Yonago acta medica最新文献

The incidence of malignancy following long-term immunosuppression is increased in organ transplant recipients. We report a case of a patient with right ureteral and bladder cancer after living donor kidney transplantation for chronic glomerulonephritis and who was administered chemotherapy and immune checkpoint inhibitors. A 75-year-old male, 20 years post-living donor kidney transplantation for chronic glomerulonephritis, presented with malignant cells in urinary cytology. Despite initial treatments including transurethral resection of the bladder tumor, the tumor progressed to high-grade urothelial carcinoma. Computerized tomography results showed a right ureteral tumor and multiple lymph node metastases. Therefore, the patient underwent systemic chemotherapy with four cycles of gemcitabine and carboplatin. Pembrolizumab was administered due to rapid cancer progression; however, the cancer progressed further, and the patient was treated palliatively. The patient was treated with an immune checkpoint inhibitor with a reduced dose of immunosuppressive drugs with no rejection during the treatment course.

An ossifying fibroma is a fibroosseous lesion from the maxilla and mandible. Its histopathological subtypes include juvenile trabecular ossifying fibroma (JTOF) and juvenile psammomatoid ossifying fibroma. It commonly affects young individuals and is invasive in nature. A 2-year-old girl with a 2-week history of swelling in the left infraorbital region and a reduced opening of the left eye was referred to our department. Clinical examination revealed a diffuse bone-like swelling extending from the left infraorbital region to the left buccal region. Computed tomography revealed a well-defined 2-cm lesion, and magnetic resonance imaging revealed moderate-to-high signal intensity on T2-weighted imaging. A definitive diagnosis could not be arrived at based solely on imaging findings. A biopsy was initially planned; however, the tumor was extracted because it was relatively easy to separate from the surrounding bone. Histological findings showed fascicular and spiral hyperplasia of the tumor cells containing spindle nuclei and cytoplasm. Fibroma-like stroma, immature chondrocytes, and mature trabecular osteogenesis are also observed. Osteoblast-like or partially chondrocytic sequences were observed at the margins of hard tissue. Thus, a definitive diagnosis of JTOF was established. Although the tumor was extracted only in the present case, JTOF has a high recurrence rate; thus, resection of the surrounding bone is recommended following a definitive diagnosis. In this case, the period from onset to surgery was short, and early treatment allowed the tumor to be removed before it invaded the surrounding bone; therefore, extraction alone prevented recurrence. It can be distinguished from fibrous dysplasia, which has similar pathological findings, based on the observation of osteoblast-like structures at the edge of the trabecular bone. Moreover, the negative guanine nucleotide-binding protein alpha-stimulating activity of polypeptide 1 further confirmed JTOF. No signs of recurrence were observed in this case at 11 years and 9 months postoperatively.

Background: Perioperative patient health literacy influences postoperative recovery and self-management. We conducted a cross-sectional study to determine perioperative patient health literacy levels and associated factors.

Methods: From August 2021 to January 2022, 187 patients undergoing surgery at an acute care hospital completed a self-administered questionnaire, based on the Functional, Communicative and Critical Health Literacy (FCCHL) scale, to assess health literacy and related factors. Multiple regression analysis was conducted to identify factors associated with health literacy.

Results: Out of 316 surveyed patients, 187 were included in the analysis. Over 70% of perioperative patients in this study were classified as having limited health literacy according to the FCCHL scale. These patients exhibited low communicative and critical health literacy. Factors significantly associated with patients' total health literacy scores included age, knowledge about diseases, education level, use of media about health and disease, and generalized self-efficacy.

Conclusion: Healthcare providers should recognize that perioperative patients generally possess low health literacy. Understanding factors influencing individual health literacy levels is essential to provide tailored support in the perioperative patient.

Background: Cognitive dysfunction is a major symptom in schizophrenia associated with social skills. It has been reported that cognitive rehabilitation can improve cognitive dysfunction. The Brief Assessment of Cognition in Schizophrenia-Japanese version (BACS-J) is often used as an outcome measure to assess the effectiveness of cognitive rehabilitation. However, the minimal clinically important difference (MCID) in the BACS-J composite score has not been reported. Therefore, we conducted this study to calculate a preliminary MCID in the BACS-J composite score and confirm the feasibility of retrospective data collection and analysis for future large-scale studies.

Methods: The medical records of patients with schizophrenia who underwent cognitive rehabilitation were retrospectively surveyed. BACS-J data were collected at the beginning and end of the cognitive rehabilitation, and Clinical Global Impression-Improvement (CGI-I) data obtained at the end of the cognitive rehabilitation were evaluated retrospectively. To calculate the MCID in the BACS-J composite score using distribution-based methods, the standard error of measurement was calculated as a characteristic of the scale itself. To calculate the MCID using anchor-based methods, the mean change in BACS-J score corresponding to "minimally improved" on the CGI-I was determined.

