Kurume Medical Journal最新文献

Enhanced oncogenic Y-box binding protein-1 (YB-1) expression, associated with the aberrant expression of genes involved in cell proliferation, survival, and drug resistance, can predict prognostic outcomes in patients with various malignancies. We examined whether YB-1 could predict prognostic outcomes in patients with endometrial cancer and whether enhanced YB-1 expression affects the expression of mammalian target of rapamycin (mTOR) in endometrial cancer. We examined the expression levels of YB-1 and mTOR in tumor samples of 166 patients with endometrial cancer, including those with endometrioid grade 1-3, serous carcinoma, and stage I-IV disease, who underwent surgery. The expression levels of both molecules were assessed using immunohistochemical analysis. The correlation between the expression levels of YB-1 or mTOR and prognosis was also confirmed.The positivity rate of nuclear YB-1 expression was 9.4%. YB-1 expression was associated with poor progression-free survival (P = 0.012) and overall survival (P = 0.003). Fifty-nine patients (35.5%) exhibited mTOR expression. Nuclear YB-1 expression was also correlated with mTOR expression (P = 0.006). We observed similar results when examining only patients who underwent adjuvant chemotherapy. Enhanced nuclear YB-1 expression could predict poor outcomes in endometrial cancer and was significantly associated with enhanced mTOR expression.

We encountered a case of situs inversus totalis in conjunction with an anomalous artery connecting the common hepatic artery and a jejunal branch of the superior mesenteric artery during anatomical dissection of a cadaver. The heart was located in the center of the thorax, with the apex located anterioinferiorly to the right of the midline and the base located posterosuperiorly to the left of the midline. The aortic arch coursed from right anterior to right posterior. The right lung was divided into two lobes, and the left lung was divided into three. The entire intraperitoneal gastrointestinal tract, from the stomach to the rectum, formed a mirror image with the expected normal anatomy. The liver was located on the left side of the upper abdominal cavity, and the spleen was located on the right. The cardia of the stomach was located on the right side, and the pylorus was on the left. The cecum and appendix were located on the left, and the sigmoid colon ran toward the pelvic cavity from the right. In addition to situs inversus totalis, an anomalous artery called the arc of Bühler that branched off the common hepatic artery and entered the mesenteric arcade between the first and second jejunal arteries was observed. These anomalies were not embryologically related and occurred separately from each other. However, their presence may cause confusion during abdominal surgery. Knowledge of this specific combination of anatomical variations may help surgeons who encounter it in clinical practice.

Background: Cerebral sinus venous thrombosis (CSVT) is a thrombosis of the cerebral veins and dural sinuses. It is a challenging condition for a physician due to varied symptoms. We aimed to study the clinical, radiological, etiology, and outcome of CSVT in a rural population.

Methods: Patients with suspected symptoms of CSVT and positive neuroimaging by MRI with MRV were enrolled in the study. Patients with normal neuroimaging, arterial stroke, space-occupying lesions, and unwillingness to participate were excluded from the study. The patient's demographic data and clinical presentation were noted. Protein C and S, anti-thrombin III, ANA, anti-phospholipid antibodies (APLA), and homocysteine were analyzed.

Results: The incidence of CSVT was most common in the age group of 21-40 years (44.3%) and in males. The presentation was mostly subacute (61.4%). Headache was the most common presentation (80%), followed by seizures. The most common site of the thrombus is the superior sagittal sinus (51.4%), the next being the transverse sinus (25.7%). CSVT was attributed to hyperhomocysteinemia in 40% of patients, and protein C and S deficiency was seen in 14.3%. Almost all of them recovered completely (93%).

Conclusion: Cerebral sinus venous thrombosis primarily afflicts adults in their middle age, marked by notable manifestations such as headaches and seizures. The prognosis is good with early diagnosis and management.

Background: Although recent studies have revealed the importance of inflammation in the pathogenesis of aortic dissection (AD), little is known about the relationships among inflammatory cells in human AD tissue.

Methods and results: We assessed the relationships among various immune cell types, including neutrophils, macrophages (M1 and M2), B cells, and helper T cells (Th1, Th2, Th17, Treg and Tfh ) in human AD tissue. AD tissues displayed abundant infiltration of immune cells. Correlation analysis revealed two groups of highly correlated cell types: a group of neutrophils and M1 and M2 macrophages, and another group consisting of B cells and helper T cells. In one particular case of AD, we were able to analyze the correlations between neutrophils and M1 and M2 macrophages in the entry, border, and intact zones of the AD lesions. Neutrophils showed significant correlations with M1 and M2 macrophages in the border zones. The entry and border zones showed M1-dominant polarization, whereas the intact zone showed M2-dominant polarization.

Conclusions: These findings indicate the existence of cell type-specific and site-specific interactions among immune cell types in human AD tissues.

Introduction: Postpancreaticoduodenectomy hemorrhage (PPH) is a serious complication. Fatty or nonfibrous pancreas, or both, is a risk factor for pancreatic fistula. This study assessed various prognostic factors for interventional procedures for PPH, also focusing on the degree of pancreatic fatty infiltration/fibrosis evaluated histopathologically.

Material and methods: The participants were 29 patients with PPH who underwent endovascular treatment from September 2001 to March 2020. Univariate analysis was performed to determine whether the histopathological degree of pancreatic fatty infiltration/fibrosis and other factors were associated with complications and mortality after endovascular treatment for PPH.

Results: Of 39 treatment sessions overall, 38 (97%) achieved technical success and 34 (87%) had clinical success. In-hospital mortality occurred in five patients (17%). No association was found between the pancreatic fistula and the histopathological degree of pancreatic fatty infiltration/fibrosis. Fourteen patients with hemorrhagic shock before endovascular treatment included all five patients with in-hospital mortality, while the 15 patients without hemorrhagic shock survived (P = 0.017). A bleeding tendency was associated with complications after endovascular treatment for PPH (P = 0.033).

