The Showa University Journal of Medical Sciences
Online ISSN : 2185-0968
Print ISSN : 0915-6380
ISSN-L : 0915-6380
26 巻, 3 号
選択された号の論文の8件中1~8を表示しています
Original
  • Hisashi SHOJI, Takahiro TAKUMA, Yoshihito NIKI
    2014 年 26 巻 3 号 p. 181-190
    発行日: 2014年
    公開日: 2015/02/19
    ジャーナル フリー
    Quinolone resistance has been attributed to amino acid mutations in the type II topoisomerases of pathogens. To better understand this mechanism of resistance, we analyzed the molecular epidemiology of levofloxacin-resistant Streptococcus pneumoniae in Japan. We measured the quinolone susceptibility of 668 strains of S. pneumoniae obtained through nationwide surveillance from 2006 to 2008. We also sequenced the quinolone resistance-determining regions (QRDRs) in type II topoisomerases and analyzed the relationship between minimum inhibitory concentration (MIC) and six specific mutations (Ser81 or Glu85 in GyrA, Asp435 in GyrB, Ser79 or Asp83 in ParC, and Asp435 in ParE). Eighteen of the isolated strains (2.7%) showed intermediate susceptibility and resistance to levofloxacin (MIC > 4µg/ml), with no significant difference among years. However, garenoxacin and sitafloxacin showed excellent activity against these strains. Of the 18 strains, 17 (94.4%) showed mutation in QRDRs, while in 12 out of 14 levofloxacin-resistant strains (85.7%) two or more mutations were identified. A single QRDR mutation was found in 3 of 60 levofloxacin-susceptible strains (5%), all of which had an MIC of 2µg/ml. We therefore found a high isolation frequency of levofloxacin-resistant S. pneumonia in Japan over a 2-year period. Furthermore, QRDR mutations were present in 5% of susceptible strains; these were thought to be in the early stages of resistance. In the future, the increasing use of levofloxacin might result in more strain resistance. We therefore suggest that strong quinolones such as garenoxacin and sitafloxacin could be proactively administered to high-risk patients.
  • Masako TOMOYASU, Joo-ri Kim-KANEYAMA, Kyoko KOHASHI, Kyoko SHINMURA, Y ...
    2014 年 26 巻 3 号 p. 191-199
    発行日: 2014年
    公開日: 2015/02/19
    ジャーナル フリー
    Our group previously demonstrated the suppressive effect of glucagon-like peptide-1 (GLP-1) on macrophage-driven atherosclerosis in apolipoprotein E-deficient (apoE-/-) mice. In the present study we investigated the suppressive effect of GLP-1 on the atherogenic phenotype of vascular smooth muscle cells (VSMCs) in vivo using apoE-/- mice, and the proliferation and migration of human VSMCs in vitro. A 4-week infusion of GLP-1 in 17-week-old apoE-/- mice significantly reduced the proliferative VSMC phenotype stained with SMemb. Platelet-derived growth factor (PDGF) -BB significantly stimulated the proliferation of human aortic VSMCs by three fold. Both 0.1 and 1nmol/l GLP-1 significantly suppressed the PDGF-induced VSMC proliferation, and this suppressive effect was significantly abolished by the GLP-1 receptor antagonist exendin (9-39) (50nmol/l). The GLP-1 receptor agonists liraglutide (100nmol/l) and exendin-4 (100nmol/l) mimicked GLP-1, significantly suppressing PDGF-induced VSMC proliferation. PDGF-BB significantly stimulated the migration of human aortic VSMCs by 1.7 -fold, and this effect was significantly suppressed by 1nmol/l GLP-1. These findings suggest that GLP-1-related treatments may prevent the progression of atherosclerotic lesions by suppressing the proliferation and migration of VSMCs, which are characteristic features of atherosclerosis.
  • Masatsugu NAGAHAMA, Naotaka MARUOKA, Eiichi YAMAMURA, Yuichi TAKANO, N ...
