Springer Science and Business Media LLC Acta Medica Okayama 1345-2630 2026 Tabtoxin biosynthetic gene cluster in Pseudomonas syringae pv. tabaci 6605 genomic island 1 (GI-1Pta6605) is required for severe disease symptoms EN Kotomi Kunishi The Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Norika Fujisawa The Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Hidenori Matsui The Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Nanami Sakata The Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Yoshiteru Noutoshi The Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Kazuhiro Toyoda The Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Yuki Ichinose The Graduate School of Environmental, Life, Natural Science and Technology, Okayama University One of the genomic islands in Pseudomonas syringae pv. tabaci 6605 (GI-1Pta6605) has been identified as a pathogenicity island required for virulence because the deletion almost completely eliminated disease symptoms in inoculation tests at 4 × 105 CFU/ml. GI-1Pta6605 contains four cargo regions (CRs) named CR-1 to CR-4. The ∆CR-4 mutant did not produce tabtoxin like ∆GI-1 and disease symptoms did not develop in tobacco. However, it grew, although to a lesser extent than the wild-type strain. These results indicate that the tabtoxin biosynthetic gene cluster in GI-1 is required for virulence but not for establishment of compatibility. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 80 1 2026 Changes in Prescribing Patterns of Antiviral Drugs before and after Public Coverage Termination among Hospitalized COVID-19 Patients in Regional Hospitals in Japan: A Retrospective, Multicenter Study 55 62 EN Hidemasa Akazawa Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Hideharu Hagiya Department of Infectious Diseases, Okayama University Hospital Shinnosuke Fukushima Department of Infectious Diseases, Okayama University Hospital Shohei Yamamoto Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Yasuhiro Nakano Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Fumio Otsuka Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Original Article 10.18926/AMO/70073 In Japan, antiviral agents for COVID-19 were freely available until September 2023 as part of national policy. This study evaluated changes in these agents’ prescribing patterns and the patient outcomes following the policy shift. We conducted a multicenter retrospective study at four hospitals in Japan’s Okayama and Kagawa prefectures from January 2022 to March 2024. The study period was divided into the public-expenditure phase (January 2022 to September 2023) and the post-expenditure phase (October 2023 to March 2024). We extracted the hospitalized patients’ clinical data from the electronic database. The study’s primary outcome was the antiviral prescription rate; the secondary outcome was in-hospital mortality. Among the 302 hospitalized patients (median age 85 years), 52.0% were classified as having a mild condition. Of the patients with mild conditions, 37.7% were diagnosed in outpatient settings prior to hospitalization. During the public-expenditure phase, 47.4% of the patients received antivirals as outpatients, mainly molnupiravir (80.9%). In the post-expenditure period, 80.0% of the patients were prescribed antivirals, mostly molnupiravir (91.7%). The antiviral prescription rate was significantly higher after the policy change. The overall in-hospital mortality was 15.8%, with no significant difference between the two periods (17.0% vs. 10.5%). Despite the termination of government funding, antiviral prescriptions remained frequent at community hospitals located in highly aging regions of western Japan such as Okayama and Kagawa prefectures. Mortality remains high among the elderly, highlighting the need for continued antiviral therapy and booster vaccinations. No potential conflict of interest relevant to this article was reported.

American Society for Microbiology Acta Medica Okayama 0066-4804 69 12 2025 Genomic portrayal of emerging carbapenem-resistant El Tor variant Vibrio cholerae O1 e00740-25 EN Sreeja Shaw ICMR-National Institute for Research in Bacterial Infections Agila Kumari Pragasam V. Ramalingaswami Bhawan, Indian Council of Medical Research Goutam Chowdhury ICMR-National Institute for Research in Bacterial Infections Prosenjit Samanta ICMR-National Institute for Research in Bacterial Infections Deboleena Roy ICMR-National Institute for Research in Bacterial Infections Debjani Ghosh ICMR-National Institute for Research in Bacterial Infections Thandavarayan Ramamurthy ICMR-National Institute for Research in Bacterial Infections Jigna Karia Medical College Baroda Govind Ninama Medical College Baroda Shin-ichi Miyoshi Okayama University Yukihiro Akeda National Institute of Infectious Diseases Hemanta Koley ICMR-National Institute for Research in Bacterial Infections Asish Kumar Mukhopadhyay ICMR-National Institute for Research in Bacterial Infections The escalating prevalence of carbapenem-resistant (CR) enteric pathogens elicits significant challenges to public health management and effective antimicrobial therapy. While carbapenem resistance is rare in Vibrio cholerae O1 (VC), the recent emergence of CR strains reveals a concerning shift in their antimicrobial resistance (AMR) landscape. This study aims to characterize the resistance mechanisms in newly identified El Tor CRVC isolated from cholera patients in Gujarat, India during 2019. Fifty VC isolates were screened for major virulence-associated genes along with the determination of their antibiotic resistance profiles using Kirby-Bauer disk diffusion and MIC assays. Whole-genome sequencing (WGS) was employed to investigate the underlying mechanisms of CR. All the isolates exhibited hypervirulent Haitian alleles of major virulence genes and AMR profiles of typical multidrug resistance (MDR). Strikingly, 12% (6/50) of them were resistant to carbapenems and other antibiotics. Molecular analysis revealed that these CR isolates were clonally related and harbored a 142 kbp IncA/C type conjugative mega-plasmid with several AMR encoding genes, including blaNDM-1, that can be easily transferred to other bacterial species and confer donor AMR patterns. The plasmid’s competence for horizontal gene transfer presents a significant risk of dissemination to other enteric pathogens and thereby may complicate the treatment. This finding emphasizes the urgent need for enhanced genomic surveillance and robust antimicrobial stewardship programs aimed at curbing the spread of CRVC strains and mitigating their impact on cholera treatment and containment strategies. No potential conflict of interest relevant to this article was reported.

The Editorial Committee of Annals of Vascular Diseases Acta Medica Okayama 1881-641X 18 1 2025 Successful Surgical Treatment of a Spontaneous Rupture of the Left Iliac Vein: What Is the Optimal and Radical Treatment? cr.25-00065 EN Kei Morioka Department of Cardiovascular Surgery, Okayama University Hospital Masanori Hirota Department of Cardiovascular Surgery, Showa Medical University Fujigaoka Hospital Shingo Kasahara Department of Cardiovascular Surgery, Okayama University Hospital Spontaneous rupture of the iliac vein (SRIV) requires surgical hemostasis and venous return restoration. We herein report a case treated with initial thrombus removal and direct venous repair. Because of early occlusion, a 2nd surgery was performed for iliac vein reconstruction using a 14-mm ringed Gore-Tex graft (W. L. Gore & Associates, Newark, DE, USA), and a 4-mm Gore-Tex arteriovenous shunt was created between the femoral artery and the femoral vein to prevent reocclusion. The patient had an uneventful recovery without recurrence. A single-stage procedure including hemostasis, vein replacement, and arteriovenous bypass may be ideal for radical SRIV treatment. No potential conflict of interest relevant to this article was reported.

Japanese Society of Internal Medicine Acta Medica Okayama 0918-2918 63 13 2024 Activated CD4+ T Cell Proportion in the Peripheral Blood Correlates with the Duration of Cytokine Release Syndrome and Predicts Clinical Outcome after Chimeric Antigen Receptor T Cell Therapy 1863 1872 EN Wataru Kitamura Department of Hematology and Oncology, Okayama University Hospital Noboru Asada Department of Hematology and Oncology, Okayama University Hospital Shuntaro Ikegawa Department of Hematology and Oncology, Okayama University Hospital, Japan Hideaki Fujiwara Department of Hematology and Oncology, Okayama University Hospital Chihiro Kamoi Department of Hematology and Oncology, Okayama University Hospital Daisuke Ennishi Center for Comprehensive Genomic Medicine, Okayama University Hospital Hisakazu Nishimori Department of Hematology and Oncology, Okayama University Hospital Keiko Fujii Division of Clinical Laboratory, Okayama University Hospital Nobuharu Fujii Division of Blood Transfusion, Okayama University Hospital Ken-ichi Matsuoka Department of Hematology and Oncology, Okayama University Hospital Yoshinobu Maeda Department of Hematology and Oncology, Okayama University Hospital Objective Chimeric antigen receptor (CAR) T cell therapy is an emerging and effective therapy for relapsed or refractory diffuse large B cell lymphoma (R/R DLBCL). The characteristic toxicities of CAR T cell therapy include cytokine release syndrome (CRS) and prolonged cytopenia. We investigated the factors associated with these complications after CAR T cell therapy by analyzing lymphocyte subsets following CAR T cell infusion.<br> Methods We retrospectively analyzed peripheral blood samples on days 7, 14, and 28 after tisagenlecleucel (tisa-cel) infusion by flow cytometry at our institution between June 2020 and September 2022.<br> Patients Thirty-five patients with R/R DLBCL who received tisa-cel therapy were included.<br> Results A flow cytometry-based analysis of blood samples from these patients revealed that the proportion of CD4+CD25+CD127+ T cells (hereafter referred to as "activated CD4+ T cells" ) among the total CD4+ T cells on day 7 after tisa-cel infusion correlated with the duration of CRS (r=0.79, p<0.01). In addition, a prognostic analysis of the overall survival (OS) using time-dependent receiver operating characteristic curves indicated a significantly more favorable OS and progression-free survival of patients with a proportion of activated CD4+ T cells among the total CD4+ T cells <0.73 (p=0.01, and p<0.01, respectively).<br> Conclusion These results suggest that the proportion of activated CD4+ T cells on day 7 after tisa-cel infusion correlates with the CRS duration and predicts clinical outcomes after CAR T cell therapy. Further studies with a larger number of patients are required to validate these observations. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 79 6 2025 Real-World Outcomes of Anti-Vascular Endothelial Growth Factor Therapy for Neovascular Age-Related Macular Degeneration in Patients Aged 85 or Older 405 412 EN Chihiro Ouchi Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Mio Morizane Hosokawa Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shuhei Kimura Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yusuke Shiode Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ryo Matoba Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tetsuro Morita Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuki Morizane Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/69842 We investigated the treatment outcomes of patients aged ≥85 years with neovascular age-related macular degeneration (nAMD) who received anti-vascular endothelial growth factor (anti-VEGF) therapy using either treat-and-extend (TAE) or pro re nata (PRN) regimens for 1 year in real-world clinical practice. Eighty-five eyes from 85 patients were included. Among them, types 1, 2, and 3 macular neovascularization and polypoidal choroidal vasculopathy were present in 27.1%, 17.6%, 18.8%, and 36.5%, respectively. TAE and PRN regimens were used in 43.5% and 56.5% of patients, respectively. At baseline, the PRN group was older and had worse best-corrected visual acuity (BCVA), greater central retinal thickness, and more intraretinal fluid than the TAE group. In the TAE group, the mean number of injections was 7.6, BCVA improved significantly, and all retinal fluid rates decreased. In the PRN group, the mean number of injections was 3.9, BCVA remained unchanged, and the rates of macular fibrosis and atrophy increased. No serious adverse events were observed in either group. Anti-VEGF therapy was safe for patients aged ≥ 85 years with nAMD, and the TAE regimen effectively improved BCVA in this population. BCVA remained unchanged in the PRN-treated patients, with baseline disease severity and/or undertreatment potentially influencing the outcomes. No potential conflict of interest relevant to this article was reported.

