Juntendo Iji Zasshi最新文献

Neurosteroids positively modulate GABA_A receptor (GABA_AR) channel activity by binding to a transmembrane domain intersubunit site. Using photo-affinity labeling and an ELIC-α₁GABA_AR chimera, we investigated the impact of mutations within the intersubunit site on neurosteroid binding. These mutations reduce neither photolabeling within the intersubunit site nor competitive prevention of labeling by allopregnanolone. Instead, these mutations change the orientation of neurosteroid photolabeling. The data indicate that mutations at Gln242 or Trp246 that eliminate neurosteroid effects do not eliminate neurosteroid binding within the intersubunit site, but significantly alter the preferred orientation of the neurosteroid within the site. The interactions formed by Gln242 and Trp246 within this pocket play a vital role in determining the orientation of the neurosteroid. We also examined how site-specific binding to three identified neurosteroid-binding sites in the α₁β₃GABA_AR contributes to neurosteroid allosteric modulation. We found that the potentiating neurosteroid, allopregnanolone, but not its inhibitory 3β-epimer epi-allopregnanolone, binds to the canonical β₃(+)-α₁(-) intersubunit site that mediates receptor activation by neurosteroids. In contrast, both allopregnanolone and epi-allopregnanolone bind to intrasubunit sites in the β₃ subunit, promoting receptor desensitization and the α₁ subunit promoting effects that vary between neurosteroids. Two neurosteroid analogues with diazirine moieties replacing the 3-hydroxyl bind to all three sites, but do not potentiate GABA_AR currents. One is a desensitizing agent, whereas the other is devoid of allosteric activity. Collectively, these data show that differential occupancy and efficacy at three discrete neurosteroid-binding sites determine whether a neurosteroid has potentiating, inhibitory, or competitive antagonist activity on GABA_AR.

Objectives: The number of elderly people with stomach cancer is increasing; therefore, minimally invasive surgical treatments are required. Elderly patients have multiple comorbidities and are prone to postoperative weight loss, nutritional disorders, Postgastrectomy syndrome (PGS), and decreased quality of life (QOL). Total gastrectomy is particularly associated with these complications, although aboral-pouch creation reportedly improves the condition by compensating for lost reservoir capacity. However, there is no consensus regarding its significance. This study aimed to investigate the impact of the aboral pouch on total gastrectomy outcomes in elderly patients.

Materials and methods: Thirty-six patients who met the eligibility criteria, defined as elderly patients aged ≥75 years, were retrospectively analyzed. The patients had undergone Roux-en-Y reconstructions with an aboral pouch in laparoscopic total gastrectomy procedures performed at Juntendo University from July 2016 to June 2022. The main outcomes were postoperative nutritional status, PGS, and QOL.

Results: The average postoperative period was approximately 1 year (12.0 vs. 13.5 months, P=0.536), for 14 elderly and 22 non-elderly patients, respectively. Elderly patients had more comorbidities (78.5% vs. 40.9%, P=0.041). The outcome of nutritional status demonstrated no differences in weight-loss rate (-5.3% vs. -8.6%, P=0.651) or prognostic nutritional status (-7.9% vs. -5.9%, P=0.243). There was no significant difference in PGS and QOL between elderly and non-elderly patients.

Conclusions: Total gastrectomy with an aboral-pouch creation could be beneficial for elderly 43 patients from the perspective of postoperative nutritional status, PGS, and QOL.

Objective: The present study aimed to report on the activity of a medical relief team from Juntendo Shizuoka Hospital that was dispatched to the Noto Peninsula Earthquake in Reiwa 6.

Design: Narrative report.

Results: The activities conducted on-site in the Noto Peninsula involved multiple deployments of the Juntendo University Shizuoka Hospital Disaster Medical Assistance Team (JS-DMAT). The first deployment from January 2nd to January 6th faced challenges due to damaged infrastructure, particularly roads, affecting mobility. The team focused on hospital medical support, patient transportation, and DMAT headquarters assistance. The second deployment, from January 8th to January 12th, encountered persistently damaged roads, leading to incidents but no significant vehicle damage. The team engaged in screening, zoning, medical examinations, and DMAT headquarters support in evacuation shelters. The third team's planned activities in early February were canceled by Shizuoka Prefecture.Additionally, on January 7, 2024, personnel from Juntendo Shizuoka Hospital participated in the Shizuoka Prefectural DMAT Coordination Headquarters activity, documenting DMAT activities and assessing team members' health. The Ministry of Health, Labour and Welfare's request for the fourth Shizuoka Prefecture DMAT dispatch led to the selection of the second JS-DMAT for deployment.

Conclusion: The activities related to the Noto Peninsula earthquake by JS-DMAT were reported. Lessons from this disaster are being sought to guide future disaster response preparations.

The advent of robotic surgery has significantly impacted various surgical fields, particularly urology, gynecology, general surgery, and cardiac surgery. While the da Vinci robotic platform has been predominant over the past two decades, recent years have witnessed the emergence of new robotic platforms in Japan, now actively used in clinical practice. Currently, the available systems in Japan, alongside the da Vinci, include the Hinotori, Senhance, Hugo Ras, and Saroa surgical systems. This review focuses on comparing the notable functions of each system in urologic surgery, emphasizing the areas in which they differ from the da Vinci robotic platform. The development of new robotic systems is ongoing, promising not only cost reductions but also the introduction of innovative devices and educational systems. Soft robotics, which constructs robotic devices using soft, adaptable materials, has the potential to become central to the next generation of robotic surgery. Moreover, the collaboration between Artificial Intelligence (AI) and robotic surgery significantly contributes to increasing efficiency, accuracy, and safety in the medical field, with more innovative applications expected in the future.

