We provided teleconsultation to outpatients for the purpose of infection control in the COVID-19 pandemic between March 1^st and October 31^st, 2020. The patients eligible for teleconsultation were only those who were taking oral anti-hypoglycemic agents. Doctors obtained information about patients' condition through telephone, and the patients received their regular prescriptions via fax at the nearest pharmacy. The present study examined the changes of HbA1c levels after teleconsultation on patients with diabetes mellitus (DM). We enrolled 218 outpatients with DM, who used teleconsultation and analyzed changes in HbA1c levels after teleconsultation. HbA1c levels in all patients significantly decreased after teleconsultation. Patients with HbA1c levels that increased by more than 0.5% after teleconsultation were significantly younger than those with HbA1c levels that decreased by more than 0.5% after teleconsultation, suggesting that in the younger generation, lifestyle changes due to the COVID-19 pandemic such as teleworking, might have reduced daily exercises. Despite a single-center study, our teleconsultation did not deteriorate HbA1c levels of patients with diabetes, who were taking oral anti-hypoglycemic agents. However, physicians should pay attention to younger, especially female, patients whether their glycemic control would be worsened at the first visit after teleconsultation use.

Radioiodide treatment is often carried out for complete ablation of residual and/or recurrent tumors after total thyroidectomy. Since radioiodide is actively accumulated via the sodium/iodide symporter (NIS), enhancement of its expression is critical to target cancer cells with radioiodide. To investigate if protein synthesis inhibitors induced endogenous NIS expression in human cancer cells, we evaluated the effects of translation inhibitors, cycloheximide (CHX) and homoharringtonine (HHT), on the NIS expression in MCF-7 breast cancer cells, MKN45 gastric cancer cells, and BHP 2-7 papillary thyroid cancer cells. CHX significantly upregulated NIS mRNA expression in MCF-7 cells (up to -397-fold; EC₅₀, -4.9 μg/mL), as well as MKN45 cells (up to 82-fold; EC₅₀, 43.8 μg/mL), but not BHP 2-7 cells. Iodide uptake was also significantly increased (-1.7-fold) in MCF-7 cells. HHT, an anti-leukemic agent, induced NIS expression in MCF-7 cells (up to -38-fold; EC₅₀, 24.6 ng/mL), MKN45 cells (-9-fold; EC₅₀, 256 ng/mL), and BHP 2-7 cells (-100 fold; EC₅₀, 767 ng/mL). The induction of NIS by CHX in MCF-7 cells, as well as that by HHT in MKN45 cells, were susceptible to p38 MAPK inhibition. To our knowledge, this is the first report demonstrating the induction of NIS by protein synthesis inhibitors in human cancer cells. Further elucidation would uncover more specific, and thus less toxic molecular targets for the enhancement of NIS expression, expecting radioiodide therapy with higher efficacy and safety.

Claudin (CLDN) 18.2, a member of the CLDN family, contains tight junctions that regulate the physiological functions of epithelial cells, such as cell differentiation, proliferation, and polarity. CLDN18.2 is also expressed, and performs various functions, in several cancers; however, its expression and function in small-cell lung cancer (SCLC) have not been elucidated. Herein, we determined the expression of CLDN18.2 in SCLC cell lines using quantitative RT-PCR and western blotting. Moreover, we established inducible CLDN18.2 expression SCLC cells and CLDN18.2 knockout SCLC cells and showed that CLDN18.2 inhibited the proliferation of SCLC via G0/G1 cell-cycle arrest using cell-proliferation assay and cell-cycle analysis. This cell-cycle arrest was caused by downregulation of CCND1 and induction of CDKN1A. The present study evokes research interest in CLDN18.2 as a potential therapeutic target and prognostic marker in SCLC, paving the way for future research prospects.

Introduction: Lumbosacral fusion is a recommended and effective treatment for patients with adult spinal deformity. The optimal spinal fusion termination location has been widely discussed because it substantially affects postoperative quality of life. However, there is no consensus on whether termination should be at the lumbar spine or at the sacrum and ilium. The study aim was to compare differences in clinical outcomes between a pelvic fixation group and non-pelvic fixation group.

