Okayama University Medical School Acta Medica Okayama 0386-300X 79 5 2025 A Review of the Endoscopic Treatment for Bile Leak Following Cholecystectomy and Hepatic Surgery 321 328 EN Taisuke Obata Department of Gastroenterology and Hepatology, Okayama University Hospital Kazuyuki Matsumoto Department of Gastroenterology and Hepatology, Okayama University Hospital Motoyuki Otsuka Department of Gastroenterology and Hepatology, Okayama University Hospital Review 10.18926/AMO/69432 Bile leak occurs in 2-25% of liver transplant, 3-27% of hepatic resection, and 0.1-4% of cholecystectomy cases. The clinical course of bile leak varies depending on the type of surgery that caused the fistula, as well as the type, severity, and timing of bile duct injury. Although infections resulting from bile leak can be life-threatening, the introduction of endoscopic treatment has enabled some patients to avoid reoperation and has reduced the negative impact on quality of life associated with external fistulas for percutaneous drainage. Endoscopic interventions, such as sphincterotomy and stent placement, reduce the pressure gradient between the bile duct and duodenum, facilitating bile drainage through the papilla and promoting the closure of the leak. We reviewed the literature from 2004 to 2024 regarding bile leak following cholecystectomy and liver surgery, examining recommended techniques, timing, and treatment outcomes. In cases of bile leak following cholecystectomy, clinical success was achieved in 72-96% of cases, while success rates for bile leak following liver surgery ranged from 50% to 100%. Although endoscopic treatment is effective, it is not universally applicable, and its limitations must be carefully considered. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 79 4 2025 Bloodstream Infections Caused by Gram-Negative Bacteria in Geriatric Patients: Epidemiology, Antimicrobial Resistance and The Factors Affecting Mortality 231 242 EN M Enes Kardan Department of Infectious Diseases, Faculty of Medicine, Namik Kemal University Ilknur Erdem Department of Infectious Diseases, Faculty of Medicine, Namik Kemal University Emre Yildiz Department of Infectious Diseases, Faculty of Medicine, Namik Kemal University Nuri Kiraz Department of Medical Microbiology, Faculty of Medicine, Namik Kemal University Aliye Çelikkol Department of Biochemistry, Faculty of Medicine, Namik Kemal University Original Article 10.18926/AMO/69148 Bloodstream infections (BSIs) are an important cause of morbidity and mortality in geriatric patients. We retrospectively analyzed the cases of geriatric patients who developed BSIs due to gram-negative bacteria in order to evaluate the epidemiology, antimicrobial resistance, and the factors affecting mortality. The cases of 110 patients aged ≥ 65 years admitted to our hospital between January 1, 2017, and December 31, 2022 were assessed; 70 (63.6%) of the BSIs were healthcare-associated BSIs. The urinary system was the most common detectable source of infection at 43.6%. The most frequently isolated bacteria were Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae, in that order. Carbapenem resistance was detected in 17 patients (15.5%), and extended-spectrum beta-lactamase (ESBL) production from Enterobacterales family members was detected in 37 (51.4%) patients. Multivariate analysis revealed that (i) the probability of mortality in the patients with total bilirubin was increased by approx. sixfold and (ii) the likelihood of mortality for those with a Pitt bacteremia score (PBS) ≥ 4 points was approx. 17 times higher. PBS and simplified qPitt scores can help predict mortality and manage geriatric patients. There is a significant increase in mortality among patients with procalcitonin (PCT) levels at ≥ 2 nm/ml. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 79 1 2025 Photoinitiators Induce Histamine Production in Human Mast Cells 51 58 EN Taro Miura Department of Clinical Pharmacy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoichi Kawasaki Laboratory of Clinical Pharmacology and Therapeutics, Kagawa School of Pharmaceutical Sciences, Tokushima Bunri University Hirofumi Hamano Department of Clinical Pharmacy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshito Zamami Department of Clinical Pharmacy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiaki Sendo Department of Clinical Pharmacy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/68362 Photoinitiators are used in the manufacture of many daily products, and may produce harmful effects due to their cytotoxicity. They have also been detected in human serum. Here, we investigated the histamine-producing effects in HMC-1 cells and the inflammatory cytokine release effects in RAW264 cells for four photoinitiators: 1-hydroxycyclohexyl phenyl ketone; 2-isopropylthioxanthone; methyl 2-benzoylbenzoate; and 2-methyl-4´-(methylthio)-2-morpholinopropiophenone. All four promoted histamine production in HMC-1 cells; however, they did not significantly affect the release of inflammatory cytokines in RAW264 cells. These findings suggest that these four photoinitiators induce inflammatory cytokine-independent histamine production, potentially contributing to histamine-mediated chronic inflammation in vitro. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 6 2024 C-arm Free Unilateral Biportal Endoscopic Discectomy: A Technical Note 475 483 EN Hongfei Xiang Department of Orthopaedic Surgery, Okayama Rosai Hospital Kajetan Latka Department of Orthopaedic Surgery, Okayama Rosai Hospital Praful Maste Department of Orthopaedic Surgery, Okayama Rosai Hospital Masato Tanaka Department of Orthopaedic Surgery, Okayama Rosai Hospital Chetan Kumawat Department of Orthopaedic Surgery, Okayama Rosai Hospital Shinya Arataki Department of Orthopaedic Surgery, Okayama Rosai Hospital Yoshihiro Fujiwara Department of Orthopaedic Surgery, Okayama Rosai Hospital Takuya Taoka Department of Orthopaedic Surgery, Okayama Rosai Hospital Akiyoshi Miyamoto Department of Orthopaedic Surgery, Okayama Rosai Hospital Case Report 10.18926/AMO/67878 This report presents a new unilateral biportal endoscopic (UBE) technique for lumbar disc herniation without C-arm guidance. Lumbar disc herniation requires surgical intervention when conservative methods fail. Shifts towards minimally invasive percutaneous endoscopic lumbar discectomy, including uniportal and biportal approaches, have been hindered by challenges such as steep learning curves and reliance on radiation-intensive C-arm guidance. We here describe the use of standard intraoperative navigation in UBE to reduce radiation exposure and increase surgical accuracy. A 24-year-old man with low back and bilateral leg pain with gait disturbance was referred to our hospital. He had had conservative treatment for 12 months in another hospital before admission, but this proved unsuccessful. On admission he had low back pain (VAS 4/10) and bilateral leg pain (VAS 8/10), muscle weakness of the bilateral legs (manual muscle testing (MMT) grade of the extensor hallucis longus: 4/4), and numbness of the bilateral lower legs. Preoperative lumbar MRI showed L4/5 large central disc herniation. He underwent C-arm free UBE discectomy under the guidance of O-arm navigation. The surgery was successful, with postoperative lumbar MRI showing good decompression of the dural sac and bilateral L5 nerve roots. The MMT grade and sensory function of both legs had recovered fully on final follow-up at one year. The new UBE technique under navigation guidance was shown to be useful for lumbar disc herniation. This innovative technique was safe and accurate for the treatment of lumbar intervertebral disc herniation, and minimized radiation exposure to surgeons. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 6 2024 Treatment of Tenosynovial Giant Cell Tumor of the Cervical Spine with Postoperative Anti-RANKL Antibody (Denosumab) Administration 469 474 EN Yuichi Hirata Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takayuki Nagase Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Susumu Sasada Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshiyuki Ayada Department of Pathology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hayato Miyake Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Chiaki Sugahara Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hidetaka Yamamoto Department of Pathology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshinao Oda Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University Takao Yasuhara Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shota Tanaka Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/67877 Tenosynovial giant cell tumor (TGCT) is a fibrous histiocytic tumor originating in the synovial membrane. While cervical TGCT may not be considered a common diagnosis preoperatively because it is relatively rare, it has a high recurrence rate and should be considered. Total resection is preferable, but it can be challenging due to the risk of damaging the vertebral artery. Denosumab has shown effectiveness as a postoperative treatment for osteolytic bone lesion. Denosumab administration coupled with close follow-up might offer an effective postoperative treatment option for unresectable TGCT with bone invasion. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 4 2024 Effect of Recipient Age on Perioperative Complications after Pediatric Liver Transplantation: A Single-Center Retrospective Study 323 330 EN Akira Katayama Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Satoshi Kimura Department of Anesthesia, Kyoto University Hospital Takashi Matsusaki Department of Anesthesiology, Mie University Hospital Hiroshi Morimatsu Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/67548 It has not been clear how recipient age affects the incidence of serious complications after pediatric living donor liver transplantation (LDLT). We investigated the records of 42 pediatric patients receiving LDLT, dividing our sample into two groups: the infant group (aged < 1 year) and the non-infant group (aged ≥ 1 year and ≤15 years). The primary outcome was postoperative complications assessed using the Clavien-Dindo classification. Multivariate analysis using the Cox regression model was applied to adjust for confounding factors in assessing the incidence of Clavien-Dindo grade ≥ III (C-D ≥ III) complications. The incidence of C-D ≥ III complications was higher in the non-infant group (46.2%) than in the infant group (12.5%) (odds ratio 6.00, 95% confidence interval [CI] 1.13-31.88, p=0.03). In multivariate analysis using the Cox regression model, the Graft-to-Recipient Weight Ratio (GRWR) was independently associated with the incidence of C-D ≥ III complications (hazard ratio [HR] 0.62, 95%CI 0.40-0.95, p=0.03), but being an infant was not (HR 0.84, 95%CI 0.35-1.98, p=0.68). In conclusion, the incidence of C-D ≥ III complications was higher in the non-infant group than in the infant group, but this was largely a function of GRWR: multivariate analysis revealed that GRWR was independently associated with complications. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 2 2024 Sigle Agent of Posttransplant Cyclophosphamide Without Calcineurin Inhibitor Controls Severity of Experimental Chronic GVHD 123 134 EN Kyosuke Saeki Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hideaki Fujiwara Department of Hematology and Oncology, Okayama University Hospital Keisuke Seike Department of Hematology and Oncology, Okayama University Hospital Taiga Kuroi Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hisakazu Nishimori Department of Hematology and Oncology, Okayama University Hospital Takehiro Tanaka Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ken-ichi Matsuoka Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Nobuharu Fujii Division of Transfusion, Okayama University Hospital Yoshinobu Maeda Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/66915 Chronic graft-versus-host disease (GVHD) is a major cause of late death and morbidity following allogeneic hematopoietic cell transplantation (HCT), but its pathogenesis remains unclear. Recently, haplo-identical HCT with post-transplant cyclophosphamide (Haplo-HCT with PTCY) was found to achieve a low incidence rate of acute GVHD and chronic GVHD. However, while the pathogenesis of acute GVHD following Haplo-HCT with PTCY has been well investigated, that of chronic GVHD remains to be elucidated, especially in HLA-matched HCT with PTCY. Based on its safety profile, PTCY is currently applied for the human leucocyte antigen (HLA)-matched HCT setting. Here, we investigated the mechanisms of chronic GVHD following HLA-matched HCT with PTCY using a well-defined mouse chronic GVHD model. PTCY attenuated clinical and pathological chronic GVHD by suppressing effector T-cells and preserving regulatory T-cells compared with a control group. Additionally, we demonstrated that cyclosporine A (CsA) did not show any additional positive effects on attenuation of GVHD in PTCY-treated recipients. These results suggest that monotherapy with PTCY without CsA could be a promising strategy for the prevention of chronic GVHD following HLA-matched HCT. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 2 2024 The Roles of Neuropeptide Y in Respiratory Disease Pathogenesis via the Airway Immune Response 95 106 EN Junko Itano Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Katsuyuki Kiura Department of Allergy and Respiratory Medicine, Okayama University Hospital Yoshinobu Maeda Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Nobuaki Miyahara Department of Allergy and Respiratory Medicine, Okayama University Hospital Review 10.18926/AMO/66912 The lungs are very complex organs, and the respiratory system performs the dual roles of repairing tissue while protecting against infection from various environmental stimuli. Persistent external irritation disrupts the immune responses of tissues and cells in the respiratory system, ultimately leading to respiratory disease. Neuropeptide Y (NPY) is a 36-amino-acid polypeptide and a neurotransmitter that regulates homeostasis. The NPY receptor is a seven-transmembrane-domain G-protein-coupled receptor with six subtypes (Y1, Y2, Y3, Y4, Y5, and Y6). Of these receptors, Y1, Y2, Y4, and Y5 are functional in humans, and Y1 plays important roles in the immune responses of many organs, including the respiratory system. NPY and the Y1 receptor have critical roles in the pathogenesis of asthma, chronic obstructive pulmonary disease, and idiopathic pulmonary fibrosis. The effects of NPY on the airway immune response and pathogenesis differ among respiratory diseases. This review focuses on the involvement of NPY in the airway immune response and pathogenesis of various respiratory diseases. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 1 2024 Role of Macrophages in Liver Fibrosis 1 8 EN Cuiming Sun Department of Pathology and Experimental Medicine, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Akihiro Matsukawa Department of Pathology and Experimental Medicine, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Review 10.18926/AMO/66664 Liver fibrosis, which ultimately leads to liver cirrhosis and hepatocellular carcinoma, is a major health burden worldwide. The progression of liver fibrosis is the result of the wound-healing response of liver to repeated injury. Hepatic macrophages are cells with high heterogeneity and plasticity and include tissue-resident macrophages termed Kupffer cells, and recruited macrophages derived from circulating monocytes, spleen and peritoneal cavity. Studies have shown that hepatic macrophages play roles in the initiation and progression of liver fibrosis by releasing inflammatory cytokines/chemokines and pro-fibrogenic factors. Furthermore, the development of liver fibrosis has been shown to be reversible. Hepatic macrophages have been shown to alternately regulate both the regression and turnover of liver fibrosis by changing their phenotypes during the dynamic progression of liver fibrosis. In this review, we summarize the role of hepatic macrophages in the progression and regression of liver fibrosis. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 5 2023 Childcare and Child Development in Japan 479 490 EN Akiko Murata Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Naomi Matsumoto Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Chikara Miyaji Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Soshi Takao Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Takashi Yorifuji Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Original Article 10.18926/AMO/65970 For decades, the notion has persisted in developed countries that exclusive care by the mothers is best for the development of children up to 3 years of age. To examine the veracity of this “myth of the first three years” in Japan, we examined the effects of childcare facility use for children younger than 3 years on their development using the cohorts of the Longitudinal Survey of Newborns in the 21st Century conducted in Japan. Of the 47,015 respondents to the survey, we studied the children of 5,508 mothers with university/professional education to evaluate the relationships between primary early (< 2.5 years) childcare providers during weekday daytime hours and specific development indices for the ages of 2.5, 5.5, and 8 years. At the age of 2.5 and 5.5 years, children attending childcare facilities were judged as having more advanced developmental behaviors by their parents, such as being able to compose a two-word sentence (adjusted odds ratio [aOR]: 0.22) or to express emotions (aOR: 0.81), compared with those cared for by mothers. However, at the age of 8 years, children who attended childcare facilities as infants < 2.5 years showed more aggressive behavior in interrupting people (aOR: 1.20) and causing disturbances in public (aOR: 1.26) than those cared for by mothers (after adjustment for numerous child and parental factors). Although these results are generally consistent with previous studies, issues potentially involved with problem behavior such as quality of childcare require further investigation, as does the case of children of mothers with more modest educational attainment. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 5 2023 Low Patient Weight and Long Intubation Time Are Key Factors for Pain during Colonoscopy 471 478 EN Shohei Oka Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Keita Harada Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shumpei Yamamoto Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Eriko Yasutomi Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shoko Igawa Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masayasu Ohmori Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Mami Hirai Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasushi Yamasaki Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshihiro Inokuchi Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hideaki Kinugasa Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masahiro Takahara Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Sakiko Hiraoka Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroyuki Okada Departments of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/65969 Although the clinical usefulness of colonoscopy has been established, the procedure remains painful for many patients. This study was designed to clarify the factors predicting colonoscopy-related pain. We evaluated 283 consecutive patients who completed a first-ever, total colonoscopy without sedatives or analgesics. The severity of pain symptoms was evaluated by a numeric rating scale (NRS) in a questionnaire immediately after the colonoscopy. Patient backgrounds and endoscopic findings were analyzed to evaluate their association with pain. Out of 283 patients, 53 scored their pain 0-1 on the NRS while 48 scored it 6-10. We defined the colonoscopies of the former and latter patients as painless and painful, respectively, and compared the two. Multivariate analyses revealed that low body weight (OR 4.95, 95%CI 1.89-12.99) and longer intubation time (OR 3.63, 95%CI 1.46-9.03) were significant risk factors for painful colonoscopy. To identify factors contributing to the increased intubation time, we divided subjects into short- and long-intubation-time groups based on a median insertion time of 7 min. Older age (OR 2.28, 95%CI 1.31-3.98), previous abdominal surgery (OR 1.93, 95%CI 1.13-3.32) and findings of invasive cancer (OR 10.90, 95%CI 1.34-88.90) were significant factors for longer intubation time. No potential conflict of interest relevant to this article was reported.

