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Usefulness of the Multimodal Fusion Image for Visualization of Deep Sylvian Veins
Get PDFThe preoperative assessment of cerebral veins is important to avoid unexpected cerebral venous infarction
in the neurosurgical setting. However, information is particularly limited regarding deep
Sylvian veins, which occasionally disturb surgical procedures for cerebral anterior circulation aneurysms.
The predictability of detecting deep Sylvian veins and their tributaries using a modern multimodal
fusion image was aimed to be evaluated. Moreover, 51 patients who underwent microsurgery
for unruptured cerebral aneurysms with Sylvian fissure dissection were retrospectively reviewed. The
visualization of the four components of the deep Sylvian veins in conventional computed tomography
(CT) venography and multimodal fusion images was evaluated. To compare the detection accuracy
among these radiological images, the sensitivity and specificity for the detection of each of the four
venous structures were calculated in comparison with those of intraoperative inspections. The kappa
coefficients were also measured and the inter-rater agreement for each venous structure in each radiological
image was examined. In all veins, the multimodal fusion image exhibited a high detection
rate without statistical difference from intraoperative inspections (P = 1.0). However, CT venography
exhibited a low detection rate with a significant difference from intraoperative inspections in the
common vertical trunk (P = 0.006) and attached vein (P = 0.008). The kappa coefficients of the fusion
image ranged from 0.73 to 0.91 and were superior to those of CT venography for all venous structures.
This is the first report to indicate the usefulness of a multimodal fusion image in evaluating deep
Sylvian veins, especially for the detection of nontypical, relatively small veins with large individual
variability.博士（医学）・甲第864号・令和5年3月15日Ⓒ 2022 The Japan Neurosurgical Society
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License
間歇的低酸素によりレニン産生細胞では microRNA-203 の発現低下を介して Renin と Cd38 の発現上昇が起こる
Get PDFSleep apnea syndrome is characterized by recurrent episodes of oxygen desaturation and reoxygenation (intermittent hypoxia [IH]), and it is a known risk factor for hypertension. The upregulation of the renin-angiotensin system has been reported in IH, and the correlation between renin and CD38 has been noted. We exposed human HEK293 and mouse As4.1 renal cells to experimental IH or normoxia for 24 h and then measured the mRNA levels using a real-time reverse transcription polymerase chain reaction. The mRNA levels of Renin (Ren) and Cd38 were significantly increased by IH, indicating that they could be involved in the CD38-cyclic ADP-ribose signaling pathway. We next investigated the promotor activities of both genes, which were not increased by IH. Yet, a target mRNA search of the microRNA (miRNA) revealed both mRNAs to have a potential target sequence for miR-203. The miR-203 level of the IH-treated cells was significantly decreased when compared with the normoxia-treated cells. The IH-induced upregulation of the genes was abolished by the introduction of the miR-203 mimic, but not the miR-203 mimic NC negative control. These results indicate that IH stress downregulates the miR-203 in renin-producing cells, thereby resulting in increased mRNA levels of Ren and Cd38, which leads to hypertension.博士（医学）・甲第831号・令和4年3月15日© 2021 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/)
結腸直腸内視鏡的粘膜下層剥離術後腸管内洗浄液中遊離腫瘍細胞に対する in vitro 解析
Get PDFPurpose: Colorectal endoscopic submucosal dissection (ESD) produces exfoliated tumor cells that occasionally cause local recurrence. However, the biological characteristics of these tumor cells have not been clarified. The aim of this study was to clarify the genetic background and viability of exfoliated tumor cells in colorectal ESDs, as well as possible method for their elimination. Methods: Post-ESD intraluminal lavage samples from 19 patients who underwent colorectal ESDs were collected. In four patients with adenocarcinoma, gene mutations in the primary tumors and exfoliated cells in lavage samples were analyzed using a next-generation sequencer (NGS). In 15 patients with adenoma or adenocarcinoma, the viability of exfoliated cells and the cell-killing effect of povidone-iodine on exfoliated cells were