Journal of Nippon Medical School最新文献

The principles of hyperbaric oxygen therapy (HBOT) have been known since ancient times. Empirical knowledge regarding relief of decompression sickness (DCS) symptoms in divers re-entering a pressurized environment was reported as early as 4,500 BC. DCS was recognized as a disease after deep diving became possible because of diving helmets. DCS also occurs in high-pressure dry workspaces (caissons) developed to construct bridges and tunnels. After the discovery of oxygen in the 18th century, its administration was found to be beneficial in treating conditions that developed after rapid decompression, and HBOT is now established as a part of recompression therapy. This review describes the indications for HBOT in Japan and its effectiveness, as indicated by the author's experience with HBOT in the Department of Emergency Room and General Medicine at Nippon Medical School.

Background: Constipation, a symptom of autonomic nervous system dysfunction affecting gastrointestinal motility, is common after acute ischemic stroke. The insular cortex is associated with autonomic symptoms, and damage to the left insula may result in constipation. We investigated the association between constipation and left-sided insular infarction in patients with acute stroke.

Methods: We retrospectively analyzed data from consecutive patients who received a diagnosis of acute infarction in the middle cerebral artery territory between January 2015 and December 2018. Constipation was defined as bowel movements less often than three times a week or a prescription for laxatives within 2 weeks of stroke onset. Clinical characteristics and factors associated with constipation were evaluated.

Results: Among 892 patients (mean age, 75 [66-82] years; male, 566 [63.5%]), 301 (32.8%) had constipation. Infarction involving the insula (57.7% vs. 25.1%) and left-sided infarction (62.5% vs. 46.4%) were more frequent in patients with constipation than in those without constipation. In multivariable analysis, infarction involving the insula (adjusted odds ratio [aOR], 2.30; 95% confidence interval [CI], 1.57-3.36; P<0.001), left-sided infarction (aOR, 1.93; 95% CI, 1.40-2.64; P<0.001), and baseline National Institutes of Health Stroke Score (aOR, 1.04; 95% CI, 1.01-1.06; P<0.001) were associated with constipation. The incidence of constipation was highest in cases of left-sided infarction with insular involvement (69.2%).

Conclusions: Left-sided infarction, infarction involving the insular cortex, and baseline National Institutes of Health Stroke Score were identified as independent factors associated with constipation in patients with acute stroke.

Fulminant type 1 diabetes mellitus (fulminant T1DM) can progress rapidly to diabetic ketoacidosis (DKA). It can develop in pregnant women with no prior history of diabetes, and such cases are associated with severe perinatal consequences. We report the detailed clinical course of a neonate born from a mother with DKA caused by fulminant T1DM. The male neonate weighed 3,024 grams and was born at 36 weeks of gestation. The patient's mother had an uneventful pregnancy until she visited the hospital on the day of delivery with headache, nausea, and decreased fetal movement. The APGAR score of the neonate was 8/8, but he was transferred to our hospital for further evaluation because umbilical cord blood gas analysis showed unexplained acidosis (pH = 6.92). We were later informed that the mother was diagnosed as having DKA due to fulminant T1DM after the neonate was born. On admission, laboratory testing of the neonate revealed hypoglycemia, hyperinsulinemia, and hyperkalemia, all of which were induced by the mother's metabolic condition. Intravenous glucose supplementation resolved the neonate's metabolic derangement, and he was discharged on day 10. He showed no neurological abnormalities, but magnetic resonance imaging showed lesions indicating hypoglycemic encephalopathy. Maternal fulminant T1DM and DKA should be considered in neonates with severe metabolic acidosis. Even a neonate who is asymptomatic at birth may rapidly develop severe disease.

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.