American Society of Hematology Acta Medica Okayama 2473-9529 9 18 2025 Refinement of day 28 treatment response criteria for acute GVHD: a collaboration study of the JSTCT and MAGIC 4640 4653 EN Yu Akahoshi Division of Hematology/Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai Yoshihiro Inamoto Department of Blood and Marrow Transplantation and Cellular Therapy, Fujita Health University School of Medicine Nikolaos Spyrou Division of Hematology/Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai Hideki Nakasone Division of Hematology, Jichi Medical University Saitama Medical Center Marcio A. Diniz Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai Noboru Asada Department of Hematology and Oncology, Okayama University Hospital Francis Ayuk Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf Hannah K. Choe Division of Hematology, Blood and Marrow Transplantation Program, The Ohio State University Comprehensive Cancer Center Noriko Doki Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital Tetsuya Eto Department of Hematology, Hamanomachi Hospital Aaron M. Etra Division of Hematology/Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai Elizabeth O. Hexner Department of Medicine and Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania Nobuhiro Hiramoto Department of Hematology, Kobe City Medical Center General Hospital William J. Hogan Division of Hematology, Mayo Clinic Ernst Holler Department of Hematology and Oncology, Internal Medicine III, University of Regensburg Keisuke Kataoka Division of Molecular Oncology, National Cancer Center Research Institute Toshiro Kawakita Department of Hematology, National Hospital Organization Kumamoto Medical Center Masatsugu Tanaka Department of Hematology, Kanagawa Cancer Center Takashi Tanaka Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital Naoyuki Uchida Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital Ingrid Vasova Department of Internal Medicine 5, Hematology and Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg and University Hospital Erlangen Satoshi Yoshihara Department of Hematology, Hyogo Medical University Hospital Fumihiko Ishimaru Technical Department, Japanese Red Cross Blood Service Headquarters Takahiro Fukuda Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital Yi-Bin Chen Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital Junya Kanda Department of Hematology, Graduate School of Medicine, Kyoto University Ryotaro Nakamura Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Yoshiko Atsuta Japanese Data Center for Hematopoietic Cell Transplantation James L. M. Ferrara Division of Hematology/Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai Yoshinobu Kanda Division of Hematology, Jichi Medical University Saitama Medical Center John E. Levine Division of Hematology/Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai Takanori Teshima Department of Hematology, Hokkaido University Faculty of Medicine and Graduate School of Medicine Overall response (OR) that combines complete (CR) and partial responses (PR) is the conventional end point for acute graft-versus-host disease (GVHD) trials. Because PR includes heterogeneous clinical presentations, reclassifying PR could produce a better end point. Patients in the primary treatment cohort from the Japanese Society for Transplantation and Cellular Therapy (JSTCT) were randomly divided into training and validation sets. In the training set, a classification and regression tree algorithm generated day 28 refined response (RR) criteria based on symptoms at treatment and day 28. We then evaluated RR for primary and second-line treatments, using the area under the receiver operating characteristic curve (AUC) and negative predictive value (NPV) for 6-month nonrelapse mortality as performance measures. RR considered patients with grade 0/1 at day 28 without additional treatment as responders. RR for primary treatment produced higher AUCs than OR with small improvement of NPVs in both validation sets: JSTCT (AUC, 0.73 vs 0.69 [P < .001]; NPV, 92.0% vs 89.6% [P < .001]) and the Mount Sinai Acute GVHD International Consortium (MAGIC; AUC, 0.71 vs 0.68 [P = .032]; NPV, 90.9% vs 89.8% [P = .009]). RR for second-line treatment produced similar AUCs but much higher NPVs than OR in both validation sets of JSTCT (AUC, 0.64 vs 0.63 [P = .775]; NPV, 74.5% vs 66.0% [P < .001]) and MAGIC (AUC, 0.67 vs 0.64 [P = .105]; NPV, 86.8% vs 76.1% [P = .004]). Classifying persistent but mild skin symptoms as responses and residual lower gastrointestinal GVHD as nonresponses were major drivers in improving the prognostic performance of RR. Our externally validated day 28 RR would serve as a better end point than conventional criteria in future first- and second-line treatment trials. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 1939-5981 2025 Upgrading Recycle Technology for Iron Removal in ADC12 Alloy Using Gravity and Magnetic Force EN M. Okayasu Department of Mechanical Systems and Engineering, Okayama University S. Takeuchi Department of Mechanical Systems and Engineering, Okayama University M. Syahid Department of Mechanical Engineering, Hasanuddin University T. Ikeda Department of Mechanical Systems and Engineering, Okayama University As there is a technical issue to remove iron elements during aluminum recycling process, an attempt was made to evaluate the effectiveness of magnetic and gravitational separation methods for removing iron from Al-Si-Cu alloy (ADC12). A rare-earth samarium–cobalt (SmCo) magnet was employed during the solidification process to attract Fe-rich eutectic structures. The microstructural analysis revealed that block-like Fe-Cr-Si-based phases formed preferentially near the magnet and at the bottom of the crucible, suggesting that magnetic and gravity attraction contributed to the localized segregation of these phases. However, other Fe-based phases, including Fe-Si-based ones, are not strongly affected by magnet. Additionally, prolonged heating in the solid–liquid coexistence (SLC) region at 577 °C for 10 h led to the settling of a largely grown Fe-Cr-Si-rich crystal at the bottom of the crucible due to gravity. Other structures, such as Si-rich eutectic phases, were not influenced by gravity, which may be caused by the low density of Si compared to Fe one. From this approach, combining magnetic attraction and gravitational settling is a promising method to promote the removal of iron impurities from aluminum alloys. No potential conflict of interest relevant to this article was reported.

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.

Springer Science and Business Media LLC Acta Medica Okayama 1939-5981 2025 MATERIAL PROPERTIES OF DIE-CASTING DIE AROUND HEAT-CHECKING CREATED BY A HIGH-PRESSURE ALUMINUM ALLOY DIE-CASTING OPERATION EN Mitsuhiro Okayasu Department of Mechanical Systems Engineering, Okayama University Junya Shimazu Department of Mechanical Systems Engineering, Okayama University In this study, the material properties of a nitride die-casting die exhibiting heat-checking after the die-casting process were experimentally investigated using various methods. Based on the obtained results, the authors believe that several possible mechanisms underlying the formation of heat-checking can be identified. The microstructure of the die-casting die near the heat-checking region is characterized by equiaxed grains along the vicinity of the prior γ-grain boundaries, resulting from the lath martensitic formation. Additionally, numerous Cr–Mo–V-based nitride particles, approximately 100 nm in diameter, are precipitated. The surface hardness of the die-casting die, enhanced by nitriding, induces compressive residual stresses and increases adhesive forces. As a result of changes in microstructural characteristics and crack formation, the stress state near the die-casting die is altered, where compressive residual stresses, observed in the die-casting die, are released, leading to the tensile residual stresses. This phenomenon could accelerate the formation of a large number of heat-checking cracks. No potential conflict of interest relevant to this article was reported.

Japan Surgical Society Acta Medica Okayama 2198-7793 11 1 2025 Obese Patient with Gastric Diverticulum Undergoing Laparoscopic Sleeve Gastrectomy Guided by Preoperative Endoscopic Measurement: A Case Report and Literature Review cr.25-0141 EN Kensuke Hirosuna Center for Graduate Medical Education, Okayama University Hospital Hajime Kashima Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Ryohei Shoji Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yuki Matsumi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yoshihiko Kakiuchi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Satoru Kikuchi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Shinji Kuroda Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Fuminori Teraishi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Shunsuke Kagawa Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences INTRODUCTION: Gastric diverticulum is a rare condition, often asymptomatic and incidentally detected. Laparoscopic sleeve gastrectomy (LSG) is a widely performed bariatric procedure, but a gastric diverticulum complicates surgical planning. In this case, careful preoperative assessment allowed safe execution of LSG despite the diverticulum’s proximity to the esophagogastric junction.<br> CASE PRESENTATION: A 45-year-old woman (BMI: 46.8 kg/m2) with hypertension, dyslipidemia, and glucose intolerance was referred for bariatric surgery after unsuccessful weight loss with conservative management. Preoperative endoscopy revealed an 18 × 14 mm gastric diverticulum on the posterior wall of the gastric fundus, 40 mm from the esophagogastric junction. LSG was performed using a surgical stapler, ensuring complete diverticulum resection while preserving gastric tube integrity. The surgery was uneventful, with minimal blood loss and a duration of 2 hours and 52 minutes. The patient had an uneventful postoperative course and was discharged on day 9. Her BMI decreased to 39.3 kg/m2 at the 1-year follow-up, with improved metabolic parameters.<br> CONCLUSIONS: This case highlights the importance of thorough preoperative evaluation when performing LSG in patients with gastric diverticulum. Accurate endoscopic measurement of the diverticulum’s location aids in determining the optimal resection line, ensuring surgical safety and efficacy. Surgeons should remain vigilant when encountering such anatomical variations to optimize outcomes in bariatric surgery. No potential conflict of interest relevant to this article was reported.

Japanese Society of Internal Medicine Acta Medica Okayama 0918-2918 63 12 2024 Gastric Mucosa-associated Lymphoid Tissue Lymphoma That Relapsed after 11 Years Subsequent to Achieving Complete Remission 1697 1702 EN Shoko Inoo Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Masaya Iwamuro Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Takehiro Tanaka Department of Pathology, Okayama University Hospital Yoshiro Kawahara Department of Practical Gastrointestinal Endoscopy, Okayama University Hospital Motoyuki Ootuka Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences A 38-year-old Japanese man was diagnosed with extranodal marginal zone lymphoma of the mucosa-associated lymphoid tissue in the stomach (gastric MALT lymphoma). Fluorescence in situ hybridization analysis revealed the absence of t (11;18) (q21;q21) translocation but the presence of extra copies of MALT1, indicating tetrasomy 18. Helicobacter pylori eradication led to complete remission (CR). However, the gastric MALT lymphoma relapsed after 11 years old. This case underscores the need for long-term observation (>10 years) of patients with gastric MALT lymphoma. Further investigation is warranted to elucidate the correlation between trisomy/tetrasomy 18 and the recurrence propensity. No potential conflict of interest relevant to this article was reported.

Japan Surgical Society Acta Medica Okayama 2198-7793 11 1 2025 A Case of Omental Bleeding as a Result of Segmental Arterial Mediolysis Treated Successfully by Laparoscopic Partial Omentectomy cr.25-0262 EN Yudai Mimata Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Nobuhiko Kanaya Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshitaka Kondo Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hitoshi Minagi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshihiko Kakiuchi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shinji Kuroda Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kunitoshi Shigeyasu Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shunsuke Kagawa Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences INTRODUCTION: Segmental arterial mediolysis (SAM) is a rare, non-atherosclerotic, non-inflammatory arteriopathy characterized by lysis of the arterial media, leading to aneurysm formation and possible rupture. Although visceral arteries are typically involved, SAM-induced omental bleeding is extremely uncommon. While transcatheter arterial embolization (TAE) has been reported, surgical resection offers both definitive hemostasis and histopathological confirmation.<br> CASE PRESENTATION: A 56-year-old man presented with upper abdominal pain without a history of trauma. Contrast-enhanced CT revealed a hematoma and fusiform dilation of an omental artery, suggesting omental hemorrhage. As he was hemodynamically stable, initial conservative management was chosen. However, a follow-up CT on day 7 demonstrated aneurysm enlargement, prompting laparoscopic partial omentectomy. Intraoperative findings included a 5-cm hematoma in the central omentum. Histopathological examination showed vacuolization of the tunica media and loss of the internal elastic lamina, confirming the diagnosis of SAM. The patient had an uneventful postoperative course and was discharged on the 3rd postoperative day.<br> CONCLUSIONS: This rare case of SAM-related omental bleeding was successfully treated with laparoscopic partial omentectomy. Tailored treatment strategies including laparoscopic surgery are essential for optimal outcomes in SAM.<br> No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 1939-5981 2025 Study of the Mechanical Properties of Al–Mg ADC6 Aluminum Alloy Produced by Unidirectional Casting Under Various Cooling Rates EN S. Takeuchi M. Okayasu To create the high strength and high ductility of Al–Mg-based aluminum alloy (JIS–ADC6), ADC6 samples were produced by the unidirectional continuous casting (HMC). The HMC process was conducted with direct water cooling to melt ADC6, which can make fine microstructures and control crystal orientation. The cast samples were prepared under various cooling rates (CRs): 6.3, 34, and 62 K/s. The microstructure and crystal orientation of the samples were altered with CR. At CRs of 34 K/s and 62 K/s, the α-Al phases and intermetallic compounds, e.g., Mg2Si and Al15(Fe, Mn)3Si2, became finer and more spherical. The secondary dendrite arm spacing for the sample at 62 K/s was 8.7 µm―more than 70% smaller than the ADC6 sample (ingot) made by a gravity casting process. Notably, at a CR of 34 K/s, the crystal orientation was predominantly arranged with the (101) plane. Tensile properties―ultimate tensile strength (σUTS), 0.2% proof stress (σ0.2), and failure strain (εf)―varied with the CR. The tensile strength (σUTS and σ0.2) consistently increased with increasing the CR. The improvement in the tensile strength resulted from the refined microstructures, such as the α-Al phase and intermetallic compounds. Similarly, the failure strain also increased with increasing CR, which was severely affected by the finer and more spherical intermetallic compounds. In this case, the εf value of the sample at 34 K/s was, however, slightly higher than that at 62 K/s, due to more uniformly organized crystal orientation, while their ductility was much higher than that of the gravity cast sample. The tensile properties in detail were further analyzed using their failure characteristics. No potential conflict of interest relevant to this article was reported.

