The Journal of Medical Investigation
Online ISSN : 1349-6867
Print ISSN : 1343-1420
ISSN-L : 1343-1420
Volume 65 , Issue 3.4
Showing 1-26 articles out of 26 articles from the selected issue
  • Kokichi Arisawa
    2018 Volume 65 Issue 3.4 Pages 151-161
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    The author reviewed recent reports about the blood levels and dietary intake of polychlorinated dibenzo‐p‐dioxins (PCDDs)/furans (PCDFs)/dioxin‐like polychlorinated biphenyls (DL‐PCBs) to investigate the trends of dioxin exposure, and epidemiologic studies on the associations of blood levels of dioxins with metabolic diseases. In recent years, dietary intake of dioxins has been decreasing, and the means are equal to or less than 1.0 pg Toxic Equivalents (TEQ)/kg/day in the general populations of several countries. The blood levels of dioxins are also decreasing, probably because of reduced dietary intake. Many cross‐sectional studies reported positive associations between blood levels of some isomers or TEQ‐based concentrations of PCDDs/PCDFs/DL‐PCBs and diabetes in general populations. Three cohort studies on populations with heavy exposure and two nested case‐control studies on general populations have also been published, but the results are inconsistent. Three large‐scale cross‐sectional studies and two cohort studies reported an association between blood levels of some isomers or TEQ‐based concentrations of PCDDs/PCDFs/DL‐PCBs and metabolic syndrome. In addition, three cross‐sectional studies reported significant positive associations with gout/hyperuricemia. Further prospective studies and experimental studies are needed to establish cause‐effect relationships, and to clarify the biological mechanisms for the association between background exposure to dioxins and potential health effects. J. Med. Invest. 65:151‐161, August, 2018

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  • Yoshichika Kawai
    2018 Volume 65 Issue 3.4 Pages 162-165
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    Many papers have suggested the health‐beneficial activity of natural dietary polyphenols to prevent chronic diseases and aging processes in humans. It is generally recognized that polyphenols are absorbed from the intestines and metabolized into the phase‐Ⅱ conjugates, i.e., the glucuronides and sulfates. For example, a major dietary flavonoid, quercetin, abundant in onion and buckwheat, is metabolized after oral intake into its conjugates, such as quercetin‐3‐O‐glucuronide and quercetin‐3'‐O‐sulfate, whereas no aglycone was found in the human plasma. Therefore, to understand the mechanisms of the biological activity of quercetin in vivo, we should focus on the molecular actions of these conjugates. In the last decade, we have demonstrated the unique actions of quercetin‐3‐O‐glucuronide at sites of inflammation, including specific accumulation in macrophages and the following deconjugation into active aglycone, catalyzed by the macrophage‐derived β‐glucuronidase. This review summarizes recent findings regarding the anti‐inflammatory mechanisms of quercetin conjugates in macrophages and propose a possible strategy for the effective utilization of natural polyphenols in our daily diet for prevention of age‐related chronic diseases. J. Med. Invest. 65:162‐165, August, 2018

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  • Momoko Chikugo, Mayu Sebe, Rie Tsutsumi, Marina Iuchi, Jun Kishi, Masa ...
    2018 Volume 65 Issue 3.4 Pages 166-170
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    Tofacitinib is the first Janus Kinase (JAK) inhibitor to treat moderately to severely active RA. In this study, we investigated whether the effect of tofacitinib have any effects on body composition in mice and female patients with RA. Female C57BL/6 mice fed with a high‐fat diet were treated with 30 mg/kg/day tofacitinib or vehicle for 70 days. Following treatment, trunk muscle, subcutaneous fat, and visceral fats were measured using X‐ray computed tomography CT scan. Glucose tolerance and insulin sensitivity were assessed. In female RA patients treated with biological disease modified anti‐rheumatic‐drugs (biological DMARDs) or tofacitinib (n=4 per group), we also evaluated the body composition after 3 months from the start of treatment initiation using bioelectrical impedance analysis. Treatment with tofacitinib did not affect the body weight, and body composition in C57BL/6 mice. It also did not affect glucose, and insulin tolerance in mice. In patients with RA, treatment with biological DMARDs did not affect the body composition whereas the muscle mass was unchanged after receiving tofacitinib and the fat mass was significantly increased. J. Med. Invest. 65:166‐170, August, 2018

