Nagoya Journal of Medical Science最新文献

Chronic kidney disease (CKD) and its treatment with hemodialysis (HD) pose unique challenges for spinal surgery due to complications such as destructive spondyloarthropathy (DSA). This study retrospectively compared the surgical outcomes of posterior lumbar interbody fusion (PLIF) between 48 HD patients and 57 non-HD controls. Patients with tumors, infections, prior spinal surgery, or severe osteoporosis were excluded. HD patients had a mean dialysis duration of 16.2 years, while controls were treated for degenerative lumbar conditions. HD patients exhibited significantly higher intraoperative blood loss (415.8 ± 231.7 mL vs 293.4 ± 57.3 mL, P < 0.001) and lower 2-year bony fusion rates (72.9% vs 94.7%, P = 0.008). Pseudoarthrosis and adjacent segment disease (ASD) were more common in the HD group, necessitating reoperation in five cases versus one in controls. Neurological recovery at 2 years was worse in the HD group, with a mean Japanese Orthopaedic Association score of 19.6 ± 4.3 compared to 26.5 ± 2.2 in controls (P < 0.01). Despite facilitating initial neurological recovery, PLIF outcomes in HD patients were compromised by greater complication rates, including pseudoarthrosis and ASD. Thus, PLIF facilitates early neurological improvement in HD patients, but long-term functional outcomes are compromised due to higher rates of pseudoarthrosis and ASD, necessitating careful long-term management. Strategies minimizing mechanical stress and maintaining spinal alignment could further support long-term patient recovery.

Atypical hemolytic uremic syndrome (aHUS) is a rare and life-threatening disease often complicated by end-stage renal disease. Anti-C5 antibody agents have been developed for the treatment of aHUS: these are highly effective but limited in use owing to the difficulty of diagnosing aHUS in the acute clinical phase. The pathophysiology of aHUS is a thrombotic microangiopathy (TMA) caused by complement dysregulation triggered by environmental factors in susceptible individuals with genetic factors. Although several germline variants associated with aHUS have been identified, approximately half of patients with aHUS lack known pathogenic variants. It is essential to recognize the characteristic clinical features of aHUS. These include the triad of hemolytic anemia, thrombocytopenia, and renal impairment, without the presence of Shiga toxin-producing Escherichia coli infection, thrombotic thrombocytopenic purpura associated with ADAMTS13 deficiency, or TMA from secondary cause. In this case, plasma exchange could not be continued owing to allergy. Early diagnosis allowed for prompt administration of eculizumab at the time of relapse, with favorable outcomes. Based on the finding of no genetic abnormalities, eculizumab was discontinued after 12 months, with no recurrence for 3 years. On day 27 of hospitalization, renal biopsy revealed endothelial damage. Since a definitive diagnosis cannot be made with genetic testing in the acute stage and approximately half of patients have no genetic abnormalities, it is suggested to diagnose the condition as per the clinical definition and commence treatment with plasma exchange. If thrombotic thrombocytopenic purpura is excluded, switching to eculizumab is another treatment option according to clinical conditions.

Maternal depression affects 17.7% of postpartum women and can emerge years after childbirth, impacting both mothers and their children. Social support plays an important role in preventing maternal depression. Family and community were traditional sources of social support, but the rise of digital media may impact social support and therefore maternal well-being. Mothers are accustomed to technology and often use digital devices for childcare and leisure activities. This study examined the association between screen time and the onset of depression two years postpartum. A cohort study was initiated in November 2020 (baseline) with follow-up in May-June 2022, employing an anonymous online questionnaire. Study participants were first-time mothers (n = 204) of children aged 5-8 months. Measures considered basic attributes, family environment, maternal depression (Edinburgh Postnatal Depression Scale [EPDS]), screen time, and sleep status. No baseline maternal depression (EPDS score < 9) was a requirement for participation. Maternal depression onset during a 1.5-year follow-up was the dependent variable. Screen time, sleep duration, and support services were independent variables. Their relationships were analyzed using Fisher's exact test, the Mantel-Haenszel test, and logistic regression. Twenty-six participants (12.7%) developed depression (EPDS ≥ 9) within two years of childbirth. Logistic regression revealed a significant association between smartphone use time and maternal depression (odds ratio [OR] = 1.89; 95% confidence interval [CI], 1.09-3.26). No association was found between social media or game use and maternal depression. Excessive smartphone use was related to depression two years after childbirth, indicating the need for health guidance on screen time for mothers.

