[Need for livelihood support and relationship with community residents: A cross-sectional survey among older adults who do not use livelihood support in a rural area].

Objectives　In recent years, the Japanese government has promoted a livelihood support system based on residents-based mutual help in the community. This study aimed to examine the associations between the need for livelihood support and the relationship with community residents among older adults who do not use livelihood support in a rural area. We operationally defined livelihood support as helping older adults with daily problems so that they can continue to live in familiar neighborhoods.Methods　A self-administered questionnaire survey was conducted in Gejo Area of Tokamachi City, Niigata Prefecture in October 2018. The questionnaires were distributed to all 1,033 residents aged 65 years or over, excluding those certified with care levels 3-5 in the long-term care insurance system. The survey items included basic characteristics, health status, relationship with community residents, and need for 33 livelihood support items.Results　A total of 802 questionnaires were returned (response rate of 77.6%), and 653 community-dwelling individuals who had not used livelihood support were included in the analysis. Factor analysis grouped the 33 livelihood support items into four factors: temporary problems and troubles (53.4%), participation in events and gatherings (38.0%), daily household chores (31.7%), and small problems in daily life (27.7%). Logistic regression analysis showed that the need for assistance with temporary problems and troubles was related to "low trust in community residents," "willing to help community residents but have not yet done so," and "willing to help community residents and have already done so." The need for assistance with participation in events and gatherings was related to "willing to help community residents but have not yet done so," "willing to help community residents and have already done so," and "higher levels of sekentei." The need for assistance with daily household chores was related to "low trust in community residents" and "willing to help community residents and have already done so." Finally, the need for assistance with small problems in daily life was related to "willing to help community residents and have already done so."Conclusion　The need for livelihood support was related to relationships with community residents. To promote the livelihood support system in communities, the relationships between older adults and community residents should be considered.

Validation of algorithms to identify colorectal cancer patients from administrative claims data of a Japanese hospital.

BACKGROUND: Administrative claims data are a valuable source for clinical studies; however, the use of validated algorithms to identify patients is essential to minimize bias. We evaluated the validity of diagnostic coding algorithms for identifying patients with colorectal cancer from a hospital's administrative claims data. METHODS: This validation study used administrative claims data from a Japanese university hospital between April 2017 and March 2019. We developed diagnostic coding algorithms, basically based on the International Classification of Disease (ICD) 10th codes of C18-20 and Japanese disease codes, to identify patients with colorectal cancer. For random samples of patients identified using our algorithms, case ascertainment was performed using chart review as the gold standard. The positive predictive value (PPV) was calculated to evaluate the accuracy of the algorithms. RESULTS: Of 249 random samples of patients identified as having colorectal cancer by our coding algorithms, 215 were confirmed cases, yielding a PPV of 86.3% (95% confidence interval [CI], 81.5-90.1%). When the diagnostic codes were restricted to site-specific (right colon, left colon, transverse colon, or rectum) cancer codes, 94 of the 100 random samples were true cases of colorectal cancer. Consequently, the PPV increased to 94.0% (95% CI, 87.2-97.4%). CONCLUSION: Our diagnostic coding algorithms based on ICD-10 codes and Japanese disease codes were highly accurate in detecting patients with colorectal cancer from this hospital's claims data. The exclusive use of site-specific cancer codes further improved the PPV from 86.3 to 94.0%, suggesting their desirability in identifying these patients more precisely.

Predictors of maximum efficacy of lenvatinib for real-world patients with differentiated thyroid carcinoma.

BACKGROUND AND OBJECTIVES: Tyrosine kinase inhibitors (TKIs) have provided excellent clinical benefits to patients with advanced differentiated thyroid cancer (DTC): however, the tumor status for which maximum efficacy can be obtained remains controversial. We conducted this study to identify effective clinical predictors, focusing on disease progression. METHODS: Using the data of 42 DTC patients treated with lenvatinib, we investigated the clinical factors related to overall survival (OS) and progression-free survival (PFS), and conducted analyses by the scoring of the factors. RESULTS: The 3 year OS and median PFS were 51% and 13.8 months, respectively. Univariate analysis identified performance status (PS), tumor-related symptoms, and tumor diameter as the only factors affecting both these outcomes. Giving 1-point for each of these three factors, a higher score was significantly related to shorter OS and PFS. Patients with two or fewer points (n = 34) had better median OS (NR vs 3.9 months, p < 0.001) and PFS (15.7 vs 2.1 months, p < 0.001) than patients with three points (n = 8). Patients with all three factors had a significantly worse prognosis than patients with two or fewer factors. CONCLUSION: DTC patients with all three indicators are unlikely to have longer survival. Therefore, it is important to commence TKIs before disease progression.

