{"title":"<Editors' Choice> Thoracic endovascular aortic repair and spinal cord injury.","authors":"Hiroshi Banno, Changi Lee, Shuta Ikeda, Yohei Kawai, Masayuki Sugimoto, Kiyoaki Niimi","doi":"10.18999/nagjms.86.1.16","DOIUrl":"https://doi.org/10.18999/nagjms.86.1.16","url":null,"abstract":"<p><p>We previously reported that spinal cord injury following thoracic endovascular aortic repair for a thoracic aortic aneurysm is a micro embolism caused by a vulnerable mural thrombus. Conversely, patients who underwent thoracic endovascular aortic repair for aortic dissection develop spinal cord injury less frequently due to fewer mural thrombi. Paying attention to preserving blood flow toward the spinal cord, namely collateral circulation and steal phenomenon, prevents spinal cord injury following thoracic endovascular aortic repair for aortic dissection.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"86 1","pages":"16-23"},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10945219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Congenital cytomegalovirus infection in a preterm infant with 22q11.2 deletion syndrome and immunological abnormalities.","authors":"Yoshihiko Shitara, Etsushi Toyofuku, Hideki Doi, Takeo Mukai, Kohei Kashima, Satsuki Kakiuchi, Motohiro Kato, Naoto Takahashi","doi":"10.18999/nagjms.86.1.149","DOIUrl":"https://doi.org/10.18999/nagjms.86.1.149","url":null,"abstract":"<p><p>The 22q11.2 deletion syndrome has many complications; one of them is immunodeficiency. However, the time of onset and the degree of immunodeficiency can vary. We report a case of a preterm infant with congenital cytomegalovirus infection complicated with 22q11.2 deletion syndrome and immunological abnormalities. Ultrasonography revealed pulmonary atresia, ventricular septal defect, major aortopulmonary collateral artery, and thymic hypoplasia. His serum chemistry tests on admission revealed immunoglobulin G, A, and M levels of 1,547 mg/dL, 70 mg/dL, and 274 mg/dL, respectively. A surface antigen analysis of the peripheral lymphocytes using flow cytometry revealed the following: relatively low CD4-positive T-cell levels (18.1%; 1,767/μL), very high CD8-positive T-cell levels (58.9%; 5,751/μL), and CD4/CD8 ratio of 0.31. The level of T-cell receptor excision circles was relatively low at 17.5 copies/μL. After birth, the CD8-positive T-cell level began to gradually decrease, whereas the CD4/CD8 ratio began to increase. Thrombocytopenia, neutropenia, and skin petechiae were observed on admission. However, the condition improved. Treatment for congenital cytomegalovirus infection was not provided due to the absence of viremia. Unfortunately, the patient died suddenly on the 158<sup>th</sup> day of life, and the cause of death was unknown. To the best of our knowledge, no association between 22q11 deletion syndrome and cCMV has been described in the recent medical literature. According to the calculation, around one newborn infant who have both 22q11 deletion syndrome and cCMV infection will be born each year in Japan. Healthcare providers should pay more attention to this medical situation in the future.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"86 1","pages":"149-154"},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10945221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Long-term results of orbicularis oris muscle reconstruction in primary cleft lip repair using the \"basket-weave method\".","authors":"Masahiro Sasaki, Shinji Togashi, Yukiko Aihara, Kaoru Sasaki, Yoichiro Shibuya, Junya Oshima, Mitsuru Sekido","doi":"10.18999/nagjms.86.1.64","DOIUrl":"https://doi.org/10.18999/nagjms.86.1.64","url":null,"abstract":"<p><p>The basket-weave method is an orbicularis oris muscle reconstruction method used in primary unilateral cleft lip repair. We compared the long-term results of the basket-weave method with those of a conventional method. For primary unilateral cleft lip repair, we compared the long-term results of 7 cases in which the orbicularis oris muscle was reconstructed by use of the basket-weave method, and of 7 cases in which the reconstruction was performed by use of the conventional method. The average postoperative follow-up period was 12 years and 7 months for the basket-weave method, and 11 years and 9 months for the conventional method. Using photographs of the front and elevation angle views, we evaluated the results as good if the philtrum ridge was formed on the fissure side and was almost symmetrical in height; as fair if the philtrum ridge was lower than the normal side; and as poor if the philtrum ridge had disappeared. For the basket-weave method, the results were good in 6 cases (85.7%), fair in 1 case (14.3%), and poor in 0 cases. For the conventional method, the results were good in 2 cases (28.6%), fair in 4 cases (57.1%), and poor in 1 case (14.3%). A significant difference was found between the 2 groups (Mann-Whitney U test, P = 0.0417). The philtrum ridge shape could be reconstructed by use of the basket-weave method, which gave better results in the long-term than did the conventional method for orbicularis oris muscle reconstruction in primary unilateral cleft lip repair.