Nagoya Journal of Medical Science最新文献

Herein, we present a case of severe immune-related adverse events (irAEs), myocarditis with myositis, and myasthenia gravis overlap syndrome (IM3OS) in a patient receiving an immune checkpoint inhibitor (ICI), as adjuvant therapy after surgery for muscle-invasive bladder cancer. An 80-year-old woman who had undergone a total cystectomy for bladder cancer presented with ptosis, diplopia, and paralysis 18 days after receiving nivolumab, an anti-programmed cell death-1 (PD-1) monoclonal antibody, as adjuvant therapy for the first time. Initial testing revealed positive findings on the ice pack test; elevated troponin, creatine kinase, and aldolase levels; and an abnormal electrocardiogram, suggesting that the patient had developed ICI-related myocarditis, myositis, and myasthenia gravis. Despite treatment with intravenous immunoglobulin (IVIG) and high-dose corticosteroids, her condition worsened, leading to a complete atrioventricular block. After cardiac pacemaker insertion and intensive treatment with repeated high-dose corticosteroids, IVIG, plasma exchange, and tacrolimus, left ventricular function and myositis symptoms improved. However, the patient developed a respiratory infection and renal failure, leading to death on day 99. Although ICIs are considered relatively safe with few side effects, they can cause serious complications and lead to death. In particular, when severe irAEs occur in multiple organs, such as IM3OS, the prognosis is poor. Although IM3OS has no specific diagnostic biomarker, making early detection difficult, clinicians should always pay attention to patient symptoms when using ICI and evaluate other pathologies with IM3OS when conditions such as myositis or myocarditis are suspected. Further research is needed to elucidate the pathophysiology and risk factors of IM3OS.

A 9-year-old boy fell off his skateboard, resulting in a supracondylar fracture of his left humerus. The fracture was surgically repaired on the same day using two Kirschner wires inserted from the medial and lateral sides. Following surgery, the patient developed ulnar nerve palsy, prompting reoperation. It was discovered that the ulnar nerve was located anterior to the medial epicondyle and was snagged on the Kirschner wire, causing compression. Despite clear confirmation of the wire entry site, the presence of an unstable ulnar nerve anterior to the medial epicondyle necessitates caution to prevent ulnar nerve injury.

A 54-year-old woman was referred to our hospital because of abnormal colonoscopic findings, including a submucosal protuberance at the appendiceal root. A biopsy showed no malignant findings. Computed tomography revealed a 20-mm cystic lesion with thick walls at the appendiceal root, suggestive of an appendiceal mucocele. Laparoscopic ileocecal resection was performed based on the preoperative diagnosis of a suspected mucinous appendiceal neoplasm. The resected specimen showed a closed appendiceal orifice surrounded by a mucus-containing submucosal tumor. Histopathologically, the appendiceal epithelium was circumferentially inverted in the appendiceal root, with hyperplasia of the submucosal connective tissue. No atypical epithelium was observed. We hypothesized that repeated partial invagination of the appendiceal root caused submucosal hyperplasia and drainage disturbance of the appendiceal content, leading to the development of a mucocele.

Eggerthella lenta (E. lenta) is known to cause intra-abdominal and anaerobic bloodstream infections. However, clinical insights and information on antimicrobial susceptibility in E. lenta infections are limited. This study aimed to elucidate the clinical characteristics and antimicrobial susceptibility of E. lenta infections. Patients with E. lenta isolated from various specimens who presented at Aichi Medical University Hospital between January 2018 and December 2022 were included. Patient information was retrospectively collected from electronic medical records. Logistic regression analysis was conducted to identify risk factors for bloodstream infections. The antimicrobial susceptibility of various antimicrobial agents against isolated strains was investigated. During the study period, seventy cases were classified as infection cases. The median age of patients was 69 years (range: 15-100 years), and 48 (68.6%) were males. The most common site of infection was the lower digestive tract (54.3%). In 70.4% of cases, polymicrobial infections occurred. Community-acquired infection was a significant risk factor for bloodstream infection, with an odds ratio of 4.94 (95% confidence interval: 1.02-23.9). The 30-day mortality rate was 10.0%. Univariate analysis showed lower mortality in patients who underwent surgical intervention than in those who did not (42.9% vs 57.1%, p = 0.02). The proportion of minimal inhibitory concentrations (MICs) of ≥ 32 μg/mL for piperacillin-tazobactam was 6.3%. Additionally, the proportions of MICs of ≥ 8 μg/mL for imipenem and meropenem were 1.4% and 0%, respectively. E. lenta should be considered when blood cultures yield gram-positive rods in community-acquired intra-abdominal infections. Effective treatment involves both antimicrobial agents and surgical interventions.

The 25-question Geriatric Locomotive Function Scale (GLFS-25) is a tool to identify locomotive syndrome, however, this tool is associated with the problem of a low complete response rate. We conducted this cross-sectional study of 2,474 community-dwelling residents to investigate the clinical characteristics of individuals who are prone to provide incomplete responses to the GLFS-25 questionnaire. The participants were divided into the following four groups based on the number of the GLFS-25 items they answered: 0 (n=279), 1-21 (n=36), 22-24 (n=273), and 25 (n=1,886). We investigated clinical characteristics including age, sex, body mass index, health consciousness, housemate status, smoking and drinking habits, physical activity level, the presence of body pain, and comorbidities. To achieve the study objective, we focused on a comparison of the clinical characteristics between the group of participants who answered 22-24 items (target group) and 0 items (control group). The participants who answered 22-24 items were older, more likely to be health-conscious, more likely to live alone, less likely to have lower levels of physical activity, and were more likely to report neck pain, low back pain, shoulder pain, elbow pain, wrist pain, hip pain, knee pain, ankle pain, and ophthalmic disease than those who answered 0 items. Among the significant factors, the only factor that can be changed to improve the number of answered items on the GLFS-25 is health consciousness.