Preventive Effects of Quercetin against the Onset of Atherosclerosis-Related Acute Aortic Syndromes in Mice.

Atherosclerosis-related acute aortic syndromes, such as aortic aneurysms or aortic dissection are life-threatening diseases. Since they develop suddenly and progress rapidly, the establishment of preventive strategies is urgently needed. Quercetin, a flavonoid abundant in various vegetables and fruits, is suggested to reduce the risk of cardiovascular disease. Therefore, in this study, the preventive effect of quercetin was evaluated using a mouse model of aortic aneurysm and dissection. The model was established by administering angiotensin II (Ang II) and ß-aminopropionitrile (BAPN), a lysyl oxidase inhibitor, to mice to induce hypertension and degeneration of the elastic lamina, which would eventually result in the onset of an aortic aneurysm. Ang II, BAPN, and a nitric oxide synthase inhibitor was administered to induce aortic dissection via endothelial dysfunction. Quercetin (60 mg/kg/day) was administered 2 weeks before inducing aortic diseases by the end of the experiments (8 weeks in the aneurysm model, 6 weeks in the dissection model). It was found to reduce the incidence of aneurysm (from 72 to 45%), dissection (from 17 to 10%), and rupture (from 33 to 15%) in mice. Elastin degradation was ameliorated in the quercetin-treated mice compared to that in the mice without quercetin treatment (degradation score 2.9 ± 0.3 vs 2.2 ± 0.2). Furthermore, quercetin suppressed the expression of vascular cell adhesion molecule-1, macrophage infiltration, and pro-matrix metalloproteinase-9 activity. Our results suggest that quercetin might prevent the onset of atherosclerosis-related acute aortic syndromes through its anti-inflammatory and endothelial cell-protective effects.

Occipital artery arising from the cervical internal carotid artery at the level of the C2 vertebral body: three cases detected utilizing magnetic resonance angiography.

We incidentally observed the occipital artery (OA) arising from the cervical internal carotid artery (ICA) at the level of the C2 vertebral body on magnetic resonance (MR) angiography in three patients. In the rare case in which the OA arises from the ICA, it is generally at its origin. The OA arises from the cervical ICA when all but the distal part of the anastomosis of the primitive proatlantal artery between the ICA and vertebral artery persists. Careful review of MR angiographic images is important to detect rare arterial variations, and both partial maximum-intensity-projection images and source images aid their identification on MR angiography.

Carotid-anterior cerebral artery (ACA) anastomosis associated with azygos ACA and ophthalmic artery arising from the middle meningeal artery: a case report.

Among variations of the anterior cerebral artery (ACA), anastomosis of its A1-A2 junction with the ophthalmic segment of the internal carotid artery is rare and described as carotid-ACA anastomosis or infraoptic course of the ACA. One common variant, an azygos ACA, demonstrates no pairing of the A2 segment. To our knowledge, association of a carotid-ACA anastomosis with an azygos ACA is not reported in the English-language literature. We report a case diagnosed by magnetic resonance angiography in which right carotid-ACA anastomosis was associated with an azygos ACA and the right ophthalmic artery originated from the middle meningeal artery.

A Fluorescent Probe for Rapid, High-Contrast Visualization of Folate-Receptor-Expressing Tumors In†Vivo.

