Relationship between hand-foot skin reaction and external force on patients with hepatocellular carcinoma: A cohort study.

PURPOSE: Hand-foot skin reaction (HFSR), a side effect of tyrosine kinase inhibitor (TKI) treatment, makes it difficult to walk and perform daily activities because of pain in the limbs. HFSR occurs predominantly in the sites where external forces (pressure and shear stress) are applied. This study aimed to determine whether pressure or shear stress induces the occurrence of HFSR. METHODS: This cohort study was conducted in patients who received TKI treatment for hepatocellular carcinoma. The external forces applied to the sole of the patients' foot while walking was measured, and its association with the occurrence of HFSR was examined. The degree of HFSR was assessed by the patient's response during the examination and by photographs of their feet. The patients' feet were divided into low (grade <2) or high (grade ≥2) HFSR foot group, and the differences in external forces between the groups were analyzed using t-test and Cox hazard analysis. RESULTS: Analysis of the feet of 55 study participants (n = 110) showed no significant difference between the groups on t-test (p ≥ 0.05), however, Cox hazard analysis showed an increased risk of HFSR with higher peak shear stress values at the fifth metatarsal head (hazard ratio = 1.01, p = 0.047; 95% confidence interval = 1.00-1.02). CONCLUSION: Shear stress is possibly related to HFSR occurrence. Nurses should assess whether patients' shoes fit their feet before initiating TKI treatment. They should instruct patients to wear shoes that are fit of both diameter and width for their feet.

Prospective Observation Study for Primary Spontaneous Pneumothorax: Incidence of and Risk Factors for Postoperative Neogenesis of Bullae.

PURPOSE: Details of the neogenesis of bullae (NOB), which causes recurrent primary spontaneous pneumothorax (PSP) following bullectomy, have not been reported and risk factors for NOB remain unclear. We aimed to clarify the details of NOB. METHODS: We conducted a prospective study using three computed tomography (CT) examinations performed 6, 12, and 24 months after bullectomy to identify the incidence of and risk factors for NOB. We enrolled 50 patients who underwent bullectomy for PSP. RESULTS: After excluding 11 patients who canceled the postoperative CT examination at 6 months after bullectomy, only 39 patients were analyzed. The incidence of NOB at 6, 12, and 24 months after bullectomy was 38.5%, 55.2%, and 71.2%, respectively. The rate of NOB in the operated lung was almost 2 times higher than that in the contralateral nonoperative lung. Male sex, multiple bullae on preoperative CT, long stapling line (≥7 cm), deep stapling depth (≥1.5 cm), and heavier resected sample (≥5 g) were suggested to be risk factors for NOB. CONCLUSIONS: We recognized a high incidence of postoperative NOB in PSP patients. Bullectomy itself seems to promote NOB. Postoperative NOB occurs frequently, especially in patients who require a large-volume lung resection with a long staple line.

Marginal calcification of thymoma: differences in the location of calcification indicate differences in the characteristics of thymomas.

Background: Thymic epithelial tumors (TETs) are the most common tumors located in the anterior mediastinum. Calcification is sometimes observed in thymomas, especially in thymomas, and has been reported to be an indicator of the invasive behavior of thymomas. However, whether or not all calcification indicates invasive behavior is unclear. The present study therefore analyzed the location, size, and patterns of thymoma calcification and the relationships between calcification and clinicopathological factors and prognosis. Methods: We conducted a retrospective study among 77 thymoma patients who underwent surgery between January 2012 and May 2022 and analyzed the relationship between the location of calcification and clinicopathological findings. The patients were categorized into three groups: those with inner calcification of the tumor (group I), those with marginal calcification (group M), and those without any calcification (group N). Results: Calcification was identified in 13 thymomas (16.9%) in group I (n=8) and group M (n=5). Group M included significantly more low-risk thymomas than the other groups (P=0.030). In low-risk thymomas, especially type AB thymoma, marginal calcification was observed more frequently than in other lesions. There were significant differences in age (P=0.024) and Masako-Koga stage (P=0.020) among the groups. In group I, younger patients and patients with advanced-stage disease were included. There were no significant differences in the rates of recurrence or the recurrence-free period among the groups. However, recurrence was not recognized in any members of group M. Conclusions: The location of calcification should be a point of focus in thymomas, and differences in the location of calcification indicate differences in the characteristics of thymomas.

