Takano Hospital

Chronic background mucosal inflammation contributes to colorectal cancer (CRC) development in ulcerative colitis (UC), but its prognostic impact is unclear. We evaluated whether background mucosal inflammation documented at cancer diagnosis is associated with oncologic outcomes. This retrospective study analyzed 1189 UC patients diagnosed with CRC using a nationwide, multicenter database in Japan. Patients were classified as CRC within the UC-involved area (within-area) or outside the UC-involved area (outside-area), based on tumor location relative to the UC disease extent documented endoscopically at cancer diagnosis. The primary end point was 5-year recurrence-free survival (RFS), and the secondary end point was 5-year cancer-specific survival (CSS). In within-area cases, inflammation severity was assessed using the Mayo Endoscopic Score (MES), stratified as Inactive, Mild-Moderate, and Severe. Of the 723 eligible patients, 683 had within-area and 40 outside-area CRC. Five-year RFS was significantly lower in within-area than outside-area CRCs (75.1% vs 87.6%, P = 0.022). Multivariable Cox regression analysis of RFS revealed this classification as an independent prognostic factor (hazard ratio = 2.99, 95% confidence interval: 1.09-8.18, P = 0.030). A significant difference was also observed in 5-year CSS (P = 0.038). Among within-area cases, higher MES was associated with stepwise declines in RFS (P = 0.150), and a similar, statistically significant gradient in CSS (P = 0.048). Background mucosal inflammation at cancer diagnosis is associated with significantly worse prognosis of CRC in UC patients. Systematic endoscopic assessment at cancer diagnosis may aid prognostic stratification and inform management.

Digital therapeutics (DTx) for hypertension are among the most promising treatment options, demonstrating proven antihypertensive effects. This study investigates the determinants of the home blood pressure (BP) lowering effect of DTx, using prospectively collected daily data. The B-INDEX study (Behavioral Modification Index) is a multicenter intervention study in patients with hypertension, involving a 6-month DTx period, followed by an additional 6 months without it. Home BP, body weight and composition, physical activity, and sleep patterns were monitored daily using digital devices. This first report on B-INDEX analyzed data collected during a 6-month DTx treatment period. A total of 198 patients with hypertension (mean age, 54.9±10.6 years; 57.1% male; mean body mass index, 26.7±5.3 kg/m2; 57.6% taking antihypertensives) were included in the analysis. A marked reduction in BP was observed in the first 4 weeks (morning home BP, -6.2/-2.6 mm Hg). Mixed model analysis demonstrated that baseline home BP, older age, self-efficacy score, reduction in self-reported salt intake, and mild initial weight loss (-0.5 kg at week 4) were significant determinants of home BP reduction at 6 months. Older age, salt reduction, and initial weight loss were predictive factors for effective BP reduction through DTx, independent of baseline BP values. We propose that the first 4 weeks are the key period for hypertension treatment with DTx. URL: https://www.umin.ac.jp/ctr/; Unique identifier: UMIN000050479.

Offshore wind turbine demands have led to diverse and increasingly larger foundation pile diameters over the years. Although the effect of scaling pile diameter (D) on lateral loading capacity (H) has been studied, its relationship with pile–soil relative stiffness (Ee/G*) remains under-explored. This study presents centrifuge experiments on nine steel tubular piles subjected to monotonic loading with unload–reload cycles in drained sand. All piles share the same diameter-embedded depth ratio and load eccentricity but vary in wall thickness and are tested under different centrifuge accelerations, resulting in nine prototype diameters and three distinct Ee/G* values. This controlled setting allows for examining the applicability of the generalised scaling law (GSL) for modelling diameters beyond small centrifuge limits. Results indicate a power-law relationship between H and D, described by parameters that vary with Ee/G*. The effects of Ee/G* are insignificant until the relative loading displacement (Y/D) reaches 10%. For low Ee/G*, better lateral response normalisation can be achieved by considering structural non-linearity. The re-loading stiffness (E) also approximates a power-law relation with D, and the higher relative stiffness (Ee/G* = 417) case shows the largest drop in E. GSL shows acceptable accuracy at small Y/D and lower Ee/G* before the pile enters non-linearity.

Introduction A human represents wholeness of biological, psychological and social nature and below impact of psychosocial stress preserves the homeostasis of the organism manifests a complete biopsychosocial response is therefore necessary in professional practice to be taken psychoneuroendocrine immunological approach in treating certain somatic and psychological. Objectives Determining emotions, various types of aggression in people who have experienced a heart attack and is currently under the influence of chronic psychosocial stress of moderate intensity. Methods The examination was conducted on an outpatient basis on 14 subjects aged 51 to 72. age of male and female who experienced a heart attack. Applied: Azingerova aggression scale, PSQ stress test, Zung anxiety scale, Zung depression scale. Results The respondents show a stress reaction at the level of moderate stress (30-60) with dominant feelings of: fatigue, tension, dissatisfaction, overload. Anxious symptoms are at the level of mild to moderate (45-59). Depressive symptoms are at the mild level (50-59). They have higher values on the aggression test. In both sexes (male and female) they have the highest values in self-aggression. Somewhat lower is verbal aggression while emotional aggression has average values. In the female gender, aggression is the lowest through physical force, while the use of aggression through physical force is occasional for men. Both sexes show little aggression towards objects around them. Conclusions In people with somatic diseases, in the case of a heart attack, emotions are high an important factor for their stability, especially the negative ones, and therefore it is necessarily needed an integrative approach to treatment, taking into account the mental state as a whole especially when they are in a state of psychosocial stress. Disclosure of Interest None Declared