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  • Akari Tsunedomi, Katsuyuki Miyawaki, Akinori Masamura, Mutsumi Nakahas ...
    2018 Volume 65 Issue 3.4 Pages 171-176
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    The number of plant factories in which crops are cultivated in an artificial environment has been increasing every year. In cultivation techniques involving hydroponics, plants are supplied with a circulating nutrient solution, which can become contaminated by pathogens that can propagate and spread throughout plant factories. Therefore, strategies to disinfect hydroponic nutrient solutions are needed. In this study, we developed a new disinfection device equipped with an ultraviolet A (UVA) light emitting diode (LED) that can be used to disinfect hydroponic nutrient solutions in plant factories. We first evaluated the basic disinfection capability of the device and then estimated its bactericidal effect in a small scale model system. The log survival ratio was related to UVA irradiation fluence and the volume of nutrient solution. From the assay results, we devised a kinetics equation to describe the relationship between nutrient solution volume, log survival ratio, and UVA fluence. Together our results show that UVA irradiation could be used to disinfect hydroponic nutrient solutions, and the derived kinetics equations can be used to determine optimal conditions, such as nutrient solution volume, UVA irradiation, and killing activity, to develop devices that disinfect hydroponic nutrient solutions. J. Med. Invest. 65:171‐176, August, 2018

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  • Koichi Iwaki, Toshinori Sakai, Daisuke Hatayama, Yohei Hayashi, Nanae ...
    2018 Volume 65 Issue 3.4 Pages 177-183
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    The purpose of this study was to evaluate the physical features of pediatric patients with lumbar spondylolysis (LS), factors that increase the load during compensatory movements at the lumbar spine, and the outcomes of rehabilitation. Twenty patients were included. Fifteen items were used:fingertip‐to‐floor distance (FFD), straight leg raising (SLR), heel‐to‐buttock distance (HBD), tightness of the rectus femoris, the lateral and medial rotator muscles, iliopsoas, tensor fascia lata, adductor muscles, soleus muscle, and latissimus dorsi, and trunk rotation, sit‐ups and endurance of the abdominal and back muscles. Initial findings were judged as positive or negative using previously reported cut‐off values and were re‐evaluated 2 or 3 months later. Positive tests were found for HBD and tightness of the rectus femoris in 85% of the patients, for endurance of the abdominal muscles in 75%, SLR and sit‐ups in 70%, and FFD and tightness of the external rotator muscles in 60%. The physical features varied according to the type of sport played, and some patients were refractory to rehabilitation. Only 17.6%, 33.3%, and 40.0% of patients with initially positive findings for HBD, tightness of the external rotator muscles, and endurance of the abdominal muscles, respectively, achieved improvements after rehabilitation. J. Med. Invest. 65:177‐183, August, 2018

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  • Satomi Moriyama, Daisuke Hinode, Masami Yoshioka, Yuka Sogawa, Takeshi ...
    2018 Volume 65 Issue 3.4 Pages 184-190
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    Objective:The aim of this study was to investigate the impact of the use of two Kampo medicines on oral mucositis, tongue coating bacteria, and gingiva condition in patients with esophageal cancer undergoing chemotherapy. Methods:Twenty‐three esophageal cancer patients who receive chemotherapy at Tokushima University Hospital, were included. The participants, who received professional oral healthcare, were randomly divided into three groups:7 subjects received Daiokanzoto sherbets, 7 subjects received Hangeshashinto sherbets, and 9 subjects received nothing (control). The numbers of total bacteria and specific periodontopathogenic bacteria in tongue coating were determined in addition to clinical parameters. Results:No difference on the onset of oral mucositis was found among the three groups. However, tongue coating index, gingival index (GI), plaque index, the number of total bacteria, Fusobacterium nucleatum and Campylobacter rectus were decreased during chemotherapy. More specifically, GI as well as the number of F. nucleatum and C. rectus were decreased significantly in the Daiokanzoto group when compared to the control group (psize 8 < 0.05). No such differences were observed for the group receiving Hangeshashinto. Conclusion:This clinical trial showed that Daiokanzoto might be effective in attenuating gingival inflammation and reducing the levels of periodontopathogenic bacteria in patients with esophageal cancer. J. Med. Invest. 65:184‐190, August, 2018