Spandidos Publications Acta Medica Okayama 1792-1074 24 4 2022 Effect of bacterium in the malignant wounds of soft tissue sarcoma 345 EN Eiji Nakata Department of Orthopedic Surgery, Okayama University Hospital Tomohiro Fujiwara Department of Orthopedic Surgery, Okayama University Hospital Haruyoshi Katayama Department of Orthopedic Surgery, Okayama University Hospital Takuto Itano Department of Orthopedic Surgery, Okayama University Hospital Toshiyuki Kunisada Department of Orthopedic Surgery, Okayama University Hospital Toshifumi Ozaki Department of Orthopedic Surgery, Okayama University Hospital Malignant wounds (MWs) are rare skin lesions, which accompany ulceration, necrosis and infection caused by infiltration or damage by malignant tumor. The present study aimed to investigate the bacterial etiology implicated in MW in soft tissue sarcoma (STS), and the effectiveness of culture‑guided perioperative antibacterial administration. A retrospective evaluation was conducted on medical records of patients who presented with MW between 2006 and 2020. A total of seven patients were included in the present study, in whom all tumors were relatively large (>5 cm) and high‑grade. Subsequently, five patients underwent limb‑sparing surgery, and three patients had distant metastases with a 5‑year overall survival of 71%. Preoperative microbiological sampling from the wound identified 11 different bacterial strains in five patients. The infections were polymicrobial with an average of 2.6 strains isolated per patient (1 aerobic, 1.6 anaerobic bacteria). They were predominantly methicillin‑sensitive Staphylococcus aureus. Patients with MWs from STS reported symptoms, including bleeding (71%), exudation (71%) and malodorous wound (43%) at the initial presentation; these completely resolved after surgery. All but one patient reported pain at the MW site with an average numeric rating scale of 4.4 at presentation that decreased to 1.4 (P=0.14) and 0.6 (P=0.04) one and two weeks after surgery, respectively. The patients had elevated C‑reactive protein (71%), anemia (57%), low albumin (86%) and renal/liver dysfunction (14‑29%). One patient was diagnosed with sepsis. Surgical resection afforded symptomatic relief and resolution of abnormal laboratory values. Although selected antibiotics were administered in four patients based on the preoperative antibiotic sensitivity test, surgical site infection (SSI) occurred in three patients. Therefore, the effectiveness of the selected antibiotics based on the results of the preoperative culture in preventing SSI needs to be investigated in the future. In conclusion, physicians should keep in mind that although surgical resection can improve the symptoms and abnormal values in laboratory examination form MW, it is accompanied with a high rate of SSI and poor prognosis. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 4 2023 Association of Tumor Necrosis Factor-Alpha with Psychopathology in Patients with Schizophrenia 395 405 EN Marko Pavlovic University Hospital Center Mostar, University of Mostar Dragan Babic University Hospital Center Mostar, University of Mostar Pejana Rastovic University Hospital Center Mostar, University of Mostar Jurica Arapovic University Hospital Center Mostar, University of Mostar Marko Martinac Health Care Center Mostar, University of Mostar Sanja Jakovac University Hospital Center Mostar, University of Mostar Romana Barbaric University Hospital Center Mostar, University of Mostar Original Article 10.18926/AMO/65750 We investigated the relationship between serum tumor necrosis factor-alpha (TNF-α) levels and psychopathological symptoms, clinical and socio-demographic characteristics and antipsychotic therapy in individuals with schizophrenia. TNF-α levels were measured in 90 patients with schizophrenia and 90 healthy controls matched by age, gender, smoking status, and body mass index. The Positive and Negative Syndrome Scale (PANSS) was used to assess the severity of psychopathology in patients. No significant differences in TNF-α levels were detected between the patients and controls (p=0.736). TNF-α levels were not correlated with total, positive, negative, general, or composite PANSS scores (all p>0.05). A significant negative correlation was observed between TNF-α levels and the PANSS cognitive factor (ρ=−0.222, p=0.035). A hierarchical regression analysis identified the cognitive factor as a significant predictor of the TNF-α level (beta=−0.258, t=−2.257, p=0.027). There were no significant differences in TNF-α levels among patients treated with different types of antipsychotics (p=0.596). TNF-α levels correlated positively with the age of onset (ρ=0.233, p=0.027) and negatively with illness duration (ρ=−0.247, p=0.019) and antipsychotic treatment duration (ρ=−0.256, p=0.015). These results indicate that TNF-α may be involved in cognitive impairment in schizophrenia, and would be a potential clinical-state marker in schizophrenia. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 2 2023 Predictive Factors for Recovery from Alcoholic Liver Failure 169 177 EN Kanae Inoue Department of Gastroenterology, Okayama City Hospital Rio Fujita Department of Gastroenterology, Okayama City Hospital Takatoshi Nagahara Department of Gastroenterology, Okayama City Hospital Shiho Murakami Department of Gastroenterology, Okayama City Hospital Yuta Nagai Department of Gastroenterology, Okayama City Hospital Rina Moriwake Department of Gastroenterology, Okayama City Hospital Nozomi Miyake Department of Gastroenterology, Okayama City Hospital Akiko Wakuta Department of Gastroenterology, Okayama City Hospital Kazuya Kariyama Department of Gastroenterology, Okayama City Hospital Mamoru Nishimura Department of Gastroenterology, Okayama City Hospital Kazuhiro Nouso Department of Gastroenterology, Okayama City Hospital Original Article 10.18926/AMO/65146 Alcoholic liver disease is a risk factor for non-virus-related hepatocellular carcinoma (HCC), which is increasing in prevalence. This study aimed to identify the factors for recovery from alcoholic liver failure. Sixty-two consecutive patients hospitalized for alcoholic liver failure at Okayama City Hospital were enrolled. The characteristics of patients who survived to the 1-month follow-up and whose liver function improved to Child–Pugh A at 3 months (CPA3) and 12 months (CPA12) were compared with the rest of the patients. The survivors at 1 month (50 patients) were significantly younger than the deceased patients and had better liver and renal function with higher levels of γ-glutamyl transferase (GGT). The same factors, except renal function, were correlated with achieving CPA3. High AST, ALT, and GGT levels as well as short spleen length, total abstinence, and good Child–Pugh scores at admission were identified as factors for achieving CPA12. The extent of alcohol intake before admission was not identified as a risk factor in any analysis. In conclusion, baseline liver function is crucial for survival and achieving CPA3, whereas high transaminase and γ-GTP levels, the absence of splenomegaly, and total abstinence are significant factors for achieving CPA12. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 1 2023 Osteonecrosis of the Jaw in Two Rheumatoid Arthritis Patients Not Treated with a Bisphosphonate 111 116 EN Katsuhiko Amano Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Akinari Sugauchi The first department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry Chiaki Yamada Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Mikihiko Kogo The first department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry Seiji Iida Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/64371 Medication-related osteonecrosis of the jaw (MRONJ) is a side effect in patients taking bone-modifying agents (BMAs), which are highly beneficial for treating osteoporosis and cancer. Bisphosphonates are prescribed to treat secondary osteoporosis in patients with rheumatoid arthritis (RA). We recently encountered two unusual cases of intraoral ONJ in RA patients who had not been treated with a BMA and did not have features of methotrexate- associated lymphoproliferative disorder. Their ONJ stage II bone exposures were treated by conservative therapy, providing good prognoses. These cases indicate that ONJ can occur in RA patients not treated with bisphosphonates. Several risk factors are discussed. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 1 2023 Image Quality Assessment of Deep Learning Image Reconstruction in Torso Computed Tomography Using Tube Current Modulation 45 55 EN Kazuhiro Takeuchi Department of Radiology, Kagawa University Hospital Yasuhiro Ide Department of Radiology, Kagawa University Hospital Yuichiro Mori Department of Radiology, Kagawa University Hospital Yusuke Uehara Department of Radiology, Kagawa University Hospital Hiroshi Sukeishi Department of Radiology, Kagawa University Hospital Sachiko Goto Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Original Article 10.18926/AMO/64361 Novel deep learning image reconstruction (DLIR) reportedly changes the image quality characteristics based on object contrast and image noise. In clinical practice, computed tomography image noise is usually controlled by tube current modulation (TCM) to accommodate changes in object size. This study aimed to evaluate the image quality characteristics of DLIR for different object sizes when the in-plane noise was controlled by TCM. Images acquisition was performed on a GE Revolution CT system to investigate the impact of the DLIR algorithm compared to the standard reconstructions of filtered-back projection (FBP) and hybrid iterative reconstruction (hybrid-IR). The image quality assessment was performed using phantom images, and an observer study was conducted using clinical cases. The image quality assessment confirmed the excellent noise- reduction performance of DLIR, despite variations due to phantom size. Similarly, in the observer study, DLIR received high evaluations regardless of the body parts imaged. We evaluated a novel DLIR algorithm by replicating clinical behaviors. Consequently, DLIR exhibited higher image quality than those of FBP and hybrid-IR in both phantom and observer studies, albeit the value depended on the reconstruction strength, and proved itself capable of providing stable image quality in clinical use. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 6 2022 A Rare Case of Idiopathic Spinal Cord Herniation Treated by DuraGen® Collagen Matrix Graft 731 736 EN Maho Kamamura Department of Radiology, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Fumiyo Higaki Department of Radiology, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Susumu Sasada Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Toshi Matsushita Division of Radiological Technology, Okayama University Hospital Takao Yasuhara Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Isao Date Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Takao Hiraki Department of Radiology, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/64124 We report a rare case of idiopathic spinal cord herniation (ISCH) with a history of cerebrospinal fluid (CSF) leakage. ISCH is a protrusion of the spinal cord through a dural defect. Thin constructive interference in steady-state (CISS) images clearly demonstrated the herniated cord in the present case. The myelopathy worsened and the patient underwent surgery for reduction of herniated spinal cord; the dural defect was filled by placing collagen matrix graft (DuraGen^®) between the inner and outer dural layers. The patient’s symptoms have improved without relapse for 8 months since surgery. This method may be a good surgical option for cases of spinal cord herniation. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 3 2022 Intrathecal Administration of the α1 Adrenergic Antagonist Phentolamine Upregulates Spinal GLT-1 and Improves Mirror Image Pain in SNI Model Rats 255 263 EN Kosuke Nakatsuka Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshikazu Matsuoka Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masako Kurita Kinoshita Pain Clinic Ruilin Wang Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Chika Tsuboi Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Nobutaka Sue Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ryuji Kaku Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroshi Morimatsu Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/63719 Mirror image pain (MIP) is a type of extraterritorial pain that results in contralateral pain or allodynia. Glutamate transporter-1 (GLT-1) is expressed in astrocytes and plays a role in maintaining low glutamate levels in the synaptic cleft. Previous studies have shown that GLT-1 dysfunction induces neuropathic pain. Our previous study revealed bilateral GLT-1 downregulation in the spinal cord of a spared nerve injury (SNI) rat. We hypothesized that spinal GLT-1 is involved in the mechanism of MIP. We also previously demonstrated noradrenergic GLT-1 regulation. Therefore, this study aimed to investigate the effect of an α1 adrenergic antagonist on the development of MIP. Rats were subjected to SNI. Changes in pain behavior and GLT-1 protein levels in the SNI rat spinal cords were then examined by intrathecal administration of the α1 adrenergic antagonist phentolamine, followed by von Frey test and western blotting. SNI resulted in the development of MIP and bilateral downregulation of GLT-1 protein in the rat spinal cord. Intrathecal phentolamine increased contralateral GLT-1 protein levels and partially ameliorated the 50% paw withdrawal threshold in the contralateral hind paw. Spinal GLT-1 upregulation by intrathecal phentolamine ameliorates MIP. GLT-1 plays a role in the development of MIPs. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 2 2022 A Pediatric Case of Cauda Equina Dermoid Cyst Resected by Minimally Invasive Unilateral Hemilaminectomy 217 223 EN Satoru Yabuno Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Susumu Sasada Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Michiari Umakoshi Department of Neurosurgery, Kagawa Rosai Hospital Takayuki Nagase Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Chiaki Sugahara Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Satoshi Kawauchi Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takao Yasuhara Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Isao Date Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/63426 A 3-year-old boy had difficulty sitting up and walking for several months. Magnetic resonance imaging (MRI) revealed an intradural tumor at the L3-4 level. The tumor was successfully resected by unilateral hemilaminectomy and diagnosed as dermoid cyst. The patient had an uneventful postoperative course without pain, and MRI found no recurrence after surgery. A small bone defect remained that might be favorably reconstructed with autologous and artificial bone. Hemilaminectomy allowed us to resect the cauda equina dermoid cyst with minimal invasiveness. Pediatric patients require follow-up as they are more likely to experience spinal deformity or instability after surgery. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 2 2022 Clinicopathological Features and Surgical Outcomes of Small Bowel Metastasis from Renal Cell Carcinoma 155 165 EN Jiro Kimura Department of Gastroenterological Surgery, National Center for Global Health and Medicine Takehiro Okabayashi Department of Gastroenterological Surgery, National Center for Global Health and Medicine Kenta Sui Department of Gastroenterological Surgery, National Center for Global Health and Medicine Motoyasu Tabuchi Department of Gastroenterological Surgery, National Center for Global Health and Medicine Jun Iwata Department of Diagnostic Pathology, National Center for Global Health and Medicine Yasuhiro Hata Department of Radiology, National Center for Global Health and Medicine Tatsuo Iiyama Department of Biostatistics, National Center for Global Health and Medicine Noriaki Ono Department of Urology, Kochi Health Sciences Center Original Article 10.18926/AMO/63409 Small bowel metastasis from renal cell carcinoma (RCC) is rare, and its clinicopathological characteristics are unclear; thus, we revisited the concept of this tumor and reviewed its diagnostic and treatment modalities. We filtered MEDLINE searches of articles published in English between 1950 and 2019, and identified 100 patients who had undergone treatment, including 1 patient from our clinic. We extracted patient characteristics, treatment, and prognostic data, resulting in clinicopathological data on 100 patients (83 men, 17 women). Mean age was 63 years (range, 16-86 years). Tumor sites were duodenum, jejunum, ileum, and multiple sites in 30, 37, 25, and 7 patients, respectively. The 1-, 3-, and 5-year overall survival rates after diagnosis were 53.0%, 36.0%, and 36.0%. Curative resection patients showed 62.1% 5-year survival after surgery, vs. 27.5% in noncurative surgical management cases. Good prognoses can be expected if these tumors are identified early for complete removal. Surgery is the only curative option. To determine the best management strategy and improve prognostic accuracy, we continue to collect and analyze epidemiological and pathological data. Although this condition is rare, surgery should be considered if curative resection is expected. Prognosis after curative resection is not poor, but recurrence is not unlikely. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 1 2022 In Vivo Microwave Ablation of Normal Swine Lung at High-power, Short-duration Settings 57 62 EN Toshihiro Iguchi Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takao Hiraki Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yusuke Matsui Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tomohiro Toji Department of Pathology, Okayama University Hospital Mayu Uka Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Koji Tomita Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiyuki Komaki Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Noriyuki Umakoshi Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiharu Mitsuhashi Center for Innovative Clinical Medicine, Okayama University Hospital Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/63212 To evaluate the volume and heat-sink effects of microwave ablation (MWA) in the ablation zone of the normal swine lung. MWA at 100 W was performed for 1, 2, and 3 min in 7, 5, and 5 lung zones, respectively. We assessed the histopathology in the ablation zones and other outcome measures: namely, length of the longest long and short axes, sphericity, ellipsoid area, and ellipsoid volume. The mean long- and short-axis diameters were 22.0 and 14.1 mm in the 1-min ablation zone, 27.6 and 20.2 mm in the 2-min ablation zone; and 29.2 and 21.2 mm in the 3-min ablation zone, respectively. All measures, except sphericity, were significantly less with 1-min ablation than with either 2- or 3-min ablation. There were no significant differences between the 2- and 3-min ablation zones, but all measures except sphericity were larger with 3-min ablation. Although there were no blood vessels that resulted in a heat-sink effect within the ablation zones, the presence of bronchi nearby in 5 lung ablation zones resulted in reduced ablation size. In high-power, short-duration MWA, the lung ablation volume was affected by ablation time. Some ablations showed that a heat-sink effect by a neighboring bronchus might occur. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 6 2021 Clinical Efficacy and Safety of Sitafloxacin 200 mg Once Daily for Refractory Genitourinary Tract Infections 763 766 EN Takehiro Iwata Department of Urology, Okayama University Hospital Takuya Sadahira Department of Urology, Okayama University Hospital Yuki Maruyama Department of Urology, Okayama University Hospital Takanori Sekito Department of Urology, Okayama University Hospital Kasumi Yoshinaga Department of Urology, Okayama University Hospital Shogo Watari Department of Urology, Okayama University Hospital Kentaro Nagao Department of Urology, Okayama University Hospital Tatsushi Kawada Department of Urology, Okayama University Hospital Yusuke Tominaga Department of Urology, Okayama University Hospital Shingo Nishimura Department of Urology, Okayama University Hospital Atsushi Takamoto Department of Urology, Okayama University Hospital Tomoko Sako Department of Urology, Okayama University Hospital Kohei Edamura Department of Urology, Okayama University Hospital Yasuyuki Kobayashi Department of Urology, Okayama University Hospital Motoo Araki Department of Urology, Okayama University Hospital Ayano Ishii Department of Urology, Okayama University Hospital Masami Watanabe Department of Urology, Okayama University Hospital Toyohiko Watanabe Department of Urology, Okayama University Hospital Yasutomo Nasu Department of Urology, Okayama University Hospital Koichiro Wada Department of Urology, Okayama University Hospital Clinical Study Protocol 10.18926/AMO/62820 The aim of this ongoing trial is to evaluate the clinical efficacy and safety of sitafloxacin (STFX) 200 mg once daily (QD) for 7 days in patients with refractory genitourinary tract infections, which include recurrent or complicated cystitis, complicated pyelonephritis, bacterial prostatitis, and epididymitis. The primary endpoint is the microbiological efficacy at 5-9 days after the last administration of STFX. Recruitment began in February 2021, and the target total sample size is 92 participants. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 6 2021 The Significance of Age and Causative Bacterial Morphology in the Choice of an Antimicrobial Agent to Treat Acute Uncomplicated Cystitis 719 724 EN Shinya Uehara Department of Urology, Abiko Toho Hospital Kei Fujio Department of Urology, Abiko Toho Hospital Tomoya Yamasaki Department of Urology, Abiko Toho Hospital Hideo Otsuki Department of Urology, Abiko Toho Hospital Original Article 10.18926/AMO/62812 Differentiating patients by age and causative bacterial morphology might aid in making the appropriate choice of antimicrobial agent when treating acute uncomplicated cystitis. In this retrospective analysis, the non-susceptibility rates of the causative bacteria to cefcapene-pivoxil (CFPN-PI) and levofloxacin (LVFX) were determined after dividing patients with acute uncomplicated cystitis by age group (15-54 and 55-74 years old) and by bacterial morphology: gram-positive cocci (GPC) or gram-negative rod (GNR). The overall non-susceptibility rates for CFPN-PI and LVFX were 19.4% and 15.3%, respectively. When the subjects were divided by age, only the non-susceptibility rate for LVFX in the younger group significantly decreased (to 8.7%). When the groups were divided by both age and bacterial morphology, the younger GNR group had non-susceptibility rates of 6.9% to CFPN-PI and 7.8% to LVFX, whereas the younger GPC group showed 10.2% non-susceptibility to LVFX. The older GNR group showed 9.8% non-susceptibility to CFPN-PI, while the older GPC group showed 7.2% non-susceptibility to LVFX. All the non-susceptibility rates were lower than 10.2% in the sub-divided groups. Differentiating patients by age and the morphology of causative bacteria can aid in making the appropriate choice of antimicrobial agent and may improve treatment outcomes in patients with acute uncomplicated cystitis. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 6 2021 EG-VEGF Induces Invasion of a Human Trophoblast Cell Line via PROKR2 677 684 EN Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takashi Mitsui Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Sakurako Mishima Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Akiko Ohira Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Jota Maki Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Eriko Eto Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kei Hayata Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Keiichiro Nakamura Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hisashi Masuyama Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/62806 Extravillous trophoblast (EVT) invasion is important for embryo implantation, placental development, and successful remodeling of the uterine spiral artery. Endocrine gland derived-vascular endothelial growth factor (EG-VEGF) and matrix metalloproteinases (MMPs) are implicated in EVT invasion; however, the high con-centrations found in pregnancy pathologies have not been investigated in non-tumor trophoblasts. The roles of EG-VEGF, prokineticin receptors (PROKR1/2), MMP-2, and MMP-9 in EVT invasion during spiral artery remodeling were evaluated using human EVT from HTR-8/SVneo cell lines. The expression of MMP-2, MMP-9, and mitogen-activated protein kinase (MAPK), and Akt pathways in HTR-8/SVneo cells treated with recom-binant EG-VEGF alongside anti-PROKR1 and/or anti-PROKR2 antibodies was evaluated using quantitative reverse transcription-PCR and western blotting. Wound-healing and cell invasion assays were performed to assess the migration and invasion of these treated cells. Interestingly, 20 nM EG-VEGF activated ERK1/2 sig-naling and upregulated MMP-2 and MMP-9. This effect was suppressed by anti-PROKR2 antibody via ERK1/2 downregulation. Anti-PROKR2 antibody inhibited the migration and invasion of EG-VEGF-stimulated HTR-8/SVneo cells. Elevated concentrations of EG-VEGF enhance EVT invasion in a human trophoblast cell line by upregulating MMP-2 and MMP-9 via PROKR2. These new insights into the regulation of epithelial cell invasion may help in developing therapeutic interventions for placental-related diseases during pregnancy. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 4 2021 Long-term Multidisciplinary Rehabilitation Efficacy in Older Patients After Traumatic Brain Injury: Assessed by the Functional Independence Measure 479 486 EN Akio Harada Department of Neurological Surgery, Faculty of Medicine, Kagawa University Nobuyuki Kawai Department of Neurological Surgery, Kagawa Rehabilitation Hospital Tomoya Ogawa Department of Neurological Surgery, Faculty of Medicine, Kagawa University Tetsuhiro Hatakeyama Department of Neurological Surgery, Faculty of Medicine, Kagawa University Takashi Tamiya Department of Neurological Surgery, Faculty of Medicine, Kagawa University Original Article 10.18926/AMO/62400 Instances of traumatic brain injury (TBI) in the elderly have been increasing along with the aging of popula-tions. In the present study, we examined the effect of aging on long-term multidisciplinary in-patient rehabili-tation efficacy after TBI. Sixty-three patients with physical and cognitive impairments after TBI were enrolled in this study. Patients were divided into 4 age groups (≤ 24, 25-44, 45-64, ≥ 65 years) and the clinical charac-teristics and rehabilitation efficacy of each age group were determined. Functional disability was evaluated using motor and cognitive Functional Independence Measure (FIM) scores. Rehabilitation efficacy was assessed by FIM gains during rehabilitation and compared among the groups. There were no statistically significant dif-ferences in motor and cognitive FIM gains among the age groups. However, cognitive FIM gain was limited in a subset of ≥ 65 patients, and initial cognitive measures could not predict cognitive FIM improvement. These results indicate that chronological age is insufficient to accurately predict rehabilitation efficacy in older TBI patients, and that such patients should be considered candidates for intensive rehabilitation programs based on these results. Accurate prognostication of rehabilitation efficacy with continuing data collection is important when using rehabilitation resources for older TBI patients. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 2 2021 Histological Analysis of Repaired Tissue after Pullout Repair of a Medial Meniscus Posterior Root Tear 225 230 EN Haowei Xue Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takayuki Furumatsu Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuki Okazaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takaaki Hiranaka Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Keisuke Kintaka Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ximing Zhang Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Aki Yoshida Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/61905 A 65-year-old man presented with a left medial meniscus (MM) posterior root tear (PRT). Unicompartmental knee arthroplasty was performed 12 months after transtibial pullout repair of the MMPRT. Repaired MM posterior root tissue was subjected to histological analysis. Immunostaining and picrosirius red staining showed sufficient deposition of type I collagen, and hematoxylin-eosin staining using a polarized microscope showed well-aligned fiber orientation in the repaired tissue. The repaired posterior root (post-transtibial pullout repair) showed mature and well-aligned ligament-like tissue. Preserving the MM posterior root remnant to mimic the original posterior root tissue might be useful when performing pullout repair. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 2 2021 Evaluation of the Imaging Process for a Novel Subtraction Method Using Apparent Diffusion Coefficient Values 139 145 EN Kentaro Hamada Radiological Technology, Graduate School of Health Sciences, Okayama University Masahiro Kuroda Radiological Technology, Graduate School of Health Sciences, Okayama University Yuuki Yoshimura Radiological Technology, Graduate School of Health Sciences, Okayama University Abdullah Khasawneh Department of Oral and Maxillofacial Radiology, Okayama University Hospital Majd Barham Department of Oral and Maxillofacial Radiology, Okayama University Hospital Nouha Tekiki Department of Oral and Maxillofacial Radiology, Okayama University Hospital Irfan Sugianto Department of Oral and Maxillofacial Radiology, Okayama University Hospital Babatunde O. Bamgbose Department of Oral and Maxillofacial Radiology, Okayama University Hospital Kohei Konishi Radiological Technology, Graduate School of Health Sciences, Okayama University Kohei Sugimoto Radiological Technology, Graduate School of Health Sciences, Okayama University Hinata Ishizaka Radiological Technology, Graduate School of Health Sciences, Okayama University Akira Kurozumi Central Division of Radiology, Okayama University Hospital Toshi Matsushita Central Division of Radiology, Okayama University Hospital Seiichiro Ohno Central Division of Radiology, Okayama University Hospital Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Junichi Asaumi Department of Oral and Maxillofacial Radiology, Okayama University Hospital Original Article 10.18926/AMO/61880 Diffusion-weighted imaging may be used to obtain the apparent diffusion coefficient (ADC), which aids the diagnosis of cerebral infarction and tumors. An ADC reflects elements of free diffusion. Diffusion kurtosis imaging (DKI) has attracted attention as a restricted diffusion imaging technique. The ADC subtraction method (ASM) was developed to visualize restricted diffusion with high resolution by using two ADC maps taken with different diffusion times. We conducted the present study to provide a bridge between the reported basic ASM research and clinical research. We developed new imaging software for clinical use and evaluated its performance herein. This software performs the imaging process automatically and continuously at the pixel level, using ImageJ software. The new software uses a macro or a plugin which is compatible with various operating systems via a Java Virtual Machine. We tested the new imaging software’s performance by using a Jurkat cell bio-phantom, and the statistical evaluation of the performance clarified that the ASM values of 99.98% of the pixels in the bio-phantom and physiological saline were calculated accurately (p<0.001). The new software may serve as a useful tool for future clinical applications and restricted diffusion imaging research. No potential conflict of interest relevant to this article was reported.

