Investigation of Patients' Motivation for Cosmetic Surgery in a Nationwide Cosmetic Surgery Group.

Background: Recently, cosmetic surgeons in Japan have used social media to advertise their procedures. We analyzed the influence of social and other media on patients' motivation to visit our clinic using the aggregated results of a questionnaire distributed to our cosmetic surgery group. Methods: We obtained the data of 146,108 patients from our database between September 2018 and February 2023. To understand changes in patient motivation over time, patient motivation was compared between the opening (September 2018-February 2020), growth (March 2020-August 2021), and expansion (September 2021-February 2023) periods. Results: Most patients were motivated to visit clinics by the internet (53.7%) and Instagram (17.3%). Between the opening and growth periods, the internet [odds ratio (OR) 1.28; 95% confidence interval (CI), 1.14-1.43] and referrals (OR, 1.48; 95% CI, 1.08-2.01) significantly increased. Between the opening and expansion periods, there was a significant increase in TV (OR, 4.86; 95% CI, 3.09-7.65) and TikTok use (OR, 24.9; 95% CI, 3.50-177.0). There was more variability in the motivation to visit our clinic during the expansion period than during the other periods, and patients' motivation differed by procedure and region. In addition, TikTok was used primarily by patients in their late teens and early twenties, whereas TV was used by those in their twenties and forties. YouTube, referrals, and review websites were distributed bimodally. Conclusions: Patients choose information from various media sources. To attract more patients to our clinics, it is important to disseminate information on both the internet and social media.

Recent Status of Procedures in a Single Nationwide Cosmetic Surgery Group.

Background: Recently, cosmetic surgery demand has increased due to the spread of promotional social media in Japan. However, understanding the overall landscape remains difficult due to many clinics with varied procedure options. To understand the current trends and status of cosmetic surgery in Japan, we analyzed large-scale data from a group of clinics throughout the country. Methods: We analyzed data from 152,457 patients in our database. The periods from September 2018 to August 2021 and September 2021 to February 2023 were defined as the first and second periods, respectively, and the statuses of procedures were compared between the two. Results: Eye procedures were the most common (23.6%), followed by face-lifts (19.5%) and dark circles under the eyes (10.4%). Between the first and second periods, the number of procedures in the second period (128,898 cases) was overwhelmingly higher than that in the first period (23,559 cases). Orbital fat removal for dark circles under the eyes significantly increased (OR 2.97, 95%CI 2.78-3.17); procedures in provincial cities significantly increased (Kinki/Chugoku/Shikoku: OR 2.21, 95%CI 2.08-2.36); and procedures for patients with occupations where appearance is considered important, such as nightlife businesses or being a celebrity, decreased (celebrity: OR 0.44, 95%CI 0.38-0.51, nightlife business: OR 0.58, 95%CI 0.53-0.62). Conclusions: In Japan, cosmetic surgery has become increasingly common in recent years, and the trend has been changing over time. In the future, it will be important to organize and enhance our large-scale database to disseminate more accurate and useful information.

Risk Factors for Post-Tooth Extraction Complications in HIV-Infected Patients: a Retrospective Study.

We aimed to assess the rate and risk factors of postoperative complications following tooth extraction in HIV-infected patients by CD4 count. The study participants were 231 HIV-infected patients who underwent tooth extraction at our institution between January 2007 and December 2011. Blood test results, underlying diseases, surgical site, extraction method, and postoperative complication data were obtained from medical records. Potential risk factors of postoperative complications were analyzed using multivariate logistic regression. Patients were divided into two groups: 61 (26%) patients with a CD4 count < 200/µL, and 170 (74%) with a CD4 count ≥ 200/µL. Of the 231 patients, 12 (5.2%) developed postoperative complications (alveolar osteitis, n = 10; surgical site infection, n = 2). The rate of complications did not differ between the CD4 < 200/µL group (1.6%) and the CD4 ≥200/µL group (6.5%) (adjusted odds ratio [aOR]: 9.328, 95% confidence interval [CI]: 0.470, 185.229; P = 0.1431). Surgical extraction with bone excavation, but without CD4 count, was identified as a risk factor for post-extraction complications (aOR: 22.037, 95% CI: 1.519, 319.617; P = 0.0234). A low CD4 count is not a risk factor for post-extraction complications in patients with HIV infection. We conclude that tooth extraction should be performed based on dental/oral conditions, and not delayed until CD4 count improvement.