Quality of life in Werner syndrome and associated subjective foot/ankle symptoms: A cross-sectional survey.

AIM: The aims of this study were to assess the general quality of life and foot/ankle health-related quality of life among subjects with Werner syndrome (WS) and to determine subjective foot/ankle symptoms associated with quality of life. METHODS: Using a questionnaire survey, patients were asked to provide information on age, sex and presence of subjective symptoms and complete both the 36-Item Short Form Health Survey (SF-36) questionnaire and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q). Statistical analyses were performed using Student's t-test, the Mann-Whitney U test, Fisher's exact test and Spearman's rank correlation. RESULTS: Data from 12 patients with an average age of 54 ± 8.6 years were analyzed. The mean SF-36 score for the domain of physical functioning was 21.2; for role-physical function, 32.6; for bodily pain, 38.5; for general health, 34.4; for vitality, 44.8; for social function, 38.5; for role-emotional function and for mental health, 46.7. The mean mental component summary was as high as the national standard, but it was low in men. The mean SAFE-Q scores were also low. Patients with ulcers had significantly more pain and low general health perception. As compared with the national standard, the role/social component score was not low, and there was a correlation in most domains of the SAFE-Q. CONCLUSION: In WS, the general health-related quality of life was low overall in the physical domain and low only in men for the mental domain, whereas it was low in the social domain when foot/ankle health-related quality of life was low. Geriatr Gerontol Int 2023; 23: 188-193.

Formal pump heel height affects the external force exerted on the foot during normal walking.

Forefoot pain, hallux valgus, shoe sore, flat foot, and calluses are among the common foot problems encountered by high heel wearers. This study aimed to investigate the external forces associated with shoe sore and callus while wearing formal heel shoes. The external force on the 1st, 2nd, and 5th metatarsal heads and heel center was measured using the ShokacChip. Women were asked to wear pumps with four heel heights (10, 30, 55, and 80 mm) and walk 15 m twice. Thirty-five women were included. The data of two participants were excluded due to sensor fault. With higher heels, normal stress (pressure) was significantly stronger on the inside of the forefoot and significantly weaker on the outside. Shear stress did not always increase or decrease proportionally with respect to heel height. SPR-i of the forefoot associated with callus formation was minimal in the 30-mm heel. Clinical Relevance- This study aims to provide a guide for shoe selection in order to avoid foot troubles in women.

Impact of GERAADA score in patients with acute type A aortic dissection.

BACKGROUND: Despite continuous developments and advances in the perioperative management of patients suffering from acute aortic dissection type A (AADA), the associated postoperative morbidity and mortality remain high and strongly depend on the preoperative clinical status. The associated postoperative mortality is still hard to predict prior to the surgical procedure. The so-called German Registry of Acute Aortic Dissection Type A (GERAADA) score uses very basic and easily retrievable parameters and was specifically designed for predicting the 30-day mortality rate in patients undergoing surgery for AADA. This study evaluated impact of the GERAADA score in the authors' institutional results. METHODS: Among 101 acute type A aortic dissection patients treated at our hospital during August 2015-March 2021, the GERAADA was calculated individually and retrospectively. Predicted and actual mortalities were assessed, and independent predicted factors were searched. The primary endpoint was defined as comparison of GERAADA scores and early mortality, and the secondary endpoints were defined as comparison of GERAADA scores and other postoperative results, and comparison of preoperative factors and postoperative results regardless to GERAADA scores. RESULTS: While the overall 30-day mortality for the entire study cohort calculated by the GERAADA score was 14.3 (8.1-77.6)%, the actual mortality rate was 6%. However, the GERAADA score was significantly high in some postoperative complications and showed significant correlation with some peri- and post-operative factors. In addition, factors not belonging to GERAADA score such as time from onset to arrival at the hospital, time from onset to arrival at the operation room, spouse presence, and hemodialysis were significantly associated with 30-day mortality. CONCLUSIONS: Although the actual mortality was lower than predicted, GERAADA score may impact on the postoperative course. In addition, it would be desirable to add parameters such as the time from onset to arrival, family background, and hemodialysis for further accuracy.

