JOURNAL OF MEDICAL INVESTIGATION最新文献

Metabolic dysfunction-associated steatohepatitis (MASH) exhibits inflammation and fibrosis in addition to lipid accumulation in the liver, which may progress to cirrhosis and liver failure. This study investigated whether the serum lipoprotein subfraction reflects fibrosis severity in a MASH mouse model. Nine-week-old male A/J and C57BL6/J mice were fed a high-fat/cholesterol/cholate-based diet to induce fibrotic MASH. To generate fibrosis of varying severity, mice were fed two diets with different cholesterol concentrations (1.25% and 2.5%). After 9 weeks of feeding, serum cholesterol and triglyceride levels of each lipoprotein were comprehensively analyzed, including chylomicron, very-large low-density lipoprotein, low-density lipoprotein (LDL), and high-density lipoprotein (HDL), with 20 subclasses according to particle size. Serum levels of very-large HDL-cholesterol, very-small HDL-cholesterol, very-small HDL-triglycerides, and very-small LDL-cholesterol were significantly higher in the stage 2 fibrosis group than the stage 1 fibrosis group. Serum very-small LDL-cholesterol levels were correlated with histological severity of MASH, which reportedly increases with the progression of MASH in humans. In conclusion, the serum lipoprotein subfraction reflects liver fibrosis severity even in early phase, independent of the severity of other MASH lesions in MASH model mice. Fractionating HDL, which have been measured in clinical practice, may help establish noninvasive markers of liver fibrosis. J. Med. Invest. 72 : 375-384, August, 2025.

The number of bedridden elderly is substantially increasing in our aging society. Bedridden patients experience muscle atrophy due to prolonged inactivity. We are concerned about whether the antioxidative flavonoid quercetin can prevent disuse muscle atrophy in elderly people considering that oxidative stress plays a role in this condition. This study explored the links between quercetin intake, oxidative stress, and muscle preservation in bedridden individuals. Onion was selected and a dose of 5 g of onion powder, which contains 99.7 mg of quercetin aglycone equivalent, was given to patients who were bedridden for 30 days. Plasma quercetin concentration was significantly increased in the onion powder group, with regular intake of quercetin meals maintaining high plasma levels (n=9). Higher plasma quercetin levels were linked to lower plasma oxidized low-density lipoprotein (ox-LDL) and urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) content. No correlation was identified in the indexes of muscle maintenance (volume of the quadriceps femoris muscle) and the minimum necessary activities of daily living (ADL). In conclusion, our small-scale pilot study involving bedridden individuals did not demonstrate a positive effect of continuous quercetin intake on the prevention of muscle atrophy. However, efficient dietary quercetin consumption can mitigate the elevation of in vivo oxidative stress. J. Med. Invest. 72 : 324-329, August, 2025.

Introduction: Vitamin D may reduce inflammation by affecting cytokine production, potentially alleviating chronic anemia. Iron deficiency can impair vitamin D absorption, yet the interaction between these deficiencies remains unclear. This study aimed to evaluate the effectiveness of combined vitamin D and iron supplementation in treating iron deficiency anemia (IDA) in children.

Methods: An open-label, randomized controlled trial was conducted at four outpatient clinics and Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia. Of 250 assessed patients, 67 met the inclusion criteria. Participants were randomized into two groups:Group A received iron supplementation (3 mg/kg BW/day), while Group B received iron combined with vitamin D (400 IU). Treatment lasted 4 weeks, and iron status was evaluated pre- and post-treatment.

Results: No significant changes were observed in complete blood count, serum iron, and ferritin levels after 4 weeks in either group (p>0.05). However, the mean change in serum ferritin levels was significantly greater in the combined group (p=0.039).

Conclusion: Both iron alone and iron with vitamin D improved hematological parameters in children with iron deficiency anemia. Combined iron and vitamin D therapy showed a significant ferritin increase, suggesting that adding vitamin D may support better iron storage. J. Med. Invest. 72 : 337-342, August, 2025.

Background: Accelerating ammonium metabolism of hepatocyte like cells (HLCs) is critical for various functions of hepatocytes. The aim of the present study was to investigate whether Farnesoid X receptor (FXR) agonist, obeticholic acid (OCA), accelerated ammonium metabolism of HLCs, which was derived from adipose derived mesenchymal stem cells (ADSCs).

Methods: Human ADSCs were seed in flat bottom plate, then our differentiation protocol was used for 21 days. OCA treatment had been performed in Step3 for 10days. Then, 1) hepatic maturation, 2) urea cycle genes, 3) urea production, and 4) ammonium metabolism was compared depend on the presence or absence of OCA.

Results: HLCs had been successfully produced for 21 days. HLCs with OCA showed significantly higher mRNA expressions of AAT than those without OCA. HLCs with OCA showed significantly higher mRNA expressions of urea cycle genes such as SLC25A13, CPS1, and OTC. Urea production was also tended to be upregulated by OCA addition. HLCs with OCA showed significantly higher clearance of NH4Cl at 6hr and 24 hr after addition of NH4Cl.

Conclusion: FXR agonist, OCA, accelerates ammonium metabolism of ADSCs derived HLCs. HLCs could be one of treatment options of hepatic encephalopathy of patients with liver failure or urea cycle disorder in the future. J. Med. Invest. 72 : 54-59, February, 2025.