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  • Tadahiro Nozoe, Mayuko Kono, Naotaka Hashimoto, Eiji Tsujita, Sosei Ku ...
    2018 Volume 65 Issue 3.4 Pages 191-194
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    Purpose. The aim of this study was to develop prognostic criteria based on the combination of nodal metastasis and preoperative elevation of serum C‐reactive protein (CRP) for patients with gastric carcinoma that have been treated with curative resection. Methods. Three hundred and twenty patients with gastric carcinoma who had been treated with curative resection were enrolled. One point was provided for each incidence of nodal metastasis and preoperative elevation of serum CRP and we examined whether this cumulative score system could provide a strict stratification of survival. Results. Significant differences regarding survival were observed both between patients with scores of 0 and 1 (P < 0.0001) and between patients with scores of 1 and 2 (P < 0.0001). Multivariate analysis showed that the cumulative score (P = 0.0003) and the depth of the tumor (P = 0.016) were independent prognostic indicators. Conclusions. Criteria for the prediction of prognosis in gastric carcinoma treated with curative resection based on tumor‐related and host‐related factors could provide a strict stratification. J. Med. Invest. 65:191‐194, August, 2018

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  • Tomoko Otani, Yasuko Kase, Kazufumi Kunitomo, Kazumi Shimooka, Mitsugu ...
    2018 Volume 65 Issue 3.4 Pages 195-202
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    In recumbent elderly patients, creatinine clearance (eCCr) estimated by the Cockcroft‐Gault (CG) equation may not necessarily reflect renal function. We aimed to develop a novel formula to revise the CG equation using anthropometric measurements in bedridden elderly patients and evaluate its clinical utility. The subjects included 77 bedridden Japanese patients aged ≦ 65, hospitalized at Naruto Yamakami Hospital. The actual CCr (mCCr) value was measured using the 24‐hour urine collection method. Anthropometric data, such as skeletal muscle mass, body fat mass (BFM), and triceps skinfold thickness (TSF), were collected. We established a novel formula to estimate CCr(BFM) or CCr(TSF) by correcting the eCCr(Enz+0.2) value with BFM or TSF. The stage of classification of renal dysfunctions in patients with eGFR(BFM) or eGFR(TSF) was equivalent to the GFR(control) based on the mCCr. Notably, the novel equation for eCCr based on TSF (eCCr(TSF)), dubbed the “Naruto" formula, can be useful to evaluate renal function in bedridden elderly patients without expensive equipment or additional costs. In this study, mCCr was considered to be the true renal function of the patient, but whether and to what extent mCCr correlates with inulin clearance is unknown. J. Med. Invest. 65:195‐202, August, 2018

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  • Chise Yamaguchi, Hisami Yamanaka‐Okumura, Haruka Esumi, Masashi Masuda ...
    2018 Volume 65 Issue 3.4 Pages 203-207
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    Humans have a high preference for fat, and its excessive intake leads to obesity. This study aimed to investigate the effects of dose‐dependent fat intake on biological responses and postprandial appetite sensation in healthy adult subjects. Age and body mass index were 29 ± 1 years and 21.1 ± 0.4 kg/m2, respectively. We conducted a randomized, crossover trial and measured laboratory data and appetite sensation via the visual analog scale. Each participant was provided with four different test meals. They consisted of common, basic foods and contained 75 g liquid glucose and 4 slices of crackers to which 0 g butter (control), 10 g butter (B10), 20 g butter (B20), and 40 g butter (B40) were added, respectively. The results indicated that single ingestion of butter did not influence laboratory values of glucose, insulin, glucose‐dependent insulinotropic polypeptide (GIP), total bile acids, or high‐sensitivity CRP (hs‐CRP). Regarding postprandial appetite sensation, appetite ratings for fullness were the highest after the B40 meal (p < 0.05);however, satisfaction ratings were not significantly different after the ingestion of this meal. Ratings were significantly different after the B20 meal. In conclusion, healthy adult subjects experienced fullness and satisfaction after ingesting 20‐40 g of butter. J. Med. Invest. 65:203‐207, August, 2018

