Tohoku Journal of Experimental Medicine最新文献

A 69-year-old female was admitted to our hospital due to muscle weakness and gait disturbance. She noted weight loss attributed to inadequate dietary intake and alcohol use approximately 4 months prior. The laboratory findings were as follows: K 2.9 mEq/L, Ca 3.7 mg/dL, Alb 2.4 mg/dL and creatine kinase (CK) 3,986 U/L. Muscle magnetic resonance imaging (MRI) demonstrated abnormal signals in the proximal lower limb muscles. Hypokalemia-induced rhabdomyolysis was suspected. However, her hypokalemia was initially refractory to potassium replacement. Further examination revealed hypomagnesemia (Mg 1.6 mg/dL), and thus oral magnesium supplementation was given alongside potassium. Afterward, the patient's clinical symptoms and electrolyte disorders normalized within10 days; her muscle weakness and myalgia with elevated levels of CK also resolved. Thus, the hypokalemia-induced rhabdomyolysis in this patient was attributed to the coexisting magnesium deficiency. Electrolyte abnormalities and trace element deficiencies can be complicated by states of malnutrition. Awareness of hypomagnesemia may be of crucial importance for the management of hypokalemia-induced rhabdomyolysis. This case report suggests that hypomagnesemia can worsen hypokalemia-induced rhabdomyolysis in patients with impaired nutritional status. Therefore, careful monitoring of electrolytes is required in patients with unusual rhabdomyolysis.

This study sought to delineate the effects of calcitriol (CAL) and clarify its role in modulating TGF-β1/SMAD-mediated myocardial fibrosis in both animal and cellular models, instigated by isoproterenol (ISO). Cardiac dysfunction was precipitated through the subcutaneous administration of ISO in BALB/c mice, followed by an assessment of the remedial effects of CAL. CAL intervention ameliorated cardiac fibrosis induced by excessive ISO exposure, which was underscored by the reduction in myocardial hypertrophy and levels of interstitial fibrosis in the cardiac tissue. ISO exposure triggered the TGF-β1/SMAD pathway and suppressed vitamin D receptor (VDR) expression; effects that were nullified by CAL therapy. Cardiac fibroblasts (CFs) were extracted from myocardial ventricles of mice, and CCK-8 assays were conducted to evaluate the viability of CFs under treatments with ISO, sTβRII (a TGF-β1 inhibitor), and CAL. The CF survival rate was increased by ISO treatment, although this was counteracted via sTβRII or CAL treatment. In this cell model, ISO treatment activated TGF-β1/SMAD pathway and downregulated VDR expression, whereas CAL cotreatment exerted a converse effect on the TGF-β1/SMAD pathway and VDR expression. VDR knockdown demonstrated its role in CAL-mediated alleviation of cell fibrosis. Our observations indicated that VDR intervention enhanced the influence of ISO on the proliferation of CFs and markedly negated the protective effects of CAL on the viability of ISO-exposed CFs. These insights unveil a pioneering role for CAL in curbing ISO-provoked cardiac fibrosis and the proliferation of CFs via the restraint of the TGF-β1/SMAD pathway through engagement with the VDR.

Esophagectomy is a high-complexity procedure, and the relationship between hospital volume, measured by the annual number of esophageal surgeries per hospital, and treatment outcomes remains a subject of debate. This study used a nationwide administrative database to identify patients diagnosed with stage 2 and stage 3 esophageal cancer between April 1, 2016, and March 31, 2022. We focused on patients who underwent preoperative chemotherapy and thoracoscopic esophageal cancer surgery and examined the relationship between hospital volume, in-hospital mortality, and postoperative complications. The hospitals were categorized into two groups: the low-volume group (n = 2,629) with less than 12 thoracoscopic esophagectomies performed annually and the high-volume group (n = 5,325) with 12 or more. We conducted propensity score matching analysis to match pairs of patients between the low-volume and high-volume groups (n = 1,984, each). In the analysis after matching, the in-hospital mortality rates were higher in the low-volume group compared to the high-volume group (1.4% vs. 0.5%, p = 0.0022). Furthermore, the incidence of postoperative complications was significantly higher in the low-volume group compared to the high-volume group: wound infections (1.7% vs. 0.7%, p = 0.0337), anastomotic leakage (6.5% vs. 2.8%, < 0.0001), and recurrent laryngeal nerve paralysis (8.3% vs. 6.5%, p = 0.0291). However, the incidence of postoperative pneumonia was higher in the high-volume group (1.7% vs. 3.5%, p = 0.0003). The length of postoperative hospital stay was also significantly longer in the low-volume group compared to the high-volume group (24 days, IQR: 18-35 vs. 20 days, IQR: 16-28, p < 0.0001). Further analysis considering the patient's quality of life, access to hospitals, and careful discussion is necessary to determine the appropriateness of esophagectomy centralization.

