It is known that infants born to mothers with hyperglycemic disorders in pregnancy have a high risk of complications such as macrosomia, neonatal hypoglycemia, and hyperbilirubinemia. Strict treatments such as dietary andinsulin therapy are necessary to prevent these complications.We retrospectively examined 374 infants born to mothers with hyperglycemic disorders in pregnancy whowere treated with dietary and insulin therapy at our hospital over a six-year period from 2014 to 2019. First, thecomplications in the infants included preterm birth in 73 cases (19%), neonatal hypoglycemia in 115 cases (31%),hyperbilirubinemia in 59 cases (16%), and respiratory disorders in 56 cases (15%), as there was a high incidenceof neonatal hypoglycemia. Second, we conducted a univariate analysis to determine the association between theoccurrence of complications (neonatal hypoglycemia, hyperbilirubinemia, and respiratory disorders) in infantsborn to mothers with hyperglycemic disorders and 12 clinical factors. Third, we conducted a multivariate analysisusing each complication as the dependent variable and identified significant factors as independent variables. Wefound that the independent clinical factors associated with neonatal hypoglycemia were mothers’ body mass indexbefore pregnancy, the use of ritodrine hydrochloride during pregnancy, gestational age, and infants with small forgestational age (SGA); those associated with hyperbilirubinemia were gestational age and infants with SGA; andthose associated with respiratory disorders were gestational age.Our study demonstrates that gestational age plays a role in complications observed in infants born to motherswith hyperglycemic disorders in pregnancy who were strictly treated, such as dietary and insulin therapy, ratherthan glycated albumin and glycosylated hemoglobin levels.

The cranium of neonates and infants grows soft and large. During this process, the cranium undergoes a multifaceted deformation under the influence of physical pressure and gravity. This deformed cranial shape is calledpositional plagiocephaly and is distinguished from craniosynostosis. In recent years, the number of infants withpositional plagiocephaly has increased due to the recommendation of “back to sleep” to prevent sudden infantdeath syndrome. Our department has established an outpatient clinic for cranial deformity and has been conducting research and treatment of cranial deformity in neonates and infants. We clarified that the prevalence ofpositional plagiocephaly in healthy infants at 1 month of age is approximately 65% and that severe cases exist inapproximately 7% of these infants. Furthermore, 66% of those with severe positional plagiocephaly did not improve after 3 months of natural history. This result suggests the need for appropriate therapeutic intervention. Inaddition, it was possible to predict the severity of cranial deformity at 6 months of age at the severity of cranialdeformity at 1 month of age. The differences in severity at approximately 1 month of age were related to the subsequent natural course. This is a major challenge for neonatologists and pediatricians in the future.

The aim of this study was to compare the clinical significance of procalcitonin and presepsin levels in associationwith different bacterial species or cultures in sepsis cases that meet the Sepsis-3 criteria.Methods: We conducted a 2-year observational study of sepsis patients found to meet the Sepsis-3 criteria. Theparameters examined included age, the infection focus, the initial blood procalcitonin and presepsin levels, andthe SOFA score. The patients were divided into several groups based on bacterial cultures from blood specimensand fluid and tissue specimens taken from the infected sites.Results: Finally, 132 sepsis patients were investigated in the study period. The patients had a mean age of 73.3, amean SOFA score of 8.9, and mean blood procalcitonin and presepsin levels of 35.6 ng/ml and 1319.6 pg/ml,respectively. The patients were divided into a culture/positive group (n = 108) and a culture/negative group (n =24) based on the bacterial specimen cultures. The culture/positive group, which included duplicate cases, wasfurther divided into a blood/positive group (n = 63) and a local infection group (n = 86). No significant differencesin the SOFA score were observed among the culture groups. Blood procalcitonin was significantly lower in theculture/negative (p < 0.0001) and blood/negative groups (p < 0.0152). The blood presepsin level, however, didnot significantly differ between those groups.Conclusions: The blood procalcitonin levels in sepsis patients diagnosed according to the Sepsis-3 criteria maybe lower when the bacterial specimen cultures are negative. In such patients, reliance on procalcitonin alone forclinical guidance may lead to an underestimation of sepsis severity.

