Shiga University of Medical Science Repository BI WAKO / 滋賀医科大学機関リポジトリ
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Locally advanced endometrial cancer with multiple immune-related adverse events coinciding with the complete response to radiotherapy after immune checkpoint inhibitor therapy: A case report
Get PDFWe report a case of a 70-year-old female patient with locally advanced endometrial cancer with primary empty sella who developed multiple immune-related adverse events (irAEs), including hypopituitarism coinciding with the complete response to radiotherapy after receiving immune checkpoint inhibitors. A computed tomography scan acquired after a traffic accident led to the discovery of endometrial cancer that had invaded the vulva and primary empty sella. Following adriamycin and cisplatin, pembrolizumab was administered for three cycles. No irAEs were observed during treatment, but the tumor was progressive. The patient underwent radiotherapy for the residual tumor. Four months after the last dose of pembrolizumab, hypopituitarism caused secondary adrenal insufficiency, primary hypothyroidism, and pseudogout at the end of radiotherapy. The tumor later achieved a complete response. In conclusion, radiotherapy after immune checkpoint inhibitor (ICI) therapy is expected to have an antitumor effect by stimulating tumor-specific immunity. However, proper management of irAEs is necessary. Patients with primary empty sella may be prone to pituitary insufficiency induced by ICIs.journal articl
Focal aware somatosensory seizures with paresis as a complication of surgery for chronic subdural hematoma
Get PDFThere has been only one previous published report of focal aware somatosensory seizures with paresis as a postoperative complication of chronic subdural hematoma (cSDH). This is the second case report of this condition captured on electroencephalography (EEG) as a postoperative complication of cSDH. A 76-year-old man with no history of epilepsy was taken to the emergency department of Shiga University of Medical Science Hospital because of transient weakness of the lower extremities. Head computed tomography showed bilateral cSDH that was larger on the left. Seven days after burr-hole evacuation of the left cSDH, the patient experienced a brief clonic seizure of the right hand without postoperative recurrence of cSDH. He then experienced a tingling sensation in, followed by clumsiness and weakness of, the right upper extremity without fluctuations in consciousness or convulsive movements. These symptoms appeared repeatedly, with intermittent improvement, persisting for 6 days after onset. Scalp EEG showed an electrographic seizure in the left central area, suggesting that the symptoms corresponded to focal aware somatosensory seizures with paresis. The symptoms and epileptiform patterns and electrographic seizures on the EEG disappeared with antiseizure medicationsjournal articl
Coronary Artery Calcium in Assessment of Atherosclerotic Cardiovascular Disease Risk and its Role in Primary Prevention
Get PDFCoronary artery calcium (CAC), which is detected using computed tomography scanning, is a well-established indicator of subclinical atherosclerosis. The CAC score is independently associated with atherosclerotic cardiovascular disease (ASCVD) outcomes and provides improved predictive values for estimating the risk of ASCVD beyond traditional risk factors. Thus, CAC is considered to have important implications for reclassification as a decision aid among individuals in the preclinical phase and as the primary prevention of ASCVD. This review is focused on epidemiological evidence on CAC in asymptomatic population-based samples from Western countries and Japan. We also discuss the usability of CAC as a tool for assessing ASCVD risk and its role in the primary prevention of ASCVD. A lack of evidence for the CAC score in ASCVD risk assessment beyond traditional risk factors in populations other than those in Western countries (including Japan) warrants further investigation. Clinical trials are also necessary to demonstrate the usefulness and safety of CAC screening in the primary prevention of ASCVD.journal articl
Association between Dietary Patterns and Serum Low Density Lipoprotein Cholesterol in Japanese Women and Men: The Japan Multi-Institutional Collaborative Cohort (J-MICC) Study
Get PDFAims:
The association between dietary patterns and serum low density lipoprotein (LDL) cholesterol would be changing in recent dietary habits in Japan. We investigated the relationship between dietary patterns and serum LDL cholesterol in a large general population.
Methods:
From the baseline survey of Japan Multi-Institutional Collaborative Cohort Study between 2005 and 2013, 27,237 participants (13,994 were women) aged 35-69 years were cross-sectionally analyzed. Using a semi-quantitative food frequency questionnaire, five major sex-specific dietary patterns were identified using factor analysis. We assessed serum LDL cholesterol by quintiles of dietary pattern factor score.
Results:
We identified dietary patterns; "vegetable rich pattern" , "meat and fried food rich pattern" and "high bread and low rice pattern" in women and men; "fish and shellfish rich pattern" and "high confectioneries and low alcohol pattern" in men; "healthy Japanese diet pattern" and "high alcohol and low rice pattern" in women. Serum LDL cholesterol in men was associated with "high bread and low rice pattern" score (Q5 was 4.2 mg/dL higher than Q1, p for trend ＜0.001) and "high confectioneries and low alcohol pattern" scores (Q5 was 9.5 mg/dL higher than Q1, p for trend ＜0.001). In women, serum LDL cholesterol was associated with "high bread and low rice pattern" score (Q5 was 7.1 mg/dL higher than Q1, p for trend ＜0.001).