American Astronomical Society Acta Medica Okayama 0004-637X 965 1 2024 Unraveling the Cr Isotopes of Ryugu: An Accurate Aqueous Alteration Age and the Least Thermally Processed Solar System Material 52 EN Ryoji Tanaka The Pheasant Memorial Laboratory for Geochemistry and Cosmochemistry, Institute for Planetary Materials, Okayama University Dilan M. Ratnayake The Pheasant Memorial Laboratory for Geochemistry and Cosmochemistry, Institute for Planetary Materials, Okayama University Tsutomu Ota The Pheasant Memorial Laboratory for Geochemistry and Cosmochemistry, Institute for Planetary Materials, Okayama University Noah Miklusicak The Pheasant Memorial Laboratory for Geochemistry and Cosmochemistry, Institute for Planetary Materials, Okayama University Tak Kunihiro The Pheasant Memorial Laboratory for Geochemistry and Cosmochemistry, Institute for Planetary Materials, Okayama University Christian Potiszil The Pheasant Memorial Laboratory for Geochemistry and Cosmochemistry, Institute for Planetary Materials, Okayama University Chie Sakaguchi The Pheasant Memorial Laboratory for Geochemistry and Cosmochemistry, Institute for Planetary Materials, Okayama University Katsura Kobayashi The Pheasant Memorial Laboratory for Geochemistry and Cosmochemistry, Institute for Planetary Materials, Okayama University Hiroshi Kitagawa The Pheasant Memorial Laboratory for Geochemistry and Cosmochemistry, Institute for Planetary Materials, Okayama University Masahiro Yamanaka The Pheasant Memorial Laboratory for Geochemistry and Cosmochemistry, Institute for Planetary Materials, Okayama University Masanao Abe Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency Akiko Miyazaki Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency Aiko Nakato Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency Satoru Nakazawa Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency Masahiro Nishimura Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency Tatsuaki Okada Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency Takanao Saiki Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency Satoshi Tanaka Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency Fuyuto Terui Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency Yuichi Tsuda Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency Tomohiro Usui Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency Sei-ichiro Watanabe Department of Earth and Planetary Sciences, Nagoya University Toru Yada Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency Kasumi Yogata Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency Makoto Yoshikawa Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency Eizo Nakamura The Pheasant Memorial Laboratory for Geochemistry and Cosmochemistry, Institute for Planetary Materials, Okayama University The analysis of samples returned from the C-type asteroid Ryugu has drastically advanced our knowledge of the evolution of early solar system materials. However, no consensus has been obtained on the chronological data, which is important for understanding the evolution of the asteroid Ryugu. Here, the aqueous alteration age of Ryugu particles was determined by the Mn–Cr method using bulk samples, yielding an age of 4.13 + 0.62/−0.55 Myr after the formation of Ca–Al-rich inclusions (CAI). The age corresponds to 4563.17 + 0.60/−0.67 Myr ago. The higher 55Mn/52Cr, ε54Cr, and initial ε53Cr values of the Ryugu samples relative to any carbonaceous chondrite samples implies that its progenitor body formed from the least thermally processed precursors in the outermost region of the protoplanetary disk. Despite accreting at different distances from the Sun, the hydrous asteroids (Ryugu and the parent bodies of CI, CM, CR, and ungrouped C2 meteorites) underwent aqueous alteration during a period of limited duration (3.8 ± 1.8 Myr after CAI). These ages are identical to the crystallization age of the carbonaceous achondirtes NWA 6704/6693 within the error. The ε54Cr and initial ε53Cr values of Ryugu and NWA 6704/6693 are also identical, while they show distinct Δ'17O values. This suggests that the precursors that formed the progenitor bodies of Ryugu and NWA 6703/6693 were formed in close proximity and experienced a similar degree of thermal processing in the protosolar nebula. However, the progenitor body of Ryugu was formed by a higher ice/dust ratio, than NWA6703/6693, in the outer region of the protoplanetary disk. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 79 3 2025 Promising Effectiveness of Combined Chemotherapy and Immunotherapy in Patients with Advanced Non-small Cell Lung Cancer: A Real-World Prospective Observational Study (CS-Lung-003) 167 176 EN Nobuhiro Kanaji Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University Kazuya Nishii Department of Respiratory Medicine, National Hospital Organization Iwakuni Clinical Center Yukari Tsubata Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine Mika Nakao Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine Takae Okuno Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine Sachi Okawa Department of Allergy and Respiratory Medicine, Okayama University Hospital Kenji Takata Department of Allergy and Respiratory Medicine, Okayama University Hospital Masahiro Kodani Division of Medical Oncology and Molecular Respirology, Faculty of Medicine, Tottori University Masahiro Yamasaki Department of Respiratory Disease, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital Kazunori Fujitaka Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University Tetsuya Kubota Department of Respiratory Medicine and Allergology, Kochi University Masaaki Inoue Department of Chest Surgery, Shimonoseki City Hospital Naoki Watanabe Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University Katsuyuki Hotta Center for Innovative Clinical Medicine, Okayama University Hospital CS-Lung-003 Investigator Original Article 10.18926/AMO/68724 This prospective observational study investigated the clinical status of patients with advanced non-small cell lung cancer (NSCLC) treated with cytotoxic chemotherapy+an immune checkpoint inhibitor (chemo + IO) as first-line treatment in a real-world setting. The cases of 98 patients treated with chemo + IO were prospectively collected and analyzed for effectiveness and safety. The response rate to chemo + IO was 46.9%, and the disease control rate was 76.5%. The median progression-free survival and overall survival (OS) in the total population were 5.2 and 22.3 months, respectively. The patients positive for PD-L1 (≥ 1%) showed significantly longer OS than the negative group (<1%) (median 26.7 vs. 18.7 months, p=0.04). Pre-existing interstitial lung disease (ILD) was associated with shorter OS than the absence of ILD (median 9.0 vs. 22.6 months, p<0.01). Immunerelated adverse events (irAEs) were observed in 28 patients (28.6%). The most frequent irAE was ILD (n=11); Grade 1 (n=1 patient), G2 (n=5), G3 (n=4), and only a single patient with a G5 irAE. In this CS-Lung-003 study, first-line chemo + IO in a real-world setting showed good effectiveness, comparable to that observed in international clinical trials. In real-world practice, chemo + IO is a promising and steadfast strategy. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 79 2 2025 Relationship between Personality Traits and Postpartum Depressive Symptoms in Women who Became Pregnant via Infertility Treatment 109 116 EN Kyoko Awai Graduate School of Health Sciences, Okayama University Mikiya Nakatsuka Faculty of Health Sciences, Okayama University Original Article 10.18926/AMO/68649 The status of postpartum depression was elucidated herein with the use of the Edinburgh Postnatal Depression Scale (EPDS) in women in Shikoku, Japan who became pregnant and gave birth after undergoing infertility treatment, including assisted reproductive technology (ART). The assessment was performed during their children’s 4-month health examination. The relationships between postpartum depression and the mothers’ background factors and scores on the Big Five personality traits scale were also examined. Of the Big Five personality traits, the scores for neuroticism were significantly higher in the ART group (n=71) than in the general infertility treatment (n=118) and natural pregnancy (n=872) groups. No significant differences in EPDS scores were seen among these three groups. A logistic regression analysis showed that neuroticism was associated with an EPDS score ≧9 points, (which is suggestive of postpartum depression, ) in all groups. Moreover, although a long-standing marriage had an inhibitory effect on postpartum depression in the natural pregnancy group, no such trend was seen in the ART group, which included many women with long-standing marriages. Particularly for women who become pregnant by ART, an individualized response that pays close attention to the woman’s personality traits is needed. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 79 2 2025 Lower Work Engagement Is Associated with Insomnia, Psychological Distress, and Neck Pain among Junior and Senior High School Teachers in Japan 93 100 EN Rina Tsuchie Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Mari Fukuda Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hideki Tsumura Department of Psychology, Graduate School of Technology, Industrial and Social Sciences, Tokushima University Minako Kinuta Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takashi Hisamatsu Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hideyuki Kanda Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/68647 School teachers are subject to both physical and mental health problems. We examined cross-sectional relationships between work engagement and major health outcomes among junior and senior high school teachers in Japan via a nationwide survey in 2019-2020. A total of 3,160 respondents were included in the analyses (19.9% response rate). Work engagement was assessed with the Utrecht Work Engagement Scale-9 (UWES-9), and we thus divided the teachers into quartiles according to their UWES-9 scores. Based on validated questionnaires, we assessed insomnia, psychological distress, and neck pain as health outcomes. A binomial logistic regression adjusted for age, gender, school type, teacher’s roles, involvement in club activities, division of duties, employment status, and whether they lived with family demonstrated that the teachers with lower UWES-9 scores had higher burdens of insomnia, psychological distress, and neck pain (odds ratios [95% confidence intervals] in 4th vs. 1st quartile, 2.92 (2.34-3.65), 3.70 (2.81-4.88), and 2.12 (1.68-2.68), respectively; all trend p<0.001). There were no significant differences in these associations between full-time and part-time teachers. Our findings indicate that low work engagement may contribute to physical and mental health issues among junior and senior high school teachers, thus providing insights for preventing health problems in this profession. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 1863-6705 2025 Novel pulmonary abdominal normothermic regional perfusion circuit for simultaneous in-donor evaluation and preservation of lungs and abdominal organs in donation after circulatory death EN Shin Tanaka Department of General Thoracic and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Masashi Umeda Department of General Thoracic and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Hiroyuki Ujike Department of General Thoracic Surgery, Shimane University Graduate School of Medicine Tsuyoshi Ryuko Department of General Thoracic and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Yasuaki Tomioka Department of General Thoracic and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Kentaroh Miyoshi Department of General Thoracic and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Mikio Okazaki Department of General Thoracic and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Seiichiro Sugimoto Department of General Thoracic and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Shinichi Toyooka Department of General Thoracic and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Objective To overcome limitations of traditional ex vivo lung perfusion (EVLP) for controlled donation after circulatory death (cDCD) lungs, this study aimed to evaluate a novel pulmonary abdominal normothermic regional perfusion (PANRP) technique, which we uniquely designed, for in situ assessment of lungs from cDCD donors.<br> Methods We modified the abdominal normothermic regional perfusion circuit for simultaneous lung and abdominal organ assessment using independent extracorporeal membrane oxygenation components. Blood was oxygenated via a membrane oxygenator and returned to the body, with pulmonary flow adjusted to maintain pressure < 25 mmHg. Femoral cannulation was performed, and the lungs were ventilated with standard settings. Organ function was assessed over 2 h using PaO2/FiO2, AST, ALT, BUN, and Cr measurements to monitor perfusion and oxygen delivery.<br> Results PANRP maintained stable lung function, with P/F ratios above 300, and preserved abdominal organ parameters, including stable AST, ALT, BUN, and Cr levels. Adequate urine output was observed, indicating normal renal function. Pulmonary artery pressure remained < 20 mmHg, and pulmonary vascular resistance was kept at 400 dyn・s/cm5, showing no signs of lung dysfunction or injury throughout the circuit.<br> Conclusions PANRP offers a promising alternative to traditional EVLP for cDCD lung evaluation, allowing in situ assessment of multiple organs simultaneously. This approach may overcome logistical and economic challenges associated with ex vivo techniques, enabling a more efficient evaluation process. Further studies are warranted to confirm its clinical applicability and impact on long-term outcomes. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 79 1 2025 Endothelial Cell Polarity in Health and Disease 1 7 EN Moe Thiha Department of Pathophysiology and Drug Discovery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takao Hikita Department of Pathophysiology and Drug Discovery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masanori Nakayama Department of Pathophysiology and Drug Discovery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Review 10.18926/AMO/68353 Endothelial cell polarity is fundamental to the organization and function of blood vessels, influencing processes such as angiogenesis, vascular stability, and response to shear stress. This review elaborates on the molecular mechanisms that regulate endothelial cell polarity, focusing on key players like the PAR polarity complex and Rho family GTPases. These pathways coordinate the front–rear, apical–basal and planar polarity of endothelial cells, which are essential for the proper formation and maintenance of vascular structures. In health, endothelial polarity ensures not only the orderly development of blood vessels, with tip cells adopting distinct polarities during angiogenesis, but also ensures proper vascular integrity and function. In disease states, however, disruptions in polarity contribute to pathologies such as coronary artery disease, where altered planar polarity exacerbates atherosclerosis, and cancer, where disrupted polarity in tumor vasculature leads to abnormal vessel growth and function. Understanding cell polarity and its disruption is fundamental not only to comprehending how cells interact with their microenvironment and organize themselves into complex, organ-specific tissues but also to developing novel, targeted, and therapeutic strategies for a range of diseases, from cardiovascular disorders to malignancies, ultimately improving patient outcomes. No potential conflict of interest relevant to this article was reported.