Coronary atherosclerosis (CAS) is a frequent clinical disease that critically affects human health and requires an early diagnostic marker. MicroRNAs (miRNAs) have the potential to be diagnostic markers due to their aberrant expression in a wide range of diseases. In this study, the levels of miR-411-5p and vasodilator-stimulated phosphoprotein (VASP) were analyzed by qRT-PCR. ROC curves were analyzed for the diagnostic value of miR-411-5p. Human Umbilical Vein Endothelial Cells (HUVECs) were treated with ox-LDL to construct a cell model. Cell proliferation, apoptosis, and inflammatory factors levels were evaluated by the CCK-8, flow cytometry, and Enzyme-linked immunosorbent assay (ELISA). The levels of miR-411-5p were higher in CAS patients than in controls. Ox-LDL promoted the miR-411-5p levels and suppressed VASP in cells. Suppressing miR-411-5p markedly mitigated ox-LDL suppressive effect on cell proliferation while also diminishing its stimulatory roles in apoptosis and inflammation. However, this alleviation was notably reversed when VASP expression was diminished. MiR-411-5p holds promising prospects as a diagnostic marker for CAS, and targeting the miR-411-5p/VASP axis could mitigate the progression of CAS.

This study aims to investigate the predictive value of long non-coding RNA taurine-upregulated gene 1 (lncRNA TUG1) for complications following cesarean section in patients with scarred uterus. We first included 186 subjects with scarred uterus. The levels of TUG1 in the serum of these subjects were measured using RT-qPCR, and based on the expression levels of TUG1, they were divided into TUG1 high expression group (90 cases) and TUG1 low expression group (96 cases). The postpartum hemorrhage, postoperative site infections, pelvic floor muscle strength, and vaginal microbiota status were compared between the two groups. And the predictive value of TUG1 for complications following cesarean section in women with scarred uteri was assessed using the receiver operating characteristic (ROC) curve. The levels of TUG1 were found to be strongly positively correlated with the abdominal scar score of the pregnant women. Furthermore, TUG1 levels in women who experienced pelvic floor dysfunction (PFD), vaginal microbiome disorders, surgical site infections (SSI), and postpartum hemorrhage were significantly higher than those in women without these complications. The ROC curve indicated that TUG1 predicted PFD, vaginal microbiota disorders, SSI, and postpartum hemorrhage with areas under the curve (AUC) of 0.811, 0.832, 0.819, and 0.887, respectively. TUG1 was positively correlated with abdominal scar scores and demonstrated good predictive value for complications after cesarean section in women with scarred uteri. These findings suggest that TUG1 has the potential to serve as a clinical biomarker for these complications.

The prevalence of type 1 (T1D) and type 2 (T2D) diabetes in reproductive women is rising. Subclinical hyperglycemia's impact on adverse pregnancy outcomes is evident. Nevertheless, the variance in outcomes between T1D and T2D pregnancies is not well-defined. We retrospectively analyzed 68 pregnancies (28 T1D, 40 T2D) at the Gunma University Hospital (Dec 2017-Mar 2022), examining maternal characteristics, insulin therapy, prepregnancy body mass index (BMI), glycated hemoglobin (HbA1c) levels, daily insulin dose, gestational weight gain, and perinatal outcomes. In T1D pregnancies, those with large-for-gestational age (LGA) infants had less improvement in HbA1c early in pregnancy and greater weight gain overall. Notably, even non-obese women with T1D often gained excessive weight, which was closely tied to LGA risk. The risk increased sharply when third-trimester HbA1c exceeded 48 mmol/mol (6.5%). These findings suggest that, despite significant gestational weight gain, insulin doses may not have been sufficiently escalated to match increased insulin resistance, contributing to both poor glycemic control and a higher risk of LGA in T1D pregnancies. Our study underscores the importance of tailoring insulin therapy and weight management to reduce LGA risk in T1D. As the use of advanced technologies such as continuous glucose monitoring (CGM), continuous subcutaneous insulin infusion (CSII), and sensor-augmented pump (SAP) therapy continues to expand in pregnancy care, ongoing data updates will be essential to refine clinical strategies and improve maternal and neonatal outcomes.