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Objective To identify risk factors for lymph node metastasis and postoperative recurrence of pT1 colorectal cancer by clinicopathological study of surgically resected cases.Methods In 801 patients with pT1 colorectal cancer who underwent surgical resection with lymph node dissection between April 2007 and January 2021, we evaluated clinicopathological factors (age, gender, BMI, serum CEA level, tumor localization, additional resection after endoscopic treatment, operation time, blood loss, histological type, tumor size, vascular invasion, and central lymph node dissection). We performed univariate and multivariate analyses to examine risk factors for lymph node metastasis. We also examined risk factors for recurrence in 583 patients up to December 2017.Results Lymph node metastasis was observed in 100/801 patients (12.5%). Multivariate analysis of lymph node metastasis showed that patients with positive lymphatic invasion (odds ratio 2.57, 95% CI 1.62-4.04, P< .0001), positive venous invasion (odds ratio 2.31, 95% CI 1.48-3.61, P= .0002), and histologically poorly differentiated type (odds ratio 4.54, 95% CI 1.35-15.2, P= .014) were identified as risk factors. Postoperative recurrence was observed in 18/580 patients (3.1%). Risk factors for postoperative recurrence were also examined, including preoperative endoscopic treatment (odds ratio 3.59, 95% CI 1.18-10.9, P= .024), positive venous invasion (odds ratio 3.63, 95% CI 1.22-10.8, P= .021), positive lymph node metastasis (odds ratio 4.91, 95% CI 1.10-21.8, P= .037) were extracted as risk factors.Discussion In this study, venous invasion, lymphatic invasion, and histologically poorly differentiated type were identified as risk factors for lymph node metastasis in T1 colorectal cancer, and positive venous invasion, positive lymph node metastasis, and preoperative endoscopic treatment were identified as risk factors for recurrence. We hope that large prospective study will lead to the development of a more specific treatment strategy, including endoscopic treatment and additional surgical resection.

Introduction/Objectives: To assess the utility of the computerized cognitive function assessment tool, CogEvo, as a screening tool for mild cognitive impairment in primary care, we explored the relationship between CogEvo performance, age, and the severity of cognitive dysfunction evaluated by the Mini-Mental State Examination (MMSE).Methods: The observational cross-sectional study included 209 individuals’ data (mean age 79.4 ± 8.9 years). We conducted a correlation analysis between CogEvo and MMSE scores, compared the performance among the 3 cognitive function groups (MMSE ≥ 28 group; MMSE24-27 group; MMSE ≤ 23 group) using the MMSE cut-off, and evaluated CogEvo’s predictive accuracy for cognitive dysfunction through ROC analysis.Results: Both total CogEvo and MMSE scores significantly decreased with age. A significant positive correlation was observed between total CogEvo and MMSE scores, but a ceiling effect was detected in MMSE performance. Significant differences were observed in the total CogEvo score, including orientation and spatial cognitive function scores, among the 3 groups. CogEvo showed no educational bias. ROC analyses indicated moderate discrimination between the MMSE ≥ 28 group and the MMSE24-27 and MMSE ≤ 23 groups.Conclusions: The computer-administered CogEvo has the advantage of not exhibiting ceiling effects or educational bias like the MMSE, and was found to be able to detect age-related cognitive decline and impairment.

There are few reports on Enhanced Recovery After Surgery (ERAS)-based perioperative management following head and neck surgery with free tissue transfer reconstruction (HNS-FTTR). Here, we prospectively evaluated our ERAS program involving preoperative glucocorticoid administration in HNS-FTTR.

Few studies are available that have addressed the prevalence of early-onset dementia (EOD), including early-onset Alzheimer disease and other forms of dementia in Japan.

The present cross-sectional study assessed the attitude of Japanese undergraduates towards mental health services and investigated whether mental distress is associated with reluctance to use, and a decreased perceived need for, mental health services. A convenience sample of 194 students (98 men and 96 women) completed the 28-item Japanese version of the General Health Questionnaire and questions regarding reluctance to use and perceived need for mental health services. Participants were in the second to fourth years of undergraduate work and their majors were psychology and technology. Analyses showed that approximately 70% of students were reluctant to use mental health services and this reluctance was less in the group scoring high on anxiety and insomnia than the group scoring lower. Also, perceived need for mental health services was higher for those scoring high on depression. There were some discrepancies in the results and previous studies. Implications of these findings for clinical and preventive practice and for direction for research are discussed.

