Toujinkai Hospital

<title>Abstract</title> Purpose Although image-enhanced endoscopy (IEE) is useful, its benefit over white light imaging (WLI) for the detection of superficial non-ampullary duodenal epithelial tumors (SNADETs) remains unclear. We evaluated whether narrow-band imaging (NBI) and texture and color enhancement imaging (TXI) could improve SNADET visibility compared to WLI under CO ₂ insufflation and underwater conditions. Methods We conducted a post-hoc analysis using a prospectively collected image database from patients with SNADET enrolled in a multicenter observational study. We used the EVIS X1 system with a GIF-H290Z or GIF-EZ1500 endoscope to compare the visibility scores for the recognition of SNADETs. We also measured the color difference (ΔE*), saturation difference (ΔC*), and lightness difference(ΔL*) between the tumor and background mucosa. Results We analyzed 50 lesions, comprising 46 intramucosal adenocarcinomas and 4 adenomas. Under CO ₂ insufflation, TXI provided a significantly higher visibility score than the WLI (2.7 ± 0.8 vs 2.5 ± 0.9, <italic>P</italic> = 0.002); however, no significant differences were observed between TXI and NBI (2.7 ± 0.8 vs 2.6 ± 0.7, <italic>P</italic> = 0.072). Underwater conditions yielded significantly higher visibility scores than CO ₂ insufflation across the three modes (WLI, 3.1 ± 0.6 vs. 2.5 ± 0.9, <italic>P</italic> &lt; 0.001; NBI, 2.9 ± 0.7 vs. 2.6 ± 0.7, <italic>P</italic> &lt; 0.001; TXI, 3.2 ± 0.5 vs. 2.7 ± 0.8, <italic>P</italic> &lt; 0.001). The ΔC* in TXI was significantly higher than that in WLI under CO ₂ insufflation (8.5 ± 6.0 vs 5.9 ± 3.9, <italic>P</italic> &lt; 0.001) and underwater condition (9.2 ± 5.6 vs 6.6 ± 3.5, <italic>P</italic> &lt; 0.001). Conclusion TXI significantly improved SNADET visibility compared to WLI under CO ₂ insufflation and underwater conditions, likely due to the increased saturation difference.

ABSTRACTBackgroundRare pathogenic variations of desmosomal genes, particularly in plakophilin‐2 (PKP2) and desmoglein‐2 (DSG2), have been implicated in arrhythmogenic cardiomyopathy (ACM); however, their potential polygenic contribution remains unclear.MethodsWe performed a genome‐wide association study of 104 Japanese patients with ACM and 46 527 controls, adjusting for case–control imbalance.ResultsThe strongest association was observed upstream of DSG2 (rs182626537, p = 2.3 × 10−42), but the signal was abolished after excluding carriers of pathogenic DSG2 variants, suggesting a synthetic association driven by linkage disequilibrium.ConclusionsThese findings highlight a population‐specific genetic architecture of ACM, with DSG2 predominating in the Japanese population.

We report a rare case of a 29-year-old pregnant woman with obesity who developed a severe intra-abdominal abscess after an emergency cesarean section (CS) for labor arrest. The patient presented with persistent fever and lower abdominal pain after CS. Enterococcus faecalis was isolated from the purulent material in the pelvis. Despite antibiotic treatment, the patient's symptoms and laboratory test results did not improve. Abdominal CT revealed multiple intra-abdominal abscesses and distended bowel loops. On the 12th day of admission, laparoscopic drainage was performed under general anesthesia because image-guided drainage using interventional radiology was not feasible. Laparoscopic adhesiolysis and peritoneal lavage were performed, and drainage tubes were placed. The patient's condition gradually improved; she was discharged without complications. Intra-abdominal abscess formation after CS is a rare but potentially fatal complication. Although no standard treatment has been established, laparoscopic drainage may be an effective alternative, particularly when conservative management fails and the percutaneous drainage of abscesses is unsuitable.