[A Retrospective Investigation of Cases in Which a Contract Was Not Concluded after a Referral for Home Care].

Cases in which the contract was not concluded after a request for home visit care was received were retrospectively surveyed. Seventy-nine new requests for home visit care were received over a period of 6 months from January 1 to June 30, 2018. Of them, a contract was not concluded in 18 cases(22.8%). Among the cases in which no agreement was reached, 9 patients were male and 9 were female, mean age was 84.6, and the patients' afflictions included dementia, orthopedic disease, malignant tumor, incurable neurological disease, heart disease, and cerebrovascular disease. Reasons for not reaching an agreement for home care included that the patient him- or herself did not feel the need for home care because the patient's condition worsened soon after the referral, for financial reasons, the patient had a strong aversion to letting outsiders into his or her home, a desire to continue outpatient treatment, the patient's home was beyond the area that could be visited, the patient's primary physician determined that home visits were possible after the referral was received, and because the patient wanted to continue treatment with a specialist.

[Use of Biologics and Home Visit by an Interdisciplinary Medical Care Team Led to the Improvement of Arthralgia-A Case of Rheumatoid Arthritis].

A woman in her 50s was diagnosed as having rheumatoid arthritis(RA)at another hospital. She refused treatment with biological therapy and had difficulty walking because of arthralgia. We formed a home-visit medical care team consisting of a physician, nurses, a physical therapist, and other medical professionals. Use of biologics, education on self-injection, and rehabilitation gradually improved her state. To support RA patients, a home-visit medical care team with the patient's cooperation and interdisciplinary professional work(IPW)would be important clinical methods.

Phylogenetic analysis and seroprevalence of influenza C virus in Mie Prefecture, Japan in 2012.

Reverse transcription polymerase chain reaction (RT-PCR) and real-time RT-PCR were used to detect 14 (6.6%) influenza C virus (InfC) among 213 clinical samples collected from children with respiratory symptoms in Mie Prefecture, Japan, between January 2012 and December 2012. Virus isolation using Madin-Darby canine kidney cells and/or embryonated chicken eggs was also successful for 3 of the 14 PCR-positive samples. Eleven patients (78.6%) were aged <3 years. Phylogenetic analysis of the hemagglutinin-esterase gene showed that the InfC detected in Mie Prefecture belonged to the C/Sao Paulo/82-related lineage. To determine the seroprevalence of InfC, a total of 575 serum samples from patients aged 1 month to 69 years in Mie Prefecture were screened by hemagglutination inhibition test using the C/Mie/199/2012 (C/Sao Paulo/82-related lineage) strain as the antigen. The samples with an antibody titer of ≥1:16 were designated as antibody-positive. The results showed that 53.7% of the 296 serum samples collected in 2011 and 85.3% of the 279 samples collected in 2012 were positive for antibodies against InfC, suggesting that an outbreak of InfC infection occurred in Mie Prefecture in 2012. Therefore, continuous and proactive monitoring is important to determine the number of InfC-infections and to better understand the epidemiology.

[Conduct of survey four months after the start of EMR for home visits to promote cooperation between hospitals and clinics].

