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Impaired eye movements in Parkinson's disease and their relationship to top-down and bottom-up neural processing
Get PDF滋賀医科大学博士（医学）Brain and Behavior. 2024 Feb 14:e3404.
doi.org/10.1002/brb3.3404令和6年度thesi
Asian adult sleep medicine fellowship training curriculum: one curriculum, many contexts
Get PDFStudy objectives:
To develop a comprehensive Asian adult sleep medicine fellowship training curriculum to address the significant disparities in sleep medicine training across Asia, guided by the principle of "One Curriculum, Many Contexts," providing a standardized yet adaptable framework for sleep medicine education across the diverse healthcare landscapes of Asian countries.
Methods:
The curriculum development process involved a gap analysis, comprehensive literature review, and expert consensus through a modified RAND appropriateness method (RAM)/Delphi survey.
Results:
The curriculum offers two flexible tracks: a one-year program (Track A) and a two-year program (Track B), accommodating varied educational pathways and healthcare system structures across Asia. Key features of the curriculum include detailed learning outcomes, competency-based educational content, and recommendations for teaching and learning activities. The assessment strategy incorporates summative and formative methods, with standard setting and program evaluation guidelines. The curriculum also provides recommendations for program accreditation, fellow-faculty ratios, and funding considerations.
Conclusions:
The Asian adult sleep medicine fellowship training curriculum provides a standardized yet adaptable framework for sleep medicine education across diverse Asian healthcare landscapes. By emphasizing flexibility and customization while maintaining high training standards, the curriculum aims to bridge the gap in sleep medicine training across Asia, ultimately improving the quality of sleep healthcare and patient outcomes throughout the region.journal articl
Vitamin B12 deficiency-induced megaloblastic anemia in a pediatric patient with autism spectrum disorder with a chronically unbalanced diet
No full textAutism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by a lack of behavioral flexibility and stereotyped language. Food selectivity is common among children with ASD because of their persnickety nature. A prolonged unbalanced diet results in an increased risk of several diseases, such as iron deficiency anemia, scurvy, rickets, dry eye, and Wernicke encephalopathy. However, no cases of megaloblastic anemia have been reported to date. We report the case of an 11-year-old boy with ASD who developed megaloblastic anemia due to vitamin B12 deficiency. He had a prolonged history of selective eating for more than 10 years. His nutritional status on admission was poor, and he had low weight and short stature. His food selectivity was so strong that intervention to expand diet variety was unsuccessful. A developmental-behavioral pediatrician found that the patient had visual dominance and could take some medications when suffering from a minor illness. Nutritional supplements were selected after consultation with a nutritionist. Although compulsory treatment was necessary during the acute phase, the therapy was continued at home. With multidisciplinary intervention tailored to the patient and his parents' characteristics, his nutritional status improved in a few months.journal articl
Right main pulmonary artery distensibility on dynamic ventilation CT and its association with respiratory function
Get PDFBackground:
Heartbeat-based cross-sectional area (CSA) changes in the right main pulmonary artery (MPA), which reflects its distensibility associated with pulmonary hypertension, can be measured using dynamic ventilation computed tomography (DVCT) in patients with and without chronic obstructive pulmonary disease (COPD) during respiratory dynamics. We investigated the relationship between MPA distensibility (MPAD) and respiratory function and how heartbeat-based CSA is related to spirometry, mean lung density (MLD), and patient characteristics.
Methods:
We retrospectively analyzed DVCT performed preoperatively in 37 patients (20 female and 17 males) with lung cancer aged 70.6 ± 7.9 years (mean ± standard deviation), 18 with COPD and 19 without. MPA-CSA was separated into respiratory and heartbeat waves by discrete Fourier transformation. For the cardiac pulse-derived waves, CSA change (CSAC) and CSA change ratio (CSACR) were calculated separately during inhalation and exhalation. Spearman rank correlation was computed.
Result:
In the group without COPD as well as all cases, CSACR exhalation was inversely correlated with percent residual lung volume (%RV) and RV/total lung capacity (r = -0.68, p = 0.003 and r = -0.58, p = 0.014). In contrast, in the group with COPD, CSAC inhalation was correlated with MLDmax and MLD change rate (MLDmax/MLDmin) (r = 0.54, p = 0.020 and r = 0.64, p = 0.004) as well as CSAC exhalation and CSACR exhalation.
Conclusion:
In patients with insufficient exhalation, right MPAD during exhalation was decreased. Also, in COPD patients with insufficient exhalation, right MPAD was reduced during inhalation as well as exhalation, which implied that exhalation impairment is a contributing factor to pulmonary hypertension complicated with COPD.
Relevance statement:
Assessment of MPAD in different respiratory phases on DVCT has the potential to be utilized as a non-invasive assessment for pulmonary hypertension due to lung disease and/or hypoxia and elucidation of its pathogenesis.
Key points:
• There are no previous studies analyzing all respiratory phases of right main pulmonary artery distensibility (MPAD).
• Patients with exhalation impairment decreased their right MPAD.