Results: Twenty-eight patients were included in this study, and BACS-J data were collected from all patients. The CGI-I was completed by 11 patients, 3 of whom showed "minimally improved" according to their CGI scores. Distribution-based methods applied to the data of 28 patients revealed an MCID of 0.735 for the BACS-J composite score. Anchor-based methods were ultimately not applied because the sample size was insufficient.

Conclusion: This study confirmed that CGI and BACS-J data can be collected and analyzed retrospectively. According to distribution-based methods, an increase of approximately 0.7 in the BACS-J composite score can be considered clinically meaningful. Future studies with larger sample sizes using both calculation methods could provide more accurate MCID.

Background: Inflammation is believed to contribute to the pathophysiology of depression, with increased levels of inflammatory cytokines, such as interleukin-1β (IL-1β), observed in patients. Depression is also common in individuals with chronic inflammatory diseases. IL-1β disrupts synaptic transmission and reduces neurogenesis in the hippocampus, playing a crucial role in depression development. Our prior research found that stress activates microglia in the brain to produce IL-1β via the nucleotide-binding oligomerization domain-like receptor family pyrin domain containing 3 (NLRP3) inflammasome. Additionally, β-hydroxybutyrate (BHB), an endogenous ketone body, alleviates stress-induced depression by inhibiting NLRP3 activation and IL-1β production. However, BHB's poor bioavailability limits its effectiveness. Medium-chain triglycerides (MCTs) can increase blood BHB levels, making them a potential treatment for stress-induced depression.

Methods: We tested MCT in two animal models: social defeat (SD) in mice and chronic unpredictable stress (CUS) in rats. MCT was orally administered to both groups to assess blood BHB levels. Behavioral tests, including the forced swim test (FST), were performed, and brain tissue was analyzed for IL-1β levels and spine density.

Results: MCT administration increased blood BHB levels 7-11 times within 1 hour. In the SD model, MCT significantly reduced immobility time in the FST, suggesting antidepressant effects. While the CUS model showed no significant change, a trend toward reduced immobility time was observed. MCT treatment also reduced stress-induced IL-1β levels in the rat hippocampus, although spine density remained unchanged.

Conclusion: MCT appears to alleviate stress-induced depression-like behaviors, likely through the suppression of IL-1β in the hippocampus. Owing to its ease of oral administration, MCT may offer a practical treatment for stress-related depression.

Background: This study evaluated the effectiveness of preoperative inflammatory response markers in distinguishing clear cell carcinoma (CCC) and endometrioid carcinoma (EC) from ovarian endometrioma.

Methods: Patients with stage I ovarian cancer with histology CCC/EC or endometrioma who underwent surgery at our institution between 2010 and 2021 were included. Preoperative inflammatory response markers evaluated were white blood cell count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, D-dimer, neutrophil/lymphocyte ratio (NLR), platelet count/lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). The tumor markers CA125 and CA19-9 were analyzed. The median values of these markers were compared between the CCC/EC and the endometrioma groups. The areas under the curve (AUC) in Receiver Operating Characteristic analysis were compared.

Results: Fifty patients with stage I CCC/EC and 247 patients with endometrioma were included in the study. Inflammatory response markers were significantly higher in CCC/EC cases than in endometrioma cases (P < 0.01). Tumor markers demonstrated higher specificity than inflammatory response markers. The AUCs of CRP, ESR, D-dimer, NLR, and SII were significantly higher than those of CA125 and CA19-9 (P < 0.01). The values of NLR, PLR, and SII in four cases of ovarian cancer with preoperative suspected endometrioma were higher than the cut-off value.

Conclusion: Inflammatory response markers may be useful for the detection of stage I ovarian cancer. Notably, the NLR or SII, calculated using a complete blood count, appears particularly efficient. Combining tumor and inflammatory response markers may enhance diagnostic accuracy in distinguishing ovarian cancer from endometrioma.

Thirst is fundamentally considered as a physiological function developed to maintain the homeostasis of body fluids. However, we occasionally experience thirst in situations that are not necessarily related to the maintenance of bodily fluid homeostasis. Because the only method available had been to quantify the degree of thirst using psychological indices, thirst research had made little progress until very recently. To quantitatively analyze thirst, it is necessary to elucidate the nature of the brain's "thirst center," which is believed to become active in response to thirst. Textbooks of physiology often refer to the "thirst center" in the hypothalamus, which is considered to sense the osmotic pressure of body fluids. However, they did not specify the location of this center in the hypothalamus. Furthermore, the existence of the so-called "osmotic pressure sensors" has yet to be confirmed. However, recently, a series of findings have been published that delve into the true nature of the thirst center. These advancements have been achieved using several new techniques, including the real-time monitoring of neural activities related to thirst regulation within the brains of experimental animals. At least at the animal level, recent advancements in experimental techniques have made it possible to objectively quantify the intensity of thirst as a physiological response. In this review article, the history of our research is presented and latest developments in thirst research are presented.