We performed total aortic arch replacement (TAR) with a frozen elephant trunk (FET) for chronic dissecting aortic aneurysm (DAA) involving the aortic arch as the initial surgery and carefully observed these aortic findings with periodic computed tomography (CT) follow-up. Additional surgical interventions were considered when aortic events were observed. Midterm outcomes were evaluated to clarify the feasibility of this strategy. Thirty-seven patients underwent TAR with FET between 2014 and 2020. The median follow-up period was 48.6 months. There was 1 case of operative mortality (2.7%) and 11 late deaths, including five aortic-related deaths. Aortic events occurred in 26 patients (72.2%), including 14 cases of stent-induced new entry (SINE), eight cases of aneurysmal enlargement, two cases of graft infection, and one each of additional aortic dissection and aortic root enlargement. Thirty-one procedures were performed, including 14 open surgeries, 16 thoracic endovascular aortic repairs (TEVAR), and 1 endovascular aortic repair (EVAR) with coil embolization. The freedom rate from aortic events was 36.9% at three years and 22.8% at five years. The distal aortic arch showed significant shrinking (slope, -1.96; P<0.001), but the lower descending aorta showed significant enlargement (slope, 0.87; P<0.001). The diameter of the middle descending aorta was a predictor of SINE (>40.5 mm) and aneurysm enlargement (>40.2 mm). The present study showed acceptable early outcomes but frequent aortic events during follow-up. Cautious periodic CT is mandatory to perform additional reinterventions at the proper time, and scheduled surgical intervention, including TEVAR, is essential for cases with enlarged middle descending aortas.

Microglia are brain specific macrophages and the only immune cells in the brain. Microglia sense the systemic immune status and contribute to neurological and psychiatric disorders. We previously showed that systemic immune activation induces microglial migration on vessels that regulate the blood brain barrier permeability. In this study, using Toll like receptor 7 induced systemic lupus erythematosus model mice, we found microglia migration on vessels and significant T cell infiltration in the brain. Additionally, microglia interacting with T cell expressed MHC class II molecules in some cases, suggesting the antigen presentation of microglia in systemic lupus erythematosus model mice. This research provides insights on the autoimmune antibody expression in the brain.

Glycosylation, a key post-translational modification, regulates protein function in many contexts. Epidermal growth factor-like repeats undergo domain-specific O-glycosylation such as O-glucosylation, O-fucosylation, and O-GlcNAc'ylation. O-Glucose glycans are attached to specific serine residues by the action of protein O-glucosyltransferase 1 (POGLUT1) and can be elongated with two xylose residues by glucoside α1-3xylosyltransferase 1 (GXYLT1) or glucoside α1-3xylosyltransferase 2 (GXYLT2) and xyloside α1-3xylosyltransferase 1 (XXYLT1) in mammals. The xylosyl elongation of O-glucose as a negative regulator of Notch in Drosophila has recently been reported, but its role in mammalian Notch signaling remains elusive. Here, we investigated the impact of terminal xylosylation by XXYLT1 on NOTCH1 signaling in Jurkat cells, a T-cell acute lymphoblastic leukemia cell line with cell-autonomous NOTCH1 activation due to the juxtamembrane expansion mutation. Mass spectrometry analysis of NOTCH1 fragments overexpressed in Jurkat cells demonstrated that the O-glucose site on NOTCH1 EGF10 was modified with various elongating patterns of O-glucose. Genetic deletion of XXYLT1 in Jurkat cells led to enhanced activation of NOTCH1, suggesting that XXYLT1 inhibited NOTCH1 activation in Jurkat cells, whereas the cell surface expression of NOTCH1 was not altered. Unexpectedly, the proliferation of Jurkat cells was impaired in XXYLT1 knockout cells, with accompanying MYC downregulation, a Notch target gene. Our results revealed for the first time that mammalian Notch activation is fine-tuned by xylosylation in Jurkat cells, thus highlighting the potential of Notch agonism by the inhibition of xylosylation. Additionally, our findings regarding cell proliferation underscore the notion that there are possibly substrates other than NOTCH1 that XXYLT1 modifies, thereby regulating their functions in Jurkat cells.

Hemolytic anemia is a rare complication after aortic surgery. We herein report an early postoperative case of hemolytic anemia caused by an internal felt strip. A 57-year-old man underwent emergency partial aortic arch replacement for acute type A aortic dissection. The proximal stump was reinforced using internal and external polytetrafluoroethylene felt strips. The patient subsequently developed profound mechanical hemolytic anemia two weeks after the operation. Computed tomography did not reveal any narrowing of the anastomosis or kinking of the graft. However, transesophageal echocardiography confirmed that the internal felt strip had become inverted by the blood flow. Reoperation was performed to redo the proximal anastomosis, while also removing the internal felt strip. Hemolysis diminished soon after the reoperation. We encountered a case of acute aortic dissection that required reoperation because of hemolytic anemia caused by internal felt strip inversion. Further measures are required to prevent hemolysis with felt strips.

