Journal of Nippon Medical School最新文献

Background: This study assessed the effectiveness of the dural puncture epidural (DPE) technique in managing breakthrough pain in parous women receiving labor analgesia during induced labor.

Methods: This single-center retrospective cohort study included term pregnant women with singleton pregnancies who received treatment for breakthrough pain during labor. All participants underwent induced labor, and some parous women among them underwent DPE. The DPE technique consisted of placing an epidural catheter after dural puncture with a 27-gauge spinal needle. Eligible women were allocated into a DPE group and conventional epidural (CE) anesthesia group. Pain was assessed with a numerical rating scale (NRS), and a patient-controlled epidural analgesia (PCEA) bolus was administered when the NRS score was ≥3. Breakthrough pain was defined as an NRS score ≥3 during PCEA management. The primary outcome was the efficacy of rescue interventions in managing breakthrough pain, as determined by a reduction in pain intensity to an NRS score <3 before birth.

Results: Among the 55 parous women who received labor analgesia, 44 required additional rescue administration for breakthrough pain. Of the remaining women, 23 received DPE and 19 received CE anesthesia. The DPE group experienced significantly more effective relief of breakthrough pain before birth than did the CE group (DPE: 100%; CE: 68.4%; p=0.005).

Conclusion: In parous women, DPE anesthesia was more effective than CE anesthesia in providing analgesia for breakthrough pain immediately before delivery during induced labor.

Background: The coronavirus disease 2019 (COVID-19) pandemic has forced people to make major life changes, and there is concern that depressive tendencies have increased in pregnant women during the pandemic. This study used the Edinburgh Postnatal Depression Scale (EPDS), administered in the second trimester, to investigate the effect of COVID-19 on the mental health of Japanese women during pregnancy and to provide early intervention.

Methods: The study included 1,320 pregnant women (663 pre-COVID-19 and 657 during COVID-19) with similar background characteristics and compared the results for the COVID-19 period (September 2020-August 2021) and control period (September 2018-August 2019). Women treated for psychiatric disorders were excluded. The EPDS cutoff score was 13.

Results: The median EPDS scores were 3 (1-6) points during the control period and 3 (1-5) points during the pandemic (p = 0.166) for the control and pandemic periods. Fourteen patients (2.1%) during the control period and 20 (3.0%) during the pandemic scored ≥13 points; however, the difference was not significant (odds ratio, 1.455; 95% confidence interval: 0.692-3.143).

Conclusions: COVID-19 did not change mid-pregnancy EPDS scores at a single Japanese center.

All life science and medical research involving human subjects must be conducted in compliance with the Declaration of Helsinki and the relevant laws and guidelines. Additionally, its scientific and ethical suitability must be reviewed by a committee well versed in the nature and content of the research. Failure to comply with these requirements when conducting research involving human subjects is a serious violation of Japanese laws, guidelines, and local regulations, so several ethics committees and institutional review boards have been established within the Nippon Medical School (NMS) Foundation and its affiliated institutions. It is essential for investigators to keep up to date with the latest developments in the ethical review process and to ensure that any projects they propose to embark on are subjected to an appropriate ethical review before the research is initiated. To help researchers and other staff affiliated with the NMS Foundation keep abreast of these developments, this report outlines NMS's current ethical review processes for research involving human subjects.

Background: Superior/middle cluneal nerve entrapment (CN-E) is an elicitor of low back pain (LBP). The painDETECT questionnaire is used to characterize CN-E symptoms.

Methods: Nineteen consecutive patients with LBP caused by CN-E (superior CN-E = 7; middle CN-E = 12) participated in a Japanese language painDETECT questionnaire survey before surgery. A score of 12 or lower was recorded as 'neuropathic component unlikely', a score of 19 or higher as 'neuropathic pain likely', and scores between 13 and 18 as 'neuropathic pain possible'. LBP severity was recorded on a numerical rating scale, the Roland-Morris Disability Questionnaire, and the EuroQol-5 dimension-5 level.

Results: The mean painDETECT score was 11.8 and did not significantly differ between the superior CN-E and middle CN-E groups. We classified low back pain as unlikely to have a neuropathic component in 13 patients, as likely to have a neuropathic component in 2 patients, and as possibly neuropathic in 4 patients. There was no significant difference in the pain level of patients with scores of ≤12 and ≥13 on painDETECT. All patients reported trigger pain; the positive rate was high for electric shock pain, radiating pain, and pain attacks and low for a burning or tingling sensation, pain elicited by a light touch, and pain caused by cold or hot stimulation.

Conclusion: The painDETECT questionnaire may not reliably identify LBP caused by superior/middle CN-E as neuropathic pain. A diagnosis of LBP due to CN-E must be made carefully because symptoms resemble nociceptive pain.