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  • Hideharu Abe, Akiko Sakurai, Hiroyuki Ono, Sanae Hayashi, Sakiya Yoshi ...
    2018 Volume 65 Issue 3.4 Pages 208-215
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    Diabetic nephropathy (DN) is the major cause of end‐stage renal failure and is associated with increased morbidity and mortality as compared to other causes of renal disease. Albuminuria is often the first clinical indicator of the presence of DN. However, albuminuria or proteinuria is a common symptom in patients with various renal disorders. Therefore, specific biomarkers for the diagnosis of DN are required. A primary hallmark of DN is the progressive damage and death of glomerular podocytes, resulting in the leaking of proteins into the urine. Urinary exosomes released by podocytes are microvesicles containing information of the originated cells. Podocyte‐derived signal transduction factors (PDSTFs) are good candidates to assess podocyte injuries. The profile of PDSTFs in urinary exosomes from patients with DN is different from that from patients with minimal change nehrotic syndrome. In addition, PDSTFs molecules in exosomes were derived from primary murine podocytes under high glucose conditions. Among PDSTFs in urinary exosomes, Wilms tumor 1 (WT1) levels reflected damage of diabetic glomeruli in the patients. Urinary exosomal WT1 can predict the decline in eGFR for the following several years. In conclusion, urinary exosomal WT1 is a useful biomarker to improve risk stratification in patients with DN. J. Med. Invest. 65:208‐215, August, 2018

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  • Aki Shimada, Jiro Udaka, Hinami Nagashima, Izumi Chida, Eiji Kondo, Se ...
    2018 Volume 65 Issue 3.4 Pages 216-220
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    Objectives:We examined speech recognition ability of elementary school‐aged Japanese children with unilateral hearing loss under noisy environments and then examined the effects of the FM system fitted into their normal hearing ear on their speech recognition ability. Methods:Twelve children with severe‐to‐profound sensorineural hearing loss and ten age‐matched children with bilateral normal hearing received speech recognition test in quiet and noisy environments. Other nine children with severe‐to‐profound sensorineural hearing loss received speech recognition test with or without the FM receiver fitted to the normal hearing ear in quiet and noisy environments. Results:Signal‐to‐noise ratio (SNR) in Japanese elementary school classrooms was estimated to be ‐6.9 dB at a preferential seat. In noisy environment of ‐5 dB SNR similar to working classrooms, the correct rates of speech recognition test in children with unilateral hearing loss were significantly lower, compared with those in children with bilateral normal hearing. In the noisy environment, the correct rates in children aided by the FM system with unilateral hearing loss were significantly better, compared with unaided ones. Conclusion:The results suggested that the FM system is recommended as an audiological management for improvement of speech recognition of children with unilateral hearing loss in noisy classrooms. J. Med. Invest. 65:216‐220, August, 2018

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  • Kanako Yoshida, Masato Nishimura, Akiko Abe, Takeshi Kato, Hiroyuki Fu ...
    2018 Volume 65 Issue 3.4 Pages 221-224
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    The objective of this study was to identify pathological indicators that could be used to identify a subgroup of patients with apparent stage I endometrial cancer who do require retroperitoneal lymphadenectomy. 188 T1 endometrial cancer patients underwent primary surgery at Tokushima University Hospital. We retrospectively evaluated their clinical records and histopathological factors. Systematic lymphadenectomy was performed for 149 patients, and 39 patients (grade 1 with < 5 mm of myometrial invasion) were treated without lymphadenectomy. Lymph node metastases were found in 19 (12.8%) of the lymphadenectomy cases. Twenty‐four patients with a T1a endometrium‐limited lesion did not exhibit lymph node metastasis. Three (3.1%) of the 95 patients with a T1a lesion exhibited lymph node metastasis, and these 3 cases exhibited approximately 50% myometrial invasion. The 39 low‐risk patients who did not undergo systematic lymphadenectomy remain alive without recurrence. Systematic lymphadenectomy could be omitted for patients with a grade 1 tumor and minor myometrial invasion of less than 5mm. J. Med. Invest. 65:221‐224, August, 2018

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  • Wenting Xu, Licht Miyamoto, Haruna Aihara, Tomomi Yamaoka, Naonobu Tan ...
    2018 Volume 65 Issue 3.4 Pages 225-230
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    Ectopic fat accumulation is associated with insulin resistance and type 2 diabetes mellitus. Citrus sudachi is an evergreen tree that is found mainly in Tokushima Prefecture in Japan. Previously, it was demonstrated that Citrus sudachi could inhibit the rising trend of blood glucose and fatty acid in human subjects. In the current study, we illustrated the function of methanol extracts from sudachi peel and investigated the mechanism of this effect. We got the five kinds of methanol extracts by using diaion HP‐20, and those were named by hydrophobicity from M‐F1 to M‐F5. Among the 5 kinds of sudachi methanol extracts, only M‐F4 significantly decreased the intracellular triglyceride of C2C12 cells. It augmented the AMPK activity and increased the transcription of PPARα and its downstream targets CPT‐1b and UCP2. In conclusion, M‐F4 improved the lipid metabolism possibly through AMPK, PPARα and their downstream targets like CPT‐1b and UCP2. Furthermore, this extract may be useful for preventing obesity and diabetes related diseases. J. Med. Invest. 65:225‐230, August, 2018

