JOURNAL OF MEDICAL INVESTIGATION最新文献

Background: Ethmoidal arteries are at risk of accidental injury during endoscopic sinus surgery (ESS).

Aims/objectives: We aimed to examine the location of ethmoidal arteries in relation to ethmoid cells and the anterior skull base (ASB) in Japanese patients.

Material and methods: CT images of 100 sides of 50 patients were retrospectively reviewed. The location of anterior ethmoidal arteries (AEAs), middle ethmoidal arteries (MEAs) and posterior ethmoidal arteries (PEAs) in relation to ethmoidal cells and their distance from the ASB were evaluated.

Results: AEAs and PEAs were present in all sides. 60% of AEAs and 9% of PEAs ran below the level of ASB. MEAs were present in 21 sides and ran below the ASB in 23.8% (5/21) of these sides. The incidence of AEAs running below the level of ASB was significantly higher in the sides with supraorbital ethmoid cells (SOECs) than in those without SOECs.

Conclusion and significance: This study revealed the position and the distance from ASB of AEAs, PEAs, and MEAs in relation to ethmoid cells in Japanese patients. In cases with SOECs, surgeons should be careful not to injure the AEAs running below the level of ASB. J. Med. Invest. 71 : 273-278, August, 2024.

Osteoporotic vertebral fracture (OVF) is common in the elderly population. In this report, we describe a case with radiculopathy due to foraminal stenosis caused by OVF in a very elderly patient that was treated successfully by full-endoscopic foraminotomy under local anesthesia. The patient was an 89-year-old woman who presented with a chief complaint of left leg pain for 5 years. She visited a couple of hospitals and finally consulted us to determine the exact cause of the pain. Computed tomography scans were obtained and selective nerve root block at L3 was performed. The diagnosis was radiculopathy at L3 due to foraminal stenosis following OVF. The patient had severe heart disease, so we decided to avoid surgery under general anesthesia and planned full-endoscopic spine surgery under local anesthesia. We performed transforaminal full-endoscopic lumbar foraminotomy at L3-L4 to decompress the L3 nerve root. The leg pain disappeared completely immediately after surgery. Postoperative computed tomography confirmed appropriate bone resection. The leg pain did not recur during a year of postoperative follow-up. OVF may cause lumbar radiculopathy as a result of foraminal stenosis, and transforaminal full-endoscopic lumbar foraminotomy under local anesthesia would be the best option in an elderly patient with poor general condition. J. Med. Invest. 71 : 179-183, February, 2024.

The "construction of a community-based comprehensive care system for mental disorders" has been promoted in Japan. However, nurses in psychiatric hospitals do not intervene with community resources and support networks in Japan. This study aimed to determine the care information required by home visit nurses from psychiatric hospital nurses. A qualitative descriptive research design was employed. Semi-structured interviews were conducted with nine psychiatric home-visiting nurses, and content analysis was performed to analyze the data. Findings revealed 319 narratives about the information that psychiatric home-visiting nurses seek from psychiatric hospital nurses, which were classified into six main categories. Information needed for home-visiting nurses to provide care includes the following : 1) to build trust with home-visiting service users, 2) to help home-visiting service users live according to their wishes, 3) to help home-visiting service users continue treatment in the community, 4) to perform symptom management, 5) to provide family care, and 6) to protect the safety of home visiting nurses during home visits. Nurses in psychiatric hospitals should communicate this information to nurses who provide psychiatric home care. This will improve the quality of continuing care for home care users and support their recovery in community living. J. Med. Invest. 71 : 162-168, February, 2024.

This study aimed to investigate blood flow dynamics in the bilateral prefrontal cortex during silent and oral reading using near-infrared spectroscopy (NIRS). The subjects were 40 right-handed university students (20.5±1.8 years old, 20 men and 20 women). After completing the NIRS measurements, the subjects were asked to rate their level of proficiency in silent and oral reading, using a 5-point Likert scale. During oral reading, the left lateral prefrontal cortex (Broca's area) was significantly more active than the right side. During silent reading, prefrontal cortex activity was lower than that during oral reading, and there was no significant difference between both sides of the brain. A significant negative correlation was found between the change in oxy-hemoglobin (oxy-Hb) concentration in the left and right lateral prefrontal cortex during silent reading and silent reading speed. In addition, students with lower self-reported reading proficiency had significantly greater changes in oxy-Hb concentrations in the left and right lateral prefrontal cortex during silent/oral reading than did students with higher self-reported reading proficiency. Reading task assessment using NIRS may be useful for identifying language lateralization and Broca's area. The results demonstrate that NIRS is useful for assessing effortful reading and may be used to diagnose developmental dyslexia in children. J. Med. Invest. 71 : 92-101, February, 2024.

