Yonago acta medica最新文献

Background: Urosepsis is defined as sepsis caused by an infection of the urogenital tract and is a systemic response to infection. Urosepsis is commonly treated in the intensive care unit (ICU) because of its acute and potentially lethal nature. Acute kidney injury (AKI) is a common complication of septic shock in ICU patients. This study predicted cases in which patients required renal replacement therapy (RRT) during the early stages of hospitalization. We also examined the relationship between the clinical information obtained at admission and the subsequent need for RRT.

Methods: This single-center, retrospective, observational study included 114 patients with sepsis caused by tract infections. We examined the multiple factors associated with AKI using clinical and social information. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines, with severe AKI defined as AKI requiring RRT. Logistic regression analyses were performed to identify the significant factors associated with severe AKI based on the information obtained at the time of admission.

Results: Severe AKI occurred in 12 patients. Multivariate analysis revealed that two factors were significantly associated with severe AKI: a high leukocyte count in the peripheral blood (> 22,100/μL) at admission (odds ratio: 21.972, 95% CI: 1.798-268.481) and the administration of vasopressors (odds ratio: 13.327, 95% CI: 1.009-176.091).

Conclusion: Physicians should be vigilant of the potential development of severe AKI in cases of urosepsis, particularly when patients require vasopressor and present with extremely high peripheral blood leukocyte counts at admission.

Background: Extensive burns induce systemic inflammation and increase vascular permeability, resulting in dehydration and edema. During burn injury, the release of high-mobility group box 1 (HMGB1) from damaged cells may promote an inflammatory response. In this study, we examined the relationship between changes in blood HMGB1 levels, vascular permeability, and lung tissue damage following burn injury.

Methods: We examined changes in blood levels of HMGB1 using a mouse model of skin burns. Additionally, we examined intercellular adhesion structures that regulate the barrier function both the skin and lung. To assess changes in vascular permeability, lung tissues of mice with burn injuries were stained with Evans blue. To elucidate the role of HMGB1 in mediating the observed changes, cultured human vascular endothelial cells (HUVECs) and alveolar epithelial cells (H441) were treated with mouse burn serum or HMGB1 protein.

Results: Herein, we observed HMGB1 leakage from burned mouse skin and elevated blood levels of HMGB1. Vascular permeability experiments using Evans blue staining confirmed increased permeability in the lung tissues of mice with burn injuries. Measurement of transendothelial electrical resistance revealed enhanced vascular permeability and reduced expression of the intercellular junction proteins in HUVECs. Conversely, treatment of H441 cells with HMGB1 disrupted the location and expression of the tight junction protein, zonula occludens-1. Treatment with the anti-HMGB1 antibody suppressed the disruption of cell-cell junctions in HMGB1-treated cells. These altered adhesion structures were also detected in pulmonary cells of mice with burn injuries. In H441 cells, HMGB1 treatment increased the activation of atypical protein kinase C (aPKC), which is essential for the formation of epithelial-specific cell-cell junctional structures. Inhibition of aPKC suppressed HMGB1-induced disruption of intercellular junction structures.

Conclusion: Collectively, these findings suggest that HMGB1-mediated dysregulation of aPKC activity may underlie burn injury-induced vascular hyperpermeability by disrupting cell-cell adhesion.

Background: We designed a single-center retrospective study comparing the performance of commercially explainable artificial intelligence (XAI)-powered computer-aided detection (CAD) system of abnormal findings on chest X-rays (CXR) with that of non-experts, and pulmonology experts.

Methods: A total of 1,262 images of 1,262 subjects (mean age 49 years; 52% female) and 1,252 images of 1,252 subjects (mean age 51 years; 51% female) were obtained from DICOM formats in Hakuai Hospital Health Check-up Center, in the pre-and post-implementing XAI-powered CAD period, respectively. The ultimate decision of abnormality on CXR was made by two pulmonology experts. The diagnostic accuracy metrics were measured accuracy and negative predictive value (NPV) for detecting abnormality on CXR.

Results: XAI-powered CAD systems achieved an accuracy of 0.84 (95% confidential interval [CI] 0.82-0.86) and NPV of 1.00 (95% CI 0.99-1.00) to detect the abnormality on CXR. For determining nodular shadows, it was found to be non-inferior to the pulmonology experts with an accuracy of 0.94 (95% CI 0.92-0.95), and NPV of 1.00 (95% CI 0.99-1.00). It tended to overestimate the abnormality of heart enlargement and pleural thickening with a tendency for lower sensitivity.

