JOURNAL OF MEDICAL INVESTIGATION最新文献

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.

Introduction: We investigated the effect of Daikenchuto (TU-100) on the early postoperative period in duodenal-jejunal bypass (DJB).

Methods: Study 1:The effect of TU-100 on diabetic rats was investigated. Rats were sacrificed after receiving TU-100 for one week. Study 2:The effect of TU-100 on DJB was investigated. Rats in the DJB and TU-100 treated DJB groups were sacrificed 24 hours postoperation to evaluate blood glucose, cytokine expression, and gut microbiome.

Results: Study 1:TU-100 did not affect glucose or body weight. TU-100 suppressed intestinal inflammation and modified the gut microbiome. Specifically, Bifidobacterium and Blautia were increased, and Turicibacter were decreased in this group. Study 2:Both DJB and TU-100 treated DJB rats showed lower blood glucose at 24 hours postoperation than at preoperation. Cytokine expression in the liver and small intestine of the TU-100 treated DJB group was significantly lower than that of the DJB group. The gut microbiome composition in TU-100 treated DJB rats was altered. In particular, Bifidobacterium and Blautia were increased in this group.

Conclusion: DJB suppressed blood glucose during the early postoperative period. TU-100 may enhance the anti-diabetic effect of metabolic surgery by changing the gut microbiome and suppressing inflammation in the early postoperative period. J. Med. Invest. 71 : 210-218, August, 2024.

Background: Hereditary angioedema (HAE), a genetic disorder caused by C1-inhibitor deficiency or dysfunction, may cause mucosal edema in the upper airway during tracheal intubation and extubation.

Case report: A 57-year-old man with HAE and a history of laryngeal edema, scheduled to undergo cervical laminoplasty under general anesthesia. General anesthesia was induced by continuous injection of remimazolam and remifentanil, during which manual mask ventilation and intubation were performed without difficulty. The patient was extubated under deep anesthesia. After emergence from general anesthesia, he had no significant upper airway edema and was treated with a C1-inhibitor seven hours post-surgery because of slight tongue swelling. No additional airway edema was observed, and the patient was discharged from the intensive care unit the following day.

Conclusions: Deep anesthesia tracheal extubation with remimazolam may be effective in preventing upper airway edema during anesthetic management in patients with HAE. J. Med. Invest. 71 : 184-186, February, 2024.

Objectives: Partially hydrolyzed guar gum (PHGG) is a soluble dietary fiber;in addition to improving bowel movements, it maintains intestinal health by producing short-chain fatty acids. However, majority of clinical studies on PHGG have been concluded within a month and excluded usual drug therapy. Hence, this study aimed to determine the effects of long-term consumption of PHGG, in combination with drug therapy, on gut bacteria ratios, laboratory values for inflammatory response, and fecal characteristics.

Methods and results: The study was performed in patients with irritable bowel syndrome (IBS), Crohn's disease (CD), and ulcerative colitis (UC), by the administration of PHGG for six months while they continued their usual treatment. PHGG treatment caused significant changes in patients with IBS, including an increase in the abundance of short-chain fatty acid-producing bacteria, a significant decrease in Bacteroides abundance, and normalization of the Bristol scale of stool. In patients with UC, non-significant normalization of soft stools and decrease in fecal calprotectin were observed. Adverse events were not observed in any of the groups.

Conclusion: Thus, it would be beneficial to include PHGG in the usual drug therapies of patients with IBS. J. Med. Invest. 71 : 121-128, February, 2024.

Background: Augmented reality navigation is the one of the navigation technologies that allows computer-generated virtual images to be projected onto a real-world environment. Augmented reality navigation can be used in spinal tumor surgery. However, it is unknown if there are any pitfalls when using this technique.

Case presentation: The patient in this report underwent complete resection of a cauda equina tumor at the L2-L3 level using microscope-based augmented reality navigation. Although the registration error of navigation was <1 mm, we found a discrepancy between the augmented reality navigation images and the actual location of the tumor, which we have called "navigation mismatch". This mismatch, which was caused by the mobility of the spinal tumor in the dura mater, seems to be one of the pitfalls of augmented reality navigation for spinal tumors.

Conclusions: Combined use of intraoperative ultrasound and augmented reality navigation seems advisable in such cases. J. Med. Invest. 71 : 174-176, February, 2024.

