Journal of Nippon Medical School最新文献

Background: In emergency interventional radiology (IR), patient motion and poor breath-holding often result in misregistration during digital subtraction angiography (DSA). As a countermeasure, digital angiography (DA) without subtraction processing is used for observation; however, evaluation is limited to areas overlapping with low X-ray transmissivity structures, such as bone. Dynamic trace (DT) is capable of real-time background compression processing of peripheral blood vessels in DA images and ensures visibility of blood vessels in such areas, without being affected by body motion. We evaluated the image quality and visualization of peripheral vascularity of DA and DT images obtained from DSA of the trunk and examined the usefulness of DT.

Methods: Data from 13 patients who underwent emergency IR involving trunk DSA between October 2022 and June 2023 were analyzed. DA and DT images were created from these angiographic images, and two independent IR specialists used a 4-point scale to visually evaluate the contrast, sharpness, and peripheral vascular visibility of the proximal and distal portions of 42 arteries. The image quality scores for DA and DT images were compared using the Wilcoxon signed-rank test, and inter-rater agreement was evaluated using weighting coefficients.

Results: As compared with the DA images, the DT images were significantly better at all endpoints (P < 0.001). Inter-rater agreement was moderate for all assessment items.

Conclusions: DT images are not affected by body motion and display better image quality and visualization of peripheral vascularity than DA images, making them useful for emergency IR of the trunk.

Background: Several studies have reported that persons with Parkinson's disease (PD) exhibit a preference for sweet foods. However, because many people favor such foods, this study investigated whether the preference for sweet foods was stronger among patients with PD than among those without PD.

Methods: We analyzed 150 patients treated in the neurology department of Nippon Medical School Hospital between July 2021 and November 2021. Forty-nine (33%) had PD and 101 patients (control group) did not. Participants were asked to rate three sweet foods, three salty foods, and three bitter foods (total, nine foods) on a questionnaire where a score of 3 indicated "like", 2 indicated "neutral", and 1 indicated "dislike". The score for each taste preference was defined as the sum of the scores for the three foods representing each taste. Differences in baseline characteristics and taste preference scores between patients with and without PD were then statistically analyzed.

Results: The PD group was significantly older than the control group. The PD group obtained a significantly higher sweetness score than the control group (8 [6-9] vs. 7 [3-9], p<0.01). There was no difference in scores for either saltiness (7 [3-9] vs. 7 [3-9], p=0.49) or bitterness (7 [4-9] vs. 7 [3-9], p=0.25). The sweetness score was not significantly correlated with L-dopa dose, L-dopa equivalent dose, or PD disease duration.

Conclusion: Patients with PD were more likely than those without PD to prefer sweet foods. These results are important new information on the taste preferences of persons with Parkinson's disease.

Background: Although advances in neoadjuvant chemotherapy (NAC) are improving the rate of pathological complete response (pCR) and outcomes for triple-negative breast cancer (TNBC) patients, the prognosis remains poor. Insulin-like growth factor II mRNA-binding protein 3 (IMP3) expression was recently reported to be associated with chemotherapy resistance and poor prognosis in TNBC.

Methods: We evaluated IMP3 expression in 40 female TNBC patients to assess its association with NAC sensitivity and outcome.

Results: Among the cohort, 11 patients (27.5%) had IMP3-positive TNBC, which was associated with a higher Ki-67 labeling index (p = 0.119), indicating greater malignancy. However, IMP3 positivity showed no significant correlation with NAC resistance or differences in disease-free survival (DFS) as compared with IMP3-negative patients.

Conclusions: Patients receiving effective immunotherapy or high-dose chemotherapy achieved pCR regardless of IMP3 status, which suggests that the NAC regimen is more important than IMP3 status for pCR. Even in IMP3-positive TNBC, NAC may improve prognosis by achieving pCR. Thus, while IMP3 might predict poor prognosis, it may not serve as a definitive marker in the context of NAC. Because IMP3 is involved in cancer stem cell (CSC) function, further research is necessary to understand its complex role in CSCs and TNBC.

Background: The optimal on-scene time after the return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA) has not been established. This study aimed to investigate the relationship between the on-scene time after ROSC and neurological outcomes.

Methods: We analyzed data recorded in the SOS-KANTO 2017 registry between September 2019 and March 2021. Patients with OHCA who achieved ROSC on the scene were included and categorized into three groups based on on-scene time after ROSC (0-<6 min, 6-<10 min, and ≥10 min). Comparisons were performed using multiple propensity score analysis. The primary outcome was favorable neurological status at one month, defined as cerebral performance categories 1 and 2.

Results: In total, 331 patients were included. Favorable neurological outcomes at one month were observed in 29.1% (32/123) of patients in the 0-<6 min group, 37.2% (35/104) in the 6-<10 min group, and 36.3% (29/104) in the ≥10 min group. There was no significant association between shorter on-scene times (0-<6 min) and favorable neurological outcomes at one month compared to the other groups (adjusted odds ratio [AOR], 0.97; 95% confidence interval [CI], 0.39-2.41 for 6-<10 min; AOR, 0.90; 95% CI, 0.30-2.70 for ≥10 min).

Conclusion: Differences in on-scene time after ROSC were not significantly associated with favorable neurological outcomes at one month. Future research should focus on identifying factors that may influence outcomes, and on exploring strategies to enhance care in the Japanese EMS context.

Background: We investigated the association between the number of patients presenting to an emergency room (ER) with vertigo/dizziness (V/D) and seasonal variations, monthly trends, and weather factors.