Conclusion: It seems likely that in the future, the most accurate screening CXR will be a double check combining with the pulmonology experts with XAI-powered CAD systems.

Polycythemia vera is a chronic myeloproliferative neoplasm characterized by a marked increase in circulating erythrocyte volume in middle-aged and elderly patients; it is associated with increased white blood cell and platelet counts and splenomegaly. There is a high risk of conflicting complications during surgical treatment, such as thrombosis and hemorrhage, with thrombosis being the leading cause of death. Hence, it is important to take measures against both in the perioperative management. We report a case of perioperative management of a patient with polycythemia vera and resection of an intraepithelial carcinoma of the tongue. The patient, a 46-year-old man, had been under observation at our hospital's Department of Internal Medicine for 10 years with a diagnosis of polycythemia vera. He came to our department with a complaint of white spots on the left tongue margin. Phlebotomy was performed when his blood count, hemoglobin, and hematocrit levels were elevated. The biopsy showed intraepithelial carcinoma. Preoperative examination revealed no abnormality, and a partial left-sided tongue resection was performed under general anesthesia. To prevent thromboembolism, the patient wore an elastic stocking from the time he entered the operating room. The patient underwent local hemostasis to prevent bleeding and systemic management centered on infusion therapy to prevent blood concentration. Four years and three months have passed since the surgery without recurrence.

Allogeneic hematopoietic stem cell transplantation (allo-HCT) has been established as a curative treatment for hematological malignancies such as acute myeloid leukemia and myelodysplastic syndrome. Patients aged ≥ 70 years have traditionally been considered ineligible for this procedure, because of concerns over high transplant-related mortality rates and difficulties managing post-transplant complications. However, recent advances in supportive care, expanded donor availability, and the development of reduced-intensity conditioning (RIC) regimens have increased the availability of allo-HCT for older patients. Notably, the number of allo-HCT procedures performed in patients aged ≥ 70 has been steadily increasing in Japan and Western countries, reflecting a re-evaluation of transplant eligibility in older patients. When assessing transplant eligibility in older patients, it is crucial to consider not only disease risk stratification and treatment response, but also comprehensive evaluations of general health status, comorbidities, cognitive function, and social backgrounds. In particular, indexes such as the Hematopoietic Cell Transplantation-Comorbidity Index and Comprehensive Geriatric Assessment have proven useful for predicting patient prognoses and non-relapse mortality. Donor selection and the intensity of the conditioning regimen used can both significantly influence transplant outcomes. RIC or non-myeloablative regimens are generally recommended for patients aged ≥ 70 years. Human leukocyte antigen-matched related or younger unrelated donors are preferred, while haploidentical donors or cord blood may be considered when matched donors are unavailable, although evidence in older patients is limited. This review provides a comprehensive overview of the current status of and challenges related to allo-HCT in patients aged ≥ 70 years. Patient eligibility, conditioning strategies, donor selection, and transplant outcomes are discussed in detail, based on the latest available evidence.

Amyloidosis is a group of disorders in which specific precursor proteins form insoluble amyloid fibrils are deposited in various organs and extracellular spaces. Sjögren's syndrome (SS) is a chronic inflammatory disease in which lymphocytes infiltrate the exocrine glands, such as the salivary and lacrimal glands, through an autoimmune mechanism. At advanced stages of SS, localized nodular amyloidosis has been reported in specific organs outside the glands. Herein, we report a case of localized nodular amyloidosis associated with SS. An 80-year-old woman, who had been biting her buccal mucosa for several years and was aware of the presence of a mass, which had increased in size since approximately 6 months, was referred to our hospital. The patient had a history of SS and systemic lupus erythematosus since her 50s. A needle biopsy was performed because malignancy was suspected by magnetic resonance imaging. The pathological diagnosis was ATTR-type amyloidosis. The patient underwent excision of the lesion to improve the swelling. The pathological findings showed plasma cell infiltration in some areas, which required differentiation from AL amyloidosis; therefore, the patient was referred to a facility specializing in amyloidosis. The pathological diagnosis was AL amyloidosis. Various clinical findings ruled out systemic involvement and the final pathological diagnosis was localized nodular amyloidosis. It has been reported that it may occur in the advanced stages of SS, and our patient had SS for 30 years. One year after the surgery, the patient's prognosis was good.

