Osaka city medical journal最新文献

Background: Anorexia nervosa (AN) is a mental disease with a high mortality rate, and progresses to a serious state, even in males; however the characteristics of male AN patients, including the sex ratio in Japan and the consultation behavior, have not yet been clarified. Therefore, the objective of the present study was to investigate the clinical characteristics of Japanese male AN patients, with the aim of achieving early interventions.

Methods: A total of 2015 AN patients, 60 males and 1955 females, were extracted from 4606 eating disorder patients who consulted Osaka City University Hospital for 34.5 years. The sex ratio was examined, and clinical features, mainly those related to consultation behavior, were compared between males and females. The rate of early drop-outs from outpatient treatments was also determined in male AN patients.

Results: The male ration in AN patients was 3.0%, which was markedly lower than generally considered. No significant sex difference was noted in the mean age at the time of consultation or delays in treatment. The rate of weight loss from the premorbid to lowest body weight was similar between males and females. Regarding social backgrounds, the employment rate was higher in males than in females. Male AN patients were more likely to initially consult the psychiatry department. Furthermore, the rate of early drop-outs from outpatient treatments appeared to be higher among males than females.

Conclusions: The male ratio in Japanese clinical AN patients was low. Consultation between may be restricted in males more than in other countries because eating disorders are considered to be female diseases. Male AN is physically severe, similar to female AN; therefore, early interventions were considered important. Educational programs for eating disorders not only in the general public, but also in school and companies may promote early interventions. Treatments that considered sex differences need to be developed in order to prevent early drop-outs.

Background This study evaluated the clinical significance of perioperative levels of plasma blood coagulation factor XlII in patients undergoing pulmonary resection. Methods The study involved 27 patients with ≥2day prolonged air leakage after pulmonary resection. The 27 pulmonary resection procedures comprised 25 lobectomies, 1 segmentectomy, and 1 partial resection. The preoperative and 5-day postoperative blood coagulation factor XIII levels were measured. Results Perioperative changes in the blood coagulation factor XlII levels showed no significant correlation with the preoperative hemoglobin Aic levels. The mean postoperative blood coagulation factor XIII level was 78.2±15.7% in patients with postoperative total protein levels of <6.6 g/dL, and 102.1±19.7% in patients with postoperative total protein levels of ≥6.6 g/dL (p=0.018). The mean drainage duration was 8.3 ±2.7 days in patients with postoperative blood coagulation factor XIII levels of ≤70% and 5.3 2.3 days in patients with levels of >70% (p=0.017). Conclusions Low blood coagulation factor XIII levels may be associated with prolonged air leakage and thereby exogenous blood coagulation factor XIII may lead to shorter drain placement durations in patients undergoing thoracic surgery, particularly patients with a poor nutritional status.

Background In Japan, four neuraminidase inhibitors (NAIs) are currently prescribed to patients with influenza A and B. To know the backgrounds and clinical courses of patients with influenza who were treated with NAIs is important in the selection of appropriate medications. Methods We conducted a multicenter observational study in Osaka with postcard questionnaires. Patients who were prescribed NAIs were provided postcard questionnaires containing questions on their backgrounds, body temperatures, and durations of other influenza symptoms. We analyzed the factors that were associated with early fever alleviation using a logistic regression model. Results The postcard response rate was 31% (326 of 1050), and 307 patients were enrolled in this study [150 patients who were under 10 years old (type A, 118; and type B, 32) and 157 patients who were 10 or older (type A, 114; and type B, 43)]. In the patients under 10, the multivariate analysis showed that influenza type (Type B vs Type A; Odds Ratio, 0.13; 95% Confidence Interval: 0.04-0.38) was associated with early fever alleviation. However, NAIs were not related to early fever alleviation. Laninamivir tended to contribute more to early fever alleviation compared to oseltamivir in patients under 10 (Odds Ratio, 2.50;$95% Confidence Interval: 0.90-7.80). Conclusions The types,of prescibed NAIs were not significantly related to early fever alleviation. However, the fever durations of the patients under 10 who were prescribed laninamivir were shorter than those of patients under 10 who were prescribed oseltamivir or zanamivir.

