Kurume Medical Journal最新文献

Background: The impact of visitation restrictions due to the coronavirus disease (COVID-19) pandemic remains uncertain. This study examined delirium incidence and length of hospital stay of patients who underwent coronary artery bypass grafting, percutaneous coronary intervention, and transcatheter aortic valve implantation before and after visitation restrictions.

Methods: The visitation restriction group (RG) included patients admitted and discharged between April 1, 2020, and March 31, 2022, whereas the non-restriction group (Non-RG) included those between April 1, 2018, and March 31, 2020. A chi-square test and sensitivity analysis were conducted to compare delirium incidence. The Mann-Whitney U test was used to compare the median length of stay. We conducted a multivariate logistic regression analysis to examine the association between delirium incidence and visitation restrictions and performed a subgroup analysis.

Results: There was no significant difference in delirium incidence between Non-RG and RG (0.7% vs. 2.1%, P=0.083), as supported by the sensitivity analysis (3.3% vs. 2.1%, P=0.29). The length of stay significantly differed between Non-RG and RG (14 vs. 16 days, P=0.021). The odds ratios for delirium incidence, visitation restriction, emergency admission, and daily living level II were 2.46 (1.11-5.84), 3.65 (1.65-8.31), and 18.2 (3.45- 78.8), respectively. In the subgroup analysis, increase in sleep medications and discharge support were observed in high-risk patients.

Conclusion: The analyses revealed no significant differences in delirium incidence between Non-RG and RG; however, the length of stay slightly increased. Delirium support and strategies for patient well-being during a pandemic are warranted.

Objective: Endometrial cancer (EC) is the third most common malignancy in woman with excellent prognosis when diagnosed in early-stage. Recurrences are extremely rare in Stage I EC especially in rectum when not associated with endometriosis. We present a case of rectal metastasis from endometrial carcinoma after 8 years of primary diagnosis. A review of the literature showed only 6 published cases.

Case presentation: Herein we present a 59-year-old woman with a rectal tumor mass. The patient before 8 years was surgically treated for EC Stage IA with bilateral salpingo-oophorectomy and hysterectomy. After ultra-low anterior resection rectum was removed with the tumor. Histology revealed adenocarcinoma with positive immunohistochemistry for CK7, ER, PAX8, Vimentin which confirmed endometrial origin. Endometriosis was not found.

Conclusion: Although rectum is a rare site of recurrence from endometrial cancer, rectal tumors should be sampled carefully. Previous patient history and positive immunohistochemistry for EC are in favor of recurrent disease. Screening of colorectal carcinoma should be performed in patients with previous gynecologic diagnosis. Further genetic analysis in bigger case series is needed in order to explain the time and the site of recurrence of early-stage endometrial carcinoma.

Bioactive peptides consist of multiple linked amino acids that are secreted from cells and act on specific receptors in order to transmit information from one cell to another. Through signal transduction, bioactive peptides regulate various physiological functions in the body, and the discovery of new bioactive peptides is therefore likely to lead to the development of various diagnostic and therapeutic agents. In this article, we have focused on the bioactive peptides that are known as feeding regulatory peptides. They are among the bioactive peptides discovered as ligands for G protein-coupled receptors (GPCRs), and we have reviewed their diverse functions. In addition, the status of structural analysis of GPCRs, which is necessary in the drug discovery process, and research on orphan GPCRs, for which new ligands are expected to be discovered in the future, is introduced to systematize modern peptide research and discuss future developments in bioactive peptide research.

The painful Os peroneum syndrome is subdivided into acute and chronic cases. The acute presentation is usually caused by trauma, most commonly a supination or inversion of the ankle, which consequently can lead to a fracture of the Os peroneum or even a rupture of the peroneus longus tendon. Furthermore, its chronic presentation comes as a result of recurrent foot injuries or even recovery from a fracture with calcification remodeling of this sesamoid bone. The problem of underdiagnosing this disease lies in the consequences attached to the remodeling of the peroneus longus tendon with its calcification, or even leading to a picture of tenosynovitis and subsequent tendon rupture. We report a 55-year-old female patient who complains of pain in the lateral region of her right foot for ten days. The right foot X-ray detected the presence of "Os peroneum." Magnetic resonance imaging (MRI) shows edematous ossification in the peroneus longus tendon compatible with Os peroneum and with swelling of the surrounding soft tissue and tendinopathy of the peroneus longus, precisely in the region indicated by the skin marker. The set of findings is compatible with painful Os peroneum syndrome. The patient was treated with a non-steroidal anti-inflammatory for five days with the resolution of symptoms.

Background: The purpose of this study was to investigate the effect of the main fragment fracture type (oblique or transverse) on the union rate of femoral shaft fractures.

