4569 research outputs found
Sort by
A case of hypertensive disorders of pregnancy that developed at 9 weeks of gestation
Get PDFPreeclampsia and superimposed preeclampsia usually develop after 20 weeks of gestation. We report a case of a 35-year-old Japanese woman who developed hypertensive disorders of pregnancy (HDP) before 20 weeks of gestation. She presented with hypertension and proteinuria at 9 and 11 weeks of gestation, respectively, and developed nephrotic syndrome at 17 weeks of gestation. She did not have definite hypertension or urinary abnormalities before pregnancy. The patient was serologically positive for the antinuclear antibody. However, the complement levels were normal and anti-phospholipid antibody was not detected. A renal biopsy performed at 18 weeks of gestation showed diffuse endotheliosis and tip lesions of secondary focal segmental glomerulosclerosis but no hypertensive changes of the arterioles. Although electron microscopic examination showed electron-dense deposits in the subendothelial lesions, they were considered nonspecific plasma exudation by mass spectrometry. An abortion was performed at 20 weeks gestation because the patient’s congestive symptoms due to nephrotic syndrome had worsened and marked fetal growth restriction was observed. After delivery, the patient’s symptoms resolved immediately without any additional treatment; however, continuous antihypertensive medication was required. Finally, the patient was diagnosed with HDP based on the renal biopsy findings and her clinical course after delivery. Compared to previous reports, this case describes the earliest onset of HDP. Thus, HDP should be considered as a differential diagnosis in pregnant women with hypertension or proteinuria presenting with symptoms before 20 weeks of gestation.journal articl
Evaluation of MBT STAR-Cepha and MBT STAR-Carba kits for the detection of extended-spectrum β-lactamases and carbapenemase producing microorganisms using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry
Get PDFRapid and simple detection of extended-spectrum β-lactamase (ESBL) and carbapenemase is essential for antimicrobial treatment and infection control. Recently, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS)-based MBT STAR-Cepha and MBT STAR-Carba kits have been developed with simplified MBT STAR-BL operations. However, the utility of these kits has not been fully examined in clinical microbiology laboratories. In this study, we evaluated the utility of MALDI-TOF MS-based MBT STAR-Cepha and MBT STAR-Carba kits to detect ESBL and carbapenemase-producing bacteria, and compared it with the conventional broth microdilution test and PCR amplification assay. We found that the MBT STAR-Cepha kit efficiently enabled to distinguish resistant strains of third-generation cephalosporin susceptibility phenotypes and non-SHV-type ESBL producers. In the receiver operating characteristic analysis, the area under the receiver operating characteristic curve (AUC) for detecting third-generation cephalosporin resistance using the MBT STAR-Cepha kit was 0.97-1.00, but the AUC for detecting ESBL producers was 0.64. In addition, we showed that the MBT STAR-Carba kit enable the accurate detection of antimicrobial resistance by IMP-type carbapenemase producers. The AUC for detecting carbapenemase producers was 1.00. The results suggested that the target bacterial strains, antimicrobial susceptibility phenotypes, and resistance genes were important for the utility of the MALDI-TOF MS-based MBT STAR-Cepha and MBT STAR-Carba kits in bacterial routine diagnostics.journal articl
Planned two-stage surgery using lateral lumbar interbody fusion and posterior corrective fusion: a retrospective study of perioperative complications
Get PDFPurpose: To determine the effect of planned two-stage surgery using lateral lumbar interbody fusion (LLIF) on the perioperative complication rate following corrective fusion surgery in patients with kyphoscoliosis.
Methods: Consecutive patients with degenerative scoliosis who underwent corrective fusion were divided into a control group that underwent single-stage posterior-only surgery and a group that underwent planned two-staged surgery with LLIF and posterior corrective fusion. We collected the patient background and surgical data and assessed the perioperative complication rates. We also investigated spinopelvic parameters and patient-reported outcome measurements (PROMs).
Results: One hundred and thirty-eight patients of mean age 69.8 (range, 50?84) years who met the study inclusion criteria were included. The two-stage group (n=75) underwent a staged anterior-posterior surgical procedure and the control group (n=63) underwent single-stage surgery. There was no significant between-group difference in the incidence of perioperative complications, except for deep wound infection (reoperation is necessary for surgical site infection). Revision surgery within 3 months of the initial surgery was more common in the control group (n=8, 12.7%) than in the two-stage group (n=3, 4.0%). Spinopelvic parameters and PROMs were significantly better in the two-stage group at 2 years postoperatively.
