Nagoya Journal of Medical Science最新文献

This study aimed to examine the effectiveness of early rehabilitation in patients with femoral neck fractures admitted to acute care settings in Japan using the data registered with the Japan Association of Rehabilitation Databases (JARD). We included data for 401 patients (out of 3088 patients) aged ≥ 65 years (85 males, 316 females) from nine hospitals who sustained a femoral neck fracture between July 2005 and September 2015. Using the number of days until surgery or the number of days until the start of rehabilitation or both as the explanatory variables, and the indoor mobility at discharge as the outcome variable, we calculated the adjusted rate ratio (ARR) and 95% confidence interval (CI) using Poisson regression analysis (age, sex, cognitive impairment, concurrent symptoms, and previous history of fracture adjusted as covariates). The ARR for independent walking at the discharge of the early-rehabilitation group (starting rehabilitation within two days after the injury) was significantly higher (ARR: 2.01, 95% CI: 1.34-3.02) than that of the non-early rehabilitation group. These results suggest that early acute-phase rehabilitation after a femoral neck fracture in older patients allows for better ambulatory ability at discharge, regardless of the time to surgery.

Japanese midwives are required to autonomously perform midwifery diagnosis and maternity care. However, education to promote the professional autonomy of midwives is inadequate, and previous studies have not been able to identify a measure for it. This study aimed to develop a professional autonomy scale for midwives, to be used for the education and career advancement of Japanese midwives. The Midwives Professional Autonomy Scale extracted items from the midwives' "autonomy" and "specialty" literature, and 10 professionals verified the surface and content validity of the scale. Overall, 695 Japanese midwives participated in a survey, of which a sample of 399 was recovered. Exploratory factor analysis was performed using the sample to confirm the validity of the construct and internal consistency of the scale (Cronbach's alpha value 0.95). Additionally, the validity of the criteria was confirmed using the self-efficacy scale, self-esteem scale, and job satisfaction, and the stability was confirmed by test-retest reliability. Consequently, the professional autonomy scale for Japanese midwives comprised 24 items and 5 factors. This scale can thus be used to evaluate the professional autonomy of Japanese midwives and for midwifery education.

This study aimed to investigate the basic data on the effectiveness and safety of the system in healthy subjects using an immersive virtual reality (VR) exercise system specialized for therapeutic exercise therapy during dialysis or hospital use. A total of 15 healthy adult subjects performed four exercises, namely lifting and rowing exercises using VR and each movement exercise without VR (control). The simulator sickness questionnaire (SSQ) was administered pre- and post-operatively to assess for VR sickness. Blood pressure, heart rate (HR), rating of perceived exhaustion, Profile of Mood States 2nd Edition Japanese version, and muscle activity (iEMG) were measured using electromyography. The correlation between changes in mood states and HR or iEMG results was examined. The SSQ measured post-VR exercise was 11.2 (18.7-7.5) and 11.2 (7.5-29.9) points in the lifting and rowing VR, respectively. The HR in lifting (VR, 82.5 ± 12.7 vs control, 71.6 ± 10.6 bpm, P<0.05) and rowing (VR, 94.2 ± 13.1 vs control, 83.5 ± 12.0, P<0.05) with VR exercise was significantly higher than in control. No significant differences were observed between the other variables. There was a positive correlation between HR and negative mood in the lifting VR condition (r=0.64, P<0.05), but not in the control group. Contrastingly, there was a positive correlation between iEMG and negative mood in rowing control (r=0.56), but not VR. Safety was confirmed, with no VR sickness or discontinuation of the system. Exercise therapy using VR resulted in a higher exercise load. This VR system has the potential for additional effective intradialytic exercises and hospital use.

The purpose of our study was to assess the usefulness of the apparent diffusion coefficient (ADC) value in differentiating between a normal spinal cord and a spinal cord with acute ischemia. Control group of 113 and 8 acute spinal cord ischemia patients were enrolled in this study. The ADC values were measured when diffusion-weighted imaging was first performed after the onset of acute spinal cord ischemia. The mean ADC value each of the control group and acute spinal cord ischemia patients was 0.99 ± 0.19 × 10^-3 mm²/s and 0.70 ± 0.15 × 10^-3 mm²/s. The mean ADC value in patients with acute spinal cord ischemia was significantly lower than that in patients with a normal spinal cord (P < 0.01). We found the cutoff ADC value (0.86 × 10^-3 mm²/s) to be a useful indicator of acute spinal cord ischemia (sensitivity = 100.0%, specificity = 71.7%, AUC = 0.92). In conclusions, it is suggested that the ADC value may be useful in the diagnosis of acute spinal cord ischemia.

The patient was a boy born at 23 weeks and 0 days of gestation weighed 401 g at birth. For treatment, an umbilical venous catheter was placed but the catheter perforated a blood vessel. We thought that prompt removal of the catheter would lead to massive bleeding, so we kept the catheter in place at the umbilicus, waited for weight gain, and removed it after confirming that the catheter tip had spontaneously become shallow and was in the umbilical vein. This procedure allowed us to handle the patient without major problems.

Frailty is considered one of the most important indicators of a patient's general condition. However, only a few studies have investigated the association between preoperative frailty and postoperative complications in pancreatic cancer. Therefore, this study aimed to examine this association in patients with pancreatic cancer. We retrospectively reviewed 52 consecutive patients who underwent pancreatectomy for pancreatic cancer between July 2019 and March 2021. Patients were classified into two groups according to the presence of postoperative complications. Their characteristics and clinical parameters, including physical function, were analyzed. Patients with postoperative complications had a higher prevalence of frailty (58.8% vs 14.3%, p = 0.003) and a shorter 6-min walk distance (380 m vs 436 m, p = 0.020) than those without postoperative complications. Logistic regression analysis identified preoperative frailty as the only independent risk factor for complications after pancreatectomy (p = 0.002). Preoperative frailty is associated with postoperative complications of pancreatectomy. Since preoperative frailty can be easily evaluated, it is a useful predictor of postoperative complications after pancreatectomy.