Electronic medical records(EMR)for home visits were introduced in October 2013 at our institution in order to ensure smooth cooperation between the hospital and clinic by sharing the details of a patient's medical record. A system was developed for remote desktop connections to the EMR terminal server(virtual server)with the use of an SSL-VPN. Mobile terminals and mobile printers were used. Four months after the start of this system, a survey was conducted for 41 home care professionals and other staff(physicians, nurses, and office staff). Home care staff indicated that they had problems with the system, including bad connections and operating conditions, and difficulties responding to problems when they arose. Other staff indicated that they were able to acquire patient information faster than with paper-based records. Future issues include improvements to the user-friendliness of the terminals and improved responses to problems when they occur.

Apolipoprotein B-48 to triglyceride ratio is a novel and useful marker for detection of type III hyperlipidemia after antihyperlipidemic intervention.

AIM: Remnant lipoproteins are atherogenic and are accumulated in patients with type III hyperlipidemia (HL). Although type III HL is diagnosed by phenotyping apolipoprotein (apo) E, this procedure is time-consuming and inconvenient for routine clinical use. Clinical indices for screening type III HL in untreated HL patients have been proposed; however, in clinical settings, HL patients are promptly treated with lipid-lowering agents without diagnosing the underlying cause. We investigated whether existing clinical indices for screening type III HL as well as the apo B-48/triglyceride (TG) ratio, which was suggested to be related to the accumulation of small chylomicron (CM) remnants, are useful after the initiation of lipid-lowering therapies. METHODS: In 25 normolipidemic subjects and 191 treated HL patients (type I, n =6; IIa, 62; IIb, 66; III, 12; IV, 22; and V, 23) from Osaka University Hospital and related hospitals, fasting low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), TG, and apolipoproteins were measured and clinical indices were evaluated statistically. RESULTS: Apo B-48 levels were significantly higher in patients with type I, III, and V HL, and TG levels were significantly higher in patients with type I and V HL. The apo B-48/TG ratio was significantly higher only in patients with type III HL compared with other types of HL (p<0.001), and was statistically significant among the other clinical indices (AUC-ROC value, 0.895; cut-off value, 0.110). CONCLUSION: The apo B-48/TG ratio is a novel and useful marker for detecting type III HL even after the initiation of lipid-lowering interventions.

Pincer nails treated using zigzag nail bed flap method: results of 71 toenails.

BACKGROUND: In instances of pincer nail deformity, patients complain of pain associated with walking, wearing shoes, or light touching. Cosmetic concerns and difficulties in terms of nail clipping also arise. Achievement of a satisfactory nail form remains elusive. OBJECTIVE: To introduce our original surgical procedure and present the satisfactory results. MATERIALS & METHODS: The zigzag nail bed flap method was used on 71 toenails in 49 patients displaying pincer nails (11 male, 38 female; age range 12-88, mean, 48.6). This investigation evaluated 70 nails from the great toe and one nail from a second toe. RESULTS: No postoperative complications, including pain, infection and conspicuous scars, were evident. The degree of improvement was determined objectively with the width and height indices, revealing the accuracy of this therapeutic measure. CONCLUSION: The authors recommend surgical intervention consequent to the vicious cycle corresponding to anatomical abnormalities associated with the nail plate-nail bed-phalanges relationship. Therefore, these architectures should be treated in conjunction rather than singularly.

Uterine natural killer cells in perforin and beta(2)-microglobulin deficient mice.

Uterine natural killer (uNK) cells have roles for immune responses at the feto-maternal interface in mice. We studied the effects of beta(2)-microglobulin (beta(2)m) and perforin on proliferation and differentiation of uNK cells in pregnancy, using beta(2)-microglobulin-deficient (beta(2)m(-/-)) mice and perforin-deficient (P(-/-)) mice. The cell population of uNK cells in the metrial gland of P(-/-) mice was tended to be higher than the control B6 mice. The cell population of uNK cells in the metrial gland of beta(2)m(-/-) mice was significantly increased at Day 12 of pregnancy comparing to B6 and P(-/-) mice. On the other hand, the cell population of uNK cells in the decidua basalis of beta(2)m(-/-) mice was tended to be lower than B6 and P(-/-) mice. These results indicate that beta(2)m may be involved in proliferation of uNK cells in the metrial gland, and that beta(2)m may affect the maturation of uNK cells in the decidua basalis.