Conclusions: Although our results revealed no significant relation between the histopathological degree of pancreatic fatty infiltration/fibrosis and clinical success, including prognosis, endovascular treatment may be effective for PPH.

This study explored postoperative outcomes for patients with lower rectal cancer who underwent low anterior resection (LAR) or intersphincteric resection (ISR). A total of 49 patients (33 LAR, 16 ISR) were followed using anorectal manometry and quality of life (QOL) questionnaires over a year, pre- and post surgery. The primary aim of this study is to clarify differences in anal manometry, sphincter function, fecal incontinence, and QOL between the two surgical arms. The secondary aim was to identify indicators suitable for assessing relationships between anorectal manometry measurements, fecal incontinence, and QOL. Anorectal manometry elements (AMEs), such as atmospheric maximum mean squeeze pressure (aMSP), maximum tolerable volume (MTV), and incremental maximum mean squeeze pressure (iMSP), showed no significant differences during the observation period. However, maximum resting pressure (MRP), high-pressure zone length (HPZ), and threshold volume (TV) were significantly worse in the ISR group. Fecal incontinence, measured by Wexner and Kirwan scores, was significantly better in the LAR group. We observed no differences in SF36 between the two groups. Multi-correlation analysis revealed positive and negative correlations among these factors, with inverse correlations between anorectal manometry measurements and incontinence assessments decreasing post-surgery. We found no correlation between SF36 and anorectal manometry at any time. The findings indicate that surgical technique affects postoperative anal function, fecal incontinence, and SF36. However, combined assessment methods should be used with caution when deriving relationships between anal function and SF36.

This study surveys the factors regarding reading and writing difficulties in children with attentiondeficit hyperactivity disorder (ADHD) and uses these results to provide support. We conducted surveys on 16 elementary school children from 3rd to 6th grades who were diagnosed with ADHD by a physician based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). We conducted a Hiragana reading test, a Kanji reading and writing test, and a visual perception test on the subject children. We requested that the parents of the children complete a reading and writing symptom checklist, the Developmental Coordination Disorder Questionnaire (DCDQ), the Strength and Difficulties Questionnaire (SDQ), the ADHD-Rating Scale (ADHD-RS), and the Autism-Spectrum Quotient (AQ). We conducted a multiple regression analysis using the Kanji reading and writing test as the dependent variable. Results revealed that the positional task score in the visual perception test was a factor that influences Kanji writing. Meanwhile, gender, reading-related items on the reading and writing symptom checklist, and performance such as misreading of hiragana were factors that influenced Kanji reading. Based on the results, we suggested that when teaching Kanji writing, children's visual cognition ability should be assessed, and ways to incorporate learning methods that supplement visual perception, such as color masses and electronic learning materials, should be devised. When teaching reading, we suggest using teaching materials that present not only text but also audio as needed, and support the awareness of parents.

Introduction: The foramen ovale (FO) is present in the posterior part of the greater wing of sphenoid. A trauma or space-occupying lesion in this area would result in clinical manifestations due to compression of the structures passing through it. This study was undertaken because of the clinical significance of the FO in radiological and neurological procedures. The aim is to study the morphometry of the FO and its bilateral variations.

Material and methods: Fifty adult dry human skulls of unknown age and sex were studied. The shape of the FO, presence of accessory foramina or abnormal bony outgrowths, if any, were noted. Maximum length and width of FO were measured.

Results: The FO was present bilaterally in all 50 skulls. Accessory foramen was present in 17 (34%) and 13 (26%) skulls on the right and left side, respectively. Bony out growths were present in 9 (18%) and 15 (30%) skulls on the right and the left side, respectively.

Conclusion: Understanding the exact topography, morphometry and variations of the FO is required to enable the clinician to correctly interpret radiographs and help in planning the surgical procedures. The findings presented here should be taken into account when neurological procedures of the middle cranial fossa are performed.

Aim: We developed and evaluated the statistical reliability and validity of a family needs scale directly answerable by families in critical care settings.

Methods: In this qualitative study, 39 questions were drafted to capture family needs. These questions were then administered to the families of patients in emergency care settings. Exploratory factor analyses identified several needs factors and factor structures of the questions with oblique rotation. A confirmatory factor analysis examined internal consistency and criterion-related and construct validity.

Results: Three factors comprising 32 items were extracted from the exploratory factor analysis: "Needs for fulfilling family roles," "Needs for appropriate treatment and care," and "Needs for respecting family ties." Cronbach's α was 0.949 for the total score and 0.927, 0.914, and 0.896 for factors A-C, respectively, with cumulative variance of 50.0%. The three factors' confirmatory factor analysis revealed a relatively good model fit. A significant correlation was found between this scale and the assessment scale for the needs of families of patients in the intensive care unit.

Conclusions: A new scale assessing family needs was developed, and its reliability and validity were confirmed. The scale has acceptable psychometric properties and can be used to measure family needs in critical care settings, particularly in Japanese cultural contexts.

A 59-year-old woman, who had a history of acute coronary syndrome (ACS) but without obstructive coronary lesions 2 years previously, presented with vertigo. MRI revealed a left cerebellar embolism. TEE detected a mobile aortic valve tumor, suggesting a papillary fibroelastoma (PFE). Reviewing previous echocardiograms, it was discovered that the tumor was present at the time of the ACS event. At surgery, the PFE was present on the right coronary cusp. When the aortic valve was opened, it was found that the tumor was obstructing the right coronary artery (RCA) ostium. ACS was probably caused by PFE's dynamic obstruction of the RCA ostium.