Propofol is a pharmaceutical agent commonly used as an intravenous anesthetic in surgical treatments and a sedative in intensive care. However, it is largely unknown how exposure to propofol affects the proliferation, invasion, and apoptosis of neoplastic cells in esophageal cancer. In this study, we sought to elucidate the impact of propofol exposure on the growth properties of human esophageal cancer cell lines in vitro. We treated two human esophageal cancer cell lines, KYSE30 and KYSE960, with up to 10 µg/mL of propofol for 12-36 h. The treated cells were then analyzed by cell proliferation assay, Matrigel invasion assay, quantification of caspase-3/7 and -9 activities, and cell staining with Annexin V and 7-aminoactinomycin D to detect early apoptosis and cell death, respectively, via flow cytometry. We found that 3-5 µg/mL propofol reduced the growth and Matrigel invasion of both cell lines in a dose-dependent manner. Executioner caspase-3/7, but not caspase-9 involved in intrinsic apoptosis pathway, was activated by cell exposure to 3-5 µg/mL propofol. In addition, 3-5 µg/mL propofol augmented early apoptosis in both cell lines and increased cell death in the KYSE30 cell line. In summary, exposure to propofol, at concentrations up to 5 µg/mL, led to the reduction of cell growth and Matrigel invasion, as well as the augmentation of apoptosis in esophageal cancer cell lines. These data will help define a methodology to safely utilize propofol, a common general anesthetic and sedative, with esophageal cancer patients.

M1 large circumferential aneurysms are clinically challenging because they cannot be treated by simple neck clipping and they may involve the lenticulostriate arteries (LSAs). Although some reports have described endovascular and direct surgical treatment of these aneurysms, the optimal treatment approach remains uncertain. We report a case involving a ruptured large M1 circumferential aneurysm that was treated with bypass-assisted trapping surgery and showed favorable outcomes. The patient was a 47-year-old man presenting with subarachnoid hemorrhage. Digital subtraction angiography revealed a large circumferential aneurysm in the right middle cerebral artery M1 segment with involvement of the lateral and medial LSAs. We successfully performed trapping surgery with the assistance of a superficial temporal artery (STA)-M2 bypass while preserving the medial and lateral LSAs. Although left hemiparesis caused by medial LSA thrombosis appeared in the early postoperative period, the patient showed good recovery from symptoms with rehabilitation and could independently perform daily activities at the five-month follow-up. The treatment of M1 large circumferential aneurysms should involve considerations for prevention of rebleeding, blood supply to the distal area, and preservation of perforating arteries. The treatment strategy for this challenging aneurysm should be planned based on the patient's condition and individual anatomy.

A 19-year-old woman presented with swelling of the left forehead without pain. She did not have any relevant past or family history. Computed tomography showed destruction of the outer cortex of the frontal bone. A solitary mass lesion with a fluid collection was detected with magnetic resonance imaging. Because the swelling of the left forehead had enlarged rapidly with osteolytic changes, surgical removal of the lesion was performed. The lesion appeared to be enveloped in a fibrous capsule. The soft lesion was removed from the frontal bone. The outer frontal bone was absent, although the inner frontal bone was preserved. Then, the frontal bone was resected with margins from the edge of the erosion. The dura mater under the lesion was intact. A cranioplasty was performed using titanium mesh. On histological examination, the trabecular bones revealed irregular shapes and arrangements, indicating fibrous dysplasia. There was a continuous high-cell-concentration pathological lesion outside the fibrous dysplasia. There were numerous cells, such as mononuclear cells, osteoclast-like multinucleated giant cells, foam cells, and red blood cells. The osteoclast-like multinucleated giant cells and other cells did not show significant nuclear atypia. Immunostaining with H3.3G34W was negative, and the ubiquitin-specific peptidase 6/Tre-2 gene showed no rearrangements. The histopathological diagnosis was secondary aneurysmal bone cyst with fibrous dysplasia. Additional postsurgical therapy was not performed. There has been no evidence of recurrence of the lesion for two years.

In lateral skull base reconstruction, it is necessary to seal the defect in the lateral skull base, fill the dead space, and, sometimes, reconstruct the facial nerve. However, this procedure is difficult to perform with a standard musculocutaneous flap. Therefore, for such cases, an omental flap is used in our hospital because of its flexibility. In this study, we report our experience with the procedure (lateral skull base reconstruction with a free omental flap) and its long-term outcome and facial nerve reconstruction, with special focus on facial nerve recovery. This study is a technical note and a retrospective review. It was conducted in Nagoya University Hospital. Overall, 16 patients (12 women and 4 men; mean age: 55.1 years) underwent lateral skull base reconstruction with a free omental flap after subtotal temporal bone resection or lateral temporal bone resection during 2005-2017. The main outcome measures were postoperative complications and facial nerve recovery: Yanagihara score and House-Brackmann grading system. Complications included partial necrosis and minor cerebrospinal fluid leakage in 2 patients. Facial nerve recovery could be observed more than 12 months after surgery, with a mean Yanagihara score of 19.6 and House-Brackmann grade of 3.60. The free omental flap is a reliable method for lateral skull base reconstruction, especially in cases where facial nerve reconstruction is needed. To the best of our knowledge, this is the first report on facial nerve recovery after lateral skull base reconstruction.