Gait due to difference in Intravenous pole position on the healthy participants.

INTRODUCTION: The gait while using an intravenous (IV) pole is close to the gait of the elderly and fallers. Additionally, one survey has reported that the diagonal position is optimal for transporting an IV pole with a light load. However, in clinical practice, carrying a heavier load may be possible. Therefore, this study clarifies the optimum operation position using an IV pole with a weight closer to that in actual clinical practice. METHOD: Using image analysis software, we investigated several variables indicating gait, such as stride length. Participants walk with an IV pole in three ways: sideways, in front, and diagonally. We investigated two types of IV pole loads, which are 0.5 kg and 5.0 kg. RESULTS AND DISCUSSION: In 0.5-kg settings, the sideways position is a way to suppress the narrowing of the heel-floor angle. No significant difference in the subjective appraisals was observed between the sideways and diagonal positions. In addition, the sideways position is as optimum as the diagonal position. In 5.0-kg settings, only the sideways position suppressed the narrowing of the step length. Therefore, the sideways position is optimal. However, the participants' impressions suggested that arm strength is required for the sideways position. If a patient has weak arms and cannot maintain the sideways position, the patient may choose the diagonal position. Moreover, the front position is the way to hold the trunk most forward. However, there is a possibility that it is easy for a specific person, such as a rollator user, to choose. Therefore, further investigate of the optimum operation position depending on the walking abilities is needed. CONCLUSION: It was suggested that the sideways position is optimal for walking with an IV pole when transporting with a total load of approximately 5.0 kg.Clinical Relevance- The results of this study help to prevent people from gait like fallers and the elderly when using IV poles in clinical settings.

Surgical site infection at chest tube drainage site following pulmonary resection for malignant lesions.

BACKGROUND: We sometimes experience postoperative surgical site infection (SSI) at the chest tube drainage site (CDS) after thoracotomy. The incidence of and risk factors for SSI at the CDS have remained unclear. METHODS: We conducted a prospective study to determine the incidence and risk factors for SSI at the CDS. We analyzed 99 patients who underwent lobectomy or segmentectomy for pulmonary malignant lesions. RESULTS: There were 56 males and 43 females with an average age of 71 years. The postoperative drainage period was 2-15 days. Bacterial species were detected in secretions in 18 of 99 cases (18.2%). Older age was a risk factor for the detection of bacteria at the timing of chest tube removal. Eighteen cases (18.2%) were diagnosed with presence of SSI at the CDS at the timing of staple or suture removal. A pathological diagnosis of squamous cell carcinoma was regarded as a candidate risk factor for SSI. Eleven of 18 SSI patients showed delayed wound healing. A higher level of HbA1c was found in patients with delayed wound healing. Enterococcus faecalis infection may influence the development of complex SSI. CONCLUSIONS: We identified the bacterial profiles, incidence of and risk factors for SSI at the CDS. More intense preoperative glycemic control and an understanding of the bacterial profile and may be useful for reducing the incidence of SSI chest tube drainage sites (CDS).

Effective appropriate use of dental remains and forensic DNA testing for personal identity confirmation.

Two severely burned human male bodies, possibly those of a parent and child, were recovered from the scene of a house fire and positive identification of the bodies was accomplished. This report describes the appropriate use of effective identification methods that made this possible. Identification of a body involves comparison of antemortem and postmortem X-ray films or dental records. In cases of poorly preserved dental remains, or in the absence of antemortem dental records, forensic DNA testing can be done. In the present case the male thought to be the son was identified from an antemortem panoramic X-ray film provided by the family dentist, which matched every significant detail in the body. On the other hand, forensic DNA testing of a sample obtained from the father's burned body was done in comparison with a swab obtained from his older brother, as the victim had no dental records for the 5 years before his death. This was able to confirm his identity. Thus positive identification was established through a combination of these methods. Although positive identification from dental records is rapid and certain, it requires antemortem dental records. If these are not available, forensic DNA testing should be attempted. In laboratories of forensic odontology, facilities for identity confirmation from both dental characteristics and forensic DNA testing should be made available.