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頚髄圧迫を診断する身体所見の正診度と信頼性についての横断的研究
Full text linkIntroduction: Cervical myelopathy diagnosis is based on specific symptoms, physical signs, and imaging findings. However, information on the accuracy and reliability of physical signs, particularly the Wartenberg reflex and the finger escape sign (FES), is lacking. Therefore, this study aimed to assess the validity and reliability of the Hoffmann and Trömner signs, FES, Wartenberg reflex, and combination of any one positive of these four physical signs.
Methods: We reviewed the Hoffmann and Trömner signs, FES, and Wartenberg reflex from the medical records of patients with cervical cord compression who underwent surgery. We included those who underwent lumbar spine surgery as
controls, except those with upper extremity symptoms or a history of cerebrospinal disease. Subsequently, we calculated the sensitivity and specificity of cervical cord compression. The primary and secondary observers performed two and one trial, respectively, to measure the intra- and interobserver reliabilities.
Results: This study included 46 cases and 42 controls. The diagnostic sensitivities for the Hoffmann sign, Trömner sign, Wartenberg reflex, FES, and combination of any one positive were 46%, 72%, 63%, 22%, and 83%, respectively; the diagnostic specificities were 98%, 79%, 95%, 98%, and 79%, respectively; the intraobserver kappa value (κ) was 0.80, 0.82, 0.86, 0.66, and 0.95, respectively; and the interobserver κ was 0.84, 0.51, 0.51, −0.02, and 0.60, respectively. Notably, all κ values, except the interobserver κ for the FES, were obtained with P<0.01.
Conclusions: Each physical sign had high specificity but low sensitivity in predicting cervical cord compression. Therefore, they may be useful for definitive diagnosis but not for screening tests. The combination of the four physical signs exhibited improved sensitivity and may be useful for screening tests. However, the results of these physical signs should be
carefully interpreted owing to the low level of interobserver reliability.権利情報：© 2025 The Japanese Society for Spine Surgery and Related Research. SSRR is an Open Access journal distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Anyone may download, reuse, copy, reprint, or distribute articles published in the journal for not-for-profit purposes if they cite the original authors and source properly. If you remix, transform, or build upon the material, you may not distribute the modified material.
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The Psychological Status of Parents of Children with Steroid Combination Therapy Depressive Symptoms During Acute Lymphoblastic Leukemia Treatment in Japan : A Literature Review
Full text linkミトコンドリアカルシウムユニポーター（MCU）は、マウスの虚血再灌流脳損傷に対す る虚血ポストコンディショニング効果に関与している
Full text linkThe phenomenon of ischemic postconditioning (PostC) is known to be neuroprotective against ischemic reperfusion (I/R) injury. One of the key processes in PostC is the opening of the mitochondrial ATP-dependent potassium (mito-KATP) channel and depolarization of the mitochondrial membrane, triggering the release of calcium ions from mitochondria through lowconductance
opening of the mitochondrial permeability transition pore. Mitochondrial calcium uniporter (MCU) is known as a highly sensitive transporter for the uptake of Ca2+ present on the inner mitochondrial membrane. The MCU has attracted attention as a new target for treatment in diseases, such as neurodegenerative diseases, cancer, and ischemic stroke. We considered
that the MCU may be involved in PostC and trigger its mechanisms. This research used the whole-cell patch-clamp technique on hippocampal CA1 pyramidal cells from C57BL mice and measured changes in spontaneous excitatory postsynaptic currents (sEPSCs), intracellular Ca2+ concentration, mitochondrial membrane potential, and N-methyl-d-aspartate receptor (NMDAR) currents under inhibition of MCU by ruthenium red 265 (Ru265) in PostC. Inhibition of MCU increased the occurrence of sEPSCs (p = 0.014), NMDAR currents (p < 0.001), intracellular Ca2+
concentration (p < 0.001), and dead cells (p < 0.001) significantly after reperfusion, reflecting removal of the neuroprotective effects in PostC. Moreover, mitochondrial depolarization in PostC with Ru265 was weakened, compared to PostC (p = 0.004). These results suggest that MCU affects mitochondrial depolarization in PostC to suppress NMDAR over-activation and prevent elevation of intracellular Ca2+ concentrations against I/R injury.権利情報：© 2024. 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/
アルコール関連肝疾患のマウスモデルにおける肝線維症および腸管バリア機能に対するエラフィブラノールの効果
Full text linkBACKGROUND
Alcohol-associated liver disease (ALD) is a leading cause of liver-related morbidity
and mortality, but there are no therapeutic targets and modalities to
prevent ALD-related liver fibrosis. Peroxisome proliferator activated receptor (PPAR) α and δ play a key role in lipid metabolism and intestinal barrier homeostasis, which are major contributors to the pathological progression of ALD. Meanwhile, elafibranor (EFN), which is a dual PPARα and PPARδ agonist, has reached a phase III clinical trial for the treatment of metabolic dysfunctionassociated steatotic liver disease and primary biliary cholangitis. However, the benefits of EFN for ALD treatment is unknown.
