Successful treatment of unresectable advanced rectal cancer with liver metastases by hemostasis re-irradiation of the rectal cancer and palliative low-dose whole-liver radiation therapy: a case report.

A 72-year-old man was admitted to the hospital with fatigue. Colonoscopy revealed a 50 × 50 mm rectal tumor with bleeding. Based on close inspection, he was diagnosed with unresectable advanced rectal cancer with multiple liver metastases. Chemotherapy was administered as 10 cycles of bevacizumab + mFOLFOX6 and 7 cycles of bevacizumab + FOLFIRI. Nine months later, he presented with hematochezia and progression of anemia. It was difficult to stop the bleeding via endoscopy. He underwent radiation therapy (39 Gy in 13 fractions), and hemostasis was confirmed. Then, further chemotherapy was performed with 3 cycles of bevacizumab + FOLFIRI and 2 cycles of TAS102. However 14 months after the initial visit, he presented with right hypochondralgia and abdominal fullness due to the progression of multiple liver metastases. Palliative low-dose whole-liver radiation therapy (WLRT) (30 Gy in 10 fractions) was performed. He developed Grade 2 nausea, but his right hypochondralgia reduced, liver dysfunction improved, and he successfully completed radiotherapy. At approximately the same time his anemia progressed, and colonoscopy revealed recurrent bleeding from the tumor. Re-irradiation (15 Gy in 5 fractions) of the rectal tumor was carried out and a blood transfusion was performed for the bleeding. He was discharged after confirmation the anemia had not progressed. Few reports have been published on the use of both palliative re-irradiation to stop bleeding from rectal cancer and palliative low-dose WLRT. Based on our experience with this case, we believe that palliative radiotherapy can be useful in treating patients with a poor prognosis

Creatinine to Body Weight Ratio Is Associated with Incident Diabetes: Population-Based Cohort Study

We investigated the association between creatinine to body weight (Cre/BW) ratio and incident diabetes. In this cohort study, 9659 men and 7417 women were follow up mean (SD) 5.6 (3.5) years and 5.4 (3.4) years, respectively. For men, tertile 1 (T1; n = 3176), Cre/BW < 0.01275; tertile 2 (T2; n = 3258), 0.01275 ≤ Cre/BW < 0.0148; and tertile 3 (T3; n = 3225), Cre/BW ≥ 0.0148; and for women, T1 (n = 2437), Cre/BMI < 0.0118; T2 (n = 2516), 0.0118 ≤ Cre/BMI < 0.014; and T3 (n = 2477), Cre/BMI ≥ 0.014. Among them, 362 men and 102 women developed diabetes. The hazard ratios (HRs) of incident diabetes in the T2 group was 0.56 (95% CI 0.44–0.71, p < 0.001) in men and 0.61 (0.38–0.99, p = 0.045) in women and in the T3 group was 0.42 (0.32–0.54, p < 0.001) in men and 0.55 (0.34–0.89, p = 0.014) in women after adjusting for covariates, compared with the T1 group. Moreover, Δ0.001 incremental of Cre/BW is negatively associated with incident diabetes (adjusted HR 0.84, 95% CI 0.80–0.88, p < 0.001 for men and 0.88, 0.81–0.96, p = 0.003 for women). In conclusion, Cre/BW ratio is inversely related to incident diabetes. Checking Cre/BW ratios may predict future diabetes risks

Association between failed eradication of 7-day triple therapy for Helicobacter pylori and untreated dental caries in Japanese adults

Abstract Helicobacter pylori (H. pylori) infection is a cause of gastric disorders and is treated mainly by pharmacotherapy with antimicrobial agents. An association has been reported between dental caries and H. pylori infection. As antimicrobial agents are less effective inside dental caries because of impaired blood circulation, the presence of untreated dental caries (decayed teeth) may influence the success of H. pylori eradication treatment. In this cross-sectional study, we examined whether failed eradication of H. pylori was associated with decayed teeth in Japanese adults. Enrolled were 226 participants who received dental checkups among those treated for eradication of H. pylori at Asahi University Hospital between April 2019 and March 2021. Treatment efficacy was assessed by urea breath test. Eradication failed in 38 participants (17%), decayed teeth in 32 participants (14%), and number of 0.34 teeth per participants. Multivariate logistic regression analyses showed that failed eradication of H. pylori was associated with decayed teeth (presence: odds ratio, 2.672; 95% confidence interval, 1.093–6.531) after adjusting for gender, age, and brushing frequency. These results indicate that failed eradication of H. pylori was associated with decayed teeth and suggest that untreated dental caries may impact treatment for eradication of H. pylori

Periodontal Condition Is Correlated with Deep and Subcortical White Matter Hyperintensity Lesions in Japanese Adults

Deep and subcortical white matter hyperintensity (DSWMH) lesions are a small-vessel disease of the brain. The aim of this cross-sectional study was to investigate the relationship between DSWMH lesions and periodontal status in Japanese adults who participated in a health check. We enrolled 444 consecutive participants (mean age, 54.5 years) who received both brain and oral health evaluation services at the Asahi University Hospital. Magnetic resonance imaging was used to detect DSWMH lesions. Periodontal status was assessed using the community periodontal index. Of the study participants, 215 (48.4%) had DSWMH lesions. Multivariate logistic regression showed that the presence of DSWMH lesions was significantly related to age ≥ 65 years (vs. < 65 years, odds ratio [OR] = 2.984, 95% confidence interval [CI] = 1.696–5.232), systolic blood pressure ≥ 140 mmHg (vs. < 140 mmHg, OR = 2.579, 95% CI = 1.252–5.314), the presence of ≥ 28 teeth (vs. < 28 teeth, OR = 0.635, 95% CI = 0.420–0.961), and probing pocket depth (PPD) ≥ 6 mm (vs. PPD < 6 mm, OR = 1.948, 95% CI = 1.132–3.354) after adjustment for confounding factors. Having PPD ≥ 6 mm may be a risk factor for DSWMH lesions in Japanese adults

Association between Self-Reported Chewing Status and Glycemic Control in Japanese Adults

This cross-sectional study investigated the relationship between self-reported chewing status and glycemic control in 30,938 Japanese adults who participated in health checkups. Chewing status was evaluated using a self-reported questionnaire. We defined high hemoglobin A1c (HbA1c) levels as a HbA1c level ≥6.5%; 692 (2.2%) respondents met this criterion. After adjusting for gender, age, smoking status, exercise habits, body mass index and eating speed, high HbA1c levels was found to be associated with male gender (odds ratio (OR), 1.568; 95% confidence interval (CI), 1.310 to 1.878; p < 0.001), older age (OR, 1.077; 95% CI, 1.068 to 1.087; p < 0.001), higher body mass index (OR, 1.246; 95% CI, 1.225 to 1.268; p < 0.001), current smoker status (OR, 1.566; 95% CI, 1.303 to 1.882; p < 0.001) and chewing difficulty (OR, 1.302; 95% CI, 1.065 to 1.591; p < 0.05). In conclusion, self-reported chewing difficulty was associated with high HbA1c levels in Japanese adults