The detection of small bowel lesions and their discrimination from normal bowel tissue are the most elementary and important factors in the computed tomography (CT) diagnosis of focal small bowel lesions. The detection and characterization of small bowel lesions have recently improved with advances in CT technology. Post-contrast multiphasic multidetector CT (MDCT) aids in the assessment of the vascular features of focal small bowel lesions. Understanding the typical multiphasic MDCT features of focal small bowel lesions is valuable because CT features overlap, and the severity and associated complications need to be assessed. However, it is often difficult to accurately diagnose focal small bowel lesions on MDCT, and histological examination is required in many cases in clinical practice. Clinical applications have been recently developed to effectively utilize dual-energy CT in the image analysis of small bowel lesions. In addition, the challenge of evaluating small bowel lesions with the aid of artificial intelligence has attracted attention in recent years. This review aimed to provide a comprehensive guide for the relevant imaging features of different types of benign focal small bowel lesions. J. Med. Invest. 72 : 1-7, February, 2025.

Community medical care faces challenges such as the uneven distribution of physicians, fluctuating medical demand, and the increased relative demand for physicians due to the increased specialization of medical fields. Hematologists primarily address issues, such as abnormal blood cell counts, lymphadenopathy, persistent fever, and coagulation abnormalities, which indicate hematological diseases. However, the emphasis on treating hematologic diseases within community medicine remains relatively low. Accurate and reliable differentiation and identification of hematological diseases with the cooperation of laboratory technicians and support of artificial intelligence is necessary. Significant advances have been made in the treatment of hematological diseases; however, small community hospitals often lack access to these treatments and are unable to conduct clinical trials that require specialized equipment such as for chimeric antigen receptor T-cell therapy. In the future, hematologists will need to focus on developing their careers within the community and further optimizing their practice to enhance patient care. J. Med. Invest. 72 : 21-25, February, 2025.

Background: Appendiceal goblet cell adenocarcinomas (GCA) are rare. Most patients who undergo appendectomy have acute appendicitis. The detection of synchronous colorectal cancer (SCRC) has increased with advances in diagnostic imaging and endoscopic examinations. However, only two cases of SCRC, including appendiceal GCA, have been reported to date. We recently encountered an extremely rare case of SCRC, involving appendiceal GCA, ascending colon cancer (ACC), and sigmoid colon cancer (SCC). Herein, we present this case and provide a discussion on the relevant literature.

Case presentation: A 69-year-old man presented to our hospital with right lower abdominal pain. Based on contrast-enhanced computed tomography (CE-CT), the patient was diagnosed with SCRC and acute appendicitis caused by appendiceal neoplasm and ACC. The patient underwent emergency laparotomy, and right colectomy with lymph node dissection (LD). Intraoperatively, we palpated the remaining segment of the colorectum whenever possible and incidentally detected SCC. Therefore, sigmoid resection with LD was suggested.

Conclusion: When treating acute appendicitis, it is important to consider the possibility of an extremely rare appendiceal tumor as the cause. If possible, CE-CT should be performed to ensure appropriate image interpretation during an unlikely SCRC event. J. Med. Invest. 72 : 194-201, February, 2025.

Non-ST-elevation myocardial infarction (NSTEMI) showing biphasic or deep negative T waves in lead V2-3 suggests the presence of a severe stenotic lesion in the proximal left anterior descending artery, called Wellens' syndrome. We report a case of NSTEMI with a positive T wave in lead aVR and widespread negative T waves in the precordial and inferior leads, presumed to be Wellens' syndrome, resulting in three-vessel severe coronary artery disease. This report highlights the importance of identifying a positive T wave in lead aVR to avoid overlooking severe organic stenosis of the coronary arteries. J. Med. Invest. 72 : 451-454, August, 2025.

A 10-year-old Japanese female was referred to our hospital for a rapidly growing and easily bleeding nodule on her right temple. A physical examination revealed a red ulcerated nodule on her right temple. Our clinical diagnosis was pyogenic granuloma (PG), and cryotherapy was performed several times. However, this did not remove the tumor;therefore, we excised it under local anesthesia. A histopathological examination of the removed tumor showed vascular proliferations arranged in discrete lobules in the dermis. Based on these findings, we confirmed the diagnosis of PG. About 4 months after the surgery, small nodules gradually developed around the surgical scar. The patient returned to our hospital 1 year after the surgery. A physical examination showed multiple, small, red papules scattered around the surgical scar. Based on the clinical findings of this case, we made a diagnosis of the recurrence of PG with satellitosis (RPGS). The lesions disappeared after 6 months of topical steroid and liquid nitrogen therapy. RPGS is a rare phenomenon, but its diagnosis and management can be problematic. It is important for physicians to recognize this phenomenon and inform patients of the possibility of recurrence and the development of satellite lesions after PG is resected. J. Med. Invest. 72 : 440-442, August, 2025.

The local renal renin-angiotensin system (RAS) is regulated independently of the systemic RAS. The renal RAS not only regulates blood pressure and hemodynamics but also plays an important role in the kidney disease development. Many studies have shown that the of angiotensinogen urinary excretion rate is a specific index of the intrarenal RAS activation. Moreover, urinary angiotensinogen (AGT) levels reflect the intrarenal RAS status associated with hypertension, chronic kidney disease, and diabetic nephropathy. In addition, urinary AGT is a novel biomarker of intrarenal RAS activation during neonatal kidney development. Furthermore, angiotensin-converting enzyme 2 and the (pro)renin receptor have recently been identified as new components of the RAS that have novel functions in kidney diseases and development. This review summarizes the current knowledge on intrarenal RAS activation in the context of pathological and physiological processes in children. J. Med. Invest. 72 : 241-244, August, 2025.