Methods: Patients who underwent surgical treatment with an antegrade intramedullary nail for femoral shaft fracture (Arbeitsgemeinschaft für Osteosynthesefragen / Orthopaedic Trauma Association; AO/OTA type 32 type B or C) between January 2009 and March 2021 were included in this study. Patients with oblique fractures of the two main fragments on radiographs immediately after surgery were classified into the oblique fracture group. Patients with at least one of the two main fractures being transverse fractures were classified into the transverse fracture group. We investigated age, sex, height, weight, body mass index (BMI), AO/OTA classification, time from fracture to surgery, intramedullary nail length and diameter, number of interlocking screws, and bone union rate.

Results: A total of 55 fractures were included. The mean age was 34.4 ± 16.7 (range, 16-77) years. There were 41 fractures classified into the oblique fracture group and 14 fractures classified into the transverse fracture group. There was a significantly higher proportion of men in the transverse fracture group. Patients in the transverse fracture group were significantly younger and taller. Only 1 of 41 (2.4%) patients in the oblique group experienced nonunion, while 3 of 14 (21.4%) patients in the transverse group experienced nonunion (p = 0.030).

Conclusion: Comminuted femoral shaft fractures with transverse fracture components are more prone to nonunion.

Profunda femoris artery aneurysms (PFAAs) are rare because of the histo-anatomical characteristics of the profunda femoris arteries. We present a case of simultaneous PFAA and common femoral artery aneurysm (CFAA) incidentally detected on computed tomography in a 58-year-old man with diverticular bleeding. Images revealed a 37-mm right PFAA and a 24-mm right CFAA. According to the report, PFAAs >20 mm are a surgical indication, and surgery should be decided based on the patient's general condition. We resected the aneurysms and reconstructed the arteries using vascular prostheses. The postoperative course was uneventful, and the patient was discharged 8 days postoperatively.

Introduction: This study aimed to investigate the efficacy of hyperbaric oxygen therapy (HBOT) in patients presenting with malignant bowel obstruction (MBO) and peritoneal dissemination.

Materials and methods: We retrospectively examined whether HBOT affects prognosis following MBO with peritoneal dissemination. This study included 44 patients diagnosed with MBO secondary to peritoneal dissemination at our hospital between January 2013 and December 2022. Among these patients, 30 underwent HBOT. The treatment protocol involved daily HBOT administration, comprising 100% oxygen at 2.5 atmospheres absolute for 60 min.

Results: In a univariate analysis of HBOT and non-HBOT groups, the proportion of patients able to resume eating was significantly higher in the HBOT group. Therefore, the percentage of patients in the non-HBOT group whose MBO did not improve was significantly higher than that in the HBOT group. The percentage of patients undergoing surgery or receiving anticancer treatment did not differ significantly between the groups, whereas overall survival was significantly longer in the HBOT group. Furthermore, when examining inoperable patients, significantly more individuals in the HBOT group could resume eating, and their overall survival was significantly prolonged.

Conclusions: HBOT may increase the spontaneous resolution rate and improve long-term prognoses of patients with MBO secondary to peritoneal dissemination.

N-myc downstream regulated gene-1 (NDRG1) has attracted much attention as a protein associated with angiogenesis. This study investigated the associations of NDRG1 expression, determined by immunohistochemical analysis, with other clinicopathological factors and prognosis in patients with endometrial endometrioid carcinoma (EEC). Surgical specimens were obtained from 113 patients with EEC. High NDRG1 expression was correlated with advanced stage, poor differentiation, lymph node metastasis, and significantly poorer survival compared with patients with low expression. High expression of NDRG1 was also correlated with high levels of angiogenesis and low expression of the estrogen receptor. These results suggest that high expression of NDRG1 is associated with angiogenesis and is an indicator of a poor prognosis in women with EEC.

Background: The present study investigated the acute mucosal reaction (AMR) after high-dose-rate interstitial brachytherapy at 54 Gy/9 fractions (HDR54) as monotherapy administered twice a day for tongue cancer in 13 patients, and attempted to validate HDR54 by comparing the AMR with that of our previously reported HDR at 60 Gy/10 fractions (HDR60), and low-dose-rate interstitial brachytherapy at approximately 70 Gy (LDR70).

Methods: The European Organization for Research on Treatment of Cancer/ Radiation Therapy Oncology Group scoring system with modifications (score: 1-4.5) was used to evaluate AMR. The time courses of the AMR scores of HDR54 were recorded. The time courses of the AMR of HDR54, HDR 60, and LDR70 were each divided into 6 phases and compared.

Results: The number of cases in the HDR54 group with a lower score (1-2) at the time of the initial response was significantly higher (12 cases) than those in the HDR60 group (1 case) (p=0.0077) and LDR70 group (1 case) (p=0.0077). In the HDR54 group, the time between the end of treatment and appearance of the first response was significantly longer (median: 3 days) than those in the HDR60 group (median: 1 day) (p<0.001) and LDR70 group (median: 1 day) (p<0.001). No significant differences were observed in the maximum score, its duration, or other parameters.

Conclusions: The results indicated that the AMR of HDR54 started later and was gentler and more easily tolerated than the other two methods, suggesting the validity of HDR54 in terms of AMR.

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.