KEIO JOURNAL OF MEDICINE最新文献

{"title":"Clinical Features of Febrile Urinary Tract Infection Caused by Extended-spectrum Beta-lactamase-producing Escherichia Coli in Children.","authors":"Takuma Ohnishi, Yoshinori Mishima, Shohei Takizawa, Kentaro Tsutsumi, Atsuko Amemiya, Nao Akiyama, Yukiko Kanna, S. Asato, Mizue Tomita, M. Ikemiyagi, Nobuaki Shikoro, Maki Nakazawa, Nobuyoshi Kurihara, I. Kamimaki","doi":"10.2302/kjm.2019-0005-OA","DOIUrl":"https://doi.org/10.2302/kjm.2019-0005-OA","url":null,"abstract":"The global prevalence of infections caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli has been increasing. In children, ESBL-producing E. coli manifest mostly as febrile urinary tract infections (fUTIs). This study aimed to elucidate the clinical features of fUTI resulting from ESBL-producing E. coli in Japanese patients. The clinical features of children with E. coli-related fUTI were retrospectively examined. These children underwent treatment at the National Hospital Organization Saitama Hospital, Japan, between May 2010 and April 2018. Urine specimens were obtained by either bladder catheterization or the clean-catch method. All children having positive urine cultures (≥104 colony-forming unit/mL for catheter specimens and ≥105 colony forming unit/mL for clean-catch specimens) and a fever of ≥38°C were considered to have fUTI. During the study period, 171 patients were diagnosed with E. coli-related fUTI. Among these, 17 (9.9%) fUTI cases were caused by ESBL-producing E. coli. A significant difference was noted in the median age of the populations having ESBL-producing E. coli and non-ESBL-producing E. coli infections (2 and 5 months, respectively); other characteristics were not significantly different between the two patient groups. ESBL-producing E. coli infections markedly increased in our hospital between 2013 and 2018. In the present study, young age was the only risk factor for fUTI caused by ESBL-producing E. coli identified in Japanese children.","PeriodicalId":46245,"journal":{"name":"KEIO JOURNAL OF MEDICINE","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2020-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2302/kjm.2019-0005-OA","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46467692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organ Fabrication Using Pigs as An in Vivo Bioreactor.","authors":"E. Kobayashi, S. Tohyama, K. Fukuda","doi":"10.2302/kjm.2019-0006-OA","DOIUrl":"https://doi.org/10.2302/kjm.2019-0006-OA","url":null,"abstract":"We present the most recent research results on the creation of pigs that can accept human cells. Pigs in which grafted human cells can flourish are essential for studies of the production of human organs in the pig and for verification of the efficacy of cells and tissues of human origin for use in regenerative therapy. First, against the background of a worldwide shortage of donor organs, the need for future medical technology to produce human organs for transplantation is discussed. We then describe proof-of-concept studies in small animals used to produce human organs. An overview of the history of studies examining the induction of immune tolerance by techniques involving fertilized animal eggs and the injection of human cells into fetuses or neonatal animals is also presented. Finally, current and future prospects for producing pigs that can accept human cells and tissues for experimental purposes are discussed.","PeriodicalId":46245,"journal":{"name":"KEIO JOURNAL OF MEDICINE","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2020-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2302/kjm.2019-0006-OA","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46631085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19: Stay Cool toward Corticosteroids.","authors":"Seitaro Fujishima","doi":"10.2302/kjm.2020-0007-LE","DOIUrl":"https://doi.org/10.2302/kjm.2020-0007-LE","url":null,"abstract":"Due to the global COVID-19 pandemic, intensive care units and general wards are packed with infected patients whose conditions are often complicated by sepsis, acute respiratory failure, or acute respiratory distress syndrome (ARDS). Under the current circumstances, in which no established drugs are available, clinicians have been attempting to treat patients with a wide range of existing drugs, including low-to-high doses of corticosteroids, particularly for critically ill patients. Corticosteroid