The artery of Percheron (AOP), a common anatomic vascular variation of the P1 segment of the posterior cerebral artery, provides arterial blood supply to the paramedian thalami and rostral midbrain. Occlusion of the AOP can lead to infarction of the bilateral paramedian thalamus, with or without midbrain involvement, but is rare in children. Here, we describe a case involving a 14-year-old girl with sudden onset of disturbance of consciousness, hypersomnia, and global aphasia. Brain magnetic resonance imaging showed symmetric bilateral paramedian thalamic infarcts. Left-sided AOP infarction was diagnosed by brain angiography.

Immune check point inhibitors (ICIs) have durable antitumor effects. However, autoimmune toxicities, termed immune-related adverse events, occur in some patients. We report a case of severe immune aplastic anemia (AA) in a patient with non-small cell lung cancer who was receiving atezolizumab with bevacizumab/carboplatin/paclitaxel. Although the cancer has not recurred, his bone marrow is depleted and he did not respond to immunosuppressive therapy. He has survived for 1.5 years with blood transfusions and infection control. Immune AA associated with ICIs is rare, and a treatment has not yet been established. This case report provides information on the management and treatment response of patients with AA caused by ICIs. Further studies should investigate the mechanism and pathogenesis of immune AA caused by ICIs.

Background: Although short stature is sometimes treatable in children, family members do not always realize that their children have short stature. To develop better educational materials for identifying short stature, we conducted a questionnaire survey on children with short stature. Using the results of the survey, we revised educational activities regarding short stature.

Methods: To assess the effectiveness of the revised activities, we examined changes in the numbers of consultations before and after the changes to the educational activities, the height of children examined after such changes, the test implementation rate, and the test results.

Results: After the start of direct promotion for school nursing staff in 2015, the number of outpatients with short stature who visited the hospital significantly increased (16.1/year before 2014 vs. 68.8/year after 2015; p = 0.02). The number of patients hospitalized for a growth hormone secretion stimulation test also significantly increased, from 9.3/year before 2014 to 47.0/year after 2015 (p = 0.02). However, 35% of families did not want to subject their child to a growth hormone stimulating test, even if their child was extremely short.

Conclusions: Our revised educational activities for short stature among school nursing staff, school physicians, and nurses at health centers were more effective than conventional activities consisting of public relations magazines and lectures for the general public. It is important to provide proper explanations to enable a better understanding of hormone therapy.

Background: Tarsal tunnel syndrome (TTS) is a common entrapment neuropathy of the posterior tibial nerve. Surgery can be performed less invasively under local anesthesia. We adopted zig-zag skin incision to prevent postoperative wound complications.

Methods: Between July 2022 and June 2023, we operated on 19 legs of 14 consecutive TTS patients (5 males, 11 females; average age 73.3 years). We made a 2- to 3-cm zig-zag skin incision on the tarsal tunnel. After posterior tibial nerve decompression by posterior tibial artery (PTA) transposition, the subcutaneous layer was tightly sutured with 4-0 PDS and the skin was closed with Dermabond Advanced. We investigated adverse events that developed during the first 30 postoperative days and recorded surgical outcomes at the final visit.

Results: In all patients the nerves were successfully decompressed with PTA transposition. There were no intraoperative complications. During the 30 postoperative days there were no adverse events, including wound complications, and patients' symptoms improved significantly.

Conclusion: Zig-zag skin incision was easy and convenient for surgical TTS treatment and may be useful for preventing postoperative wound complications.

Background: Antithrombotic therapy (AT) should generally be avoided within 24 hours after recombinant tissue-plasminogen activator (rt-PA) treatment but should be considered in patients with large-artery atherosclerosis (LAA) who undergo concomitant emergent endovascular treatment (EVT). The aim of the present study was to assess the safety of AT within 24 hours after rt-PA treatment in patients with hyperacute ischemic stroke due to LAA who received concomitant EVT.

Methods: From January 2013 through July 2019, consecutive patients with acute ischemic cerebrovascular disease due to LAA who were admitted within 6 hours from symptom onset were recruited. The patients were classified into six groups based on the reperfusion treatment and early (within 24 hours) AT from rt-PA treatment. Safety outcomes were compared among the groups.

Results: A total of 155 patients (35 women [23%], median age 74 [IQR 66-79] years; NIHSS score 3 [1-10]) were included in the present study. Of these, 73 (47%) received no reperfusion therapy, 24 (15%) received rt-PA treatment and early AT, seven (6%) received rt-PA without early AT, 26 (17%) received EVT only, six (4%) received both rt-PA and EVT without early AT, and 19 (12%) received rt-PA and EVT with early AT. AT was administered a median of 3.9 (1.6-8.0) hours after rt-PA in patients with rt-PA+EVT with early AT. AT within 24 hours after rt-PA and EVT treatment did not increase hemorrhagic complications (p > 0.05 for all).

Conclusion: In this retrospective analyses, early AT administration for patients with hyperacute stroke due to LAA treated with rt-PA plus EVT did not increase hemorrhagic events.