CapeOX is a regimen used as postoperative adjuvant chemotherapy for the treatment of advanced recurrent colorectal cancer. If early adverse events occur, treatment may not progress as planned and further dose reduction may be necessary. In this study, we investigated whether pre-treatment medical records could be used to predict adverse events in order to prevent adverse events caused by CapeOX treatment. The 178 patients were classified into two groups (97 in the adverse event positive group and 81 in the adverse event-negative group) based on withdrawal or postponement of four or fewer courses. In univariate analysis, age, height, weight, body surface area (BSA), creatinine clearance, muscle mass, and lean body mass were associated with early adverse events (P<0.05). The area under the receiver operating characteristic curve obtained by Stepwise logistic regression analysis using the Akaike information criterion method was 0.832. For nested k-fold cross validation, the accuracy rates of the support vector machine, random forest, and logistic regression algorithms were 0.71, 0.70, and 0.75, respectively. The results of the present study suggest that a logistic regression prediction model may be useful in predicting early adverse events caused by CapeOX therapy in patients with colorectal cancer. J. Med. Invest. 71 : 141-147, February, 2024.

Objective: This study aimed to assess age-related changes in Stroop Color and Word test indices in individuals with high-functioning pervasive developmental disorder (HF-PDD) and compare their performance with typically developing (TD) individuals.

Methods: There were a total of 125 participants (57 TD, 68 HF-PDD), aged 6-24. Stimuli were displayed on computer screens, and participants verbally responded with response times recorded via voice key function.

Results: Single regression analysis revealed age-associated trends in Stroop test indices for both groups, indicating shorter response times and reduced Stroop interference with age. The age at which the best Stroop test results were obtained ranged from 220 to 260 months for TD and from 195 to 201 months for HF-PDD. While color naming and word reading tasks showed no significant group differences, color word naming task response times were significantly longer for the HF-PDD group. Around 30% of HF-PDD participants scored over two standard deviations above the TD mean.

Conclusions: Both TD and HF-PDD groups exhibited age-related changes in Stroop task performance, which were fitted by a quadratic regression curve. Prolongation of the color word naming task in the HF-PDD group suggests that approximately 30% of individuals with HF-PDD have difficulty with stereotype suppression. J. Med. Invest. 71 : 254-259, August, 2024.

The purpose of this study was to investigate the hemodynamic activity in the left cerebral hemisphere during silent reading in college students with typical development using near-infrared spectroscopy (NIRS). Sixty college students with typical development participated in this study. In the silent reading task, participants were asked to read a text from Andersen's fairy tale. Then, the change in oxygenated hemoglobin (oxy-Hb) concentration during silent reading of the text was calculated. The number of letters read during the silent reading task was also measured to calculate the silent reading speed. The average trend graph of 60 college students revealed increased oxy-Hb concentration in both the left inferior frontal gyrus (Broca's area) and the left inferior occipitotemporal gyrus during silent reading. A negative correlation was found between the change in oxy-Hb concentration in Broca's area and silent reading speed. A positive correlation was found between oxy-Hb concentration change in the left inferior occipitotemporal gyrus and silent reading speed. The increase in oxy-Hb concentration in Broca's area observed during silent reading may reflect effortful reading in students with reading difficulty. The increase in oxy-Hb concentration in the left inferior occipitotemporal gyrus observed during silent reading may reflect proficiency in reading. Our findings suggest the usefulness of NIRS in assessing reading function and its potential use in the diagnosis of developmental dyslexia. J. Med. Invest. 71 : 267-272, August, 2024.

Foraminal stenosis is one of the types of lumbar spinal stenosis. The pathology can be treated minimally invasively by full-endoscopic spine surgery (FESS). The final challenge in transforaminal FESS is foraminal stenosis in patients with stable isthmic spondylolisthesis at L5. This article provides a step-by-step explanation of how to achieve complete decompression. A cannula of 8 mm in diameter is docked at the base of the superior articular process of the sacrum. The pars crisscross that consists of the superior articular process at S1, the floating lamina, the inferior articular process at L4, and the pars ragged edge is then clearly seen endoscopically. Visualization of the pars crisscross is key to successful decompression. Starting with the superior articular process at S1, followed by partial removal of the floating lamina. Next, the tip of the inferior articular process at L4 is removed. The pars ragged edge is then carefully shaved. Finally, decompression of the exiting nerve root at L5 is confirmed. This report provides the first step-by step description of full-endoscopic decompression of foraminal stenosis under local anesthesia in patients with stable L5 isthmic spondylolisthesis, which we have named "full-endoscopic pars crisscross decompression". J. Med. Invest. 71 : 191-196, August, 2024.