Methods: This was a single-center observational study. Participants were 127 patients (mean age 67.4 years) who had undergone surgery for adult spinal deformity. The L group comprised 33 patients with the lowest instrumented vertebra at L4; the SI group comprised 94 patients with the lowest instrumented vertebra at the sacrum and pelvis. Propensity score analysis was used to exclude confounding factors and match patient backgrounds. Analyzed covariates were age, body mass index, preoperative Cobb angle, and SRS-Schwab adult spinal deformity classification parameters of pelvic tilt, sagittal vertical axis, pelvic incidence minus lumbar lordosis, and fixed upper end height.

Results: Prior to propensity score adjustment, group L showed better Scoliosis Research Society-22 (SRS-22) scores and less severe deformity than group SI on all radiographic measurements except Cobb angle. Propensity score adjustment analysis selected two groups of 22 patients each that had similar preoperative patient backgrounds and fixed upper end elevations. The two groups showed similar postoperative radiographic measurements and postoperative satisfaction. Both groups showed significant improvement on all SRS-22 domains. After propensity score matching, postoperative Function domain scores were significantly higher in the L group than in the SI group.

Conclusions: The findings generally support previous research indicating that SI and L patients have similar health-related quality of life. However, the results of the between-group comparisons indicate that the L group showed superior function to the SI group.

Thyroid nodules occur frequently, and ultrasonography and cytological examinations are the standard methods for evaluating the characteristics of thyroid nodules and determining the indications for surgery. Although several reports have evaluated the accuracy of ultrasonographic or cytological examinations in detecting malignant thyroid tumors, their accuracy is not high enough, and inadequate diagnosis may cause delayed treatment of malignant tumors. Therefore, we combined the ultrasonographic and cytological findings and established a new surgical criterion to improve the accuracy of the preoperative detection of malignant tumors. The results of ultrasonography and cytological and histological diagnosis of 191 cases of resected thyroid tumors were retrospectively analyzed.

Ultrasonography findings were assessed for microcalcifications, irregular tumor margins, and high intratumoral blood flow; cytological findings were categorized into six types based on the Bethesda classification; and the histological diagnosis was classified into malignant and non-malignant.

Statistical analysis revealed that intratumoral microcalcifications and irregular tumor margins were characteristic ultrasonography features indicating the possibility of malignant tumors (p < 0.05). A combination of ultrasonographic and cytological findings, Bethesda classification V (suspicious for malignancy), VI (malignant), or I-IV with either intratumoral microcalcifications or irregular margins of the tumor, could be used to preoperatively identify malignant tumors with a relatively high accuracy (sensitivity, 93.4%; specificity, 71.0%; area under the curve [AUC], 0.822 [95% confidence interval: 0.753-0.892]). Our new surgical indication showed higher sensitivity and AUC than previous surgical indications based only on the Bethesda classification in cytological examinations.

Background: The early mortality rate is high in elderly patients after hemodialysis initiation, and conservative kidney management (CKM) is introduced as an alternative to renal replacement therapy. Thus, we examined the prognosis of elderly dialysis patients at the Blood Purification Center of Dokkyo Medical University Hospital.

Methods: Among 378 hemodialysis-introduced patients at our hospital from November 2018 to December 2021, we examined the short-term mortality rate in 79 elderly patients of ≥ 80 years of age and analyzed the risk factors from the data at hemodialysis initiation compared to the 298 patients of < 80 years of age.

Results: For dialysis patients of ≥ 80 years of age, the mortality rate was 13% within 3 months (6% under 80), 23% (8%) within 6 months, and 28% (10%) within 12 months. Mortality after 12 months was further increased by up to 40% in patients of ≥ 90 years of age. Data at the time of the initiation of dialysis showed the risk of short-term death in elderly patients with low blood pressure, low body weight, and high hematocrit and potassium levels, and formula to predict the risk of death was proposed with a receiver operating characteristics (ROC) curve area under curve (AUC) of 0.8124.

Conclusion: The early mortality rate within 1 year after the initiation of hemodialysis was high in elderly patients. CKM could be an option in the high-risk patients with declining body weight and albumin levels, and elevated serum potassium and hematocrit.