Burn wounds cause pain through various mechanisms, making pain management challenging. Although treatment and management strategies for healing burns have been developed, clear guidelines for analgesia in burn injuries are lacking. Opioids are commonly used for pain relief, but regional anesthesia performed by anesthesiologists has shown effectiveness in some cases. We encountered a case in which epidural anesthesia was effective for analgesia of a lower-extremity burn injury in a 19-year-old man. The patient with burn injuries to his lower extremities was transferred to the emergency department. On the day of the injury, an epidural catheter was administered for burn pain. The epidural anesthesia was removed during hospitalization, but the pain worsened, so it was placed again to provide adequate analgesia. In this case, epidural anesthesia proved effective for managing the lower-extremity burn pain and facilitated patient rehabilitation. Epidural anesthesia should be actively considered for the management of burn pain.

Background: A survey was conducted to determine the demand for the use of digital health content for health promotion, both among those interested in using digital tools and those interested in health promotion.

Methods: This study targeted smartphone owners who attended a class on how to use a smartphone (CS) and/or a class on advancements in health (CH) held in Nanbu Town. The main questionnaire items included questions on age, gender, frailty, subjective cognitive decline (SCD), smartphone usage, and interest in health promotion using digital technology. An analysis was conducted on 33 participants in the CS and 33 participants from the CH who provided complete responses to the questionnaire.

Results: The percentages of interest in using smartphones for accessing content on exercise, cognitive training, and nutrition management were 97.0%, 97.0%, and 87.9%, respectively, among CS participants and 69.7%, 78.8%, and 81.8%, respectively, among CH participants. The percentage of responses regarding interest in exercise content was significantly different between the two groups. Furthermore, some individuals responded that they were interested but concerned about how to use the services. No statistically significant differences were found with respect to the comparison of the percentages of responses by age group, frailty determination results, and SCD determination results among the participants of the CS and CR groups.

Conclusion: Regardless of age or the risk of developing health problems, there is demand for content related to health promotion using digital tools for those who want to master digital tools and who want to improve their health. However, support should be provided to them to ensure that they correctly use those tools. Notably, some individuals who want to improve their health are not interested in using digital tools.

Paroxysmal sympathetic hyperactivity (PSH) is a clinical syndrome characterized by recurrent episodes of sympathetic overactivity, including hypertonia, tachycardia, hypertension, and hyperthermia, typically following severe brain injury. While PSH is well documented in adult populations, reports on pediatric patients, particularly those with severe motor and intellectual disabilities (SMID), remain limited. Here, we report three pediatric patients with SMID due to neonatal hypoxic-ischemic encephalopathy (NHIE) who developed PSH. All patients presented with characteristic PSH symptoms and were diagnosed according to the Pediatric Clinical Practice Guidelines based on the 2014 consensus criteria. Gabapentin (GBP) was initiated at low doses (5-10 mg/kg/day) in all patients, resulting in the rapid resolution of PSH symptoms. In two patients, symptoms partially recurred within several months but were controlled through GBP dose adjustment and the addition of clonidine or other agents. No severe adverse events were observed. To our knowledge, this is the first report describing the short-term efficacy of GBP in pediatric patients who developed PSH with SMID status due to NHIE. Our findings suggest that GBP is a valuable and well-tolerated therapeutic option for the management of PSH in children with these conditions.

Background: The number of hikikomori individuals has been increasing not only in Japan but also worldwide while few studies have looked into the societal elements that could lead to further isolation of hikikomori individuals. This study examines the psychological factors in local residents related to social exclusion of hikikomori individuals.

Methods: 365 participants living in Tottori, Japan were analyzed. The questionnaire includes key questions such as social exclusion of hikikomori individuals, daily lifestyle, personal opinions and attitudes towards hikikomori individuals.

Results: Those who are unwilling to interact with people who have different sense of values were 3.6 times likely to exclude hikikomori individuals than those who did not. Those who believe that hikikomori is a family issue so that others should not intervene were 2.2 times likely to exclude them than those who did not. Conversely, those who think that people can make a fresh start in the society even after making mistakes were 0.5 times likely to exclude hikikomori than those who did not. Those who feel that they have something in common with hikikomori individuals were 0.4 times likely to exclude them than those who did not. Those who think that they can enjoy activities such as hobbies together with hikikomori individuals were 0.3 times likely to exclude them than those who did not.

Conclusion: The analysis indicates that the tendency to reject relationships with people who have different sense of values and the opinion that hikikomori is a family issue are the risk factors for social exclusion of hikikomori individuals. Contrarily, the opinion that even if we make a mistake or fail, we can make a fresh start, awareness of the similarities between oneself and hikikomori individuals, and willingness to share enjoyable activities with them are shown to be the protective factors which could reduce social exclusion of hikikomori.