Shirasagi Hospital

The purpose of the present observational study was to examine whether there is a difference in prognosis for hemodialysis patients with or without continued orthopedic outpatient visits over five years. Methods: One hundred and thirteen hemodialysis patients who visited the dialysis center of Takagi Hospital, Okawa, Japan, as of December 2017 were included in this study. Data were collected from the medical records until December 2022. All 113 patients were divided into two groups: patients who continuously visited the orthopedic outpatient department (n = 59) and those who did not (n = 54). Patients who had orthopedic consultation were divided into three semi-groups: patients who consulted for the upper body (n = 11), the lower body (n = 22), and both the upper and lower bodies (n = 26). During the five-year follow-up period, 13 out of 59 patients (22.0%) who had orthopedic consultation died, and this ratio tended to be lower compared to the mortality rate of patients without orthopedic consultation (37.0%) but not significant (P < 0.08). Duration of hemodialysis was significantly longer in patients with orthopedic consultation (P = 0.009). The mortality rate was significantly lower in patients who consulted for both upper and lower bodies than those without orthopedic consultation (P < 0.05, respectively). These differences were not observed in patients who consulted for only upper or lower bodies. The mortality of hemodialysis patients was significantly lower in the group which was undertaking continuous outpatient orthopedic consultations for both upper and lower bodies, which suggested that periodical consultation with orthopedics might be critical for hemodialysis patients.

PurposeCough represents a natural mechanism that plays an important defensive role in the respiratory tract, but in some conditions, it may become persistent, nonproductive, and harmful. In general, refractory chronic cough (RCC) occurs in about 20% of individuals; hence, we aimed to assess the presence of altered gut–lung communication in RCC patients through a compositional and functional characterization of both gut (GM) and oral microbiota (OM).Methods16S rRNA sequencing was used to characterize both GM and OM composition of RCC patients and healthy controls (HC). PICRUST2 assessed functional changes in microbial communities while gas chromatography was used to evaluate fecal short-chain fatty acid levels and serum-free fatty acid (FFA) abundances.ResultsIn comparison with HC, RCC patients reported increased saliva alpha-diversity and statistically significant beta-diversity in both GM and OM. Also, a, respectively, significant increased or reduced Firmicutes/Bacteroidota ratio in stool and saliva samples of RCC patients has been shown, in addition to a modification of the abundances of several taxa in both GM and OM. Moreover, a potential fecal over-expression of lipopolysaccharide biosynthesis and lipoic acid metabolism pathways and several differences in serum FFA levels have been reported in RCC patients than in HC.ConclusionSince differences in both GM and OM of RCC patients have been documented, these findings could provide new information about RCC pathogenesis and also pave the way for the development of novel nutritional or pharmacological interventions for the management of RCC through the restoration of eubiotic gut–lung communication.

Abstract Background: This study aimed to evaluate gender differences in patient characteristics in maintenance hemodialysis in Takagi Hospital and, in particular, to evaluate gender differences in adverse events, gastrointestinal bleeding, and bone fractures during longitudinal follow-up period. Methods: This study included 151 patients undergoing maintenance hemodialysis for end-stage renal failure at Takagi Hospital, a regional core hospital in Japan, in December 2017. All the patients were followed up for five years or until mortality with monitoring in outpatient care. All patients were divided into a female group of 61 and a male group of 90. Patient characteristics and events were evaluated in the electronic medical record including gastrointestinal bleeding and bone fractures diagnosed and treated in Takagi Hospital. Gastrointestinal bleeding was diagnosed by endoscopy. Upper bone fractures included humeral fractures and radius fractures, and lower bone fractures were femoral neck fractures and vertebral compression fractures. Results: The patient number was small in females, which was due to the origin of renal failure with less frequency of diabetes mellitus (P &lt; 0.02). Mortality rate was significantly less in females (P &lt; 0.03) of younger generations less than 75 years old (P &lt; 0.014). Multivariate analysis indicated a decrease in diabetes mellitus (odd ratio: 2.3, 95% confidence interval: 1.1-4.8, P = 0.03) and less mortality in those younger than 75 years old (odd ratio: 0.2, 95% confidence interval: 0.1-0.8, P = 0.02) were independent characterized factors in females. Regarding adverse severe events during five years, gastrointestinal bleeding and mortality due to bleeding were not different between females and males. Bone fractures were high in females (females: 34.4% vs. males: 18.9%; P &lt; 0.03), whereas the mortality rate of bone fractured patients was markedly high in males (females: 28.6% vs males: 76.5%; P = 0.003). The increase in mortality rate in males was in patients with lower body bone fractures (P = 0.006). Conclusions: Diabetes mellitus-induced end-stage renal failure was less common in females. The mortality rate during hemodialysis was lower in females, especially in patients less than 75 years old. Lower body bone fractures exacerbated mortality more frequently in males compared to females.