Conclusion:
Some recent dietary patterns in Japan were associated with serum LDL cholesterol. Serum LDL cholesterol was associated with high bread and low rice pattern in both sex, and high confectioneries and low alcohol pattern in men.journal articl
Polypoid Malignant Melanoma with Spontaneous Decapitation Showing Favorable Prognosis : A Case Report
Get PDFIntroduction:
Regression of malignant melanoma (MM) is a commonly observed phenomenon, which refers to disappearance or loss of all or part of MM. It can be identified both clinically and histologically, and high probability of histological regression of MM (10-58%) has been reported. However, the decapitation of skin tumor has rarely been described in the English literature, and decapitation in MM has not been reported. Here, we report the case of polypoid MM with spontaneous decapitation.
Case presentation:
An 81-year-old Japanese woman was referred to our hospital due to a polypoid nodule on her cheek. She was diagnosed with MM at stage IIC (T4bN0M0) by histological examinations. Three weeks after the biopsy, the nodule decapitated spontaneously without bleeding, and an ulcer developed on the base of the polypoid nodule. The histological examination of the additionally resected ulcerative lesion under the nodule revealed infiltration of T cells mainly composed of CD8⁺ natural killer T cells. No recurrence or metastasis has been observed for 4 years.
Conclusion:
This is the first case report of polypoid MM with spontaneous decapitation, which may be attributed to natural killer T cells. Moreover, this case shows favorable prognosis, while it is said that the regression in thick MM does not have prognostic advantage and polypoid topography has been reported to be related to extremely poor prognosis. Further investigations are needed to evaluate the prognostic advantage of decapitation in MM and other skin tumors.journal articl
The effect of nonrestorative sleep on incident hypertension 1-2 years later among middle-aged Hispanics/Latinos
Get PDFBackground:
Insomnia is known to be a major risk factor for incident hypertension. Nonrestorative sleep (NRS), which refers to insufficiently rested sleep, has reported to associate with various diseases. This study aimed to investigate the longitudinal association between insomnia-related symptoms including NRS and incident hypertension 1-2 years later by age group (young, 18-39 years and middle-age, 40-64 years) using existing cohort data involving Hispanics/Latinos.
Methods:
This study included 1100 subjects who had participated in both the Hispanic Community Health Study/Study of Latinos and its follow-up study, the Sueño Ancillary Study, and met additional eligibility criteria. Incident hypertension was assessed by self-reported history and/or the use of antihypertensives. The Women's Health Initiative Insomnia Rating Scale (WHIIRS) was used to evaluate insomnia-related symptoms (difficulty initiating sleep, difficulty maintaining sleep, early morning awakening, difficulty returning to sleep, and NRS). Logistic regression analyses were conducted to assess the degree to which insomnia-related symptoms at baseline predicted incident hypertension.
Results:
Among the participants (64% middle-aged, 36% young adults), 140 (12.7%) developed hypertension during the follow-up period. Among the sleep-related symptoms, only NRS predicted incident hypertension after adjusting for sociodemographic factors and physical condition (odds ratio: 1.88, 95% confidence interval: 1.10-3.21, p = 0.022) in middle-aged adults. None of the insomnia-related symptoms were associated with incident hypertension in the young adults. No association was found between WHIIRS-defined insomnia (total score ≥ 9) and incident hypertension in middle-aged adults or young adults.
Conclusion:
The present findings suggest the importance of focusing on NRS to help prevent the development of hypertension in middle-aged adults.journal articl
サイセンタン ノ サンジゲン イメージング システム : シンゾウ ケッカン ゲカ ニオケル Virtual Reality ギジュツ ノ ユウヨウセイ
Get PDF滋賀医科大学心臓血管外科では医療用画像を三次元構築し、臓器を立体表示するVirtual Reality (VR) 技術を用いて心臓血管系の3D解析研究を進めている。VRでは臓器の内腔を可視化することができ、また3D構築した画像に直接介入し、従来の2D解析では評価困難であった複雑な構造も術者の視点で直観的に計測できるという利点がある。あらゆる医療画像データを三次元化し, かつ直感的な立体計測が可能なVR技術は, これまでの診断精度を上回る形態学的な情報を臨床医に提示し得ると考えられる。特に外科医にとって有用な手術支援VR画像は, 難易度が高い手術の治療成績を向上させる可能性が高い。