    2014 年 26 巻 3 号 p. 201-210
    発行日: 2014年
    公開日: 2015/02/19
    ジャーナル フリー
    We assessed the diagnostic capability of diffusion-weighted magnetic resonance imaging (DWI) to predict the histological diagnosis of ampullary lesions to resolve the diagnostic uncertainty of endoscopic biopsy for ampullary neoplasms. From January 2009 to August 2011, we performed DWI using b values of 0 and 1000s/mm2 for 15 patients with a histological diagnosis of ampullary lesion (adenocarcinoma, n = 8; adenoma, n = 4; hyperplasia, n = 3). We compared the signal intensities (determined by comparing signal intensities of ampullary lesions and rating them as markedly hyperintense, hyperintense, or hypo-to-isointense relative to the duodenal wall) and the apparent diffusion coefficient (ADC, × 10-3 mm2/s) values of the ampullary lesions on DWI among the three groups based on the histological diagnosis. Values are expressed as median (range). The cancer-group lesions showed a significantly higher signal intensity than either adenoma or hyperplasia (markedly hyperintense/hyperintense/hypo-to-isointense; adenocarcinoma, 7/1/0; adenoma, 0/4/0; hyperplasia, 0/0/3; P < 0.005). The ADC values were significantly lower in adenocarcinoma at 1.46 (0.83-1.63) than in either adenoma at 2.14 (1.92-2.37) or hyperplasia at 2.06 (1.88-2.53) (P < 0.005). In addition, the ADC values in the malignant group (adenocarcinoma) were significantly lower than those in the benign groups (adenoma and hyperplasia) (P < 0.001). The findings suggested that DWI could contribute significantly to accurate preprocedural diagnosis of ampullary lesions.
  • Shingo MATSUDAIRA, Mitsuko KANAMARU, Makito IIZUKA, Ikuo HOMMA, Masahi ...
    2014 年 26 巻 3 号 p. 211-217
    発行日: 2014年
    公開日: 2015/02/19
    ジャーナル フリー
    Medullary 5-hydroxytryptamine (5-HT) neurons are involved in ventilatory responses to hypercapnia. Underdeveloped medullary 5-HT neurons and reduced 5-HT1A receptor binding activity in the dorsomedial medulla oblongata (DMM) have been found in infants with sudden infant death syndrome (SIDS). The DMM includes the solitary tract nucleus, which receives primary afferent inputs from the lung, and the hypoglossal nucleus, which affects genioglossal muscle tone. We hypothesized that hypercapnia would elicit 5-HT release in the DMM and that local 5-HT1A receptors would affect ventilatory and airway responses to hypercapnia. This hypothesis was investigated in unanesthetized infant Wistar rats by microdialysis of the DMM coupled with double-chamber plethysmography. After microdialysis probe placement, the rats were acclimatized to the chamber for over 5h, and artificial cerebrospinal fluid (aCSF) or a 5-HT1A receptor antagonist, WAY-100635, was then perfused into the DMM, and extracellular fluid was collected. Respiratory flow curves were recorded while the rats inhaled five concentrations of CO2 in O2 for 10 min each (0% [100% O2], 5%, 7%, 9%, and 0% again). 5-HT concentration was measured using high-performance liquid chromatography with electrochemical detection. 5-HT release in the DMM and hypercapnic ventilatory and airway responses increased dose dependently with CO2 concentration during both aCSF and WAY-100635 perfusion, with no difference between groups. However, early-onset ventilatory and airway responses to hypercapnia were significantly delayed or reduced by WAY-100635 perfusion in the DMM. These results suggest that 5-HT release in the DMM is dependent on hypercapnia, while early ventilatory and airway responses to hypercapnia are mediated by 5-HT1A receptors in the DMM. Blunted early onset of hypercapnic ventilatory and airway responses may be one cause of SIDS.
  • Rena SHIGENAGA, Sadako AKASHI-TANAKA, Satoko UCHIDA, Murasaki IKEDA, H ...
    2014 年 26 巻 3 号 p. 219-227
    発行日: 2014年
    公開日: 2015/02/19
    ジャーナル フリー
    Germline mutations of BRCA1/2 genes cause hereditary breast and/or ovarian cancer. However, whether guidelines like those of the National Comprehensive Cancer Network (NCCN) can suitably predict the likelihood of BRCA1/2 mutations in the Japanese population is unclear. Methods BRCA1/2 gene mutation frequencies were investigated in relation to parameters such as age, family history (FH), and breast cancer subtype using data collected from 922 Japanese breast cancer patients who underwent surgery between September 2010 and June 2013. BRCA1/2 mutations were present in 15 of 57 (26.3%) tested patients. The frequency of the mutations was not significantly related to age. Among the 180 patients who reported an FH of breast cancer, 11 of the 37 who were tested (29.7%) were positive for BRCA1/2 mutations. Of those with an FH of ovarian cancer (n = 34), seven of 12 patients tested (58.3%) were carriers of BRCA1/2 (P = 0.013). Six of these seven carriers were triple-negative breast cancer (TNBC) patients. In all, there were 97 TNBC patients, and the presence of the BRCA1/2 mutation in this subgroup was significantly greater than in non-TNBC patients, with 12 of 17 TNBC patients (70.5%) testing positive (P = 0.03). There were 59 TNBC patients < 60 years of age, and of the 16 (27.1%) who underwent BRCA1/2 genetic testing, 11 (68.8%) were found to have mutations in BRCA1/2. Among the TNBC patients, 29 also reported an FH of breast or ovarian cancer; of these, nine of the 13 tested (69.2%) were positive for a BRCA1/2 mutation. The data demonstrate that BRCA1/2 mutations are observed more frequently in TNBC patients, especially those < 60 years of age or in combination with an FH of breast and/or ovarian cancer, suggesting that some of the NCCN guidelines can adequately predict BRCA1/2 carriers in the Japanese population.