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  • Nami Nakamura, Hiroyoshi Watanabe, Kazumi Okamura, Shoji Kagami
    2018 Volume 65 Issue 3.4 Pages 231-235
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    Several factors besides renal function influence serum cystatin C (CysC) levels. The present study evaluates the value of serum CysC and the equation for CysC based estimated glomerular filtration rate (CysC‐eGFR) for Japanese children with malignancies. We collected information at 36 time points from 13 patients aged ≤ 17 years with malignancies. We assessed tumor activity, cell recovery phase after chemotherapy, neutropenia phase, inflammation response and medication with granulocyte‐colony stimulating factor, steroid, and levothyroxine as risk factors associated with serum CysC levels. Although no 24‐h creatinine clearance (CCr) data collected at 36 time points indicated renal dysfunction, serum CysC levels were above and below the reference values at four and five time points, respectively. The frequency of elevated serum CysC levels was higher in patients without therapy or with stable or progressive disease than among those with a complete or partial response (p = 0.0046). The correlation coefficient between CCr and CysC‐eGFR was 0.355 (p = 0.054), but this improved to 0.663 (p = 0.0010) when restricted to patients with a complete or partial response. Levels of serum CysC might become elevated regardless of renal function, and CysC‐eGFR might become unpredictable during the active phase of tumors. J. Med. Invest. 65:231‐235, August, 2018

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  • Jun Kurai, Hisashi Noma, Hiroyuki Sano, Kyoko Iwata, Yuji Tohda, Masan ...
    2018 Volume 65 Issue 3.4 Pages 236-241
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    The average annual ozone levels have been increasing in Japan, even though the high ozone levels have decreased in recent years. There is limited information on the relationship between ozone exposure, pulmonary function, and respiratory symptoms in schoolchildren in Japan. The aim of this study was to investigate the effects of short‐term ozone exposure on pulmonary function and respiratory symptoms in Japanese schoolchildren. Afternoon peak expiratory flow (PEF) values and respiratory symptom scores were recorded daily in 276 schoolchildren from September to October 2016 and from January to February 2017. The association of daily ozone levels with PEF was assessed using a linear mixed model and that with respiratory symptoms was evaluated by generalized estimating equations logistic regression analysis. There was a significant association of daily ozone levels with PEF values. A 13.6‐ppb increment in the interquartile range for ozone exposure was significantly associated with a decrease in PEF of -3.67 L/min (95% confidence interval -4.73, -2.61). However, increased ozone levels were not associated with an increased risk of respiratory symptoms. Our present findings suggest that more attention should be paid to the potential adverse effects of short‐term ozone exposure on pulmonary function in schoolchildren. J. Med. Invest. 65:236‐241, August, 2018

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  • Rezwanul Islam, Hiroyuki Mizuguchi, Aurpita Shaha, Kohei Nishida, Masa ...
    2018 Volume 65 Issue 3.4 Pages 242-250
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    As expression level of allergic disease‐sensitive genes are correlated with allergic symptom severity, suppression of these gene expressions could be good therapeutics. We have demonstrated that PKCδ signaling and NFAT signaling, involve in histamine H1 receptor (H1R) and IL‐9 gene expressions, respectively, are responsible for the pathogenesis of allergic rhinitis. We explore anti‐allergic compounds that suppress these signaling pathways and found that wild grape (WG) contains such compounds. Here, we investigated the effect of WG hot water extract (WGE) on the signaling pathways for PKCδ‐mediated H1R and NFAT‐mediated IL‐9 gene expressions. WGE suppressed histamine/PMA‐induced H1R gene up‐regulation in HeLa cells. Toluene‐2,4‐diisocyanate (TDI)‐induced H1R mRNA elevation in TDI‐sensitized rats was also suppressed by WGE treatment. Treatment with WGE in combination with Awa‐tea, suppresses NFAT signaling‐mediated IL‐9 gene, markedly alleviated nasal symptoms. Furthermore, WGE suppressed PMA‐induced IL‐33 gene up‐regulation in Swiss 3T3 cells. Data suggest that combination of WGE, suppresses PKCδ signaling with Awa‐tea, suppresses NFAT signaling would have distinct clinical and therapeutic advantages as a substitute for anti‐allergic drugs. In addition, as the expression level of IL‐33 mRNA was correlated with the blood eosinophils number in patients with pollinosis, WG could alleviate eosinophilic inflammation through the suppression of IL‐33 gene expression. J. Med. Invest. 65:242‐250, August, 2018