The present retrospective study aimed to examine the real-world data regarding time-dependent changes in the age distribution of patients with coronavirus disease 2019 (COVID-19) as well as the severity and infectivity in a regional core hospital in Japan. Patients with COVID-19 who visited the fever outpatient branch in Takagi Hospital during phase I (May 1 to December 31, 2021), and during phase II (January 1 to April 30, 2022) were evaluated. The age distribution of outpatients and the characteristics of inpatients aged > 75 years were compared between phases I and II. The age distribution of outpatients shifted from the older generation in phase I to the younger generation in phase II (p < 0.01). Disease severity might be reduced in a time-dependent manner with a decrease in the hospitalization rate (phase I: 145/368 (39.4%); phase II: 104/1496 (7.0%); p < 0.01) and mortality rate (phase I: 10/368 (2.7%); phase II: 7/1496 (0.5%); p < 0.01). The number of patients increased in phase II (374.0/month) compared to that in phase I (36.8/month). Regarding the older inpatients, the disease severity of COVID-19 and hospitalization days were reduced in phase II compared to those in phase I (p < 0.01, each). In conclusion, the present study suggests a change in the age distribution of patients with COVID-19, a decrease in toxicity, and an increase in infectivity of severe acute respiratory syndrome coronavirus 2 in a time-dependent manner.

The importance of the microenvironment is widely recognized as it regulates not only malignant cell behavior but also drug sensitivity. The cancer cell microenvironment is composed of biological, physical and chemical elements, and simultaneous reproduction of these three elements are important conditions investigated in cancer research. In the present study, we focused on the epidemiological and anatomical specificities of endometrioid carcinoma, obesity (biological), fluid flow (physical) and anticancer agents (chemical) to target the specific microenvironmental elements of endometrioid carcinoma. To elucidate the individual effects of these elements on endometrioid carcinoma and to investigate the relationships between these factors, we developed an adipose tissue fragments (ATFs)-embedded cell disc under a rotational culture method to generate carcinoma-stroma interactions and to create fluid flow. ATFs and fluid flow individually or synergistically influenced proliferative cellular behavior and the morphological changes underlying endometrioid carcinoma. ATFs and fluid flow also governed the expression of extracellular signal-regulated kinase and p38 signaling synergistically or individually, depending on the endometrioid carcinoma cell type. Adipose tissue induced chemoresistance to cis-diamminedichloro-platinum (CDDP) in endometrioid cancer, but the resistance effect was abolished by fluid flow. Thus, a simple reconstructed model was established to investigate three elements of the microenvironment of endometrioid carcinoma in vitro. This culture model unequivocally demonstrated the individual and synergistic effects of the three elements on endometrioid carcinoma. This new culture model is a promising tool for elucidating the mechanisms underlying endometrioid carcinoma and for developing further treatment strategies.