Folate receptors (FRs) are membrane proteins involved in folic acid uptake, and the alpha isoform (FR-α) is overexpressed in ovarian and endometrial cancer cells. For fluorescence imaging of FRs in vivo, the near-infrared (NIR) region (650-900 nm), in which tissue penetration is high and autofluorescence is low, is optimal, but existing NIR fluorescent probes targeting FR-α show high non-specific tissue adsorption, and require prolonged washout to visualize tumors. We have designed and synthesized a new NIR fluorescent probe, FolateSiR-1, utilizing a Si-rhodamine fluorophore having a carboxy group at the benzene moiety, coupled to a folate ligand moiety through a negatively charged tripeptide linker. This probe exhibits very low background fluorescence and afforded a tumor-to-background ratio (TBR) of up to 83 in FR-expressing tumor-bearing mice within 30 min. Thus, FolateSiR-1 has the potential to contribute to the research in the field of biology and the clinical medicine.

The effects of a two-minute original exercise program supported by the workplace unit on the workers' work engagement: the "Bipoji" exercise.

[Purpose] This study examined whether workplace support of an exercise program would increase the workers' engagement. [Participants and Methods] Employees at two facilities of the Kyoto Industrial Health Association (the Uji branch and the headquarters) were recruited. A survey of 238 employees was conducted. A seminar was held, at the facilities, about the "Bipoji" exercise program and afterward the participants underwent different procedures. The Uji branch (the support group) supported the continuation of the program for two months. At the headquarters (the control group), the individual decided whether to continue the program. Data were collected at the time of the seminar (the baseline) and two months later. A questionnaire measured work engagement using the Utrecht Work Engagement Scale. [Results] At the follow-up, data were collected from 65 people (60.2%) from the support group and 97 people (74.6%) from the control group. The average change in the Utrecht Work Engagement Scale scores was 1.7 and -1.2, for the support group and the control group, respectively. When adjusted for background factors, the change was 1.6 and -1.2, for the support group and the control group, respectively. This indicates a significant increase in work engagement for the support group. [Conclusion] These results suggest that a workplace exercise program can improve work engagement.

Association of ghrelin dynamics with beta cell function in Japanese subjects with normal glucose tolerance.

BACKGROUND: Ghrelin is involved in feeding regulation and energy metabolism and is also known to inhibit insulin secretion (ß). However, few clinical studies have demonstrated the relationship between ß and ghrelin dynamics. This study tested the hypothesis that, in oral glucose tolerance tests (OGTT), ghrelin dynamics are associated with ß. METHODS: Subjects were 1145 healthy individuals <40 years old who tested normal on the 75-g OGTT. The following indicators and the ghrelin suppression ratio (GSR) during OGTT were calculated: insulin sensitivity (SI) [1/homoeostasis model assessment of insulin resistance, insulin sensitivity index-Matsuda and 1/fasting insulin (1/FIRI)]; and ß [Stumvoll first-phase index (Stumvoll-1), Stumvoll second-phase index and insulinogenic index]. From nine combinations of SI and ß, combinations that produce hyperbolic relationships were identified. RESULTS: Stumvoll-1 and 1/FIRI showed a hyperbolic relationship in nonobese subjects, and the product of Stumvoll-1 and 1/FIRI was used as the disposition index (DI). When analyzed by BMI quartiles, post-loading glucose and insulin levels at each time point increased from Q1 (low BMI) through Q4 (high BMI), whereas the DI, ghrelin levels at each time point, and GSR decreased from Q1 to Q4. On multivariate and bivariate analysis, GSR and DI were positive and independent, and fasting ghrelin and FIRI were negatively and independently correlated. CONCLUSIONS: Ghrelin dynamics were associated with beta cell function in subjects with normal glucose tolerance. Glucose intolerance in obesity may be due not only to insulin resistance but also to impaired beta cell function associated with abnormalities of ghrelin dynamics.

Ferroportin Disease Caused by a Heterozygous Variant p.Cys326Phe in the SLC40A1 Gene and the Efficacy of Therapeutic Phlebotomy in Children.

Therapeutic phlebotomy is recommended for treating hereditary hemochromatosis. However, the procedure and its efficacy for children remain unclear. We describe a young female patient with ferroportin disease, which was confirmed from excess iron deposition within hepatocytes and by identifying a heterozygous variant p.Cys326Phe in SLC40A1. She had been followed without phlebotomy. Liver histology at age 13 years revealed iron deposition progression. Phlebotomy was initiated and her iron markers and imaging findings improved without severe adverse effects. Therapeutic phlebotomy for children is effective and well-tolerated and should be considered as early as possible after a hemochromatosis diagnosis.