administration often lowers fever and decreases laboratory indices of inflammation; however, these short-term clinical improvements do not necessarily lead to improved long-term outcomes. Because corticosteroids produce a broad spectrum of anti-inflammatory and immunosuppressive effects,1,2 we should be cautious before initiating corticosteroid treatment, especially at a high dose, without the coadministration of antimicrobials for such acute infections. Over the past two decades, corticosteroids have been used to a significant extent to treat patients during epidemics of severe acute respiratory syndrome (SARS)coronavirus (CoV), Middle East respiratory syndrome (MERS)-CoV, and H1N1 influenza. In the initial phase of the SARS epidemic, even high-dose pulse therapy with methylprednisolone (≥500 mg/day) was suggested to be effective.3 However, the efficacy of corticosteroids remains unproven, and an increase in viral load was observed in SARS patients.4,5 With regard to acute respiratory failure or ARDS associated with H1N1 influenza, the efficacy of low-to-moderate dose corticosteroids in combination with oseltamivir was suggested in early reports,6,7 but later larger studies and systematic reviews showed either no efficacy or harmfulness for H1N1 infection and H1N1-associated ARDS.8–10 Corticosteroids were also administered to MERS-CoV patients, but its ineffectiveness and resultant delayed viral clearance were revealed in a recent large-scale multicenter study.11 There are conflicting results regarding COVID-19. A singlecenter retrospective study reported the possible efficacy of corticosteroids for COVID-19-associated ARDS by unadjusted Kaplan–Meier analysis.12 In contrast, another larger single-center cohort study suggested the harmfulness of high-dose corticosteroids by Cox proportional hazards analysis, although the definition of high dose was not clear.13 In a recently published systematic review of coronavirus infection, corticosteroid use was associated with higher mortality.14 COVID-19 infections are often associated with sepsis and ARDS, and the efficacy of corticosteroids for these critical conditions has been assessed by multiple randomized controlled trials. High-dose methylprednisolone treatments using either 30 mg/kg/6 h four times or an initial dose of 30 mg/kg followed by 5 mg/kg/h for 9 h were proven ineffective for both sepsis and ARDS.15–18 Although low-dose hydrocortisone is effective for the reversal of shock, its efficacy in impr","PeriodicalId":46245,"journal":{"name":"KEIO JOURNAL OF MEDICINE","volume":"69 2","pages":"27-29"},"PeriodicalIF":2.0,"publicationDate":"2020-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2302/kjm.2020-0007-LE","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37993561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous Tendon Needling without Ultrasonography for Lateral Epicondylitis.","authors":"Taku Suzuki,&nbsp;Takuji Iwamoto,&nbsp;Noboru Matsumura,&nbsp;Masaya Nakamura,&nbsp;Morio Matsumoto,&nbsp;Kazuki Sato","doi":"10.2302/kjm.2019-0004-OA","DOIUrl":"https://doi.org/10.2302/kjm.2019-0004-OA","url":null,"abstract":"<p><p>Percutaneous ultrasonic tendon needling has been used to treat persistent lateral epicondylitis, and its efficacy has been demonstrated. However, whether ultrasonography is necessary remains unclear. The purpose of this retrospective study was to evaluate the efficacy of percutaneous tendon needling without ultrasonography for lateral epicondylitis. A total of 36 patients who underwent tendon needling without ultrasonography for lateral epicondylitis were retrospectively included in the study. The tendinotic lesion was needled by fenestration approximately 20-30 times without sonographic assistance. The Visual Analogue Scale (VAS) pain score, the grip strength, and success rates were assessed at baseline and at 1, 3, 6, and 12 months after treatment. The Nirschl tennis elbow score was evaluated at baseline and at 6 and 12 months after the needling procedure. The mean VAS pain score and grip strength at 3, 6, and 12 months significantly improved compared to the baseline values. At 6 and 12 months, the success rates had significantly increased compared to the rates at 1 month. The mean Nirschl scores at 6 and 12 months were significantly better than the baseline value. No severe complications were observed during the study period. Percutaneous tendon needling without ultrasonography is a simple and safe technique. The procedure is effective for lateral epicondylitis that is unresponsive to conventional conservative treatments.