Reported rates of delayed bleeding (DB) after endoscopic resection using direct oral anticoagulants (DOACs) are high and heterogeneous. This large-scale multicenter study analyzed cases of DB after ...colorectal endoscopic submucosal dissection related to various types of DOACs in Japan (the ABCD-J study) with those associated with warfarin.
We retrospectively reviewed 1019 lesions in patients treated with DOACs and 459 lesions in patients treated with warfarin among 34,455 endoscopic submucosal dissection cases from 47 Japanese institutions between 2012 and 2021. The DB rate (DBR) with each DOAC was compared with that with warfarin. Risk factors for DB in patients treated with DOACs or warfarin were also investigated.
The mean tumor sizes in the DOAC and warfarin groups were 29.6 ± 14.0 and 30.3 ± 16.4 mm, respectively. In the DOAC group, the DBR with dabigatran (18.26%) was significantly higher than that with apixaban (10.08%, P = .029), edoxaban (7.73%, P = .001), and rivaroxaban (7.21%, P < .001). Only rivaroxaban showed a significantly lower DBR than warfarin (11.76%, P = .033). In the multivariate analysis, heparin bridging therapy (odds ratio OR, 2.18; 95% confidence interval CI, 1.27-3.73, P = .005), rectal location (2.01, 1.28-3.16, P = .002), and procedure time ≥55 minutes (2.43, 1.49-3.95, P < .001) were significant risk factors for DB in the DOAC group. The DB risk in the DOAC group (OR, (95% CI)) was 2.13 (1.30-3.50) and 4.53 (2.52-8.15) for 1 and 2 significant risk factors, respectively.
Dabigatran was associated with a higher DBR than other DOACs, and only rivaroxaban was associated with a significantly lower DBR than warfarin.
Stroke occurring while driving may not be uncommon. While some elderly drivers sustaining large vessel occlusion (LVO) and subsequent severe stroke may be brought to emergency departments after ...causing traffic accident (TA), there were few reports on whether mechanical thrombectomy (MT) can be safely performed in that population. Between 2010 and 2019, we treated two elderly drivers who had caused TA secondary to LVO-induced stroke by MT. While MT established good recanalization within 6 h of TA in both patients, the outcomes had not been favorable: a hemispheric infarction developed in a patient with an MCA occlusion and a large hemorrhage developed in the other patient with an ICA occlusion, creating doubt that their outcomes might have been different if MT had been performed earlier. Their therapeutic timelines were critically analyzed to identify what had been the medical/social activities causing delay. The interval between TA and recanalization was trichotomized: (1) between TA and arrival, (2) between arrival and arterial puncture, and (3) between arterial puncture and recanalization. During (1), securement of an injured driver to a backboard in one and accident investigation by police in the other were found to have consumed extra time. During (2), performing bodily CT and abdominal ultrasound was found to have consumed extra time. Coordinated effort by emergency physicians and strokologists to shorten the door-to-needle-time is warranted to improve the outcomes of drivers sustaining large vessel occlusion and causing traffic accident.
Tick-borne encephalitis virus (TBEV) is a zoonotic agent causing severe encephalitis in humans. A recent epizootiological survey indicated that endemic foci of TBEV have been maintained in the ...southern part of Hokkaido until recently. In this study, we sought to isolate TBEV from wild rodents in the area. One virus, designated Oshima 08-As, was isolated from an Apodemus speciosus captured in Hokuto in 2008. Oshima 08-As was classified as the Far Eastern subtype of TBEV and formed a cluster with the other strains isolated in Hokkaido from 1995 to 1996. Thirty-six nucleotide differences resulted in 12 amino acid changes between Oshima 08-As and Oshima 5-10 isolated in 1995. Oshima 08-As caused high mortality and morbidity in a mouse model compared with Oshima 5-10. Although similar transient viral multiplication in the spleen was observed in the mice infected with Oshima 08-As and Oshima 5-10, greater viral multiplication with an inflammatory response was noted in the brains of mice infected with Oshima 08-As than those infected with Oshima 5-10. These data indicate that a few naturally occurring mutations affect the pathogenicity of the Oshima strains endemic in the southern part of Hokkaido.
Background
Cardiac tamponade caused by gynecologic malignancies are extremely rare.
