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後縦隔ミュラー管嚢胞の３切除例
Get PDFMullerian cysts in the posterior mediastinum are cystic lesions that occur near the spine in females, and they are considered relatively rare with few reported cases. We encountered three cases of Mullerian cysts in the posterior mediastinum. Case 1 was a 42-year-old female who was diagnosed with a right ovarian endometriotic cyst after surgery in our department. Case 2 was a 34-year-old female with no previous medical history. Case 3 was a 40-year-old female with a history of taking low-dose oral contraceptives with no previous medical history. All cases underwent thoracoscopic resection of cystic lesions, and immunohistochemical staining confirmed the diagnosis of Mullerian cysts in the posterior mediastinum. The results at our institution suggest that Mullerian cysts in the posterior mediastinum may not be as rare as previously thought. Additionally, we investigated the relationship between Mullerian cysts in the posterior mediastinum and anti-Mullerian hormone（AMH） in one case. We report our case, along with the relevant literature.journal articl
Nmnat1 Deficiency Causes Mitoribosome Excess in Diabetic Nephropathy Mediated by Transcriptional Repressor HIC1
Get PDFNicotinamide adenine dinucleotide (NAD) is involved in renal physiology and is synthesized by nicotinamide mononucleotide adenylyltransferase (NMNAT). NMNAT exists as three isoforms, namely, NMNAT1, NMNAT2, and NMNAT3, encoded by Nmnat1, Nmnat2, and Nmnat3, respectively. In diabetic nephropathy (DN), NAD levels decrease, aggravating renal fibrosis. Conversely, sodium–glucose cotransporter-2 inhibitors increase NAD levels, mitigating renal fibrosis. In this regard, renal NAD synthesis has recently gained attention. However, the renal role of Nmnat in DN remains uncertain. Therefore, we investigated the role of Nmnat by establishing genetically engineered mice. Among the three isoforms, NMNAT1 levels were markedly reduced in the proximal tubules (PTs) of db/db mice. We examined the phenotypic changes in PT-specific Nmnat1 conditional knockout (CKO) mice. In CKO mice, Nmnat1 expression in PTs was downregulated when the tubules exhibited albuminuria, peritubular type IV collagen deposition, and mitochondrial ribosome (mitoribosome) excess. In CKO mice, Nmnat1 deficiency-induced mitoribosome excess hindered mitoribosomal translation of mitochondrial inner membrane-associated oxidative phosphorylation complex I (CI), CIII, CIV, and CV proteins and mitoribosomal dysfunction. Furthermore, the expression of hypermethylated in cancer 1, a transcription repressor, was downregulated in CKO mice, causing mitoribosome excess. Nmnat1 overexpression preserved mitoribosomal function, suggesting its protective role in DN.journal articl
Prospective Multicenter Registry-Based Study on Thyroid Storm : The Guidelines for Management From Japan Are Useful
Get PDFContext: The mortality rate in thyroid storm (TS) has been reported to be higher than 10%.
Objective: We aimed to evaluate the effectiveness of the 2016 guidelines for the management of TS proposed by the Japan Thyroid Association and Japan Endocrine Society.
Methods: In this prospective multicenter registry–based study, patients with new-onset TS were registered in the Research Electronic Data Capture (REDCap), a secure web platform. On day 30 after admission, clinical information and prognosis of each patient were added to the platform. On day 180, the prognosis was described.
Results: This study included 110 patients with TS. The median of Acute Physiology and Chronic Health Evaluation (APACHE) II score was 13, higher than the score (10) in the previous nationwide epidemiological study (P = .001). Nonetheless, the mortality rate at day 30 was 5.5%, approximately half compared with 10.7% in the previous nationwide survey. Lower body mass index, shock, and lower left ventricular ejection fraction were positively associated with poor prognosis at day 30, while the lack of fever ≥ 38 °C was related to the outcome. The mortality rate in patients with an APACHE II score ≥ 12 for whom the guidelines were not followed was significantly higher than the rate in patients for whom the guidelines were followed (50% vs 4.7%) (P = .01).