Bilateral persistent hypoglossal arteries: a case report and literature review.

Bilateral persistent hypoglossal arteries (PHAs) are extremely rare, with only 5 cases reported in the English-language literature. Using magnetic resonance angiography, we diagnosed a case in which the left side was a typical PHA and the right side was presumed a PHA variant that supplied only the posterior inferior cerebellar artery.

Bilateral carotid-anterior cerebral artery anastomoses associated with bilateral ophthalmic arteries arising from the anastomotic arteries diagnosed by magnetic resonance angiography: a case report.

Rarely, the anterior cerebral artery (ACA) arises from the ophthalmic segment of the internal carotid artery, a condition described as carotid-ACA anastomosis or infraoptic course of the ACA that generally demonstrates right-sided predominance. We diagnosed a case of bilateral anastomoses of the carotid and ACA vessels in which bilateral ophthalmic arteries arose from the origins of the anastomotic vessels using magnetic resonance (MR) angiography. Identification of rare arterial variations on MR angiography requires careful scrutiny of source images, and creation of partial volume-rendering images can aid visualization of detailed anatomic structures.

Anastomosis of the external carotid artery and the V3 segment of the vertebral artery (presumed persistent second cervical intersegmental artery) diagnosed by CT angiography.

Congenital anastomosis of the external carotid (ECA) and vertebral (VA) arteries is extremely rare. We report a case of right ECA-VA anastomosis diagnosed by computed tomography (CT) angiography. The presumed dilated ascending pharyngeal artery coursed posteriorly and entered the C1 right transverse foramen. The proximal right VA was aplastic, and the C2 right transverse foramen was absent. Based on these findings, we diagnosed congenital anastomosis of the ECA and V3 segment of the VA, which we presumed to represent persistence of the second cervical intersegmental artery. Detection of rare variations of the vertebral arteries requires careful observation of CT angiography with bone images and source images, especially to identify the level of entry into the transverse foramen. Correct diagnosis of anastomosis is important when intravascular embolization or infusion chemotherapy or surgical ligation of the ECA is planned.

Sarcoidosis in the Head and Neck: An Illustrative Review of Clinical Presentations and Imaging Findings.

OBJECTIVE: Sarcoidosis is referred to as a great imitator because of its propensity to radiologically mimic a variety of pathologic entities. Symptomatic neurosarcoidosis is present in approximately 5% of patients with sarcoidosis, and it is found histopathologically in approximately 25% of asymptomatic patients. CONCLUSION: An understanding of the multifaceted imaging manifestations of head and neck sarcoidosis will aid early recognition of the diagnosis, with a goal for earlier initiation of therapy and prevention of irreversible sequelae of the disease.

Lenvatinib induces early tumor shrinkage in patients with advanced thyroid carcinoma.

Although advanced thyroid carcinoma patients who cannot be cured by conventional therapy have lacked effective treatment, multitargeted tyrosine kinase inhibitors have recently become available. Phase 3 trials of lenvatinib showed a median time to objective response of 2 (95 % confidence interval (CI) 1.9-3.5) months, demonstrating that shrinks tumors rapidly. The phenomenon of immediate tumor shrink is known as early tumor shrinkage (ETS) which is related to clinical outcome in other malignancies. However, precisely when within 8 weeks lenvatinib starts to affect tumors remains unclear. In tumors near the carotid arteries, trachea, or esophagus, a rapid therapeutic effect can induce fistula formation or arterial bleeding. To prevent such treatment-emergent serious adverse events (SAE), early imaging evaluation seems to be very important. In this study, the point in time when lenvatinib started to shrink tumors was retrospectively investigated. The subjects were 16 patients who started lenvatinib administration between May and August 2015. Tumor size was evaluated by computed tomography (CT) scans frequently within the first 8 weeks according to the Response Evaluation Criteria In Solid Tumors (RECIST) guideline. Initial tumor response was defined as ≥ 10% tumor reduction. Serum thyroglobulin (Tg) level was monitored in 8 differentiated thyroid carcinoma (DTC) without TgAb patients. At the first evaluation, 13 patients (83.3 %) showed tumor reduction and that decreased with time. Thirteen patients (83.3 %) showed >10 % tumor reduction within 8 weeks. In all DTC patients, serum Tg level was markedly decreased. In conclusion, lenvatinib immediately shrinks tumors, the so-called ETS phenomenon. Therefore, careful attention should be paid to fistula formation from the early phase.

