Higashi Chikushi Junior College

Adjunctive techniques are frequently required in endovascular treatment (EVT) for ruptured intracranial aneurysms (RIAs) with complex morphology. However, comprehensive nationwide data on technique selection and its relationship with outcomes remain limited. We aimed to clarify anatomical and clinical factors associated with technique selection and to evaluate short-term outcomes using a large nationwide registry. The Japanese Registry of Neuroendovascular Therapy (JR-NET) 4 included over 4,000 RIAs treated between 2015 and 2019. After exclusions, 3,600 patients treated with balloon-assisted coil embolization (BAC), double-microcatheter coil embolization (DMC), or stent-assisted coil embolization (SAC) were analyzed. Multinomial logistic regression identified factors associated with treatment selection, and multivariable logistic regression evaluated predictors of favorable outcome (modified Rankin Scale; mRS 0-2) and mortality at 30 days. Wide-neck and large RIAs were associated with DMC and SAC, while bifurcation RIAs were more often treated with DMC. BAC remained the most frequently used technique. Thirty-day outcomes were primarily determined by World Federation of Neurosurgical Societies (WFNS) grade and aneurysm morphology, rather than treatment type. WFNS grade IV-V was linked to a markedly lower chance of favorable outcome (OR 0.10, 95% CI 0.07-0.14), whereas neither DMC nor SAC showed an independent effect compared with BAC. In this nationwide registry, technique selection was chiefly determined by aneurysm morphology and location, while outcomes were influenced by patient severity and aneurysm complexity. These findings, from the largest nationwide registry of EVT for RIAs, provide real-world evidence to guide treatment planning.

ABSTRACTBackground and ObjectiveGenetic polymorphisms have been associated with susceptibility to interstitial lung diseases including idiopathic pulmonary fibrosis (IPF). We have now examined the relation between single nucleotide polymorphisms (SNPs) and clinical course, including acute exacerbation (AE), in addition to disease susceptibility for IPF and unclassifiable idiopathic interstitial pneumonias (IIPs).MethodsDNA samples were collected from 223 IPF patients and 160 unclassifiable IIP patients included in a prospective, multicentre observational study in Japan. Nonfibrotic control subjects (n = 379) were selected from a previous study. Genotyping of TERT rs2736100, TERC rs1881984, MUC5B rs35705950, DSP rs2076295, and AKAP13 rs62025270 was conducted with commercial assays. The association between these SNPs and disease susceptibility, prognosis, or the cumulative incidence of AE was assessed.ResultsTERT rs2736100 and MUC5B rs35705950 were significantly associated with IPF risk, and DSP rs2076295 was linked to prognosis and the incidence of AE in IPF patients. TERT rs2736100 was significantly associated with prognosis in IPF patients and the incidence of AE in patients with unclassifiable IIPs. No individuals with the TT genotype of MUC5B rs35705950 were identified, and the proportion of those with the T allele was low (minor allele frequency of 0.005 in control subjects). In addition, no individuals with the minor allele (A) of AKAP13 rs62025270 were detected.ConclusionConsideration of genetic polymorphisms has the potential to facilitate prediction not only of prognosis but also of AE in individuals with IIPs, providing a foundation for the development of personalised management strategies based on genetic profiles.

Abstract In this paper, the thermodynamically consistent fractional derivative model is developed for viscoelastic materials such as rubbers under large deformations. As the basis of fractional derivative model, the Maxwell model for finite strain is proposed as a natural extension of the Maxwell model for infinitesimal strain. In the proposed Maxwell model, the stress-strain relationship is defined for both the elastic and viscous components. The viscous stress satisfies the thermodynamic requirement that entropy production is always positive except at zero stress. The two components are combined into the linear evolution equation based on the fact that the stress of the two components is the same. Through the generalized Maxwell model, several types of fractional-derivative stress-strain relations of order less than one have been derived. These relations include a new relation as well as relations already known in the literature. It is shown that one of the relations proposed by Fukunaga and Shimizu (2015, J Comput Nonlin Dyn, vol. 10, 061002) is a special cases of the new relation. For both these fractional derivative models and the generalized Maxwell model under finite strain, the viscous dissipation can be explicitly calculated in thermodynamically consistent manner. The newly obtained model is expected to serve as the powerful tools for understanding the stress behavior of rubberlike materials.

