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卵巣悪性腫瘍と良性内膜症性嚢胞の鑑別における各予測インデックスの特徴と有用性の比較
Get PDFThis study aimed to evaluate the prediction efficacy of malignant transformation of ovarian
endometrioma (OE) using the Copenhagen Index (CPH-I), the risk of ovarian malignancy algorithm
(ROMA), and the R2 predictive index. This retrospective study was conducted at the Department
of Gynecology, Nara Medical University Hospital, from January 2008 to July 2021. A total of
171 patients were included in the study. In the current study, cases were divided into three cohorts:
pre-menopausal, post-menopausal, and a combined cohort. Patients with benign ovarian tumor
mainly received laparoscopic surgery, and patients with suspected malignant tumors underwent
laparotomy. Information from a review chart of the patients’ medical records was collected. In the
combined cohort, a multivariate analysis confirmed that the ROMA index, the R2 predictive index,
and tumor laterality were extracted as independent factors for predicting malignant tumors (hazard
ratio (HR): 222.14, 95% confidence interval (CI): 22.27–2215.50, p < 0.001; HR: 9.80, 95% CI: 2.90–33.13,
p < 0.001; HR: 0.15, 95% CI: 0.03–0.75, p = 0.021, respectively). In the pre-menopausal cohort, a
multivariate analysis confirmed that the CPH index and the R2 predictive index were extracted as
independent factors for predicting malignant tumors (HR: 6.45, 95% CI: 1.47–28.22, p = 0.013; HR:
31.19, 95% CI: 8.48–114.74, p < 0.001, respectively). Moreover, the R2 predictive index was only
extracted as an independent factor for predicting borderline tumors (HR: 45.00, 95% CI: 7.43–272.52,
p < 0.001) in the combined cohort. In pre-menopausal cases or borderline cases, the R2 predictive
index is useful; while, in post-menopausal cases, the ROMA index is better than the other indexes.博士（医学）・甲第875号・令和5年3月15日© 2022 by the authors. Licensee MDPI, Basel, Switzerland.
This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/)
再灌流後急性心筋梗塞患者におけるリバースリモデリングと非造影T1低信号梗塞コア
Get PDFBackground: Non-contrast T1 hypointense infarct cores (ICs) within infarcted myocardium detected using cardiac magnetic resonance
imaging (CMR) T1 mapping may help assess the severity of left ventricular (LV) injury. However, because the relationship of
ICs with chronic LV reverse remodeling (LVRR) is unknown, this study aimed to clarify it.
Methods and Results: We enrolled patients with reperfused AMI who underwent baseline CMR on day-7 post-primary percutaneous
coronary intervention (n=109) and 12-month follow-up CMR (n=94). Correlations between ICs and chronic LVRR (end-systolic
volume decrease ≥15% at 12-month follow-up from baseline CMR) were investigated. We detected 52 (47.7%) ICs on baseline CMR
by non-contrast-T1 mapping. LVRR was found in 52.1% of patients with reperfused AMI at 12-month follow-up. Patients with ICs
demonstrated higher peak creatine kinase levels, higher B-type natriuretic peptide levels at discharge, lower LV ejection fraction at
discharge, and lower incidence of LVRR than those without ICs (26.5% vs. 73.3%, P<0.001) at follow-up. Multivariate logistic regression
analysis showed that the presence of ICs was an independent and the strongest negative predictor for LVRR at 12-month followup
(hazard ratio: 0.087, 95% confidence interval: 0.017–0.459, P=0.004). Peak creatine kinase levels, native T1 values at myocardial
edema, and myocardial salvaged indices also correlated with ICs.
Conclusions: ICs detected by non-contrast-T1 mapping with 3.0-T CMR were an independent negative predictor of LVRR in patients
with reperfused AMI.博士（医学）・乙第1529号・令和5年3月15日© 2022, THE JAPANESE CIRCULATION SOCIETY
This article is licensed under a Creative Commons [Attribution-NonCommercial-NoDerivatives 4.0 International] license
経皮的冠動脈インターベンションにおけるステント血栓症発症に特徴的なステント留置後の光干渉断層法の冠動脈内の所見
Get PDFBackground:The association between unfavorable post-stent optical coherence tomography (OCT) findings and subsequent stent thrombosis (ST) remains unclear. This study investigated the ST-related characteristics of post-stent OCT findings at index percutaneous coronary intervention (PCI).