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"86 1","pages":"64-71"},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10945217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Potential arrhythmic substrate of atrial fibrillation at the left atrial diverticulum.","authors":"Takehiko Takayanagi","doi":"10.18999/nagjms.86.1.142","DOIUrl":"https://doi.org/10.18999/nagjms.86.1.142","url":null,"abstract":"<p><p>Catheter ablation therapy for persistent atrial fibrillation (PeAF) is both difficult and has limited outcomes. The mechanisms underlying the development and persistence of atrial fibrillation (AF) are not fully understood; therefore, ablation strategies are diverse. A 45-year-old man was referred to our hospital for persistent atrial fibrillation to undergo radiofrequency catheter insertion (RFCA). In the first session we conducted pulmonary vein isolation and additional linear ablation, including that of the roof line and posterior inferior line (posterior box lesion) as the stepwise ablation. However, AF was recurred in six months, therefore he was readmitted for second session ablation preoperative 3D computed tomography (CT) scan for drug-refractory PeAF was performed. The additional isolation of the left superior pulmonary vein and potential drivers of AF by mapping wavefront propagation using multipolar catheters by CARTOFINDER (Biosense Webster, Inc, Diamond Bar, CA, USA) was conducted. However, AF did not terminate. Tomography revealed that the left atrial (LA) diverticulum (LAD) was found uniquely. Electrophysiological findings showed focal firing of the myocardial sleeve and LA diverticulum by an approach for defragmented potentials by re-visiting in interval confidence level (ICL) mode included in the electroanatomical mapping system (CARTO 3, Biosense Webster, Inc, Diamond Bar, CA, USA) and the ablation by encircling this site finally made AF terminate. The AF has not recurred for more than 12 months without the use of antiarrhythmic drugs. This case report suggests that additional ablation around substrates in LAD may be effective for treating refractory AF.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"86 1","pages":"142-148"},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10945233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Protocol of a phase II study investigating the efficacy and safety of trifluridine/tipiracil plus ramucirumab as a third-line or later treatment for advanced gastric cancer.","authors":"Koki Nakanishi, Chie Tanaka, Mitsuro Kanda, Kazushi Miyata, Nozomu Machida, Mitsuru Sakai, Daisuke Kobayashi, Hitoshi Teramoto, Akiharu Ishiyama, Bin Sato, Takashi Oshima, Masaki Kajikawa, Hidenobu Matsushita, Kiyoshi Ishigure, Katsuya Yamashita, Shinichi Fujitake, Satoshi Sueoka, Takahiro Asada, Dai Shimizu, Shizuki Sugita, Yachiyo Kuwatsuka, Osamu Maeda, Satoshi Furune, Kenta Murotani, Yuichi Ando, Tomoki Ebata, Yasuhiro Kodera","doi":"10.18999/nagjms.86.1.43","DOIUrl":"https://doi.org/10.18999/nagjms.86.1.43","url":null,"abstract":"<p><p>In Japan, systemic chemotherapy is the standard treatment for unresectable, advanced, or recurrent gastric cancer. However, numerous patients with gastric cancer do not receive late-line treatment because of the rapid progression of gastric cancer. Additionally, late-line treatments, such as nivolumab, trifluridine tipiracil (FTD/TPI), or irinotecan, have limited effects on improving clinical symptoms and delaying the onset of symptoms associated with cancer progression. Recently, a combination of FTD/TPI and ramucirumab was reported to have a high response rate in late-line treatment; however, owing to patient selection bias and a high rate of hematologic toxicity in that previous study, this regimen may not be feasible in real-world clinical applications. Our objective is to conduct a single-arm phase II study to assess the safety and efficacy of FTD/TPI plus ramucirumab combination therapy for gastric cancer after third-line treatment under real-world clinical conditions. This study will recruit 32 patients according to eligibility criteria and administer FTD/TPI (35 mg/m<sup>2</sup>) and intravenous ramucirumab (8 mg/kg). The primary endpoint will be the time to treatment failure. The secondary endpoints will include the overall survival time, progression-free survival time, overall response rate, disease control rate, relative dose intensity, and incidence of adverse events. The results will add new insights for improving the late-line treatment of advanced gastric cancer.