天災・人災を問わず，世間を揺るがす大事件などの「負の現象」が起きた場合には，複数の対象が次から次へと槍玉に挙がり，非難される傾向がしばしば見られる。釘原ら（2006）はこれを社会がスケープゴートを探すような集合現象と考えた。本研究ではCOVID-19におけるこの傾向を分析し，2003年に流行したSARSの分析結果と比較を行った。分析対象として，「コロナ」または「肺炎」というキーワード検索により，3ヶ月間（2020/1/8-4/7）の新聞記事を抽出し，データベース化した。総記事数は6268記事であった。分析の結果，COVID-19での非難対象はのべ617件（9.8％）であり，SARSよりも少なかった。記事数自体は純増しており，批判対象は国が多かったが，後半には個人が非難対象として増加していた。当初は人災とみなされたのは，対応の遅れや対応のまずさであったが，五輪延期決定（3/24）以降，実際の感染者数も増えたのと呼応して，元々非難対象であったライブハウスや屋形船に加えて，海外旅行帰国者などの他者に伝染した例が急増して，自粛しないなど個人の行為に非難が向くようになったと考えられる。

Evidence for endoscopic balloon dilation of small intestinal strictures in Crohn's disease (CD) using balloon-assisted enteroscopy is scarce. To evaluate endoscopic balloon dilation for the treatment of small intestinal CD strictures using balloon-assisted enteroscopy. Citations in Embase, MEDLINE, and Cochrane were systematically reviewed. In a meta-analysis of 18 studies with 463 patients and 1189 endoscopic balloon dilations, technical success was defined as the ability to dilate a stricture. Individual data were also obtained on 218 patients to identify outcome-relevant risk factors. In the pooled per-study analysis, technical success rate of endoscopic balloon dilation was 94.9%, resulting in short-term clinical efficacy in 82.3% of patients. Major complications occurred in 5.3% of patients. During follow-up, 48.3% of patients reported symptom recurrence, 38.8% were re-dilated and 27.4% proceeded to surgery. On the per-patient-based multivariable analysis, that patients with disease activity in the small intestine had lower short-term clinical efficacy (odds ratio 0.32; 95% confidence interval 0.14-0.73, P=0.007). Patients with concomitant active disease in the small and/or large intestine had an increased risk to proceed toward surgery (hazard ratio 1.85; 95% confidence interval 1.09-3.13, P=0.02 and hazard ratio 1.77; 95% confidence interval 1.34-2.34, P<0.001). Balloon-assisted enteroscopy for dilatation of CD-associated small intestinal strictures has high short-term technical and clinical efficacy and low complication rates. However, up to two-thirds of patients need re-dilation or surgery.

We develop an educational method for adults. The method helps adults think how they should behave in a society. They are also expected to deal with information according to the so-called “information ethics.” In order to educate their information ethics, our method of moral education is applied. We evaluate the method whether the moral education contributes to the development of adults’ information ethics or not. We apply a self-debate to the moral education. The self-debate is thinking oneself, worrying this and that and putting together oneself. According to case studies, we could clarify that subjects were able to reflect upon themselves and acquire knowledge about information ethics through the self-debate. In this paper, we report the result of the education.

We report here a case of multiple prolapsing mucosal polyps with diverticulosis in the sigmoid colon. A 52-year-old man was admitted to our hospital because of bloody diarrhea. Colonoscopy and barium enema showed multiple diverticula, markedly thickened mucosal folds and polypoid lesions with mucus on the top of them in the sigmoid colon. Endoscopic ultrasonography showed thickening of the mucosal and submucosal layers. Several endoscopic biopsy specimens were taken from the polypoid lesions. Histological examination revealed only chronic inflammatory cell infiltration. In order to obtain a definite diagnosis, we performed endoscopic jumbo biopsy for the polypoid lesions after obtaining informed consent. Histological examination revealed marked lymphocyte infiltration, hemosiderin deposits and fibromuscular obliteration in the lamina propria, features similar to those of mucosal prolapsing syndrome. After anti-diarrhetic treatment, clinical findings were improved. Thus, jumbo biopsy is useful for diagnosis and treatment of prolapsing mucosal polyps.