Methods: We retrospectively investigated age, sex, cause of V/D, emergency triage level (Japan Triage and Acuity Scale), month, and seasonality among patients with V/D transported to the ER of Nippon Medical School between October 2014 and September 2017. We examined weather data, including monthly average precipitation and humidity, with respect to the number of patients with V/D.

Results: Among 706 patients with V/D, 481 presented with vertigo and 225 with dizziness. The mean age was 59±18 years and 66% were female. Regarding triage level, emergent (level 2) and urgent (level 3) cases accounted for 86% of cases and were more frequent in June-September (p=0.012). Regarding seasonality, 158 (22%), 195 (28%), 183 (26%), and 170 (24%) patients presented in spring, summer, autumn, and winter, respectively (p=0.744). The monthly number of V/D emergency transports tended to be higher between June and October and was significantly associated with average temperature (r=0.648, p=0.023), precipitation (r=0.655, p=0.021), humidity (r=0.676, p=0.016), and vapor pressure (r=0.648, p=0.023).

Conclusions: Although no apparent seasonality was observed in the monthly number of V/D-related emergency transports, the emergency triage level increased from the rainy season to early autumn. The monthly number of V/D cases transported by emergency services was significantly associated with average temperature, precipitation, humidity, and vapor pressure. These findings could inform public health policy and increase emergency preparedness.

Background: Details of in-hospital stroke are unknown. This study aimed to clarify the incidence rate and risk factors for in-hospital stroke among all inpatients.

Methods: This retrospective single-center study included consecutive patients admitted to our hospital. Patients aged <18 years, discharged within 24 h, and admitted to the neurology and neurosurgery departments were excluded. The incidence rate for in-hospital stroke was calculated, and patients were divided into stroke and control groups based on ischemic stroke occurrence, and the risk factors were assessed using multivariate analysis.

Results: Of the 83,990 enrolled patients, 101 (0.12%) developed stroke. The stroke group had a higher proportion of patients with older age (76 vs 69 years; P <.01), hypertension (49% vs 26%; P <.01), diabetes mellitus (34% vs 22%; P =.01), atrial fibrillation (25% vs 8%; P <.01), cardiovascular disease (20% vs 11%; P =.01), and emergency admission (68% vs 32%; P <.01) compared to the control group. The risk factors for in-hospital stroke were old age (odds ratio [OR], 1.03; P <.01), hypertension (OR, 1.57; P =.04), diabetes mellitus (OR, 1.61; P =.03), atrial fibrillation (OR, 2.43; P <.01), emergency admission (OR, 3.38; P <.01), and low serum albumin (OR, 0.66; P =.03).

Conclusion: The incidence rate of in-hospital stroke was 0.12% and the independent risk factors were old age, history of hypertension, diabetes mellitus, atrial fibrillation, emergency admission, and low serum albumin.

Background: Atrial functional mitral regurgitation (MR) involves functional MR with left atrial (LA) dilatation and mitral annulus (MA) remodeling. The relationship between LA dilatation and MA remodeling, and the mechanism of MR associated with MA remodeling, are unclear and were investigated in this study.

Methods: This single-center, cross-sectional retrospective study prospectively enrolled 97 consecutive patients with atrial fibrillation (AF) referred for three-dimensional transesophageal echocardiography. Mitral valve echocardiographic data of 18 AF patients with moderate or severe MR (MR group) and 79 with mild or less severe MR (non-MR group) were analyzed.

Results: The LA volume index was larger and tenting height was lower in the MR group than in the non-MR group (63.9±17.9 mL/m² vs. 43.6±13.9 mL/m²; p<0.001; 3.9 mm vs. 4.9 mm; p = 0.041). Anteroposterior (AP) diameter, annulus area, and sphericity index (AP diameter/anterolateral-posteromedial diameter) of MA were larger in the MR group than in the non-MR group (30.1 mm vs. 26.4 mm; p<0.001; 8.8 cm² vs. 7.4 cm²; p = 0.002; 80.1% vs. 74.5%; p<0.001, respectively). Linear regression analysis indicated that AP diameter was moderately correlated with LA volume index (R = 0.535, p<0.001). The area under the receiver operating characteristics curve of the AP diameter for the association with significant MR was significantly larger than that for the annulus area (0.8003 vs. 0.7180; p = 0.003). Multivariable analysis revealed that AP diameter (p = 0.006) and sphericity index (p = 0.041) were independently associated with significant MR, but annulus area was not (p = 0.083).

Conclusions: LA dilatation correlated with MA remodeling, primarily via enlargement of AP diameter. Circular change with AP diameter enlargement in MA may be a key mechanism of MR associated with MA remodeling.

During the period from September 5 to November 4, 1915 (Taisho 4), the bacteriologist Dr. Hideyo Noguchi temporarily returned to Japan after living and working in the United States for 15 years. This article discusses the many lectures he delivered during his visit, particularly those at the alumni meeting of Saisei-Gakusha, the institution from which he graduated, and the Mita Speech Meeting at Keio University. Additionally, this paper provides an overview of Saisei-Gakusha, a private medical school from the Meiji era that later became the predecessor of Nippon Medical School, highlighting its founding philosophy of "Saisei" (to save lives). It also introduces materials such as Noguchi's handwritten Curriculum Vitae and Autograph, which he prepared while studying abroad at the Rockefeller Institute for Medical Research. Furthermore, we examine an article from The New York Times reporting on Noguchi's serious illness several years after his return to the United States, as well as related articles from Japanese newspapers. We also present a thank-you postcard and a business card sent by Noguchi to his close friend Dr. Shinichi Wani, a fellow alumnus of Saisei-Gakusha, illustrating their enduring friendship. These materials reflect Noguchi's meticulous nature, thoughtful personality, and warm character, as seen through his relationship with his dear friend Wani.