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Aging-related volume changes in the brain and cerebrospinal fluid using artificial intelligence-automated segmentation
Get PDFapplication/pdfObjectives:
To verify the reliability of the volumes automatically segmented using a new artificial intelligence (AI)-based application and evaluate changes in the brain and CSF volume with healthy aging.Methods:
The intracranial spaces were automatically segmented in the 21 brain subregions and 5 CSF subregions using the AI-based application on the 3D T1-weighted images in healthy volunteers aged > 20 years. Additionally, the automatically segmented volumes of the total ventricles and subarachnoid spaces were compared with the manually segmented volumes of those extracted from 3D T2-weighted images using the intra-class correlation and Bland-Altman analysis.Results:
In this study, 133 healthy volunteers aged 21-92 years were included. The mean intra-class correlations between the automatically and manually segmented volumes of the total ventricles and subarachnoid spaces were 0.986 and 0.882, respectively. The increase in the CSF volume was estimated to be approximately 30 mL (2%) per decade from 265 mL (18.7%) in the 20s to 488 mL (33.7%) in ages above 80 years; however, the increase in the volume of total ventricles was approximately 20 mL (< 2%) until the 60s and increased in ages above 60 years.Conclusions:
This study confirmed the reliability of the CSF volumes using the AI-based auto-segmentation application. The intracranial CSF volume increased linearly because of the brain volume reduction with aging; however, the ventricular volume did not change until the age of 60 years and above and then gradually increased. This finding could help elucidate the pathogenesis of chronic hydrocephalus in adults.Key points:
• The brain and CSF spaces were automatically segmented using an artificial intelligence-based application.
• The total subarachnoid spaces increased linearly with aging, whereas the total ventricle volume was around 20 mL (< 2%) until the 60s and increased in ages above 60 years.
• The cortical gray matter gradually decreases with aging, whereas the subcortical gray matter maintains its volume, and the cerebral white matter increases slightly until the 40s and begins to decrease from the 50s.Journal Articlejournal articl
A case of Neuropsychiatric systemic lupus erythematosus with varying stenotic lesions in several cerebral major arteries and a vertebral artery aneurysm
Get PDFapplication/pdf症例は42 歳女性，約20 年前に全身性エリテマトーデス（systemic lupus erythematosus，以下SLE と略記）と診断された．ステロイド誘発性精神障害のためステロイド漸減中に錯乱状態を主とする神経精神SLE（neuropsychiatric SLE，以下NPSLE と略記）を発症し，MRI では右側頭葉皮質を中心に急性期梗塞像，複数の脳主幹動脈で亜急性に変動する狭窄と拡張，右椎骨動脈瘤形成を認めた．シクロホスファミド静注療法等を早期から導入し動脈瘤は拡大なく血管狭窄は改善した．NPSLE における血管攣縮と拡張，動脈瘤形成は稀であるが，疾患活動性の指標となり，強固な免疫治療を検討する必要性があると考え報告した．A 42 years old female suffered from systemic lupus erythematosus (SLE) about 20 years ago. While steroid was tapered for a steroid-induced psychiatric disorder, she presented with an acute confusional state and was diagnosed with neuropsychiatric SLE (NPSLE). MRI showed acute infarction mainly in the cortex of the right temporal lobe and MRA demonstrated dynamic subacute morphological changes such as stenosis and dilation in several major intracrainal arteries. The right vertebral artery diffusely dilated and subsequently formed an aneurysm in a week. Contrast-enhanced MRI vessel-wall imaging showed a remarkable enhancement of the aneurysm wall, which might indicate an unstable unruptured aneurysm. The prompt introduction of intravenous cyclophosphamide improved both clinical and radiological signs. Our case indicates that intensive immunosuppressive treatments should be considered in NPSLE patients with varying vasospasm and aneurysm, indicating exacerbated disease activity.Journal Articlejournal articl