BMC Acta Medica Okayama 1751-0759 18 1 2024 Assessment of the renal function of patients with anorexia nervosa 19 EN Hiroyuki Miyahara Department of Clinical Pediatrics, Okayama University Academic Field of Medicine, Dentistry, and Pharmaceutical Sciences Yoshie Shigeyasu Department of Pediatrics, Okayama University Hospital Chikako Fujii Department of Pediatrics, Okayama University Hospital Chie Tanaka Department of Pediatrics, Okayama University Hospital Hanzawa Mana Department of Pediatrics, Okayama University Hospital Akiko Sugihara Clinical Psychology Section, Department of Medical Support, Okayama University Hospital Ayumi Okada Department of Pediatrics, Okayama University Hospital Hirokazu Tsukahara Department of Pediatrics, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Background A decreased glomerular filtration rate (GFR), estimated using creatinine (Cr- eGFR), is often found at the initial presentation of anorexia nervosa (AN). Its pathophysiology has been explained mainly by dehydration, and chronic hypokalemia is also thought to be a cause. However, because we have often experienced cases of AN with decreased Cr-eGFR without these conditions, we must consider different etiologies. The focus of this paper is on low free triiodothyronine (FT3) syndrome. We also discuss the utility of eGFR, estimated using cystatin-C (CysC-eGFR), for these patients.<br> Methods The data of 39 patients diagnosed with AN between January 2005 and December 2023 was available for study. The characteristics of patients at the lowest and highest body mass index standard deviation score (BMI-SDS) were examined. Data on the parameters Cr-eGFR, CysC-eGFR, dehydration markers, potassium (K), and hormonal data and BMI-SDS were assessed during the treatment course to evaluate the correlations in these parameters. Blood hematocrit, uric acid (UA), blood urine nitrogen (BUN) level, and urine specific gravity were adopted as dehydration markers; FT3, free thyroxine, thyroid stimulating hormone, and insulin-like growth factor were adopted as hormonal data. Cr-eGFR and simultaneously evaluated dehydration markers, K, or hormonal data were extracted and correlations associated with the changes in BMI-SDS were examined. Furthermore, Cr-eGFR and simultaneously assessed CysC-eGFR were compared.<br> Results When the BMI-SDS was at the lowest value, low-FT3 syndrome was shown. Severe hypokalemia was not found in our study. A linear relation was not found between Cr-eGFR and BMI-SDS. A statistically significant correlation was found between Cr-eGFR and FT3 (p = 0.0025). Among the dehydration markers, statistically significant correlations were found between Cr-eGFR and BUN or UA. The difference between Cr-eGFR and CysC-eGFR was prominent, and CysC-eGFR showed much higher values.<br> Conclusions Our data indicates that low-FT3 syndrome and dehydration were related to the renal function of our patients with AN. Furthermore, our data suggest that caution is needed in the interpretation of kidney function evaluation when using CysC-eGFR in cases of AN. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 4 2024 Middle-Ear Salivary Gland Choristoma with Congenital, Single-Sided Hearing Loss 349 355 EN Yuichiro Tominaga Department of Otolaryngology, Head and Neck Surgery, Hiroshima City, Hiroshima Citizens Hospital Akiko Sugaya Department of Otolaryngology, Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shin Kariya Department of Otolaryngology, Head and Neck Surgery, Kawasaki Medical School Hospital Aiko Shimizu Department of Otolaryngology, Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuko Kataoka Department of Otolaryngology, Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Mizuo Ando Department of Otolaryngology, Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/67554 Middle-ear salivary gland choristoma (SGCh) is a rare, benign tumor that causes conductive hearing loss owing to middle-ear morphological abnormalities. Early diagnosis is challenging, and surgical resection is indispensable for a definitive diagnosis. We report the case of a 3-year-old boy diagnosed with middle-ear SGCh during the follow-up period for left-sided hearing loss discovered at newborn hearing screening (NHS). Long-term follow-up after the NHS result, subsequent computed tomography/magnetic resonance imaging, and surgical resection led to its relatively early diagnosis and treatment. No potential conflict of interest relevant to this article was reported.

Japanese Society of Internal Medicine Acta Medica Okayama 0918-2918 63 9 2024 Severe Cytokine Release Syndrome and Immune Effector Cell-associated Neurotoxicity Syndrome in a Man Receiving Immune Checkpoint Inhibitors for Lung Cancer 1261 1267 EN Takaaki Tanaka Department of Respiratory Medicine, Okayama University Hospital Masataka Taoka Department of Respiratory Medicine, Okayama University Hospital Go Makimoto Department of Respiratory Medicine, Okayama University Hospital Kiichiro Ninomiya Center for Comprehensive Genomic Medicine, Okayama University Hospital Hisao Higo Department of Respiratory Medicine, Okayama University Hospital Masanori Fujii Department of Respiratory Medicine, Okayama University Hospital Eiki Ichihara Department of Respiratory Medicine, Okayama University Hospital Kadoaki Ohashi Department of Respiratory Medicine, Okayama University Hospital Katsuyuki Hotta Center for Innovative Clinical Medicine, Okayama University Hospital Masahiro Tabata Center for Clinical Oncology, Okayama University Hospital Yoshinobu Maeda Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences A 55-year-old man with stage IV lung adenocarcinoma was treated with cisplatin, pemetrexed, nivolumab, and ipilimumab. Approximately 100 days after treatment initiation, he became disoriented and presented to the emergency department with a high fever. Blood tests revealed liver and kidney dysfunctions. Subsequently, the patient developed generalized convulsions that required intensive care. He was clinically diagnosed with cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Organ damage was gradually controlled with immunosuppressive drugs, including steroids, and the patient was discharged. Successful treatment is rare in patients with CRS, including ICANS, during immune checkpoint inhibitor treatment for solid tumors. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers Acta Medica Okayama 2169-3536 12 2024 WLAN Channel Status Duration Prediction for Audio and Video Services Using Probabilistic Neural Networks 28201 28211 EN Yafei Hou Faculty of Environmental, Life, Natural Science and Technology, Okayama University Satoshi Denno Faculty of Environmental, Life, Natural Science and Technology, Okayama University Due to massive increase in wireless access from smartphones, IoT devices, WLAN is aiming to improve its spectrum efficiency (SE) using many technologies. Some interesting techniques for WLAN systems are flexible allocation of frequency resource and cognitive radio (CR) techniques which expect to find more useful spectrum resource by modeling and then predicting of channel status using the captured statistics information of the used spectrum. This paper investigates the prediction accuracy of busy/idle duration of two major wireless services: audio service and video service using neural network based predictor. We first study the statistics distribution of their time-series busy/idle (B/I) duration, and then analyze the predictability of the busy/idle duration based on the predictability theory. Then, we propose a data categorization (DC) method which categorizes the duration of recent B/I duration according the their ranges to make the duration of next data be distributed into several streams. From the predictability analysis of each stream and the prediction performance using the probabilistic neural network (PNN), it can be confirmed that the proposed DC can improve the prediction accuracy of time-series data in partial streams. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 1 2024 Long-Term Follow-up Data of a Multi-Institutional Phase-2 Study of S-1/oxaliplatin and Bevacizumab Therapy in Patients with Advanced Colorectal Cancer: The HiSCO-02 Study 47 52 EN Manabu Shimomura Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University Katsunori Shinozaki Division of Clinical Oncology, Hiroshima Prefectural Hospital Takuya Yano Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University Shintaro Akabane Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University Hideki Ohdan Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University Hiroshima Surgical study group of Clinical Oncology (HiSCO) Original Article 10.18926/AMO/66670 Oral fluoropyrimidines (FUs) have certain advantages over intravenous FUs, such as longer intervals between outpatient visits, no requirement for central venous port (CVP) implantation, and lower incidence of neutropenia. We previously reported the efficacy of S-1/oxaliplatin (SOX) with bevacizumab therapy as a first-line treatment for advanced colorectal cancer (CRC) in a prospective phase-II multi-institutional clinical trial (HiSCO-02 study). However, our prognostic data at the time lacked a sufficient observation period. Herein, we analyze the longer-term follow-up data, focusing on the status of eventual CVP implantation via an open-label, non-randomized, multicenter study. This study enrolled 55 patients (mean age, 64 years), of whom 43 died (41 of primary cancer). The median overall survival was 22.7 months (95% CI: 20.1-34.7 months). Post-treatment regimens after failure of first-line treatment were initiated in 43 patients; CPT11-based regimens were selected in most cases, and other oral FU combinations in nine. CVP was implanted in 35 patients prior to first-line treatment; eleven of the remaining 20 patients did not require CVP implantation. In conclusion, we report here the final prognostic update of the Phase II clinical trial examining the efficacy of SOX plus bevacizumab therapy, the results of which confirm the clinical efficacy of this regimen. 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.

