Nagoya Journal of Medical Science最新文献

The Japan Multi-Institutional Collaborative Cohort Study, the Yamagata Molecular Epidemiological Cohort Study, and the Tsuruoka Metabolomics Cohort Study use a 47-item food frequency questionnaire (FFQ) developed in central Japan in 2004. We applied regression analyses to estimate nutrient intakes in the FFQ. The regression equations, however, may not be so robust and may vary among areas, even in Japan. We aimed to evaluate the reproducibility and validity of the FFQ over an expanded area of Japan. Healthy volunteers aged 34-70 years from 13 areas of Japan provided 12-day weighed dietary records (WDRs) and completed two FFQs over 1 year. We evaluated reproducibility and validity by comparing the intakes of 27 nutrients between the two FFQs and the first FFQ (FFQ1) and WDRs, respectively. Spearman's rank correlation coefficients (SRs) between estimates from the FFQs and WDRs were calculated and corrected for intra-individual variation in the WDRs. Intakes of the selected nutrients estimated from the two FFQs were equivalent. The median energy-adjusted SRs between FFQ1 and the second FFQ were 0.66 for both men and women. Regarding validity adjusted for within-individual variation, energy-adjusted SRs for WDRs vs FFQ1 ranged from 0.13 (thiamin) to 0.79 (alcohol) for men, and the median was 0.35. The energy-adjusted SRs ranged from 0.20 (protein) to 0.71 (alcohol) for women, and the median was 0.43. The FFQ demonstrated high reproducibility and moderate validity, which suggests that it is appropriate to clarify associations between diet and health and/or disease among adults in Japan.

Non-tuberculous Mycobacterium avium complex (MAC) disease is caused by inhalation of water or soil dust containing MAC bacteria. Treatment of MAC disease should include not only drug treatment, usually a three-drug regimen consisting of a macrolide, ethambutol, and a rifamycin, but also environmental intervention. However, there is no standardized approach to environmental evaluation or remediation of potentially harmful exposures from potting soils in home or workplace environments for patients with non-tuberculous mycobacterial infection. We present two patients with MAC disease who were positive for anti-MAC antibodies but had no culturable mycobacteria in sputum. One patient discontinued gardening, and the other patient moved her many indoor plants outside. Both patients subsequently had decreased sputum, and subsequent chest computed tomography showed decreased ground-glass opacities, consolidation, and small nodules. Environmental intervention may therefore be sufficient treatment for mild MAC disease.

Innominate artery aneurysms are rare, accounting for only 0.26% of all aneurysms. Although usually asymptomatic, they carry a significant risk of rupture, which can be fatal, making timely diagnosis and treatment essential. There is limited literature on the management of innominate artery aneurysms during pregnancy, and no established treatment guidelines exist. In this case, a 42-year-old multigravida woman was diagnosed with an innominate artery aneurysm four years prior to pregnancy. Genetic panel testing ruled out inherited connective tissue disorders, including Marfan syndrome. The aneurysm measured 24 × 36 mm and possessed a saccular configuration. At 23 weeks of gestation, due to the high risk of rupture, the patient underwent successful endovascular stent grafting without complications. Later, the patient developed preeclampsia and fetal growth restriction, necessitating an emergency cesarean section at 33 weeks. A female infant was delivered, and both mother and neonate were discharged without further complications. Open surgical intervention with cardiopulmonary bypass is the standard therapeutic approach for innominate artery aneurysms. However, maternal and fetal mortality rates associated with cardiopulmonary bypass during pregnancy are high. This case suggests that although innominate artery aneurysms during pregnancy are exceedingly rare, endovascular repair with stent grafting may be a viable treatment option to avoid the serious maternal and fetal risks associated with aneurysm rupture or open surgical repair.