Conclusion: Prognosis seemed better than in the previous nationwide survey, even though disease severity was higher. The mortality rate was lower when the guidelines were followed. Thus, the guidelines are useful for managing TS.journal articl
Microdialysis-integrated HPLC system with dual-electrode detection using track-etched membrane electrodes for in vivo monitoring of dopamine dynamics
No full textA capillary high-performance liquid chromatography (HPLC) system equipped with a dual-electrode detector utilizing track-etched membrane electrodes (TEMEs) was combined with a microdialysis sampling setup. The electrochemical detector benefits from the high electrolysis efficiency of TEMEs, allowing for calibration-free coulometric detection and simplifying data analysis to determine the dopamine recovery through a dialysis probe. Additionally, this system was used for in vivo monitoring of dopamine in the right striatum of a mouse brain. Temporal changes in dopamine levels, including an exponential decay immediately after the dialysis probe insertion and an excess release of dopamine induced by a high concentration of potassium ions, confirmed the system's proper operation. Furthermore, subsequent measurements following the intraperitoneal injection of mirtazapine showed no increase in dopamine levels in the right dorsal striatum. The dual-electrode system displayed characteristic dopamine detection behavior, with anodic and cathodic peak pairs indicative of reversible electrochemical reactions. This capability facilitated the identification of the dopamine peak within the complex chromatogram of the mouse brain dialysate. The consistency between dopamine collection efficiency from standard solutions and dialysate indicated the absence of interfering electroactive substances overlapping with the dopamine peak in the chromatogram. This integrated analysis system successfully tracked temporal fluctuations in dopamine concentration within the mouse brain.journal articl
Quenching high-temperature phase in Cu–Sn alloy system by femtosecond and picosecond laser irradiation
Get PDFThis study investigated the dependence of irradiation fluence and pulse duration on the non–thermal alloying of Cu and Sn through laser irradiation. Femtosecond and picosecond laser irradiation were applied to the GaN part of a bilayer of Cu and Sn deposited on GaN. The laser beam operated at a wavelength and repetition rate of 1030 nm and 1 MHz, respectively, with pulse durations of 0.65 and 38 ps. Subsequently, the irradiated samples were thinned using a focused ion beam, and the cross-sections were examined with transmission electron microscopy. The lattice constants of the resultant phases were identified from selected area diffraction patterns. In data analysis, we identified the phases as β-Sn and ε-phases first, if discernible within a 5% error margin, employing high-temperature phases when identification was not possible. In the irradiated area, only Cu and Sn were detected under a lower fluence and shorter pulse duration. However, δ-phases, which are alloys of Cu and Sn, formed at relatively higher fluences and longer pulse durations. This high-temperature phase, unique to picosecond laser irradiation, cannot be obtained through conventional thermodynamic processes, highlighting the unique capabilities of laser-induced processing in creating novel alloy phases. These findings advance our understanding of laser-material interactions and provides a foundation for developing advanced materials with tailored properties for various applications.journal articl
Current Real-World Status of Oral Anticoagulant Management in Japanese Patients
Get PDFAnticoagulant therapy is a drug therapy that inhibits the formation of blood clots. Although anticoagulants are effective in preventing thromboembolism, they also carry the risk of bleeding, so they must be managed carefully, taking both efficacy and safety into account. Evidence regarding the effectiveness and safety of each anticoagulant has already accumulated through many large clinical trials and post-marketing surveillance. However, when making decisions in clinical practice, it is necessary to always take into consideration differences in patient populations between clinical trials and actual clinical practice, as well as differences in historical background. (For example, there are differences in antiplatelet drugs and coronary artery interventions that were mainly used in each era.) In this review we discuss the effectiveness and safety of currently used anticoagulants, focusing on different patient backgrounds and points to keep in mind regarding their proper use, based on the latest reports in Asian populations, especially Japanese people, over the past 1–2 years.journal articl
Risk Factors for Intraoperative Instability in Sedated Patients Undergoing Pulmonary Vein Isolation Ablation
Get PDFPersistent or paroxysmal atrial fibrillation is typically treated with pulmonary vein isolation (PVI) ablation under deep sedation with propofol. Intraoperative hemodynamic or respiratory instability often interferes with the surgical procedure. We retrospectively investigated risk factors in 80 patients who underwent their first PVI ablation for atrial fibrillation at our hospital. Background and echocardiography findings were collected from their electronic charts and the questionnaires they completed during hospitalization. Total intraoperative propofol dose and bolus injections (total number and volume) were defined as surrogate measures of patient instability. Single and stepwise multiple regression were performed using each measure as the dependent variable. When total propofol dose was employed as the dependent variable, significant associations were observed with drinking status (P < 0.05) and body mass index (BMI) (P < 0.05). When total number or volume of intravenous propofol boluses were each used as the dependent variable, significant associations were noted with age (P < 0.05) and BMI (P < 0.05). Separately, statistical analyses were conducted using total propofol dose or total number of bolus injections as the dependent variable and echocardiography parameters as independent variables. A significant association was detected between total dose and left atrial dimension (P < 0.05). These results suggested that younger age, higher BMI (obesity), and current drinking status adversely affect patient stability under deep sedation. To ensure safe ablation, physicians should pay attention to these risk factors when administering deep sedation for PVI.journal articl