Background: To evaluate and compare the survivals and radiotherapy-induced adverse events (AEs) of intensity-modulated radiotherapy (IMRT) with androgen deprivation therapy (ADT) and trimodality therapy, including low-dose iodine-125 brachytherapy, external beam radiotherapy, and ADT, for high-risk localized prostate cancer (LPC).

Methods: High-risk patients with LPC at T stage ≥ 3a, Gleason score ≥ 8, and initial prostate-specific antigen ≥ 20.0 ng/mL treated between 2010 and 2021 were retrospectively evaluated. All the patients were treated with IMRT plus ADT or trimodality therapy. In both groups, ADT was initiated 6 months before and continued for 2 years after radiotherapy. Survival and acute and late radiation-induced AEs were evaluated and compared.

Results: Two hundred and thirty-eight patients were treated with IMRT, and 91 underwent trimodality. Five- and 7-year biochemical-clinical failure-free survival (BCFFS) rates in the IMRT/trimodality group were 94.9/96.2, and 91.8/91.5%, respectively (P = 0.511). Stratified by 1-2/3 factors, 5- and 7-year BCFFS rates in the IMRT groups were 95.8/91.8, and 95.8/75.6%, respectively (P = 0.009). Five and 7-year BCFFS rates in the trimodality group were 96.8/94.1, and 91.4/94.1%, respectively (P = 0.995). The cumulative 3-/5-year incidence of late genitourinary AEs in the IMRT/trimodality group was 7.3/8.4, and 15.5/16.9%, respectively (P = 0.037), and the cumulative 3-/5-year incidence of late gastrointestinal AEs was 2.2/3.4, and 11.0/12.2%, respectively (P = 0.001). Thirty patients (9.1%) could not complete long-term ADT.

Conclusion: Treatment results of both IMRT and trimodality were considered to be good, and our results also indicated that the long-term survival of unfavorable high-risk patients with LPC who had three risk factors was poor in the IMRT group. Further treatment experience of both modalities must be accumulated with more appropriate patient allocations.

Background: In recent years, various psychological interventions have garnered attention as effective support methods to promote self-management and comprehensively understand those with physical and psychological problems associated with knee pain. The purpose of this study was to implement an instructional design (ID) based self-management program for outpatients diagnosed with KOA and to verify the effectiveness of the program.

Methods: In this single-arm uncontrolled before‒after comparative intervention study, 41 subjects diagnosed with symptomatic knee osteoarthritis participated in an intervention program. Their pain, physical function, self-efficacy, self-care agency, and daily life difficulties were evaluated. A mixed-effects model was employed to examine the changes in each outcome from baseline to immediately before and after the intervention, and after one, three, and six months.

Results: "Pain at the beginning of walking," "pain from standing to sitting position," and "pain after long-distance walking" reduced significantly immediately after the intervention and after one month. "Pain when climbing stairs" reduced significantly immediately after the intervention and after one, three, and six months. The sit-to-stand test showed significant improvement from baseline to immediately after and one, three, and six months after the intervention. Self-care agency scores improved significantly immediately after the intervention and after one and six months.

Conclusion: The intervention program effectively improved physical function, self-care agency, and self-efficacy, and reduced pain from one to six months. Innovation: This program could lead to an increase in the healthy life expectancy of the older adults.

Background: Perioperative hypothermia, a common occurrence in patients undergoing general anesthesia, is defined as a core body temperature below 36°C. The relationship between patient body composition and the incidence of hypothermia remains underreported. This study aims to elucidate the association between body composition and perioperative hypothermia in patients undergoing open gastrectomy.

Methods: Patients undergoing open gastrectomy were enrolled in the study. Patients whose bladder temperature was lower than 36°C were allocated to the hypothermia group, and the other patients were allocated to the control group. The patient's body composition was evaluated by bioelectrical impedance analysis.

Results: A total of sixty-eight patients participated in this study. Among them, 34 experienced perioperative hypothermia (bladder temperature below 36°C) and were classified into the hypothermia group, while the remaining 34 were placed in the control group. The hypothermia group had a significantly higher body surface area per body weight. Additionally, the hypothermia group exhibited significantly lower total fat mass, skeletal muscle mass index, and basal metabolic rate (P < 0.05). However, body fat percentage and visceral fat mass did not differ significantly between the groups. Multivariate analysis identified total fat mass below 11.2 kg (HR 4.51, 95% CI: 1.35-15.03, P = 0.014) and skeletal muscle mass index below 10.06 kg/m² (HR 5.61, 95% CI: 1.86-16.93, P = 0.002) as independent risk factors for perioperative hypothermia.

Conclusions: Low total fat mass and a low skeletal muscle mass index are significant risk factors for perioperative hypothermia in patients undergoing open gastrectomy. These risk factors could improve the accuracy of identifying high-risk patients for perioperative hypothermia.