Case
A 56-year-old woman was referred to our hospital with vaginal bleeding and abdominal distension. Computed ...tomography showed massive peritoneal fluid, peritoneal dissemination, swelling of the paraaortic lymph nodes and liver metastasis. Endometrial biopsy showed an admixture of both carcinomatous and sarcomatous elements. The final pathological diagnosis was uterine carcinosarcoma, homologous type. After four cycles of chemotherapy consisting of ifosfamide, adriamycin, and cisplatin, we performed laparotomy, and then two additional courses of chemotherapy were administered postoperatively. Eight months after chemotherapy, echocardiography demonstrated massive pericardial effusion with features of tamponade such as diastolic compression of the right ventricle. Cytological examination of the pericardial fluid showed two different cellular patterns, epithelial and non-epithelial components.
Conclusion
Although cardiac tamponade is rare and has a poor prognosis, it is important for physicians to consider this possibility in the course of treating of uterine carcinosarcoma.
BodyMap is a collection of site-directed 3' expressed sequence tags (ESTs) (gene signatures, GSs) that contains the transcript compositions of various human tissues and was the first systematic ...effort to acquire gene expression data. For the construction of BodyMap, cDNA libraries were made, preserving abundance information and histologic resolutions of tissue mRNAs. By sequencing 164,000 randomly selected clones, 88,587 GSs that represent chromosomally coded transcripts have been collected from 51 human organs and tissues. They were clustered into 18,722 independent 3' termini from transcripts, and more than 3000 of these were not found among ESTs assembled in UniGene (Build 75). Assessment of the prevalence of polyadenylation signals and comparison with GenBank cDNAs indicated that there was no significant contamination by internally primed cDNAs or genomic fragments but that there was a relatively high incidence (12%) of alternative polyadenylation sites. We evaluated the sensitivity and resolution of expression information in BodyMap by in silico Northern hybridization and selection of tissue-specific gene probes. BodyMap is a unique resource for estimation of the absolute abundance of transcripts and selection of gene probes for efficient hybridization-based gene expression profiling.
Abstract We studied the effects of milk and milk product intake on bone health in Japanese adult women (n=1252; 19-80 years of age), high school girls (n=2651; 15-18 years of age), and high school ...boys (n = 2110; 15-18 years of age). The data for subjects who performed and did not perform exercise (described herein as with-exercise and no-exercise) were analyzed separately to see whether exercise habits would modify the effects of dairy product intake on bone density. In this study, bone status was evaluated by the Osteo Sono Assessment Index (OSI). The term Z -score was used in the statistical analysis and is defined as the ratio of an individual's OSI to the average OSI of the Japanese at a specific age and sex. Weekly intake of milk and other milk products, as well as exercise habits, was surveyed via a questionnaire. The Z -score of adult women dropped as their weekly milk intake increased, although not enough to be statistically significant ( P <.1). With respect to cream, the Z -score was highest in the subgroup with an intake of 4 to 5 times a week and lowest in the subgroup with an intake of once a week or less ( P < .01). The Z -score of high school boys rose as their intake frequency of milk increased in both the with-exercise ( P < .05) and no-exercise groups ( P < .1). The Z -score of the with-exercise girls rose with increased intake frequency of milk, up to a certain point. The Z -score was highest in the subgroup with a milk intake of 4 to 5 times a week; however, it dropped in the subgroup with a daily intake of milk ( P < .005). The Z -score of the no-exercise girls did not exhibit any correlation with milk consumption. These results suggest that extensive milk intake reduces the bone density of women, including high school girls, and exercise habits modify the effects of dairy product intake on the bone health of high school students.
A primary survey on the time-dependent influence of life cycle thinking-based environmental education (LCT-EE) on pro-environmental awareness and behavior was carried out for learners who took a ...class of LCT-EE for the detailed design of a survey on the education effects of LCT-EE. The present survey was performed by using a questionnaire form. In this form, survey respondents were asked three question items with respect to a change in pro-environmental awareness and behavior before and after the class. The reasons for their responses to the two items on pro-environmental behavior were also asked in a multiplechoice method on the basis of the other related research results. We sent a questionnaire to 96 learners and we had a response from 77 learners. The result suggested that the exposure to LCT-EE contributed to a positive change in pro-environmental awareness after the elapse of a certain period of time. We also obtained two important potentials with regard to the influence of the learning of LCT on pro-environmental awareness and behavior. We will continue this project towards the detailed survey on the education effects of LCT-EE in order to interpret the mechanism of a change in pro-environmental behavior based on the learning of LCT.
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