Background: Traumatic asphyxia is a major cause of death in fatal crowd disasters, but the relationships between compression site, load magnitude, load time, and medical outcomes are unclear. This study estimated thoracoabdominal compression conditions (load magnitude, load time) that could result in respiratory failure in adults. Methods: Eight load patterns-A (chest load: 0 kg, abdominal load: 10 kg), B (0, 20), C (10, 0), D (10, 10), E (10, 20), F (20, 0), G (20, 10), and H (20, 20)-were applied to 14 healthy women. Blood pressure, heart rate, respiratory rate, SpO₂, tidal volume, vital capacity, respiratory phase, and modified Borg dyspnea score were measured over time. Breathing Intolerance Index (BITI) was also calculated. Results: Vital capacity decreased in patterns C, D, E, F, G, and H. BITI reached the critical range of ≥0.15 (at which respiratory failure occurs after about 45 min) after 14 min in pattern G and 2 min in pattern H. A vital capacity ≤1.85 L and a modified Borg scale score ≥8.3 corresponded to a BITI of ≥0.15 and were regarded as equivalent to reaching the critical range. Furthermore, change in chest load was positively correlated with BITI when abdominal load remained constant. Conclusions: In women, respiratory failure can occur within 1 h from respiratory muscle fatigue, even when total thoracoabdominal load is only about 60% of body weight. A vital capacity ≤1.85 L and modified Borg scale score ≥8.3 can be regarded as indices for predicting respiratory failure.

Background: In a previous study that used the Starlet high-resolution manometry system to assess integrated relaxation pressure (IRP) in healthy adults, the predicted cutoff value was about 26 mm Hg. However, some patients with achalasia have an IRP value of <26 mm Hg. This study examined the validity of the Starlet IRP cutoff value in patients with achalasia. Methods: Among 37 patients with achalasia, the percentage of patients with a Starlet IRP value ≥26 mm Hg was calculated. Patients were then classified as IRP-high (IRP ≥26 mm Hg) and IRP-low (IRP <26 mm Hg), and the groups were compared in relation to basal lower esophageal sphincter (LES) pressure, Chicago classification achalasia subtype, and esophagography subtype. Results: Twenty (54%) of the 37 patients had an IRP of ≥26 mm Hg. Basal LES pressure was significantly higher in the IRP-high group than in the IRP-low group. Chicago classification Type II achalasia was most common in the IRP-high group, whereas Type I was most common in the IRP-low group. No significant difference was noted in the distribution of esophagography subtypes between groups. Conclusions: It is difficult to determine an IRP cutoff value with Starlet. When diagnosing achalasia with Starlet, comprehensive assessment must consider findings other than IRP values. In addition, IRP was associated with Chicago classification type.

Background: The rapid aging of the Japanese population is leading to an increase in the number of patients with bone metastases. Since 2014, our orthopedics department has promoted multidisciplinary hospital activities, including offering lectures to hospital staff on multidisciplinary approaches for bone metastases and holding regular cancer board meetings on bone metastases. This study investigated whether these activities were effective in promoting multidisciplinary approaches and improving outcomes of patients with bone metastasis. Methods: To investigate the effects of changes in medical practice on patients with bone metastases, we compared patient clinical characteristics after (January 2014 through December 2017) and before the start of the activities (January 2011 through December 2013). Results: The semiannual numbers of first-visit, referral, and orthopedic surgical patients, the number of patients with slower growing primary cancers, and the number of patients with milder pain were significantly higher post-activity than pre-activity. The number of patients without paralysis was higher after the start of the activity than before the activity, but the difference was not significant. Survival after the first visit to the orthopedics department was significantly longer after the start of the activity than before the activity. Conclusions: The potential demand for a multidisciplinary approach to bone metastases is high, and orthopedic specialists should actively participate in this approach.

Background: This study aimed to identify risk factors affecting cancer-specific survival (CSS) and overall survival (OS) in patients with lung squamous cell carcinoma (LSCC) and to develop nomograms for prognostic prediction in these patients. Methods: Patients who received an LSCC diagnosis between 2007 and 2013 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. The prognostic effect of each variable on survival was evaluated with Cox regression and Kaplan-Meier analysis, and nomograms were developed to predict 3-, 5-, and 7-year CSS and OS rates. Results: Data from 23,004 patients with LSCC were analyzed. Nomograms were first developed by using variables that were significantly associated with CSS and OS and then validated by using an internal bootstrap resampling approach, which showed that they had a sufficient level of discrimination, according to the C-index. Conclusions: The nomograms satisfactorily predicted 3-, 5-, and 7-year CSS and OS rates for patients with LSCC.