Objectives: This study aimed to develop and validate a machine learning prediction model for post-dispatch cancellation of physician-staffed rapid car.

Materials: Data were extracted from the physician-staffed rapid response car database at our Hospital between April 2017 and March 2019.

Methods: After obtaining 2019 cases, we divided the dataset into a training set for developing the model and a test set for validation using stratified random sampling with an 8 : 2 allocation ratio. We selected random forest as the machine-learning classifier. The outcome was the post-dispatch cancellation of a rapid car. The model was trained using predictor variables, including 18 different reasons for rapid car request, age and gender of a patient, date (month), and distance from the hospital.

Results: This machine learning model predicted the occurrence of post-dispatch cancellation of rapid cars with an accuracy of 75.5% [95% confidence interval (CI): 71.0-79.6], sensitivity of 81.5% (CI: 75.0-86.9), specificity of 70.8% (CI: 64.4-76.6), and an area under the receiver operating characteristic value of 0.83 (CI: 0.79-0.87). The important features were distance from the hospital to the scene, age, suspicion of non-witnessed cardiac arrest, farthest geographic area, and date (months).

Conclusions: We developed a favorable machine learning model to predict post-dispatch cancellation of rapid cars in a local district. This study suggests the potential of machine-learning models in improving the efficiency of dispatching physicians outside hospitals.

Defining success in a clinical trial is not necessarily a straightforward task, especially when the target population is critically ill patients where few agents have demonstrated effectiveness. This has been the case for trials of anticoagulation in patients with sepsis-associated disseminated intravascular coagulation (DIC), which have generally examined patients with severe sepsis but not specifically DIC. Limitations of existing studies include inadequate anticoagulant doses and delayed initiation of treatment. Furthermore, 28-day mortality has been adopted as the primary endpoint but is affected by a panoply of factors other than anticoagulant therapies and may not be the most relevant measure. Future trials must address several current limitations in order to improve our understanding of the role of anticoagulation in patients with sepsis-associated DIC.

The hypothalamus maintains homeostasis by controlling various organs and the central nervous system, but analyzing the human hypothalamic nuclei is challenging. Our previous studies applied areal parcellation to high-resolution functional magnetic resonance imaging (fMRI) data to delineate hypothalamic nuclei boundaries. This article presents stereotaxic coordinates of these nuclei for fMRI analyses, offering guidance on defining regions of interest and appropriate spatial smoothing kernel sizes. The provided coordinates aid future research in nuclear level hypothalamus analyses.

Disseminated Intravascular Coagulation (DIC) has been a common diagnosis made by health care givers since the dawn of the 20^th century. However, currently, this diagnosis is entertained rarely in clinical settings that can predispose to this complication. The incidence of four common clinical scenarios traditionally associated with DIC, sepsis, trauma, obstetrical disorders, and cancers, are on the increase due to better diagnostics and management strategies, but DIC is rarely diagnosed in these disease categories currently. The authors suggest the rarity of a DIC diagnosis is due to varied understanding of the pathophysiology of this condition. In this perspectives, we would like to present reasons for this change in consideration and encourage caregivers to consider a DIC diagnosis at an early stage based on new criteria to help patients benefit from available treatments.

Several problems differentiate the treatment of children, especially those with congenital ocular disease, from adults, including the absence of complaints and the complication of systemic diseases. However, the most challenging is the continuing developing anatomical and functional development and immaturity in children. Consequently, the timing of disease onset and treatment can greatly affect the prognosis, and the prognosis cannot be confirmed without long-term follow-up periods. The prognosis for unilateral congenital cataract is very poor. However, some cases achieved good vision with successful refractive correction and amblyopia therapy, suggesting that long-term parental enthusiasm and adherence are important for the visual prognosis. Penetrating keratoplasty is rarely performed in children, and outcomes at our hospital have been extremely poor for congenital corneal opacity over the past 28 years. The visual prognosis is also poor for large limbal dermoids approaching the center of the cornea, which did not respond to preoperative amblyopia therapy. Consequently, early excision, lamellar keratoplasty, wearing of hard contact lenses, and amblyopia therapy were considered necessary. Treatment of pediatric ocular disease should consider the pros and cons, methods, and timing, especially the development of the pediatric eye and the time of onset of the disease.

Platelets are one of the major targets of SARS-CoV-2. Activated platelets release prothrombotic substances, express adhesion molecules, and activate coagulation, thereby contributing to the thrombotic tendency in COVID-19. However, the antiplatelet therapy is not recommended in the current international guidelines. We think that the initiation timing and the target severity are the causes of the failure in clinical trials. As shown in the clinical studies that examined the effects of anticoagulants, early initiation in moderate severity is necessary for the success of antithrombotic therapy. Future trials are warranted to study the effects of antiplatelets in such conditions.