AIM
To evaluate the inhibitory effects of EFN on liver fibrosis and gut-intestinal barrier
dysfunction in an ALD mouse model.
METHODS
ALD-related liver fibrosis was induced in female C57BL/6J mice by feeding a 2.5% ethanol (EtOH)-containing Lieber-DeCarli liquid diet and intraperitoneally injecting carbon tetrachloride thrice weekly (1 mL/kg) for 8 weeks. EFN (3 and 10 mg/kg/day) was orally administered during the experimental period. Histological and molecular analyses were performed to assess the effect of EFN on
steatohepatitis, fibrosis, and intestinal barrier integrity. The EFN effects on HepG2
lipotoxicity and Caco-2 barrier function were evaluated by cell-based assays.
RESULTS
The hepatic steatosis, apoptosis, and fibrosis in the ALD mice model weresignificantly attenuated by EFN treatment. EFN promoted lipolysis and β-oxidation and enhanced autophagic and antioxidant capacities in EtOH-stimulated HepG2 cells, primarily through PPARα activation. Moreover, EFN inhibited the Kupffer cell-mediated inflammatory response, with blunted hepatic exposure to lipopolysaccharide (LPS) and toll like receptor 4 (TLR4)/nuclear factor kappa B (NF-κB) signaling. EFN improved intestinal hyperpermeability by restoring tight junction proteins and autophagy and by inhibiting apoptosis and proinflammatory responses. The protective effect on intestinal barrier function in the EtOH-stimulated Caco-2 cells was predominantly mediated by PPARδ activation.
CONCLUSION
EFN reduced ALD-related fibrosis by inhibiting lipid accumulation and apoptosis, enhancing hepatocyte autophagic and antioxidant capacities, and suppressing LPS/TLR4/NF-κB-mediated inflammatory responses by
restoring intestinal barrier function.権利情報：©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved
ラット膵腫瘍モデルにおけるSN-38含有ミセル型ナノ粒子を用いた動注療法
Full text linkPurpose To evaluate advantages of micellar nanoparticles encapsulating SN-38, a biologically active metabolite of irinotecan, in intraarterial therapy for pancreatic cancer.
Materials and Methods Rat pancreatic cancer cells (DSL-6A/C1) were implanted in Lewis rats under laparotomy. This study consists of two parts. Firstly, after confirming tumor formation by ultrasonography, celiac arteriography was performed, and tumor blood supply was visually evaluated by dye injection and CT during arteriography. Secondly, 18 rats were divided into two groups; the Micellar Nanoparticles group and the Irinotecan Infusion
group. Micellar nanoparticles or irinotecan was injected via the celiac artery, and SN-38 and irinotecan concentrations in the tumor, duodenum and pancreatic parenchyma, were
measured at 5 min, 6 h and 24 h.
Results The maximum concentration (Cmax) of SN-38 were shown at 6 h in the Micellar Nanoparticles group, while Cmax of irinotecan was shown at 5 min in the Irinotecan Infusion group. Tumor concentration in the Micellar Nanoparticles group maintained elevated for 24 h without significant decrease (P = 0.068). Conversely, a significant decrease was observed in the regular pancreas parenchyma (P = 0.006) and duodenum (P = 0.028). In the Irinotecan Infusion group, tumor irinotecan concentration
significantly decreased at 24 h (P = 0.016).
Conclusion Micellar nanoparticles may improve arterial infusion chemotherapy for pancreatic cancer. These nanoparticles have the potential to reduce SN-38 accumulation in duodenum, while increasing it in the tumor. Further research is warranted to validate and expand upon these findings.権利情報：© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 202
免疫抑制剤による腸内細菌叢の変化が骨格筋量の減少を引き起こす：マウスを用いた動物実験とヒトの観察研究からの証拠
Full text linkBackground/Objectives: The number of older adults requiring a kidney transplant (KT) is increasing; hence, postoperative sarcopenia prevention is necessary. KT recipients require permanent oral immunosuppressants (ISs), and the gut microbiota (GM) plays a role in various systemic diseases. However, few studies have evaluated post-kidney transplantation frailty and the associations among ISs, GM, and muscle mass alterations. Therefore, we investigated the effects of ISs on GM and skeletal muscle mass in mice and human KT recipients. Methods: Mice were treated with six different ISs, and their skeletal muscle mass, GM diversity, and colonic mucosal function were assessed. Human KT recipients and donors were monitored before and after surgery for 1 year, and GM diversity
was evaluated before and 1 month after surgery. Results: The abundance of Akkermansia, crypt depth, and mucin 2 expression were lower in tacrolimus- and prednisolone-treated mice. The psoas muscle volume changes at 1 month and 1 year after surgery were lower in KT recipients than in donors. Furthermore, the beta diversity was significantly different between the operative groups (p = 0.001), and the KT group showed the lowest Shannon index. Conclusions: The findings of this study indicate potential links among ISs, GM, and muscle mass decline. Further investigation is required to improve therapeutic strategies and patient outcomes.権利情報：© 2025 by the authors.
