Investigation of Patients' Motivation for Cosmetic Surgery in a Nationwide Cosmetic Surgery Group.

Background: Recently, cosmetic surgeons in Japan have used social media to advertise their procedures. We analyzed the influence of social and other media on patients' motivation to visit our clinic using the aggregated results of a questionnaire distributed to our cosmetic surgery group. Methods: We obtained the data of 146,108 patients from our database between September 2018 and February 2023. To understand changes in patient motivation over time, patient motivation was compared between the opening (September 2018-February 2020), growth (March 2020-August 2021), and expansion (September 2021-February 2023) periods. Results: Most patients were motivated to visit clinics by the internet (53.7%) and Instagram (17.3%). Between the opening and growth periods, the internet [odds ratio (OR) 1.28; 95% confidence interval (CI), 1.14-1.43] and referrals (OR, 1.48; 95% CI, 1.08-2.01) significantly increased. Between the opening and expansion periods, there was a significant increase in TV (OR, 4.86; 95% CI, 3.09-7.65) and TikTok use (OR, 24.9; 95% CI, 3.50-177.0). There was more variability in the motivation to visit our clinic during the expansion period than during the other periods, and patients' motivation differed by procedure and region. In addition, TikTok was used primarily by patients in their late teens and early twenties, whereas TV was used by those in their twenties and forties. YouTube, referrals, and review websites were distributed bimodally. Conclusions: Patients choose information from various media sources. To attract more patients to our clinics, it is important to disseminate information on both the internet and social media.

Recent Status of Procedures in a Single Nationwide Cosmetic Surgery Group.

Background: Recently, cosmetic surgery demand has increased due to the spread of promotional social media in Japan. However, understanding the overall landscape remains difficult due to many clinics with varied procedure options. To understand the current trends and status of cosmetic surgery in Japan, we analyzed large-scale data from a group of clinics throughout the country. Methods: We analyzed data from 152,457 patients in our database. The periods from September 2018 to August 2021 and September 2021 to February 2023 were defined as the first and second periods, respectively, and the statuses of procedures were compared between the two. Results: Eye procedures were the most common (23.6%), followed by face-lifts (19.5%) and dark circles under the eyes (10.4%). Between the first and second periods, the number of procedures in the second period (128,898 cases) was overwhelmingly higher than that in the first period (23,559 cases). Orbital fat removal for dark circles under the eyes significantly increased (OR 2.97, 95%CI 2.78-3.17); procedures in provincial cities significantly increased (Kinki/Chugoku/Shikoku: OR 2.21, 95%CI 2.08-2.36); and procedures for patients with occupations where appearance is considered important, such as nightlife businesses or being a celebrity, decreased (celebrity: OR 0.44, 95%CI 0.38-0.51, nightlife business: OR 0.58, 95%CI 0.53-0.62). Conclusions: In Japan, cosmetic surgery has become increasingly common in recent years, and the trend has been changing over time. In the future, it will be important to organize and enhance our large-scale database to disseminate more accurate and useful information.

Septic shock caused by a carbon dioxide-dependent and extended spectrum ß-lactamase-producing Proteus mirabilis small colony variant in a long-term bedridden patient.

Here, we report a 60-year-old chronically bedridden man with cerebral palsy who had septic shock following a history of urinary tract infection with extended spectrum ß-lactamase-producing and auxotrophic Proteus mirabilis detected on blood and urine cultures. This auxotroph formed small colonies only on the blood agar at 24 h in 5% CO2, but not in the conditions without CO2, and lacked motility and some biochemical activities. The five-year history of stones in the right renal pelvis suggests chronic urinary tract infection with P. mirabilis requiring a 28-day antibiotic treatment. This paper highlights that the CO2-dependent P. mirabilis small colony variant may cause sepsis, probably due to chronic infection in uroliths, which should warrant immediate identification.

Maintenance antisepsis in reducing the rate of late-onset central venous catheter-related bloodstream infection: A comparison of 0.05% and 1% chlorhexidine.