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  • Tomoo Kishaba, Rita McGill, Yuichiro Nei, Sachi Ibuki, Masashi Momose, ...
    2018 Volume 65 Issue 3.4 Pages 251-257
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    Background:Dermatomyositis (DM) and polymyositis (PM) often have association with interstitial lung disease (ILD) which have disease specific autoantibody. Methodology:We reviewed medical records of DM/PM associated ILD from January 2000 to December 2017 according to the autoantibody. Result:We identified 52 patients, of whom 30 were antibody negative, 18 had anti aminoacyl‐tRNA synthetases (ARS) antibodies and 4 had anti melanoma differentiation‐associated gene (MDA)‐5 antibody. In high resolution computed tomography (HRCT) of the chest, area of ground glass opacity (GGO), consolidation, and lung tip consolidation were more extensive in anti MDA‐5 antibody positive patients (p=0.051, p=0.026, and p=0.027, respectively). Among laboratory findings, GOT had strong correlations with CPK (r=0.889, p < 0.001), and LDH (r=0.910, p < 0.001). Among roentgenographic findings, there were moderate correlations between GGO and consolidation (r=0.668, p < 0.001), and between reticular shadow and traction bronchiectasis (p=0.633, p < 0.001). ILD patients with anti MDA‐5 antibodies had decreased survival (1.00 vs 84.3, 22.9 months, p < 0.001). Conclusion:ILD patients with anti ARS antibody had intense inflammation, but reversible fibrosis and good prognosis. On the other hand, anti MDA‐5 antibody positive ILD patients had shorter survival. Extent of parenchymal shadow and serum GOT were useful indicator of disease activity of PM/DM associated ILD patients in our cohort. J. Med. Invest. 65:251‐257, August, 2018

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  • Susumu Yasuoka, Mari Miki, Rie Tsutsumi, Masami Yoshioka, Takashi Band ...
    2018 Volume 65 Issue 3.4 Pages 258-267
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    We first discovered human airway trypsin‐like protease (HAT) in human mucoid sputum. Precursor HAT (47 kDa), a cell surface type Ⅱ transmembrane serine protease, is proteolyzed to mature HAT (27 kDa). Hitherto, HAT has not been detected in other biological fluids except for human sputum. We aimed to clarify whether human saliva contains mature HAT. Trypsin‐like protease was isolated from saliva of healthy volunteers by a method adopted for isolation of HAT from sputum using Boc‐Phe‐Ser‐Arg‐MCA as the substrate. Biochemical properties of purified protease were similar to those of recombinant HAT (rHAT). HAT concentration in saliva was measured by ELISA, and immunoreactive HAT:total protein ratio (ng/mg) in saliva samples from healthy subjects was similar to that in mucoid sputum. RT‐PCR showed that HAT mRNA was expressed in human gingival epithelial cells but not in gingival fibroblasts. Both indirect immunofluorescence and western blotting using monoclonal antibody for α‐smooth muscle actin (α‐SMA;a myofibroblast marker) showed that HAT enhanced α‐SMA fiber expression in gingival fibroblasts. These results indicate that both mucoid sputum and saliva from healthy subjects have similar concentrations of mature HAT, and HAT is related to certain physiological functions and pathological states of myofibroblasts in the oral cavity. J. Med. Invest. 65:258‐267, August, 2018