evaluated. Results: The analysis using a NGS demonstrated that tumors targeted for ESD had already acquired mutations in many genes involved in cell proliferation, angiogenesis, and invasions. Furthermore, gene mutations between the exfoliated tumor cells and tumors resected by ESDs showed a 92 to 100% concordance. The median viable cell counts and the median viability of exfoliated cells in intraluminal lavage samples after ESDs were 4.9 × 105 cells/mL and 24%, respectively. The viability of the exfoliated cells did not decrease even 12 h after ESD. However, contact with 2.0% povidone-iodine solution reduced both viable cell counts and viability, significantly. Conclusion: A large number of tumor cells exfoliated during colorectal ESDs had acquired survival-favorable gene mutations and could survive for some time. Therefore, a lavage using a solution of 2.0% povidone-iodine may be effective against such cells. Trial registration: The prospective study registered 1317, and the retrospective study registered 2729. The prospective study approved on June 20, 2016, and the retrospective study approved on October 6, 2020.博士（医学）・乙第1520号・令和4年3月15日© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: http://dx.doi.org/10.1007/s00384-021-04037-y.発行元が定める登録猶予期間終了の後、本文を登録予定（2023.01
Study Of Factors Promoting And Hindering Subjective Well-Being Among Institutionalized Older Adults In Japan.
Get PDFObjective: This study aimed to examine the factors that promote or inhibit subjective well-being among Japanese older adults.
Methods: Factors that promote or hinder subjective well-being among residents of Japanese senior care facilities were identified and analyzed based on the background and characteristics of the Japanese people.
Results: Factors found to promote subjective well-being included a total of 23 items related to age and physical and mental health, functions and roles in life, health and vitality, participation and perception of roles, level of freedom in activities and level of staff responsiveness, and connection with nature. The inhibiting factors included 14 items related to aging, morbidity, pain, decreased mental and physical functions that inhibit activities, and dissatisfaction with family and facilities.
Conclusion: The subjective well-being of the institutionalized elderly in Japan is promoted when the degree of freedom at the behavioral level is high and inhibited when it is low. In addition, because of the Japanese elderly's unique traditions, culture, and lifestyle, they are less receptive to care from others outside the family, making institutionalization an inhibiting factor for their subjective well-being. In this context, it is useful older adults to acquire new roles and thereby recognize their dignity
日本人男性における携帯式尿流量計(P-Flowdiary®)を用いた排尿量/尿流量に関する年齢階層別ノモグラムの作成
Get PDFBackground: To develop a nomogram of urinary volume and flow based on the data of Japanese men without lower urinary tract symptoms and multiple flows per participant whose characteristics were clear. Methods: Overall, 101 Japanese male volunteers without lower urinary tract symptoms aged between 20 and 59 years were enrolled. A portable uroflowmeter (P-Flowdiary®) was used to record urinary information (flow rate and volume) for 2 successive days. The model (quadratic, linear, or logarithmic regression) most fit for the relationship between maximum flow rate and voided volume was determined. The maximum flow rate at > 150 mL was compared among the 20-29-, 30-39-, 40-49-, and 50-59-year age groups. Nomograms appropriate for the age groups were created. Results: The mean age, International Prostate Symptom Score, and Overactive Bladder Symptom Score were 38.5 years, 0.42, and 0.24, respectively. The quadratic regression model was the most fit because its mean coefficient determination was 0.93 ± 0.06. The mean maximum flow rate was significantly lower in the 50-59-year age group (21.8 ± 5.05 mL/s, P < 0.01) than in the younger groups (24.14 ± 4.94, 24.05 ± 6.99, and 24.64 ± 5.72 mL/s). The 2 nomograms are Y = 28.99 {1 - exp(- 0.01 × X)} and Y = 25.67 {1 - exp(- 0.01 × X)} for the 20-49- and 50-59-year age groups, respectively. Conclusions: The nomogram can predict maximum flow rate based on voided volume in Japanese men aged 20-59 years without lower urinary tract symptoms.博士（医学）・甲第858号・令和4年12月22日© 2022. The Author(s). Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data