Qualitative research, used to analyse non-numerical data including interview texts, is crucial in understanding medical education processes. However, it is often complex and time-consuming, leading to an interest in technology for streamlining the analysis. This study investigated the applicability of ChatGPT, a large language model, in thematic analysis for medical qualitative research. Previous research has used ChatGPT to explore the deductive process as a qualitative study. This study evaluated thematic analysis including the inductive process by ChatGPT with reference to human qualitative analysis. A convergent design mixed-methods study was used. Using a thematic analysis approach, ChatGPT (model: GPT-4) analysed some interview data from a previously published medical research article. The assessors evaluated the qualitative analysis of ChatGPT using human qualitative analysis as a benchmark. Three assessors compared the human-conducted and ChatGPT-driven qualitative analyses. ChatGPT scored higher in most aspects but showed variable transferability and mixed depth scores. In the integrated analysis including qualitative data, six themes were identified: superficial similarity of results with human analysis, good first impression, explicit association with data and process, contamination by directions in prompts, deficiency of thick descriptions based on context and research questions, and lack of theoretical derivation. ChatGPT excels at extracting key data points and summarising information; however, it is prone to prompt contamination, which necessitates careful scrutiny. To achieve deeper analysis, it is essential to supplement the research context with human input and explore the theoretical framework.

Afghanistan has an increasing trend of mortality due to non-communicable diseases but most studies were conducted in urban areas. This study aimed to assess the prevalence and factors associated with diabetes mellitus and hypertension in a rural area in Afghanistan. A cross-sectional study was conducted from September to October 2019 including 373 people who were 18-79 years old and lived in Andkhoy District, Afghanistan. Demographic and lifestyle data was collected by face-to-face interviews after informed consent was obtained. Height, body weight, blood pressure, waist circumference, and blood sugar level were measured by the data collection team. A logistic regression model was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). The prevalence of diabetes mellitus and hypertension was 9.7% and 29.5%, respectively. Factors associated with diabetes mellitus were male gender (adjusted OR [AOR]=9.81, 95% CI: 2.48-38.90), family history of diabetes mellitus (AOR=3.84, 95% CI: 1.30-11.38), low physical activity (AOR=4.53, 95% CI: 1.13-18.26), and high waist circumference (AOR=7.93, 95% CI: 2.40-26.20). Snuff users were negatively associated with diabetes mellitus (AOR=0.18, 95% CI: 0.04-0.75). Factors associated with hypertension were the age group of 40-59 years (AOR=4.22, 95% CI: 1.99-8.95) and 60-79 years (AOR=19.83, 95% CI: 7.19-54.71) compared to 18-39 years, family history of hypertension (AOR=2.17, 95% CI: 1.15-4.10), and palaw intake of 3 times per week or more (AOR=1.86, 95% CI: 1.03-3.38). Lifestyle interventions for increasing physical activity should be introduced and health education about snuff usage and salt intake should be promoted in communities in Afghanistan.

Ganglioneuromas are rare benign tumors that arise from the sympathetic nervous system. The presentation of tumors is variable and associated with adolescent thoracic scoliosis. Herein, we present two case reports and a review of literature. The two cases involved 10 and 13-year-old patients who were asymptomatic for muscle pain or weakness, and ganglioneuromas were incidentally detected through imaging screening. Both patients underwent a two-stage surgery. The first stage involved detachment of the tumor from the spinal cord and simultaneously performing deformity correction surgery from the posterior aspect. The second stage was resection of the ganglioneuroma through the anterior approach without neurological problems. A two-stage surgery was necessary to excise the tumor and correct the deformity, thereby avoiding neurological problems and concurrently establish a pathological diagnosis. Commencing with the posterior approach proved to be safe and was more effective.

Adenylate cyclase family members have recently received attention as novel therapeutic targets. However, the significance of adenylate cyclase 9 (ADCY9) in breast cancer has not been elucidated. Here, we evaluated ADCY9 expression in breast cancer (BC) cell lines, and polymerase chain reaction array analysis was performed to determine the correlations between ADCY9 expression levels and 84 tumor-associated genes. The association of ADCY9 messenger RNA (mRNA) expression levels in clinical breast cancer specimens with patients' clinicopathological factors and prognosis was evaluated. The database of cancer cell line showed that estrogen receptor-positive and progesterone receptor-positive cells expressed higher ADCY9 mRNA levels. ADCY9 expression showed positive correlations with several oncogenes, such as TGFB1, CDKN1A, and BAX in the polymerase chain reaction array analysis. We defined the ratio of ADCY9 mRNA expression levels in breast cancer and adjacent noncancerous tissues as the "C/N ratio". Among 149 patients with BC, estrogen receptor-positive and progesterone receptor-positive patients exhibited higher C/N ratios than estrogen receptor-negative and progesterone receptor-negative patients, respectively. Patients in the lowest C/N ratio quartile experienced shorter prognosis periods. The C/N ratio of ADCY9 was found as an independent prognostic factor for disease-free survival. Thus, ADCY9 expression is high in hormone receptor-positive breast cancer, and its low expression indicates a poor prognosis in patients with breast cancer.