Mucosa-associated lymphoid tissue (MALT) lymphoma, which was first reported in 1984, shows an indolent clinical course. However, the detailed clinicopathological characteristics of gastric MALT lymphoma have not been fully elucidated. We performed a literature search concerning the clinical features and treatment for gastric MALT lymphoma using PubMED. MALT lymphomas develop in single or multiple extranodal organs, of which the stomach is one of the most frequent sites; gastric MALT lymphoma accounts for 7% to 9% of all B-cell lymphomas, and 40% to 50% of primary gastric lymphomas. The eradication of Helicobacter pylori (H. pylori) is the first-line treatment for patients with gastric MALT lymphoma, regardless of the clinical stage. Approximately 60-90% of cases with stage I/II1 disease only achieve a complete histological response via H. pylori eradication. In patients who do not respond to H. pylori eradication therapy, second-line treatments such as watch-and-wait, radiotherapy, chemotherapy, rituximab immunotherapy, and/or a combination of these are recommended. Thus, H. pylori plays a causative role in the pathogenesis of gastric MALT lymphoma, and H. pylori eradication leads to complete histological remission in the majority of cases.

Objective: To determine whether endometrial thickening is an important factor for pregnancy outcomes in platelet-rich plasma (PRP) treatment for patients with thin endometrium. Methods: Data from the registry database of the Japan Gynecologic PRP Study Group from April 2019 to October 2021 were analyzed retrospectively. A total of 208 patients who underwent single blastocyst transfer (SBT) after PRP due to thin endometrium (¡8 mm) in their previous cycle were included in the study. Their pregnancy outcomes were compared with their own historical data before PRP infusion. The same patient group was then divided into 136 patients whose endometrium thickened after PRP and 72 patients whose endometrium did not, and the pregnancy outcomes of the two groups were compared. Furthermore, to eliminate embryonic confounding, 28 patients who had single euploid blastocyst transfer (SEBT) with preimplantation genetic testing for aneuploidy (PGT-A) were selected from the same patient group and divided into two groups of 22 patients whose endometrium thickened and 6 patients whose endometrium did not, and the pregnancy outcomes were compared in the same method. Results: After PRP administration, the clinical pregnancy rate, live birth rate, and miscarriage rate were all significantly improved compared with the historical controls (34.1 vs 20.0, [Formula: see text]; 22.6 vs 3.9, [Formula: see text]; 33.8 vs 73.4, [Formula: see text]). There were no statistically significant differences in the respective rates between the “thickened endometrium” group and the “unthickened endometrium” group in SBT group (36.0 vs [Formula: see text], [Formula: see text]; 25.7 vs [Formula: see text], [Formula: see text]; 28.5 vs [Formula: see text], [Formula: see text], respectively). Likewise, in the SEBT with PGT-A group, there were no statistically significant differences in results between the two groups (36.4 vs [Formula: see text], [Formula: see text]; 36.4 vs [Formula: see text], [Formula: see text]; 0 vs [Formula: see text], respectively). Conclusions: PRP administration to patients with thin endometrium improves pregnancy outcomes even when endometrial thickening is not achieved.

IntroductionThis study compared the outcomes of dialysis patients who received SARS‐CoV‐2 vaccine with those who did not use data from the Japanese COVID‐19 registry.MethodsA total of 1260 dialysis patients with confirmed positive SARS‐CoV‐2 infection was included in this study. Patients were divided into two groups: patients who experienced breakthrough infection and those who were unvaccinated. The need of oxygen supplementation and mortality risks were compared using multivariate logistic regression analysis.ResultsThe mortality rate was 24.2% in unvaccinated patients and 8.6% in breakthrough patients. The odds ratio of need of oxygen supplementation in the breakthrough patients relative to unvaccinated patients was 0.197. The hazard ratio of mortality in the breakthrough patients relative to unvaccinated patients was 0.464.ConclusionOur prospective observational study showed that SRAS‐CoV‐2 vaccination in hemodialysis patients is vital for reducing need of oxygen supplementation and mortality risk.