JOURNAL OF MEDICAL INVESTIGATION最新文献

Orbital apex syndrome (OAS) is a complex condition characterized by visual loss, diplopia, and eye pain that occurs secondary to several pathological processes involving the orbital apex. We report a case of acute invasive fungal rhinosinusitis (AIFRS) associated with OAS. A 76-year-old man with left-sided visual loss, diplopia, palpebral ptosis, and headache was diagnosed with OAS secondary to Tolosa-Hunt syndrome and received systemic corticosteroid therapy from his neurologist. Owing to persistent symptoms, we opened the optic canal using a transnasal endoscopic approach for a surgical biopsy of the orbital apex lesions. Histopathological evaluation revealed numerous Aspergillus organisms in the biopsied granuloma. After surgical debridement, he received a 12-month course of voriconazole, and no recurrence of AIFRS occurred during 8-year follow-up. Patients with OAS may occasionally be prescribed corticosteroids because the clinical manifestations of AIFRS-induced OAS are similar to those observed in OAS secondary to Tolosa-Hunt syndrome, especially no nasal symptoms which is known to respond to corticosteroid therapy. Because both AIFRS-induced OAS and OAS secondary to Tolosa-Hunt syndrome induce ophthalmoplegia, proptosis, eye pain, it is sometimes difficult to differentiate these two diseases in early stage. However, corticosteroid therapy causes exacerbation of fungal infection in patients with AIFRS-induced OAS resulting in delayed accurate diagnosis and poor prognosis. AIFRS is associated with a high mortality rate ; therefore, transnasal endoscopic biopsy of orbital apex lesions before corticosteroid administration is recommended in patients with OAS. J. Med. Invest. 71 : 310-313, August, 2024.

Evidence is inconsistent on the effectiveness of home rehabilitation for patients post-stroke. This review aims to explore home care practices that improve the performance of activities of daily living of patients post-stroke. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), clinical trials and mixed-methods studies published from 2012 to 2022 were gathered from PubMed, ScienceDirect, EBSCO, and ProQuest in December 2022. The Mixed Method Appraisal Tool (MMAT) was used for quality appraisal. Narrative synthesis approach was utilized to present the findings. A total of 758 articles were screened, and 10 were included in the final analysis. Five out of ten programs were found superior compared with usual care. Factors that influence the effectiveness of the programs include the age of the participants, severity of disabilities, family participation, and presence of a multidisciplinary team. A multidisciplinary healthcare team approach toward the enhancement of knowledge, skills, and behaviors of patients and their families is common in effective home care. The role of nurses is emphasized not only as providers of direct patient care but also as coordinators of the healthcare team and patients and their families. This study provides insights for policymakers in developing healthcare system for post-stroke care. J. Med. Invest. 71 : 197-204, August, 2024.

Open axillary arterial injury is life-threatening, and upper-extremity reperfusion must be performed within approximately 6 h. We present the case of a patient who underwent reperfusion of the upper limb and nerve reconstruction of the post-ganglionic brachial plexus injury in one stage while maintaining stable vital signs. The injury was an avulsion with no fracture. Nerve grafting was necessary to reconstruct the nerves without tension. Although the sural nerve is commonly used, we decided to sacrifice the ipsilateral ruptured ulnar nerve because it was less likely to recover over a long reinnervation distance. Nine months postoperatively, the patient was able to flex the elbow and rotate the forearm, although finger function was poor. Nevertheless, the patient could use the hand to assist her in performing daily activities and return to the previous workplace as a clerk. J. Med. Invest. 71 : 332-334, August, 2024.

Purpose;Lumboperitoneal shunting (LPS) is a common procedure for treating idiopathic normal pressure hydrocephalus (iNPH), involving two abdominal approaches:anterior abdominal laparotomy and lateral abdominal laparotomy (LAL). While LAL is advantageous in terms of infection risk, it presents challenges such as muscle manipulation and potential deviation from the desired trajectory. This report presents a novel technique that utilizes ultrasound examination of the lateral abdominal wall (UELAW) to visualize the three muscle layers (external oblique, internal oblique, and transversus abdominis) before abdominal manipulation during LAL. Illustrative Case;An 83-year-old iNPH patient underwent LPS with this approach, ensuring precise alignment of the trajectory and successful access to the abdominal cavity. Following the procedure, the patient experienced an improvement in gait disturbance and was discharged without any surgical complications. Conclusion;The use of UELAW during LPS provides clear visualization of the abdominal muscle layers, allowing surgeons to perform the procedure with confidence and accuracy, minimizing the risk of trajectory deviation, and ultimately improving patient outcomes. J. Med. Invest. 71 : 343-345, August, 2024.

This study investigated the mental states, such as depression and anxiety, of Japanese psychology graduate trainees (N = 57) who aspired to become psychologists, compared with non-trainees (N = 80) in other departments. The results showed that, among trainees, 25% exhibited mild depression, 26% exhibited moderate depression, 9% exhibited moderately severe depression, and 5% exhibited severe depression. Among non-trainees, the corresponding figures were 31%, 10%, 6%, and 4%, respectively. Welch's t-test revealed that the trainees showed significantly higher anxiety and higher scores on the "work or study" subscale of the Sheehan Disability Scale (SDISS) compared with the non-trainees. A two-way ANOVA indicated that first-year trainees had a significantly higher SDISS total score than second-year trainees. The survey was conducted 2-4 months after the commencement of first-year clinical training, during which first-year trainees tend to face many new challenges. This might be the reason for their higher SDISS than the second-year trainees. These findings emphasize the importance of prioritizing the mental well-being of Japanese graduate students pursuing careers in psychology, given their high levels of anxiety. J. Med. Invest. 71 : 356-359, August, 2024.