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  • Aya Kondou, Mari Haku
    2018 Volume 65 Issue 3.4 Pages 268-273
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    The aim of this study was to clarify the experiences of husbands present at their wives' emergency cesarean sections. Semi‐structured interviews were conducted for nine husbands who attended their wives' emergency cesarean sections. The results were analyzed using a qualitative inductive approach. Several categories such as [wife's labor pain will be unbearable if I look], [situation was beyond one's control], and [sense of relief experienced by midwife care] were extracted from the husbands' experiences the need for an emergency cesarean section was established. Additional categories such as [sense of relief at cesarean section decision], [convincing oneself], and [anxiety for life and hope for safety] were extracted at the time of the emergency cesarean section decision. Other categories [anxiety while waiting for prolonged periods], [ease of mind with family], and [pleasure in meeting the baby] were extracted from the husbands' experiences while waiting for their wives' cesarean section. Finally, the categories of [unloading of responsibilities], [to thank my wife], and [remaining anxious and fearful] were extracted from the husbands' experiences on their wives return to their hospital rooms. Husbands were anxious about the life and safety of their wife and child, and considered their futures in case of an unexpected occurrence. J. Med. Invest. 65:268‐273, August, 2018

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  • Hiroyuki Nodera, Kazuki Sogawa, Naoko Takamatsu, Atsuko Mori, Hiroki Y ...
    2018 Volume 65 Issue 3.4 Pages 274-279
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    Texture analysis characterizes regions in an image by their texture content and has been utilized to infer the underlying structures of medical images such as skeletal muscles. Although potentially useful in tissue diagnosis and assessing disease progression of neuromuscular diseases, the use of texture analysis in such purposes are limited, due to lack of information such as effects of aging. Thus, we performed texture analysis of medial gastrocnemius in healthy individuals form their 20s to late 80s. Among the 283 texture features in 6 classes, the features related to histogram, co‐occurrence matrix, absolute gradient, and wavelet were correlated to age in 17‐40% of the parameters, while none of the features related to run‐length matrix and autoregressive model had significant correlation to age. This study showed that age‐dependency in many texture features are present and need to be taken into account in elucidating the clinical significance. By contrast, the features related to run‐length matrix and autoregressive model could have clinical utility. J. Med. Invest. 65:274‐279, August, 2018

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  • Yurika Numata‐Uematsu, Hiroyuki Yokoyama, Hiroki Sato, Wakaba Endo, Mi ...
    2018 Volume 65 Issue 3.4 Pages 280-282
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    Many studies have reported many adverse effects of children's use of media. These effects include reduced cognitive development and hyperactivity and attention disorders. Although it has been recommended that child be kept away from the media during the early developmental period, many modern parents use the media as a way to calm their children. Consequently, these children lack the opportunity to form selective attachments by reduced social engagement. These children's symptoms occasionally mimic autism spectrum disorder (ASD). However, few studies have examined the symptoms children develop with early media exposure. Here, we present a boy exposed to the media during his early development who was diagnosed with attachment disorder. He was unable to make eye contact and was hyperactive and had delayed language development, like children with ASD. His symptoms improved dramatically after he was prevented from using all media and encouraged to play in other ways. After this treatment, he would make eye contact, and talked about playing with their parents. Simply avoiding the media and playing with others can change the behavior of a child with ASD‐like symptoms. It is important to understand the symptoms caused by attachment disorder and early media exposure. J. Med. Invest. 65:280‐282, August, 2018

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  • Koichiro Kajiura, Haruki Taniguchi, Tomonari Ishimine, Kei Nakamura, M ...
    2018 Volume 65 Issue 3.4 Pages 283-285
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    Solitary abdominal paraaortic lymph node recurrence after radical lung cancer surgery is very rare. Here, we report a case of a solitary abdominal paraaortic lymph node recurrence of lung squamous cell carcinoma (SCC). A 63‐year‐old man was diagnosed with lung SCC (cT1cN0M0 stage IA3), underwent a video‐assisted right lower lobectomy (ND2a‐1), and the pathological findings showed SCC (pT1cN0M0 stage IA3). The EGFR mutation and ALK translocation statuses of SCC were negative, and adjuvant therapy was not performed. Follow‐up positron emission tomography - computed tomography (PET/CT) showed a solitary fluorodeoxyglucose (FDG)‐concentrated region in the swollen paraaortic lymph node. A paraaortic lymph node biopsy was performed by open laparotomy, to determine the precise diagnosis and identify the genetic status. Pathological findings revealed that the paraaortic lymph node contained poorly differentiated SCC, which was thought to metastasize from the lung cancer. The genetic status of the lymph node recurrence revealed a lack of EGFR mutations, ALK translocations, and ROS1 mutations, while the tumor proportion score (TPS) of PD‐L1 was 55%, and we therefore administered pembrolizumab, an immune checkpoint inhibitor. Biopsies are very important for achieving precise diagnoses and determining the genetic statuses of tumors, since molecular‐targeting drugs and immune checkpoint inhibitors are available. J. Med. Invest. 65:283‐285, August, 2018

