Journal of Nippon Medical School

BACKGROUND: This study was performed to evaluate the orientation of lower esophageal sphincter (LES) pressure in patients with untreated achalasia using three-dimensional high-resolutionmanometry (3D-HRM). METHODS: The study involved 20 patients with untreated achalasia (10 men, 60 [47-74] years of age). The 3D-HRM assembly had 32 standard channels and 12 3D channels. During basal LES pressure measurements, the orientations of the LES high- and low-pressure zones were evaluated at end-expiration...

BACKGROUND: In Japan, increasing the number of ambulance requests, the case with the use of respiratory assistance devices in prehospital care by paramedics is also increasing. When patient experiences respiratory failure, the first responders frequently select a respiratory assist device (RAD) such as Bag Valve Mask (BVM), Jackson Rees (JR), or BVM with Gas Supply Valve® (BVM+GSV). This is based on both evaluation and experience as there is no study indicating which RAD is the best choice at the pre-hospital emergency site...

BACKGROUND: The emergence of molecular-targeted agents (MTAs) has altered the treatment landscape of hormone receptor-positive (HR+), human epidermal growth factor 2-negative (HER2-) advanced breast cancer (ABC) /metastatic breast cancer (MBC). Various guidelines recommend molecular-targeted therapy as first-line treatment for HR+/HER2- ABC/MBC. However, subsequent treatment following progressive disease after MTA therapy remains undetermined. This study evaluated the suitability of different types of MTAs for such patients...

BACKGROUND: Trauma is a serious medical and economic problem worldwide, and patients with trauma injuries have a poor survival rate following cardiac arrest. This study aimed to create a prediction model specific to prehospital trauma care and to achieve greater accuracy with techniques of machine learning. METHODS: This retrospective observational study investigated data of patients who had blunt trauma injuries due to traffic accident and fall trauma from January 1, 2018, to December 31, 2019, using the National Emergency Medical Services Information System, which stores emergency medical service activity records nationwide in the United States...

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BACKGROUND: The optimal treatment modality for locally advanced prostate cancer has not been established. Radiotherapy, hormonal therapy, and combinations of treatments are the main strategies, although the feasibility of radical prostatectomy as a first-line therapy needs to be considered. This retrospective study evaluated the long-term oncological outcome of high-risk prostate cancer treated surgically, using pathological results of the extracted specimen. The relationship between the number of risk factors and the long-term outcome was specifically analyzed...

Background Down syndrome (DS) is the most frequent chromosomal condition; however, knowledge about associated health issues in adulthood is inadequate. We aimed to obtain health information from Japanese adults with DS.Methods We conducted a retrospective chart review of 151 patients with DS who visited the Internal Medicine Outpatient Department of the Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled.Results Endocrine disorders, such as obesity, hyperlipidemia, and hyperuricemia, were most common in both adulthood (≤ 40 years) and senescence (> 40 years), whereas neurological diseases were more prevalent in senescence...

BACKGROUND: Non-invasive cardiovascular assessment has become an alternative to invasive techniques. VaSera® , a vascular screening device, measures arterial stiffness with the cardio-ankle vascular index (CAVI); it also measures cardiophysiological variables of ejection time (ET) and pre-ejection period (PEP). We aimed to apply the parameters obtained by VaSera® to estimate heart function based on left ventricular end-systolic elastance/arterial elastance (Ees/Ea) and to assess the minimal required number of measurements for estimation...

BackgroundAlthough coronary artery disease (CAD) is characterized by epicardial atherosclerosis and microvascular disease, the importance of evaluating microvascular dysfunction has not been sufficiently recognized in clinical practice. We estimated microvascular disease severity by assessing the hyperemic microvascular resistance (MVR) via absolute quantification of myocardial blood flow (MBF) with 13 N-ammonia positron emission tomography-myocardial perfusion imaging (PET-MPI).MethodsWe retrospectively collected the data for 23 CAD patients who underwent both stress/rest PET-MPI and invasive coronary angiography (CAG) with fractional flow reserve (FFR) measurement...

Immune checkpoint inhibitors (ICIs) are widely used for various types of advanced cancers. Currently, three types of ICIs are clinically available, a monoclonal antibody targeting cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), and antibodies targeting the programmed cell death protein-1 (PD-1) and its ligand, programmed cell death ligand 1 (PD-L1). Although ICIs have improved the survival rates of several types of cancers, they induce immune-related adverse events (irAE) by their enhancement of immune responses...

Cardiovascular complications resulting from coronavirus disease 2019 (COVID-19) are occasionally observed; however, takotsubo cardiomyopathy (TCM) with QT prolongation and Torsade de pointes have rarely been reported. We herein present a case of TCM that occurred after QT prolongation and Torsade de pointes. A 58-year-old woman was admitted because of COVID-19 pneumonia. Seven days after admission, she had a sudden loss of consciousness without any precursor of cardiovascular disease. Monitoring electrocardiogram indicated Torsade de pointes and a prolonged QT interval...