Conclusion: The complication rate for planned two-stage surgery was similar to that of previous posterior-only single-stage surgery. However, early reoperation was less common, and the degree of spinal correction and clinical results were significantly better after two-stage surgery.journal articl
MALDI imaging mass spectrometry revealed atropine distribution in the ocular tissues and its transit from anterior to posterior regions in the whole-eye of rabbit after topical administration
Get PDF浜松医科大学博士（医学）doctoral医学系研究科It is essential to elucidate drug distribution in the ocular tissues and drug transit in the eye for ophthalmic pharmaceutical manufacturers. Atropine is a reversible muscarinic receptor used to treat various diseases. However, its distribution in ocular tissues is still incompletely understood. Matrix-assisted laser desorption/ionization?imaging mass spectrometry (MALDI-IMS) evaluates drug distribution in biological samples. However, there have been few investigations of drug distribution in ocular tissues, including whole-eye segments. In the present study, we explored the spatial distribution of atropine in the whole-eye segment by MALDI-IMS, and then evaluated the changes in atropine level along the anterior?posterior and superior?inferior axes. A 1% atropine solution was administered to a rabbit and after 30 min, its eye was enucleated, sectioned, and analyzed by MALDI-IMS. Atropine accumulated primarily in the tear menisci but was found at substantially lower concentrations in the tissue surrounding the conjunctival sacs. Relative differences in atropine levels between the anterior and posterior regions provided insights into the post-instillation behavior of atropine. Atropine signal intensities differed among corneal layers and between the superior and inferior eyeball regions. Differences in signal intensity among tissues indicated that the drug migrated to the posterior regions via a periocular-scleral route. Line scan analysis elucidated atropine transit from the anterior to the posterior region. This information is useful for atropine delivery in the ocular tissues and indicates that MALDI-IMS is effective for revealing drug distribution in whole-eye sections.doctoral thesi
Regional and temporal differences in brain activity with morally good or bad judgments in men: a magnetoencephalography study
Get PDF浜松医科大学博士（医学）doctoral医学系研究科Many neuroimaging studies on morality focus on functional brain areas that relate to moral judgment specifically in morally negative situations. To date, there have been few studies on differences in brain activity under conditions of being morally good and bad along a continuum. To explore not only the brain regions involved but also their functional connections during moral judgments, we used magnetoencephalography (MEG), which is superior to other imaging modalities for analyzing time-dependent brain activities; only men were recruited because sex differences might be a confounding factor. While analyses showed that general patterns of brain activation and connectivity were similar between morally good judgments (MGJs) and morally bad judgments (MBJs), activation in brain areas that subserve emotion and “theory of mind” on the right hemisphere was larger in MGJ than MBJ conditions. In the left local temporal region, the connectivity between brain areas related to emotion and reward/punishment was stronger in MBJ than MGJ conditions. The time-frequency analysis showed distinct laterality (left hemisphere dominant) occurring during early moral information processing in MBJ conditions compared to MGJ conditions and phase-dependent differences in the appearance of theta waves between MBJ and MGJ conditions. During MBJs, connections within the hemispheric regions were more robust than those between hemispheric regions. These results suggested that the local temporal region on the left hemisphere is more important in the execution of MBJs during early moral valence processing than in that with MGJs. Shorter neuronal connections within the hemisphere may allow to make MBJs punctual.doctoral thesi
Current trends of vitamins and trace elements in the clinical practice of chronic kidney disease
Get PDFビタミンおよび微量元素の摂取量は食事量と比例するため，食事摂取量が不足した透析患者では欠乏症を合併する．とくに水溶性ビタミンは透析や濾過によって容易に除去されるため，ビタミンB1欠乏症を中心に高頻度に存在する．また，脂溶性ビタミンではビタミンDとK，微量元素では亜鉛の欠乏症が多い．
現時点で，透析患者に対するビタミンおよび微量元素の目標摂取量は，「日本人の食事摂取基準（2020年版）」を参考とする．ビタミンや微量元素の欠乏は，透析患者の非特異的なさまざまな症状と関連する可能性があるため，原因として欠乏症が疑われる場合は血中濃度を測定する．ビタミンおよび鉄，亜鉛，セレンなどの微量元素には保険適応の薬があるため，欠乏症の診断がつけば治療は可能である．しかし，透析患者にビタミンおよび微量元素を補充することで，長期的な予後が改善するというエビデンスはないため，漫然とした長期投与は避けるべきである．journal articl
A Case of Cervical Schwannoma that Was Initially Suspected as a Cystic Lymph Node Metastasis Secondary to Papillary Thyroid Carcinoma
Get PDF浜松医科大学医学部耳鼻咽喉科・頭頸部外科学教室 峯田周幸教授退任記念論文集～症例から学ぶ～Festschrift for Professor Hiroyuki Mineta In Hornor of His Retirement as Chairman of Hamamatsu University School of MedicineNeck cystic masses of various causes are frequently encountered in otorhinolaryngological practice. Papillary thyroid carcinoma is also known to be associated with cystic cervical lymph node metastasis. Measurement of the thyroglobulin level in the cyst fluid is considered to be useful for the diagnosis. Herein, we report a case of cervical schwannoma that was initially suspected as a cystic lymph node metastasis secondary to a papillary thyroid carcinoma. A 49-year-old woman was diagnosed as having thyroid papillary carcinoma and cervical lymph node metastases. She was treated by total thyroidectomy and cervical lymph node resection. Three years after the operation, she developed a cystic mass in the upper left neck, which began to gradually increase in size. We resected this cystic mass in the upper neck under the suspicion that it was a cystic lymph node metastasis secondary to the papillary thyroid carcinoma, but histopathology of the resected specimen revealed the diagnosis of schwannoma.journal articl
Expression profile of S100A2 and its clinicopathological significance in renal cell carcinoma
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