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  • Kosai Cho, Takeya Minami, Yoshinori Okuno, Youhei Kakuda, Takahiko Tsu ...
    2018 Volume 65 Issue 3.4 Pages 286-288
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    Hyperbaric oxygen therapy (HBOT) for carbon monoxide (CO) poisoning is widely performed to prevent delayed neuropsychiatric syndrome. Although HBOT can generally be performed with safety, the appropriate management of HBOT still remains unestablished. A 31‐year‐old man was transferred to our facility to undergo HBOT in a multiplace chamber with a diagnosis of CO poisoning. The first HBOT session ended uneventfully. During the second HBOT session, the patient suddenly experienced convulsive seizures. The accompanying doctor administered intravenous propofol to stop the convulsion and terminated the HBOT. Soon after the convulsion, the patient developed frothy secretions through the endotracheal‐tube with impaired oxygenation. Head computed tomography scan showed no abnormalities, suggesting the seizure was associated with complications of HBOT. A chest X‐ray revealed bilateral pulmonary edema, and echocardiography revealed normal cardiac function, indicating that the pulmonary edema resulted from HBOT or neurogenic mechanism secondary to the seizure. The patient's respiratory status improved without recurrence of the seizure and no delayed neurological sequelae was seen afterwards. Here we report unexpected rare adverse events during HBOT. Hyperbaric oxygen therapy for acute indications should be performed in multiplace chambers, with appropriate preparation and medical equipment. J. Med. Invest. 65:286‐288, August, 2018

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  • Tadahiro Nozoe, Emiko Nozoe, Takefumi Ohga, Takahiro Ezaki, Katsuo Sue ...
    2018 Volume 65 Issue 3.4 Pages 289-291
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    An 85‐year old woman who had a large tumor in the left breast came to our out‐patient clinic. Computed tomography showed multiple lung tumors in addition to a huge tumor in the left breast. A needle biopsy brought about a histological diagnosis of ductal carcinoma. A simple mastectomy was performed and a histological examination using the resected specimen demonstrated a coexistence of an adenoid structure and a false ductal structure according the histologic characteristics of adenoid cystic carcinoma, which is quite rare among breast tumors. J. Med. Invest. 65:289‐291, August, 2018

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  • Mayumi Sugimoto, Akemi Ono, Keigo Yada, Hiroki Mori, Hiroki Ishibashi, ...
    2018 Volume 65 Issue 3.4 Pages 292-295
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    Natural rubber latex (NRL) allergy is one of the most important causes of severe anaphylaxis during medical intervention. We report a pediatric case of latex allergy with multiple surgical histories. A 12‐year‐old girl developed anaphylactic shock during the pyeloplasty for ureteropelvic junction restenosis. Latex gloves or medications used during the surgery were suspected to be the cause of anaphylactic shock. We diagnosed her latex allergy on the basis of the results that serum latex‐specific IgE, skin prick tests of extract from NRL gloves and recombinant Hev b 6.02 solution were positive. Basophil activation test of NRL gloves was also positive, supporting the diagnosis of immediate allergic reactions caused by NRL. It was speculated that a history of multiple surgeries in infancy became a trigger of sensitization to latex in this patient. Reoperation after the diagnosis of NRL allergy was carried out in a latex‐free environment and completed without any allergic symptoms. It would be necessary to perform the pre‐screening of latex allergy to prevent the onset of latex allergy especially in the patients with multiple surgical histories. J. Med. Invest. 65:292‐295, August, 2018

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  • Tetsuya Abe, Masahide Fukaya, Masato Nagino
    2018 Volume 65 Issue 3.4 Pages 296-298
    Published: 2018
    Released: October 04, 2018
    JOURNALS FREE ACCESS

    In patients with esophageal cancer, esophageal conduit necrosis is a catastrophic complication of esophagectomy that requires surgical restoration. Because such patients are generally fatigued, less‐invasive surgery is encouraged whenever possible. Therefore, we trim the sternum minimally above the healthy part of the gastric conduit, expose its surface, and then make anastomoses between the remnant esophagus and the exposed gastric conduit using a free jejunal graft through a retrosternal‐subcutaneous route. The risk involved with this procedure is low, because we avoid manipulation of the heavily inflamed lesion due to mediastinitis. J. Med. Invest. 65:296‐298, August, 2018

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