BackgroundOpioids are almost mandatorily used as analgesia for cancer pain and postoperative pain. Opioid analgesics frequently induce a side effect of nausea which is one of the most unpleasant symptoms. However, the incidence of nausea caused by opioids varies among individuals, and the genomic factors involved are still mostly unknown.Aims & ObjectivesWe aim to clarify the genetic background for individual differences in the occurrence of nausea during opioid administration.MethodsIncidence of nausea was investigated in 428 patients (HS) who received morphine for cancer pain treatment at Higashi-Sapporo Hospital and 806 patients (CIH) who underwent standby surgery under general anesthesia at Cancer Institute Hospital. Genomic DNA was purified from patients’ blood and whole genome genotyping was performed. Nine single nucleotide polymorphisms (SNPs) out of the top 20 SNPs strongly associated with nausea in genome-wide association analysis (GWA) of HS were found in the whole-genome genotyping data of CIH (Nishizawa et al., 2023). Out of these 9 SNPs, only TMEM132C rs7296262 SNP had been reported to be associated with suicide attempts in bipolar disorder subjects in a previous study (Willour et al., 2012). Thus, TMEM132C rs7296262 SNP was further analyzed for the association with nausea in HS and CIH by using SPSS software.ResultsTMEM132C rs7296262 SNP showed a significant association with nausea in HS and CIH (TT+TC vs CC, HS, p = 0.0001; CIH, p = 0.006). In HS, a higher incidence rate of nausea was observed in CC carriers compared to TT+TC carriers (TT+TC/CC (%) are shown: with nausea, 77/23; without nausea, 92/8), while in CIH, a higher incidence rate of nausea was observed in T-allele carriers (with nausea, 87/13; without nausea, 83/17).Discussion and ConclusionTMEM132C rs7296262 SNP was significantly associated with nausea during opioid use. The nausea-prone genotype of the rs7296262 SNP was reversed in HS and CIH. Opioids are used chronically for cancer pain, whereas opioids are used acutely during postoperative analgesia. The effect of TMEM132C rs7296262 SNP on nausea may be reversed between the chronic and acute phases of opioid use. The acute administration of morphine may cause an increase in central nervous system expression of substance P and upregulates functional expression of the NK-1 receptor in cortical neurons, while chronic opioid use may lead to long-term repeated activation of mu opioid receptors, resulting in opioid-induced bowel dysfunction that may be associated with nausea and/or vomiting (Howard et al., 2012). Thus, different effects of acute and chronic opioid use may relate to our reversed results on nausea after opioid use.ReferencesHoward S.S., et al. (2012) Opioid-induced nausea and vomiting. Ann Palliat Med. 1(2):121-129.Nishizawa D., et al, (2023) Genome-wide association study identifies novel candidate variants associated with postoperative nausea and vomiting. Cancers. 15(19), 4729.Willour V.L., et al. (2012) A genome wide association study of attempted suicide. Mol Psychiatry. 17(4): 433-444.

To investigate factors associated with symptomatic urinary tract infection (sUTI) in persons with chronic spinal cord lesion (SCL) who were using single-use catheters for intermittent self-catheterization (ISC). Among respondents to an internet survey on the burden of illness on persons with SCL who were considered to be able to perform ISC, 111 persons using single-use catheters were included to examine factors associated with self-reported sUTI by univariate as well as multivariable analysis. The incidence of sUTI was significantly higher in males than in females (56.9% vs. 31.6%, p = .011), persons with stocks of antibiotics than those without it (82.9% vs. 28.6%, p < .011), and persons with more frequent bleeding during catheterization than those with less frequent bleeding (100% vs. 46.5%, p = .036). The incidence did not significantly differ between respective groups when various variables were evaluated by other characteristics of the participants, adherence to ISC procedures, and complications. On multivariable analysis, male gender and stocks of antibiotics were significant independent factors for sUTI. Male gender and stocks of antibiotics were associated with sUTI in persons with SCL who were performing ISC with single-use catheters.

Hemodialysis patients are highly vulnerable during the COVID-19 pandemic and face multiple challenges that affect their physical, psychological, social, and economic well-being. This study aims to thoroughly investigate the experiences of end-stage renal disease patients undergoing hemodialysis during the COVID-19 pandemic. A qualitative descriptive design was applied. Fifteen participants were recruited purposively from Wahidin Sudirohusodo Hospital and Hasanuddin University Hospital. Data were collected through in-depth interviews and analyzed thematically, guided by Roy's Adaptation Model to capture adaptive and maladaptive responses. There are three themes produced in this research: 1) various responses to the COVID-19 pandemic, 2) various impacts, and 3) coping mechanisms developed. The findings underscore the importance of holistic nursing interventions, psychosocial support, and continuous professional development for dialysis nurses to strengthen patient resilience during current and future health crises.

To investigate the main symptoms of female sexual dysfunction (FSD) and lower urinary tract symptoms associated with vulvovaginal atrophy (VVA) symptoms as the core symptoms of genitourinary syndrome of menopause. We extracted the data of 4134 Japanese women aged 40-79 years who participated in the GENitourinary syndrome of menopause in JApanese women (GENJA) study. All participants responded to web-based questionnaires assessing their health situation, including the Vulvovaginal Symptoms Questionnaire, the Female Sexual Function Index (FSFI), and the Core Lower Urinary Tract Symptom Score. Multivariable regression and multivariable logistic regression analyses were applied to analyze the association between VVA symptoms and FSD, and between VVA symptoms and lower urinary tract symptoms. Multivariable regression analysis revealed that VVA symptoms were associated with lower scores for arousal, lubrication, orgasm, satisfaction, and pain domains in the FSFI in sexually active women (p < 0.01). Regression coefficients were higher for lubrication and pain domains than for the other domains. Multivariable logistic regression analysis revealed that women reporting VVA symptoms were more likely to have increased daytime urinary frequency, nocturia, urgency, slow stream, straining to void, feeling of incomplete emptying, bladder pain, and feeling a bulge/lump from or in the vagina (p < 0.05). Adjusted odds ratios were particularly high for straining to void, feeling of incomplete emptying, and bladder pain. Vulvovaginal atrophy symptoms were significantly associated with decreased lubrication and dyspareunia in FSD, and urinary symptoms of straining to void, feeling of incomplete emptying, and bladder pain.

Purpose: To assess the quality of the evaluation of the actual state of pain in older adults with dementia by nurses, care workers, and rehabilitation staff at a long-term care facility.