Pseudomonas aeruginosashowing resistance to imipenem were found in 100 of 1,058 strains (9.5%) from six hospitals (a–f) in Hiroshima City, Japan. Of the 100 strains, 14 (14%) were double disk synergy test positive using sodium mercaptoacetic acid disks, and 18 (18%) were blaIMP‐1or blaVIM‐2allele positive by polymerase chain reaction (PCR). Among 100 imipenem‐resistant strains, 32 were categorized into multi‐drug resistant strains, in which 13 were positive for the metallo‐β‐lactamase gene. Fifty‐one strains (51%) among the 100 imipenem‐resistant strains had elevated RND efflux pump activity against levofloxacin. But only 6 of 51 strains were classified as multi‐drug resistant strains. The pulsed field gel electrophoresis analysis of the SpeI‐digested DNA from the 100 isolates suggested not only clonal spread but spread of heterogeneous clones started to contribute to the prevalence of metallo‐β‐lactamase producing P. aeruginosastrains in Japanese hospitals.

The JMM-ZTA, a kind of zirconia-toughened alumina, is a bearing ceramic newly developed for artificial joints. Although it has already been reported that mechanical strength and fracture toughness are higher in the JMM-ZTA than in alumina, the stability of the JMM-ZTA has not been studied in detail yet. In the present study, the stability of the JMM-ZTA with respect to mechanical strength and crystalline phases was examined under hydrothermal environment, and the results were compared with those of alumina. Both the 4-point bending strength and the fraction of monoclinic zirconia unchanged even after the aging test at 121°C for 300 h. These results indicate that the JMM-ZTA possesses quite excellent stability to be used as bearing material of artificial joints.

A macroporous phosphate invert glass ceramic (PIGC) was prepared by dipping polymer sponges in the powder-slurry of the mother glass with a composition of 60CaO-30P2O-3TiO2- 7Na2O in mol%, and subsequent burning off the sponge at 850°C for 1 hr. The macroporous PIGC consists predominantly of ß-tricalcium phosphate (β-TCP) and ß-calcium pyrophosphate, and it has macropores of 500 μm in diameter and porosity of 83 %. Its compressive strength was estimated to be 160 kPa. The PIGC composite containing a large amount of β-TCP was also prepared by heating the mixture of Ca(OH)2 with the mother glass powders of the PIGC. Solubility of the composite was higher than PIGC. The macroporous PIGC and PIGC composite were expected to be applicable in high resorbable scaffolds for bone tissue engineering.

The results of stress coping studies do not clearly demonstrate whether dispositional and situational coping can predict health status or whether dispositional coping can predict situational coping. The present study used structural equation modeling to test proposed directional relationships. 292 Japanese university students completed questionnaires concerning dispositional and situational coping and mental health status. Analysis showed that dispositional coping predicted situational coping for some coping strategies. In women, an increase in dispositional Problem-solving predicted a reduction in mental distress via situational Problem-solving. The results suggest that, only for Problem-solving by women, dispositional coping is related to mental health status, but only through situational coping.

Although a number of recent studies have shown that panic disorder is associated with deterioration in quality of life and social dysfunctions, details of these impairments and their correlates have not been well studied. The present study aims to examine which aspects of quality of life and social functioning were particularly impaired in patients with panic disorder and to search for their clinical correlates. Fifty patients with panic disorder with or without agoraphobia who participated in our group cognitive-behavioral treatment program were administered the Medical Outcomes Study Short-Form Health Survey and the Work, Home and Leisure Activities Scale. Their panic disorder symptomatology was assessed with the Panic Disorder Severity Scale and Fear Questionnaire. Compared with the population mean, the patients reported less than average quality of life in both physical and mental domains, especially in the latter domain. They also reported substantial social dysfunctions, especially in work and social leisure activities. Different aspects of patients' psychopathology were associated with these impairments. While agoraphobia appeared as a consistent predictor for most of the aspects examined, social phobia emerged as a strong predictor for mental quality of life and for work and social leisure functions. The findings suggest that we need to remain sensitive to different aspects of functional impairments of patients with panic disorder and that we may need to pay more attention to the role of social anxiety in their treatment.

