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11.
Junichi Mazaki Kenji Katsumata Tetsuo Ishizaki Noritoshi Fukushima Ryutaro Udo Tomoya Tago Kenta Kasahara Hiroshi Kuwabara Masanobu Enomoto Yuichi Nagakawa Akihiko Tsuchida 《Medicine》2022,101(27)
Anastomotic leakage (AL) after colorectal surgery is a serious complication. This study aimed to evaluate the effectiveness of the EEA™ circular stapler, a new triple-row circular stapler (TCS), relative to a conventional, double-row circular stapler (DCS).A total of 285 patients who underwent anastomosis with the double stapling technique at the Tokyo Medical University Hospital between 2017 and 2021 were included in this nonrandomized clinical trial with historical controls using a propensity score (PS) analysis. The primary endpoint was the risk of AL.We performed a 1:2 PS matching analysis. Before case matching, AL occurred in 15 (7.4%) and 2 (2.4%) patients in the DCS and TCS groups, respectively, with no significant difference (P = .17). After case matching, AL occurred in 13 patients (11.6%) and 1 patient (1.8%) in the DCS and TCS groups, respectively, revealing a significant difference (P = .04). Cox models were created by applying PS to adjust for group differences via regression adjustment. Odds ratios for AL in the DCS group versus the TCS group were 0.31 (95% confidence interval [CI]: 0.07–1.38) in the entire cohort, 0.15 (95% CI: 0.02–0.64) in the regression adjustment cohort, and 0.14 (95% CI: 0.02–1.09) in the 1:2 PS-matched cohort.PS analysis of clinical data suggested that the use of TCS contributes to a reduced risk of AL after colorectal anastomosis CTwith the double stapling technique. 相似文献
12.
Akita H Masuda T Nishio T Niikura K Ijiro K Harashima H 《Molecular pharmaceutics》2011,8(4):1436-1442
The successful control of intracellular trafficking (i.e., endosomal escape and nuclear delivery) is prerequisite for the development of a gene delivery system. In the present study, we developed an in vivo hepatic gene delivery system using a plasmid DNA (pDNA)-encapsulating lipid envelope-type nanoparticle, to which we refer as a multifunctional envelope-type nanodevice (MEND). The critical structural elements of the MEND are a DNA/protamine condensed core coated with lipid bilayers including serum-resistant cationic lipids. Intravenous administration of bare MEND represents minimal transfection activity. For the surface modification of functional devices, hydrophobic moieties were chemically attached, which are shed in the spontaneous orientation outward from the MEND surface by anchoring to the lipid bilayers. Modification of the pH-dependent fusogenic peptide GALA as an endosome escape induced transfection activity by 1 and 2 orders of magnitude. In an attempt to induce the nuclear delivery of pDNA, maltotriose, a recently characterized nuclear localization signal, was additionally modified. As a result, transfection activity further enhanced by 1 order of magnitude, and it reached to the higher level obtained for a conventional lipoplex and an in vivo jetPEI-Gal, with less hepatic toxicity. The data show that the combination of GALA and maltotriose results in a highly potent functional device that shows an enhanced endosomal escape and nuclear delivery in vivo. 相似文献
13.
Tomoya Ikeda Naoto Tani Tatsuya Hirokawa Kei Ikeda Fumiya Morioka Alissa Shida Yayoi Aoki Takaki Ishikawa 《Internal medicine (Tokyo, Japan)》2022,61(13):1999
A man in his 30s injected insulin several times into his abdomen and was found dead several hours later. Micropathological findings showed alveolar injury with hemorrhaging and cerebral parietal lobe nerve cell edema. Biochemical examinations showed that the blood insulin level was high, significantly so at the insulin injection sites. The blood glucose and C-peptide levels were low. The insulin level in the kidneys was low. In forensic medicine, a postmortem diagnosis of insulin subcutaneous injection is often difficult. When insulin injection is suspected, particularly high insulin levels can be expected at the insulin injection site, rather than in the blood. 相似文献
14.
Kenji Nakahama Hiroyasu Kaneda Koichi Ogawa Yoshiya Matsumoto Yoko Tani Tomohiro Suzumura Shigeki Mitsuoka Tetsuya Watanabe Kazuhisa Asai Tomoya Kawaguchi 《Internal medicine (Tokyo, Japan)》2022,61(7):1039
A 68-year-old Japanese man was diagnosed with lung adenocarcinoma stage IVB. We introduced a first-line chemotherapy of four cycles of carboplatin and pemetrexed and pembrolizumab, followed by pemetrexed and pembrolizumab maintenance therapy. Approximately four months after anticancer therapy, a small nodule appeared in the right peripheral S3 lesion. After five months, the nodule was confirmed as a Mycobacterium tuberculosis (TB) nodule. We initiated anti-TB therapy without stopping pembrolizumab, and the right S3 nodule shrank immediately. This report supports the concurrent use of anti-TB treatment with an immune checkpoint inhibitor when the TB infection area is limited. 相似文献
15.