Endurance exercise is known to reduce the risk of cardiovascular disease. Myonectin, a myokine, is increased by endurance exercise and affects remote organs such as the heart. However, the role of myonectin in the blood vessels is unknown. In this study, we investigated the role of myonectin in angiogenesis. Human umbilical vein endothelial cells (HUVECs) were treated with recombinant myonectin to assess tube formation, proliferation, and migration. An in vivo Matrigel plug assay was performed by transplanting Matrigel containing myonectin into myonectin-knockout (Myo-KO) mice, and angiogenic response was evaluated. Mouse models of hindlimb ischemia were developed by ligating and removing the femoral arteries of wild-type (WT), Myo-KO, and myonectin-overexpressing transgenic (Myo-TG) mice, and blood flow was evaluated over time by laser Doppler imaging. In vitro, treatment with myonectin increased the differentiation of HUVECs into vascular-like structures. Myonectin significantly stimulated HUVEC migration, as assessed using a modified Boyden chamber assay. Treatment with myonectin also increased HUVEC proliferation, as assessed by the MTS assay. In the Matrigel plug assay, plugs containing myonectin displayed a significantly higher-degree of endothelial cell infiltration than plugs containing vehicle. Angiogenic repair of ischemic hindlimbs was impaired in Myo-KO mice compared to that in WT mice. However, Myo-TG mice had significantly increased limb perfusion after ischemic surgery compared to that in WT mice. This study showed that myonectin acts directly on vascular endothelial cells and promotes angiogenesis. Treatment aimed at increasing myonectin production may be useful in the treatment of cardiovascular diseases with vascular dysfunction.

This study aimed to clarify the temporal changes in transcutaneous hemoglobin levels up to 1 month postpartum and the influencing factors in postpartum women using a noninvasive transcutaneous hemoglobin measuring device. The study participants were pregnant women recruited at an outpatient clinic. We collected information on their dietary history using a concise self-administered questionnaire and an agreement document when they were hospitalized for delivery. Transcutaneous hemoglobin levels of the mothers were measured using Pronto (Masimo) at 1 day, 4 days, 2 weeks, and 1 month postpartum. We included 135 mothers (mean age, 31.7 years) who delivered at full term. The mean transcutaneous hemoglobin levels decreased slightly from day 1 (11.9 ± 1.6 g/dL) to day 4 postpartum (11.8 ± 1.7 g/dL), followed by a significant increase from day 4 to 2 weeks postpartum (13.8 ± 1.0 g/dL; p < 0.01), and no change from 2 weeks to 1 month postpartum (13.8 ± 0.9 g/dL). Iron intake in the third trimester of pregnancy affected transcutaneous hemoglobin levels from day 4 postpartum to recovery by 2 weeks postpartum. The rapid increase in hemoglobin levels from day 4 to 2 weeks postpartum was a novel finding. Evaluation of hemoglobin levels in women at 2 weeks postpartum is important for postpartum recovery. Furthermore, health guidance regarding iron intake in the third trimester of pregnancy has been suggested to be effective in restoring postpartum hemoglobin levels.

Fosbury flop tears (FFTs) are a type of rotator cuff tear characterized by the tendon flipping upon itself and adhering medially. These tears have been observed arthroscopically as either bursal-sided partial-thickness tears (BSPTTs) or full-thickness tears (FTTs), though the mechanism leading to FFTs in these tear types remains unclear. This study aimed to investigate the clinical features, acromial morphology, and treatment outcomes of FFTs, stratifying patients into BSPTT and FTT groups. We included patients with small-to-medium-sized supraspinatus tendon tears who underwent arthroscopic rotator cuff repair (ARCR). Those with BSPTTs were categorized as Group P, and those with FTTs as Group F. Variables such as age, sex, diabetes mellitus status, critical shoulder angle (CSA), lateral acromial angle (LAA), sagittal and coronal acromion morphologies, Japanese Orthopaedic Association (JOA) score, and retear rate were evaluated. Group P consisted of 13 patients, primarily younger males with traumatic tears, while Group F included 40 patients, with a higher proportion of females. There were no significant differences between the groups in CSA, LAA, JOA scores, or retear rates. Both groups had a high prevalence of double-floor type osteophytes in coronal acromial morphology. FFTs were frequently observed in both BSPTTs and FTTs, particularly in patients with double-floor osteophytes. BSPTTs with FFTs may be more common in younger patients with trauma. Overall, ARCR outcomes for FFTs were similar between BSPTTs and FTTs, suggesting similar efficacy in treatment across these tear types.