Objectives: This study aimed to clarify the cumulative effectiveness of microsurgical penile revascularization over time and factors that affect surgical outcomes.

Subjects and methods: This study analyzed 114 men with a median age of 30.5 years. They had localized arterial lesions on the internal pudendal artery by angiography. They underwent the anastomosis of the distal end of the inferior epigastric artery to the dorsal artery of the penis with 11-0 sutures.

Results: The final cumulative effectiveness rate calculated by the Kaplan-Meier method was 92.5%. The 1- and 3-year cumulative effectiveness rates were 58.0% and 92.5%, respectively. Twenty-one patients were not cured during the study. Age was a factor significantly affecting the surgical outcomes (p=0.018), and the peak systolic and end-diastolic velocities on Doppler ultrasound, corporal veno-occlusive dysfunction, and venous ligation were less significant (p=0.290, p=0.559, p=0.054, and p=0.732, respectively).

Conclusion: The final cumulative effectiveness rate of penile revascularization was 92.5%. Latency was observed until cure, half of the cases were cured in approximately 10 months. Cavernous function appears to be reversible and cavernous dysfunction was not a significant factor in surgical outcome. J. Med. Invest. 71 : 219-224, August, 2024.

Background: The prevalence of bladder cancer increases rapidly among individuals. The knowledge, attitude, and healthy lifestyle behaviors of individuals in Turkey regarding bladder cancer are unknown. The present study aim was to examine the knowledge and attitudes of the participants about bladder cancer and healthy lifestyle behaviors. Methods?:?This cross-sectional study was conducted with 400 participants from outpatient clinic at Erciyes University. Data were collected by using a socio-demographic form and Healthy Lifestyle Behaviors Scale. Results?:?Findings revealed that 55% of the participants were aware of bladder cancer risks?;?smoking 55.5%, older ages 67%, synthetic dyes and some chemicals 43.7%, and overweight 34.5% increases the risk of bladder cancer. The findings showed that economic status and education effect on the Healthy Lifestyle Behaviors Scale scores. The positive relationship was found between self-realization, exercise, and interpersonal subscale in those with high-income participants. It is found that exercise, nutrition, and stress management that have a positive attitude among non-smokers toward the risk factors of bladder cancer. Conclusion?:?The information obtained from the study can be used to inform patients about bladder cancer, risk factors, and cancer prevention. In this regard, healthcare professionals can increase patients f knowledge and create awareness by preparing informative brochures, giving information during the examination, or making presentations. J. Med. Invest. 71 : 40-46, February, 2024.

Objective: To evaluate change in higher-level functional capacity of older Japanese individuals during the COVID-19 pandemic.

Methods: Four hundred older Japanese individuals completed an online questionnaire in early May 2021. Participants were asked retrospectively about their higher-level functional capacity and lifestyle before and during the COVID-19 pandemic. Higher-level functional capacity was determined as total score on the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC). Total TMIG-IC score ranges from 0 to 13. A decline in higher-level functional capacity was defined as a decrease in TMIG-IC score of more than 2 points during the COVID-19 pandemic. Changes in higher-level functional capacity during the COVID-19 pandemic were assessed by paired t-test and a general linear model.

Results: Decreased TMIG-IC scores were found in 43 (21.5%) men and 61 (30.5%) women. Among those with higher-level functional capacity, scores for total TMIG-IC and Social Role decreased significantly in both sexes (all p<0.005).

Conclusion: The findings suggest an association of the COVID-19 pandemic with a decrease in higher-level functional capacity, especially in Social Role, among older adults living in Japan. J. Med. Invest. 71 : 66-74, February, 2024.

Patients with interstitial lung disease (ILD), especially those with idiopathic pulmonary fibrosis, are at increased risk of developing lung cancer (LC). Pharmacotherapy for advanced LC has dramatically progressed in recent years;however, management of LC with pre-existing ILD (LC-ILD) is challenging due to serious concerns about the risk of acute exacerbation of ILD (AE-ILD). As patients with LC-ILD have been excluded from most prospective clinical trials of advanced LC, optimal pharmacotherapy remains to be elucidated. Although the antitumor activity of first-line platinum-based cytotoxic chemotherapy appears to be similar in advanced LC patients with or without ILD, its impact on the survival of patients with LC-ILD is limited. Immune checkpoint inhibitors may hold promise for long-term survival, but many challenges remain, including safety and appropriate patient selection. Further understanding the predictive factors for AE-ILD after receiving pharmacotherapy in LC-ILD may lead to appropriate patient selection and lower treatment risk. The aim of this review was to summarize the current evidence related to pharmacotherapy for advanced LC-ILD and discuss emerging areas of research. J. Med. Invest. 71 : 9-22, February, 2024.

We examined the effects of polymethoxyflavonoids (PMFs) on T helper (Th) 17 cell differentiation in vitro and in vivo. Five different PMFs including nobiletin (NOB), sudachitin (SUD), demethoxysudachitin, heptamethoxyflavone and natsudaidain were used for the in vitro study, and effects of those flavonoids on Th17 responses were investigated. NOB and heptamethoxyflavone significantly suppressed the proliferation response, but SUD, demethoxysudachitin and natsudaidain did not suppress the proliferation response. All of the five flavonoids decreased IL-17A production. Mice with experimentally induced autoimmune encephalomyelitis were used as an in vivo Th17 differentiation model. We focused on two flavonoids, NOB and SUD, and examined the effects of those flavonoids. NOB significantly suppressed Th17 cell proliferation and cytokine responses, but SUD only decreased proliferation responses. The results suggest that the suppressive effect of NOB on Th17 response in vivo is stronger than that of SUD. J. Med. Invest. 70 : 166-170, February, 2023.