BACKGROUND: Bundled measures have been recommended to reduce the risk of central venous catheter (CVC)-related bloodstream infection. However, the importance of each procedure involved in CVC insertion/management for preventing catheter-related bloodstream infection (CRBSI) has not been thoroughly assessed. We aimed to analyze the effectiveness of maintenance antisepsis at the CVC insertion site in reducing the CRBSI risk through comparing the use of 0.05% chlorhexidine to 1% chlorhexidine. PATIENTS AND METHODS: In the South Miyagi Medical Center, Japan, 372 patients with a CVC who had undergone antisepsis maintenance using 0.05% chlorhexidine swabs 12 months prior to implementing 1% chlorhexidine swabs, and 344 patients at 12 months post-implementation of 1% chlorhexidine swabs, were followed prospectively for the development of CRBSI and signs of infection, and their data compared. RESULTS: Post-implementation of the 1% chlorhexidine swabs, the CRBSI rate decreased from 3.64/1000 catheter-days to 1.77/1000 catheter-days. The risk of CRBSI decreased to 0.465 (95% confidence interval [CI]: 0.216-1.001). Furthermore, the risk of CRBSI ≥20 days after CVC insertion decreased to 0.200 (95% CI: 0.049-0.867); however, we found no difference between 0.05% and 1% chlorhexidine use within 19 days of CVC insertion. The increased number of patients with insertion site tenderness after implementing 1% chlorhexidine indicated a possible adverse effect of chlorhexidine. CONCLUSION: Maintenance antisepsis with 1% chlorhexidine decreased the risk of developing CRBSI ≥20 days after CVC insertion, indicating the effectiveness of antisepsis with 1% chlorhexidine. Our data highlight the importance of maintenance antisepsis in reducing the rate of late-phase CRBSI.

Hepatic blood flow by perfusion computed tomography as an imaging biomarker for patients with gastric cancer.

Perfusion computed tomography (PCT) is a less invasive imaging modality that provides information about tissue hemodynamics at the capillary level. The present study aimed to investigate the correlation between hepatic perfusion and gastric cancer progression. A total of 136 patients with gastric adenocarcinoma were evaluated in the present study. Prior to initial treatment, liver PCT was performed across the hepatic hilar plane and the hepatic blood flow (HBF) was measured using the dual-input deconvolution method. HBF was compared with clinicopathological factors, patient prognosis and circulating serum proangiogenic cytokines. The median HBF was 217 ml/min/100 g tissue. Patients with high HBF had larger tumors (43 mm vs. 71, P<0.001) and more advanced tumor-node stages (P<0.001 for both). When both patient groups of operable and inoperable were compared by their respective median HBF values, each high-HBF group had a significantly worse prognosis (P=0.002 and P=0.024), notably in the inoperable group, with <1-year survival. In 17 postoperative recurrent patients, the high-HBF at recurrence group also had a significantly worse postrecurrent prognosis (P=0.019). HBF was an independent prognostic factor (hazard ratio, 2.019; P=0.048) and was strongly associated with serum vascular endothelial growth factor level (R=0.607, P<0.001). HBF was significantly correlated with gastric cancer progression, and is an easily measured imaging biomarker reflecting patient survival.

Fulminant type 1 diabetes mellitus with anti-programmed cell death-1 therapy.

Anti-programmed cell death-1 (PD-1) antibodies are regarded as a risk factor for insulin-dependent diabetes mellitus as a side-effect. While a small number of cases have been reported, evidence remains limited. This is the first report of an Asian patient developing insulin-dependent diabetes during anti-PD-1 therapy. A 55-year-old euglycemic woman receiving nivolumab for malignant melanoma showed abrupt onset of ketonuria, and elevated levels of plasma glucose (580 mg/dL) and hemoglobin A1c (7.0%). Over the next 2 weeks, serum C-peptide levels fell below the limit of detection. Islet autoantibodies were negative, and the patient showed a human leukocyte antigen haplotype associated with type 1 diabetes. Anti-PD-1 therapy can cause rapid onset of insulin-dependent diabetes, possibly because of inappropriate activation of T cells. Human leukocyte antigen haplotypes might be related to the onset of this disease. Physicians should be aware of this serious adverse event and carry out routine blood glucose testing during anti-PD-1 therapy.

Primary esophageal adenocarcinoma arising from heterotopic gastric mucosa: report of a case.

Adenocarcinoma arising from heterotopic gastric mucosa (HGM) is exceedingly rare. This report presents the case of a 57-year-old male who presented with the chief complaint of dysphagia. Endoscopy and computed tomography revealed a locally advanced tumor of the cervical esophagus and swollen mediastinal lymph nodes. He underwent chemoradiotherapy followed by esophagectomy with three-field lymph node dissection. The resected tumor was a circumferentially scarred lesion located 1.5 cm from the proximal margin. The tumor was identified to be a well-differentiated adenocarcinoma arising from HGM with invasion to the muscularis propria. Postoperative chemoradiotherapy was performed because positive surgical margins were observed in the resected tissue. The patient has remained alive for more than 4 years after surgery, without any evidence of recurrence.

Tissue Doppler combined with pulsed-wave Doppler echocardiography for evaluating ventricular diastolic function in normal children.