Elsevier Acta Medica Okayama 0003-2670 1278 2023 Determination of mass-dependent chromium isotopic compositions in geological samples by double spike-total evaporation-thermal ionization mass spectrometry (DS-TE-TIMS) 341723 EN Dilan M. Ratnayake The Pheasant Memorial Laboratory for Geochemistry and Cosmochemistry, Institute for Planetary Materials, Okayama University Ryoji Tanaka The Pheasant Memorial Laboratory for Geochemistry and Cosmochemistry, Institute for Planetary Materials, Okayama University Eizo Nakamura The Pheasant Memorial Laboratory for Geochemistry and Cosmochemistry, Institute for Planetary Materials, Okayama University Background: Chromium isotopes have been used to trace geochemical and cosmochemical processes in the past. However, the presence of multivalent Cr species has made it difficult to isolate Cr from geological samples, particularly for samples with a low Cr mass fraction.<br> Results: Here, a simple three-step ion exchange chromatography procedure is presented to separate Cr from various sample matrices, ranging from ultramafic to felsic rocks. Throughout each of the column chromatography step, 1 mL of cation exchange resin AG50W-X8 (200–400 mesh) was used as the stationary phase and oxalic acid as a chelating agent, was used in addition to the inorganic acids. This method yielded high recoveries of Cr [93 ± 8% (2SD, N = 7)] regardless of the lithology. The total procedural blank of Cr was <0.5 ng. We also developed a double spike-total evaporation-thermal ionization mass spectrometry (DS-TE-TIMS) technique that significantly reduced sample consumption to ∼20 ng of Cr per each measurement of mass-dependent 53Cr/52Cr.<br> Significance: This study achieved a 2SD external precision of 0.02‰ for the analysis of NIST NBS3112a and of 0.01–0.07‰ for the geological samples. This study enabled high-precision Cr isotope analysis in geological samples with various matrix and Cr compositions using relatively small sample volumes. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 6 2023 Abnormal Vaginal Cytology after Total Laparoscopic Hysterectomy in Patients with Cervical Intraepithelial Neoplasia 627 634 EN Yumi Hibino Department of Gynecologic Oncology, NHO Shikoku Cancer Center Mika Okazawa-Sakai Department of Gynecologic Oncology, NHO Shikoku Cancer Center Takanori Yokoyama Department of Gynecologic Oncology, NHO Shikoku Cancer Center Etsuko Fujimoto Department of Gynecologic Oncology, NHO Shikoku Cancer Center Shinichi Okame Department of Gynecologic Oncology, NHO Shikoku Cancer Center Norihiro Teramoto Department of Pathology, NHO Shikoku Cancer Center Kazuhiro Takehara Department of Gynecologic Oncology, NHO Shikoku Cancer Center Original Article 10.18926/AMO/66155 To explore the incidence of abnormal vaginal cytology after total laparoscopic hysterectomy for the treatment of cervical intraepithelial neoplasia 3, we retrospectively analyzed the medical records of patients treated at NHO Shikoku Cancer Center (Japan) in 2014-2019. The cases of 99 patients who underwent a laparoscopic (n=36) or open (n=63) hysterectomy and postoperative follow-up were examined. Abnormal vaginal cytology was detected in 13.9% (5/36) of the laparoscopic-surgery (LS) group and 14.3% (9/63) of the open-surgery (OS) group. A vaginal biopsy was performed at the physicians’ discretion; one LS patient and six OS patients were diagnosed with vaginal intraepithelial neoplasia. The cumulative incidence of abnormal vaginal cytology at 3 years post-hysterectomy was 21.4% (LS group) and 20.5% (OS group), a nonsignificant difference. A multivariate analysis showed that age > 50 years was the only independent risk factor for abnormal vaginal cytology among the covariates examined including age; body mass index; histories of vaginal delivery, abdominal surgery, and smoking; and surgical approach (hazard ratio 8.11; 95% confidence interval 1.73-37.98; p=0.01). These results suggest that the occurrence of abnormal vaginal cytology after a hysterectomy may not be influenced by the laparoscopic procedure but is associated with older age. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 6 2023 Review of a Series of Surveys on Adverse Reactions to the COVID-19 mRNA-1273 Vaccine at Okayama University 567 575 EN Naomi Matsumoto Department of Epidemiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Chigusa Higuchi Okayama University Health Service Center Chikara Miyaji Okayama University Health Service Center Toshiharu Mitsuhashi Center for Innovative Clinical Medicine, Okayama University Hospital Hideharu Hagiya Department of Infectious Diseases, Okayama University Hospital Soshi Takao Department of Epidemiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Takashi Yorifuji Department of Epidemiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Review 10.18926/AMO/66148 This paper presents the results of a series of surveys conducted from July 2021 to March 2023 to investigate the post-vaccination adverse reactions to the mRNA-1273 (Moderna) vaccine among faculty, staff, and students at Okayama University. These studies complement the official surveys conducted by the Ministry of Health, Labour and Welfare (MHLW) and provide a more representative picture of adverse reactions in the general population including large numbers of healthy young people. Pain, swelling, redness at the injection site, fever, headache, and malaise were the main adverse reactions reported. The proportion of adverse reactions was generally higher after the second vaccination and decreased with each additional vaccination. No statistically significant differences in the adverse reactions were found for males and females and those with/without a history of allergy, but a lower proportion of fever was observed in older participants and those with underlying medical conditions. We also evaluated the association between adverse reactions and antibody titers after the third vaccination and found no significant differences in antibody levels one month after vaccination. This series of studies highlights the importance of conducting surveys in diverse populations to provide a more representative picture of post-vaccination adverse reactions during a pandemic. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 4 2023 Usefulness of Force-Controlled Pelvic Stress Radiograph in the Evaluation and Treatment of Fragility Fractures of the Pelvis in Geriatric Patients: A Pilot Study 407 414 EN Kensuke Hotta Department of Orthopaedic Surgery, Amagi Chuo Hospital Takaomi Kobayashi Department of Orthopaedic Surgery, Karatsu Red Cross Hospital Original Article 10.18926/AMO/65751 This study aimed to investigate the usefulness of force-controlled pelvic stress radiographs in the evaluation and treatment of fragility fractures of the pelvis (FFP) using a functional treatment strategy. We conducted a retrospective study of 55 geriatric patients with FFP who underwent pelvic stress radiographs on admission. The differences in the sacral width, pelvic ring width, and medial femoral head width between the radiographs with and without the Sam Sling II M size were defined as Δ sacral width, Δ pelvic ring width, and Δ medial femoral head width, respectively. We used Pearson’s correlation test to assess the relationship between the degree of radiographic instability and the Johns Hopkins highest level of mobility scale (JH-HLM) at 10-days postadmission. Conventional receiver-operating-characteristic curve analysis was used to identify cases requiring surgery using the best cutoff value for radiographic instability. The JH-HLM was significantly correlated with Δ sacral width (r=−0.401, p=0.017), but not with Δ pelvic ring width (r=−0.298, p=0.080) nor with Δ medial femoral head width (r= −0.261, p=0.128). The best cutoff value of Δ sacral width in identifying surgical cases was 10.7 mm (sensitivity 75.0%, specificity 98.0%). Force-controlled pelvic stress radiographs could be helpful in assessing the need for surgery on admission. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 4 2023 Disease Progression-Related Markers for Aged Non-Alcoholic Fatty Liver Disease Patients 377 385 EN Kosaku Morimoto Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasuto Takeuchi 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 Nozomu Wada 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 Hideki Onishi 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 Original Article 10.18926/AMO/65748 Liver fibrosis is an important phenomenon in non-alcoholic fatty liver disease (NAFLD) progression. Standard markers reflecting liver fibrosis, including the FIB-4 index, increase with age. This study aimed to identify fibrosis progression-related markers that are diagnostically beneficial even in aged individuals. Serum levels of pro- and anti-inflammatory cytokines were measured by multiple enzyme-linked immunosorbent assay. Two standard NAFLD or fibrosis progression-related markers ― the FIB-4 index and APRI score ― were analyzed along with cytokine levels to define the best approach to discriminate advanced fibrosis. Ninety-eight NAFLD patients were enrolled: 59 and 39 patients with fibrosis stages 1-2 and 3-4 respectively. In addition to the FIB-4 index and APRI score, the following factors showed significant differences between stages 1-2 and stages 3-4 in a multivariate analysis: platelet counts, IP-10, and RANTES. The fibrosis stage, FIB-4, APRI, PDGF-BB, and RANTES were related to the prognosis. In aged patients, IP-10, GM-CSF, and RANTES differed between stages 1-2 and stages 3-4. FIB-4 and APRI were beneficial for their correlation with fibrosis. However, to stratify either young or elderly advanced fibrosis patients, and to identify patients likely to have a bad outcome, RANTES was the best marker. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 4 2023 Changes in TRPV1 Receptor, CGRP, and BDNF Expression in Rat Dorsal Root Ganglion with Resiniferatoxin-Induced Neuropathic Pain: Modulation by Pulsed Radiofrequency Applied to the Sciatic Nerve 359 364 EN Tomohiro Koshida Department of Anesthesiology and Pain Clinic, Faculty of Medicine, University of Miyazaki Toyoaki Maruta Department of Anesthesiology and Pain Clinic, Faculty of Medicine, University of Miyazaki Nobuhiko Tanaka Tanaka homecare clinic Kotaro Hidaka Department of Anesthesiology and Pain Clinic, Faculty of Medicine, University of Miyazaki Mio Kurogi Department of Anesthesiology and Pain Clinic, Faculty of Medicine, University of Miyazaki Takayuki Nemoto Department of Pharmacology, Faculty of Medicine, Fukuoka University Toshihiko Yanagita Department of Clinical Pharmacology, School of Nursing, Faculty of Medicine, University of Miyazaki Ryu Takeya Department of Pharmacology, Faculty of Medicine, University of Miyazaki Isao Tsuneyoshi Department of Anesthesiology and Pain Clinic, Faculty of Medicine, University of Miyazaki Original Article 10.18926/AMO/65741 Pulsed radiofrequency (PRF) is a safe method of treating neuropathic pain by generating intermittent electric fields at the needle tip. Resiniferatoxin (RTX) is an ultrapotent agonist of transient receptor potential vanilloid subtype-1 (TRPV1) receptors. We investigated the mechanism of PRF using a rat model of RTX-induced neuropathic pain. After administering RTX intraperitoneally, PRF was applied to the right sciatic nerve. We observed the changes in TRPV1, calcitonin gene-related peptide (CGRP), and brain-derived neurotrophic factor (BDNF) in the dorsal root ganglia by western blotting. Expressions of TRPV1 and CGRP were significantly lower in the contralateral (RTX-treated, PRF-untreated) tissue than in control rats (p<0.0001 and p<0.0001, respectively) and the ipsilateral tissues (p<0.0001 and p<0.0001, respectively). BDNF levels were significantly higher in the contralateral tissues than in the control rats (p<0.0001) and the ipsilateral tissues (p<0.0001). These results suggest that, while TRPV1 and CGRP are decreased by RTX-induced neuronal damage, increased BDNF levels result in pain development. PRF may promote recovery from neuronal damage with concomitant restoration of TRPV1 and CGRP, and exert its analgesic effect by reversing BDNF increase. Further research is required to understand the role of TRPV1 and CGRP restoration in improving mechanical allodynia. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 3 2023 A Case of High-Grade Glioma in an Eloquent Area Treated with Awake Craniotomy in an 85-year-old Patient 335 340 EN Kentaro Fujii Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Shuichiro Hirano Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Kazuhiko Kurozumi Department of Neurological Surgery, Hamamatsu University School of Medicine, University Hospital Isao Date Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/65504 An 85-year-old woman presented with aphasia due to an occupying lesion in the left frontal lobe near the language area. Complete resection of the contrast-enhancing lesion was performed under awake conditions. The pathological diagnosis was anaplastic astrocytoma, and postoperative radiochemotherapy was administered. Awake surgery is a useful technique to reduce postoperative neurological sequelae and to maximize surgical resection. Although the patient was elderly, which is generally considered high risk, she did not have any severe neurological deficits and had a good outcome. Even in the extreme elderly, awake surgery can be useful for gliomas in language cortices. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 3 2023 Associations between Comorbidities and Acute Exacerbation of Interstitial Lung Disease after Primary Lung Cancer Surgery 301 309 EN Takahide Kato Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine Seigo Miyoshi Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine Chizuru Hamada Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine Yoshifumi Sano Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine Naoyuki Nogami Department of Community Medicine, Pulmonology and Cardiology, Ehime University Graduate School of Medicine Osamu Yamaguchi Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine Naohiko Hamaguchi Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine Original Article 10.18926/AMO/65495 Acute exacerbation (AE) of interstitial lung disease (ILD) is a severe complication of lung resection in lung cancer patients with ILD (LC-ILD). This study aimed to assess the predictive value of comorbidities other than ILD for postoperative AE in patients with LC-ILD. We retrospectively evaluated 68 patients with LC-ILD who had undergone lung resection. We classified them into two groups: those who had developed postoperative AE within 30 days after resection and those who had not. We analyzed patient characteristics, high-resolution computed tomography findings, clinical data, pulmonary function, and intraoperative data. The incidence of postoperative AEs was 11.8%. In univariate analysis, performance status (PS), honeycombing, forced vital capacity (FVC), and high hemoglobin A1c (HbA1c) levels without comorbidities were significantly associated with postoperative AE. Patients were divided into two groups according to cutoff levels of those four variables as determined by receiver operating characteristic curves, revealing that the rates of patients without postoperative AE differed significantly between groups. The present results suggested that preoperative comorbidities other than ILD were not risk factors for postoperative AE in patients with LC-ILD. However, a high preoperative HbA1c level, poor PS, low FVC, and honeycombing may be associated with postoperative AE of LC-ILD. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 3 2023 Impact of Immediate Breast Reconstruction on Survival of Breast Cancer Patients: A Single-Center Observational Study 281 290 EN Yuko Mukai Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Naruto Taira Department of Breast and Thyroid Surgery, Kawasaki Medical School Hospital Yukiko Kajiwara Department of Breast Surgery, Hiroshima Citizens Hospital Takayuki Iwamoto Department of Breast and Endocrine Surgery, Okayama University Hospital Yohei Kitaguchi Department of Plastic and Reconstructive Surgery, Okayama University Hospital Miho Saiga Department of Plastic and Reconstructive Surgery, Okayama University Hospital Satoko Watanabe Department of Plastic and Reconstructive Surgery, Okayama University Hospital Tadahiko Shien Department of Breast and Endocrine Surgery, Okayama University Hospital Hiroyoshi Doihara Department of Breast and Endocrine Surgery, Okayama University Hospital Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/65493 Although immediate breast reconstruction following mastectomy has become increasingly common, its oncological safety has been debated. We enrolled patients with breast cancer who underwent surgery at Okayama University Hospital between 2007 and 2013. The primary outcome was relapse-free survival (RFS). Secondary outcomes were overall survival and the duration from the surgery to the initiation of adjuvant chemotherapy. We divided into immediate breast reconstruction, mastectomy alone, and breast conservative surgery groups. Outcomes were compared using Cox’s regression analysis. A total of 614 patients were included (reconstruction: 125, mastectomy: 128, breast conservative surgery: 361). The median follow-up duration was 79.0±31.9 months. The immediate-reconstruction patients were younger, had more lymph node metastases, and more often received postoperative chemotherapy. The RFS was better after the breast conservative surgery compared to after reconstruction (hazard ratio 0.33, 95% confidence interval: 0.144-0.763). The proportion of local recurrence was highest in the reconstruction group. No patients in the reconstruction group underwent postoperative radiation therapy. However, reconstruction did not affect overall survival or the time to the initiation of adjuvant chemotherapy. Surgeons should explain the risks of breast reconstruction to their patients preoperatively. Careful long-term follow-up is required after such procedures. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 3 2023 Brown Adipose Tissue PPARγ Is Required for the Insulin-Sensitizing Action of Thiazolidinediones 243 254 EN Yusuke Shibata Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Jun Eguchi Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Jun Wada Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/65489 Brown adipose tissue (BAT) plays a critical role in metabolic homeostasis. BAT dysfunction is associated with the development of obesity through an imbalance between energy expenditure and energy intake. The nuclear receptor peroxisome proliferator-activated receptor gamma (PPARγ) is the master regulator of adipogenesis. However, the roles of PPARγ and thiazolidinediones (TZDs) in the regulation of BAT metabolism remain unclear. TZDs, which are selective PPARγ activators, improve systemic insulin resistance in animals and humans. In the present study, we generated brown adipocyte-specific PPARγ-deficient mice (BATγKO) to examine the in vivo roles of PPARγ and TZDs in BAT metabolism. In electron microscopic examinations, brown adipocyte-specific PPARγ deletion promoted severe whitening of brown fat and morphological alteration of mitochondria. Brown adipocyte-specific PPARγ deletion also reduced mRNA expression of BAT-selective genes. Although there was no difference in energy expenditure between control and BATγKO mice in calorimetry, norepinephrine-induced thermogenesis was impaired in BATγKO mice. Moreover, pioglitazone treatment improved diet-induced insulin resistance in the control mice but not in the BATγKO mice. These findings suggest that BAT PPARγ is necessary for the maintenance of brown adipocyte function and for the insulin-sensitizing action of TZDs. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 2 2023 Prolonged Sedentary Bouts Are Critically Involved in All-Cause Mortality in Patients on Chronic Hemodialysis: A Prospective Cohort Study 139 145 EN Keiichi Namio Department of Hygiene, Faculty of Medicine, Kagawa University Takashi Kondo Innoshima General Hospital Nobuyuki Miyatake Department of Hygiene, Faculty of Medicine, Kagawa University Shuhei Hishii Department of Hygiene, Faculty of Medicine, Kagawa University Hiroyuki Nishi Innoshima General Hospital Akihiko Katayama Faculty of Social Studies, Shikokugakuin University Kazuhiro Ujike Innoshima General Hospital Hiromi Suzuki Department of Hygiene, Faculty of Medicine, Kagawa University Kiichi Koumoto Innoshima General Hospital Original Article 10.18926/AMO/65143 We investigated the link between prolonged sedentary bouts and all-cause mortality in patients on chronic hemodialysis, using a prospective cohort. A total of 104 outpatients on chronic hemodialysis from 2013 to 2019, aged 71.4±11.4 years, were enrolled. Prolonged sedentary bouts (≥ 30 min and ≥60 min) (min and bouts) and relative prolonged sedentary bouts (≥ 30 min and ≥ 60 min) (%) on the patients’ non-hemodialysis days were measured by a tri-accelerometer, and we also analyzed the patients’ clinical parameters. The relationship between prolonged sedentary bouts and all-cause mortality was evaluated by a survival analysis and the Cox proportional hazard model. Thirty-five patients died during the follow-up period. A Kaplan-Meier analysis detected significant differences in the survival rate between two groups stratified by the median for all prolonged sedentary-bout parameters. After the adjustment for confounding factors, all of the prolonged sedentary-bout parameters were determinant factors for all-cause mortality. These results indicate that prolonged sedentary bouts on non-hemodialysis days were closely related to all-cause mortality in the patients on hemodialysis. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 2075-4418 13 4 2023 Association between Urinary Creatinine Excretion and Hypothyroidism in Patients with Chronic Kidney Disease 669 EN Natsumi Matsuoka-Uchiyama Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kenji Tsuji Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kensaku Takahashi Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazuhiko Fukushima Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hidemi Takeuchi Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shinji Kitamura Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kenichi Inagaki Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Haruhito A. A. Uchida Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Jun Wada Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences While hypothyroidism increases serum creatinine (Cr) levels, it is uncertain whether the elevation is mediated via a decline in the glomerular filtration rate (GFR) or the reflection of enhanced Cr production from the muscles or both. In the present study, we explored an association between urinary Cr excretion rate (CER) and hypothyroidism. A total of 553 patients with chronic kidney disease were enrolled in a cross-sectional study. Multiple linear regression analysis was performed to explore the association between hypothyroidism and urinary CER. The mean urinary CER was 1.01 +/- 0.38 g/day and 121 patients (22%) had hypothyroidism. The multiple linear regression analysis revealed explanatory variables with urinary CER, including age, sex, body mass index, 24 h Cr clearance (24hrCcr), and albumin while hypothyroidism was not considered an independent explanatory variable. In addition, scatter plot analysis with regression fit line representing the association between estimated GFR calculated using s-Cr (eGFRcre) and 24hrCcr revealed that eGFRcre and 24hrCcr had strong correlations with each other in hypothyroid patients as well as euthyroid patients. Collectively, hypothyroidism was not considered an independent explanatory variable for urinary CER in the present study and eGFRcre is a useful marker to evaluate kidney function regardless of the presence of hypothyroidism. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 1 2023 Ipsilateral Periprosthetic Fractures above and below the Knee Associated with Navigation Tracker Pin and Bone Fragility 71 74 EN Yasuaki Yamakawa Department of Orthopedic Surgery, Kochi Health Sciences Center Yusuke Kamatsuki Department of Orthopedic Surgery, Kochi Health Sciences Center Tomoyuki Noda Department of Orthopaedic Surgery, Okayama University Hospital Miho Kure Department of Orthopaedic Surgery, Okayama University Hospital Shinichi Miyazawa Department of Orthopaedic Surgery, Okayama University Hospital Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Hospital Case Report 10.18926/AMO/64364 We report a case of ipsilateral periprosthetic fractures above and below the knee that occurred at different times due to navigation tracker pin and bone fragility. A 66-year-old Japanese woman with rheumatoid arthritis (RA) underwent a total knee arthroplasty. Four months post-surgery, a periprosthetic fracture above the knee at the navigation pin hole was detected. She underwent osteosynthesis and could walk independently, but she developed an ipsilateral tibial component fracture. Conservative treatment with a splint was followed by bone union. Patients with RA treated with oral steroids tend to develop ipsilateral periprosthetic fractures around the knee due to bone fragility. No potential conflict of interest relevant to this article was reported.