Complete surgical excision is the standard treatment for hydrocele of the canal of Nuck. We developed a novel open posterior wall technique for laparoscopic transabdominal pre-peritoneal (TAPP) excision. A 38-year-old woman with a 5-month history of a painless reducible lump in the right groin had recently noticed a slight increase in the size of lump. Computed tomography showed a simple cystic lesion measuring 30 × 27.5 mm. We performed laparoscopic excision of the hydrocele by using the TAPP approach and the open posterior wall technique developed by us. Complete excision of the hydrocele was satisfactorily performed because the region from the external inguinal ring to the periphery could be clearly observed. After an uneventful postoperative course, the patient was discharged. Laparoscopic TAPP excision with open posterior wall technique was useful for complete excision of hydrocele of the canal of Nuck.

The lipid cell variant of urethral carcinoma (UC) is rare and poorly understood clinicopathologically. A nodular tumor detected in the bladder of an 87-year-old man with asymptomatic gross hematuria was transurethrally resected, and high-grade UC, lipid cell variant, was diagnosed pathologically. The tumor cells resembled lipoblasts and contained numerous cytoplasmic vacuoles. Immunohistochemically, the tumor cells stained positive for the epithelial markers CK7, CK20, EMA, CAM5.2, and 34betaE12 and negative for vimentin and S100. Focal positivity for adipophilin was detected in cytoplasm but not in the vacuoles. These findings suggest that the patient had lipid-producing UC.

This study investigated the feasibility of a cognitive behavioral therapy (CBT) program for improving mood and quality of life in an older woman with mild cognitive impairment (MCI), depression, and anxiety. The program comprised eight 30-minute weekly sessions; interventions included behavioral activation, relaxation, and cognitive reconstruction, in which the patient's caregiver also participated. The patient's condition was assessed before and immediately after the intervention. After 3 and 12 months, the caregiver reported the patient's behavioral and psychological symptoms by using self-reported psychological scales for depression, anxiety, and quality of life. Although CBT helped to improve mood and quality of life in the short term (3 months), the results were not sustained over the long term (12 months). Even though improvement in psychological symptoms did not persist and only one patient with MCI was evaluated, these results suggest that CBT is a feasible nonpharmacological treatment option and provide preliminary support for wider use of CBT in Japan. CBT programs should be tailored to the needs of patients with MCI and dementia, and regular follow-up sessions should be used to evaluate program feasibility and improvement in patient mental health.

A 65-year-old man was referred to our hospital for evaluation of hoarseness and deteriorating voice. Computed tomography revealed an area of poor contrast enhancement in soft tissue (size, 30 mm) in the inferior pole of the thyroid gland, extending to the upper margin of the sternum. No infiltration of blood vessels or bones, and no significant swelling of neck lymph nodes, was observed. These findings suggested a diagnosis of thymoma, thymic carcinoma, or thyroid tumor. Surgery was performed via median sternotomy, and complete thymectomy and tumor excision accompanied by partial thyroidectomy were performed. Histopathological examination revealed atypical polygonal tumor cells in a sheet-like arrangement, which formed a solid proliferative focus, and squamous cell carcinoma with infiltrative growth was diagnosed. Postoperatively, radiotherapy (60 Gy) was administered to the superior mediastinum. The patient is alive 22 months after surgery, without recurrence.

Objective: To identify associations of solitary death with social determinants of health, namely, labor force status and welfare status, in Tokyo in 2015. Methods: We obtained data on solitary deaths in 2015 in the 23 special wards of Tokyo and calculated the incidence rate and postmortem interval of solitary death in relation to sex, age, and labor force status. Results: Data for 3,972 solitary deaths (2,785 males, 1,187 females) were analyzed. The non-employed rate was 79.3% among males and 89.5% among females. The incidence rate was significantly higher among non-employed persons than among employed persons in both sexes. Moreover, with the exception of women 65 years or older, the postmortem interval was significantly longer among non-employed persons than among employed persons in both sexes. Conclusions: The incidence rates of solitary death were significantly higher among non-employed persons than among employed persons in both sexes, and the postmortem interval was significantly longer for non-employed persons.