BACKGROUND: The ratio of the peak transmitral velocity during early diastole (E) to the peak mitral valve annular velocity during early diastole (E') obtained by tissue Doppler imaging correlates with the left ventricular end-diastolic pressure in adults. However, the E/E' ratio has not been established in normal children. The purpose of this study was to assess the effect of age on the various tissue Doppler indices of ventricular diastolic function. METHODS: The subjects in this study included 174 children with normal cardiac function. The left and right ventricular inflow velocities were recorded, and the peak of late diastolic flow velocities (A), E, and the ratio of E/A were determined. The following tissue Doppler indices were obtained: peak velocities of early and late diastolic mitral annulus in the left ventricular lateral wall (E'l and A'l) and in the interventricular septum (E'se and A'se) and those of the lateral tricuspid annulus in the right ventricle, E'r and A'r. RESULTS: The E'l and the E'se increased with age up to 5 years after birth, after which they became constant. The E'r was constant after birth. The E'l/A'l and E'se/A'se increased with age up to 5 years after birth, after which they became constant. The E'r/A'r was constant after birth. The Em/E'se and Em/E'l decreased with age up to 5 years after birth, after which they became constant. The Et/E'r was constant after birth. CONCLUSION: The age-related changes suggest age-related alterations in left ventricular diastolic function. Right ventricular diastolic function is constant after birth.

Grown-up Kawasaki disease patients who have giant coronary aneurysms.

BACKGROUND: Many Kawasaki disease (KD) patients have reached adulthood in Japan. The current status of adult patients who have giant coronary aneurysms with KD is not well understood. METHODS: Medical records of 48 KD patients (33 males and 15 females) with giant coronary aneurysms (maximum coronary artery internal diameter >8 mm) aged 20 years or over were retrospectively reviewed. RESULTS: The age of the patients at the diagnosis of KD ranged from 0.3 to 12.8 years (median 2.9 years) and the age of the patients in this review ranged from 20.0 to 33.1 years (median 25.2 years). During the follow-up period, the maximum coronary artery internal diameter ranged from 8.2 to 30.0 mm (median 10 mm). Giant coronary aneurysms progressed to coronary artery stenosis and/or complete occlusion in 34 (74%) of 46 patients. Coronary artery bypass graft surgery was performed in 9 (19%) of 48 patients. Myocardial infarction occurred in 14 (31%) of 45 patients. Other complications or problems occurred in 5 patients with angina pectoris, low left ventricular ejection fraction, ventricular tachycardia, hemorrhagic cerebral infarction, or thyroid carcinoma respectively. In the patients followed up, 4 dropped out. In addition, 1 patient succeeded in pregnancy and delivered a baby. CONCLUSIONS: Close attention should be paid to ventricular tachycardia in adult KD patients with giant coronary aneurysms, especially for those who have low left ventricular ejection fraction. To reduce the number of dropped out patients, it is important that the patients should be referred to a new doctor when they change their place of residence.

[Regional treatment of esophageal liver metastasis by intra-arterial low-dose 5-FU therapy].

The prognosis of esophageal liver metastasis remains poor because of the high incidence of synchronous metastasis in other area and insufficient response to systemic chemotherapy. We assessed loco-regional anticancer potential of intra-arterial 5-FU chemotherapy for esophageal liver metastasis aimed at combination with systemic chemotherapy, radiotherapy and ablation therapy as a multidisciplinary treatment. Six patients of esophageal cancer with liver metastasis and without extra-hepatic metastasis were enrolled. Intra-aortic chemotherapy consisted of 5-FU (250 mg/body) in a one-shot infusion or a continuous infusion for 7 days with 2-week intervals until failure. The responses of liver metastasis were 2 cases of CR, 3 of PR and 1 of SD. The response rate and the local control rate were 83% and 100%, respectively. The maximum time to progression was 53 months. Grade 3/4 toxicity was not observed. Two cases had catheter failure and the treatment was interrupted. Liver metastases were controlled well until death in all cases except one. Low-dose intra-aortic 5-FU chemotherapy provided a good regional response and a combination with systemic chemotherapy may prolong survival for the patients of liver metastasis of esophageal cancer.

[Diffusion-weighted MR imaging for postoperative nodal recurrence of esophageal squamous cell cancer in comparison with FDG-PET].

We evaluated the power of DWIBS in patients with postoperative lymph node recurrence of esophageal cancer and compared with FDG-PET findings. Forty-seven suspected lesions by MDCT were enrolled. No significant difference between DWIBS and PET was observed in sensitivity (95% vs 97%), PPV (83% vs 90%) and overall accuracy rate (81% vs 87%). The ADCs (x10(-3) mm2/s) of recurrent nodes, primary cancer and normal esophagus were 1.124, 1.058 and 2.079, respectively. ADCs of recurrent nodes were significantly lower than those of normal esophagus (p<0.0001). The cut-off ADC line of 1.5 revealed 100% overall accuracy for separating the recurrent lesion from normal esophagus. Noninvasive DWIBS may become a valid modality to discriminate nodal recurrence of esophageal cancer by no means inferior to PET.

