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術中運動誘発電位モニタリングによる内頚動脈閉塞に対する虚血耐性評価
Get PDFBalloon test occlusion (BTO) is a useful examination for evaluating ischemic tolerance to internal carotid artery (ICA) occlusion. The aim of this study was to investigate the relationships between intraoperative motor evoked potential (MEP) monitoring and the results of preoperative BTO. Between 2013 and 2017, 32 patients undergoing surgery under general anesthesia with intraoperative MEP monitoring, in whom preoperative BTO was performed, were identified. A receiver operator characteristic (ROC) analysis was performed to determine the appropriate cutoff value of MEP amplitude for BTO-positive. Furthermore, the accuracy of MEP monitoring for BTO-positive was compared with electroencephalogram (EEG) and somatosensory evoked potential (SEP) monitoring. Four of 32 (12.5%) patients were BTO-positive. The cutoff value of MEP amplitude for BTO-positive was a > 80% reduction from the baseline level, which showed sensitivity of 100% and specificity of 100%. Thus, the sensitivity and specificity for BTO-positive were significantly higher for MEP than for EEG (100% and 72.0%, p = 0.02) in 28 patients, but they were not significantly different compared with SEP (33.3% and 100%, p = 0.48) in 21 patients. MEP monitoring might be one of the alternatives for evaluating ischemic tolerance to ICA occlusion during surgery. The cutoff value of MEP amplitude was a > 80% reduction.博士（医学）・乙第1483号・令和2年12月24日© Springer Nature B.V. 2020This is a post-peer-review, pre-copyedit version of an article published in Journal of clinical monitoring and computing. The final authenticated version is available online at: http://dx.doi.org/10.1007/s10877-020-00573-0
Clinically aggressive solid pseudopapillary neoplasmの一例
Get PDF背景: Solid pseudopapillary neoplasm (SPN) は若年女性に好発する膵腫瘍であり、通常は被膜を有する境界明瞭な病変であるが、時として局所浸潤や転移を伴う。厚い線維性被膜と変性による嚢胞化、細胞・組織所見における偽乳頭状構造など典型例は診断が容易であるが、細胞像のみでは神経内分泌腫瘍などとの鑑別が困難なことが多い。SPNの多くはCTNNB 1の変異を有し、免疫染色でのβ-cateninの核内陽性像が診断に有用とされている。症例: 70歳代男性。糖尿病にて通院中、膵尾部及び肝多発病変を指摘された。膵癌多発肝転移が疑われ当院を紹介受診した。膵尾部からの細胞検体では、核分裂像を伴いN/C比の高い小型細胞が結合性に乏しく出現していた。免疫染色ではβ-cateninの核内陽性像が確認され、SPNと診断した。結論: 多発肝転移を伴うSPNの1例を経験した。SPNはしばしば転移を伴うが、そのような症例も予後は良好であると報告されている。細胞検体ではSPNの診断はしばしば困難ではあるが、縮小手術が考慮されるなど治療方針に関わるため、免疫染色も含めた診断が望まれる
Visiting Nurses' Attitudes for the Prevention of Repeated Offences among Patients Receiving Regional Treatment Based on the Medical Treatment and Supervision Act.
Get PDFTo clarify nurses' attitudes for the prevention of repeat offenses among patients receiving regional treatment based on the Medical Treatment and Supervision Act, interviews were conducted with 6 nurses engaged in the provision of home-visit nursing services, and the obtained data were qualitatively and descriptively analyzed. The nurses' focuses of support for such patients aimed at preventing repeat offenses were summarized as , , , , and
アンギオテンシン受容体を遮断することによりYes関連蛋白質の発癌活性が阻害されて胆管癌細胞増殖が抑制される
Get PDFCholangiocarcinoma (CCA) is a destructive malignancy with limited responsiveness to conventional chemotherapy. Although angiotensin receptor blockers (ARBs) have gained attention for their potential anticancer activity, little is known about their effects on CCA. The transcriptional co-activator, Yes-associated protein (YAP) is a critical oncogene in several cancers, including CCA. Following recent evidence showing that YAP is regulated by angiotensin II (AT-II), we investigated the effects of an ARB, losartan, on two human CCA cell lines (KKU-M213 and HuCCT-1) with regards to YAP oncogenic regulation. Losartan suppressed AT-II-induced CCA cell proliferation in a dose-dependent manner, induced apoptosis, decreased YAP (Ser127), and downregulated the YAP target genes CTGF, CYR61, ANKRD1, and MFAP5. However, losartan did not affect epithelial-mesenchymal transition, differentiation, or stemness in the CCA cells. Xenograft tumor growth assay showed that oral administration of a low clinical dose of losartan considerably reduced subcutaneous tumor burden and attenuated intratumor vascularization in CCA cell-derived xenograft tumors in BALB/c nude mice. These results indicate that ARB therapy could serve as a potential novel strategy for CCA treatment.博士（医学）・甲第728号・令和2年3月16日Copyright © 2018 Elsevier B.V. All rights reserved
内耳前庭細胞由来の培養上清を用いた胚性幹細胞から内耳前庭有毛細胞への分化誘導
Get PDFVestibular hair cells (V-HCs) in the inner ear have important roles and various functions. When V-HCs are damaged, crippling symptoms, such as vertigo, visual field oscillation, and imbalance, are often seen. Recently, several studies have reported differentiation of embryonic stem (ES) cells, as pluripotent stem cells, to HCs, though a method for producing V-HCs has yet to be established. In the present study, we used vestibular cell conditioned medium (V-CM) and effectively induced ES cells to differentiate into V-HCs. Expressions of V-HC-related markers (Math1, Myosin6, Brn3c, Dnah5) were significantly increased in ES cells cultured in V-CM for 2 weeks, while those were not observed in ES cells cultured without V-CM. On the other hand, the cochlear HC-related marker Lmod3 was either not detected or detected only faintly in those cells when cultured in V-CM. Our results demonstrate that V-CM has an ability to specifically induce differentiation of ES cells into V-HCs.博士（医学）・甲第743号・令和2年3月16日© 2019 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/BY-NC-ND/4.0/)