Wiley Acta Medica Okayama 0915-5635 35 4 2022 Endoscopic ablation therapy for the pancreatic neoplasms 430 442 EN Kazuyuki Matsumoto Department of Gastroenterology and Hepatology, Okayama University Hospital Hironari Kato Department of Gastroenterology and Hepatology, Okayama University Hospital Recently, endoscopic ultrasound (EUS)-guided ablation therapy has been reported as a less invasive therapy for patients with pancreatic neoplasms. Some ablation techniques, including injective ablation (using ethanol or other ablative agents), radiofrequency ablation (RFA), photodynamic therapy, and laser ablation, have been described in the literature. Among these, injective ablation and RFA are more frequently used for treating pancreatic neoplasms. Few studies have evaluated the effectiveness of EUS-guided ethanol ablation (EUS-EA) for potentially malignant solid neoplasms (neuroendocrine neoplasms or solid pseudopapillary neoplasms) and have reported a complete response (CR) rate of 60-80%. In addition, the CR rate after EUS-RFA for these lesions has been reported to be 55-100%, with no additional procedure-related adverse events (AEs). Regarding the amelioration of the symptoms of an insulinoma, the success rates of both the therapies were found to be excellent. Regarding complete tumor ablation, EUS-RFA appeared to be superior to EUS-EA. Although EUS-RFA has been reported as a safe treatment for pancreatic cancers, its effectiveness remains inadequate. Some studies have examined the effectiveness of EUS-guided injection ablation therapy for pancreatic cystic neoplasms (PCNs) and have reported CR rates that range from 35% to 79%. Alcohol-free chemotherapeutic agent ablation appears to be effective, with a low risk of AEs. However, studies on the effectiveness of EUS-RFA for PCNs are limited. In the future, EUS-guided ablation therapy could become a more widely used approach for potentially malignant and malignant pancreatic lesions. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 6 2022 Salvage Surgery for Symptomatic Recurrence of Retro-Odontoid Pseudotumor after a C1 Laminectomy 749 754 EN Masanari Takami Department of Orthopaedic Surgery, Wakayama Medical University Yasutsugu Yukawa Department of Orthopaedic Surgery, Wakayama Medical University Yusuke Noda Department of Orthopaedic Surgery, Wakayama Rosai Hospital Munehito Yoshida Department of Orthopaedic Surgery, Wakayama Medical University Hiroshi Yamada Department of Orthopaedic Surgery, Wakayama Medical University Case Report 10.18926/AMO/64127 We provide the first report of successful salvage surgery for a post-C1 laminectomy symptomatic recurrence of a retro-odontoid pseudotumor (ROP) that caused myelopathy. The 72-year-old Japanese woman presented with an ROP causing symptomatic cervical myelopathy. With ultrasonography support, we performed the enucleation of the ROP via a transdural approach and fusion surgery for the recurrence of the mass. At the final observation 2-year post-surgery, MRI demonstrated the mass’s regression and spinal cord decompression, and the patient’s symptoms had improved. Our strategy is an effective option for a symptomatic recurrence of ROP. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 5 2022 A Simple and Descriptive Assessment of Morphology Based on the Horizontal Plane of the Pediatric Head and Creation of a Normative Database in Japanese Children 6 Years Old and under: Horizontal Vector Analysis 565 575 EN Sho Komagoe Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takaya Senoo Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Soshi Takao Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshinori Shiraishi Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroshi Matsumoto Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/64038 We herein introduce horizontal vector analysis, a simple method for assessing cranial morphology based on measurement of the head’s horizontal plane, and use this method to establish normal cranial morphology in Japanese children Computed tomography scans taken in 2010-2019 in healthy Japanese children aged ≤ 6 years. The two measurement planes were parallel to the orbitomeatal plane: namely, a plane passing through the dorsum sellae (DS) and the plane superior to that with the maximal area (Max plane). A protractor was used to circumferentially measure the lengths from the central point to the outer surface of the skull. A total of 487 images were extracted. The distances between the DS and Max planes were consistently almost 30 mm for each age group, so we fixed the Max plane as the plane 30 mm superior to the DS plane. Finally, we established datasets of normal values for each age group and sex. Using these norms, perioperative evaluation of various cranial deformities could be performed more easily and circumstantially. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 5 2022 Current Insights into Mesenchymal Signatures in Glioblastoma 489 502 EN Yuji Matsumoto Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Tomotsugu Ichikawa Department of Neurological Surgery, Kagawa Prefectural Central Hospital Kazuhiko Kurozumi Department of Neurosurgery, Hamamatsu University Hospital Isao Date Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Review 10.18926/AMO/64024 Glioblastoma (GBM) is a fatal primary malignant brain tumor in adults. Despite decades of research, the prognosis for GBM patients is still disappointing. One major reason for the intense therapeutic resistance of GBM is inter- and intra-tumor heterogeneity. GBM-intrinsic transcriptional profiling has suggested the presence of at least three subtypes of GBM: the proneural, classic, and mesenchymal subtypes. The mesenchymal subtype is the most aggressive, and patients with the mesenchymal subtype of primary and recurrent tumors tend to have a worse prognosis compared with patients with the other subtypes. Furthermore, GBM can shift from other subtypes to the mesenchymal subtype over the course of disease progression or recurrence. This phenotypic transition is driven by diverse tumor-intrinsic molecular mechanisms or microenvironmental factors. Thus, better understanding of the plastic nature of mesenchymal transition in GBM is pivotal to developing new therapeutic strategies. In this review, we provide a comprehensive overview of the current understanding of the elements involved in the mesenchymal transition of GBM and discuss future perspectives. No potential conflict of interest relevant to this article was reported.