Pyrroloquinoline quinone disodium salt (PQQ) is a red trihydrate crystal that was approved as a new food ingredient by FDA in 2008. Now, it is approved as a food in Japan and the EU. PQQ has redox properties and exerts antioxidant, neuroprotective, and mitochondrial biogenesis effects. The baseline intake level of PQQ is considered to be 20 mg/day. PQQ ingestion lowers blood lipid peroxide levels in humans, suggesting antioxidant activity. In the field of cognitive function, double-blind, placebo-controlled trials have been conducted. Various improvements have been reported regarding general memory, verbal memory, working memory, and attention. Furthermore, a stratified analysis of a population with a wide range of ages revealed unique effects in young people (20-40 years old) that were not observed in older adults (41-65 years old). Specifically, cognitive flexibility and executive speed improved more rapidly in young people at 8 weeks. Co-administration of PQQ and coenzyme Q10 further enhanced these effects. In an open-label trial, PQQ was shown to improve sleep and mood. Additionally, PQQ was found to suppress skin moisture loss and increase PGC-1α expression. Overall, PQQ is a food with various functions, including brain health benefits. J. Med. Invest. 71 : 23-28, February, 2024.

A 71-year-old male was referred to our institution for further examination of chest abnormal shadow. A cavitation in the right apical region, a mass adjacent to the pleura in the right upper lobe, and a nodule in the right middle lobe were observed in a chest computed tomography. The sputum smear and culture of acid-fast bacilli were positive, and Mycobacterium heckeshornense (M. heckeshornense) was identified with the matrix-assisted laser desorption ionization time-of-flight mass spectroscopy. Moreover, computed tomography-guided biopsy of a mass adjacent to the pleura in the right upper lobe yielded the diagnosis of primary lung adenocarcinoma. Taken together, the patient was finally diagnosed as coexistence of pulmonary M. heckeshornense infection and primary lung cancer. An anti-mycobacterial treatment with rifampicin, ethambutol and clarithromycin and a combined chemotherapy were fairly successful for pulmonary M. heckeshornense infection and primary lung adenocarcinoma, respectively. These observations suggest that triple anti-mycobacterial therapy may contribute to good controls of M. heckeshornense infection and that careful selection of anti-cancer drugs against lung cancer might be lead to favorable outcomes even during the course of anti-mycobacterial treatment. To the best of our knowledge, this is the first report of pulmonary M. heckeshornense infection coexisted with lung cancer. J. Med. Invest. 71 : 327-331, August, 2024.

Intermittent clinical course of akinetic mutism is very unusual. We describe a 74-year-old man who started to demonstrate episodes of altered mental state with stopped moving and talking, poor response to commands, and muscle stiffness in both upper limbs approximately 1.5 months after cardioembolic bilateral paramedian thalamic infarction. Their frequency gradually increased and poststroke nonconvulsive status epilepticus was suspected, but prolonged video-electroencephalography monitoring did not reveal any epileptiform abnormalities. The patient had no significant metabolic or infectious disorders. Thus, upon exclusion of other causes his condition was considered as intermittent akinetic mutism, which was indirectly confirmed by good response of symptoms to amantadine therapy and their recurrence upon termination of this treatment. J. Med. Invest. 71 : 306-309, August, 2024.

Aims: We aimed to assess the relationships between lower urinary tract symptoms (LUTS) and various parameters including diabetes complications in patients with type 2 diabetes.

Methods: In this single-center cross-sectional study, we enrolled 404 patients hospitalized for diabetes. We ultimately analyzed data from 160 patients. To evaluate LUTS, the International Prostate Symptom Score and overactive bladder symptom score were used. The identified relationships were then analyzed considering parameters such as age, sex, body mass index (BMI), HbA1c, creatinine, and urinary albumin excretion.