• Analysis of MPAD on dynamic ventilation computed tomography contributes to understanding the pathogenesis of pulmonary hypertension due to lung disease and/or hypoxia in patients with expiratory impairment.journal articl
Role of basal cells in nasal polyp epithelium in the pathophysiology of eosinophilic chronic rhinosinusitis (eCRS)
Get PDFBackground:
Basal cell hyperplasia is commonly observed in nasal polyp epithelium of eosinophilic chronic rhinosinusitis (eCRS). We examined the function and mechanisms of basal cell hyperplasia in the pathophysiology of eCRS.
Methods:
We found that normal human bronchial epithelial (NHBE) cells obtained basal cell characteristics when cultured with PneumaCult™-Ex Plus Medium. Most of the cells passaged three times expressed basal cell surface markers CD49f and CD271 by flow cytometry, and basal cell nuclear marker p63 by immunohistochemical staining. We named these NHBE cells with basal cell characteristics cultured Basal-like cells (cBC), and NHBE cells cultured with BEGM™ cultured Epithelial cells (cEC). The characteristics of cBC and cEC were examined and compared by RNA sequencing, RT-PCR, ELISA, and cell proliferation studies.
Results:
RNA sequencing revealed that cBC showed higher gene expression of thymic stromal lymphopoietin (TSLP), IL-8, TLR3, and TLR4, and lower expression of PAR-2 compared with cEC. The mRNA expression of TSLP, IL-8, TLR3, and TLR4 was significantly increased in cBC, and that of PAR-2 was significantly increased in cEC by RT-PCR. Poly(I:C)-induced TSLP production and LPS-induced IL-8 production were significantly increased in cBC. IL-4 and IL-13 stimulated the proliferation of cBC. Finally, the frequency of p63-positive basal cells was increased in nasal polyp epithelium of eCRS, and Ki67-positive proliferating cells were increased in p63-positive basal cells.
Conclusions:
Type 2 cytokines IL-4 and IL-13 induce basal cell hyperplasia, and basal cells exacerbate type 2 inflammation by producing TSLP in nasal polyp of eCRS.journal articl
Predictors of longitudinal changes in body weight, muscle and fat in patients with and ever-smokers at risk of COPD
Get PDF滋賀医科大学博士（医学）Respirology. 2023 Sep;28(9):851-859.令和5年度thesi
Association with the nonparoxysmal atrial fibrillation duration and outcome of ExTRa Mapping-guided rotor ablation
Get PDF滋賀医科大学博士（医学）J Arrhythm. 2023 Jul 5;39(4):531-538.令和5年度thesi
ニュウガン ジュツゼン カガク リョウホウ FECリョウホウ チュウ ニ モウマク ジョウミャク ヘイソクショウ ニ ヨル ヘンソクセイ ノ オウハン フシュ オ ハッショウシタ 1レイ
Get PDF症例は60歳女性。検診で右乳癌が疑われ、精査により浸潤性乳管癌の診断となった。術前化学療法としてDTX療法(docetaxel)4サイクル終了後にFEC療法(5-FU+epirubicin+cyclophosphamide)を開始した。FEC療法2サイクル目投与中に、左眼の視力低下が出現し、翌日に左眼底に出血を伴う網膜静脈分枝閉塞症および嚢胞状黄斑浮腫を確認した。FEC療法を中止し、非ステロイド性抗炎症点眼薬(NSAIDS点眼薬)投与、抗血管内皮増殖因子抗体薬(抗VEGF抗体薬)の硝子体内注射による治療を開始した。その後も3か月毎に抗VEGF抗体薬投与を行ったところ、徐々に黄斑浮腫は改善、視力は治療開始 1 年後に回復した。これまでにタキサン系の抗癌剤で黄斑浮腫が出現した報告はあるが、FEC療法の副作用で黄斑浮腫が出現したとの報告はなく、本症例は希少な症例と考えられた。また、抗癌剤治療の際には眼副作用の予防、発症の早期検知、早期治療を心掛ける必要がある。The case is a 60-year-old woman. Right breast cancer was suspected during a medical checkup, and a close examination revealed a diagnosis of invasive ductal carcinoma of the breast. After 4 cycles of DTX (docetaxel) as neoadjuvant chemotherapy, FEC (5-FU + epirubicin + cyclophosphamide) was started. During the second cycle of FEC therapy, vision loss in the left eye appeared, and the next day, branch retinal vein occlusion with hemorrhage and cystoid macular edema were observed in the left fundus. FEC therapy was discontinued, and treatment with non-steroidal anti-inflammatory eye drops (NSAIDS eye drops) and intravitreal injection of anti-vascular endothelial growth factor antibody drug (anti-VEGF antibody drug) was started. After administration of anti-VEGF antibody drug every 3 months, macular edema gradually improved and visual acuity was restored one year after the start of treatment. Although there have been reports of macular edema caused by taxane-type anticancer drugs, there have been no reports of macular edema as a side effect of FEC therapy, and this case was considered to be a rare one. In addition, it is necessary to keep in mind the prevention of ocular side effects, early detection of their onset, and early treatment when anticancer drug therapy is used.departmental bulletin pape