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"86 1","pages":"43-51"},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10945229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Safety of antiplatelet therapy during the perioperative period of revascularization surgery for moyamoya disease patients with ischemic onset.","authors":"Akihiro Nakamura, Syuntaro Takasu, Yukio Seki, Ryuta Saito","doi":"10.18999/nagjms.86.1.82","DOIUrl":"https://doi.org/10.18999/nagjms.86.1.82","url":null,"abstract":"<p><p>For patients with moyamoya disease, antiplatelet agents are often used during the perioperative periods of revascularization surgeries to prevent ischemic events. However, antiplatelet therapy is associated with the risk of hemorrhagic complications. Further, the influence of antiplatelet therapy on perioperative ischemic or hemorrhagic complications has not been investigated. This study aimed to determine the impact of antiplatelet agents on adult moyamoya disease patients with ischemic onset during the perioperative period. From January 2016 to December 2020, 183 consecutive combined (direct and indirect) revascularization surgeries for moyamoya disease patients were performed. Among these surgeries, 96 consecutive combined revascularization surgeries for adult moyamoya disease patients with ischemic onset were analyzed and perioperative ischemic and hemorrhagic complications were reviewed. Antiplatelet agents were continued during the perioperative period including on the day of surgery and the day after the surgery. Among 96 surgeries, no hemorrhagic complications occurred postoperatively. Infarction occurred in five cases (5.2%). Among the five cases, neurological deficits persisted in two cases and improved in three. The median value of bleeding volume was 112.5 mL (interquartile range, 80.0 - 200.0). Twenty-five cases (26.0%) needed blood transfusion. The modified Rankin Scale score deteriorated in two cases due to cerebral infarction. The incidence of hemorrhagic and ischemic complications after combined revascularization surgery in patients with ischemic moyamoya disease under antiplatelet therapy was low, indicating the safety of continued antiplatelet therapy.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"86 1","pages":"82-90"},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10945227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Nursing-care for family caregivers of terminally ill cancer patients to enhance preparedness for death.","authors":"Akiko Unesoko, Naoki Ozawa, Ayumi Sugimura, Kazuki Sato, Shoko Ando","doi":"10.18999/nagjms.86.1.121","DOIUrl":"https://doi.org/10.18999/nagjms.86.1.121","url":null,"abstract":"<p><p>Family caregivers of terminally ill cancer patients prepare for a patient's death. Nursing-care for preparedness is effective for their psychological health. This study aims to structuralize nursing-care for preparedness and extract related factors while presenting the implications for improved quality of care. Data from a cross-sectional survey of general ward and palliative care unit nurses in designated cancer care hospitals (n=561) was analyzed with exploratory factor analysis and multiple regression analyses. The results of the analysis, the structure was classified into \"Nurse-centered support\" and \"Support through inter-professional work.\" Both supports were practiced significantly more frequently in palliative care units than general wards. Related factors in general wards were; communication skills, cooperation with doctors, the existence of certified nurse/certified nurse specialists as consultants, attitudes toward care of the dying, frequency of death conferences, and cooperation with specialist cancer counselors. Therefore, the results can help improve the quality of family care in palliative care, especially in general wards.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"86 1","pages":"121-134"},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10945228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The gonio scratch study: methodology of a multicenter clinical trial establishing a new minimally invasive glaucoma surgery.","authors":"Kana Tokumo, Naoki Okada, Tsukasa Mochizuki, Hiromitsu Onoe, Kaori Komatsu, Hideaki Okumichi, Kazuyuki Hirooka, Hideki Mochizuki, Mitsunobu Yokoyama, Yoshiaki Kiuchi","doi":"10.18999/nagjms.86.1.36","DOIUrl":"https://doi.org/10.18999/nagjms.86.1.36","url":null,"abstract":"<p><p>There are numerous surgical procedures for glaucoma. Minimally invasive glaucoma surgery is becoming popular; however, the disadvantage is the high incidence of anterior chamber hemorrhage. Heavy