Background Delirium is the most frequent psychiatric syndrome in patients with advanced cancer, but its management is complicated by its multifactorial pathology. In this study, we investigated the association of the clinical subtypes, possible etiologies, and reversibility of delirium in patients having cancer with risperidone monotherapy. Methods This study included 16 inpatients with advanced cancer who were consecutively referred to psychiatric consultation service or palliative care team and were diagnosed with delirium by a psychiatrist. These patients were assessed using the Delirium Rating Scale Revised 98 (DRS-R98) at baseline and on a follow up visit (seventh day). The etiologies of delirium were determined using the Delirium Etiology Checklist. Oral risperidone was given once a day (0.5 or 1 mg/day) with routine clinical management. A detailed examination of the association between each clinical factor and their reversibility after risperidone treatment was examined retrospectively. Results Of the 15 patients (mean age 64.1? 9.5 years) whose data were available, 53% had hyperactive delirium and 47% had mixed delirium, while no patient showed hypoactive delirium. The most frequent etiology of delirium was metabolic/endocrine disturbance, drug intoxication, and systemic infection. In 10 patients (67%), remission of delirium was achieved, according to the DRS-R98. Neither clinical subtypes nor possible etiologies were associated with delirium reversibility after risperidone treatment. Conclusions Risperidone monotherapy is effective for treating delirium in patients with advanced cancer.

Background Alzheimer's disease (AD) patients frequently show depressive symptoms, yet the pathological background remains unclear. The voxel-based specific regional analysis system for AD (VSRAD) allows quantification of atrophy in the medial temporal structures. We measured the degree of parahippocampal atrophy in AD patients using VSRAD, and investigated the association between imaging analysis results and the severity of depressive symptoms. Methods Brain magnetic resonance imaging (MRI) was conducted in 39 AD outpatients, and all MRI data were analyzed using VSRAD. The target region of interest (ROI) mainly consisted of the parahippocampal gyrus. The degree of atrophy in the ROI was obtained from the averaged positive z score (Z-score) of the ROT. AD patients were divided into two groups based on the severity of their depressive symptoms using the Geriatric Depression Scale (GDS), the depressive group (D group: 20 patients) and non- depressive group (ND group: 19 patients), and the clinical characteristics and VSRAD results of both groups were compared. Results There were no significant differences in demographics or cognitive function between the two groups. The Z-scores of the D group were significantly higher than those of the ND group (p<0.05). Additionally, there was a significant positive correlation between the GDS score and Z-scores in the parahippocampal gyrus. Conclusions Our findings suggested that the severity of depressive symptoms is associated with the severity of parahippocampal atrophy in AD patients.

Background: Tolvaptan is an orally administered selective vasopressin 2 receptor antagonist that promotes aquaresis. This study aimed to evaluate the efficacy and safety of tolvaptan on management of systemic fluid balance after cardiovascular surgery using cardiopulmonary bypass. .

Methods: Sixty-four patients who underwent cardiovascular surgery using cardiopulmonary bypass in our hospital were enrolled for this prospective, randomized study. These patients were divided into three groups: tolvaptan 15 mg+furosemide 20 mg (TH group), tolvaptan 7.5 mg+furosemide 20 mg (TI group), and furosemide 40 mg+spironolactone 50 mg (C group). The endpoint was safety management of systemic fluid balance using tolvaptan without renal dysfunction and electrolyte imbalance.

Results: The mean daily urine output in the TH and TL groups (2656±767 and 2505 ±684 mL) was significantly higher than that in the C group (1956±494 mL, TH vs C: p<0.01 and TL vs C: p=0.03). The lowest serum sodium level during medication in the TH group (139.3 ±2.3 mEq/L) was significantly higher than that in the C group (137.1±2.9 mEq/L, p=0.03) The lowest serum osmolality during medication in the TH group was significantly higher than that in the C group (284.8 ±4.3 vs 279.5± 6.3 mOsm/kg, p<0.01). None had critical hypernatremia, hyperosm6lality, or renal dysfunction in any. of the groups.

Conclusions: Tolvaptan exerts, a strong diuretic effect compared with conventional diuretics (furosemide and spironolactone) during the postoperative period after an operation using cardiopulmonary bypass without adverse effects on electrolyte balance and renal function.

Background To effectively detect surgical patients carrying methicillin-resistant Staphylococcus aureus (MRSA) in a pediatric ward, we investigated who should be tested through bacteriological surveillance on admission. Methods In 1124 patients, bacteriological examination of throat swabs and stool samples was performed within 48 hours after admission. The relations between carrier rate (CR) of MRSA and a history of hospitalization, neurological disorder (ND), and age group were retrospectively investigated. Results The CR of all patients was 7.8%. The CRs of the patients with no history of hospitalization, a history of hospitalization before the previous year, and a history of hospitalization within the past year (HWPY) were 2.3%, 3.4%, and 14.5%, respectively; the CR of those with HWPY was significantly higher than the CRs of the other 2 groups (p<0.0001). The CR of the patients with an ND (19.2%) was significantly higher than that of the patients without an ND (6.1%) (p<0.0001). The CRs of the patients <3 (11.7%) and 15 (11.9%) years old were higher than that of other patients (3.8%) (p< 0.05). With multivariate logistic regression analysis, HWPY, an ND and age groups <3 and k15 were independent risk factors. Conclusions - HWPY, an ND, and being <3 or k 15 years old were found to be risk fqctors for carrying MRSA on admission. Active bacteriological surveillance on admission should be performed for patients with these risk factors.