</p>","PeriodicalId":46245,"journal":{"name":"KEIO JOURNAL OF MEDICINE","volume":"69 2","pages":"37-42"},"PeriodicalIF":2.0,"publicationDate":"2020-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2302/kjm.2019-0004-OA","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37402372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical Parameters, Use of Specific Medical Treatments, Nursing Levels, and Activities of Daily Living Are Potential Indicators for Forgoing Maintenance Hemodialysis.","authors":"Nobuko Yamaguchi,&nbsp;Tadashi Yoshida,&nbsp;Miho Oba,&nbsp;Reiko Nakano,&nbsp;Miwa Saito,&nbsp;Mihoko Hirokawa,&nbsp;Tazuru Shinmi,&nbsp;Chisa Urasawa,&nbsp;Mototsugu Oya","doi":"10.2302/kjm.2019-0001-OA","DOIUrl":"https://doi.org/10.2302/kjm.2019-0001-OA","url":null,"abstract":"<p><p>Maintenance hemodialysis (HD) therapy is essential for survival in patients with end-stage renal disease (ESRD); however, HD can also be life-threatening in the final stages of ESRD. Currently, no clear indicators and/or biomarkers exist regarding when HD should be forgone. In the present study, we examined temporal changes in multiple clinical parameters, including biochemical data, physical data, the use of specific medical treatments, nursing care levels, and the activities of daily living (ADL) in 47 ESRD patients who underwent maintenance HD and who died in our hospital. We also investigated the status of informed consents regarding the forgoing of HD in these patients. We found that while biochemical parameters were unaltered, physical parameters such as consciousness levels and blood pressure gradually deteriorated during hospitalization. The use of the following specific medical treatments significantly increased over time: vasopressor use, O₂ inhalation, and ventilator use. The need for nursing care increased and the ADL levels decreased toward the time of death. Medical doctors gave information regarding forgoing HD to patients and/or their family/relatives in 55% of cases, obtained agreement to forego HD in 45% of cases, and HD was actually foregone in 38% of cases. Most clinical parameters were not significantly different between the patients whose HD sessions were forgone versus those in whom HD was continued, indicating that HD was foregone in the very last stages of life. The results suggest that physical parameters, the use of specific medical treatments, the levels of nursing care, and ADL are potential indicators for forgoing HD in the final stages of ESRD.</p>","PeriodicalId":46245,"journal":{"name":"KEIO JOURNAL OF MEDICINE","volume":"69 1","pages":"16-25"},"PeriodicalIF":2.0,"publicationDate":"2020-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2302/kjm.2019-0001-OA","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37386274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Casting Light on Life.","authors":"Atsushi Miyawaki","doi":"10.2302/kjm.69-001-ABST","DOIUrl":"https://doi.org/10.2302/kjm.69-001-ABST","url":null,"abstract":"<p><p>The behavior of biochemical molecules moving around in cells makes me think of a school of whales wandering in the ocean, captured by the Argus system on the artificial satellite. When bringing a whale back into the sea --- with a transmitter on its dorsal fin, every staff member hopes that it will return safely to a school of its species. A transmitter is now minute in size, but it was not this way before. There used to be some concern that a whale fitted with a transmitter could be given the cold shoulder and thus ostracized by other whales for \"wearing something annoying.\" How is whale's wandering related to the tide or a shoal of small fish? What kind of interaction is there among different species of whales? We human beings have attempted to fully understand this fellow creature in the sea both during and since the age of whale fishing.In a live cell imaging experiment, a luminescent probe replaces a transmitter. We put a luminescent probe on a specific region of a biological molecule and bring it back into a cell. We can then visualize how the molecule behaves in response to external stimulation. Since luminescence is a physical phenomenon, we can extract various kinds of information by making full use of its characteristics.Cruising inside cells in a supermicro corps, gliding down in a microtubule like a roller coaster, pushing our ways through a jungle of chromatin while hoisting a flag of nuclear localization signal --- we are reminded to retain a playful and adventurous perspective at all times. What matters is mobilizing all capabilities of science and giving full play to our imagination. We believe that such serendipitous findings can arise out of such a sportive mind, a frame of mind that prevails when enjoying whale-watching.