We identified a novel pathogenicity island in Staphylococcus aureus which contains open reading frames (ORFs) similar to the exfoliative toxin (ET) gene, glutamyl endopeptidase gene, and edin-B gene in tandem and the phage resistance gene, flanked by hsdM, hsdS (restriction and modification system), and IS256. The protein encoded by the ET-like gene showed 40, 59, and 68% amino acid sequence identities with exfoliative toxin A (ETA), exfoliative toxin B (ETB), and Staphylococcus hyicus ETB (ShETB), respectively. When injected into neonatal mice, the recombinant protein derived from the ET-like gene induced exfoliation of the skin with loss of cell-to-cell adhesion in the upper part of the epidermis as observed in histological examinations, just as was found in neonatal mice injected with ETA or ETB. Western blot analysis indicated that the recombinant protein is serologically distinct from ETA and ETB. Therefore, the product encoded by this new ORF is a new ET member produced by S. aureus and is termed ETD. ETD did not induce blisters in 1-day-old chickens. In the skins of mice injected with ETD, cell surface staining of desmoglein 1 (Dsg1), a cadherin type cell-to-cell adhesion molecule in desmosomes, was abolished without affecting that of desmoglein 3 (Dsg3). Furthermore, in vitro incubation of the recombinant extracellular domains of Dsg1 and Dsg3 with the recombinant protein demonstrated that both mouse and human Dsg1, but not Dsg3, were directly cleaved in a dose-dependent manner. These results demonstrate that ETD and ETA induce blister formation by identical pathophysiological mechanisms. Clinical strains positive for edin-B were suggested to be clonally associated, and all edin-B-positive strains tested were positive for etd. Among 18 etd-positive strains, 12 produced ETD extracellularly. Interestingly, these strains are mainly isolated from other sources of infections and not from patients with bullous impetigo or staphylococcal scalded-skin syndrome. This strongly suggests that ETD might play a pathogenic role in a broader spectrum of bacterial infections than previously considered.

ABSTRACTWe identified a novel pathogenicity island in Staphylococcus aureuswhich contains open reading frames (ORFs) similar to the exfoliative toxin (ET) gene, glutamyl endopeptidase gene, and edin-Bgene in tandem and the phage resistance gene, flanked by hsdM, hsdS(restriction and modification system), and IS256. The protein encoded by the ET-like gene showed 40, 59, and 68% amino acid sequence identities with exfoliative toxin A (ETA), exfoliative toxin B (ETB), and Staphylococcus hyicusETB (ShETB), respectively. When injected into neonatal mice, the recombinant protein derived from the ET-like gene induced exfoliation of the skin with loss of cell-to-cell adhesion in the upper part of the epidermis as observed in histological examinations, just as was found in neonatal mice injected with ETA or ETB. Western blot analysis indicated that the recombinant protein is serologically distinct from ETA and ETB. Therefore, the product encoded by this new ORF is a new ET member produced by S. aureusand is termed ETD. ETD did not induce blisters in 1-day-old chickens. In the skins of mice injected with ETD, cell surface staining of desmoglein 1 (Dsg1), a cadherin type cell-to-cell adhesion molecule in desmosomes, was abolished without affecting that of desmoglein 3 (Dsg3). Furthermore, in vitro incubation of the recombinant extracellular domains of Dsg1 and Dsg3 with the recombinant protein demonstrated that both mouse and human Dsg1, but not Dsg3, were directly cleaved in a dose-dependent manner. These results demonstrate that ETD and ETA induce blister formation by identical pathophysiological mechanisms. Clinical strains positive for edin-Bwere suggested to be clonally associated, and all edin-B-positive strains tested were positive for etd. Among 18 etd-positive strains, 12 produced ETD extracellularly. Interestingly, these strains are mainly isolated from other sources of infections and not from patients with bullous impetigo or staphylococcal scalded-skin syndrome. This strongly suggests that ETD might play a pathogenic role in a broader spectrum of bacterial infections than previously considered.

The efficacy of LSVT-BIG for advanced Parkinson’s disease (PD) patients with wearing off remains to be determined. Therefore, we evaluated whether LSVT-BIG improves motor disability in eight PD patients with wearing off. Unified Parkinson’s Disease Rating Scale (UPDRS) scores, daily off time, and mobility assessments were evaluated during the “on” time before and after the LSVT-BIG course. LSVT-BIG significantly improved UPDRS III scores at 4 weeks and UPDRS II scores in the “off” state at 12 weeks, with no changes in the other measures. The findings suggest that LSVT-BIG may be an effective therapy for advanced PD patients with wearing off.