Cancer treatment for centenarians can be challenging. High-dose-rate surface mold brachytherapy is a non-invasive, radical treatment modality for surface cancer. Further, it is used for patients who cannot remain at rest or have poor posture. We performed this treatment on a 103-year-old female patient with forehead skin cancer, dementia, tremors, and kyphosis since radical surgery and external beam radiotherapy were not feasible. A custom-made surface mold with tube applicators was developed with vinyl sheet and silicone. The vinyl sheet was utilized to enable tumor visualization through the mold and to confirm the tumor position relative to the mold. The mold with tumor translucency was fixed to the tumor surface, and the radioisotope (Ir-193) was sent remotely through tube applicators for irradiation. The planning-aim doses were 48 Gy in eight fractions. The positional relationship between the mold and the tumor was confirmed similarly during irradiation by checking them through the vinyl sheet before and after irradiation. We treated the patient, although she was in constant motion during irradiation. The local tumor was well-controlled without any metastatic disease evidence. The tumor disappeared before her eventual death 11 months post-treatment. No serious adverse events were reported during the follow-up period. Our results indicate that high-dose-rate surface mold with tumor translucency brachytherapy is an effective cancer treatment for centenarians with dementia, tremors, and kyphosis.

The objective of this study was to evaluate and compare the clinical and radiographic outcomes between in situ fixation and fixation after reduction of severe valgus-impacted femoral neck fractures in patients aged 65 years or older. This was a multicenter retrospective study of 561 patients who underwent open reduction and internal fixation for femoral neck fracture. From this population, we selected patients aged 65 years and older with severe valgus-impacted femoral neck fractures characterized by a Garden alignment index greater than 15 degrees compared to that on the non-injury side. After exclusion criteria were applied, the study included 92 patients who were categorized into two groups: in situ fixation group (n = 56) and fixation after reduction group (n = 36). Our analysis covered patient demographics, surgical details, postoperative complications, radiographic evaluations, Numeric Rating Scale for pain, and Parker's Mobility Score for clinical outcomes. Bone union was achieved in all patients. The incidence of avascular necrosis was consistent between the groups. Patients in the reduction group reported lower Numeric Rating Scale scores (mean: 0 vs 2, p = 0.003) and higher Parker's Mobility Score scores (mean: 7 vs 6, p = 0.009) compared with the in situ group. Radiographically, the reduction group showed significantly lower femoral neck shortening (mean: 4.75 mm vs 5.75 mm, p = 0.049) and a reduced length of cannulated cancellous screw backout (mean: 3.4 mm vs 5.4 mm, p = 0.007) at the final follow-up. Fixation after reduction for severe valgus-impacted femoral neck fractures in patients aged 65 and above appears to be a safe and effective approach.

We sought to explore factors associated with changes in activities of daily living (ADL) in home-based medical care (HBMC). We used data from the Observational Study of Nagoya Elderly with Home Medical Care 2, in which HBMC was provided for physical and/or mental disability. ADL were assessed using the Barthel Index and its mobility and self-care categories. Of 40 eligible participants, half were classified into an ADL decline group. The percentage with a decreased Mini-Nutritional Assessment-Short Form (MNA-SF) score was significantly higher in the ADL decline group. Worsening of MNA-SF was significantly associated with a decline in the mobility category but not in the self-care category. ADL decline was frequently observed and was associated with worsening of nutritional status in HBMC.

Short stature and growth retardation is a common condition in children. Genetic variations are responsible for many cases of short stature of unknown etiology. In particular, pathogenic copy number variants (CNVs) have been found in 10%-16% of children with unexplained short stature. This paper reports on a 5-year-old Japanese girl with both growth retardation and developmental delay associated with a 16p13.11 microduplication. Although the patient's mother also carries this microduplication, she did not show growth retardation and developmental delay. These cases illustrate the diverse phenotypic manifestations of 16p13.11 microduplication. Consequently, we conducted the literature review of 274 cases associated with this duplication revealed neurological disorders in approximately 70% of cases, 15.3% of these cases were associated with short stature. Diagnosis of 16p13.11 microduplication remains challenging due to its diverse symptomatology and elusive genotype-phenotype correlations. Comprehensive genetic evaluation is crucial for patients presenting with short stature and developmental disorders, underscoring the need for further investigation into the 16p13.11 microduplication to clarify its specific role and implications.