[Evaluation of hepatic arterial infusion chemotherapy for liver metastasis from gastric cancer].

We performed hepatic arterial infusion (HAI) chemotherapy for 11 patients with liver metastasis from gastric cancer, who had no other metastasis. The main antineoplastic drug was 5-fluorouracil (5-FU). The catheter was inserted into the hepatic artery using the GDA coiling method by interventional radiologic technique in 9 patients, and by operative treatment in 2 patients. The response rate for 10 patients was 91% (CR 3, PR 7, PD 1). The survival time from the beginning of the HAI chemotherapy was 8-34 months. The causes of withdrawal from the chemotherapy were PD in 7 patients and catheter troubles in 4 patients. There was no patient suffering from severe adverse effect. The HAI chemotherapy was effective and useful for patients with liver metastasis of gastric cancer. We thought a gastric cancer patient with liver metastasis who didn't have an uncontrollable other organ metastasis was a good target for this regimen.

[Evaluation of preoperative chemoradiation therapy for lower rectal carcinoma using DWIBS].

We investigated the efficacy of diffusion-weighed whole body imaging with background body signal suppression (DWIBS) in assessing effects of chemoradiation therapy (CRT) on rectal carcinoma. DWIBS was performed in patients (n=12) with primary rectal carcinoma undergoing preoperative CRT before and 3 weeks after the treatment. Each patient received a total irradiation dose of 45 Gy at a single dose of 1.8 Gy administered once daily. Parallel to this, in the 1st, 3rd and 5th weeks 350 mg/m2 5-fluorouracil and 35 mg/m2 l-leucovorin were administered for 5 days. The apparent diffusion coefficient (ADC) was measured by DWIBS and surgical resection of the tumors enabled a correlation of ADC values with the pathological findings. With respect to histopathological grading of regression, two, five and five cases exhibited Grade 3, Grade 2 and Grade 1, respectively. In all patients, ADC values were higher after completion of CRT compared to those before it( 1.23+/-0.26x10(-3) mm2/s vs 0.75+/-0.13x10(-3) mm2/s, p<0.001). After completion of CRT, mean ADC values were 1.71+/-0.38x10(-3) mm2/s, 1.25+/-0.10x10(-3) mm2/s and 1.02+/-0.08x10(-3) mm2/s for Grade 3, Grade 2 and Grade 1, respectively. These preliminary results indicate that DWIBS may be a valuable tool to assess effects of CRT on rectal carcinoma by using appropriate cut-off values.

Direct binding of TReP-132 with TdT results in reduction of TdT activity.

N regions at the junction of V, D and J DNA segments are synthesized with large protein complexes including terminal deoxynucleotidyltransferase (TdT) during V(D)J recombination in B- or T-cells. TdT directly binds to TdIF1, TdIF2, PCNA and the Ku70/86 heterodimer. Using a yeast two-hybrid system, we isolated a cDNA clone encoding the gene for TReP-132, which is involved in P450scc gene expression in steroid-hormone-producing cells or lymphoid cells. Interaction between TReP-132 and TdIF1 was confirmed by pull-down assay and immunoprecipitation assay using specific antibodies against TReP-132 both in vitro and in vivo. TdT also directly bound to TReP-132 through its confined N-terminal region. Furthermore, the co-expression of TdIF1 and TReP-132 or TdT and TReP-132 in COS7 cells showed that these proteins are co-localized within the nucleus. TReP-132 reduces TdT activity to 2.5% of its maximum value in the in vitro assay system using double-stranded DNA with a 3' protrusion as a primer. These findings suggest that TdT synthesizes N region under a negative control of TReP-132 during V(D)J recombination.

DNA polymerase lambda directly binds to proliferating cell nuclear antigen through its confined C-terminal region.

DNA polymerase lambda (Pol lambda) was recently identified as a new member of the family X of DNA polymerases. Here, we show that Pol lambda directly binds to proliferating cell nuclear antigen (PCNA), an auxiliary protein for DNA replication and repair enzymes, both in vitro and in vivo. A pull-down assay using deletion mutants of Pol lambda showed that the confined C-terminal region of Pol lambda directly binds to PCNA. Furthermore, a synthetic peptide of 20-mers derived from the C-terminal region of Pol lambda competes with full-length Pol lambda for binding to PCNA. The residues between amino acids 518 and 537 of Pol lambda are required for binding to PCNA, and are different from the consensus PCNA interacting motif (PIM). Pol lambda associates with PCNA in vivo by immunoprecipitation analysis and EGFP-tagged Pol lambda co-localizes with PCNA as spots within a nucleus using fluorescent microscopy. Through direct binding, PCNA suppressed the distributive nucleotidyltransferase activity of Pol lambda. Pol micro, which also belongs to the family X of DNA polymerases, binds to PCNA by a pivotal amino acid residue.