Methods and Results:Fifteen patients with ST onset after OCT-guided PCI (ST group) were retrospectively enrolled. Post-stent OCT findings in the ST group were compared with those in 70 consecutive patients (reference group) without acute coronary syndrome onset for at least 5 years after OCT-guided PCI. The incidence of acute myocardial infarction (AMI) was higher in the ST than reference group (60.0% vs. 17.1%, respectively; P=0.0005). The incidence of incomplete stent apposition (93.3% vs. 55.7%; P=0.0064), irregular protrusion (IP; 93.3% vs. 62.8%; P=0.0214), and thrombus (93.3% vs. 51.4%; P=0.0028) was significantly higher in the ST than reference group. The maximum median (interquartile range) IP arc was significantly larger in the ST than reference group (265° [217°–360°] vs. 128° [81.4°–212°], respectively; P180° was significantly higher in the ST than reference group (100% vs. 58.3%, respectively; P=0.0265).
Conclusions:IP with a large arc was a significant feature on post-stent OCT in patients with ST.博士（医学）・甲第868号・令和5年3月15日© 2021, THE JAPANESE CIRCULATION SOCIETY
This article is licensed under a Creative Commons [Attribution-NonCommercial-NoDerivatives 4.0 International] license
筋層浸潤性膀胱癌における壁浸潤長は予後予測因子であり、血清cell-free DNAと関連する
Get PDFBackground: We investigated the potential of the depth of invasion (DOI) as a
prognostic factor in patients with muscle-invasive bladder cancer (MIBC) who
underwent radical cystectomy (RC). Moreover, we examined the association between
the preoperative levels of circulating cell-free DNA and DOI.博士（医学）・甲第876号・令和5年3月15日© 2023 The Authors. Published by Wolters Kluwer Health, Inc.
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal
頸椎症性脊髄症における椎間関節変性の有病率と臨床的影響：CT新分類での検討
Get PDFObjective: To evaluate cervical facet joint degeneration using a newly developed classification, investigate its prevalence and relationship with cervical degenerative spondylolisthesis, and clarify its clinical significance in patients with degenerative cervical myelopathy (DCM).
Methods: This study included 145 consecutive patients with DCM who underwent surgical treatment. Clinical variables and radiological findings were analyzed. A new 6-grade computed tomography (CT) classification for cervical facet joint degeneration was adapted, and its prevalence was evaluated by categorizing the joints into those at responsible and those at nonresponsible spinal segmental levels. We evaluated the association between rapidly progressive myelopathy and the presence of significant facet joint degeneration or spondylolisthesis at the responsible segmental level.
Results: Finally, 140 patients with a mean age of 64.1±12.8 years were analyzed. The prevalence of grade 1, 2, 3, 4, 5A, and 5B classification in all facet joints was 72.0%, 9.5%, 10.9%, 4.3%, 2.9%, and 0.4%, respectively. There was a statistically significant difference in the distribution of CT grades between the joints at the responsible and nonresponsible segmental levels (p<0.001), with a high prevalence of grade 4 or 5B degeneration at the responsible segmental level, reflecting articular irregularity. There was also a statistically significant relationship between rapidly progressive myelopathy and grade 4 or 5B degeneration at the responsible segmental level (p<0.001), but not between rapidly progressive myelopathy and spondylolisthesis (p=0.255).
Conclusion: This novel CT classification for facet joints deserves additional evaluation in patients with DCM. Abnormal findings on the articular surfaces might be related to the progression of myelopathy.博士（医学）・甲第870号・令和5年3月15日© 2022 by the Korean Spinal Neurosurgery Society
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited
持続的腎代替療法におけるメシル酸ナファモスタットの血中動態
Get PDFContinuous renal replacement therapy (CRRT) is the preferred dialysis modality
in critical care settings for patients with hemodynamic instability. Nafamostat
mesylate (NM) is an anticoagulant commonly used (mainly in Japan)
during CRRT in patients with high bleeding risk. In this study, we evaluated
the pharmacokinetics of NM during CRRT. Patients undergoing CRRT
therapy and using NM as the anticoagulant in the intensive care unit were
enrolled in the study. Blood was collected from the CRRT circuit just after
blood removal, just before and after the membrane for CRRT, and from the
filtrates after the membrane. NM concentrations were measured using
high-performance liquid chromatography. NM was detected in the intracorporeal
circulation during CRRT in some cases, and liver enzymes were severely
elevated in almost all of the cases. Coagulation time was prolonged
even before the initiation of NM administration in these cases and may be
associated with liver damage. This study suggests that NM dosage should take
into account liver damage assessed by elevated liver enzymes.博士（医学）・乙第1531号・令和5年3月15日© 2022 by author(s) and Scientific Research Publishing Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0)