Increased CT Use and No Change in Injury Severity among Child Motor Vehicle Victims: A National Trauma Database Study in Japan
Get PDFapplication/pdfThe number of fatalities associated with traffic accidents has been declining owing to improvements in vehicle safety performance and changes in the law. However, injuries in children can lead to social and economic losses. We examined 10-year changes in the characteristics of traffic trauma among pediatric motor vehicle passengers by analyzing data from the Japan Trauma Data Bank (JTDB). Among the 36,715 injured motor vehicle passengers under the age of 15 years who were registered in the JTDB from 2004 to 2019, we compared the groups injured during 2004-2007 (n = 94) and 2017-2019 (n = 203). Physiologically, the 2004-2007 group had a lower body temperature and Glasgow Coma Scale score as well as a higher mortality. Anatomical severity was higher in the 2004-2007 group for the head, face, and neck, according to the Abbreviated Injury Scale. In terms of treatment, only craniotomy as a primary surgery was significantly lower in the 2017-2019 group. The 2017-2019 group had significantly higher rates of receiving whole-body computed tomography (CT). Because the rate of performing CT has increased, with no changes in the injury severities of the trunk and extremities, limiting the number of CT examinations is suggested for pediatric motor vehicle passengers involved in road traffic collisions. The severity of trunk and extremity injuries has not improved in more than 10 years; further preventive measures for these injuries should be considered.Journal Articlejournal articl
Feasibility study of an artificial placenta system consisting of a loop circuit configuration extracorporeal membrane oxygenation with a bridge circuit in the form of the umbilical arterial-venous connection
Get PDF滋賀医科大学博士（医学）application/pdfThesis or DissertationJournal of Artificial Organs. 2022 Oct 13.令和4年度thesi
カントン オ キタシタ ジンコウ コウモン ダッシュツ ニ タイシテ ジドウ ホウゴウキ デ シュウフクシタ ２レイ
Get PDF人工肛門脱出は人工肛門造設後の合併症の一つであり，疼痛や出血，パウチ貼付困難といった症状が出現すると手術が必要になる．ところが，人工肛門脱出に対する標準的な手術や治療法は確立していないのが現状である．過去の文献では自動縫合器を用いた手術の報告が散見され，良好な治療経過をえている．今回，われわれは人工肛門脱出に対して自動縫合器を用いて非開腹下に手術を施行した．症例１は81歳の男性．原因不明のS状結腸狭窄に対して横行結腸で双孔式人工肛門を造設した．術後１か月目から口側腸管から人工肛門脱出を認めた．さらに１か月経過し増悪するため手術を施行した．症例2は82歳の女性．閉塞性S状結腸癌に対して横行結腸で双孔式人工肛門を造設した．術後3か月目に肛門側から人工肛門脱出を認め，手術を施行した．自動縫合器を用いた術式では，縫合部が直視困難な位置に自然に還納するため，縫合部出血の確認と止血を念頭に置き切離前から縫合部を牽引して術野に牽引しておくことが重要であると考えられた．Stoma prolapse is one of the complications after colostomy, and we have to operate it if symptoms such as pain, bleeding, and difficulty in attaching the pouch occur. However, we have no standard surgery or treatment for stoma prolapse. In the past literature, there have been some reports of surgery using automatic sutures. We performed non-laparotomy surgery using automatic sutures for incarcerated colostomy.
Case 1 was an 81-year-old man. A biperal colostomy was constructed in the transverse colon for sigmoid colon stenosis of unknown cause. From the first month after surgery, a stoma prolapse was observed from the mouth intestinal tract. After another month, we performed operation for worsen the disease.
Case 2 was an 82-year-old woman. A biperal colostomy was constructed in the transverse colon for obstructive sigmoid colon cancer. Three months after surgery, a stoma prolapse was observed from the side. And we performed operation.
While the usefulness of surgery using automatic sutures has been found in some places, it may also be useful in incarcerated cases. In this surgical procedure, since the suture is naturally returned to a position where it is difficult to see directly, it is important to tow the proboscis suture to the surgical field before dissection, keeping in mind the confirmation of suture bleeding and hemostasis.departmental bulletin pape
Participation in health and frailty check-ups predicted functional outcomes and mortality in older adults in Japan.
