Journal of Nippon Medical School最新文献

Background: We retrospectively examined image quality (IQ) of thin-slice virtual monochromatic imaging (VMI) of half-iodine-load, abdominopelvic, contrast-enhanced CT (CECT) by dual-energy CT (DECT) with deep learning image reconstruction (DLIR).

Methods: In 28 oncology patients with moderate-to-severe renal impairment undergoing half-iodine-load (300 mgI/kg) CECT by DECT during the nephrographic phase, we reconstructed VMI at 40-70 keV with a slice thickness of 0.625 mm using filtered back-projection (FBP), hybrid iterative reconstruction (HIR), and DLIR; measured contrast-noise ratio (CNR) of the liver, spleen, aorta, portal vein, and prostate/uterus; and determined the optimal keV to achieve the maximal CNR. At the optimal keV, two independent radiologists compared each organ's CNR and subjective IQ scores among FBP, HIR, and DLIR to subjectively grade image noise, contrast, sharpness, delineation of small structures, and overall IQ.

Results: CNR of each organ increased continuously from 70 to 40 keV using FBP, HIR, and DLIR. At 40 keV, CNR of the prostate/uterus was significantly higher with DLIR than with FBP; however, CNR was similar between FBP and HIR and between HIR and DLIR. The CNR of all other organs increased significantly from FBP to HIR to DLIR (P < 0.05). All IQ scores significantly improved from FBP to HIR to DLIR (P < 0.05) and were acceptable in all patients with DLIR only.

Conclusions: The combination of 40 keV and DLIR offers the maximal CNR and a subjectively acceptable IQ for thin-slice VMI of half-iodine-load CECT.

Background: Psoriasis is accompanied by systemic inflammation that includes the liver. The fibrosis-4 (FIB-4) index was developed to predict significant liver fibrosis. The present study evaluated the effects of biologics, including TNF inhibitors, on the FIB-4 index in psoriasis patients.

Methods: All adult patients with psoriasis who were prescribed biologics (TNF inhibitors, IL-17 inhibitors, or IL-23 inhibitors) at Nippon Medical School from June 2014 to January 2024 for the first time (biologic-naïve patients) were included in this study. The FIB-4 index was calculated before and after 6 months of treatment with biologics.

Results: A total of 105 patients were enrolled. The FIB-4 index was higher after 6 months of treatment with TNF inhibitors (P=0.0018) and IL-17 inhibitors (P=0.045) but did not change with IL-23 inhibitors. Aspartate aminotransferase and alanine aminotransferase levels did not change after treatment with TNF inhibitors, IL-17 inhibitors, or IL-23 inhibitors. Platelet count decreased after treatment with TNF inhibitors (P=0.0011) and IL-23 inhibitors (P=0.039) but did not change with IL-17 inhibitors.

Conclusions: Downregulation of platelets seems to be a major contributing factor for the increase in FIB-4 index in patients treated with TNF inhibitors. Although the FIB-4 index is a simple marker to screen for liver fibrosis, changes in this index should be interpreted with caution, and imaging findings such as transient elastography should also be used to evaluate the status of liver fibrosis.

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.

Tarsal tunnel syndrome (TTS) is elicited by compression of the tibial nerve in the tarsal tunnel. TTS in the absence of a lesion tends to be idiopathic, and most TTS is idiopathic. Patients complain of several plantar symptoms, and TTS affects their quality of life. The symptoms tend to worsen with walking, and ankle joint movement and arterial distortion may also be involved. Because TTS symptoms are similar to those of diabetic neuropathy and lumbar disease, clinical symptoms are diagnostically important. While magnetic resonance imaging reveals nerve compression, it is difficult to identify causative factors, and false-positive results are a concern. Wound-related complications after TTS surgery may be reduced by a zigzag skin incision. Surgery for carpal tunnel syndrome yields better outcomes and greater patient satisfaction than TTS surgery.

Cell adhesion molecule 1 (CADM1) is an immunoglobulin superfamily cell adhesion molecule that was first identified as a tumor suppressor in non-small cell lung cancer because of its role in suppressing tumor formation in nude mice. CADM1 forms a homophilic dimer on the cell membrane and associates with actin-binding proteins (4.1s) and scaffold proteins (MAGuKs), which contain PDZ motifs. It forms a ternary protein complex involved in cell adhesion and the formation of epithelium-like structure. While CADM1 is expressed in epithelium, neuronal tissue, and testes, CADM1 expression is absent in many cancers of epithelial origin, including cancers of the lung, esophagus, stomach, liver, pancreas, breast, and prostate. In addition to its tumor-suppressive activity in epithelial cell adhesion, CADM1 acts as a tumor antigen, recognized by activated NK cells and CD8+ T cells through heterophilic interaction with CRTAM, thereby serving as a tumor suppressor in two ways. In contrast, CADM1 is overexpressed in adult T-cell leukemia/lymphoma (ATL) cells, making it a specific diagnostic marker of ATL on FACS analysis. CADM1 is also highly expressed in small cell lung cancer (SCLC) and other neuroendocrine tumors, and promotes metastasis, suggesting its potential as a target for diagnosis and treatment of SCLC. CADM1 also has a role in synapse formation and spermatogenesis, and deficient or abnormal CADM1 is linked to disorders such as male infertility in mice and autism spectrum disorder. Here, we summarize the multiple functions of CADM1 and its involvement in cancer and other diseases, focusing on disorders of aberrant cell adhesion.

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: 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.