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Concerns of Nursing Students Affected by COVID-19 Outbreak and Need for Pre-graduate Technical Training
Full text link目的：新型コロナウイルス感染症は看護学生の実習や技術演習時間に影響を与えた。本研
究は、卒業前の看護学生の技術演習に対するニーズと、卒業前演習への参加の違いによる卒
業後3か月の不安を明らかにすることを目的とした。方法： 2022年3月に大学を卒業した看護
学生76名を対象に、卒業前と卒業3か月後に質問紙による縦断調査を実施した。結果：卒業
前調査は72名、卒業後調査は16名を有効回答とした。就職進学の不安の内容は、卒業前と
卒業後ともに看護技術が最も多かった。卒業前の技術演習では、より高度な看護技術の希望が
多かった。卒業前技術演習の参加の有無による卒業3か月後の状態不安尺度平均得点の違
いには、有意差を認めなかった。考察：看護技術に対する不安が高い学生が多く、感染症拡大
に伴い、実習で看護技術の実施機会が減少したことが影響していると考えられる。結論：卒業前
の技術演習項目は、実習で扱う機会が少ない、より高度な看護技術の必要性が示された
術中脊髄モニタリングにおいて波形増幅法を必要とするのはどのような症例か？
Full text linkBACKGROUND CONTEXT: Transcranial electrical stimulation motor-evoked potentials (Tc-MEPs) are the current trend and are important in preventing intraoperative neurological deficits. Post-tetanic Tc-MEPs (p-MEP) can augment the amplitudes of compound muscle active potentials (CMAPs), especially in the case of insufficient conventional Tc-MEPs (c-MEP).
PURPOSE: To retrospectively investigate pre- and intraoperative factors necessitating p-MEP
monitoring and to examine changes in the success rates of baseline Tc-MEP monitoring before and after tetanic stimulation in patients with such factors.
STUDY DESIGN: Retrospective observational study.
PATIENT SAMPLE: Patients (n=184) who underwent spinal surgery with Tc-MEP monitoring in
our department between August 2020 and July 2022.
OUTCOME MEASURES: Manual muscle testing (MMT) scores were calculated to identify patients with preoperative motor deficits. c-MEP and p-MEP amplitudes were recorded from the defined muscles.
METHODS: We compared preoperative and intraoperative factors between the c-MEP and p-MEP groups (study 1). In cases where the factors were identified, we investigated the success rate of the baseline MEP measurement of each muscle before and after tetanic stimulation (study 2).
RESULTS: One hundred fifty-seven patients were included. Of those, 87 showed sufficient
CMAPs with c-MEP. Meanwhile, 70 needed p-MEP because of insufficient CMAPs. In univariate
analysis, cervical/thoracic surgery (p<.001), preoperative MMT 3 or below (p=.009), shorter dura tion of illness (p=.037), previous cerebrovascular disease (p=.014), and dialysis (p=.031) were sig nificantly associated with p-MEP group. Preoperative MMT 3 or below was the only factor requiring p-MEP (odds ratio, 3.34; 95% confidence interval, 1.28-8.73, p=.014) in multivariate analysis. In the p-MEP group, 24 patients had preoperative motor deficits; 16 patients with complete data were included in the analysis (study 2). The success rates of MEP monitoring before and after tetanic stimulation of the entire lower-extremity muscles were 42.7 and 57.3%, respectively (p<.001). The success rates for each muscle before and after tetanic stimulation were abductor pollicis brevis: 81.3% and 96.9%, tibialis anterior: 34.4% and 50.0%, gastrocnemius: 25% and 40.6%, and abductor hallucis: 68.8% and 81.3%, respectively. No significant differences were observed in success rates for any of the muscles.
CONCLUSIONS: Patients with preoperative MMT 3 or below highly needed p-MEP. The success
rate of baseline MEP monitoring increased with tetanic stimulation, even in patients with preoperative motor deficits. We believe that p-MEP monitoring can result in reliable CMAP recording, especially in cases of preoperative motor deficits with MMT scores of 3 or below.権利情報：© 2024 Elsevier Inc. All rights reserved