Eldecalcitol (ELD), an active vitamin D3 analog, is extensively prescribed in Japan for the treatment of osteoporosis. However, hypercalcemia remains a significant concern, particularly in patients with impaired renal function. Data on the extent to which renal dysfunction increases the risk of hypercalcemia are limited. This retrospective study investigated the relationship between hypercalcemia and renal function in 212 ELD-treated outpatients at Matsuyama Shimin Hospital. Hypercalcemia was observed in 17.0% of the patients. A weak negative correlation was observed between follow-up serum calcium levels and estimated glomerular filtration rate (eGFR). Receiver operating characteristics (ROC) analysis identified a baseline eGFR cutoff of ≤45.9 mL/min, and propensity score matching (1 : 1) adjusted for 12 covariates, including baseline calcium, demonstrated a significantly higher incidence of hypercalcemia in patients with eGFR ≤45.9 mL/min. These findings indicate that a low baseline eGFR predisposes patients to hypercalcemia during ELD therapy. In clinical practice, patients with baseline eGFR ≤45.9 mL/min may require more frequent calcium monitoring and consideration of alternative treatments such as alfacalcidol, with close collaboration between physicians and pharmacists.
Background/Objectives: Postoperative recurrence is a critical issue in the treatment of resectable pancreatic ductal adenocarcinoma (rPDAC). Moreover, the prognosis after early recurrence is extremely poor. This study aimed to develop a recurrence prediction model and to define early recurrence after upfront surgery (UFS) for rPDAC. Methods: This multicenter retrospective study included patients who underwent UFS for anatomically rPDAC between January 2013 and December 2017. Multivariate analyses were conducted to identify the risk factors for recurrence-free survival and to construct a recurrence prediction model. Subsequently, a minimum p value approach was used to determine the optimal cutoff values for early and late recurrence. Results: The cohort included 603 patients (325 men and 278 women). During the median follow-up period of 25 months (interquartile range, 15-38 months), 381 patients (63.2%) experienced a recurrence. Multivariate analyses revealed carbohydrate antigen 19-9 ≥37 U/mL (hazard ratio [HR], 1.58; p < 0.001), tumor size ≥ 2.2 cm (HR, 1.59; p < 0.001), lymph node metastasis (HR, 1.86; p < 0.001), R1 resection (HR, 1.56; p = 0.002), and no adjuvant chemotherapy (HR, 1.54; p < 0.001) as independent predictors. The recurrence prediction model demonstrated an area under the curve of 0.72-0.75. The optimal threshold for early and late recurrences was a recurrence-free interval of five months. Carbohydrate antigen 19-9 ≥ 156 U/mL was a significant predictor of early recurrence (OR, 3.28; p < 0.001). Conclusions: This study identified the prognostic risk factors for recurrence and developed a recurrence prediction model for patients undergoing UFS for rPDAC. Moreover, a recurrence-free interval of five months was identified as the optimal threshold for distinguishing between early and late recurrences.
Full-endoscopic trans-Kambin's lumbar interbody fusion (FE-KLIF) is a type of minimally invasive fusion surgery that requires only a 14-mm skin incision for cage insertion. The only surgery-related complication of concern with FE-KLIF is exiting nerve root injury (ENRI). We investigated the incidence of ENRI in 131 cases that underwent FE-KLIF at 10 hospitals. After encountering 5 cases of ENRI, all of which occurred during insertion of an open cannula, we devised a novel type of open cannula, which we call a rescue cannula, to avoid ENRI. There were 5 cases of ENRI (5.7%) in the 88 patients who underwent FE-KLIF before use of the rescue cannula. We have put the rescue cannula in the FE-KLIF system, and one can use the rescue cannula when electromyography alarms. Under such strategy to avoid the ENRI for using the rescue cannula, none of these 43 cases developed ENRI. FE-KLIF is a minimally invasive fusion surgery in which ENRI is the only worrisome complication. Use of a rescue cannula could be the solution to avoiding ENRI. J. Med. Invest. 73 : 26-31, February, 2026.
Evidence regarding the association between oral environment and the inflammatory bowel disease (IBD), including ulcerative colitis (UC), exists. However, evidence regarding the association between oral health parameters and disease activity of UC is limited. This study aimed to evaluate the association between remaining tooth number and toothbrushing frequency and mucosal healing (MH) in Japanese UC patients. The study included 275 patients with UC. Information on lifestyle and oral health parameters was collected via self-administered questionnaires. The definition of MH was based on the Mayo endoscopic subscore (MES) of 0. The prevalence of MH in this cohort was 24.7
OBJECTIVES:A meta-analysis showed that serum folate concentrations, but not vitamin B12 concentrations, are lower in patients with ulcerative colitis compared to healthy controls. However, no epidemiological study has investigated the association between dietary intake of folate, vitamin B12, vitamin B6, vitamin B2, and vitamin B1 and the risk of ulcerative colitis. This study examines this association using data from a multicenter, hospital-based, case-control study. METHODS:The study included 384 cases of ulcerative colitis diagnosed within the past 3 years and 665 controls. Data were collected through a self-reported questionnaire. Dietary information was obtained using a 169-item semi-quantitative food frequency questionnaire. Adjustment was made for sex, age, pack-years of smoking, alcohol consumption, history of appendicitis, family history of ulcerative colitis, education level, and BMI. RESULTS:Higher dietary intakes of folate and vitamin B1 were independently associated with a decreased risk of ulcerative colitis after adjusting for confounding factors. The adjusted odds ratio for extreme quartiles was 0.60 [95% confidence interval (CI): 0.39 - 0.91, P for trend = 0.009) for folate and 0.54 (95% CI: 0.36 - 0.81, P for trend = 0.004) for vitamin B1. Dietary intake of vitamins B12, B6, or B2 was not independently associated with ulcerative colitis risk. CONCLUSION:This is the first study to demonstrate significant inverse relationships between dietary intake of folate and vitamin B1 and the risk of ulcerative colitis. Our results should be interpreted as exploratory and require validation through further, more focused studies.
