Bone mass is tuned by various factors, including aging, menopause, low body weight, and genetic variations. Here, we showed an independent association between a genotype on the fat mass- and obesity-associated FTO gene (#610966 on OMIM) and bone loss after adjusting for age and body mass index (BMI). A cross-sectional study was nested in a prospective observational study of 1,828 participants (median age: 69 [62-76] years in men and 68 [61-75] years in women) residing in a rural city in western Japan (Goto Island study). Participants were recruited during medical checkups in 2014 and 2016 from the community-dwelling population. The bone mass of the calcaneus was evaluated using quantitative ultrasound. The single nucleotide polymorphism (SNP) rs1421085 was genotyped using a hydrolysis probe. The chi-squared test was used to deter-mine whether the variants were in equilibrium in this population. There were differences in medians of BMI among the geno-types (24.3 in CC, 23.0 in CT, and 22.6 in TT, P = 0.01), but not in those of bone mass. There was a significant association between the minor allele (C) and being overweight in a gene dosage-dependent manner (BMI > 25, OR per allele =1.52, 95% CI = 1.07-2.14, P = 0.02 in men, OR = 1.48, 95% CI = 1.16-1.95, P = 0.01 in women). Logistic regression analysis showed a significant protective association in male carriers of the minor allele against low bone mass (QUS T-score less than -2.0) after adjusting for age and BMI in men aged 65-75 years (OR = 0.50, 95% CI = 0.27-0.96, P = 0.036), with no significant association in women.

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Aim: The purpose of this study was to compare the usefulness between the National Early Warning Score (NEWS), which uses the absolute value range, and the Modified Early Warning Score (MEWS), which considers individual-specific ranges (evaluated by mean and standard deviation [SD], relative measures), in predicting pneumonia hospitalization among nursing home residents. Methods: The current study was a retrospective, observational study. The subjects were 235 nursing home residents (75 men and 160 women; pneumonia group, n=62; non-pneumonia group, n=173). The mean and SD of each vital sign (systolic blood pressure, heart rate, body temperature, and oxygen saturation) of each subject recorded over 28 days was calculated. In the pneumonia group, the points at the date of hospitalization were aggregated to derive the NEWS and MEWS. In the non-pneumonia group, the point at the 35th day from the start of the nursing home stay was aggregated to derive the NEWS and MEWS. Results: The area under the curve (AUC) for predicting pneumonia hospitalization was 0.80 (95% confidence interval [CI], 0.72- 0.88) for NEWS and 0.92 (95%CI, 0.87-0.97) for MEWS using individual-specific ranges. The AUC of MEWS using individual-specific ranges was significantly greater than that of NEWS (p < 0.0001). When 3 was used as a cutoff value in MEWS, the Youden Index was the best value (0.75). Sensitivity, specificity, positive predictive value, and negative predictive value were 0.77, 0.97, 0.91, and 0.92, respectively. Conclusion: Our MEWS system using individual-specific ranges showed good performance in predicting hospitalization for pneumonia among nursing home residents.

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Background: The aim of this study was to investigate the factors that associate the decayed, missing due to caries, and filled teeth (DMFT) index of patients with dental anxiety during dental treatment discontinuation. Methods: A total of 110 patients who complained of fear and anxiety toward dental treatments and who re-visited following treatment discontinuation were enrolled in the study. Patient and dental data considered to be related to caries were digitally collected from medical and dental records. The decayed (D), missing (M), and filled (F) scores, and the DMFT index before and after discontinuation were compared using Wilcoxon signed-rank tests, and the associated factors were evaluated using the Poisson and multiple regression analyses. Results: The D score and DMFT index augmented significantly during the discontinuation period, and the F score reduced. There was no significant change in the M score. The change in the D score was associated by the pre-discontinuation D score and the number of experiences of intravenous sedation, and the change in the F score was associated by the duration of treat-ment discontinuation, the DMFT index before discontinuation, and the number of experiences of intravenous sedation. The upsurge in the DMFT index was associated by the experience of intravenous sedation, the D and M scores, and the DMFT index before discontinuation. Conclusion: Discontinuation of dental treatment was proven to be associated with the incidence of caries in dentally-fearful patients.