The Maze procedure is a well-established technique for treating atrial fibrillation; however, atrial tachyarrhythmias can recur postoperatively. This study analyzed the mechanisms of recurrence in patients who underwent electrophysiological studies and catheter ablation following the Maze procedure. Among 88 patients who underwent treatment with a modified Maze procedure, 42 developed recurrent atrial tachyarrhythmias. Among these, 18 underwent electrophysiological studies and simultaneous transcatheter radiofrequency ablation. The median period between the Maze procedure and catheter ablation was 29 months. Macro-reentrant circuits were identified in 12 patients (67%) with or without atrial fibrillation. Most patients (n = 15, 83%) had more than one conduction gap. The most frequently identified gap was around the left inferior pulmonary vein (n = 10, 56%), followed by the peri-coronary sinus area (n = 8, 44%), and the mitral isthmus area (n = 5, 28%). Catheter ablation targeting these gaps successfully eliminated tachyarrhythmias in 15 (83%) patients. At a follow-up examination 49 months after catheter ablation, 14 patients (78%) had no recurrence of tachyarrhythmia. An electrophysiological study revealed conduction gaps in patients with recurrent atrial tachyarrhythmia after the Maze procedure. Modifications to the Maze procedure should include meticulous ablation around the left inferior pulmonary vein orifice, mitral isthmus, and coronary sinus where conduction gaps frequently occur. In cases of recurrence, catheter ablation targeting the lesion effectively controlled the tachyarrhythmia.

Although conservative treatment and laparoscopic surgery are becoming increasingly popular for acute appendicitis, emergency open appendectomy is still performed in many situations. The purpose of this study was to examine the surgical outcomes of emergency open appendectomy for acute appendicitis. Between July 2008 and August 2022, 2,268 patients who underwent emergency open appendectomy for acute appendicitis were enrolled in this study. Of these patients, 417 (18.4%) had complicated appendicitis (CA), and 1,851 (81.6%) had uncomplicated appendicitis (UA). Clinical characteristics and both surgical and postoperative outcomes were compared between the groups. The percentage of CA patients increased after 2020, and by age, the proportion was greater for those aged 50 and older. In the CA group, patients were older (55.5 vs 30.0 years, p<0.001) and had more comorbidities (34% vs 12%, p<0.001). Additionally, in the CA group, the operation time was longer (86 vs 55 min, p<0.001), and the rate of postoperative complications was greater (16% vs 3.0%, p<0.001). There was one mortality in the CA group due to postoperative cerebral infarction. The postoperative hospital stay was significantly longer in the CA group (9 vs 5 days, p<0.001). In conclusion, in the CA group, the patients were older and had more comorbidities. Patients who underwent emergency open appendectomy for CA had longer operation times and more complications. This large single-center study provides insights into emergency open appendectomy for acute appendicitis and useful information in terms of comparisons with other treatment modalities, such as laparoscopic appendectomy and elective appendectomy.

Locomotive syndrome is a decline in mobility and is believed to occur before the occurrence of frailty and sarcopenia; therefore, early detection of risk factors is important. However, systematic reviews have not been conducted. A systematic review of observational studies was performed to identify risk factors for the development or progression of locomotive syndrome. We searched the electronic databases of MEDLINE, Scopus, Web of Science, Ichushi Web (in Japanese), and Cumulative Index to Nursing and Allied Health Literature. Studies that used the development or progression of locomotive syndrome as an outcome and were written in English or Japanese were included. However, studies with nonadult participants and review articles were excluded. The quality of the eligible studies was evaluated using the Cochrane risk-of-bias instrument. This study included 79 observational studies (8 cohort and 71 cross-sectional studies). A meta-analysis was not performed. All studies were conducted in Japan. The eight cohort studies included 2,343 participants aged 57.0-79.3 years upon study initiation. The risk factors for developing locomotive syndrome were objectively assessed by parameters of motor function and muscle strength, such as short one-leg standing time and weak grip strength. The progression of locomotive syndrome was associated with the preoperative risk stage of locomotive syndrome and postoperative surgical failure syndrome. Locomotive syndrome can be detected through the regular assessment of motor function and muscle strength. To prevent locomotive syndrome in middle-aged and older people, an examination by an expert is necessary.