岡山大学教師教育開発センター Acta Medica Okayama 2186-1323 11 2021 教師のビリーフが自律的な学習姿勢に及ぼす影響―職能成長への示唆― 43 57 EN Ryo MISAWA Mizuki NABETA Fumihiko MORIYASU 10.18926/CTED/61564 本研究は，教師のビリーフが自律的な学習姿勢に及ぼす影響について検討した。公立小学校の現職教員へ質問紙調査を行い，77 名から回答を得た。教師の自律的な学習姿勢については，既存尺度に基づき「同僚の経験の取り入れ」，「児童・保護者の視点の考慮」，「前向きな挑戦姿勢」，「自己省察」の 4 つの側面を測定した。教師のビリーフについては，因子分析により「学校教育の理想像」，「規律重視」，「権威志向」の 3 つの側面を表す因子を抽出した。相関分析の結果では，「学校教育の理想像」ビリーフが自律的な学習姿勢の各側面と正の関連を示した。また交互作用項を含む重回帰分析の結果，「学校教育の理想像」が学習姿勢に及ぼす効果は，「規律重視」ビリーフに調整されることが示された。すなわち，「規律重視」が高い場合にのみ，「学校教育の理想像」は学習姿勢を促進していた。得られた知見を基に，教師の職能成長に関する示唆を考察した。 No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 5 2020 Seronegative Oligoarthritis Preceding Psoriasis by 9.5 Years 449 453 EN Junpei Tsuchiya Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences Naoki Kondo Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences Atsushi Fujimoto Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences Rie Kondo Division of Respiratory Medicine, Niigata University Graduate School of Medical and Dental Sciences Masahiko Yamada Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences Tatsuya Kuraishi Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences Takuya Yoda Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences Riichiro Abe Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences Naoto Endo Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences Case Report 10.18926/AMO/60807 We report a case of psoriatic arthritis where oligoarthritis preceded the skin lesions. A 57-year-old man complained of left third-finger pain. Laboratory examinations were negative for anti-cyclic citrullinated peptide antibodies and rheumatoid factor; he was treated for suspected rheumatoid arthritis. Six years later, X-ray revealed enthesitis of his fingers and wrist joint. At 9.5 years after the initial visit, skin lesions appeared in the left auricular region and buttock and dermatopathology findings indicated psoriasis vulgaris. The final diagnosis was psoriatic arthritis. In cases of seronegative oligoarthritis, psoriatic arthritis must be considered because some patients demonstrate osteoarticular lesions preceding skin lesions. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 4 2020 Tibial Tunnel Positioning Using the Posterolateral (PL) Divergence Guide in Anterior Cruciate Ligament Reconstruction 345 350 EN Takaaki Tanaka Department of Orthopaedic Surgery, Sumitomobesshi Hospital Takayuki Furumatsu Department of Orthopaedic Surgery, Okayama University Hospital Takaaki Hiranaka Department of Orthopaedic Surgery, Okayama University Hospital Yuki Okazaki Department of Orthopaedic Surgery, Okayama University Hospital Kenji Masudaa Noritaka Senoa Department of Orthopaedic Surgery, Sumitomobesshi Hospital Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Hospital Original Article 10.18926/AMO/60373 The aim of this study was to evaluate tunnel coalition and inter-tunnel distance by comparing the tibial tunnel position in double-bundle anterior cruciate ligament (ACL) reconstruction performed with a conventional guide versus a posterolateral (PL) divergence (PLD) guide. Subjects were 43 patients (ACL tip aimer: 20 knees; PLD guide: 23 knees) who underwent double-bundle ACL reconstruction between September 2014 and December 2017. In all cases, the tibial tunnel position, tunnel edge distance and tunnel angles were evaluated based on CT images. Clinical outcome was evaluated using the Lachman test, pivot-shift test, and Lysholm score. Tibial tunnel positions were similar between the conventional and PLD guide groups, while tibial tunnel edge distance was significantly less in the conventional group. Tunnel coalition was observed in 5 knees in the conventional and no knees in the PLD guide group. Distance between two tibial tunnel centers was 9.1 mm for the tip aimer, and 10.5 mm for the PLD guide. Creation of the PL tunnel tended to involve insertion from a more medial aspect for the PLD guide group than the conventional guide group. No differences in clinical outcomes were noted. The PLD guide can be used to create anatomically-positioned PL tunnels, and reduce the probability of occurrence of tunnel coalition. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 4 2020 Factors Predicting a Favorable Disease Course Without Anti-TNF Therapy in Crohn’s Disease Patients 265 274 EN Toshihiro Inokuchi Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Sakiko Hiraoka Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Eriko Yasutomi Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shohei Oka Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasushi Yamasaki Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hideaki Kinugasa Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masahiro Takahar Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Seiji Kawano Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Keita Harada Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroyuki Okada Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Jun Kato bDepartment of Gastroenterology, Mitsui Memorial Hospital Original Article 10.18926/AMO/60363 Determining factors that predict a favorable disease course without anti-tumor necrosis factor (TNF) agents would help establish a more cost-effective strategy for Crohn’s disease (CD). A retrospective chart review was performed for CD patients with disease durations > 10 years who had not received anti-TNF agents as first-line therapy. Patients were divided into 2 groups: those who received neither anti-TNF agents nor bowel resection (G1), and those who had received an anti-TNF agent and/or bowel resection (G2). The patient backgrounds, therapies and clinical courses were compared between the groups. A total of 62 CD patients met the inclusion criteria (males: 71%; median duration of follow-up: 19 years). Six patients were included in G1; they were significantly less likely to have upper gastrointestinal lesions than G2 (p=0.007). A multivariate analysis revealed that the significant factors for avoidance of bowel resection without anti-TNF treatment were non-stricturing and non-penetrating behaviors, and absence of upper gastrointestinal lesions at the diagnosis (hazard ratios 0.41 and 0.52; p=0.004 and 0.04, respectively). In consideration of the long treatment course of CD, patients with non-stricturing and non-penetrating behaviors and no upper gastrointestinal lesions should not be treated with anti-TNF agents as first-line therapy. No potential conflict of interest relevant to this article was reported.

Karger Acta Medica Okayama 2296-3774 7 3 2020 The Early Decline of alpha-Fetoprotein and Des-gamma-Carboxy Prothrombin Predicts the Response of Hepatic Arterial Infusion Chemotherapy in Hepatocellular Carcinoma Patients 83 92 EN Shumpei Yamamoto Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Hideki Onishi Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Akinobu Takaki Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Atsushi Oyama Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Takuya Adachi Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Nozomu Wada Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Masahiro Sakata Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Tetsuya Yasunaka Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Hidenori Shiraha Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Hiroyuki Okada Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Introduction: Molecular targeting drugs are recommended as second-line treatment for intrahepatic advanced hepatocellular carcinoma (HCC). However, in Asia, hepatic arterial infusion chemotherapy (HAIC) is also considered as a second-line treatment because it improves the survival of responders. The aim of this study was to predict responders and non-responders to HAIC with low-dose cisplatin plus 5-fluorouracil (LFP) using tumor markers.</br> Objective and Methods: The data of 47 patients who received LFP for the first time in our hospital were analyzed retrospectively. We evaluated the association between treatment response by Response Evaluation Criteria in Solid Tumors and the changing ratio of the serum concentration of alpha-fetoprotein (AFP),Lens culinarisagglutinin-reactive fraction of AFP (AFP-L3), and des-gamma-carboxy prothrombin (DCP) 2 weeks after LFP initiation. </br> Results: The number of patients showing a complete response (CR), a partial response (PR), stable disease (SD), and progressive disease (PD) was 0 (0%), 20 (43%), 18 (38%), and 9 (19%), respectively. The AFP ratio showed significant positive correlations for PR vs. SD (p= 0.004) and PR vs. PD (p= 0.003). The DCP ratio correlated significantly for PR vs. SD (p= 0.02). The optimal cutoff values for responders were 0.79 for the AFP ratio and 0.53 for the DCP ratio. Prediction using both or either cutoff value showed 93% sensitivity, 53% specificity, a 94% negative predictive value, and a 57% positive predictive value. </br> Conclusion: Optimal cutoff values for AFP and DCP ratios enable prediction of nonresponders to HAIC with LFP. This simple and early assessment method allows the use of HAIC and molecular targeting drugs for HCC treatment. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 2 2020 Increased Plasma Levels of Platelet Factor 4 and β-thromboglobulin in Women with Recurrent Pregnancy Loss 115 122 EN Sayoko Kotani Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasuhiko Kamada Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Keiko Shimizu Okayama Rosai Hospital Ai Sakamoto Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Mikiya Nakatsuka Graduate School of Health Sciences, Okayama University Yuji Hiramatsu Okayama City Hospital Hisashi Masuyama Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/58269 Thrombosis in decidual vessels is one of the mechanisms of pregnancy loss. However, few studies have assessed the relation between platelet activation, which is known to cause of thrombosis, and recurrent pregnancy loss (RPL). We investigated platelet activation in women with RPL compared to controls by measuring plasma levels of platelet factor 4 (PF4) and β-thromboglobulin (βTG), and assessed correlations between PF4/βTG and coagulative risk factors associated with RPL. The study group included 135 women who had experienced two or more consecutive pregnancy losses. The control group included 28 age-matched healthy women who had never experienced pregnancy loss. PF4 and βTG plasma levels were significantly higher in the women with RPL than controls (PF4: 14.0 [8.0-20.0] vs. 9.0 [6.0-12.0] ng/ml, p=0.043; βTG: 42.0 [24.3-59.8] vs. 31.5 [26.6-36.4] ng/ml, p=0.002). There was a significant association between βTG and anti-phosphatidylethanolamine antibody immunoglobulin M (aPE IgM) (p=0.048). Among the women with RPL, 18 of those who were positive for PF4 (45%) and 18 of those who were positive for βTG (37%) were negative for all known coagulative risk factors associated with RPL. Measurements of PF4 and βTG may be important because they help identify women who are at risk of RPL. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 6 2019 Phase II Study of Treatment for Newly Diagnosed Multiple Myeloma Patients Over 75 Years Old with Alternating Bortezomib/dexamethasone and Lenalidomide/dexamethasone: the MARBLE Trial 547 552 EN Akihiro Yokoyama Division of Hematology, Department of Internal Medicine, NHO Tokyo Medical Center Akiko Kada Department of Clinical Trials and Research, Clinical Research Center, NHO Nagoya Medical Center Akiko M. Saito Department of Clinical Trials and Research, Clinical Research Center, NHO Nagoya Medical Center Morio Sawamura Department of Hematology, NHO Shibukawa Medical Center Takuya Komeno Department of Hematology, NHO Mito Medical Center Kazutaka Sunami Department of Hematology, NHO Okayama Medical Center Naoki Takezako Department of Hematology, Disaster Medical Center of Japan Clinical Study Protocol 10.18926/AMO/57722 Elderly multiple myeloma (MM) patients, who are generally ineligible for transplantation, have high risks of death and treatment discontinuation, and require a regimen incorporating novel agents that balance safety, tolerability, and efficacy. We evaluated alternating bortezomib-dexamethasone and lenalidomide-dexamethasone treatments administered over a 63-day cycle in transplant-ineligible elderly patients with newly diagnosed MM. Subcutaneous bortezomib 1.3 mg/m2 was administered weekly on Days 1, 8, 15, and 22; oral lenalidomide 15 mg daily on Days 36-56; and oral dexamethasone 20 mg on Days 1, 8, 15, 22, 36, 43, 50, and 57 for 6 cycles. The primary endpoint was the overall response rate. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 6 2019 The Aging Population and Research into Treatments for Abdominal Aortic Aneurysms 475 477 EN Ryoko Umebayashi Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Haruhito A. Uchida Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Junzo Wada Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Review 10.18926/AMO/57710 Abdominal aortic aneurysms (AAAs) usually expand asymptomatically until the occurrence of a life-threatening event such as aortic rupture, which is closely associated with high mortality. AAA and aortic dissection are ranked among the top 10 causes of death in Japan. The major risk factors for AAA are age over 65 years, male gender, family history, and smoking. Thus, for prevention, smoking cessation is the most important lifestyle-intervention. For treatment, since AAA generally affects elderly people, less invasive treatment is preferable. However, the only established treatment for AAA is open repair and endovascular repair. This review describes potential medical treatments to slow aneurysm growth or prevent AAA rupture. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 5 2019 “Active Guide” Brochure Reduces Sedentary Behavior of Elderly People: A Randomized Controlled Trial 427 432 EN Yutaka Owari Shikoku Medical College Hiromi Suzuki Department of Hygiene, Faculty of Medicine, Kagawa University Nobuyuki Miyatake Department of Hygiene, Faculty of Medicine, Kagawa University Original Article 10.18926/AMO/57373 The aim of this study was to examine in a randomized controlled trial how much the sedentary behavior (sitting time) of community-dwelling elderly Japanese subjects decreased as a result of using the “Active Guide” brochure published by the Ministry of Health, Labour and Welfare (2013) and additional documents related to the benefits of reducing sedentary behavior. A total of 86 elderly people who participated in health-club activities for one year were randomly allocated to two groups. Subjects in the intervention group received explanations of the importance of physical activity using the “Active Guide” brochure (n=42) and additional documents, while subjects in the control group did not (n=44). Physical activity was measured using a triaxial accelerometer for two weeks at baseline and again after one year. After one year of intervention, the difference in the sedentary behavior rate from baseline was −2.2% for the intervention group (n=40) and +2.5% for controls (n=40) (Welch’s t-test, p=0.007). Use of the “Active Guide” brochure and additional documents may reduce the sedentary behavior of community dwelling elderly people in Japan. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 3 2019 Post-traumatic Articular Cartilage Lesions Increase at Second-look Arthroscopy Following Primary Anterior Cruciate Ligament Reconstruction 223 228 EN Kazuhisa Sugiu Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takayuki Furumatsu Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuya Kodama Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yusuke Kamatsuki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshiki Okazaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuki Okazaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takaaki Hiranaka Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/56864 Anterior cruciate ligament (ACL) reconstruction (ACLR) after ACL rupture improves the instability of the knee joint and decreases mechanical stress to the meniscus and articular cartilage. However, there are reports that post-traumatic osteoarthritis (PTOA) is observed over time following ACLR. In this study, we assessed changes in cartilage lesions by arthroscopic findings following anatomical double-bundle ACLR and at post-operative second-look arthroscopy about 14 months later. We retrospectively evaluated 37 knees in cases with patients <40 years of age who had undergone an anatomical double-bundle ACL reconstruction <1 year after ACL rupture injury from March 2012 to December 2016. Clinical results and arthroscopic cartilage/meniscal lesion were evaluated and compared between a cartilage lesion-detected group and intact-cartilage group. Surgery improved anteroposterior laxity and other clinical measures; however, cartilage lesions were detected at 11 sites during ACLR and at 54 sites at second-look arthroscopy. The periods from injury to second-look arthroscopy and from ACLR to second-look arthroscopy were significantly longer in the cartilage-lesion group (n=23) than in the intact-cartilage group (n=14). Conversely, 96% of meniscal damage observed during ACLR was cured at the time of second-look arthroscopy. Knee articular cartilage lesions after ACL rupture cannot be completely suppressed, even using the anatomical ACL reconstruction technique. This study suggested that articular cartilage lesions can progress to a level that can be confirmed arthroscopically at approximately 17 months after ACL injury. Therefore, in ACLR patients, the possibility of developing knee articular cartilage lesions and PTOA should be considered. No potential conflict of interest relevant to this article was reported.