Effects of bezafibrate on dyslipidemia with cholestasis in children with familial intrahepatic cholestasis-1 deficiency manifesting progressive familial intrahepatic cholestasis.

No appropriate pharmaceutical therapy has been established for dyslipidemia with cholestasis in progressive familial intrahepatic cholestasis (PFIC)-1. We evaluated the efficacy of bezafibrate in PFIC-1. We monitored the clinical presentation and lipoprotein metabolism of 3 patients, aged 3, 4, and 8 years, with FIC1 deficiency, manifesting PFIC-1, over 12 months of bezafibrate therapy. Pruritus was substantially alleviated in the 3 patients after initiation of bezafibrate. Cholestasis was alleviated in 2 of them. Serum high-density lipoprotein cholesterol and low-density lipoprotein cholesterol increased 1.6- to 2.0-fold and 1.1- to 1.2-fold, respectively; but the values remained low and normal, respectively. Serum lipoprotein X, which was at normal levels before treatment, was elevated to levels above the upper limit of the reference range. High serum triglyceride levels decreased by 15% to 30%, to normal levels, after treatment initiation. The activities of lipoprotein lipase and hepatic triglyceride lipase were increased, but those of high-density lipoprotein regulators remained unchanged. Liver expression of multidrug resistance protein-3, which regulates lipoprotein X synthesis, was enhanced by bezafibrate therapy. Bezafibrate treatment favorably affected pruritus, dyslipidemia, and cholestasis in PFIC-1.

Cytokine-rich autologous serum system for cartilaginous tissue engineering.

Animal serum used for tissue engineering approaches has unacceptable risk for contamination with infectious agents. In this study, a cytokine-rich autologous serum (CRAS) system was developed. Canine auricular chondrocytes were cultured in medium supplemented with either fetal bovine serum (FBS) or autologous canine serum, alone or supplemented with basic fibroblast growth factor (b-FGF). Cell proliferative capacity was higher in the CRAS cultures than in those cultured in FBS, with greater expression of aggrecan and type II collagen in the b-FGF-supplemented CRAS group. The chondrocytes were seeded onto an ear-shaped biodegradable polymer (poly-L-lactide:epsilon-caprolactone, 50:50) and cultured in a Bioflow reactor for 1 week, using the 3 different culture media indicated above, and subsequently implanted into nude mice. The best outcome (cartilage gene expression and morphologic properties) was seen with tissue-engineered constructs precultured in the b-FGF-supplemented CRAS media. These findings indicate a clinically realizable approach for tissue engineering of cartilaginous structures.

Estrogen-related receptor expression in placenta throughout gestation.

Estrogen receptor (ER) alpha and beta mRNA levels increased from the first to the second trimester and then decreased until normal term delivery. Estrogen-related receptor (ERR) alpha, beta and gamma mRNA levels gradually increased up to the second trimester and then comparatively rapidly increased until normal term delivery. ERRs can bind to the steroid receptor coactivator family without any ligands and drive transcription activity of the target genes. The manner of ERR and ER gene expressions might show a competitive interaction associated with the use of common cofactors. It is speculated that the up-regulation of ERRs is related to placental growth after the down-regulation of ERs because of the remarkably high concentration of estrogens for ERs from the second trimester until delivery.

Estrogen-related receptor in reproductive organs.