</p>","PeriodicalId":46245,"journal":{"name":"KEIO JOURNAL OF MEDICINE","volume":"69 4","pages":"105"},"PeriodicalIF":2.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38774738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cell Atlases as Roadmaps in Health and Disease.","authors":"Aviv Regev","doi":"10.2302/kjm.69-002-ABST","DOIUrl":"https://doi.org/10.2302/kjm.69-002-ABST","url":null,"abstract":"<p><p>The recent advent of methods for high-throughput single-cell and spatial profiling have opened the way to complete the 150-year-old endeavor of identifying all cell types in the human body, by their distinctive molecular profiles, and to relate this information to other cellular descriptions, physiological phenotypes, molecular mechanisms and functions. Our effort to build a comprehensive reference map of the molecular state of cells in healthy human tissues is propelling the systematic study of physiological states, developmental trajectories, regulatory circuitry and interactions of cells, provides a framework for understanding cellular dysregulation in human disease, and suggests the possibility of predicting cell types and behaviors, towards a \"periodic table of our cells\". In this talk, I describe our foundational work underlying single cell genomics and the conceptual framework and impact of our understanding of cell and tissue biology in health, as well as how we use it to shed light on rare disease, cancer, and COVID-19.</p>","PeriodicalId":46245,"journal":{"name":"KEIO JOURNAL OF MEDICINE","volume":"69 4","pages":"105"},"PeriodicalIF":2.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38774736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence, Clinical Characteristics, and Long-term Outcome of the Dilated Phase of Hypertrophic Cardiomyopathy.","authors":"Yoshiyasu Aizawa,&nbsp;Yoko Tanimoto,&nbsp;Yoshiko Hirata,&nbsp;Taishi Fujisawa,&nbsp;Ryoma Fukuoka,&nbsp;Kazuaki Nakajima,&nbsp;Yoshinori Katsumata,&nbsp;Takahiko Nishiyama,&nbsp;Takehiro Kimura,&nbsp;Shinsuke Yuasa,&nbsp;Takashi Kohno,&nbsp;Shun Kohsaka,&nbsp;Mitsushige Murata,&nbsp;Yuichiro Maekawa,&nbsp;Yoshiko Furukawa,&nbsp;Seiji Takatsuki,&nbsp;Keiichi Fukuda","doi":"10.2302/kjm.2018-0004-OA","DOIUrl":"https://doi.org/10.2302/kjm.2018-0004-OA","url":null,"abstract":"<p><p>Some patients with hypertrophic cardiomyopathy (HCM) develop systolic dysfunction, called the dilated phase of HCM (d-HCM), which is associated with increased morbidity and mortality. We conducted a retrospective study using an HCM database to clarify the incidence, clinical characteristics, and long-term outcomes of d-HCM. We analyzed an HCM cohort consisting of 434 patients (273 with apical HCM and 161 with non-apical HCM; 18 had obstructive HCM, 16 had dilated HCM, and 127 had other HCM) diagnosed by echocardiography in our hospital between 1991 and 2010. The follow-up period was 8.4 ± 6.7 years. The mean age at final follow-up was 67 ± 14 years, and 304 patients (70%) were men. The mean age of the 16 d-HCM patients at the initial visit was 45 ± 17 years, the age at final follow-up was 59 ± 18 years, and 13 were men. Thirteen d-HCM patients developed atrial fibrillation and six patients developed ischemic stroke. Twelve d-HCM patients were implanted with cardiac devices: one pacemaker, nine implantable cardioverter-defibrillators, and two cardiac resynchronization therapy with defibrillator. Five patients died of progressive heart failure at the age of 61 ± 23 years. The age at the initial visit and final follow-up were lower and the NYHA class, brain natriuretic peptide levels, and left ventricular function at initial evaluation were worse in the d-HCM group. Univariate analysis demonstrated that a lower age at the initial visit was associated with d-HCM (hazard ratio 0.955/1 year increase; 95% CI 0.920-0.991, P = 0.015). In our HCM cohort, the incidence of d-HCM was 4%. A high prevalence of atrial fibrillation and cerebral infarction and poor prognosis were noted in this group, despite patients undergoing medication and device implantation.