Squamous cell carcinoma of the anal canal (SCCA) is a rare condition. Standard treatment includes chemoradiotherapy, with surgical treatment reserved for limited cases. In the future, the decrease in surgical frequency makes it more difficult to pathologically assess the depth of tumor invasion and lymph node status; therefore, those studies based on relatively recent surgical cases may offer valuable insights into diagnosing and treating SCCA. This multicenter, retrospective cohort study evaluated 435 patients with SCCA in Japan, of which 84 underwent surgical lymph node dissection. The correlation of regional/extraregional lymph node metastasis with T-primary tumor category/depth of tumor invasion, and the index of estimated benefit from lymph node dissection (IEBLD) was evaluated histopathologically. Primary tumor progression was associated with metastasis and recurrence of the inguinal node and further inferior mesenteric trunk/root node metastasis, an extraregional lymph node. The IEBLD for the inferior mesenteric trunk/root node was 6.9, which was higher than 4.0 IEBLD of the lateral lymph nodes classified as the regional lymph nodes. The assessment of the primary tumor involvement can predict metastases of the inguinal node and inferior mesenteric trunk/root node and recurrence of the inguinal node. Although the UICC TNM Classification considered the inferior mesenteric trunk/root nodes as extraregional lymph nodes, actively targeting them with the treatment can improve the prognosis.

PurposeFew studies have reported the association of macroscopic classification with clinicopathological characteristics and prognosis of ulcerative colitis-associated colorectal cancer (UC-CRC), unlike sporadic CRC. In this study, we aimed to clarify the clinical significance of macroscopic classification of UC-CRC.MethodsThe cohort included 480 patients with UC-CRC with invasion beyond the muscularis propria treated at 43 Japanese institutions between 1983 and 2023. The patients were divided into six groups based on the macroscopic type (types 0–5), and clinicopathological features and prognoses were compared.ResultsAmong 480 patients, 66 (13.8%), 75 (15.6%), 116 (24.2%), 63 (13.1%), 68 (14.2%), and 92 (19.2%) had type 0–5 tumors, respectively. There were significant differences in the clinicopathological characteristics with a younger age in type 4 or 5 tumors than in type 2 tumors (p < 0.01) and a higher frequency of undifferentiated carcinomas (p < 0.01) and lymph node metastasis (p < 0.01) and more advanced depth of invasion (p < 0.01) in type 4 tumors than in type 1 or 2 tumors. Type 4 and 5 were independent risk factors for 5-year recurrence-free survival (p = 0.02; type 4 [HR: 6.35], type 5 [HR: 5.25]) and type 0, 4, and 5 for overall survival (p = 0.02; type 0 [HR: 4.51], type 4 [HR: 5.70], type 5 [HR: 4.02]).ConclusionsType 0, 4, and 5 tumors were characteristic macroscopic types of UC-CRC and correlated with worse prognosis. Therefore, endoscopic diagnosis of the macroscopic type of UC-CRC might be helpful in determining tumor aggressiveness.

In October 2021, to elucidate the issues that should be resolved before the transition, a questionnaire survey regarding the transitional care of childhood-onset viral liver disease was administered to 204 councilors of the Japan Society of Hepatology. Of the 86 councilors (42.2%) who responded, 31 (36%) received referrals from pediatric departments for patients with viral hepatitis in the preceding 5 years. Considering the difficulties encountered in accepting the patients and the information that would be needed, the most common opinion was that a transition system acceptable to patients and caregivers should be created. Therefore, according to the results of this survey, we aimed to develop a manual for transitioning pediatric patients with viral hepatitis into adult care.

BackgroundThe standard treatment for anal squamous cell carcinoma is chemoradiation therapy (CRT), but there is a possibility of over-treatment for early-stage disease. cTisN0 and cT1N0 disease is currently indicated for local excision, but it is unclear whether the indication of local excision can be expanded to cT2N0 disease.Methods126 patients with cTis-T2N0 anal cancer treated at 47 centers in Japan between 1991 and 2015 were included. Patients were first classified into the CRT group and surgical therapy group according to the initial therapy, and the latter was further divided into local excision (LE) and radical surgery (RS) groups. We compared prognoses among the groups, and analyzed risk factors for recurrence after local excision.ResultsThe CRT group (n = 87) and surgical therapy group (n = 39) showed no difference in relapse-free survival (p = 0.29) and overall survival (p = 0.94). Relapse-free survival curves in the LE (n = 23) and RS groups (n = 16) overlapped for the initial 3 years, but the curve for the LE group went lower beyond (p = 0.33). By contrast, there was no difference in overall survival between the two groups (p = 0.98). In the LE group, the majority of recurrences distributed in locoregional areas, which could be managed by salvage treatments. Muscular invasion was associated with recurrence after local excision (hazard ratio: 22.91, p = 0.011).ConclusionLE may be applied to selected patients with anal cancer of cTis-T2N0 stage. Given the high risk of recurrence in cases with muscular invasion, it may be important to consider close surveillance and additional treatment in such patients.

当院にて2019年度で治療した肛囲膿瘍の①臨床的背景②経肛門的超音波検査の有用性について検討を行った．