Estrogen-related receptor (ERR) was studied in the placenta and uterine endometrium, especially endometrial cancers, among reproductive organs. In the placenta, the estrogen receptor (ER) alpha and beta mRNA levels increased from the first to the second trimester, and then decreased until normal term delivery. Estrogen-related receptor alpha, beta and gamma mRNA levels gradually increased up to the second trimester, and then comparatively rapidly increased until normal term delivery. In endometrial cancers, ER alpha and beta mRNA levels decreased with clinical stage, myometrial invasion and dedifferentiation. Estrogen-related receptor alpha levels increased with clinical stage and myometrial invasion, and the ERR gamma levels increased with myometrial invasion. Estrogen-related receptors can bind to the steroid receptor coactivator family without any ligands, and drive transcription activity of the target genes. The manner of ERR and ER gene expressions might show a competitive interaction associated with the use of common cofactors. It is speculated that the upregulation of ERR is related to the placental growth after the downregulation of ER from the second trimester until delivery, and that ERR alpha and gamma are candidates for prognostic factors in endometrial cancer, although ERR are not directly related to tumor growth and advancement of endometrial cancer. (Reprod Med Biol 2005; 4: 129-131).

Uterine contractions might increase heart preload in the recipient fetus in early-onset twin-twin transfusion syndrome: an ultrasound assessment.

OBJECTIVES: Uterine contractions (UC) in twin pregnancy are often experienced, yet the effects of UC in twin-twin transfusion syndrome (TTTS) remain to be clarified. The recipient heart preload condition and the effects of UC were evaluated and the final objective was to clarify the effects of tocolysis. METHODS: Firstly, the preload indexes (PLIs) and cardiothoracic area ratios (CTARs) were analyzed on both fetuses of 10 TTTS cases, aged from 14 to 28 gestational weeks in stage III/IV cases for evaluating the preload condition. Then, the PLIs in the presence and absence of UC in the recipient fetuses were determined to evaluate the difference. RESULTS: The PLIs of the recipient and the donor fetuses were 0.78 +/- 0.34 (n = 163) and 0.35 +/- 0.13 (n = 71) respectively. The CTARs were 30.2 +/- 6.1 (n = 62) and 23.4 +/- 5.4 (n = 62) respectively. The PLIs in the absence and presence of UC in the recipient fetuses were 0.69 +/- 0.29 and 0.99 +/- 0.38 (n = 35). All above comparisons showed highly significant differences (p < 0.0001). CONCLUSION: The recipient fetuses have signs of cardiac dilatation and a high-preload condition. UC transiently further raises high-preload conditions of the recipient fetus. Thus, tocolysis may be necessary for management in cases of early-onset severe TTTS.

Drastic decrease of progesterone receptor form B but not A mRNA reflects poor patient prognosis in endometrial cancers.

OBJECTIVES: Progesterone receptor (PR) has been recognized as an important factor that correlates with success of endocrine treatment and patients' prognoses in endometrial cancers (EC). This study was designed to determine the clinical implications of expression of PR form A (PR-A) and B (PR-B) in EC. METHODS: We have quantified the mRNA levels of total PR (PR-AB) and PR-B by real-time RT-PCR in 120 EC and 40 normal endometria (NE). We then analyzed the correlation between expression levels of each receptor and clinical characteristics including clinical stages, histological grades, depth of myometrial invasion and patients' prognoses. RESULTS: Although the expression level of PR-B is correlated with that of PR-A, the expression pattern of PR-B classified according to clinical characteristics was different from that of PR-A. We found that high PR-B mRNA levels but not PR-A mRNA levels correlated significantly with survival, independent of clinical characteristics including clinical stages, histological grades and depth of myometrial invasion. Percentage of PR-B to total PR (B/AB) in EC is widely distributed and the ratios of middle B/AB group (0.15 < B/AB < 0.35) are 75% in NE, 47% in surviving cases of EC and 18% in dead cases of EC at 5 years, respectively. CONCLUSIONS: These results taken together indicate that PR-B may have a different function from PR-A and the intact coordinate expression of PR isoforms was disrupted in EC, especially in poor prognostic case. The measurement of PR isoforms has prognostic value in EC.