No full textAim:
This study aimed to examine the association between participation in health and frailty check-ups and functional outcomes and mortality, controlling for physical and cognitive function, or self-rated health among Japanese community-dwelling older adults.Methods:
A cohort of 5093 participants aged ≥65 years (not disabled or institutionalized), completed the baseline survey in April 2013. Functional outcomes and mortality served as follow-up data from April 2013 to March 2018. However, the data did not include events, such as certified cases for long-term care and death for 12 months from the start of follow-up. We collated data on the use of the annual health check system in 2012 and frailty check-ups using the postal Kihon Checklist in 2013. Cox proportional hazards regression models were used to determine the association between participation in the check-ups, and functional outcomes and mortality, adjusting for potential confounders.Results:
Long-term care and mortality risks were significantly lower among those aged <75 years who used health screening than among those who did not, despite adjusting for confounding factors (hazard ratios: 2.1-3.5). In those aged ≥75 years, the risk for long-term care was lower in individuals participating in both health and frailty check-ups and in those who participated in the frailty check-ups only, than in those who did not participate.Conclusions:
The association between participation in health and frailty check-ups and adverse health outcomes differed among the age groups, indicating the potential benefit of health and frailty check-ups in older adults. Geriatr Gerontol Int 2023; 23: 348-354.Journal Articlejournal articl
Restoration of External Rotation by Sequential Glenoid Lateralization Based on Body Size in Reverse Shoulder Arthroplasty
Get PDFapplication/pdfBackground:
Although reverse shoulder arthroplasty (RSA) for rotator cuff arthropathy reliably restores anterior elevation (AE), restoration of external rotation (ER) had been unreliable using traditional Grammont-type designs, which has been addressed by lateralizing the center of rotation. This study investigated whether sequential lateralization based on the intraoperatively measured glenoid-humeral axis interval (GHI) results in better outcomes than RSA with a uniform amount of lateralization irrespective of the GHI.Methods:
Fifty-four shoulders were treated with a nonlateralized Grammont-type implant between 2016 and 2018 (group A). Forty shoulders were treated with the same Grammont-type implant with 8.0-mm-thick bony increased offset (BIO) between 2014 and 2016 (group B). Fifty consecutive shoulders were treated with a different Grammont-type implant with glenoid-side prosthetic lateralization based on the GHI between 2019 and 2020 (group C). Group C was further stratified into 3 subgroups: group C1 (GHI 24.0 mm, n = 13), by +7.4 mm. Active ER with the arm at the side (ER0) and abducted to 90° (ER90) as well as functional outcomes including active AE and Constant and UCLA scores were evaluated at 2 years postoperatively.Results:
The mean age, height, and body mass index and the percentage of male patients were not significantly different between groups A, B, and C. However, the patients in subgroup C1 were the shortest (151.3 ± 3.9 cm) and most elderly (77.5 ± 4.1 years) and had the highest proportion of female patients (91.7%). The patients in subgroup C3 were the tallest (161.1 ± 5.6 cm) and had the highest proportion of male patients (69.2%). ER0, ER90, and the Constant score were significantly larger in group C than in group A. AE, ER0, and the Constant and UCLA scores were significantly larger in group C than in group B.Conclusions:
Rather than using a single ideal offset, the optimal lateralization may be better determined according to the body size, the muscle volume, or perhaps the excursion of the musculotendinous unit of each individual patient.Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.Journal Articlejournal articl
Bovine lactoferrin suppresses inflammatory cytokine expression in endometrial stromal cells in chronic endometritis
Get PDF滋賀医科大学博士（医学）application/pdfThesis or DissertationJournal of reproductive immunology. 2022 Dec;154:103761.令和4年度thesi
Essential Roles of Exocyst Complex Component 3-like 2 on Cardiovascular Development in Mice
Get PDF滋賀医科大学博士（医学）application/pdfThesis or DissertationLife (Basel). 2022 Oct 28;12(11):1730.令和4年度thesi