Nature Portfolio Acta Medica Okayama 2045-2322 12 1 2022 The association between hypothyroidism and proteinuria in patients with chronic kidney disease: a cross-sectional study 14999 EN Natsumi Matsuoka-Uchiyama Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kenji Tsuji Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yizhen Sang Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kensaku Takahashi Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazuhiko Fukushima Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hidemi Takeuchi Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kenichi Inagaki Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Haruhito A. Uchida Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shinji Kitamura Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hitoshi Sugiyama Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Jun Wada Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hypothyroidism is known to be correlated with kidney function and nephrotic range proteinuria. However, it is uncertain whether non-nephrotic proteinuria is associated with hypothyroidism. This study aimed to evaluate the association of proteinuria and hypothyroidism in chronic kidney disease (CKD) patients. We conducted a cross-sectional study composed of 421 CKD patients in a single hospital with measurements of 24-h urine protein excretion (UP) and thyroid function tests. Spearman correlation analysis revealed that 24-h Cr clearance (24hrCcr) was positively (r = 0.273, p < 0.001) and UP was negatively (r = - 0.207, p < 0.001) correlated with free triiodothyronine. Frequency distribution analysis stratified by CKD stage and UP for hypothyroidism revealed that the prevalence of hypothyroidism was higher among participants with higher CKD stage and nephrotic range proteinuria. Multivariate logistic regression analysis revealed that 24hrCcr and UP were significantly correlated with hypothyroidism (24hrCcr/10 mL/min decrease: odds ratio [OR], 1.29; 95% confidence interval [CI], 1.18-1.41; UP/1 g increase: OR, 1.10; 95% CI, 1.03-1.17). In addition, nephrotic range proteinuria, but not moderate UP (UP: 1.5-3.49 g/day), was significantly correlated with hypothyroidism compared to UP < 0.5 g/day. In summary, decreased kidney function and nephrotic range proteinuria, not non-nephrotic proteinuria, are independently associated with the hypothyroidism. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 4 2022 Social Capital and Post-traumatic Stress Disorder among Heavy Rainfall and Flood Victims in Japan 439 446 EN Chikara Miyaji Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Soshi Takao Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masayuki Noguchi Okayama Prefectural Mental Health and Welfare Center Tsubasa Okazaki Okayama Prefectural Mental Health and Welfare Center Shunsuke Sato Okayama Prefectural Mental Health and Welfare Center Takashi Yorifuji Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/63903 This study examined the relationship between cognitive/structural social capital and post-traumatic stress disorder (PTSD) among victims of heavy rain and flood. Participants were individuals aged≥18 years affected by the July 2018 heavy rainfall in the cities of Kurashiki and Soja, Japan, and living in temporary housing. We distributed five copies of a questionnaire to 1,991 households and received responses from 1,927 individuals (907 men, 1,008 women, 12 respondents of unspecified sex) in 1,029 households (51.7%). We estimated odds ratios (ORs) and 95% confidence intervals (CIs) for associations between high (vs. low) social capital and PTSD or other outcomes. After covariate adjustment, the odds of having PTSD were lower in participants with high cognitive social capital than those with low cognitive social capital (OR=0.346, 95%CI: 0.263-0.456). Elderly women with higher structural social capital tended to have lower PTSD odds than those with lower structural social capital (OR=0.671, 95%CI: 0.431-1.046). The opposite pattern was observed for elderly men (OR=1.315, 95%CI: 0.792-2.183). Cognitive social capital is a protective factor that may reduce PTSD or promote a favorable PTSD prognosis after heavy rainfall and flood events. The associations between structural social capital and PTSD differ by age and sex. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 4 2022 The Association between Preoperative Blood Pressure Elevations and Postoperative Adverse Outcomes after Non-cardiac Surgery: A Single-center Retrospective Observational Study 429 437 EN Yusuke Yamadori Department of Anesthesiology, Faculty of Medicine, Kagawa University Tomohiro Hirao Department of Public Health, Faculty of Medicine, Kagawa University Nlandu R. Ngatu Department of Public Health, Faculty of Medicine, Kagawa University Kanae Kanda Department of Public Health, Faculty of Medicine, Kagawa University Syed Mahfuz Al Hasan Department of Public Health, Faculty of Medicine, Kagawa University Akitsu Murakami Department of Anesthesiology, Faculty of Medicine, Kagawa University Yukinori Mashima Department of Public Health, Faculty of Medicine, Kagawa University Gotaro Shirakami Department of Anesthesiology, Faculty of Medicine, Kagawa University Original Article 10.18926/AMO/63902 Blood pressure (BP) often rises before surgery. This study investigated whether BP elevation immediately before surgery was associated with adverse outcomes. Medical records of 11,732 patients (average age: 61 years; male: 47.4%) who underwent non-cardiac elective inpatient surgery under general anesthesia at Kagawa University Hospital between January 2011 and June 2019 were reviewed. Differences between the first BP values measured on the day before surgery and the first BP values in the operating room were defined as Δ systolic BP (ΔSBP) and Δ diastolic BP (ΔDBP). The relationships between ΔSBP/ΔDBP and 30-day mortality, 30-day readmission, and over-the-standard length of hospital stay (OSLOS) were assessed. OSLOS was defined as a hospital stay longer than mean+2 standard deviations and was calculated using the Japanese Diagnosis Procedure Combination data. In univariate analysis, the differences in ΔSBP and ΔDBP between the OSLOS and standard LOS groups were both 2 mmHg. In multivariate logistic regression analysis, only ΔDBP was associated with OSLOS. The adjusted odds ratio (95% confidence interval) for the largest quartile was 1.31 (1.02-1.69) (p<0.05). ΔDBP was associated with OSLOS; however, there may be little need to worry about large ΔSBPs and ΔDBPs in clinical practice. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 4 2022 Therapeutic Approaches Targeting miRNA in Systemic Lupus Erythematosus 359 371 EN Sumie Hiramatsu-Asano Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Jun Wada Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Review 10.18926/AMO/63887 Systemic lupus erythematosus (SLE) is a potentially fatal systemic autoimmune disease, and its etiology involves both genetic and environmental factors such as sex hormone imbalance, genetic predisposition, epigenetic regulation, and immunological factors. Dysregulation of microRNA (miRNA) is suggested to be one of the epigenetic factors in SLE. miRNA is a 22-nucleotide single-stranded noncoding RNA that contributes to post-transcriptional modulation of gene expression. miRNA targeting therapy has been suggested to be useful for the treatment of cancers and other diseases. Gene knockout and miRNA targeting therapy have been demonstrated to improve SLE disease activity in mice. However, these approaches have not yet reached the level of clinical application. miRNA targeting therapy is limited by the fact that each miRNA has multiple targets. In addition, the expression of certain miRNAs may differ among cell tissues within a single SLE patient. This limitation can be overcome by targeted delivery and chemical modifications. In the future, further research into miRNA chemical modifications and delivery systems will help us develop novel therapeutic agents for SLE. No potential conflict of interest relevant to this article was reported.