Acquired hemophilia A (AHA) is a rare disease in which an autoantibody causes bleeding by interacting with and inhibiting the coagulation activity of endogenous factor VIII (FⅧ). Most cases of AHA are idiopathic, and other causes include autoimmune diseases, malignant tumors, pregnancy, drugs, and viral infections. An 86-year-old man was diagnosed with AHA based on the following results: activated partial thromboplastin time (aPTT) extension of 130.7 seconds, inhibitor pattern by mixing study, endogenous factor VIII (FⅧ) level at <1%, and FⅧ inhibitor titer at >5...

Posterior inferior cerebellar artery (PICA) infarction can lead to ischemic stroke at the lateral part of the medullary oblongata. PICA dissection can also elicit an ischemic event in this region but its detection on radiological images is difficult due to the small diameter of the vessel. We report a 48-year-old male with Wallenberg syndrome due to PICA dissection, which was difficult to diagnose on first admission. He reported sudden-onset sensory disturbance on the right side of his face, ataxic gait, and headache...

Perineural spread (PNS) from pelvic carcinoma has been regarded as a pathway to muscle and bone metastasis. However, few cases have been reported, especially in patients with bladder carcinoma. In the present report, we discuss a case of diffuse cancer involvement in the muscle 5 years after radical cystectomy for advanced bladder carcinoma. Careful observation of temporal changes on medical images confirmed PNS as the pathway to muscle metastasis (i.e., primary PNS). Our report presents early and post-treatment CT, MRI and FDG-PET/CT findings of PNS from the bladder carcinoma...

BACKGROUND: We previously evaluated blood screening data, including antinuclear antibodies (ANA), before initiating biologic treatment for patients with psoriasis in a real-world setting. However, we did not analyze change in ANA titers after the start of biologics. No previous study has comprehensively investigated change in ANA titers over time in individual patients or the effectiveness of certolizumab pegol or tildrakizumab. OBJECTIVES: This study evaluated change in ANA titers in individual patients during treatment with biologics, including certolizumab pegol and tildrakizumab...

BACKGROUND: Oxidative stress is an important mechanism in liver ischemia/reperfusion (I/R) injury. Hepatocyte apoptosis and proliferation occur in parallel with liver I/R injury, and the degree of apoptosis and proliferation determines the effects on hepatocytes. Vitamin D receptor (VDR) can lessen liver I/R injury, but previous studies focused mostly on inflammation and immunity. METHODS: H2 O2 was used to induce hepatocyte injury. Before treatment with H2 O2 , Hep-3B cells were pretreated with paricalcitol (PC) and siRNA-VDR...

BACKGROUND: The prognostic value of the neutrophil-to-lymphocyte ratio (NLR), an inflammatory indicator, for 90-day outcomes has not been determined for patients with acute ischemic stroke aged ≥ 80 years. Therefore, this study examined the predictive significance of the NLR for estimating the 90-day outcomes of older patients with acute ischemic stroke. METHODS: Data from patients aged ≥ 80 years were recorded within 7 days of ischemic stroke onset during the period from January 2019 to June 2021...

BACKGROUND: Postoperative complications of thoracoabdominal aortic aneurysm include paraplegia due to impaired blood flow in the spinal cord. Sivelestat sodium hydrate (ONO-5046), a specific neutrophil elastase inhibitor, can prevent neuropathy after ischemia-reperfusion of the spinal cord; however, the underlying mechanism remains unclear. Here, we examined whether ONO-5046 elicits its protective effects in spinal cord ischemia by affecting endoplasmic reticulum (ER) stress. METHODS: Forty-five male Japanese white rabbits (weight 2...

BACKGROUND: Photodynamic therapy (PDT) -a minimally invasive anti-cancer therapy-is undergoing experimental studies to increase its anti-cancer effects. This study investigated the influence of iron on the anti-cancer effects of PDT. METHODS: PDT was performed in a cancer-bearing mouse model, which was created by using a murine colon carcinoma (CT26) cell line after administration of Photolon and iron. Tumor volume and the results of TdT-mediated dUTP-biotin nick end labeling (TUNEL), 8-OHdG, and TBARS assays were used to measure anti-cancer effect...

As liver disease progresses, intrahepatic vascular resistance increases (backward flow theory of portal hypertension) and collateral veins develop. Adequate portal hypertension is required to maintain portal flow into the liver through an increase in blood flow into the portal venous system (forward flow theory of portal hypertension). The splenic artery resistance index is significantly and selectively elevated in cirrhotic patients. In portal hypertension, a local hyperdynamic state occurs around the spleen...