Adequate preoperative planning may facilitate successful procedures in cardiovascular surgery. We have newly developed a system the Vesalius 3D suite, combining three-dimensional (3D) image-processing software with an optic-tracking spatial navigation, allowing quick, accessible 3D image interpretation for virtual reality (VR) exploration and measurement of complex anatomy. In this review, we present a novel method of virtual imaging analysis for preoperative planning and simulation in cardiovascular operation using this 3D-VR system. Based on unimodal or multimodal medical imaging data, DICOM data sets can be reconstructed for 3D visualization. Virtually reconstructed images can be viewed on stereoscopic 3D display, revealing each patient’s specific anatomy and the internal structures in exquisite detail. Highly accessible 3D interpretation promptly permits precise and intuitive measurements of repair-relevant anatomical parameters including geometrically complex shapes. This technology may promote understanding of form and function in the cardiovascular system, and facilitate operative procedures in more challenging cases. Furthermore, this system can be especially valuable for any surgeon to gain experience in practicing for rarely-performed procedures or uncommon patient-specific preoperative surgical simulations.departmental bulletin pape
ワルファリン ト アミオダロン オ ヘイヨウ シテイル ソウボウベン ケイセイ ジュツゴ カンジャ ニオイテ レモン カヒ オ ガンユウスル ミズ ノ ジョウヨウ ニヨリ シュッケツ ケイコウ オ クリカエシタ ト カンガエラレタ イチレイ
Get PDF今回レモン果皮を用いた水を常用したことで出血傾向を繰り返したと考えられる症例を経験したため報告する。症例は61歳女性で、僧帽弁狭窄症に対して11年前と4年前に僧帽弁形成術を施行された。発作性心房細動再発および軽度僧帽弁狭窄症に対してワルファリンおよびアミオダロンを処方し外来加療を続けていた。1年前に腹痛、下痢、血便、皮下出血を主訴に近隣病院の救急外来を受診され、感染性腸炎の診断で入院加療を受けた。入院時の血液検査でプロトロンビン時間 国際標準比(PT-INR)が 6.35と異常な延長を認めていた。退院後は当科外来へ通院再開したが、PT-INRの延長傾向が１ヶ月ほど続いた。今回、腹痛、下痢、血便、皮下出血が再発し当科外来を受診となった。血液検査にてPT-INR 4.14と延長を再度認めた。健康食品や嗜好品、生活習慣を含む生活歴を聴取したところ、1年前から初夏にレモン果皮を用いて飲用水を作成し頻回に飲んでいることが判明した。PT-INRが異常延長していた時期とレモン果皮が含まれる飲用水を常用していた時期が同じであったため、レモン果皮を用いた飲用水の常用によりPT-INRが異常延長し、出血傾向となったと考えられた。直ちにレモン果皮が含まれる水の飲用を中止させ、PT-INRは約1ヶ月のうちに治療域で安定した。以後PT-INRの異常延長および出血傾向は認められなくなった。We report a case of repeated bleeding tendencies due to regular use of lemon peel water. A 61-year-old woman underwent mitral valvuloplasty 11 and 4 years ago for mitral stenosis. She had recurrent paroxysmal atrial fibrillation and mild mitral stenosis after second surgery, and been administered with warfarin and amiodarone and continued outpatient treatment. One year ago, she visited the emergency department of a nearby hospital with chief complaints of abdominal pain, diarrhea, bloody stools, and subcutaneous bleeding, and she was hospitalized with a diagnosis of infectious enteritis. A blood test revealed the extremely elevated PT-INR value of 6.35. After she was discharged from the hospital, she returned to our outpatient clinic. The PT-INR prolongation trend had been continued for a month. This year, she visited our outpatient clinic because of recurrence of abdominal pain, diarrhea, bloody stools, and subcutaneous bleeding. A blood test showed the elevated PT-INR value of 4.14. Her social history was revealed that she had started to make water containing lemon peel and drunk it frequently in early summer for about one year. Since the time of extremely elevated PT-INR value and the time when she had started to drink the water with lemon peel frequently was the same, it was suspected that there was a causal relationship between them. After we stopped her from drinking the water with lemon peel immediately, the PT-INR value was normalized within in a month. Since then the extremely elevated PT-INR value has never been observed.departmental bulletin pape
Neuronal glutathione loss leads to neurodegeneration involving gasdermin activation
Get PDFAccumulating evidence suggests that glutathione loss is closely associated with the progression of neurodegenerative disorders. Here, we found that the neuronal conditional-knockout (KO) of glutamyl-cysteine-ligase catalytic-subunit (GCLC), a rate-limiting enzyme for glutathione synthesis, induced brain atrophy accompanied by neuronal loss and neuroinflammation. GCLC-KO mice showed activation of C1q, which triggers engulfment of neurons by microglia, and disease-associated-microglia (DAM), suggesting that activation of microglia is linked to the neuronal loss. Furthermore, gasdermins, which regulate inflammatory form of cell death, were upregulated in the brains of GCLC-KO mice, suggesting the contribution of pyroptosis to neuronal cell death in these animals. In particular, GSDME-deficiency significantly attenuated the hippocampal atrophy and changed levels of DAM markers in GCLC-KO mice. Finally, we found that the expression of GCLC was decreased around amyloid plaques in AppNL-G-F AD model mice. AppNL-G-F mouse also exhibited inflammatory events similar to GCLC-KO mouse. We propose a mechanism by which a vicious cycle of oxidative stress and neuroinflammation enhances neurodegenerative processes. Furthermore, GCLC-KO mouse will serve as a useful tool to investigate the molecular mechanisms underlying neurodegeneration and in the development of new treatment strategies to address neurodegenerative diseases.journal articl