Background: Mitochondrial myopathy, Encephalopathy, Lactic Acidosis, Stroke-like episodes/Leigh overlap syndrome (MELAS) is caused by defects in the mitochondrial respiratory chain. It is still largely unknown how these mitochondrial respiratory chain defects affect cellular metabolisms and lead to variable clinical phenotypes. Here, we analyzed metabolic signatures in a cellular model of MELAS/ Leigh overlap syndrome using untargeted gas chromatography coupled to mass spectrometry (GC-MS). .

Methods: We obtained fibroblasts from a MELAS/Leigh overlap syndrome patient carrying the heteroplasmic m.10191T>C mutation, and generated induced pluripotent stem cells (iPSCs) from these fibroblast. Isogenic iPSC clones carrying two different loads of the heteroplasmic mutation (ND3hig-iPSC, ND3"*w- iPSC-) were subjected to metabolome analysis. Metabolite profiles, which were identified by GC-MS, were analyzed by principal component analysis (PCA).

Results: We were able to identify about 40 metabolites in control fibroblasts and iPSCs. Upon comparative metabolome analysis between fibroblasts and iPSCs, lactic acid and proline were distinct between the two groups. When we compared patient fibroblasts and control fibroblasts, no significant distinct metabolites were found. On the other hand, patient specific iPSC with high mutational load (ND3high_ iPSC) showed a distinct metabolite profile compared with ND3""-iPSC and control-iPSCs. Metabolites that contributed to this distinction were pyruvate, malic acid, palmitic acid, stearic acid, and lactic acid. This metabolomic signature was only seen in the undifferentiated state of iPSCs and was lost upon differentiation

Conclusions: These findings suggest that patient specific iPSC technology is useful to elucidate unique pathogenic metabolic pathways ,6mitochondrial chain diseases.

Background: Although sex hormones are thought to play an important role in the carcinogenesis of non-small cell lung cancer (NSCLC) in never-smokers, the causative mechanism remains unknown. Passive smoking (PS) is common among East Asian women and has been suggested to be a potential cause of the disease.

Methods: We systematically evaluated the expression of estrogen receptor (ER), the prevalence of PS, and genetic mutations using tumor samples from a prospectively registered cohort of never-smokers with lung cancer. The study enrolled 92 never-smokers with NSCLC. Expression of ERa, ERP, and progesterone receptor (PR) was examined via immunohistochemical staining (IHC). Detailed PS information was obtained through a standardized questionnaire. The cumulative dose of PS (CPS) was evaluated as a sum of the number of exposure years at home and/or in the work place.

Results: Nuclear expression of ERa, ERP, and PR was detected in 0, 14, and 3 cases, respectively. ERP was more frequently overexpressed in earlier stage cancer (p=0.043). Ninety patients (97.9%) had a PS history, and the median CPS was 47.5 years (range, 0-103 years). There was no significant correlation between the amount of PS -and ERP expression (p=0.101). Twelve patients (85.7%) had Epidermal growth factor receptor ,EGFR) mutations in 14 .tumors expressing ERP, and a trend towards an association between ERP expression and EGFR mutations (p =0.067) was -observed.

Conclusions: Nuclear expression of ERP was more frequently observed in early stage NSCLC in never-smokers.

Background: Children with autism spectrum disorder (ASD) have varied comorbidities. With regard to comorbidity, there has been increasing interest in bipolar disorder (BP) in children. However, the prevalence of BP with ASD has varied because of the methodological differences used. Therefore the adequate criteria for determining BP in children are still debated. The purpose of this study is to identify reliable prevalence of BP and to evaluate a variety of subclinical BP symptoms in children with ASD.

Methods: This is a cross-sectional and case-control study. The participants were 110 referred children aged 6-15 years: 46 with ASD (the case group), 64 without ASD (the control group). We used the strict operational criteria for diagnosing BP, and assessed the presence of subclinical BP symptoms using a semi-structured diagnostic interview.

Results: None of the children were diagnosed with BP in the case group, although two children were diagnosed with BP in the control group. Based on the subclinical BP symptoms, the prevalence of elation/expansive mood and racing thoughts was significantly higher in the case group than in the control group: 26.1% versus 3.1% (p<.001) and 32.6% versus 9.4% (p=0.002), respectively.

Conclusions: Our finding indicates that school-aged ASD children frequently present subclinical BP symptoms. It is important to be aware of over-diagnosis of BP, even though the children present subclinical BP symptoms, and to provide -the children with effective treatments.