversy about the availability of invasive treatment for esophageal/gastric varices in patients with Child-Pugh class C (CP-C) end-stage liver cirrhosis (LC). We have evaluated the validity of invasive treatment with CP-C end-stage LC patients. METHODS: The study enrolled 51 patients with CP-C end-stage LC who had undergone invasive treatment. The treatment modalities included endoscopic variceal ligation in 22 patients, endoscopic injection sclerotherapy in 17 patients, and balloon-occluded retrograde transvenous obliteration (BRTO) in 12 patients. We have investigated the overall survival (OS) rates and risk factors that contributed to death within one year after treatment. RESULTS: The OS rate in all patients at one, three, and five years was 72.6%, 30.2%, and 15.1%, respectively. The OS rate in patients who received endoscopic treatment and the BRTO group at one, three, and five years was 67.6%, 28.2% and 14.1% and 90.0%, 36.0% and 18.0%, respectively. The average of Child-Pugh scores (CPS) from before treatment to one month after variceal treatment significantly improved from 10.53 to 10.02 (P=0.003). Three significant factors that contributed to death within one year after treatment included the presence of bleeding varices, high CPS (≥11), and high serum total bilirubin levels (≥4.0 mg/dL). CONCLUSIONS: The study demonstrated that patients with a CPS of up to 10 and less than 4.0 mg/dL of serum total bilirubin levels may not have a negative impact on prognosis after invasive treatment for esophageal/gastric varices despite their CP-C end-stage LC.
Balloon Occlusion ; Bilirubin ; Endoscopy ; Esophageal and Gastric Varices ; Hemorrhage ; Humans ; Hypertension, Portal ; Ligation ; Liver Cirrhosis ; Liver ; Prognosis ; Risk Factors ; Sclerotherapy ; Varicose Veins

BACKGROUND: Sedentary behaviors have recently become an important public health issue. We aimed to investigate the relationship between screen time and nutrient intake in children and adolescents. METHODS: The present study was conducted in 2013. Data were collected from children and adolescents aged between 6 and 15 years old in Shika town. Questionnaires were distributed to 1459 subjects, 1414 of whom participated in the study (96.9%). Sedentary behaviors were assessed based on participants' screen behaviors (television (TV) viewing, personal computer (PC) use, and mobile phone (MP) use). The main outcomes were the intake of nutrients from a validated food frequency questionnaire. Analysis of covariance (ANCOVA) was used to examine the significance of differences in nutrient intake estimates. Multivariate linear regression analyses, adjusting for age, BMI, and physical activity, were used to provide parameter estimates (β) and 95% CI for the relationship between screen time and nutrient intake. RESULTS: In boys, longer TV viewing times correlated or tended to correlate with a lower intake of protein, potassium, calcium, iron, vitamin K, vitamin B-2, and total dietary fiber. In girls, longer TV viewing times correlated with a lower intake of protein, sodium, calcium, vitamin D, and vitamin B-2. Longer TV viewing times correlated with a higher intake of n-6 fatty acids in girls. PC use was related or tended to be related to a lower intake of potassium, iron, vitamin K, and folic acid in boys, but not in girls. A relationship was observed between MP use and a lower intake of vitamin K in boys, and MP use and a higher intake of vitamin D in girls. CONCLUSIONS The present results revealed that longer TV viewing times are associated with less protein, minerals, vitamins, and total dietary fiber intake in children and adolescents. It was also revealed that boys with PC use have less minerals and vitamins. These results support the need to design intervention programs that focus on decreasing TV viewing time in both sexes and PC use in boys while encouraging adherence to dietary guidelines among children and adolescents.
Adolescent ; Body Mass Index ; Child ; Cross-Sectional Studies ; Diet ; Energy Intake ; Exercise ; Female ; Humans ; Japan ; Male ; Screen Time ; Sedentary Behavior ; Sex Factors ; Socioeconomic Factors

Hemolysis, hemoglobinuria, skin eruption and hypotension were noticed following transfusion of 11 units of fresh blood during mitral valve replacement in a 57-year-old man. Irregular antibody incompatibility was suspected. Further investigation revealed anti Lewis-a antibody. Three of 11 units of transfused blood were positive for the indirect Coombs test. The patient recovered without renal failure, and was discharged. One year later, he had urgent re-MVR due to malfunction of the prosthetic valve. Hemolytic transfusion reaction had occured after the administration of donor blood which had been showed to be compatible by cross matching. This means that antibody titer diminishes with time, and that posttransfusion screening tests should minimize the unexpected hazards of incompatible blood transfusion. We recommend that antibody screening tests should be routinely performed after open heart surgery, to minimize the risk of hemolysis during future reoperation.

Problems with postoperative respiratory management of three patients after division of double aortic arch are described. Tracheomalacia was present in two of three cases with intracardiac anomalies of different types. Intracardiac anomalies of each patient were as follows: Patient 1, ventricular septal defect (VSD), atrial septal defect and pulmonary valve stenosis (PS); Patient 2, VSD, corrected transposition of the great arteries with PS; Patient 3, VSD with pulmonary hypertension (PH). In patient 1 and 2, no concomitant surgical intervention was performed for tracheomalacia. In these patients respiratory support had been continued for 41 and 60 days respectively. In patient 3, remaining VSD with PH was the cause of unexpected respiratory problem even after the successful division of the double aortic arch, and necessitated emergency VSD closure 49 days after the initial operation. The patient was extubated on postoperative day 12. Tracheomalacia is a life-threatening problem even after surgical division of the double aortic arch. Although prolonged respiratory support was needed, our two cases were successfully extubated without concomitant surgical intervention of tracheomalacia. Severe cases should be operated on simultaneously with the relief of vascular ring and tracheomalacia. Intracardiac anomalies are also the causes of prolonged intubation. Patient 3 should have been treated by pulmonary artery banding along with the division of aortic arch. In conclusion, precise evaluation of the existence and severity of the tracheomalacia and intracardiac anomalies is of utmost importance to overcome postoperative respiratory failure and for eventual satisfactory results.

A 63-year-old woman who was diagnosed a having impending rupture of abdominal aortic aneurysm underwent urgent anatomic reconstruction. Histopathological findings revealed abscess formation around the aneurysmal wall, and a definitive diagnosis of mycotic aneurysm was established. Successful management of this rare aortic disease depends on early accurate diagnosis, control of infection and careful surgical management.