Asian Pacific Organization for Cancer Prevention Acta Medica Okayama 1513-7368 18 6 2017 Molecular Subtypes of Breast Cancers from Myanmar Women: A Study of 91 Cases at Two Pathology Centers 1617 1621 EN Thar Htet San Department of Pathology and Experimental Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Masayoshi Fujisawa Department of Pathology and Experimental Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Soichiro Fushimi Department of Pathology and Experimental Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Lamin Soe Department of Pathology, Myeik General Hospital Ngu Wah Min Department of Pathology, Sakura Specialist Hospital Teizo Yoshimura Department of Pathology and Experimental Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Toshiaki Ohara Department of Pathology and Experimental Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Myint Myint Yee Department of Pathology, Central Women Hospital Shinsuke Oda Department of Pathology and Experimental Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Akihiro Matsukawa Department of Pathology and Experimental Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University BACKGROUND: Breast cancer is the most common cancer in Myanmar women. Revealing the hormonal receptor status, human epidermal growth factor receptor 2 (HER2) and Ki-67 expression is useful for estimating patient prognosis as well as determination of treatment strategy. However, immunohistochemical features and classification of molecular subtypes in breast cancers from Myanmar remain unknown. METHODS: The clinicopathological features of 91 breast cancers from Myanmar women were examined. Immunohistochemistry was performed on tissue specimens with antibodies to estrogen receptor (ER), progesterone receptor (PgR), HER2, Ki-67, cytokeratin (CK)5/6 and CK14. Immunohistochemistry-based molecular subtyping was conducted. RESULTS: Breast cancers in Myanmar women were relatively large, high grade with frequent metastatic lymph nodes. Of the 91 patients, tumors with ER positive, PgR positive, and HER2 positive were 57.1%, 37.4%, and 28.6%, respectively. The most prevalent subtype was luminal B (HER2-) (39.6%), followed by HER2 (22.0%), triple negative (TN)-basal-like (12.1%), luminal A (11.0%), TN-null (8.8%) and luminal B (HER2+) (6.6%). The mean Ki-67 expression of 91 cases was 33.9% (33.9% ± 19.2%) and the median was 28% (range; 4%-90%). The mean Ki-67 expression of luminal A, luminal B, HER2 and TN-basal-like/ null was 7%, 30%, 40%, and 57%/43%, respectively. A higher Ki-67 expression significantly correlated with a higher grade, larger size and higher stage of malignancy. CONCLUSIONS: We, for the first time, investigated the histopathological features of breast cancers from Myanmar women. Myanmar breast cancers appeared to be aggressive in nature, as evidenced by high frequency of poor-prognosis subtypes with high level of Ki-67 expression. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 129 2 2017 POEM (Per-Oral Endoscopic Myotomy) を施行した 食道アカラシアの1例 115 121 EN Yuusaku Sugihara Department of Gastroenterology and Hepatology, Okayama University Hospital Keita Harada Division of Endoscopy, Okayama University Hospital Ryo Kato Department of Gastroenterology and Hepatology, Okayama University Hospital Kenji Yamauchi Department of Gastroenterology and Hepatology, Okayama University Hospital Shiho Takashima Department of Gastroenterology and Hepatology, Okayama University Hospital Daisuke Takei Division of Endoscopy, Okayama University Hospital Toshihiro Inokuchia Department of Gastroenterology and Hepatology, Okayama University Hospital Masahiro Takahara Department of Gastroenterology and Hepatology, Okayama University Hospital Seiji Kawano Department of Gastroenterology and Hepatology, Okayama University Hospital Sakiko Hiraoka Department of Gastroenterology and Hepatology, Okayama University Hospital Shunsuke Tanabe Department of Gastroenterological Surgery, Okayama University Hospital Kazuhiro Noma Department of Gastroenterological Surgery, Okayama University Hospital Yasuhiro Shirakawa Department of Gastroenterological Surgery, Okayama University Hospital Noriaki Manabe Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School Haruhiro Inoue Digestive Diseases Center, Showa University Koto Toyosu Hospital Hiroyuki Okada Department of Gastroenterology and Hepatology, Okayama University Hospital Esophageal achalasia is a disorder of the lower esophageal sphincter muscle. Patients present with dysphagia, chest pain, vomiting, and aspiration. Esophageal achalasia had traditionally been treated with esophageal achalasia balloon dilatation and the Heller-Dor method, but in recent years, the use of per-oral endoscopic myotomy (POEM) has increased. Our patient, a 39-yr-old male, began experiencing dysphagia 4 years prior to his referral to our hospital. Based on the results of esophagogastroduodenoscopy, esophageal radiography and high-resolution manometry, we made the diagnosis of esophageal achalasia (Chicago classification type I) . After informed consent from the patient and his family and approval from our hospital's ethics committee were obtained, we performed a POEM. The patient was discharged on the 4th day post-surgery. At the 1-year post-operative examination, no worsening of symptoms and no relapse were observed. POEM is an excellent treatment method for esophageal achalasia from the perspective of therapeutic effect and prevention of invasion. We recommend that it be considered as the first-choice treatment for achalasia. However, accessibility to the procedure itself is limited due to the few adequately trained operators worldwide. POEM should thus be performed by an expert operator at a high-volume center. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 129 2 2017 家族性大腸腺腫症術後20年後に小腸癌を発症した1例 111 114 EN Yuusaku Sugihara Department of Gastroenterology and Hepatology, Okayama University Hospital Seiji Kawano Department of Gastroenterology and Hepatology, Okayama University Hospital Keita Harada Department of Gastroenterological Surgery, Okayama University Hospital Shiho Takashima Department of Gastroenterology and Hepatology, Okayama University Hospital Daisuke Takei Department of Gastroenterological Surgery, Okayama University Hospital Toshihiro Inokuchi Department of Gastroenterology and Hepatology, Okayama University Hospital Masahiro Takahara Department of Gastroenterology and Hepatology, Okayama University Hospital Sakiko Hiraoka Department of Gastroenterology and Hepatology, Okayama University Hospital Yoshiko Mori Division of Endoscopy, Okayama University Hospital Hiroyuki Kishimoto Division of Endoscopy, Okayama University Hospital Takeshi Nagasaka Division of Endoscopy, Okayama University Hospital Hiroyuki Okada Department of Gastroenterology and Hepatology, Okayama University Hospital A 58-year-old Japanese man visited a local clinic for the evaluation of a stomachache. He was diagnosed with intestinal obstruction. His medical history included a proctocolectomy at the age of 38 years, due to familial adenomatous polyposis (FAP). He was referred to our institution, where he underwent a computed tomography examination and endoscopy of the small intestine. The pathological diagnosis was adenocarcinoma. No invasive or metastatic lesions were observed. Therefore, partial resection of the ileum with lymphadenectomy and reconstruction of the ileostomy were performed. Pathological examination revealed that the tumor was type 2, pT3 (SS) , pN1, pPM0, pDM0, pRM0, INFb, ly1, v1, pEX0, PN0. Twenty-nine days after the surgery, the patient was diagnosed with lung metastasis and he underwent lung radiofrequency ablation. We suggest that long-term follow-up is necessary for patients after surgery for FAP, because of the risk of malignant disease developing in other organs. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 129 1 2017 水素水は怪しい水でしょうか？ 9 15 EN Atsunori Nakao Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 127 3 2015 色素結合薄膜型（岡山大学方式）の人工網膜（OURePTM）の医師主導治験 223 229 EN Toshihiko Matsuo Tetsuya Uchida No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 127 3 2015 血管内皮機能を対象にした基礎および臨床医学研究 187 195 EN Hirokazu Tsukahara No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 125 3 2013 横行結腸憩室穿通による腸間膜膿瘍に対して手術を施行した２症例 235 238 EN Naoaki Maeda Hidenori Kondo We encountered 2 cases of penetration of fecal matter through a diverticulum of the transverse colon, which is a rare disease. Case 1 was a 33-year-old man who was examined in the clinic with a complaint of epigastralgia. Tenderness and muscular defense were found in the upper abdomen. On abdominal CT examination, wall thickening and increased fat concentration were seen in the transverse colon. He was diagnosed with peritonitis and underwent emergency surgery. On laparotomy, a tumor mass was found in the transverse colon close to the liver curvature. The patient was diagnosed with mesenteric abscess due to penetration of fecal matter through a diverticulum of the transverse colon. Right hemicolectomy was carried out. Case 2 was a 43-year-old woman who was examined in the clinic with a complaint of right lower abdominal pain. Muscular defense and rebound tenderness were found in the lower abdomen. On abdominal CT examination, abscess formation was seen in the right lower abdomen. She was diagnosed with peritonitis and underwent emergency surgery. On laparotomy, a tumor mass was found in the transverse colon. The patient was diagnosed with mesenteric abscess due to penetration of the transverse colon associated with a diverticulum. Partial removal of the transverse colon was carried out. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 124 3 2012 高分化型ヒト肝癌由来細胞株“HuH-7” 231 238 EN Hidekazu Nakabayashi Kazuhisa Taketa 高分化型ヒト肝癌由来細胞株“HuH-7”は，1982年にCancer Researchにその樹立を報告した．HuH-7は，当時の岡山大学医学部附属癌源研究施設病理部門（故佐藤二郎教授）の下で樹立し，これまで多くの研究分野で利用され，世界的に有名な肝癌細胞株となっている．本稿では，有用性の高い分化機能を有するヒト肝癌細胞株HuH-7について，肝細胞癌の腫瘍マーカーであるα-fetoprotein（AFP）を中心に，この細胞株を用いた研究分野に関する詳細を紹介する． No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 124 1 2012 ニガウリ抽出物の血糖降下作用に関する文献的考察 15 26 EN Mitsumasa Mankura Yasuko Noda Akitane Mori Diabetes mellitus (DM) represents a global health and economical problem. Many patients with DM in Asia, South America, India and East Africa have traditionally used the water extract of unripe fruits of Momordica charantia (bitter melon) as some form of complementary and alternative medicine. Studies of laboratory animals have shown the beneficial blood-glucose lowering and anti-diabetic effects of this remedy. Some oral components that bring lower blood glucose level have been isolated : charantin (sterol glycosides), charantin (polypeptide) and cucurbine-type triterpenes. Part of their actions are related to AMP-activated kinase and repression of the oxidative stress that is increased in DM. Most clinical reports are not fully convincing due to the lack of randomized control studies. The present article reviews the pharmacological and clinical effects of bitter melon with special emphasis on the anti-diabetic effects, and some effects that would require caution in the context of human trials. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 124 1 2012 ランビエ絞輪周囲のECMによるdiffusion barrier形成と跳躍伝導における役割 1 4 EN Yoko Bekku Yoshifumi Ninomiya Toshitaka Oohashi No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 123 3 2011 生活習慣病治療のパラダイムシフト―慢性炎症を標的とした治療戦略― 197 206 EN Kenichi Shikata No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 43 6 1931 後腹膜腔ヨリ發生セル交感神經形成細胞腫Sympathogoniomノ1例 1451 1460 EN Keisin Oda In unserer Klinik begegnete mir neuerdings ein Fall von sogenanntem Sympothogoniom, den man mit Recht zu dieser Erscheinungsform rechnen kann. Diese Art von Geschwülsten erhielt ihren Namen zuerst von Kohler (1914) und der Ausdruck “Sympathogoniom ” wurde die stehende Bezeichnung für alle solche Geschwülste, die aus dem System der sympathischen Nerven entspringen. Bei der Durcharbeitung der östlichen und westlichen Fachliteratur konnte ich 57 Fälle solcher Geschwülste finden und zusammenstellen. Jedoch fanden sich alle diese Fälle auf dem Gebiet der pathologischen Anatomie. Auf klinischem Gebiet ist der oben genannten Fall der erste. In den meisten Fälle zeigten sick mikroskopische Rosettenfiguren, nestartige Gebilde der Geschwülstzellen, Nervenzellen und Nervenfibrillen von junger Form. Bei meinem Fall konnte ich nicht jedoch weder Nervenzellen noch Nervenfibrillen von junger Form in dem Geschwülstgewebe nachweisen. Als Behandlung sollte man möglichst die Tumoren exstirpieren oder auch versuchsweise Radium anwenden. Die Prognose ist im allgemeinen schlecht. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 47 3 1935 過去10年間ニ於ケル濕疹患者統計 788 796 EN Syuiti Endo Sinzi Miyake In unserer Klinik in Okayama haben wir von Anfang Januar 1922 bis zum Ende Dezember 1931 3367 Ekzemkranken behandelt und haben diese Fälle statistisch bearbeitet. Das Alter der Ekzemkranken war wie folgt: 721 Fälle bei unter dem 5. Lebensjahr, 199 (5.9%) bei 6.-10., 140 (4.2%) bei 11.-15., 152 (4.5%) bei 16.-20., 380 (11.3%) bei 21.-25., 243 (7.2%) bei 26.-30., 249 (7.4%) bei 31.-35., 231 (6.9%) bei 36.-40., 223 (6.6%) bei 41.-45., 182 (5.4%) bei 46.-50., 218 (6.5%) bei 51.-55., 198 (5.9%) bei 56.-60., und 231 (6.9%) bei über dem 61. Lebensjahr. Von den 3367 Fällen waren 1905 Männer (57%) und 1462 Frauen (43%), 2174 (65%) im akuten und 1193 (35%) im chronischen Stadium. Arten des Ekzem: 336 Fälle (15.6%) von ecz. eryth., 963 (44.5%) von ecz. papul., 30 (1.4%) von ecz. vesic., 744 (34.3%) von ecz. pust. und 98 (4.5%) von ecz. squam. Lokalisation: 2231 Fälle (48.4%) am Kopf, 499 Fälle (10.8%) au Hals, 854 Fälle (18.5%) am Rumpf, 574 Fälle (12.4%) an den äusseren Genitalien 374 Fälle (8.1%) an den oberen Extremitäten und 589 Fälle (12.7%) an den unteren Extremitäten. Was die Jahreszeit betrifft, in der die Ekzemkranken unsere Klinik besuchten, so war ihre Zahl grösser im März, April und Mai und geringer im November, Dezember und Januar. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 51 7 1939 Aleukaemische Lymphadenoseノ2剖檢例 1583 1604 EN Sei Kuwabara Erster Fall: Ein 57-jähriger heruntergekommener Kaufmann wurde am 27.11. 1936. in unsere Klinik aufgenommen. Status praesens: Statur mittelgross, Koerperbau mässig, Ernährung sehr schlecht, Haut und Schleimhaut deutlich anämisch, Lippe und Zunge mehr trocken, rechtseicht aufgetrieben, Ascitesflüssigkeit nicht vorhanden, Leber in der Mamillalinie 3 querfingerbreit unterhalb des Rippenbogens derb fühlbar. Aufallendste Befunde waren Lymphdrüsenanschwellungen. Submaxillare, cervicale, axillare und inguinale Lymphdrüsen waren von Taubenei- bis uber Huhnereigrösse angeschwollen, elastisch derb, gut beweglich, nicht so druckempfindlich, sowohl mit der Haut, als auch miteinander nicht verwachsen. Wassermann negativ. Urin normal. Leukozyten 9.200, Hämoglobin 22%, Erythrozyten 3, 420, 000. Das Blutbild ergibt basophile Leukozyten 2%, Eosinophile L. 0%, Stabkernige L. 1%, Segmentkernige L 43%, Lymphozyten 48%, grösse mononukleäre Zellen und übergangsform 5%. Beobachtenswert ist die sehr geringe Vermehrung in der Gesamtzahl der Leukozyten. Eine Lymphdrüse wurde aus der Achselhohle exstirpiert und histologisch untersucht und nur eine Lymphozyteninfiltration konstatiert. Die Lymphknoten waren durch Rontgentherapie sehr verkleinert worden. Der Patient verliess am 12.12. das Krankenhaus, um am 11. 1. 1937. wieder zurückkehren. Seit der Entlassung hatte er wieder Lymphdrüsenanschwellung und hochgradige Schwäche. Exitus letalis am 2. 2. 1937. Bei der Sektion einwandfrei lymphatische, leukaemische Infiltration sowohl in den blutbildenden Organen, wie auch in fast allen anderen Geweben nachgewiesen. Die lymphatische Zellen hatten zweifellos auch das Knochenmark ergriffen, die erythroblastischen Zentren in Mitleidenschaft gezogen und hatten zu einer Blutarmut geführt. 2ter Fall: Ein 23-jähriger Bauer kam am 20. 9. 1937. in einen das Krankenhaus. Vor 5 Monaten bemerkt er am r-Seitenhals einen erbsengrossen Tumor, der sich allmählich vergrössert und vermehrt, aber beschwerdelos verlauft. Seit Monaten mit der Zeit cervicale (1-), submaxillare und inguinale Lymphdrusen. Diese waren von Taubenei-bis über Hühnereigrosse angeschwollen nebeneinander, elastisch derb, nicht so druckempfindlich, mit der Unterlage fixiert, aber mit der Haut nicht verwachsen. Keine Atmungs-und Schluckbeschwerde. Appetit normal. Fieber 37-37.5°C. Urin normal. WaR. negativ. Blutsenkungsgeschwindigkeit 5.5 (1st), 15 (2st). Leukozyten 4.4000, Hamoglobin 90%, Erythrozyten 518, 000. Das Blutbild ergibt Lymphozyten 42%, neutrophile L. 43%, stabkernige L. 5%, Monozyten und übergangsform 9.5%, keine jugendlichforme Leukozyten. Eine Lymphdrüse wurde aus dem Seitenhals exstirpiert und histologisch untersucht und nur eine Lymphozyteninfiltration konstatiert. Die Untersuchung erwiess aleukaemische Lymphadenose. Nach 7 Monaten exitus letalis. Im Vordergrund der heutigen Therapie steht die Strahlentherapie, vor allem Rontgenbehandlung. Wichtig und erfolgreich ist die Arsen-Behandlung. Sie wird angewandt, wenn die Arsentherapie erfolglos und der Allgemeinzustand und das ganze Krankheitsbild einer Behandlung bedürftig ist. Die Rontgenbestrahlung richtet sich hier vor allem gegen die peripheren Lymphdrüsenpakete, aber auch gegen die Milz, selbst wenn sie nicht wesentlich vergrössert ist, weil oftmals erst nach der Milzbestrahlung die Leukozytenzahl zur Norm absinkt, obwohl die Lymphdrüsen vorher schon zuruckgingen. Mit 30% H.E.D. auf jedes Feld, wobei man 1 Feld pro Tag vornimmt und die Leukozytenzahl täglich kontrolliert. Die Intensivbestrahlung, die einen plotlichen tiefen Absturz bringt, ist vollig unzweckmässig, wie auch jede nicht genau kontrollierte Strahlentherapie. Sie kann direkt schädlich seiu dadurch, dass die Leukozytenzahl schnell unter die Norm sinkt und diesem starkem Abfall rasch wieder eine Verschlimmerung und ein höher Anstieg mit Komplikation des roten Blutbildes usw. folgt (Reizwirkung). Die Rontgenbehandlung wird wiederholt, wenn das Krankheitsbild sich wieder verschlechert. Sie hat aber dann möglichst bald einzusetzen und nicht erst bei weitgehender Verschlimmerung. Der Kranke muss also in dauernder Beobachtung bleiben und alle 3-4 Wochen soll ein morphologischer Blutstatus aufgenommen werden. In der Zeit zwischen den eiuzelnen Röntgenbestrahlungen nimmt man zweckmässigerweise Arsentherapie vor. Rezidive treten immer auf. Die Leukaemie ist durch kein Mittel zu heilen. Sie wird vielmehr über kurz oder lang gegen jede Behandlung auch die Strahlenbehandlung refraktär und führt schliesslich unter dem Bild einer akuten Verschlechterung oder durch Komplikationen zum Tode. Die Röntgentherapie muss abgebrochen werden, wenn die Zahl der weissen Blutzellen sehr schnell und tief absinkt, wenn zahlreiche unreife Zellen auftreten, wenn das rote Blutbild aber das Allgemeinbefinden sich unter der Bestrahlung akut verschlechtert, und Gewichtssturz, Durchfälle und höheres Fieber eintreten. Ber vorsichtiger Dosierung und dauernder strenger Kontrolle jeder einzelnen Bestrahlung treten aber derartige Verschlimmerungen erst nach evtl.langjähriger Bestrahlung auf. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 123 1 2011 成人先天性胆道拡張症の6例 39 43 EN Hirotoshi Takashima Akira Sasaki Kaoru Sasaki We report six patients with adult congenital biliary dilatation treated by surgery. Of the six cases, five were female and the patients' age at diagnosis ranged from 19 to 51 years old. By Todani's classification for bile duct dilatation, three were categorized as Ⅰa, one as Ⅰb, and two as Ⅳa. All six cases had anomalous arrangement of the pancreatobiliary duct. Resection of the cystic portion and hepaticojejunostomy (Roux-Y) were performed in all. After surgery, one patient classified as Ⅰa and one as Ⅳa had complications of cholangitis and intrahepatic stones. We removed the stones by the percutaneous transhepatic route with dilatation of the stenotic anastomosis, but cholangitis recurred in the Ⅳa patient. Although surgical resection of the cystic portion and reconstruction of biliary tract is considered to be a standard treatment for adult congenital biliary dilatation, this Ⅳa case had complications after surgical treatment. Thus short-term follow-up is necessary to prevent or diagnose stenotic anastomosis following the operation. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 123 1 2011 十二指腸潰瘍穿孔に対する治療法の適応についての検討 33 38 EN Nobuhiro Ishido Ryuji Tamura Takahiro Okamoto Yoshihiko Kadowaki Takashi Mori Background: Although conservative therapy has been acceptable as the first-line therapy for duodenal ulcer (DU) perforations, surgical therapies are known to have certain advantages. We investigated the indications for laparoscopic (LS) or open surgery (OS) or conservative therapy (CoT) among 56 DU perforation cases over 5 years. Methods: 31 LSs, 22 OSs and 5 CoTs were analyzed for patient's physical and surgical factors and clinical course. Results: Mean age was 51.6. Male/female ratio was 49/9. Survival ratio was 98%. Although the hospital stay (10.9 vs 19.5 days) and analgesic administrations (1.9 vs 4.6 days) were significantly shorter in LS than OS, almost all OS patients were in serious condition as evidenced by longer waiting time before treatment, stronger pain, bigger hole of perforation, more ascites accumulation and higher morbidity of complications. Two cases of multisurgery were experienced in both LS and OS groups due to leakage of seam, abscess formation, relapsed ulcer or idiopathic intestinal perforation. LS is a therapy more widely usable and more beneficial than the other two. Conclusion: LS, a minimally invasive surgery for DU perforation, should be considered as a first-line standard therapy because of significant advantages such as shorter hospital stay. OS or CoT may be selected when appropriate. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 122 3 2010 壁外性に腫瘤を形成し胃・小腸浸潤を示した横行結腸癌の１例 231 236 EN Ryosuke Hamano Shinya Otsuka Yuuji Kimura Manabu Nishie Naoyuki Tokunaga Hideaki Miyasou Yousuke Tsunemitu Masaru Inagaki Kazuhide Iwakawa Hiromi Iwagaki A 77-year-old woman was admitted to our hospital due to abdominal pain and body weight loss. A palpable mass the size of an infant's head was tender on palpation and identified as an epigastric lesion. Colonoscopic examination revealed stenosis of the transverse colon, although no intraluminal growth of the tumor was found. The histologic findings of the biopsy material were poorly differentiated and/or undifferentiated cells. Abdominal CT scan showed an irregular-shaped tumor with a diameter of 10cm invading the stomach and jejunum. We performed an operation under a diagnosis of extramurally growing cancer or malignant lymphoma of the colon. Partial resection of the transverse colon was done by distal gastrectomy and partial resection of the jejunum. Histologic examination of the operative specimens revealed moderately differentiated adenocarcinoma of the transverse colon, prominently proliferating into the surrounding tissues. The finding of a long stenotic lesion and extramural compression by colonography are characteristic of this tumor, based on a review of 43 literature reports in Japan. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 48 1 1994 Ovarian Metastasis in Patients with Colorectal Carcinoma 43 46 EN Jose A Perdomo Akio Hizuta Hiromi Iwagaki Shinji Takasu Yasuyuki Nonaka Toshikazu Kimura Shigemi Takada Luis F Moreira Noriaki Tanaka Kunzo Orita Article 10.18926/AMO/31137 <p>The records of 159 patients who underwent surgical resection of colorectal cancer were reviewed to assess the incidence of ovarian metastasis and to define the role of oophorectomy. Four of these patients presented with metachronous metastases, and one patient had synchronous ovarian involvement. The incidence of ovarian involvement was higher in younger patients. While most patients with ovarian involvement had the primary tumor located at the rectosigmoid region, a similar distribution of the primary tumor was observed in patients without ovarian metastasis. The histological type and degree of differentiation was similar regardless of whether or not ovarian metastasis was present. Of the patient without ovarian metastasis, 57% presented with nodal metastases and 3.2% with peritoneal dissemination, while all patients with ovarian metastasis had nodal and peritoneal involvement. Our results suggest that histological type and degree of differentiation of the primary tumor do not influence likelihood of ovarian metastasis. However, the exposure of the tumor to the serosal surface and the subsequent peritoneal dissemination may be an important route by which malignant tumor cells reach the ovaries. However, due to the wide lymphatic involvement in patients with ovarian metastasis, the lymphatic route may be important as well. Thus, we consider that oophorectomy should be performed in all postmenopausal women, when the ovaries are macroscopically affected, and in premenopausal patients with Astler-Coller B2 tumors or over.</p> No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 43 1 1989 Importance of immunoenzyme histochemical reaction in diagnosis of disseminated intravascular coagulation in human and animal material. 29 38 EN Keiki Hayashi Chao-Liang Hsueh Hideaki Kawasaki Hiroyuki Toyofuku Takanao Miyashima Michiyasu Awai Article 10.18926/AMO/30896 <p>Renal tissues from 208 human necropsies were observed histologically for disseminated intravascular coagulation (DIC). The tissues were stained with hematoxylin-eosin, Mallory's phosphotungstic acid hematoxylin (PTAH) and cationic ferric hydroxide colloid stabilized with cacodylate (Fe-Cac), and tested by immunoenzyme histochemical (IEH) reaction for fibrin-related materials (FRMs). The use of the IEH method increased FRM recognition, and FRMs were detected in a total of 80 cases (38.5%). In 26 cases diagnosed clinically as DIC, FRMs were shown in 23 of the cases (88.5%). Thus, 57 patients with FRMs were clinically asymptomatic. In rats with DIC induced by endotoxin injection, glomerulus FRM was effluxed into the tubulus through the Bowman's capsule and was excreted into urine. The electric charge was reduced on the endothelial surface of the glomerular capillaries in both human and rat DIC. Under the scanning electron microscopy, the endothelial surface appeared coarse in the glomerular capillary and fibrin degradation was present. Our conclusions are: (a) PTAH is non-specific for FRMs, (b) IEH aids the pathohistological diagnosis of DIC, especially in asymptomatic forms including the compensated DIC state, (c) FRMs in tubuli suggest DIC, and (d) DIC is possibly initiated by a reduction in the capillary electric surface charge.</p> No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 43 3 1989 Return to work after heart valve replacement. 185 192 EN Masaharu Shigenobu Yoshimasa Senoo Shigeru Teramoto Article 10.18926/AMO/30890 <p>One hundred patients who underwent heart valve replacement during the years 1977 to 1985 were reviewed an average of 57 months after surgery. The overall rate of reemployment after the operation was 78%. The most important factors influencing the return to work were the employment status before surgery, age at the time of surgery, the number and site of the diseased valve, the preoperative New York Heart Association (NYHA) functional class and the number of times cardiac surgery was performed. These factors were closely related to the optimal timing of heart valve replacement. It was suggested that the rate of return to work and the quality of life would be improved if the heart valve replacement had been performed at an earlier stage of the disease.</p> No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 43 4 1989 Hepatitis B virus markers in patients with schistosomiasis, liver cirrhosis and hepatocellular carcinoma in Khartoum, Sudan. 241 244 EN Tatsuya Itoshima Sulieman S. Fedail Ikhlas Suliman Abbas K. Ali Toshihiro Higashi Takao Tsuji Article 10.18926/AMO/30852 <p>Markers of hepatitis A and B virus were tested in 88 adult Sudanese subjects in Khartoum, Sudan. The subjects consisted of 25 control hospitalized patients, 21 volunteer blood donors, 23 patients with hepatosplenic schistosomiasis, 13 patients with liver cirrhosis and 6 patients with hepatocellular carcinoma (HCC). Antibody to hepatitis A virus was detected in 96% of the total. Hepatitis B surface antigen (HBsAg) was positive in 4, 24, 22, 31, and 67% of the subject groups, respectively. Antibody against hepatitis B core antigen (HBcAb) of undiluted serum was positive in 60, 57, 65, 77 and 83%, and there was no difference in incidence among the groups. It was positive in 200X diluted serum in 4, 24, 17, 23 and 60%. HBsAg and HBcAb (200X) were detected more often in HCC patients than in the control subjects (p less than 0.01). Hepatitis B virus is an important factor in the etiology of HCC in the Sudan.</p> No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属環境病態研究施設, 岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0913-3771 57 1986 膵外分泌機能に及ぼす加齢の影響 ―加齢と糞便中キモトリプシン活性― 24 28 EN Shuji Matsumoto Hideo Harada Koji Ochi Masahiko Takeda Juntaro Tanaka Hiroshi Morinaga Mitsuo Yoshida Ikuro Kimura 10.18926/19662 膵外分泌機能に及ぼす加齢の影響を検討する目的で，健常人43名，非膵疾患患者41名，老人ホーム入居者39名を対象として比色法により糞便中キモトリプシン活性（FCA）を測定し，以下の結論を得た。1）FCAは逐齢的に低下し，60歳以上は60歳未満より有意の低値を示した。しかし，分布図のretrospectiveな検討からは，膵外分泌機能の低下は，実際には65～70歳あたりから明らかになることが示唆された。2）FCAの正常下限値を14.5U/gに定めたが，高齢者の診療にあたってはこの正常値のみを根拠にして疾病の有無を判定すべきではない。3）老人ホーム入居者のFCAは特に低値を取ったがその主要因は高齢者が多いためと考えられた。 No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 121 3 2009 特異的プロモータを用いた目的遺伝子発現システムの開発と癌治療への応用 157 162 EN Takuya Fukazawa Junji Matsuoka Tomoki Yamatsuji Noriaki Tanaka Yoshio Naomoto No potential conflict of interest relevant to this article was reported.