</p>","PeriodicalId":46245,"journal":{"name":"KEIO JOURNAL OF MEDICINE","volume":"68 4","pages":"87-94"},"PeriodicalIF":2.0,"publicationDate":"2019-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2302/kjm.2018-0004-OA","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36831825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selected Topics Relating to Functional MRI Study of the Brain.","authors":"Seiji Ogawa,&nbsp;Yul-Wan Sung","doi":"10.2302/kjm.2018-0011-OA","DOIUrl":"https://doi.org/10.2302/kjm.2018-0011-OA","url":null,"abstract":"<p><p>The authors selected some interesting current topics among many in the field of functional MRI (fMRI) of the brain. The selection was based on authours' immediate interests in exploring these aspects further; the topics are presented and discussed along with their perspectives. If progress can be made in these areas, it would be very advantageous to the field of brain research. The topics are (I) Detectable MRI signals in response to functional activity of the brain, including the current status of neurocurrent MRI; (II) Vascular-dependent and vascular-independent MRI signals, leading to the distinction of functional and structural MRI; (III) Functional specificity and functional connectivity of local sites, including differences between task-fMRI and resting state fMRI; (IV) Functional networks: an example of application to assessing the vocational aptitude test by fMRI; (V) Neural oscillation relevant to the formation of fMRI signals and of networks; (VI) Upgrading fMRI to \"information-content-reflecting\" fMRI, discussed as one of the prospects of near-future fMRI.</p>","PeriodicalId":46245,"journal":{"name":"KEIO JOURNAL OF MEDICINE","volume":"68 4","pages":"73-86"},"PeriodicalIF":2.0,"publicationDate":"2019-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2302/kjm.2018-0011-OA","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37141043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rivaroxaban Promotes Reduction of Embolus Size within Cerebrocortical Microvessels in a Mouse Model of Embolic Stroke.","authors":"Masahiro Katsumata,&nbsp;Koichi Oki,&nbsp;Naoki Tsukada,&nbsp;Takato Abe,&nbsp;Yoshiaki Itoh,&nbsp;Shinichi Takahashi,&nbsp;Norihiro Suzuki","doi":"10.2302/kjm.2018-0010-OA","DOIUrl":"https://doi.org/10.2302/kjm.2018-0010-OA","url":null,"abstract":"<p><p>Previous reports have suggested that direct oral anticoagulants exert a prothrombolytic effect against intracardiac thrombi. We hypothesized that these anticoagulants may also help recanalize occluded intracranial arteries via prothrombolytic effects. In this study, we evaluated the effects of rivaroxaban, a direct oral anticoagulant, on fibrin emboli within the cerebrocortical microvessels in a mouse model of embolic stroke. Fibrin emboli prepared ex vivo were injected into the common carotid artery of male C57BL/6 mice, and embolization in the microvessels on the brain surface was observed through a cranial window. Oral administration of rivaroxaban was initiated a week before injection of the emboli. The number and sizes of the emboli were measured at two time points: immediately after and 3 h after the embolus injection in the rivaroxaban-treated mice (n =6) and untreated mice (n =7). The rates of recanalization and change in the embolus size were analyzed between the two groups. Complete recanalization was observed only in the rivaroxaban group (three mice in the rivaroxaban group compared with none in the control group). A significantly higher rate of reduction of the embolus size was observed in the rivaroxaban group than in the control group (P=0.0216). No significant differences between the two groups were observed in the serum levels of the following coagulation markers: thrombin-antithrombin III complexes, D-dimers, or plasmin-α2-plasmin inhibitor complex. Our findings indicate that rivaroxaban may promote reduction in the size of stagnated fibrin emboli in cerebrocortical microvessels in cases of embolic stroke.</p>","PeriodicalId":46245,"journal":{"name":"KEIO JOURNAL OF MEDICINE","volume":"68 3","pages":"45-53"},"PeriodicalIF":2.0,"publicationDate":"2019-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2302/kjm.2018-0010-OA","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36741317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}