Left ventricular outflow tract stenosis is present in patients with hypertrophic cardiomyopathy; however, this is a dynamic change, and the pressure gradient changes easily. We aimed to compare the hemodynamic effects of moderate exercise or diet in hypertrophic obstructive cardiomyopathy with dynamically changing obstruction and aortic stenosis with fixed stenosis. We included 14 hypertrophic obstructive cardiomyopathy patients with a left ventricular outflow tract continuous-wave Doppler pressure gradient of ≥ 30 mmHg on fasting or postprandial condition and eight aortic stenosis with pressure gradient of ≥ 20 mmHg. Echocardiographic examinations were performed during fasting, passive leg raising, 5 min of exercise, early and late recovery periods, and 30 min after meals. The pressure gradient in patients with aortic stenosis increased during passive lower extremity elevation, causing increased preload pressure, but that at the left ventricular outflow tract stenosis in hypertrophic obstructive cardiomyopathy decreased. The pressure gradient in hypertrophic obstructive cardiomyopathy did not change during supine exercise but increased rapidly after exercise and slowly recovered thereafter. A diet with decreased afterload slightly increased the pressure gradient in patients with aortic stenosis and significantly increased left ventricular outflow tract stenosis in patients with hypertrophic obstructive cardiomyopathy. Left ventricular outflow tract-pressure gradient in hypertrophic obstructive cardiomyopathy fluctuates dynamically with daily exercise and diet. The left ventricular outflow tract-pressure gradient increases immediately after exercise; therefore, it is important to encourage drinking before exercise and instruct patients to cool down at the end of exercise. Exercise after eating should be avoided in patients with hypertrophic obstructive cardiomyopathy.

A 9-year-old boy was admitted to hospital for bronchial asthma due to respiratory distress with SpO₂ 86% under room air and failure of earlier treatment. Diffuse interstitial shadows in the bilateral lung fields were found on chest CT. He was diagnosed with an asthmatic attack, treated with intravenous steroids, and discharged after 2 weeks. One week after discharge, his respiratory status worsened again. In an interview, it was found that he had previously had coughing and dyspnea in the summer, and that he lived in a 50-year-old wooden house. Additionally, restriction of outings due to the COVID-19 pandemic may have increased the duration of antigen exposure at home. On admission, the patient was also found to be positive for anti-Trichosporon asahii antibody. Based on all of this information, he was diagnosed with summer-type hypersensitivity pneumonitis. This case indicates the need for a detailed interview including the living environment, chest CT, and measurement of anti-Trichosporon asahii antibodies for a patient with chronic cough that does not respond to treatment, based on a suspicion of summer-type hypersensitivity pneumonitis.

A 75-year-old man was initially admitted to a hospital with complaints of malaise and fever of 39°C. He had Bacillus subtilis bacteremia and septic thrombophlebitis. He was immunocompetent and a regular consumer of natto, a traditional Japanese food fermented with B. subtilis. We suppose he was natto-induced septic thrombophlebitis.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is usually mild in children. However, a condition known as "multisystem inflammatory syndrome in children" (MIS-C) has recently attracted attention. Typically, MIS-C develops 2-6 weeks after acute respiratory SARS-CoV-2 infection, and the affected patients present with gastrointestinal symptoms and cardiovascular dysfunction in addition to Kawasaki disease (KD)-like features. A six-year-old boy was admitted to our hospital with a 2-day history of fever, abdominal pain, vomiting, and tender cervical lymph node swelling. The patient was found to be negative for acute appendicitis and bacterial enteritis. Although he did not meet the diagnostic criteria for KD, the presence of abdominal symptoms and laboratory evidence of inflammation, a history of SARS-CoV-2 infection in family members living in the same household, and positive results from the new coronavirus antibody test made it possible to diagnose MIS-C. Interleukin-6 was high at admission but decreased with fever resolution after treatment. All pediatricians and pediatric surgeons should consider the possibility of MIS-C when encountering patients with gastrointestinal symptoms after SARS-CoV-2 infection or after intense contact, even in pediatric patients who do not fulfill the diagnostic criteria for KD.