Bilateral carotid-anterior cerebral artery anastomoses associated with bilateral ophthalmic arteries arising from the middle meningeal arteries diagnosed by magnetic resonance angiography: a case report.

Anastomosis between the ophthalmic segment of the internal carotid artery and the A1-A2 junction of the anterior cerebral artery (ACA), described as carotid-ACA anastomosis or infraoptic course of the ACA, is rare and known to demonstrate right-sided predominance. We report a case of bilateral carotid-ACA anastomoses associated with bilateral ophthalmic arteries arising from the sphenoidal branch of the middle meningeal artery that were diagnosed by magnetic resonance (MR) angiography. Identification of rare arterial variations on MR angiography requires careful scrutiny of source images.

Multiple variations of the cerebral arteries associated with tetralogy of Fallot: a case report.

Tetralogy of Fallot (TOF) can be associated with vascular malformations or variations, especially of the aortic arch or supracardiac major venous systems. We report its association with an extremely rare combination of three such variations of the cerebral arteries-a right persistent hypoglossal artery, an extremely rare left carotid-right anterior cerebral artery (ACA) anastomosis, and a left accessory middle cerebral artery arising from the A1-A2 junction of the left ACA-which were diagnosed by magnetic resonance angiography in a 9-year-old girl during evaluation of multiple acute cerebral infarctions.

Duplicate origin and extremely long P1 segment of the posterior cerebral artery diagnosed by MR angiography.

We present what we believe is the first report of a patient with an anomalous artery arising from the distal basilar artery and fusing with the mid-portion of an extremely long P1 segment of the left posterior cerebral artery that was diagnosed on magnetic resonance (MR) angiography. Careful review of MR angiographic images is important to detect rare arterial variations, and partial maximum-intensity-projection images aid their identification on MR angiography.

Variations of the posterior cerebral artery diagnosed by MR angiography at 3 tesla.

INTRODUCTION: Fenestration, early bifurcation, and duplication of the posterior cerebral artery (PCA) and the so-called hyperplastic anterior choroidal artery (AChA), considered a variation of the PCA, are rare. We evaluated the prevalence and characteristic features of these PCA variations on magnetic resonance (MR) angiography. METHODS: We reviewed intracranial MR angiographic images of 2402 patients examined using a 3-tesla scanner. Images from the skull base to the intracranial region were obtained using the standard time-of-flight technique. We excluded images of 52 patients with insufficient image quality or occlusion of the PCA(s) and retrospectively evaluated the images of 2350 patients using a picture archiving and communication system. RESULTS: We observed PCA fenestration in eight (0.34%) patients, most at the P1 segment and P1-P2 junction and all small in size, early bifurcation at the P1-P2 junction or proximal P2A segment in eight (0.34%) patients, complete duplication in one patient, and hyperplastic AChA in 13 (0.55%) patients. Eleven of the 13 hyperplastic AChAs supplied only the territory of the temporal branch of the PCA, and the remaining two supplied the entire territory of the PCA. CONCLUSION: We observed PCA variations in 30 (1.28%) patients. We believe the name "hyperplastic AChA" inaccurately describes variations of the PCA in which the AChA supplies part of or all of the territory of the PCA and propose "accessory PCA" to describe an AChA that supplies part of the territory of the PCA or "replaced PCA" to describe that vessel that supplies the territory all branches of the PCA.

Duplicate origin of the anterior cerebral artery diagnosed by magnetic resonance angiography: a case report.

An anterior cerebral artery (ACA) of duplicate origin results from the fusion of two arteries that arise from the terminal segment of the internal carotid artery (ICA) to form a ring. This variation is extremely rare and differs from proximal ACA fenestration, supraclinoid fenestration of the ICA, and duplicate origin of the middle cerebral artery. We report a case diagnosed incidentally by magnetic resonance angiography.