We retrospectively analyzed 72 patients with PitNETs who underwent transsphenoidal surgery at our hospitalfrom April 2015 to March 2023 to identify factors that prolong postoperative hospital stays. The median age of thepatients was 52.0 years, and the sex ratio was 1:1. The cases consisted of 47 primary nonfunctioning PitNETs, 11recurrent nonfunctioning PitNETs, and 14 primary functional PitNETs. The median operative time was 148.0 minutes, the median preoperative tumor length was 25.0 mm, and the median Knosp grade was 3. Eighteen patientshad pituitary apoplexy (including subclinical pituitary apoplexy), and 10 patients received preoperative hormonalreplacement therapy. Cerebrospinal fluid leakage was noted intraoperatively in 28 patients, and total extracapsularresection was performed in 19 patients. There were 2 cases of postoperative cerebrospinal fluid leakage (requiringsurgical treatment), 1 case of residual intratumoral hemorrhage, and 1 case of reoperation due to poor resectionwithin the same hospitalization period. Two cases of meningitis and 5 cases of SIADH occurred on postoperative days 3–4 and 6–7, respectively, and treatment was terminated in both cases on postoperative days 9–11.Twenty-two patients received continuous hormone replacement therapy after the surgery. In addition to PitNET,diseases requiring treatment during hospitalization included oculomotor nerve palsy, cerebral infarction, pneumonia, and liver dysfunction. When we analyzed the correlation between these items and the length of postoperativehospital stay (median value 12.0 days), we found that age was significantly associated with a longer postoperativehospital stay ( p < 0.01). Furthermore, multiple surgeries within the same hospitalization ( p < 0.01) and having adisease requiring treatment other than PitNET (p < 0.01) were significantly associated with a prolonged postoperative hospital stay. These results suggest that PitNET patients who are not elderly and have no additional diseasesrequiring treatment may be allowed to leave the hospital by postoperative day 11 if postoperative complicationsrequiring reoperation do not occur.

Background: Glutamate is a fundamental neurotransmitter in the brain, and the gliotransmitter adenosine triphosphate (ATP) acts as a paracrine signal to communicate with the surrounding astrocytes, synapses, and microglia.The present study investigated the relationship between glutamate and ATP signaling in the extracellular spaceafter traumatic brain injury.Material and Methods: Rat stab wound injury models were used to measure the changes in ATP and glutamateconcentrations (ΔGlutamate and ΔATP) in the extracellular space using biosensors. The cellular responses wereevaluated by histopathological staining and Western blotting of glial fibrillary acidic protein (GFAP) as an astrocytic marker and CD11b as a microglial marker. Neuronal cell death was assessed by Fluoro-Jade C staining.Results: ATP and glutamate were released into the extracellular space after injury. ATP and glutamate levelspeaked within 1 second. Apyrase and tetrodotoxin are inhibitors of glia and neurons, respectively. The apyrase andtetrodotoxin groups showed significantly decreased ΔATP and Δglutamate compared to the control group. On theother hand, the apyrase and tetrodotoxin groups showed no significant difference between groups. Furthermore,Western blotting showed that GFAP and CD11b significantly decreased in the apyrase group compared to the control group on days 3, 7, and 28. The apyrase and tetrodotoxin groups suffered significantly decreased neuronal celldeath compared to the control group.Conclusion: This study indicated that apyrase decreased glutamate changes in the extracellular space and reducedneuronal cell death by suppressing ATP signaling. Knowledge of these interactions

A 37-year-old woman was referred to our hospital because of suspicion of a pituitary tumor based on an MRIperformed to investigate the cause of hypertension. A blood test revealed high levels of adrenocorticotropic hormone (ACTH) and cortisol, 70.6 pg/ml (normal range: 7.2–63.3 pg/ml) and 26.5 µg/dl (normal range: 7.0–19.6µg/dl), respectively. In addition, she was suffering from central obesity. All results of the endocrine loading testsperformed met the diagnostic criteria for Cushing’s disease. However, sinus venous sampling, which was performed to confirm the diagnosis, showed no difference in central and peripheral ACTH levels, a finding inconsistent with Cushing’s disease. Since no lesions were found in organs other than the pituitary gland, she underwenttranssphenoidal surgery. A neoplastic lesion was found during the surgery, the tumor was removed, and a diagnosis of a PitNET was made histopathologically. Postoperatively, ACTH and cortisol levels normalized. In this case,a definitive diagnosis of Cushing’s disease was obtained through the surgery, and the result of venous sampling ofACTH was judged to be false negative. False-negative results with venous sampling of ACTH are very rare, but itis important to understand that it is possible.