Journal of Nippon Medical School最新文献

Background: Diuretics are commonly used to reduce renal dysfunction during cisplatin-based chemotherapy; however, reports suggest that renal function is unaffected when diuretics are not administered. This phase II trial evaluated the effectiveness and safety of a short hydration method without diuretics.

Methods: Patients were included if they were aged 20-74 years, had a thoracic malignancy for which a cisplatin-based regimen (dose: ≥60 mg/m²) was indicated, and had adequate renal function. All patients received cisplatin-based chemotherapy using a short hydration method without diuretics. The primary endpoint was the proportion of patients without grade 2 or higher elevations in creatinine levels during the first cycle of cisplatin.

Results: Forty-six patients were enrolled between June 2019 and April 2022. The patients included 38 men and 8 women with a median age of 64 years (range: 45-74 years). Of these, 13 patients received adjuvant chemotherapy, 19 received chemoradiotherapy, 1 received chemotherapy for post-surgical recurrence, and 13 received chemotherapy for advanced disease. The median number of chemotherapy cycles was 3 (range: 1-4). A total of 93.5% (43/46) of the patients completed cisplatin-based chemotherapy without grade 2 or higher creatinine elevation during the first cycle, and 84.8% (39/46) of participants, including those who discontinued treatment, did not show grade 2 or higher creatinine elevation after all cycles of cisplatin-based chemotherapy.

Conclusions: Short hydration without diuretics is safe for patients receiving cisplatin-containing chemotherapy. Randomized trials with or without diuretics in this setting are warranted.

Cancers originating from the same tissue vary significantly in genetic mutations and patient drug response. Furthermore, tumor tissue is composed of diverse cancer cell clones. This phenomenon, known as "cancer cell heterogeneity," occurs among tumors (between patients) and within individual tumors and is an important mechanism driving resistance to cancer therapy. Therefore, an understanding of cancer cell heterogeneity is essential for the development and delivery of more effective personalized treatments. The cancer cell lines typically used in cancer research cannot accurately replicate this heterogeneity. However, patient-derived tumor organoids (PDTOs), three-dimensional cultures of tumor cells, can precisely replicate the histological, molecular, and cellular heterogeneity of the original tumor. PDTOs generated from human cancers are now widely used as innovative tools in cancer research, including in studies of the mechanisms of cancer development and progression and in screening of anti-cancer drug. This review summarizes recent advances in human tumor research that uses PDTOs.

Background: The purpose of this study was to determine whether cases of placenta previa and low-lying placenta previa in patients with retroverted uterus are significantly associated with endometriosis.

Methods: Participants were patients who underwent cesarean section at our hospital with a diagnosis of placenta previa or low-lying placenta previa within a 7-year period from January 2015 to December 2022. Of these, patients with multiple pregnancies and those without a complete uterine image in the medical record at less than 12 weeks' gestation were excluded. Included patients were divided into two groups according to the presence or absence of endometriosis. The presence of endometriosis was determined based on intraoperative findings. A retrospective case-control study was conducted by examining the presence or absence of retroverted uterus during early pregnancy and the presence or absence of posterior placenta.

Results: A total of 110 patients were included, 32 in the group with endometriosis and 78 in the group without endometriosis. There were 15 (46.9%) cases of retroverted uterus in the group with endometriosis and 17 (21.8%) in the group without endometriosis, indicating significantly more cases in the group with endometriosis (P=0.01). There were 15 (46.9%) cases of retroverted uterus with posterior placenta in the group with endometriosis and 16 cases (20.5%) in the group without endometriosis, indicating significantly more cases in the group with endometriosis (P=0.009).

Conclusion: Placenta previa and low-lying placenta previa in cases of retroverted uterus are significantly associated with endometriosis.

Background: Rapid treatment of patients with emergency large vessel occlusion (ELVO) improves outcomes. With Vitrea software, the cerebral infarct size and penumbra can be quantified, and 4D images can be constructed quickly. We investigated the performance of Vitrea in ELVO patients.

Methods: To evaluate indications for mechanical thrombectomy, we performed plain brain CT, then MRI (group 1, n=30). In May 2022 we acquired perfusion CT scans with Vitrea after plain CT on the same equipment (group 2, n=27) and then compared time from onset to the end of mechanical thrombectomy. At 1 month post-treatment we recorded the neurological outcome by using the modified Rankin scale (mRS). We also compared the infarction areas identified with Vitrea and MRI the day after treatment using DWI-ASPECTS in 25 of 27 patients in group 2. We excluded 2 patients with basilar artery occlusion because this type of occlusion is not included in DWI-ASPECTS.

Results: There were no significant intergroup differences in patient characteristics, time from admission or puncture to re-canalization, and outcome 1 month after treatment. Vitrea overestimated the infarct area in 1 of 25 patients (4.0%). Times from admission to transit for examination, to the examination end, and time from admission to puncture, were significantly shorter in group 2.

Conclusions: In ascertaining indications for thrombectomy in patients with acute cerebral stroke, perfusion CT with Vitrea shortened time to treatment. However, further investigation is needed to confirm the accuracy of Vitrea in determining the infarct area.