Results: The prevalences of overactive bladder (OAB), storage symptoms and voiding symptoms were 21.9%, 63.8%, and 39.4%, respectively. In multivariate logistic regression analysis, the coefficient of variation of the R-R interval, indicating autonomic neuropathy, correlated negatively with OAB, while BMI and duration of diabetes correlated positively with storage symptoms. A history of cerebrovascular disease correlated significantly with voiding symptoms in multivariate logistic analysis.

Conclusions: Our analysis of diabetic patients with LUTS revealed differences in the characteristics of storage and voiding symptoms. These findings provide evidence that the features of LUTS associated with diabetes may have different pathogenic origins. J. Med. Invest. 71 : 237-245, August, 2024.

Purpose: The purpose of this study was to evaluate the ischemic penumbra and prognosis in acute cerebral infarction using cerebral blood flow (CBF) and delay time (DT) derived from multi-delay pseudo-continuous arterial spin-labeling (pCASL) imaging and to estimate the possible use of such indices to predict prognosis.

Method: Our subjects comprised 25 patients who were diagnosed with cerebral infarction in our stroke center between September 2017 and December 2018 and underwent pCASL perfusion MRI. The time from onset to MRI was 0.6 to 20 h (mean, 6 h) and was less than 4.5 h in 16 patients. Twelve patients received conservative treatment, three were treated with tPA, and the remaining 10 patients underwent invasive treatment (e.g., thrombectomy). They were subdivided by recanalization:18 patients were non-recanalized and 7 were recanalized. We evaluated the mean cerebral blood flow (CBF) and mean arterial transit DT at the infarct core and penumbra and the infarct size at the initial and follow-up examinations and calculated the infarct enlargement ratio (ER) from the initial and final infarct sizes. We also assessed clinical prognosis by using the initial and final NIHSS scores. We investigated the relationship among the ASL, ER, and NIHSS parameters and determined predictors of infarct enlargement using logistic analysis.

Result: The degree of the CBF decrease was related to the size of the initial infarct lesion (CBF at core:r=-0.4060, p=0.044;CBF at penumbra:r=-0.4970, p=0.012) and initial NIHSS (r=-0.451, p=0.024;CBF at penumbra:r=-0.491, p=0.013). Because no parameters were correlated with the ER in all patients. Specifically in the non-recanalization group, the DT at the penumbra was positively correlated with the ER (r=-0.496, p=0.034). Moreover, by logistic regression analysis, the DT at the penumbra was the only independent predictor of infarct enlargement in all patients (p=0.047) and in non-recanalization patients (p=0.036).

Conclusion: The only parameter predicting the ER was the mean DT at the penumbra, and the tendency was affected by recanalization status. DT obtained by multi-delay ASL may become a prognostic index of acute cerebral infarction. J. Med. Invest. 71 : 286-292, August, 2024.

Background: FreeStyle Libre uses the algorithm to calculate the sensor glucose (SG) levels. The manufacturer announced that they had changed the algorithm from the first generation (Gen. 1) to the third generation (Gen. 3). To assess the difference, we conducted an observational study to analyze the characteristics of the measurements by these two algorithms compared to the capillary blood glucose (BG) levels.

Methods: Participants with type 1 diabetes wore two FreeStyle Libre sensors, one on the left arm used with Gen. 3 algorithm, and another on the right arm used in combination with the FreeStyle Libre Reader with Gen. 1 algorithm.

Results: Data were collected from 11 participants. The Bland-Altman analysis of the measurements by Gen. 3 algorithm showed bias of 7.4 mg/dl and no proportional bias was observed (r=0.130). In contrast, the Bland-Altman analysis of the measurements by Gen. 1 algorithm showed bias of 4.4 mg/dl and proportional bias was observed (r=0.424). The MARD of Gen. 3 algorithm and Gen. 1 algorithm was 11.9±9.0% and 9.7±8.3%, respectively (P=0.053).

Conclusion: No proportional bias in the measurements by Gen. 3 algorithm was observed, but in those by Gen. 1 algorithm. J. Med. Invest. 71 : 225-231, August, 2024.