Ayuko Yamashita Mineaki Kitamura Yohei Tateishi Kenta Torigoe Kumiko Muta Yasushi Mochizuki Tsuyoshi Izumo Takayuki Matsuo Akira Tsujino Hideki Sakai Hiroshi Mukae Tomoya Nishino 《Internal medicine (Tokyo, Japan)》2022,61(8):1133
Objective The quality of life and activities of daily living (ADL) are generally poor among dialysis patients after intracerebral hemorrhaging, and their precise clinical course remains unclear. In addition, the association between the severity of cerebral hemorrhaging and the long-term prognosis in these patients has not been fully elucidated. This study aimed to evaluate the subsequent prognosis of hemodialysis patients who survived the acute phase of intracerebral hemorrhaging. Methods We included hemodialysis patients who were admitted to Nagasaki University Hospital between 2007 and 2015 for intracerebral hemorrhaging treatment. After excluding cases of in-hospital death, survivors were classified using the 5-point modified Rankin Scale (mRS), which specifically measures the ADL in patients with cerebrovascular diseases. The patients were followed up at the medical facilities to which they were transferred in the same medical zone until 2017. Results Out of 91 patients with cerebral hemorrhaging (65±11 years old, 66% men, hemodialysis duration 108±91 months), 62 survived until discharge. Twenty-one patients died during observation, largely due to infectious diseases, such as sepsis and pneumonia (n=16, 76%). Compared to patients with mRS 0-4 (n=31), those with mRS 5 (n=31) showed a significantly poorer prognosis. The hazard ratio adjusted for age and antiplatelets was 13.7 (95% confidence interval: 3.88-63.7, p<0.001). Conclusion Hemodialysis patients with intracerebral hemorrhaging who were bedridden showed poor outcomes. The major causes of death were infections. Therefore, these patients should be carefully monitored for infections in order to improve their prognosis. 相似文献
16.
Tomoya Matsuhashi Alexander W. Hooke Kristin D. Zhao John W. Sperling Scott P. Steinmann Kai-Nan An 《Clinical biomechanics (Bristol, Avon)》2013,28(9-10):961-966
BackgroundThe humeral head and glenoid cavity are not perfectly spherical, nor do they have matching radii of curvature. We hypothesized that glenohumeral stability is dependent on axial humeral rotation.MethodsSeven cadaveric shoulders were investigated. For each test, the humeral head was translated relative to the glenoid in 2 directions (starting from neutral), anterior and anteroinferior. Contact forces and lateral humeral displacement were recorded. Joint stability was quantified using the stability ratio and energy to dislocation. The humerus was set in 60° of abduction for all tests. Testing was performed in neutral rotation and 60° of external rotation.FindingsThe force displacement curves differed between rotations. In both displacement directions, the peak translational force occurred with less displacement in neutral rotation than in external rotation. The stability ratio and energy to dislocation in the anteroinferior direction were greater than in the anterior direction for both rotation positions. While there were no significant differences in the stability ratio or energy to dislocation between rotation conditions at complete dislocation, the energy required to move the humeral head 10% of the glenoid width was significantly greater with the arm in neutral rotation.InterpretationThe energy to dislocation, a new parameter of dislocation risk, and the stability ratio, indicate that the glenohumeral joint is more stable in the anteroinferior direction than the anterior direction. During initial displacement, axial rotation of the humeral head contributes to glenohumeral geometrical stability. However, humeral head rotation does not have a significant effect when looking at complete dislocation. 相似文献
17.
Asaoka Kohei Watanabe Yuki Itoh Kazuhiro Hosono Naoko Hirota Tomoya Ikawa Masamichi Yamaguchi Tomohisa Hatta Satomi Imamura Yoshiaki Nishino Ichizo Yamauchi Takahiro Iwasaki Hiromichi 《Clinical rheumatology》2021,40(6):2477-2483
Clinical Rheumatology - Eosinophilic fasciitis (EF) is a rare connective tissue disease that causes inflammation and fibrosis of the fascia, inducing pain and motor dysfunction. Characteristic skin... 相似文献
18.
Shingo Tsujinaka Hideyuki Suzuki Tomoya Miura Yoshihiro Sato Chikashi Shibata 《World journal of gastroenterology : WJG》2022,28(47):6732-6742
This review aimed to highlight the etiology, diagnosis, treatment, and prevention of obstructive and secretory complications associated with diverting ileostomy (DI). Obstructive complications at the stoma site are termed stoma outlet obstruction (SOO) or stoma-related obstruction (SRO). The incidence of SOO/SRO is 5.4%-27.3%, and the risk factors are multifactorial; however, the configuration of the stoma limb and the thickness of the rectus abdominis muscle (RAM) may be of particular concern. Trans-stomal tube decompression is initially attempted with a success rate of 33%-86%. A thick RAM may carry the risk of recurrence. Surgical refinement, including a wider incision of the anterior sheath and adequate stoma limb length, avoids tension and immobility and may decrease SOO/SRO. Secretory complications of DI are termed high output stoma (HOS). Persistent HOS lead to water and sodium depletion, and secondary hyperaldosteronism, resulting in electrolyte imbalances, such as hypomagnesemia. The incidence of HOS is 14%-24%, with an output of 1000-2000 mL/d lasting up to three days. Treatment of HOS is commenced after excluding postoperative complications or enteritis and includes fluid intake restriction, antimotility and antisecretory drug therapies, and magnesium supplementation. Intensive monitoring and surveillance programs have been successful in decreasing readmissions for dehydration. 相似文献
19.
Hirota Tomoya McElroy Eoin So Ryuhei 《Journal of autism and developmental disorders》2021,51(8):2764-2772
Journal of Autism and Developmental Disorders - In the present study, we employed network analysis that conceptualizes internet addiction (IA) as a complex network of mutually influencing symptoms... 相似文献
20.