bleeding can also lead to increased intraocular pressure (IOP) postoperatively. Gonio scratch is a surgical procedure that improves aqueous humor outflow by rubbing off deposits on the trabecular meshwork with a Diamond Dusted Sweeper. As the conjunctiva and trabecular meshwork are not incised, no postoperative bleeding is expected, and the IOP spike will be minimal. We designed this study to determine the efficacy and safety of gonio scratch. This is an on-going multicenter, prospective, clinical trial. Patients who are scheduled for glaucoma surgery with or without cataract surgery are being enrolled. A total of 80 eyes will be recruited in the Hiroshima University Hospital, Miyoshi Eye Clinic, Yokoyama Retina Clinic, and Kusatsu Eye Clinic. All patients will undergo gonio scratch. When combined with cataract surgery, gonio scratch is performed after the intraocular lens is inserted. The primary study endpoint is the change in IOP from baseline to 1 year after surgery. The secondary endpoints are complications, number of glaucoma medications, surgical time, and changes in visual acuity and the visual field. This study protocol was approved by the institutional review board of Hiroshima University. The trial results will be shared with the scientific community at international conferences and by publication in a peer-reviewed journal. Trial registration number is jRCTs062200003.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"86 1","pages":"36-42"},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10945225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Diseases categorized as autoinflammatory keratinization diseases (AiKDs), and their pathologies and treatments.","authors":"Masashi Akiyama","doi":"10.18999/nagjms.86.1.1","DOIUrl":"https://doi.org/10.18999/nagjms.86.1.1","url":null,"abstract":"<p><p>Whole-exome and whole-genome sequencing have become widespread in approximately the last 15 years, and the predisposing factors and pathomechanisms of inflammatory keratinization diseases, which have been unknown for a long time, have gradually been revealed. Hence, various inflammatory keratinization diseases are recognized to cause innate immunity hyperactivation. Therefore, we have been advocating for the clinical entity, \"autoinflammatory keratinization diseases (AiKDs)\" since 2017. AiKDs are inflammatory keratinization diseases caused by autoinflammatory-related pathomechanisms in the skin. The aberrant activation of innate immunity and the resultant autoinflammation in the epidermis and the superficial dermis in AiKDs cause hyperkeratosis in the epidermis. Our initially proposed concept of AiKDs included generalized pustular psoriasis and related conditions, pityriasis rubra pilaris type V, and familial keratosis lichenoides chronica. Since then, the number of diseases known to be AiKDs has increased as previously unknown disease-causing factors and pathogenetic mechanisms of inflammatory keratinization diseases have been clarified one by one. To date, porokeratosis, hidradenitis suppurative, keratosis linearis with ichthyosis congenita and sclerosing keratoderma (KLICK) syndrome, and AiKDs associated with epidermal growth factor receptor (EGFR) deficiency or with hepatitis and autism have been recognized as AiKDs. The concept of AiKDs is considered extremely useful in our precise understanding of the pathogeneses behind inflammatory keratinization diseases and our appropriate treatment method selection. The number of AiKDs is expected to grow with the clarification of the pathomechanisms of further inflammatory keratinization diseases.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"86 1","pages":"1-15"},"PeriodicalIF":0.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10945231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140178714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ultra-high-density mapping for safe and effective typical atrioventricular nodal reentrant tachycardia ablation.","authors":"Yusuke Sakamoto, Hiroyuki Osanai","doi":"10.18999/nagjms.85.4.844","DOIUrl":"10.18999/nagjms.85.4.844","url":null,"abstract":"<p><p>Ultra-high-density mapping was used for potential-guided radiofrequency ablation for typical atrioventricular nodal reentrant tachycardia. The mapping detailed the spread of activation in the Koch's triangle and identified target potentials and tachycardia circuits. This mapping provides additional information to the slow pathway conventionally used for safe and effective ablation.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"85 4","pages":"844-851"},"PeriodicalIF":0.9,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10751505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139058901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}