  • Nozomi BELL, Naomi YAGI, Kumi HATANO, Makoto SAIKI, Yoshimitsu OHGIYA, ...
    2014 年 26 巻 3 号 p. 229-236
    発行日: 2014年
    公開日: 2015/02/19
    ジャーナル フリー
    Endometrial cancer is the seventh most common human malignancy and the most common form of cancer treated in women by obstetrics and gynecology departments. Until now, magnetic resonance imaging (MRI) has been used for pre-surgical evaluation of endometrial cancer and evaluating the depth of myometrial invasion, in addition to being a valuable diagnostic tool. Diffusion-weighted imaging (DWI) has been reported as useful in distinguishing between benign and malignant tumors when observing lesions in the endometrium. Subsequent reports suggest that DWI is also effective in identifying malignancy and diagnosing local extension in a range of tissues. Based on this, we implemented a study of the effectiveness of DWI in identifying local extension of endometrial cancer. This study enrolled patients undergoing surgery at this hospital for cancer of the uterine body during the six years from January 2008 to February 2014. Cases in which images were unclear or the lesions were too small to be described by MRI examination were excluded, leaving 61 patients in the study. Using the results from pre-surgical MRI, a sequence comprising a T2-weighted axial view alone and a T2-weighted axial view to which a diffusion-weighted axial view had been added was created for each patient. Two radiologists then independently examined the image sequence to determine localized extension. Following surgery, the pre-surgical assessment was compared to the localized extension determined by histopathology of post-surgical samples to evaluate the effectiveness of adding diffusion-weighted imaging to the process. The first radiographic interpreter's rate of correct diagnosis using the T2-weighted axial view alone was 45 out of 55 cases (81.8%), while using the T2-weighted axial view to which a diffusion-weighted axial view had been added gave a correct diagnosis rate of 51 out of 55 cases (92.7%). The second radiographic interpreter's rate of correct diagnosis using the T2-weighted axial view alone was 41 out of 55 cases (74.5%), while using the T2-weighted axial view with diffusion-weighted axial view added gave a correct diagnosis rate of 51 out of 55 cases (92.7%). These differences were statistically significant based on the McNemar testing. This study confirmed that DWI is an effective means of diagnosing localized extension from images. It is anticipated that DWI will be used in the future clinical workplace to provide more accurate pre-surgical diagnoses.
Case Report
  • Junichi FURUSHO, Yusuke ISOZAKI, Akira IWANAMI
    2014 年 26 巻 3 号 p. 237-243
    発行日: 2014年
    公開日: 2015/02/19
    ジャーナル フリー
    We are investigating whether medical support improves not only the core symptoms of children with attention deficit/hyperactivity disorder (ADHD), but also their quality of life (QOL) using the Japanese version of the Kid-KINDLR (for ages 7-13 years) questionnaire (Kid-KINDLR). Herein, we report two cases of adequate medical support using Kid-KINDLR for children with ADHD. Case 1 is a 9-year-old boy. The Kid-KINDLR questionnaire revealed that this patient had conflict with his father; however, the father was unaware of such situation and had no understanding of the conflict. In addition to medical treatment, we advised his father to ascertain a good relationship with his son in order to better understand him. Case 2 is an 8-year-old boy who showed a decreasing self-esteem score after administration of medicine, despite improvements in his ADHD symptoms. We considered that the medicine had improved both his self-discernment and his relationships with others, indicating that the medical support was more effective in case 2 than in case 1. The Kid-KINDLR Questionnaire, and in particular the self-esteem scores, enabled us to understand the QOL changes in the reported cases. We speculated that children with ADHD have a greater obstacle of self-discernment than children showing normal development. However, such children may learn to recognize the concept of self-esteem, and we conclude that it is necessary to support these patients with specialized care to improve their ability to compare themselves with others.
Transactions of The Showa University Society: The 317th Meeting
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