岡山大学医療技術短期大学部 Acta Medica Okayama 0917-4494 9 1 1998 皮膚サルコイドーシスの臨床 ―最近20年間に岡山大学第2内科にて経験した65症例について― 49 57 EN Yasunari Nakata Mikio Kataoka Junichi Hiramatsu Kazunori Okazaki Mine Harada 10.18926/15275 1976年から1996年に岡山大学第2内科を受診したサルコイドーシス255例のうち,65例(71病変)の皮膚サルコイドーシス(皮膚サ症)について,臨床経過,臨床検査成績,胸部病変との関連,予後について検討した｡皮膚サ症患者の年齢は18歳から77歳で中央値は51歳であった｡女性例が42例(65%)と多 く,特に50歳代女性に43%と最も高率であった｡皮膚病型では結節型33例,皮下型16例,び慢浸潤型3例,局面型6例,結節性紅斑様皮疹3例,苔癬様型1例,瘢痕浸潤9例であった｡皮膚サ症では非皮膚サ症に比して気管支肺胞洗浄液中リンパ球の低率が見られたが,その他の臨床成績に差は認められなかった｡皮膚病型別に検討すると,局面型,び慢浸潤型では気管支肺胞洗浄液中リンパ球CD4/CD8比は高く,3年後の皮膚および肺病変の残存率は高かった｡一方皮下型ではCD4/CD8比は低く皮膚,肺病変の残存率も低かった｡ No potential conflict of interest relevant to this article was reported.

岡山大学医学部附属病院三朝分院 Acta Medica Okayama 0918-7839 66 1995 QCTにより測定した骨塩量と骨代謝マーカーについての検討 37 43 EN Kazuhiro Kajimoto Fumihiro Mitsunobu Takashi Mifune Satoshi Yokota Yasuhiro Hosaki Yoshiro Tanizaki Mutsuro Nakai Tsuneo Akiyama 10.18926/15122 当院内科に通院または入院中の女性患者24例(57～89才,平均71.8才)を対象とし,定量的QCT法による骨塩量測定と同時に血中骨代謝マーカーを測定し検討を行った｡年齢についての検討では,カルシウム(Ca)が70才台で60才台に比べ有意に高値であった以外は年代による有意差は認められなかった｡オステオカルシン(OC)とイオン化Ca(Ca(2+))との間にr=-0.50,p<0.01の有意の逆相関を認め,OCとBody mass indexとの間に有意の正の相関(r=0.41,p<0.05)を認めた｡平均骨塩量と各生化学parameterとの間には有意な相関はみられなかった｡副腎皮質ステロイド剤(ステロイド)投与群では非投与群に比べ,投与群でALP骨型アイソザイム(ALP3)高値,OC低値の傾向がみられた｡またステロイド投与症例はすべてOC値が8.4ng/mℓ以下であり,ステロイドによる骨粗鬆症誘発の機序として骨形成の抑制が関与している可能性が考えられた｡今後骨塩量と骨代謝マーカーとの関連について,若年者を含めた検討が必要と考えられた｡ No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 102 3-4 1990 頑痛の発生および抑制に関する基礎的・臨床的研究　第1編　三叉神経脊髄路尾側亜核におけるサブスタンス P およびエンケファリン濃度変動の意義に関する基礎的研究 287 297 EN Noriaki Fujiwara The possible role of substance P (SP) and enkephalin (ENK) was investigated in the mechanism of deafferented pain (DP) and excess pain. The concentration of SP anf ENK was quantitatively estimated with radioimmunoassay using 17 adults cats. The animal were divided into 3 group, DP group (8 cats), EP group (6 cats) and untreated conrol group (3 cats). The DP group was prepared according to the method described by Shimizu and EP model was made by injection 1 ml of Freund's adjuvant subcutaneously into the unilateral face of the cats every day for 3 weeks. The amount of SP in STN markedly decreased in DP group and significantly higher in EP group than with the control group. This is explained by the fact that SP is a neurotransmitter for pain of trigeminal nerve. No significant decrease in ENK in the DP group was observed. This suggests that ENK in STN is not always controlled by the descending inhibitory system, but may be working in the propriospinal system. ENK in the EP group also showed no significant increase. This can be explained not only by the difficulty in estimating the rapid degeneration of ENK, but also by the strong participation of monoamines as well as ENK in pain relief. The role of ENK should not be overstimated and the studies including monoamines will be necessary to detemine the mechanism of pain. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 103 5-6 1991 慢性膵炎の経過と予後に関する研究 第3編 合併症，予後および予後決定因子について 483 494 EN Hirofumi Miyake To investigate complications, prognosis and prognostic factors for chronic pancreatitis (CP), 170 patients with CP (112 with alcoholic CP, nine with biliary CP and 49 with idiopathic CP) were followed up. Pancreatic pseudocysts were found in 29 patient with CP, biliary stenosis in 20 patients, and a peptic ulcer in 26 patients. Determination of whether the abdominal pain is caused by acute exacerbation of CP or by the peptic ulcer is important, because abdominal pain due to peptic ulcer is easily relieved by administration of H2-receptor antagonist. Mild liver damage or chronic hepatitis was observed in 26 patients with CP ; and liver cirrhosis in nine. Duodenal stenosis was found in two patients. Thirty-nine patients with CP died during the follow-up period. Patients with alcoholic CP were significantly younger than those with nonalcoholic CP at the time of death. Thirteen patients died from malignancy which was the most frequent cause of deaths. Sudden deaths were observed in seven patients. Six patients died from pneumonia which was refractory to the intensive medical treatment. Three patients died from diabetic renal failure and three from heart failure. The observed number of CP was significantly higher than the expected number for the sex-age-matched general population in total deaths and cancer deaths. A similar finding was obtained in alcoholic CP. Alcoholic CP showed poorer prognosis than nonalcoholic CP. Contributing factors to the prognosis were age at the time of diagnosis, diabetes, smoking habit, outcome of pain, years at diagnosis in alcoholic CP, whereas they were age at diagnosis, smoking habit and diabetes in nonalcoholic CP. This indicates that abstinence, quitting smoking, and careful treatment for diabetes are important for improving the prognosis of CP. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 102 1-2 1990 一過性虚血後の慢性期ラット脳における生化学的変化に検する研究 129 141 EN Hiroshi Yoshikawa In recent years, cases of sequelae of cerebrovascular disease such as vascular dementia due to death of many neurons have been increasing. Such neuronal death following brain ischemia had been considerd to be due to an energy deficiency resulting from an impaired respiratory chain. However, the detection of the delayed neuronal death showed that neuronal death is not caused by mere energy deficiency. Most previous studies on delayed neuronal death focused on the changes in morphology and energy metabolism in the acute to subacutte stage. There are few reports concerning biochemical changes in the chronic stage, especially in neurotransmitter receptors. Transient ischemia for 20 minutes in a rat four-vessel occlusion model was induced, and serial histological and biochemical changes were evaluated until the chronic stage. Destruction of pyramidal cells in the CAI area of the hippocampus was completed by 10 days after cerebral ischemia followed by recirculation of cerebral blood flow. Light microscopy showed no progression after this day. The level of acetylcholine (ACh) was significantly decreased in the hippocampus, striatum, and frontal cortex at the termination of ischemia but recovered to normal 21 days after recirculation of cerebral blood flow. The binding sites of muscarinic ACh receptors (mACh-R) per usit of protein were increased in the hippocampus 21 days after recirculation of blood flow. However, no changes were observed in the total number of mACh-R in the entire hippocampus. Thuse finings suggest no changes in the ACh neuronal system in the chronic stage and no direct association between this ayatem and delayed neuronal death. On the other hand, N-methyl-D-aspartate (NMDA) receptors, a subtype of glutamate receptirs, showed no change in the hippocampus until after 10 days, but decreased to half after 21 days despite no evidence of histological progression of neuronal death. Thus, delayed neuronal death after transient forebrain ischemia appears to be deu to release of glutamate, an excitatory amino acid. Our findingd show the specific death of neurons with NMDA receptors for glutamate. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 103 11-12 1991 体外循環下における心筋の虚血再灌流に関する検討-h-SOD の効果と至適投与量- 1225 1235 EN Yukio Yamada The efficacy of recombinant human superoxide dismutase (h-SOD) was examined and its optimal dose when given before reperfusion in an experimental canine cardiopulmonary bypass (CPB) model was determined. Mongrel dogs were placed on total CPB for 130 minutes without aortic cross clamping (Group Ⅰ). Others were placed on CPB for 120 minutes aortic cross clamping with intermittent administration of cardioplegic solution and core cooling (Group Ⅱ). Before reperfusion, saline, and 1 mg, 3 mg, 10 mg and 20 mg h-SOD per kilogram were administered via the aortic root as a bolus injection (Group Ⅲ,Ⅳ,Ⅴ,Ⅵ,Ⅶ). Reperfusion after hypothermic global ischemia with aortic cross clamping deteriorated cardiac function (cardiac index, left ventricular maximum dp/dt), increased myocardial water content and increased cardiac enzyme release (creatinine kinase MB isozyme, α-hydroxybutyric dehydrogenase). Administration of 3 mg/㎏ h-SOD significantly ameliorated this reperfusion injury, protected myocardial function early after CPB and gave a desirable peak serum h-SOD concentration. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 103 4 1991 気管支喘息における体液因子に関する研究 第2編 補体系C3 (β(1c/1A)), C4(β(1E)) 値の変動について 435 444 EN Ken Ishibashi Serum C3 and C4 levels were measured in 23 healthy subjects and 105 patients with bronchial asthma, by an immunodiffusion method using M-Partigen Plates. The serum levels of C4 were significantly increased in patients over 60 years old compared to the healthy subjects. The levels of C3 were significantly higher in male cases than in female cases with bronchial asthma. The serum levels of C3 and C4 in asthma patients with infectious type, in severe cases and in cases with steroid therapy were within the normal limits during non-attack periods, but significantly increased during attack periods. In asthmatic patients with mixed and infectious type, and in mild and severe cases, a significant correlation was observed between the serum levels of C3 and C4 during their non-attack periods. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 102 1-2 1990 核 DNA 量による乳癌の悪性度判定ならびに内分泌療法の作用機序の研究―Flow cytometry による解析― 37 49 EN Hiroyoshi Doihara To evaluate for primary breast cancer, flow cytometric DNA analysis has been performed on 105 paraffin-embedded tissues. The S-phase fraction and proliferation index correlated significantly with clincopathological factors, sunh as n-number, tumor size, histological stage and hormone receptors. However, there was no correlation between the level of ploidy and the clinicopathological factors. DNA analysis using flow cytometry was found to be useful for the estimation of prognosis and evaluation of malignancy of breast cancer. The effect of medroxyprogesterone acetate (MPA) on primary breast cancer cell kinetics was investigated by flow cytometry. Nuclear DNA contents were measured in 67 cases. MPA, 1,200mg/day, was orally administered for two weeks in 12 cases (MPA group) and the remain-ing cases (n-MPA group) served as the controls, until the day before operatopn. The DNA histograms were compared between both groups. The mean percentage of G0 + G1 phase was higher and that of S-phase and G2 + M phase, lower, in the MPA group than in the n-MPA group. Especially in estorogen receptor-positive and premenopausal cases, significant differ-ences were present between both groups. These results suggest that MPA could inhibit DNA synthesis with a delay of the cell cycle progression in human breast cancer. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 104 5-6 1992 膠原病肺の病態に関する研究　第2編　膠原病肺における血清中および気管支肺胞洗浄液中 soluble IL-2 receptor の検討 701 711 EN Satoshi Yokota Abnormality of cellular immunity has been reported in the pathogenesis of collagen vascular diseases (CVD). IL-2 and IL-2 receptors play important roles as immunological regulation in CVD. In this study, the soluble forms of IL-2 receptor (sIL-2R) and IL-2 receptor positive lymphocytes (CD25) were analyzed to evaluate the role of IL-2R in the pathogenesis of interstitial pneumonia (IP) of CVD such as RA, SLE, polymyositis/dermatomyositis (PM/DM), and PSS and idiopathic interstitial pneumonia (IIP) as a disease control. High levels of sIL-2R were found in sera of patients with IP of CVD. The level of soluble IL-2R in sera of RA without IP correlated with the disease activity of the joints, while the level of sIL-2R in sera of RA with IP was higher than in that of RA without IP. Soluble IL-2R in bronchoalveolar lavage fluind (BALF) was also measured and the level was higher in IP with CVD. There were fewer IL-2R positive lymphocytes in the peripheral blood of CVD with IP than in the normal controls or IIP cases, although the serum level of sIL-2R was higher in CVD with IP and IIP than in the normal controls. These findings indicate that actibve immunological activities involving IL-2/IL-2R/sIL-2R systems play an important role in the pathogenesis of IP of CVD. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 104 5-6 1992 モルモット鼓膜固有層コラーゲン線維網の三次元的組織構築 : アルカリ水浸軟法を用いた走査電気顕微鏡による観察 561 569 EN Shuji Tasaka Three dimensional organization of the collagen fibril network of the guinea pig tympanic membrane was studied by a modified alkali/water maceration method and scanning electron microscopy. The collagen fibril network of the tympanic membrane is formed of the outer radial fibril bundles and inner circular fibril bundles and additional oblique and parabolic fibril bundles. In the lower half of the tympanic membrane, long radial bundles arising from the umbo and the lower two-fifths of the malleus handle spread radially to blend into the fibrocartilageous tympanic ring. In the upper half portion of the tympanic membrane, short radial bundles run antero- or posterosuperiorly almost paralled with each other connecting the upper three-fifths of the handle of the malleus and the tymanic ring. Oblique bundles running oblique against circular bundles were found only in the inferior portion of the tympanic membrane and the parabolic bundles running parabolically aganinst the circular bundles were observed in the antero- and posterosuperior, anterior and posterior portion of the tympanic membrane. The oblique and parabolic bundles merge with the circular bundles in places but with only a few connections with the radial bundles in the outer layer. At the periphery of the tympanic membrane, circular bundles increase in number to form a thick band of collagen fibrils, annular ligament. Beneath the annular ligament, the radial bundles blend with these special circular bundles. The radial and circular bundles are considered to be the main bundles of the tympanic membrane responsible for the mechanical property to the tympanic membrane. The oblique and parabolic bundles seem to strenghen the connection of the radial and circular fibrils forming a collagen network in the connective layer of the tympanic membrane. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 103 1-2 1991 Deafferentation pain に対する脳深部刺激療法の研究 第1編― Deafferentation hyperactivity に対する神経伝達物質の影響及び下行性抑制系との関係について― 129 146 EN Susumu Tomita Deafferentation hyperactivity (DH) was provoked in the neurons of the subnucleus caudalis of the spinal trigeminal nucleus and the lateral reticular formation in cats by Gasserian ganglionectomy, and was used as a model of peripheral deafferentation pain. The influence of neurochemical substances upon DH was investigated. Neurotransmitters and their antagonists were applied topically around the soma of hyperactive neruons by the microiontophoretic technique, using a 7-barreled glass micropipette. Then the participation of inhibitory amino acids in the descending inhibitory systems, which were activated by deep brain stimulation (DBS), was investigated. Discharges of hyperactive neurons (n=75) were recorded extracellularly and analyzed using a spike density histogram. DH was suppressed by topically injected GABA and glycine, but not by met-enkephalin. The suppressive effects of GABA and glycine were almost completely antagonized by bicuculline and strychnine, respectively. Stimulation of the internal capsule or VPM suppressed DH, and this suppression was not affected by microiontophoretically injected bicuculline or strychnine. Intravenous injection of picrotoxin reduced the suppression, but intravenous strychnine did not. GABA may play an important role as an inhibitory neurotransmitter in the descending inhibitory systems activated by DBS. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 103 1-2 1991 1-Methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine (MPTP)　を用いたパーキンソニズム・モデルマウスにおける脳内神経ペプチドに関する研究 105 116 EN Makio Kawata 1-Methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine (MPTP) has been shown to destroy the nigrostriatal dopaminergic system, inducing biochemical and histopathological changes resembling Parkinson's disease. Biochemical changes, especially changes of neuropeptides were determined 1,2 or 6 weeks after MPTP treatment in various regions of the mice brain. The dopamine (DA) concentration decreased to 22% of the control level in the striatum 1 week after MPTP treatment, but recovered to 50% of the control level 6 weeks after MPTP treatment. The decrease in the noradrenaline concentration was less than that of DA. Amine fluorescence histochemistry revealed, markedly decreased amine fluorescnece in the striatum 6 weeks after MPTP treatment, and this decrease in amine fluorescence was recovered after levodopa treatment. The results of a pole thst revealed the bradykinesia of MPTP-treated mice and it was attenuated b y levodopa and amantadine hydrochloride treatments. Among the neuropeptides tested, somatostatin (SOM) increased 1 week after MPTP treatment in the striatum and the thalamus＋midbrain but decreased 6 weeks after MPTP treatment in the striatum and the hippocampus. In the striatum the decreased SOM recovered with levodopa treatment. Thus, the SOM might be regulated by a dopaminergic system. On the other hand, in the cerebral cortex, while no changes appeared in the SOM concentration after MPTP treatment, the concentration decreased significantly with levodopa treatment. Other neuropeptides such as substance P, cholecystokinin-octapeptide and thyrotropin releasing hormone did not show any significant changes up to 6 weeks after MPTP treatment. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 103 1-2 1991 右冠動脈反応性充血の検討―左冠動脈との比較― 77 84 EN Hirofumi Watanabe Flow reserve of the right coronary artery (RCA) was studied in open-chest dogs and compared with that of the left anterior descending coronary artery (LAD). The maximum percent peak reactive hyperemia (％PRH) of the RCA was greater, and the duration of occlusion that produced one-half of the maximum coronary vasodilation (T1/2) in the RCA was about twice that in the LAD. With an increase in right ventricular MVO2 produced by construction of pulmonary artery or isoproterenol infusion, T1/2 of the RCA was shortened significantly. For estimating the quantitative contribution of the perfusion pressure to coronary flow reserve, we occluded the RCA for 60 sec and the LAD for 30 sec, during which each vessel reached maximum vasodilation with various perfusion pressure in the range of 100 to 20 mmHg. ％PRH decreased with a reduction in perfusion pressure, and perfusion pressure below which the RH abolished was significantly lower in the RCA than the LAD : 32.2±5.7 VS 41.5±5.0 mmHg. Thus, the RCA has a greater flow reserve than the LAD, and lower cardiac work and less extravascular artery compression of the right ventricle would account for this finding. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 103 1-2 1991 無麻酔･無拘束下ラットの出血性低血圧モデルにおける内因性 Thyrotropin releasing hormone (TRH) の血圧維持作用ならびにその作用部位に関する実験的研究 53 63 EN Mineo Miyazaki A pressor effect of TRH in hemorrhagic hypotensive rats was studied. First, TRH (1mg/kg, 2mg/kg, 5mg/kg), its analogue MK771 (0.2mg/kg) and anti-TRH antibody were given intravenously. The change in the mean arterial blood pressure (MAP) was observed. After administration of TRH, MAP rose dose-dependently, and it also rose after administration of MK771. The anti-TRH antibody significantly suppressed the compensatory and reflective increase of MAP following the hemorrhage. This suggested that the endogenous TRH plays an important role in the maintenance of MAP in the hemorrhagic hypotensive state. Next, the same hypotention models were made using adreno-demedullated rats. TRH or anti-TRH antibody was given intravenously. TRH significantly increased MAP, while the anti-TRH antibody suppressed MAP. This indicates that the pressor effect of TRH is not mediated by the adrenal medulla. The endogenous TRH may play its maintenance role of blood pressure via medulla oblongata. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 103 1-2 1991 セボフルレン麻酔の Minimum Alveolar Concentration (MAC) に及ぼす血漿蛋白と笑気の影響に関する実験的研究 41 51 EN Masato Maeta The effects of plasma protein concentration (TP) on sevoflurane plasma protein/gas partition coefficient and of hematocrit values (Ht) on sevoflurane red cell/gas partition coefficient were examined in dogs. Furthermore, the effects of TP and inhalated nitrous oxide on sevoflurane MAC and sevoflurane concentration in blood at 1 MAC were studied in dogs during sevoflurane anesthesia. Snginificantly posotive correlations were noted in vitro between TP and plasma/gas partition coefficient, and between Ht and red cell/gas partition coefficient. However, the change in blood/gas partition coefficient appeared to be affected by TP. Sevoflurane MAC and seveflurane concentration in blood at 1 MAC rose in positive correlation with the rise of TP with or without nitrous oxide in combination, but there was no correlation with Ht. This seemed to be related to the predominancy of sevoflurane to dissolve into the plasma. The sevoflurane MAC and sevoflurane concentration in blood were significantly lower in the 33% nitrous oxide combined group than those in the oxygen alone group, but there was no significant difference between the 66% nitrous oxide combined group and the 33% nitrous oxide combined group. Furthermore, TP affected the sevoflurane MAC but not the nitrous oxide MAC. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 104 3-4 1992 特発性間質性肺炎の病態に関する研究　第1編　臨床集計による特発性間質性肺炎の検討 399 412 EN Michio Fujita Clinical features, laboratory findings including hematological and biochemical exmination, pulmanary function test and chest x-ray findings of patients with idiopathic interstital pneumonia (IIP) were analyzed to determine the response to steroid therapy. Sixty three patients with IIP were analyzed in comparison with 43 patietns of interstitial pneumonia due to various diseases such as collagen disease, tuberculosis and chronic obstructive lung disease. Almost half of the patients with IIP were treated with steroids and improvement of interstitial pneumonia was shown only in the patients given steroid therapy. The improvement with steroid therapy was shown to the 50% in acute form of IIP, 32.1% in chronic form of IIP and 36.8% in total. Furthermore, the response of steroid therapy was better in patients with a relatively high oxygen level and high vital capacity and with no honeycombing on the chest X-ray film. These findings indicate the therapeutic effectivesess of steroid therapy in some patients and it should be started in the early stage of the clinical of IIP to obtain a good response rate. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 104 3-4 1992 血小板凝集能の個体差を考慮した至適抗血小板療法―心臓血管外科手術後遠隔期における検討― 341 354 EN Yoshimasa Tsushima Platelet aggregation was studied on 670 samples of 20 healthy controls and 279 patients in the late period after cardiovascular surgery. Aggregating agents used were 0.5 and 2.0μM ADP as well as 2mM arachidonic acid (AA). Among the healthy controls, a maximum aggregation rate over 18% (ADP 0.5μM) was considered hyperaggregability, those under 47% (ADP 2μM) or under 78% (AA 2mM) consid-ered hypoaggregability. Maximun aggregation rate in patients not given antiplatelt agents widely varied from hyperaggregability to hypoaggregability. There was a positive correlation botween the first sample and the second one gained from each patient. This suggested that individual variation existed on platelet aggregation. Maximum aggregation rate significatly decreased by ticlopidine for ADP and by aspirin for AA. Both ADP and AA should be used for platelet aggregation. Comparison among three groups of different ticlopidine doses revealed that the doses should be decided on the basis of platelet aggregation for each patient. Thrombotic or hemorrhagic complications were observed in only 9 cases. Four of 7 cases of thrombotic complicatiion showed hyperaggregability and only 1 case showed hypoaggregability. Both cases of hemorrhagic complication showed hypoaggregability. These findings suggest that indication for antiplatelet therapy and doses of antiplatelet agent should be decided in consideration of individual variation on platelet aggregation. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 104 3-4 1992 排卵障害における腹腔鏡下卵巣 multiple punch resection の適応について 287 295 EN Yukio Hirano Laparoscopic multiple punch resections were applied on the surface of the ovaries in 38 infertile patients who did not have spontaneous ovulation, and the effects on the clinical aspects of ovulation and gestation, and endocrinological state were examined. The patients were categorized into three groups to determine the indication of this treatment as follows. Group A (n=9) : ovulated under administration of 100mg/day clomiphene. Group B (n=22) : ovulated under administration of 200mg/day clomiphene, failed to ovulate under administra-tion of 100mg/day. Group C (n=7) : failed to ovulate even under administration of 200mg/day. The dose of clomiphene to induce ovulation was reduced in 8 (89%) in group A, 19 (86%) in Group B and 6 (86%) patients in group C. Although no patients became pregnant in group A, 17 (77%) in Group B and 5 (71%) in Group C became pregnant after this treatment. Irre-spective of the good clinical outcome, no endocrinological improvements was found in the results of LH-RH test and serum testosterone leves. These findings suggest that this treat-ment is effective on the patients with severe anovulation, and that this effect is not based on the endocrinological improvement but ont the local mechanical factors. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 104 3-4 1992 インターフェロン並びにインターフェロン誘発剤に関する基礎的・臨床的研究　第2編　急性非リンパ性白血病寛解期における β-Carboxyethylgermanium sesquioxide (Ge-132) の臨床効果 259 266 EN Mitsuhiro Fukumoto The clinieal of Ge-132 in the management of acute nonlymphocytic leukemia (ANLL) patients at remission phase were studied. Twenty-two ANLL patients with complete remission were randomized into Groups A and B. Patients in Group A were treated with the combianation with Ge-132 (2,250mg/day ; p. o daily) and intermittent-alternating chemotherapy 〔daunorubicin, vincristine, cytosine arabinoside and prednisolone (DVCP)/aclarubicin vincristine cytosine arabinoside and prednisolone (AVCP)〕and patients in Groyp B were treated with intermittent-alter nating chemotherapy (DVCP/AVCP) alone. Evaluable patients were 7 in Group A and 10 in Group B. Remission duration and survival time were not significantly different between Groups A and B. (median remission duration ; 5.7 month in Group A vs 8.1 month in Group B/median surival time ; 23.9month in Group A vs 18.3month in Group B) The rates of second remission in relapsed cases were not significantly different between Groups A and B.〔2 of 7,(28.6%) in Group A vs 3 of 10,(30.0%) in B〕Ge-132 did not accelerate the recovery from myelosuppression after intensification with the DVCP regimen. The incidence of liver damage and levels of serum GOT and GPT tended to be lower in Group A than in Group B. In this clinical study the incidence of liver damage tended to be lowere in patients treated with Ge-132. The liver damage which often develops during intensificantion chemotherapy, not only limits the chemotherapy but also causes adverse effects on the quality of life of the patient. In part 1 of this series, Ge-132 was reported to activate the neutrophil chemiluminescence. Ge-132 seems to be useful in the management of ANLL patients not only by the enhancement of the host defense system but also by the prevenation of liver damage. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 104 3-4 1992 インターフェロン並びにインターフェロン誘発剤に関する基礎的・臨床的研究　第1編　インターフェロン並びにインターフェロン誘発剤の好中球 Chemiluminescence に及ぼす影響 247 258 EN Mitsuhiro Fukumoto To evaluate one the effects of interferon (IFN) and its inducers on neutrophil functions neutrophil chemiluminescence (ChL) was assayed on 31 healthy individuals, nine patients treated with IFN-α (human lymphoblastoid interferon, 3×10(6)units/day i. m. daily) and 11 patients treated with Ge-132 (2,250mg/day p. o. daily). The base lines (BLs), peak levels (PLs) and times to PLs (PLs) of neutrophil ChL were examined before, one week and one month after the treatment. The direct effects of IFN-α, Ge-132 and OK-432 on neutrophil ChL were also evaluated by using an in vitro experimental system. PLs were significantly increased one week after the treatment with IFN-α or Ge-132. However, they were decreased to the pretreatment level one month after the treatment. In vitro experimental system IFN-α enhanced PLs of neutrophil ChL showing dose and time dependencies. On the other hand Ge-132 and OK-432 showed no direct effect on neutrophil ChL in vitro. These findings suggest that IFN-α and Ge-132 enhance the host defense mechanism by the activation of neutrophil functions, and also suggest that they have some benefits not only in the clinical management of cancer but also of chronic infection. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 104 11-12 1992 サルの L-Dopa-induced dyskinesia に対する Ceruletide の長期効果 1173 1187 EN Masayuki Mizobuchi The long-lasting effects of ceruletide(CLT), a cholecystokinin-8(CCK-8) analogue, on involuntary movements were investigated. Nine monkeys were used. One group(6 monkeys) received unilateral lesions to the ventromedial tegmentum(VMT) of the midbrain. The second group(3 monkeys) served as controls. Hypokinesia was produced after lesioning of the VMT. Administration of a large amount of L-Dopa or direct intracaudate injection of dopamine(DA) relieved the symptoms initially but then induced dyskinesias later. Two monkeys with reproducible dyskinesias were chosen for further study. Systemically administered CLT combined with L-Dopa improved the hypokinesia without inducing dyskinesia. These effects of a single dose of 50 μg/kg CLT continued up to 9 days. Direct combined administration of CLT and DA into the dorsomedial part of the head of the caudate nucleus ipsilateral to the VMT lesion improved the hypokinesia without inducing dyskinesia. The effect of a single direct injection of 20 ng/kg CLT persisted for 3 days. The long-lasting effects of systemically and directly administered CLT were confirmed. These findings suggest that CLT modulates the DA system indirectly through the central CCK system, especially in the dorsomedial part of the head of the caudate nucleus. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 103 7-8 1991 骨髄異形成症候群におけるヒト赤芽球トランスフェリン受容体発現に関する研究　第2編　骨髄異形成症候群におけるトランスフェリン受容体発現の特徴について 879 888 EN Ritsurou Tsuyuno Expression of TfR on the cell surface is known to be regulated by the cellular iron content. We previously reported an inverse correlation between mean number of TfR expressed and stainable iron granules (SIGs) of erythroblasts (EBLs) in normal subjects. In MDS, EBLs contain an increased number of SIGs, though the mechanism of this phenomenon is not well understood. In this report, expression of surface transferrin receptor (TfR) on bone marrow EBLs was examined in comparison with the number of SIGs in 11 patients with myelodysplastic syndrome (MDS) and 11 patients with acute leukemia (AL). The mean numbers of TfR from MDS (5.56±1.35x10(5)) and AL (5.73±2.25x10(5)) were not different from those of normal subjects (5.00±1.80x10(5)). However, in MDS the mean number of TfR from 8 patients (72%) was similar to the normal level in spite of the increased mean number of SIG. Four of the 11 patients with AL showed a similar change such as MDS in TfR, but notably 2 of those 4 patients were AL transformed from MDS. There is a correlation (r＝0.61) between TfR and MCV in MDS different from that in healthy subject. These findings suggest that TfR expression on EBLs, from MDS may escape from the regulation by the cellular iron content as iron-TfR regulation disturbance. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 104 11-12 1992 ハロタンのラット肝ミクロソーム中チトクロームP-450に及ぼす影響 1033 1046 EN Yukio Ido Hepatic microsomes were collected from male rats in which hepatic microsomes enzymes were induced by phenobarbital (PB) and untreatend rats. Microsomes were deoxygenated by vacuum-freezing and exposed to 2% or 10% halothane and then incubated in a 37℃ bath for 5 or 20 minutes. Microsomal enzyme contents and enzyme activities were measured. The contents of cytochrome P-450 were decreased in PB-induced microsomes (PB-microsomes) and the decrease wes greater with 10% halothane or 20-minute incubation than with 2% halothane or 5-minute incubation. The contents of cytochrome P-450 in non-PB-microsomes were also decreased by 10% halothane. Heme contents were decreased in PB-microsomes by 10% halothane, and in non-PB-microsomes by 20-minute incubation with 2% halothane. The activities of aminopyrine demothylation were decreased both in PB and non-PB-microsomes and the decrease was greater with 10% halothane. The activities of aniline hydroxylation were decreased in PB and non-PB-microsomes, and after 20-minute incubation. The contents of cytochrome b(5), the tetrabutylic acid reacting substances and the activities of cytochrome P-450 reductase were not changed. The decreases of microsomal cytochrome P-450 and microsomal enzyme activities by halothane exposure in deoxygenated states might be related to hepaitc injury following halothane anesthesia. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 104 9-10 1992 肺癌における簡易式一時バイパス法を用いた大動脈合併切除の一例 923 929 EN Fumiyuki Inoue Yasuaki Kamikawa Yoshio Naomoto Akira Gouchi Kunzo Orita Takato Hata Masahiko Kuinose Hirofumi Nanba Gyou Taniguchi Left pneumonectomy and concomitant resection of the invaded aorta were performed by the simple temporary bypass method. The patient was a 59-year-old male with the chief complaint of left thoracic pain. The 57×43×35 mm tumor was in a region centering on segment 6 of the left lung and had infiltrated the descending aorta. It was diagnosed as T4NOMO, Stage IIIb. A bypass for blood flow was established between the aortic arch avobe the invasion and the left femoral artery, after ligation of the pulmonary artery and vein and closure of the left bronchial stump. Vascular blocking forceps were applied to the descending aorta above and below the tumor infiltration, and two thirds of the circumference of the invaded aortic wall, 4.0×3.0 cm, along with the tumor, was resected. Reconstruction was performed with an 18mm Cooly double velour graft. Blood pressure was monitored with a pressure probe inserted into the right femoral artery. It did not fall below 60 mmHg during the operation. Local recurrence was observed 10 montns post-operatively, and the patient is now receiving radiation therapy. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 104 9-10 1992 肺小細胞癌化学療法実施例における重複癌の発生に関する研究 915 922 EN Kenichi Miyake Development of double cancer was evaluated in 337 small cell lung cancer patients who had received intensive chemotherapy with or without radiotherapy. Of them, 14 patients (4.2%) developed a second malignancy: non-small cell lung cancer in six, stomach cancer in four, acute myelogenous leukemia in two, liver cancer in one, and esophagus cancer in one. The relative risk for the development of double cancer calculated by person-year method utilizing age and sex adjusted cancer incidence in Japan was 2.75-fold (P<0.01). The risk of non-small cell lung cancer (8.75-fold) and acute myelogenous leukemia (37.82-fold) was particularly high. The cumulative risk for the development of double cancer was 2.0% at 1 year, 4.1% at 2 years, 14.3% at 3 years, and 100% at 8.1 years. Of 27 patients who survived disease-free for more than 2 years, 10 patients died; five patients (50%) died of double cancer, two died of infectious disease, and only three patients died from recurrent small cell lung cancer. These findings indicate that a cautious follow-up program for the detection of double cancer is indicated in patients with small cell lung cancer. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 104 9-10 1992 組織培養法を用いた肺癌の細胞生物学並びに治療に関する研究 第1編 Human Tumor Clonogenic Assay を用いた制癌剤感受性試験の検討―肺癌を中心として― 897 904 EN Nobuyasu Kishimoto The selection of a series of effective drugs for individual patients in advance of drug therapy should increase the success of cancer chemotherapy. The human tumor clonogenic assay was evaluated as a drug sensitivity test mainly in patients with lung cancer. Tumor cells from malignant pleural effusion, tumor-positive bone marrow aspirates, and tumor tissues from the primary or metastases were used as sepcimens. Prior to plating, tumor cells were exposed to 4-hydroperoxy ifosfamide, adriamycin, mitomycin C, methotrerxate, and cisplatin for one hour at graded concentrations which were achievable in man. Of 151 specimens tested, 93(62%) yielded at least 5 colonies in the control plates containing no durgs. Colony growth (≧5/plate) was seen in 80% of squamous cell carcinoma, in 73% of small cell carcinoma, in 62% of adenocarcinoma, and in 40% of large cell carcinoma. Among the 93 specimens with colony growth, 62 yielded more than 30 colonies in the control plates and were put in force for drug sensitivity testing. Of 37 instances in which the clinical response to a certain drug was examined, 34(92%) showed an in vitro-in vivo correlation, showing a true positive rate of 57% and a true negative rate of 100%. In summary, the human tumor clonogenic assay would be an excellent technique for testing the drug sensitivity of the tumor in individual patients tumor. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 104 1-2 1992 慢性関節リウマチ患者における大腿骨頸部骨折の臨床的ならびにX線学的研究 63 74 EN Masahide Kawamura Clinical and radiological studies were performed on 58 patients with rheumatoid arthritis (RA) who had sustained 64 femoral neck fractures. All but one patietns werre female, the mean age was 66.5 years, and mean duration of RA was 17 years. Only 3 hips showed rheumatoid changes. Sixteen fractures of 14 patietns were spontaneous fractures without trauma. Ipsilateral total knee replacements were performed on 5 patients with spontaneous fractures. Results of treatment were analyzed on 47 fractures in 43 patients that could be followed up for more than 1 year (mean 42 months). Clinical results were evaluated by ability of ambula-tion and complications such as nonunion and avascular necrosis of the femoral head. All 4 fractures treated conservatively and 5 of 9 displaced fractures treated by internal fixation developed complications. Femoral head replacements had a high rate of proximal migration (23.8%) and distal migration (76.2%), and ambulation ability was lowered significantly in 10 patients with distal migration for more than 5 mm. On the other hand, satisfactory results were obtained on all 6 fractures treated by total hip replacements (THR). THR is advisable for tratmetn of displaced femoral neck fracture in patients with RA. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 104 9-10 1992 脳静脈環流障害に関する実験的研究 871 884 EN Toshikazu Saijo A new experimental model of cerebral venous occlusion was developed and the cerebral hemodynamics and water content using this model were studied. An anatomical study of the cerebral venous system using methacyrl resin showed that the venous system was composed of superficial and deep veins. The superficial veins drained into the superior sagittal sinus (SSS). The SSS was connected to internal and external jugular veins via the transverse sinuses and diploic veins (DV), respectively. The cats were divided into three groups on the basis of the occlusion sites as follows ; Group I : SSS occlusion, Group II : DV occlusion, Group III : occlusion of both the SSS and DV. Intracranial pressure (ICP) and cerebral blood volume (CBV, photoelectric method) were monitored continuously. Local cerebral blood flow (1-CBF) and water content were measured by hydrogen clearance and gravimetric methods, respectively. Somatosensory evoked potential (SEP) was also recorded. Evans blue was injected intravenously to evaluate blood brain barrier permeability. There were no siginificant changes in ICP, 1-CBF or N1 latency of SEP after the occlusioon in Group I or II. However, in Group III, 1-CBF decreased significantly 2 hours after the occlusion as ICP increased gradually. N1 latency of SEP was prolonged and water content increased significantly. CBV increased immediately after the occlusion. There was no extravasated Evans blue. The increase in CBV and water content during sinus occlusion appeared to have led to intracranial hypertension and decrease of 1-CBF, which resulted in neural dysfunction. The brain edema in this model seemed to be hydrostatic edema or cytotoxic edema. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 106 5-6 1994 間質性肺疾患の病態に関する研究―気管支肺胞洗浄液中サイトカインの検討― 641 654 EN Keisuke Sugimoto Various cytokines are known to participate in the pathogenesis of interstitial pneumonia follewed by lung fibrosis due to the proliferation of fibroblasts and production of collagen fibers. Patients with interstitial pneumonia including idiopathic interstitial pneumonia (IIP) and interstitial pneumonia with collagen vascular disease (IP with CVD) were examined by bronchoalveolar lavage (BAL). Cytokines such as IL-1α,　TGF-α, and TGF-β in BAL fluid were measured by enzyme linked immunosorbent assay (ELISA). The concentrations of TGF-α and TGF-β in BAL fluid of patients with IIP and IP with CVD were higher than those of normal control, while IL-1α, in BAL fluid was detected in few patoents. The level of TGF-β in BAL fluid was higher in patients with greater decreases in pulmonary function and overt fibrosis on chest X-ray film, although TGF-α was higher in patients with milder disorders. The concentrations of TGF-α and TGF-β showed positive correlation with soluble IL-2 receptor as well as procollagen type Ⅲ in BAL fluid. These results indicated that cytokines regulationg lung fibrosis play important roles in the pathogenesis of interstitial pneumonia. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 104 7-8 1992 難治性喘息における好中球の役割に関する研究　第1編　好中球からの Leukotrienes 産生能及び superoxide 産生能に関する検討 763 775 EN Ikki Shimizu The role of neutrophils migrated in the sputum and bronchoalveolar lavage fluid of intractable asthmatics is not difficult to understand. The production of leukotrienes (LTs) and superoxide stimulated by the calcium ionophores (CaI) from neutrophil-rich fraction of 29 intractable, 70 non-intractable asthmatics and 18 healthy subjects was examined by high performance liquid chromatography and a cytochrome C reduction method. Significantly larger amounts of LTC(4) and LTB(4) were produced by CaI in the neutrophil-rich fraction from asthematics, than in that from the healthy subjects (p<0.01). Moreover, a significantly larger amounts of LTC(4) was producted in the fraction obtained from the intractable asthmatics than in that from the non-intractable asthmatics (p<0.05). However, there was no significant difference in LTB(4) production between the two groups of asthmatics. The production of superoxide by concanavalin A was significantly increased in the neutrophil-rich fraction from prednisolone-within-10mg-dependent asthmatics than in those from prednisolone-over-10mg-dependent patients (p<0.01). There were correlations between the LTC(4) and LTB(4) production, and also between LTB(4) and superoxide production. LTs and superoxide released from inflammatory cells, especially neutrophils, may play an important role in the pathgenesis of intractable asthma. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 104 7-8 1992 実験的閉塞性黄疸および肝循環障害における血清と胸管リンパ液組成の変動に関する研究 747 761 EN Yuzo Ueda A long-term study on the chemical and physiological changes of serum and thoracic-duct lymph in the dog with a ligated common bile duct and/or artificial liver circulation was performed. The influencee of ligation of the common bile duct appeared earlier in the thoracic-duct lymph than in the serum. The portal pressure did not increase in the dog with a ligated common bile duct, but the lymph flow of the thoracic duct was 3 times that before ligation, which would prevent the rapid stagnation of bile pigment in the liver. The portal pressure was not elevated after ligation of the hepatic artery. The cholesterol level in the thoracic-duct lymph was about half of that in the serum. In the dog with ligature of the common bile duct, the serum total cholesterol level was elevated with the elevation of serum bilirubin, whereas that in the lymph of the thoracic duct was not elevated with the elevation of the bilirubin level in the lymph. These findings suggested that cholesterol would not easily enter into the lymphatic route. The serum GPT level increased during the first week after ligation of the hepatic artery, and decreased thereafter. However, after ligation of the common bile duct, the GPT level increased for several weeks after the first week of ligation. The pattern of GPT by both ligations seemed to be cross-crossed. The marked change in the total bilirubin level in the lymph of the thoracic duct suggested its close relation with the lymphatic system. It was proved possible to secure a tube into the thoracic duct for over three weeks by the use of a U-type connector and jacket-type plaster cast. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 103 7-8 1991 気管支喘息における好酸球動態の調節に関する研究　第1編　喘息患者末梢血単核球由来の好酸球遊走因子（ECF）の解析 779 789 EN Hisaho Takahashi Eosinophilic infiltration in bronchial tissue is characteristic in the pathogenesis of bronchial asthma. The eosinophil chemotactic factor (ECF) derived from mononuclear cells has been reported to have some effect on the cell infiltration, and interleukin-5 (IL-5), a lymphokine derived from T lymphocytes, to be a factor related to growth, chemotaxis and activation for eosinophils. Lymphocytes accumulated in the bronchoalveolar lavage fluids of non-atopic and severe asthmatics have been shown to be highly responsive to Candida antigen, and high ECF production was observed in non-atopic and severe asthmatics by measurement of ECF activity in the supernatant of peripheral blood mononuclear cells cultured with Candida antigen. In this report, the molecular weight by gel filtration and inhibition test using anti-murine IL-5 antibody were studied to characterize the lymphocyte-derived ECF. Gel filtration analysis of the ECF indicated a molecular weight of 20,000 to 65,000 Da with a peak of activity around 40,000 to 50,000 Da. The ECF activity was reduced by incubation with anti-murine IL-5 antibody, which suggests that the supernatant contains IL-5. ECF from mononuclear cells, containing IL-5, may play an important role in the pathogenesis of eosinophil infiltration in non-atopic and severe asthmatics. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 105 5-6 1993 びまん性汎細気管支炎の病態に関する研究　第2編　びまん性汎細気管支炎患者の免疫能 619 628 EN Takamasa Shiraishi Various immunological processes are suspected of having some relationship with the onset of diffuse panbronchiolitis (DPB). Therefore, the cellular and humoral immunity of patients with DPB were studied. Sera of patients with DPB showed a high frequency of positive RA factor and high titer of cold agglutinin. Delayed skin tests with phytohemagglutinin (PHA) and purified protein derivative (PPD) in patients with DPB revealed normal responses to PHA as nonspecific mitogen and suppressed responses to PPD as specific antigen, although lymphocyte blastogenesis in vitro showed suppressed responses to PHA. The proportion of lymphocytes in bronchoalveolar lavage (BAL) fluid of DPB patients equaled that of normal controls. Furthermore, the CD4/CD8 ratio of T-cell subsets in BAL fluid of DPB patients were significantly lower than that of normal controls, although the CD4/CD8 ratio in peripheral blood of DPB were significantly higher than that in normal controls. The percentage of B-cells in the peripheral blood of DPB patients was hihger than that in normal controls. These data suggest that the activation of cellular and humoral immune mechanisms could play an important role in the pathogenesis of DPB. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 105 5-6 1993 びまん性汎細気管支炎の病態に関する研究　第1編　びまん性汎細気管支炎患者の気道細胞反応 611 618 EN Takamasa Shiraishi Diffuse panbronchiolitis (DPB) is known as a chronic progressive inflammation of the peripheral airway followed by lethal respiratory failure. Bronchoalveolar lavage (BAL) was performed to clarify the pathogenesis of DPB compared to chronic bronchitis. The recovery rate of BAL fluid in DPB decreased, but total cell count increased enormously. Furthermore, increased proportions of neutrophils in BAL fluid from DPB patients was characteristic and included a relative decrease in alveolar macrophages. Patients with DPB were classified based on the presence or absence chronic airway infection with Pseudomonas aeruginosa. There was no significant difference in cellular components of BAL fluid among the patients with or without Pseudomonas infection. Patients with DPB showed both obstructive and restrictive ventilatory disturbances. There was no correlation between parameters of these respiratory functions and total cell counts or various cellular proportions in BAL fluid. Infiltrating cell density around bronchioles of patients with DBP was measured. Significantly higher cell density was shown in patinets with DPB compared to other disease controls. There were also significant negative correlations between cell density and respiratory parameters such as % vital capacity, % V50 and % V25. These results indicate that remarkable increase in neutrophils in BAL fluid and the marked cell infiltration around bronchioles in DPB patients could play a crucial role in the pathogenesis of DPB. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 103 7-8 1991 教室における直腸癌側方リンパ節転移の検討 741 747 EN Hiromi Iwagaki Sadanori Fuchimoto Fumihiro Hamada Shigeo Shiiki Yoshimasa Yasui Nagahide Matsubara Yoshihiro Akazai Tetsuya Watanabe Akira Gouchi Akio Hizuta Yasuaki Kamikawa Kunzo Orita The records of 182 consecutive rectal carcinomas treated in this department between JAN 1978 and DEC 1990 were reviewed to assess the outcome of the patients presenting with lateral pelvic lymph node infiltration. Lateral lymph node dissection was carried out in 24 (42.1%) of the 57 Ra tumors and 63 (72.4%) of the 87 Rb tumors, but in none of the 38 cases of Rs tumors. Lymph node involvement was detected 0% and 15.9% of the Ra and Rb tumors, respectively. In this series, none of the cases in which the tumors were confined to m, sm and pm had positive lymph nodes. However, 23.3% of the 43 cases in which invasion was beyond pm showed positive lymph node invasion. The main lymph nodes involved were located in the roots of the middle rectal arteries. Half of the patients presented with distant metastases within one year, with poorer prognosis considering the mean survival rate of 1.8 years. In conclusion, we advocate that in Rb rectal tumors with circular invasion or invasion beyond the pm, careful lateral lymph nede dissection should be carried out. On the other hand, we suggest the use of preoperative radiation therapy which could improve the curability, the disease-free interval, and survival rates. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 105 5-6 1993 甲状腺腫瘍の核DNA量と生物学的悪性度に関する研究 475 487 EN Yuji Onoda To evaluate the biological malingnacy of differentiated thyroid cancer, we determined the nuclear DNA content in thyroid tumors by flow cytometry using paraffin-enbedded materials. The subjects were 80 patients with thyroid tumors. The thyroid tumors were follicular adenoma in 11 cases and thyroid cancer in 69 cases. Of the 69 cases of thyroid cancer, 42 were histologically classfied as papillary carcinoma, 18 as follicular carcinoma, 3 as medullary carcinoma and 6 as anaplastic carcinoma. DNA ploidy pattern and the percentage of proliferating phase cells were analyzed in relation to the prognosis and the following clinicopathological findings : age, gender, histological type, tumor size (t), extrathyroidal invasion (Ex), lymph node metastases (n) and distant metastases (M). DNA ploidy pattern correlated with histological type (p<0.005), but did not correlate with other clinicopathological findings. The percentage of prolipherating phase cells correlated with age (p<0.01) and the histlogical type (p<0.05), but did not correlate with other clinicopathological findings. The percentage of proliferating phase cells correlated with age (p<0.01) and the histological type (p<0.05), but did not correlate with other clinicopathological findings. The comulative survival rate (Kaplan- Meier) of differentiated carcinomas was worse in the aneuploid group than in the diploid group (p<0.0001). the percentage of proliferaging phase cells increased as the prognosis deteriorated. The results suggest that flow cytometric DNA analysis may be useful to evaluate biological malignancy of thyroid tumors. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 106 5-6 1994 塵肺症におけるHTLV-Ⅰ感染の検討―悪性腫瘍との関連を含めて― 461 471 EN Takashi Sasaki The pathogenesis of pneumocniosis following exposure to inorganic dust remains obscure. HTLV-Ⅰ, known as a cause of adult T cell leukemia, has been reported to participate in various interstitial lung diseases. So, HTLV-Ⅰ infection in patients with pneumoconiosis was inves-tigated by detecting anti-HTLV-Ⅰ antibodies by the indirect immunofluorescent methoh and the pX gene by polymerase chain reaction (PCR) and Southern blotting. Furthermore, various malignancies in pneumoconiosis were also analyzed in relation to HTLV-Ⅰ infection. Three of 24 patients (12.5%) demonstrated anti-HTLV-Ⅰ antibodies. Four of 5 patients includ-ing the 3 patients with antibodies demonstrated the pX gene. Various malignant diseases including myelodyspastic syndrome and lung cancer showed a higher incidence in patients with HTLV-Ⅰ infection than in those without HTLV-Ⅰ infection. These findings indicate that HTLV-Ⅰ infection could play an important role in the path-ogenesis of pneumoconiosis and complications of malignancy. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 106 3-4 1994 OK-432による悪性リンパ腫のinterferon-γ (IFN-γ)産生能に関する研究 335 347 EN Seiji Saito OK-432, a streptococcal preparatopn, is a potent inducer of interferon-γ (IFN-γ) which is known to modulate the immune response. The OK-432-induced IFN-γ production of peripheral blood mononuclear cells (PBMC) was examined in 98 patients with malignant lymphoma, The PBMC were incubated in RPMI-1640 containing 0.1KE/ml OK-432 for 48 hours and the IFN-γ secreted in the supernatant was measured thereafter. Patients at diagnosis or those with relapsing disease showed a decreased production of IFN-γ compared with the healthy controls (P<0.001). The production at diagnosis was related to the clinical stage. The production was significantly decreased immediately after multi-drug chemotherapy. However, it recovered to the level of the healthy controls, once a patient achieved a complete response. At diagnosis, 13 of the 32 patients with non-Hodgkin's lymphoma showed low IFN-γ production. These patients responded poorly to chemotherapy or had early relapse. The 2-year actuarial survival rate was 54% for these patients and 92% for the remainder. There was no decrease in IFN-γ production after chemotherapy in patients treated with G-CSF. These findings suggest that measurement of OK-432-induced IFN-γ production is useful for evaluating the immunological status and predicting the prognosis in patients with malignant lymphoma. They also suggest that G-CSF affects the IFN-γ production in vivo. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 105 1-2 1993 完全全脳虚血後の脳障害に対する炭酸リチウムの効果に関する研究 205 216 EN Yutaka Yaida The efficacy of lithium carbonate (Li) in preventing ischemic brain injury was evaluated in 36 dogs in a vegetative state. The dogs were subjected to 18 minutes of complete global brain ischemia and diveded into the following three groups ; control group (n=12), L-Ⅰ group (n=12), and L-Ⅱ group (n=12). In the L-Ⅰand L-Ⅱgroups, dogs were administered Li (10mg/kg) immediately after the end of ischemia (post-treatment). Only in the L-Ⅱ group, dogs were administered Li (100mg/kg) orally one day before the ischemic insult (pre-treatment). In each group, nuerologic outcome was evaluated for seven days after ischemia, and morphological changes in hippocampal CA1 pyramidal cells, small to medium-sized striatal neurons and cerebellar Purkinje cells were evaluated at day seven. In the L-Ⅱ group, neutrologic outcome was significantly better than that in the control group, and morphological improvement was recognized. Pre-treatment with Li might improve both neurologic and morphologic outcomes due to powerful inhibition of the stimulated phosphoinositide turnover during ishchemia. These fingings suggest that the stimulated phosphoinositide turnover during and immediately after ischemia might play an important role in brain injury induced by 18 minutes of complete global brain ischemia. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 105 9-10 1993 HTLV-I 関連細気管支・肺胞異常症 (HABA) における肺組織中 ADF の検討 859 869 EN Tomoki Kitamura ATL-derived factor (ADF) is an acid protein, molecular weight about 13KD, which is related to cell classification, activation, and various viral infections. The localization of ADF was studied in the lung tissues of HTLV-I associated bronchiolo-alveolar disorder : HABA, diffuse panbronchiolitis : DPB, and idiopathic interstitial pneumonia : IIP. The localization of ADF in the lung tissues was demonstrated by immunohistochemical staining with anti-ADF antibody as the first antibody, which was made by affinity purification. In all 4 cases of HABA, one of 6 cases of DPB, and two of 5 cases of IIP, staining of the lung tissue was positive. ADF was demonstrated in the bronchial epithelia, alveolar epithelia, vascular endothelia, and desquamative cells in HABA cases as the result of the study. ADF was also restrictively demonstrated in bronchial epithelia in DPB and IIP cases. The case of DPB in which ADF was demonstrated also showed positive HTLV-I related reaction. In conclusion, the localization of ADF in the lung tissues was demonstrated in HABA, DPB and IIP, suggesting immunological abnormalities based upon infections from HTLV-I or a related retrovirus. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 106 11-12 1994 びまん性汎細気管支炎の病態に関する研究―エリスロマイシンの作用機序を中心に― 1143 1157 EN Shoichiro Irie DPB has been known as a chronic respiratory infection with poor prognosis until introduction of erythromycin (EM) therapy with low-dose and long-term administration. As symptoms and prognosis of DPB were improved enormously under EM therapy, EM therapy on DPB was analyzed to clarify the action and mechanisms. EM in a daily dese of 600 mg was administered to 9 patients with DPB for about 38 months and 7 normal volunteers for 2 months. Most patients with DPB showed the relief of symptoms within 2 months, although the EM concentrations in the blood and sputa were lower than the antibacterial therapeutic level. Immunological examination revealed the decrease in cold agglutinin titer and CD4/CD8 ratio after EM therapy. The neutrophil chemotactic factor (NCF) derived from the mononuclear cell culture of DPB patients was higher than that in the normal control. EM therapy decreased the level of NCF not only in patients with DPB but also in normal volunteers. These findings indicate that the immunological effects of EM play an important role in the treatment of DPB. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 106 11-12 1994 担癌マウスならびに胃癌患者における Cyclophosphamide と Indomethacin による薬物学的摘脾効果の可能性，および外科的摘脾と免疫化学療法併用に関する研究 1125 1142 EN Jiro Yui Using tumor-bearing C(3)H/He mice, in which syngeneic MH-134 tumor cells were transplanted into the back subcutaneously, the possibility of drug-induced splenectomy using cyclophosphamide (CY) and indomethacin (INDO), the timing of chemo- and immuno-therapy, and the usefulness of the combination of surgical splenectomy with immunotherapy were investigated. In patients with gastric cancer, the significance of splenectomy and its combination with immunochemotherapy was also studied. The administration of CY in mice on day 3 after tumor transplantation in the initial stage of the tumor prolonged the survival time, while INDO under the same condition shortened it only when administered on day 3 after transplantation. The administration of an immunopotentiator, OK-432, prior to CY administration shortened the survival time, compared with that of single administration of CY, whereas the OK-432 administration on day 2 after the administration of CY prolonged the survival time. In the immunochemotherapy in which CY was administered on day 7 after transplantation of tumor and OK-432 was given every two days after additional 2 days, the anti-tumor effect of drug-induced splenectomy was not observed as judged from the tumor proliferating curve, but the splenectomy on day 3 after tumor transplantation, in the initial stage of the tumor, prolonged tne survival time. Similar results were observed, when INDO was used instead of CY. The concomitant splenectomy in the initial stage of gastric cancer resulted in a more effective prolongation of survival time. In the cases with adjuvant immunochemotherapy, preservation of the spleen in advanced cancer and splenectomy in the terminal stage of cancer were found to be preferable for effective prolongation of the survival time. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 105 7-8 1993 PCR-RFLP 法による HLA-DNA-DQ タイピングと腎移植 715 731 EN Keiichi Hirakawa Two methods of HLA-DNA typing (PCR-RFLP method and PCR-SSO method) were performed on HLA-DQ in living related, living unrelated and cadaveric renal transplants. These two DNA typing methods allowed more accurate and more detailed typing than the conventional typing method. The effect of DNA histocompatibility of DQA 1 and DQB 1, both typed by the PCR-RFLP method, on clinical outcome and surviving graft rate of renal transplant patients was analyzed. There was no correlation found between the number of mismatches between donor and recipient of DQA 1 typing in cadaveric renal transplants, of DQB 1 typing in cadaveric, living unrelated and living related transplants and the clinical outcome nor the surviving graft rate of renal transplant patients. Both the clinical outcome and the surviving graft rate in the group in which DQ 5 mismatch between donor and recipient was positive were statistically poorer than that in the group in which DQ 5 mismatch was negative. This result suggests the existance of DQ 5 mismatch between donor and recipient greatly influences graft survival after renal transplantation. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 106 9-10 1994 サルの L-Dopa 誘発不随意運動に関する実験的研究 1035 1051 EN Masaru Sakurai Hypokinesia in the unilateral limbs was induced in 8 monkeys (Macaca fuscata fuscata) by a lesion in the contralateral mesencepahlic ventromedial tegmentum (VMT). Daily oral administration of L-Dopa/carbidopa (40mg/kg, 4mg/kg) relieved the hypokinesia and thereafter induced continuous abnormal (choreo-athetoid) involuntary movements (AMI) in upper and lower limbs contralateral to the lesion. These movements were always uniform and continued for a few hours. The author performed a series of pharmacological studies using these VMT-lesioned monkeys. 1) Direct injection of dopamine (500-1000μg/10μl) and apomorphine (500-1500μg/10μl)into the dorsomedial part of the head of the caudate nucleus ipsilateral to the VMT lesion induced the same AIM as those induced by oral administration of L-Dopa/carbidopa. However, intraputaminal injection of these agents induced AIM in bucco-lingual region only. 2) After oral administration of L-Dopa/cabidopa, direct injection of methionine-enkephalin (300μg/10μl), GABA (500-1000μl/10μl) and serotonin (100-200μg/10μl) into the dorsomedial part of the head of the caudate nucleus (HCN) slightly decreased the AIM. However, substance p(200-400μg/10μl) or atropine (100-200μg/10μl) had no effect on the AIM. Neither the direct injection of GABA (500-1000μg/10μl) nor substance P (200-400μg/10μl) into the internal segment of the globus pallidus had any effect of the AIM. 3) The dopaminergic receptor (DA-2) binding study was performed on caudate tissues which were removed 5 weeks after creating the lesion in the unilateral VMT. DA-2 receptor binding of the dorsomedial part of the caudate nucleus, ipsilateral to the lesion, had a higher affinity than that of the ipsilateral ventrolateral part or the contralateral caudate tissue. These results suggest that denervation supersensitivity of the post-synaptic DA-2 receptors in the dorsomedial part of the caudate nucleus is a basic condition for the development of L-Dopa induced AIM, and the postdopaninergic neuronal systems in the caudate nucleus are slightly suppressed by the intra-caudate neurons, of which transmitter substances are methionine-enkephalin, GABA and serotonin. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 105 7-8 1993 肥大型心筋症における肥大様式とベクトル心電図の対比検討 681 693 EN Teruo Shiraki We compared vectorcardiographic (VCG) findings with the distribution of hypertrophy in patients with hypertrophic cardiomyopathy (HCM). Distribution of left ventricular hypertrophy was determined by both echocardiogram (UCG) and magnetic resonance imaging (MRI). According to the specific hypertrophic site evaluated by UCG and MRI, 43 patients with HCM were classified into 4 types : septal, anterior, posterolateral or apical type. In patients classified as anterior, posterolateral and apical types, the QRS loop was directed toward the hypertrophic site because of increased electromotive force in the hypertrophic site. In contrast, in patients classified as septal types, the QRS loop was directed away from the hypertrophic site. This opposite direction was probably due to altered electromotive force and/or conduction disturbance in the hypertrophic site as the disease progressed. The present study indicates that QRS loop direction suggests the location of hypertrophy. The T loop was most slender in patients with apical hypertrophy and the slenderness was associated with the relative degree of hypertrophy in the apex compared with hypertrophy in other sites. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 106 9-10 1994 骨髄異形成症候群における melphalan 少量療法の検討 947 962 EN Seiji Takaba Myelodysplastic syndrome (MDS) is a disorder of multipotential hematopoietic stem cells. There is no effective therapy for MDS, especially for MDS associated with an excess of blasts, such as refractory anemia with excess blasts (RAEB) or RAEB in transformation (RAEBt). We previously reported the effect of K-18 (a human IgG-melphalan conjugate) in 15 patients with RAEB or RAEBt. The overall response rate was not high, but no side effects were noted. Although the mode of action of K-18 is not certain, it was suggested that the effect was associated with the activity of melpahlan itself. Therefore, low-dose melphalan therapy was initiated in eldery patients with RAEB or RAEBt. Six patients with RAEB and 12 patients with RAEBt received 2mg oral administration daily. Median age of the patients was 64. Six patients achieved complete remission (CR), one patient showed a partial response and four patients had a minor response. Total dosage of melpahlan for patients who achieved CR was 143±18 mg. Median duration of CR was 14.5 months. Serious toxicity was not encountered in any case and neither marrow suppression nor pancytopenia were observed in cases that achieved CR during the administration of melphalan. Changes in cell surface markers (CD34, CD33, CD13) were examined during the time course of CR in two cases. CD34 + cells decreased rapidly during the first two weeks and CD34-CD33+cells increased after four weeks of melpahlan administration. Studying the clinical course of CR with cell surface marker analysis provided evidence that melphalan therapy induced differentiation of transformed hemopoietic precursors. We conclude that daily chronic administration of melpahlan is a useful therapy for elderly patients with RAEB or RAEBt. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 106 7-8 1994 低親和性 IgG レセプター（FcγRⅡ）を介するヒト好塩基球の活性化機序に関する研究―フローサイトメーターによるカルシウム動態の解析― 847 860 EN Toshimitsu Suwaki A new method for flow cytometric analysis of calcium mobilization in human peripheral blood basophils without prior purification was developed. The method is based on dual color analysis of centrifugation-enriched mononuclear cell populations using fluo-3 and phycoerythrin (PE)-conjugated CD2, CD14, CD16, CD19 monoclonal antibodies (mAb) to stain contaminated cells. This technique allows the detection of fluo-3 fluorescence as a measure of an increase in the cytoplasmic free calcium concentration ([Ca(2+)]i) while simulataneously discriminating PE-mAb-unlabelled basophils. To clarify whether the human peripheral blood basophil is activated through the low affinity IgG receptor, Fc γ RⅡ, as well as the high affinity IgE receptor, Fc ε　RⅠ, calcium mobilization after Fc γ RⅡ stimulation was analyzed by this method. After cross-linking of Fc γ RⅡ, transient [Ca(2+)]i elevation was observed but there was no apparent difference with interleukin-3(IL-3)-treated cells, and no significant histamine release was observed with or without short pre-incubation of IL-3. These findings suggest that the cross-linking of Fc γ RⅡ, not only Fc ε　RⅠ, can activate human basophils which may result in mediator release other than histamine. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 106 7-8 1994 骨髄増殖性疾患並びに骨髄異形成症候群におけるEndogenous CFU-C の検討 701 716 EN Toshio Murase An endogenous colony formation assay was performed on 24 patients with chronic myelogenous leukemia in the chronic phase (CML-CP), 11 patients with CML-accerelated phase (CML-AP), nine patients with CML-blastic crisis (CML-BC),nine patients with polycythemia vera, two patients with essential thrombocythemia, two patients with primary myelofibrosis, two patients with juvenile CML (JCML), one patient with chronic neutrophillic leukemia, two patients with unclassified myeloproliferative disorder (UMPD), five patients with refractory anemia with excess of blasts (RAEB), 10 patients with RAEB in transformation (RAEBt) or overt leukemia, and 10 patients with chronic myelomonocytic leukemia (CMML). Endogenous colony formation was observed in two patients with CML-AP, one patient with CML-BC, two patients with JCML, one patient with UMPD, one patient with RAEBt, and seven patients with CMML. All of these endogenous colonies were identified as CFU-C by chemical staining. In some patients with CML or RAEBt, endogenous colonies were observed when progression of disease occurred. Endogenous colony formation was partially inhibited by the depletion of phagocytes in five patients with CMML or RAEBt. Four of these patients revealed increased releases of granulocyte-macrophage colony stimulating factor (GM-CFS) to the culture medium, and the addition of anti-GM-CSF antibody totally inhibited the formation of endogenous colony in one case. Patients who formed endogenous colonies often had chromosomal abnormalities and short survival. These findings suggest that paracrine or autocrine GM-CSF plays an important role in endogenous colony formation and that such endogenous colony formation is one of the risk factors in hematological malignancies. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 107 7-8 1995 びまん性肺疾患における好中球スーパーオキサイド産生能に関する研究 143 153 EN Toyoaki Fujita The superoxide released from neutrophils works as a bacteriocidal agent in the biological protection system. On the other hand, superoxide also has been known to progress inflam-mation, tissue damage and fibrisis. Therfore, the superoxide production by neutrophils of patients with diffuse panbronchiolitis (DPB), idiopathic interstitial pneumonia (IIP) and collagen vascular disease with interstitial pneumonia (CVD+IP) were studied in relation to disease activity and progression. Superoxide production was measured by deduction of cytochrome C with a spectrophotometer. The superoxide production was higher in DPB than in the normal controls. The superoxide in DPB showed a positive correlation with CRP and white blood cell count, but inverse correlation with arterial blood oxygen pressure. High levels of superoxide in DPB decreased following erythromycin therapy with clinical improvement. The averagr levels of superoxide in the patients with IIP and CVD+IP were lower than those in the normal controls. However, the superoxide level in the patients with IIP and CVD+IP in the active stage was higher than that in those in the nonactive stage. In the active stage, the increase of steroid dose was follwed by a decrease of superoxide production in IIP and CVD+IP. These findings indicate that measurement of superoxide production by neutrophils could be an useful means to evaluate activity in diffuse pulmonary diseases. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 110 11-12 1999 Teratomatosis Peritonei―卵巣奇形腫由来の腹膜播種性病巣に関する文献学的考察：今世紀報告された156例の臨床病理学的検討による集大成― 171 210 EN Masanao Kobayashi Jun-ichi Kobayashi Hiromi Iwagaki Noriaki Tanaka We performed clinicopathological analyses of peritoneal dissemination caused by ovarian teratoma (PD caused by OV-T), on the English great table of 156 cases in 105 papers published in this century. We classified PD caused by OV-T into 3 categories as follows ; 1. (TP) teratomatosis peritonei (new term) : PD composed by three germ teratomas cells. 2. (GP) gliomatosis peritonei : PD composed by only glia cells. 3. (MIX) mixed type : PD composed by glia and teratoma cells. TP and MIX were newly designated in this present paper. The number of TP, GP and MIX were 22, 95 and 25, respectively. The review of these 156 cases and 105 papers were demonstrated that the clinical features between GP and TP were cleary different. TP had a more tendency of recurrentn character in comparison to GP and MIX, but had a good long survivals resulted by repeated surgical resections. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 107 7-8 1995 改良型神経伝達物質放出測定装置によるE1マウス海馬切片よりの神経伝達物質放出と抗てんかん薬ゾニサミドの影響に関する研究 69 78 EN Atsushi Endo Using an experimental apparatus for estimating neurotransmitter release from brain slices, which involved an improved type of perfusion chamber and more well-controlled tube lines than the previous one were aspartic acid and γ-aminobutyric acid (GABA) release from hippocampal slices from epileptic E1 mice estimated more exactly and stably. Zonisamide had no effect on the aspartic acid release from hippocampal slices of E1 mice by zonisamide. However, zonisamide accelerated dose dependently GABA release from hippocampal slices of non-stimulated E1 mice, though no such acceleration was observed in stimulated E1 mice, i. e., repeatedly convulsed E1 mice. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 108 3-6 1996 循環，呼吸，免疫動態よりみた胸部食道癌に対する1期的手術と分割手術との比較検討 83 95 EN Tomoyoshi Muramatsu There are two major surgical procedures for excision of esophageal carcinoma and reconstruction of the esophagus: the one-stage procedure and the two-stage procedure. In the present study, we evaluated the two methods by comparing the cardiovascular, respiratory and immune parameters of 10 patients who underwent one-stage procedure with those of 10 other patients who underwent two-stage procedure. To estimate cardiovascular function, we measured the left ventricular stroke work index (LVSWI)-pulmonary capillary wedge pressure (PCWP). Most of the patients treated by the one-stage procedure showed a significant decrease in LVSWI-PCWP, whereas the index of patients treated by the two-stage procedure did not change much. When we assessed the respiratory system by forced vital capacity (FVC) and peak expiratory flow (PEF), the patients treated by the two-stage procedure recovered much faster and better than those receiving the one-stage procedure. Natural killer (NK) activity in lymphocytes was also measured as a marker of the immuno-reactive system. Although most patients show a drop in NK activity one week after major surgery, NK activity did not demonstrate a significant change in any of the patients who underwent the two-stage procedume. Thus, our systemic comparison of the three different parameters demonstrated better results after the two-stage procedure and we recommend it over the one-stage procedure, especially for aged and high risk patients. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 114 2 2002 Helicobacter Pylori 感染胃粘膜における胃ムチン生合成の変化 ―UDP-ガラクトース転移酵素活性測定による検討― 167 171 EN Shoichi Tanaka Background/aims : Alterations of gastric mucin have been postulated as important pathogenic properties of Helicobacter pylori. In this study, we investigated gastric mucin synthesis in H. pylori-infected gastric mucosa by measuring UDP-galactosyltransferase (UDP-Gal-T) activity, a key enzyme for the synthesis of mucin, and the amount of intracellular mucin in the gastric mucosa. Methods : Gastric biopsy specimens were obtained from thirty-seven patients(20 H. pylori-positive and 17 H. pylori-negative). UDP-Gal-T activity of the biopsy specimens was measured by an assay aystem we had developed, using a peanut agglutinin lectin. The amount of intracellular mucin in the gastric epithrlial cells was analyzed by measuring the cells' periodic acid-Schiff-alcian blue staining-positive subtances. Results : UDP-Gal-T activites in the antral mucosa of H. Pylori-positive patients were significantly lower than that of H. pylori-negative patients (p<0.05). The amount of intracelluar mucin in the antral epithelial cells of H. pylori-positive patients was significantly lower than that of H. pyolori-negative patients (p<0.01). Conclusions : H. pylori infection decreases gastric mucin synthesis by the inhibition of UDP-Gal-T activity. This effect may impair the gastric mucosal barrier and contribute to the mucosal injury induced by H. pylori infection. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 114 1 2002 抗リン脂質抗体症候群における動脈血栓の発症機序：β2-グリコプロテインIに特異的なリガンドと自己抗体の関与 39 51 EN Qingping Liu β2-Glycoprotein I (β2-GPI) is a major antigen for anticardiolipin antibodies (aCL) appeared in patients with antiphospholipid syndrome (APS). We recently reported that β2-GPI specifically binds to oxidized low-density lipoprotein (oxLDL) and that on of the β2-GPI's major ligands derived from oxLDL, oxLig-1, is 9-(7-ketocholest-5-en-3β-yloxy)-9-oxononanoic acid (J. Lipid Res. 42, 697, 2001). In the present study, it was demonstrated that carboxylated variants of cholesteryl linoleate have a critical role for β2-GPI binding.In vitro experiments indicate that oxLDL was uptaken by macrophages via an interaction among the ligand such as oxLig-1, β2-GPI, and anti-β2-GPI autoantibodies. The uptake was not occurred by cholesterol or its ester without a free carboxyl residue, i.e., cholesteryl lenoleate, by cholesterol, or by 7-ketocholesterol alone, even in the presence of β2-GPI and anti-β2-GPI antibodies. Thus, carboxyl variants of cholesteryl ester specific for β2-GPI may mediate anti-β2-GPI Ab-dependent uptake of oxLDL by macrophages and autoimmune atherogenesis developed in APS. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 114 1 2002 腹臥位呼吸管理とARDSの治療戦略上の意義 5 18 EN No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 115 1 2005 変形性膝関節症における高位脛骨骨切り術後の骨変化－脛骨近位部と膝蓋骨に生じる単純Ｘ線写真上の輝度変化－ 21 32 EN Toru Honda Radiographic brightness was measured in the proximal tibia and patella of 57 knees before and after high tibial osteotomy (HTO) for osteoarthritis. The brightness was converted to the thickness of a reference Aluminum phantom using NIH Image software. The knees were classified into 4 groups according to the position of the point at which the mechanical axis of the leg intersects the tibial articular surface after HTO, namely "overcorrected" (the position; lateral 0～25%), "adequately corrected" (mid lateral 25～50%), "undercorrected" (mid medial 50～75%), and "correction failure" (medial 75%～). Brightness was high in the lateral and central regions of the proximal tibia in the adequately corrected group, while that of the lateral loading region was high in the overcorrected group. The brightness was broadly high in the undercorrected group, and was not distinct in the correction failure group. In the patella, the brightness of the lateral region was higher than that of the medial region before HTO, and the difference between the two regions was considerably reduced in the adequately corrected group. These findings indicate that adequate correction of leg alignment causes favorable changes in the patellofemoral joint as well as in the femorotibial joint. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 116 1 2004 医学教育概説―教育評価とその運用― 29 38 EN No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 117 1 2005 複合糖質を可視化する 35 39 EN No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 118 3 2007 3-ニトロチロシン 225 234 EN 種々の機序により産生された活性窒素種 (reactive nitrogen species) によるチロシン残基のニトロ化による3-ニトロチロシン (3-NT) の生成は, 蛋白質の翻訳後修飾の一つとして広く認められている.種々の炎症性疾患組織では, 一酸化窒素・二酸化窒素・ペルオキシナイトライトといった活性窒素種が異なる機序で産生され, 3-NTの産生に関与している. チロシンニトロ化蛋白質の同定や, 蛋白質分子中のチロシンニトロ化部位が決定できるようになり, 蛋白質の寿命, 蛋白質問相互作用に対する悪影響, 蛋白質機能喪失との関連づけが可能になってきた. 測定法としては, 免疫組織化学的手法, ウェスタンブロッティングによる半定量法から, ELISA, HPLC-ECD, LC-MS/MS, GC-MS/MSを用いた定量的な方法がある. 本総説では, 3-NTについて, その生成機序, 測定方法, 予防医学的応用を述べる. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 00301558 119 3 2008 III 肺がんの外科的治療 ―肺癌診療ガイドラインを中心に― 293 300 EN Yoshifumi Sano No potential conflict of interest relevant to this article was reported.

岡山大学農学部 Acta Medica Okayama 0474-0254 57 1 1981 ラット胚の液体窒素ガスによる急速簡易凍結法に関する研究 25 33 EN Yoshitaka Fujii Kyozo Utsumi Masataka Yuhara 哺乳動物胚凍結保存法を簡易化するため,家畜動物胚のモデルとしてラット胚を用い,液体窒素ガスによる簡易急速凍結を試みた. 凍結保護物質には比較的高濃度感作後でもin vitroにおけるラット胚の発育性に影饗を及ぼさなかったerythritolを選定した. 冷却方式は凍結開始後,胚の温度が20分で-20℃､25分で-60℃,30分で-180℃になるようにし,融解方式はストローを液体窒素から30℃温湯へ直接入れるようにした時に,その生存率が最も高かった. 10% erythritolによるラット胚の凍結法において,-20℃から-38℃までの冷却脱水温度域を持った冷却法による融解胚の生存率は50%以上であった. -43℃から-74℃までの冷却脱水温度域を持った冷却法による融解胚の生存率は40%以下で,しかも冷却脱水温度域の下降に供なって生存率も低下していった. そしてこの冷却脱水温度域と融解胚の生存率の関係から凍結の機序を検討した. erythritol を凍結保護物質としてラット胚を凍結した際に最も生存率の高かった冷却融解方式で他の凍結保護物質を用いてラット胚を凍結してみたが,inositol,ethylene glycol,glycerinでは融解胚の生存率は0%であった。 No potential conflict of interest relevant to this article was reported.

岡山大学農学部 Acta Medica Okayama 0474-0254 43 1 1974 飼料作物の化学的成分と飼料価値に関する研究 (第18報)草類の窒素溶性区分とその消化性に及ぼす窒素肥料の施用水準の影響について 53 57 EN Takashi Miaki 窒素肥料の多用が草類茎葉中の窒素の各溶性区分とその消化性に及ぼす影響について,主としてイタリアンライグラス乾草を用いて検討した. 得られた結果を要約すると次のとおりである. 1)イタリアンライグラス乾草の各溶性区分別窒桑の中で熱アルカリ性アルコール溶性窒素の消化率が最もよい. 2)供試乾草の窒素中熱アルカリ性アルコール溶性窒素の割合が最も多く,その割合は窒索肥料の多用によってさらに高められた. 3)熱アルカリ性アルコール溶性窒素含量と粗蛋自質消化率の間に高い正の相関関係の間に高い正の相関関係(r=0.767, P<0.01)が得られた. 4)窒素多用による草類粗蛋白質消化率の向上は,消化性のよい熱アルカリ性アルコール溶性窒素が茎葉中に増加することと深い関係がある。 No potential conflict of interest relevant to this article was reported.