It is difficult to detect glycemic excursions using CGM in daily clinical practice. We retrospectively analyzed CGM data in type T2DM to define the correlations between HbA1c and GA levels at admission and the parameters representing glycemic excursions measured by CGM, including the mean amplitude of glycemic excursions (MAGE) and standard deviation (SD). The MAGE correlated significantly with GA and HbA1c, but not with the GA/HbA1c ratio. The SD correlated significantly with GA, HbA1c, and GA/HbA1c. Multivariate analysis identified the GA value to be the most reflective of MAGE. Patients were divided into 2 groups using a MAGE cutoff value of 75 mg/dl, which reflects stable diabetes. There was a significant difference in GA, but not HbA1c, between the groups with low and high mean amplitudes of glycemic excursions. Receiver operating characteristic curve analysis indicated that the cutoff for GA for identifying patients with MAGE of ≤75 mg/dl was 18.1%. Our study identified GA to be the most reflective of glycemic excursions in patients with T2DM. GA can be a useful index of glycemic excursions and treatment optimization to prevent arteriosclerosis.
Assessment of personal exposure to particulate matter with an aerodynamic diameter less than or 2.5 µm (PM2.5) is necessary to study the association between PM exposure and health risk. Development of a personal PM2.5 sensor or device is required for the evaluation of individual exposure level. In this study, we aimed to develop a small-sized, lightweight sensor with a global positioning system (GPS) attached that can measure PM2.5 and PM10 every second to assess continuous personal exposure levels. The participants in this study were apparently healthy housewives (n = 15) and university female teaching staff (n = 15) who live in a high PM2.5 area, Yangon, Myanmar. The average PM2.5 exposure levels during 24 h were 16.1 ± 10.0 µg/m3 in the housewives and 15.8 ± 4.0 µg/m3 in the university female teaching staff. The university female teaching staff showed high exposure concentrations during commuting hours, and had stable, relatively low concentrations at work, whereas the housewives showed short-term high exposure peaks due to differences in their lifestyles. This is the first study to show that a GPS-attached standalone PM2.5 and PM10 Sensor [PRO] can be successfully used for mobile sensing, easy use, continuous measurement, and rapid data analysis.
Cervical cancer commonly metastasizes first to the pelvic lymph nodes and then subsequently spreads to distant organs, making lymph node metastases the most significant prognostic factor in cervical cancer, and the strategy for its treatment directly influences prognosis. This review focuses on the treatment strategies for cases of cervical cancer with bulky pelvic lymph nodes. Concurrent chemoradiotherapy is the standard treatment modality for patients with pelvic lymph node metastases, but it is inadequate for bulky pelvic lymph nodes. Accordingly, surgical resection of the bulky lymph nodes has been attempted, and its therapeutic significance has been reported. If the bulky lymph nodes are unresectable, definitive concurrent chemoradiotherapy is performed. If it yields an inadequate degree of lymph node shrinkage, boosted radiation should be considered. The addition of chemotherapy after concurrent chemoradiotherapy has also been reported to be effective in patients with lymph node metastases and is currently being evaluated in clinical trials.
A 60 year-old woman with hip dysplasia battled with duodenal cancer that was complicated with Candida tropicalis sepsis. Two years later, the patient underwent a total hip arthroplasty (THA). She complained of a persisting low-grade fever and local heat on the THA scar. Arthrocentesis of the hip was performed and the Candida tropicalis was detected. Debridement and polyethylene liner/modular head exchange were performed 28 days after the primary THA. Fluconazole was administrated for one year. The patient reported no symptoms five years later. It was found that periprosthetic infection could be prevented by implant preservation surgery.
When performing esophageal reconstruction, a colonic pedicle graft is chosen as the next candidate to the stomach because of complications arising from the operation time and vascular anastomosis. Vascular anastomosis is not necessarily required for pedicle grafts, but it is necessary to perform additional vascular anastomosis in some cases. We herein report a case of superdrainage in which anastomosis of the colonic vein and the right internal thoracic vein was effective against congestion. A 68-year-old man with thoracic esophageal cancer and pyloric antrum gastric cancer was referred to our hospital. Complete resection was performed with subtotal esophageal resection and total gastrectomy. We added superdrainage (right internal thoracic vein – ileocolic vein) to the colonic pedicle graft, which showed congestion, and performed esophageal reconstruction. Venous superdrainage using a colonic pedicle graft is effective for esophageal reconstruction.
Secondhand smoke (SHS) caused by smoking on apartment verandas is a severe social problem in Japan. If someone smokes on a veranda, SHS drifts into other residents’ rooms through their windows. Most non-smoking residents are annoyed by this, but they do not confront the person responsible. To study this situation, we burned cigarettes and measured the spread of SHS in terms of fine particle (PM2.5) concentrations. Cigarette smoke generated on a lower veranda spread to upper and horizontal neighboring verandas and into rooms through windows, reaching a maximum concentration of 139 μg/m3. The Health Promotion Act that was revised in 2018 and enacted in 2019–2020 requires all smokers to avoid producing SHS, even outdoors and at home. It is expected that combining the measurement of SHS from verandas to other verandas and rooms with the revised Health Promotion Act could create a national consensus on “no smoking on apartment verandas.”
症例は79歳，女性．18年前に甲状腺乳頭癌，15年前に肺腺癌の手術歴があった．両疾患とも5年間再発なく経過したため，経過観察は行われていなかった．前胸部痛および胸部違和感を主訴に近医を受診し，胸部CTで右下葉に14 mm大の結節影と両肺に散在する5-7 mm大の小結節影を指摘された．当科で診断のためにガイドシース併用気管支腔内超音波断層法（endobronchial ultrasonography with a guide sheath（EBUS-GS））を行う方針となり，超音波下に病変を確認し，透視下に経気管支生検を行った．病理学的には十分量の腫瘍細胞が採取され，腺癌の所見が得られた．核異型と核内封入体を有する異型円柱上皮細胞が乳頭状に増殖しており，免疫組織化学染色においてもサイログロブリン陽性であり，甲状腺乳頭癌の肺転移再発と診断した．甲状腺乳頭癌では肺腺癌のマーカーとして汎用されているthyroid transcription factor-1（TTF-1）が陽性となることから，両者の鑑別に用いることはできない．甲状腺乳頭癌は進行が緩徐であること，また，転移性肺腫瘍は原発性肺癌と異なり，発生母地が気管支ではないことから，気管支鏡ではアプローチしづらく診断に難渋することが多い．しかしながら，甲状腺乳頭癌のような緩徐に進行する転移性肺腫瘍に対しても，手技を工夫することで，経気管支生検は診断において有用な手技と考えられた．