【Purpose】We aimed to evaluate the outcomes of and the quality of life (QOL) after conventional aortic valve replacement (AVR) amongst octogenarians. 【Methods】We enrolled 48 patients aged ≥ 80 years who underwent conventional aortic valve replacement between May 1999 and November 2012. Patient conditions were assessed before surgery, at 6 and 12 months after surgery, and during the late period regarding the need for nursing care, degree of independent living, and living willingness. 【Results】The follow-up rate was 100% with 45.6 ± 41.3 months follow-up. Two patients (4%) died during hospitalization and 11 (23%) died during the follow-up period. The 1-, 5-, and 10-year survival rates were 84.9, 76.9, and 39.6%, respectively. During the late period, of 35 surviving patients, 31 (88%) were living at home. The degree of independent living score decreased after surgery. However, scores of the need for nursing care and living willingness remained preoperative level. 【Conclusions】QOL following conventional aortic valve replacement for elderly patients aged ≥80 years who showed inde pendence in activities of daily living (ADL) before surgery were satisfactory. Therefore, aortic valve replacement could be a viable option for elderly patients aged ≥ 80 years after accounting for preoperative ADL levels.

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Background: From 1949 to 1989, 456 nuclear tests were conducted at the Semipalatinsk Nuclear Test Site (SNTS). Exposure was primarily from the first test in August 1949, an atomic bomb test in 1951, and a thermonuclear bomb test in 1953 that af-fected the Semipalatinsk region. Surgical procedures for patients with thyroid cancer in Semipalatinsk remain unclear. As-sessing the clinical behavior of thyroid cancer in patients affected by the SNTS is crucial for confirming an accurate diagnosis and establishing standardized surgery. The first author has been collaborating with the Semey Oncology Center since 1999 to establish an optimal method to diagnose and perform thyroidectomy and lymph node dissection. Objective: To assess the change in the diagnostic accuracy and thyroid surgery from 1999 to 2008 at Semey Oncology Cen-ter in collaboration with the Nagasaki University and Nagasaki Medical Center. Materials and Methods: In this cross-sectional study, 169 patients with thyroid cancer who underwent thyroid surgery at the Semey Oncology Center from 1999 to 2008 were evaluated; 125 patients with papillary thyroid cancer were assessed. Results: Before 2001, there were few preoperatively diagnosed thyroid cancer cases; since 2002, the number of preopera-tively diagnosed papillary cancer cases increased. From 1999 to 2001, thyroid surgery, including cervical lymph node dissec-tion, was not performed. Partial lobectomy was mainly performed until 2001. Since 2002, total lobectomy was most com-monly performed; total thyroidectomy and lymph node dissection were rarely performed. Conclusion: The optimal method for diagnosing thyroid cancer was performed, and an accurate diagnosis changed the surgical procedure

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Background. Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths worldwide. The progno-sis of patients with HCC is generally poor, and life expectancy is difficult to predict because of various factors. The purpose of the present study was to investigate the relationships between FDG PET parameters and other parameters that may influence the prognosis of patients with HCC. Materials and methods. We conducted a retrospective study on 26 patients who underwent dual-time-point FDG PET imag-ing before treatment between June 2010 and April 2016 at Nagasaki University Hospital. The SUVmax, SUVpeak, TLG, and MTV of tumors and the SUVmean of the liver were assessed on PET images using Metavol software. All statistical analyses were performed using JMP Pro11 software. P-values of < 0.05 were considered to be significant. Results. Log AFP and log PIVKA II showed strong relationships between many FDG parameters. Several types of therapy performed before the introduction of FDG PET showed some relationships but few for FDG parameters. Relationships be-tween AFP, PIVKA II, and therapy were only found between log AFP and the number of transarterial chemoembolizations. The results of the event-free survival analysis showed that patients with larger tumors on PET images had a poorer prognosis. Conclusion. Relationships were observed between FDG PET parameters and AFP and PIVKA II levels, which affect patient prognoses. Based on the present results and previous findings, the combination of FDG parameters with serum AFP and PIVKA II levels may be useful for predicting the outcomes of patients with HCC.