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Objective: The purpose of this study was to investigate the results of tricuspid valve (TV) repair with three-dimensional ring (3DR) and risk factors of recurrent tricuspid regurgitation (TR). Methods: We retrospectively investigated 171 patients who underwent TV repair with a 3DR for TR from 2007 to 2016 at our institution. The patients were divided into the non-Recurrence group (<2+ TR) and Recurrence group (≥2+ TR), and compared to identify the cause of recurrent TR. The mean follow-up period was 58±35 months. Results: The preoperative TR grade was 3.0±0.8. A total of 22 patients had at least ≥2+ TR in the follow-up period. Freedom from ≥2+ TR and re-operation at 5 years were 83.6±3.3% and 97.9±2.1%. Comparison of the non-Recurrence and Recurrence groups revealed significant differences in the preoperative TR grade (2.9±0.8 and 3.4±0.6, p=0.008), proportion of the patients with left ventricular ejection fraction (LVEF) <40% (9% and 32%, p=0.003) and right ventricular end-systolic dimension (RVDs, 22.8±7.1 mm and 31.1±12.3 mm, P=0.001). In the multivariate analysis, LVEF <40% (hazard ratio: 12.65, 95% confidence interval: 2.66–60.18; p=0.002) and RVDs (hazard ratio: 1.08, 95% confidence interval: 1.02–1.14; p=0.02) were identified as risk factors for recurrent TR. Conclusion: Our results of TV repair with 3DR were of satisfactory. However, patients with preoperative lower LVEF and larger RVDs were identified at risk of recurrent TR. This result suggests the limitation to use of 3DR alone for TV repair and need for additional procedure.

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Somatic mutations in epidermal growth factor receptor (EGFR) found in lung adenocarcinomas are used as biomarkers for the treatment with EGFR-tyrosine kinase inhibitors, including gefitinib. The bypass tracks with amplification of AXL is one of the mechanisms underlying the resistance to gefitinib. We, therefore, carried out a candidate gene approach method to identify AXL polymorphisms associated with the effectiveness of gefitinib. EGFR mutations were first identified by mutant-enriched PCR-restriction fragment length polymorphism (RFLP), and then 2 tag single nucleotide polymorphisms (SNPs) of AXL were examined by PCR-RFLP in 62 Japanese patients with advanced lung adenocarcinoma and treated with gefitinib in two general hospitals in Nagasaki. Subsequently, the association of EFGR mutations and the AXL polymorphism with the effectiveness of gefitinib was examined in these patients. We next examined the effect of the AXL polymorphism on the expression and function of this gene. It is worthy of note that EGFR mutations and the AXL polymorphism rs6508974 independently contributed to the effectiveness of gefitinib, and the polymorphism was proved to be a possible biomarker for selecting non-responders and responders to gefitinib treatment even in the absence of EGFR mutations. Furthermore, this SNP increased the transcriptional activity of the AXL transcript variant 3, one of the three AXL transcript variants, which to some extent increased the epithelial-mesenchymal transition in cancer cells. Taken together, AXL is one of the genes that determine the effectiveness of gefitinib and a biomarker for selecting non-responders and responders among lung adenocarcinoma patients with no EGFR mutations, suggesting that rs6508974 in AXL might be a functional SNP in lung adenocarcinoma.

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Background. Although joint space width on weight-bearing radiographs of the knee is critical for early diagnosis and grading knee osteoarthritis, the optimal method with which to accurately measure this value remains controversial. The purpose of this study was to investigate and quantify the effects of the radiographic technique on joint space width in medial knee osteoarthritis. Materials and Methods. We compared maximum plateau gaps and minimum joint space widths on bilateral weight-bearing plain radiographs acquired using three different methods in 31 patients with medial knee osteoarthritis (56 knee joints): stand-ing with the knee extended (standard imaging); SynaFlexer method; and Rosenberg method. Measured values were com-pared statistically, with values of P <0.05 considered significant. Results. Maximum plateau gap in the medial compartment was significantly lower with the SynaFlexer method (3.2 ± 1.5 mm) and Rosenberg method (2.2 ± 1.2 mm) than with standard imaging (4.7 ± 2.2 mm; P <0.05 each). Minimum width of the me-dial joint space was also significantly lower with the SynaFlexer method (3.1 ± 1.4 mm) and Rosenberg method (2.3 ± 1.4 mm) than with standard imaging (4.1 ± 1.4 mm; P <0.05 each). Conclusion. The Rosenberg method appears beneficial for diagnosing early knee osteoarthritis, while the SynaFlexer meth-od seems more appropriate for assessing disease severity or progression in patients with painful intermediate to severe knee osteoarthritis.

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A 96-year-old man with a rapidly growing right chest wall mass was referred to our department for further treatment. Enhanced chest computed tomography showed a huge pectoral hematoma (12×6 cm) in the right thorax. He was on oral antiplatelet medication, but no abnormalities in clotting ability were detected. Because the hematoma was enlarging and painful, it was evacuated surgically and hemostasis achieved around the pectoral branches of the thoraco-acromial artery. His postoperative course was uneventful with no evidence of subcutaneous fluid retention. Surgical hemostasis and hematoma evacuation of this pectoral hematoma might be effective as one treatment method.

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