The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of December 2020 was searched in PubMed, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution Service (Minds) technique. A total of 38 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, pathological diagnosis deciding the diagnosis, and causal genes of vascular anomalies. Thus, the Japanese clinical practice guidelines for vascular tumors, vascular malformations, lymphatic malformations, and lymphangiomatosis 2022 have been prepared as the evidence-based guidelines for the management of vascular anomalies.
Purpose Fundus parameters can be used to quantify masculinity or femininity as a fundus sex index (FSI) ranging from 0 to 1. The purpose of this study was to investigate the association between smoking, hypertension, diabetes, and FSI in the Kumejima population study Study design Prospective cross-sectional observational population study Methods Using color fundus photographs obtained from the Kumejima population study, 1653 healthy right eyes with reliable fundus parameter measurements were included. The tessellation fundus index R/(R + G + B), red-green-blue intensity in eight locations around the optic disc and foveal region, optic disc ovality ratio, papillomacular angle, and retinal vessel angles were quantified using ImageJ. The FSI was calculated using machine learning from the 42 fundus parameters, and the Mann-Whitney U-test was used to assess whether there were differences in the FSI depending on the presence or absence of smoking, hypertension, and diabetes Results The mean age of the 838 men and 815 women included in this study was 52.8 and 54.0 years, respectively. The FSI of the smoking group was lower than of the non-smoking group overall (P < 0.001). The FSI of the hypertension and diabetes groups was significantly higher than of the non-hypertension (P = 0.005) and non-diabetes (P = 0.017) groups only in women Conclusion In the Kumejima population study of healthy eyes in individuals aged 40 years or older, the fundus tended to be more feminine in women with hypertension or diabetes than in those without these conditions
Aim: The liver is the major source of circulating insulin-like growth factor (IGF)-I. Serum IGF-I levels are decreased in cirrhotic patients depending on severity. IGF-I administration was shown to improve liver function in patients and animal models of liver cirrhosis. However, controversy exists as to whether IGF-I stimulates or reduces fibrosis in the liver. The effects of IGF-I on collagen accumulation by hepatic stellate cells (HSCs) and its mechanisms were studied. Methods: A moderately activated HSC clone was used to determine the effect of IGF-I administration on the collagen production system, including its degradation. The intracellular signaling system was also studied in the cells stimulated by IGF-I. Results: IGF-I treatment reduced total amounts of collagen deposition in a dose-related manner, while DNA synthesis was stimulated by IGF-I. IGF-I treatment did not affect transforming growth factor-beta levels and type I procollagen mRNA expression. Expression of matrix metalloproteinase (MMP)-2 and -9 was upregulated, and tissue inhibitor of metalloproteinase (TIMP)-1 expression was downregulated by IGF-I treatment. Rapamycin, an inhibitor of mammalian target of rapamycin (mTOR), suppressed phosphorylation of 70 kDa ribosomal protein S6 kinase and eukaryotic initiation factor 4E-binding protein 1, and abrogated IGF-I-induced increase in MMP-2 and -9 expression and decrease in TIMP-1 expression. Conclusions: IGF-I has the ability to stimulate the collagen degradation system by HSCs through an mTOR-dependent pathway independent of modulation of the activation state of HSCs.
Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed procedure; however, the treatment of staple line leakage is very complicated. Therefore, this study assessed the incidence and treatment outcomes of staple line leakage in Japan. The first survey of patients with leakage after LSG until September 30, 2022, was sent to 83 Japanese institutions. The second survey was sent to institutions that reported patients with leakage after LSG. The timing of conversion to curative surgery was statistically analyzed. Thirteen institutions (15.7