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Purpose: Our aim was to re-evaluate the usefulness of perfusion single-photon emission computed tomography (SPECT) for the diagnosis of AD and DLB. Methods: A total of 1,232 patients, including 180 cognitively normal subjects (NSs), 148 patients with amnestic mild cognitive impairment (aMCI), 802 patients with AD and 102 patients with dementia with Lewy bodies (DLB) were enrolled. A voxel-based stereotactic extraction estimation analysis was used to assess hypoperfusion areas using the cut-off value of 20% for the “extent %” and >2 hypoperfused lesions. Results: The top 10 areas with hypoperfusion in AD were the angular gyrus, supramarginal gyrus, precuneus, superior occipital gyrus, inferior parietal lobule, middle temporal gyrus, superior parietal lobule, inferior temporal gyrus, superior temporal gyrus. and posterior cingulate, while DLB had 6 areas in common with AD. The respective sensitivity and specificity for differentiating AD from NSs were 84.2% and 78.9% for 50-59 years old, and 91.8% and 70.0% for 60-69 years old, but those values decreased from 70 years old. The respective sensitivity and specificity in DLB patients were 100% and 75.6% for 50-69 years old, 84.6% and 70.1% for 70-79 years old and 81.4% and 77.1% for 80-89 years old. In aMCI patients, the 1-year change in the MMSE scores was -2.38±2.02 (n=16) in patients with abnormal SPECT images and -0.67±1.81 (n=18) in those with normal SPECT images (P<0.02). Conclusions: Our study confirms that perfusion SPECT is still a valid alternative for the diagnosis of AD and DLB when fluorodeoxyglucose-PET is unavailable.

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The Determinants of Outcome of Severe Mental Disorders (DOSMeD) study, a global epidemiological study led by the World Health Organization, reported the annual incidence rate of schizophrenia from 1979 to 1980. In 2011, approximately 30 years later, we conducted a large-scale epidemiological study to investigate the incidence rate of first-episode schizophrenia in Nagasaki using the same method as the DOSMeD study. A telephone survey was conducted by researchers daily at 52 psychiatric hospitals, clinics, and institutes in Nagasaki. When a subject was confirmed, the researcher visited the medical facility in person to evaluate the patient’s symptoms. Of 441,706 people in Nagasaki City, 131 people were surveyed in the way, resulting in the diagnosis of psychosis in 25 patients, 20 of whom were determined to have schizophrenia. These data were used to calculate the incidence rates of psychosis (1.00 per 10,000 population; 95% confidence interval [CI], 0.54-1.46) and schizophrenia (0.80 per 10,000 population; 95% CI, 0.38-1.21). The 95% CI for the incidence rate of psychosis did not include the incidence rate for psychosis (broad definition) reported in the DOSMeD study (2.02). However, the 95% CI for the incidence rate of schizophrenia did include the incidence rate for schizophrenia (restrictive definition) reported in the DOSMeD study (1.01). Although the incidence rate of psychosis appeared to be decreasing, no significant change was found in the incidence rate of schizophrenia, comparing the present findings with those of the survey conducted 30 years ago. The incidence rate of schizophrenia is said to vary with changes in gender differences, racial differences, urbanization, and immigration; we therefore considered this possibility. In the future, it is necessary to carry out longer-term surveys covering multiple cities using the same methods.

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Aim: Lack of contact with patients with mental illness may contribute to mental health stigma. We conducted a half-day training program in the outpatient psychiatry clinic of a rural general hospital for postgraduate interns in Nagasaki University Hospital. Our study investigated the effectiveness of this program in reducing stigma toward mental illness. It also examined the association between an intern’s perception of mental illness and their consideration of psychiatry as a career. Methods: Participants were 12 interns at Nagasaki University Hospital who competed a pre- and post- training questionnaire. The questionnaire assessed perceptions of mental illness using a semantic differential scale and measured consideration of psychiatry as a career on a 7 point Likert scale. Paired t-tests were used to compare mean pre- and post-training scores on the semantic differential scale. Pearson’s correlation was used to examine associations between semantic differential scores and consideration of psychiatry as a career. Results: Post-training scores were higher than pre-training scores on the items “warm” (P = 0.003), “clean” (P = 0.009), “bright” (P = 0.001), and “calm” (P = 0.003) as associated with mental illness. Consideration of psychiatry as a career significantly correlated with post-training score on “warm” (r = 0.587, P = 0.045). Conclusion: Interns can develop positive perceptions of mental illness after a half-day training program in a psychiatry outpatient clinic. Perceptions of mental illness as “warm” after training correlated with consideration of psychiatry as a career.

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