MicroRNA (miRNA) is a small RNA molecule that does not code for proteins, and organ- and disease-specific miRNAs are being investigated as diagnostic tools and therapeutic targets, particularly for cardiovascular disease and cancer. Much remains unknown about how anesthetics, other drugs, and perioperative management affect miRNAs, but miRNA-targeted drugs might eventually be used perioperatively. This review examines changes in miRNA expression related to anesthesia management. Sevoflurane results in gene expression patterns that differ by organ. The author investigated changes in miRNA expression induced by anesthetics in the brain, lungs, and liver and found that changes in miRNA expression differ by drug and organ. Since miRNA does not have a one-to-one correspondence with its target mRNA and exhibits complex effects within and between cells, as well as remotely, drug- and organ-specific changes in mRNA expression caused by anesthetics likely involve complex alterations. Cardiovascular disease and cancer are related to perioperative management via miRNAs. Inhalational anesthetics may exacerbate or suppress cellular activity, depending on the type of cancer, and the mechanisms of action differ depending on the inhalational anesthetic. These findings suggest that propofol is more likely to contribute to suppression of cancer cells through intercellular communication. The role of miRNA in perioperative management remains unclear. In the future, it is expected that changes in miRNA expression will be considered when selecting and administering anesthetic drugs perioperatively.

Cerebral venous thrombosis is common in individuals using contraceptives. However, the potential existence of an underlying occult prothrombotic condition is frequently overlooked. We report a case of a 46-year-old woman who experienced acute cerebral venous thrombosis, primarily affecting the deep cerebral veins, after a month of contraceptive use. The distinctive "unicorn" pattern observed in the attenuated vein signs on the sagittal plane of non-contrast brain computed tomography served as crucial indicators for diagnosing deep cerebral vein thrombosis. The patient's platelet counts slightly increased during initial admission. However, a gradual increase in the platelet count coupled with the presence of the JAK2 V617F mutation over the subsequent 2 years led to the diagnosis of essential thrombocythemia. After the initiation of cytoreductive treatment, the platelet counts rapidly decreased to the normal range. Myeloproliferative neoplasms (MPNs) should be considered in individuals with cerebral venous thrombosis. The JAK2 V617F mutation is a valuable target for MPNs screening. Clinicians can choose a more appropriate course of treatment and lower the risk of recurrent thrombosis if they promptly detect other prothrombotic states in the patient.

Background: Remimazolam is an ultrashort-acting benzodiazepine that maintains stable hemodynamics during anesthesia. However, few reports have focused on hemodynamic stability and opioid use during cardiac surgery with remimazolam. We hypothesized that administration of remimazolam for induction and maintenance of anesthesia for transcatheter aortic valve implantation would maintain hemodynamics as effectively as conventional anesthetics and allow use of an appropriate dose of opioids. We compared intraoperative hemodynamics and opioid use in patients with severe aortic stenosis who received remimazolam or conventional anesthetics.

Methods: This retrospective cohort study analyzed data for patients who underwent transcatheter aortic valve implantation from October 2022 to September 2023. The 23 patients were divided into two groups: a remimazolam group and midazolam + sevoflurane group. The primary outcome was intraoperative blood pressure. The secondary outcomes were the doses of vasoconstrictors, vasodilators, and opioids used.

Results: There was no significant difference in any patient characteristic or intraoperative blood pressure between the two groups (before anesthesia: 92.0 [87.0-99.8] vs. 91.0 [86.0-107.0] mm Hg, P=0.935; 1 minute after induction of anesthesia: 91.0 [83.0-98.5] vs. 90.0 [86.3-95.3] mm Hg, P=0.843; at the start of surgery: 77.0 [70.0-79.0] vs. 82.5 [75.5-105.5] mm Hg, P=0.072; at the end of surgery: 74.0 [71.0-78.0] vs. 82.5 [75.5-90.8] mm Hg, P=0.082). The maximum rate of remifentanil administration was significantly higher in the remimazolam group (0.10 [0.10-0.20] vs. 0.10 [0.013-0.10] μg/kg/min, P=0.012).

Conclusions: Remimazolam maintained hemodynamics as effectively as midazolam + sevoflurane, even when used in combination with opioids. Remimazolam thus appears to be noninferior to midazolam + sevoflurane.

Informed consent (IC) is closely related to shared decision making (SDM), and SDM can lead to IC. IC is fundamental to medical ethics as described in the Geneva, Helsinki, and Lisbon declarations and is essential for clinical practice, as it provides legal protection for healthcare professionals. IC should be achieved through SDM based on both narrative-based medicine and evidence-based medicine. SDM should also involve healthcare professionals other than physicians (e.g., nurses, pharmacists, social workers). Communication skills for IC are important and are encapsulated in the SPIKES protocol. IC for breast cancer treatment requires explanation of the roles of local and systemic therapy. A documented "do not attempt resuscitation" order should be obtained for end-of-life IC.

The Oikawa-Nagao (ON) mouse is a polygenic animal model of type 2 diabetes and obesity developed by selective breeding of mice with inferior glucose tolerance [diabetes-prone (ON mouse DP^®; ON-DP) strain] and superior glucose tolerance [diabetes-resistant (ON mouse DR^®; ON-DR) strain]. Hybrid mice of three different inbred strains (C57BL/6, AKR, and AKR) were fed a high-fat diet and then selectively bred for higher and lower post-challenge blood glucose levels in oral glucose tolerance tests over 20 generations. Compared to ON-DR mice, ON-DP mice were found to be predisposed to develop obesity and diabetes after being fed a high-fat diet. Our recent studies suggest that the emergence of these phenotypes is associated with novel pathophysiology of type 2 diabetes and obesity, such as low insulin secretion capacity associated with high CD36 expression in pancreatic β-cells and hypoleptinemia preceding obesity due to low leptin secretion capacity in adipocytes. In addition, it has been suggested that ON-DP mice fed an atherogenic diet are a suitable model to reproduce atherosclerotic lesion formation due to fluctuations in blood glucose levels. This may facilitate the elucidation of mechanisms underlying diabetic macrovascular complications. This review will present the development strategy of the ON mouse strain, representative metabolic phenotypes and their underlying mechanisms. Furthermore, their relevance to the pathophysiology of type 2 diabetes and obesity in humans will be discussed.