Springer Acta Medica Okayama 2198-7793 8 1 2022 Verrucous carcinoma of the esophagus with complete response after chemoradiotherapy 128 EN Masashi Hashimoto Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasuhiro Shirakawa Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shunsuke Tanabe Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takehiro Tanaka Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Naoaki Maeda Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazufumi Sakurama Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazuhiro Noma Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Background : Verrucous carcinoma of the esophagus (VCE) is a rare tumor that is difficult to diagnose. In most cases, biopsies show nonspecific inflammatory and hyperkeratotic changes and do not show malignant findings. Most VCEs are slowly growing, locally advanced tumors with few metastases. Treatments for VCE are the same as for normal esophageal cancer, involving combined chemotherapy, surgical resection, and radiation therapy. However, it has been reported that VCE has a poor response to radiation or chemoradiotherapy (CRT). A case of VCE with complete response (CR) after CRT is presented. <br> Case presentation : A 70-year-old man was found to have white, irregular esophageal mucosa 4 years earlier. He had been followed up as an outpatient as having candidal esophagitis. However, his tumor grew gradually, and biopsy was performed by endoscopic mucosal resection (EMR). He was finally diagnosed with VCE. He had no metastases to distant organs, but some lymph node metastases were suspected. The tumor invaded his left bronchus. The esophagostomy and gastrostomy were constructed as emergent procedures. The patient then underwent definitive CRT. 4 weeks after the end of CRT, two-stage esophagectomy was performed. First, he underwent esophagectomy with thoracic lymph node dissection. A latissimus dorsi flap was patched to the bronchus after primary suture of the hole. 6 weeks later, reconstruction of the gastric tube was performed through the antethoracic route. The pathological findings showed CR to CRT, with no proliferative cancer cells in the specimen. The patient has had no recurrence for three and half years after the resection. <br> Conclusions : We presented a locally advanced VCE that achieved CR to CRT. In cases that have some difficulty for local resection, CRT might be an appropriate treatment for VCE. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 3 2022 Bilateral Blunt Ocular Trauma Caused by an Exercise Resistance Band during Muscle Building Exercise for Swimming 349 354 EN Kanazu Ariyasu Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shuhei Kimura Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ryo Matoba Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Mio Morizane Hosokawa Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yusuke Shiode Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shinichiro Doi Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuki Kanzaki Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuki Morizane Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/63747 An 18-year-old male high school student presented to our clinic with bilateral blunt ocular trauma caused by an exercise resistance band (ERB) during a muscle-building exercise. Best-corrected decimal visual acuities (BCVAs) for right and left eyes were light perception and 0.15, respectively. The right eye was operated 10 days after injury for persistent vitreous hemorrhage, and the left eye 5 months later because of macular hole onset. After 36 months, the right eye showed extensive retinal degeneration (BCVA 0.04), and the left eye macular hole closure (BCVA 1.2). ERBs should be used cautiously as they can cause serious ocular trauma. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 3 2022 Factors Associated with Surgical Field Bacterial Detection during Total Hip Arthroplasty 291 295 EN Yoshiaki Miyake Department of Bone and Joint Surgery, Kawasaki Medical School Shigeru Mitani Department of Bone and Joint Surgery, Kawasaki Medical School Yoshifumi Namba Department of Bone and Joint Surgery, Kawasaki Medical School Norifumi Umehara Department of Bone and Joint Surgery, Kawasaki Medical School Toyohiro Kawamoto Department of Bone and Joint Surgery, Kawasaki Medical School Shuro Furuichi Department of Bone and Joint Surgery, Kawasaki Medical School Original Article 10.18926/AMO/63738 Total hip arthroplasty (THA) provides relief from hip pain and improves hip function. However, periprosthetic joint infection (PJI) remains an area of concern. We examined the detection rate of bacteria from surgical fields in wound closure, along with the relationship between bacterial detection rate and type of antiseptic, surgery time, and surgeon experience for 500 patients who underwent THA at our department. The mean age at surgery was 64.3 (± 27.3) years. The bacterial detection rate was 4.6%. None of the cases revealed PJI. No significant association between the detection rate and type of antiseptic used or surgery time was observed. However, for patients treated by surgeons with < 10 years of orthopedic experience, a detection rate of 7.3% was found, while a rate of 1.3% was observed for those treated by surgeons with ≥ 10 years of orthopedic experience. This finding indicated that orthopedic experience of less than 10 years was significantly associated with an increased bacterial detection rate (chi-square test, p=0.002). The detection rate was associated with surgeon experience but not with antiseptic type or surgery time. It is possible that intraoperative handling may increase the number of bacteria in surgical fields in wound closure. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 1 2022 Chidamide and Decitabine in Combination with a HAG Priming Regimen for Acute Myeloid Leukemia with TP53 Mutation 63 70 EN Bei Zhang Department of Hematology, Jiaozuo People’s Hospital Zhixin Pei Department of Hematology, Jiaozuo People’s Hospital Hongxia Wang Department of Hematology, Jiaozuo People’s Hospital Huimin Wu Department of Hematology, Jiaozuo People’s Hospital Junjie Wang Department of Hematology, Jiaozuo People’s Hospital Junjun Bai Department of Hematology, Jiaozuo People’s Hospital Qinglin Song Department of Hematology, Jiaozuo People’s Hospital Original Article 10.18926/AMO/63213 We analyzed the treatment effects of chidamide and decitabine in combination with a HAG (homoharringtonine, cytarabine, G-CSF) priming regimen (CDHAG) in acute myeloid leukemia (AML) patients with TP53 mutation. Seven TP53 mutated AML patients were treated with CDHAG. The treatment effects were assessed using hemogram detection and bone marrow aspirate. The possible side effects were evaluated based on both hematological and non-hematological toxicity. Four of the seven patients were classified as having achieved complete remission after CDHAG treatment; one patient was considered to have achieved partial remission, and the remaining two patients were considered in non-remission. The overall response rate (ORR) to CDHAG was 71.4%. Regarding the side effects, the hematological toxicity level of the seven patients ranged from level III to level IV, and infections that occurred at lung, blood, and skin were recorded. Nausea, vomiting, liver injury, and kidney injury were also detected. However, all side effects were attenuated by proper management. The CDHAG regimen clearly improved the ORR (71.4%) of TP53-mutated AML patients, with no severe side effects. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 1 2022 Obesity’s Influence on Insulin Resistance in Pregnant Women with Polycystic Ovary Syndrome 51 56 EN Eriko Eto Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazumasa Tani 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 Kei Hayata 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/63209 Polycystic ovary syndrome (PCOS) is a common endocrine metabolic disorder that is associated with high insulin resistance and obesity. However, ~70% of women with PCOS in Japan are non-obese. We retrospectively analyzed the cases of 163 Japanese women with PCOS who visited our Ob/Gyn department in 2006-2018 to determine which has a greater effect on insulin resistance: PCOS or obesity. We reviewed the women’s medical records and calculated their insulin resistance and insulin secretion. The women’s mean age and pre-pregnancy body mass index (BMI) were 30±5.8 years and 24.8±5.6 kg/m2, respectively; their mean ± SD fasting plasma glucose, 94.1±13.7 mg/dL; HOMA-IR, 2.1±2.0; QUICKI, 0.4±0.0; and HOMA-β, 108.9±88.0%. Sixtyeight women were pregnant, and 37% (n=25) were obese (BMI ≥ 25 kg/m2). Obesity had a greater effect on insulin resistance: fasting plasma glucose F(1, 53)=6.134, p<0.05; fasting insulin F(1, 53)=31.606, p<0.01; HOMA-IR F(1, 53)=31.670, p<0.01; QUICKI F(1, 53)=16.156, p<0.01. There was no significant difference in values other than QUICKI and testosterone between the women with and without PCOS. Obesity thus had a greater effect on increased insulin resistance in pregnant women with PCOS. Further studies of the insulin resistance of non-obese women with PCOS is needed, as non-obese women with PCOS are common in Asia. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 1 2022 Plasma Concentrations of Trace Elements Selenium and Cobalt During and After Coronary Artery Bypass Grafting Surgery 33 39 EN Jia-Yi Zhou The Institute of Cardiovascular Diseases & Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital Hai-Tao Hou Unit of Perfusion, Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospita Shi-Fu Wang Unit of Perfusion, Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital Qin Yang The Institute of Cardiovascular Diseases & Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital Guo-Wei He The Institute of Cardiovascular Diseases & Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital Original Article 10.18926/AMO/63206 Trace elements selenium (Se) and cobalt (Co) are essential in the human body, and a correlation between Se and cardiac surgery has been suggested. We investigated the plasma concentrations of Se and Co during and after coronary artery bypass grafting (CABG) surgery under cardiopulmonary bypass (CPB). From December 2019 to January 2020, preoperative plasma samples from isolated first-time CABG patients (n=20; 10 males, 10 females) were prospectively collected post-anesthesia and before CPB (T1), 45 min after CPB started (T2), 90 min after CPB started (T3), and postoperative days 1 (T4), and day 4 (T5). The plasma concentrations of Se and Co were measured. The Se concentration was significantly decreased at T2 (105.24±4.08 vs. 68.56±2.42 μg/L, p<0.001) and T3 (105.24±4.08 vs. 80.41±3.40 μg/L, p<0.001). The Co concentration was significantly decreased at T4 (0.35±0.19 vs. 0.26±0.13 μg/L, p<0.01) and T5 (0.35±0.19 vs. 0.23±0.11 μg/L, p<0.001). Five patients developed atrial fibrillation (AF); there was no other operative mortality or major morbidity. This is the first report of alterations of plasma Se and Co concentrations during and after CABG surgery. Our results may indicate that Se supplementation before or during CABG and Co supplementation after CABG may become necessary for patients undergoing CABG. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 6 2021 Novel Technique for Removing a Well-Fixed Cemented Cup with a Dedicated Original Device during Revision Total Hip Arthroplasty: Surgical Technique 751 754 EN Hirosuke Endo Department of Bone and Joint Surgery, Kawasaki Medical School, Kurashiki City Kazuki Yamada Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Denstry and Pharmaceutical Scineces Tomonori Testunaga Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Denstry and Pharmaceutical Scineces Takayuki Furumatsu Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Denstry and Pharmaceutical Scineces Shigeru Mitani Department of Bone and Joint Surgery, Kawasaki Medical School, Kurashiki City Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Denstry and Pharmaceutical Scineces Case Report 10.18926/AMO/62817 The improved cemented cup technique has attained excellent long-term results in primary total hip arthroplasty. When cup revision surgery was performed, the cemented cup, which was loosened at the bone-cement interface, was easily removed. However, with a well-fixed bone-cement interface, it remains difficult to remove the cemented cup for a revision in the event of a recurring dislocation. In addition, protrusions in the cement can cause unpredictable bone defects. A new removal device was created and used successfully to remove a well-fixed cemented cup safely and efficiently. This report introduces the device and the technique used in cemented cup removal. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 6 2021 Multiple Roles of Histidine-Rich Glycoprotein in Vascular Homeostasis and Angiogenesis 671 675 EN Shangze Gao Department of Pharmacology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masahiro Nishibori Department of Pharmacology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Review 10.18926/AMO/62805 Histidine-rich glycoprotein (HRG) is a 75 kDa plasma protein that is synthesized in the liver of many verte-brates and present in their plasma at relatively high concentrations of 100-150 μg/mL. HRG is an abundant and well-characterized protein having a multidomain structure that enable it to interact with many ligands, func-tion as an adaptor molecule, and participate in numerous physiological and pathological processes. As a plasma protein, HRG has been reported to regulate vascular biology, including coagulation, fibrinolysis and angiogenesis, through its binding with several ligands (heparin, FXII, fibrinogen, thrombospondin, and plas-minogen) and interaction with many types of cells (endothelial cells, erythrocytes, neutrophils and platelets). This review aims to summarize the roles of HRG in maintaining vascular homeostasis and regulating angiogen-esis in various pathological conditions. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 5 2021 Glial Cells as Possible Targets of Neuroprotection through Neurotrophic and Antioxidative Molecules in the Central and Enteric Nervous Systems in Parkinson’s Disease 549 556 EN Nami Isooka Department of Medical Neurobiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ikuko Miyazaki Department of Medical Neurobiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masato Asanuma Department of Medical Neurobiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Review 10.18926/AMO/62767 Parkinson’s disease (PD) is the second most common neurodegenerative disease worldwide. The loss of nigrostriatal dopaminergic neurons produces its characteristic motor symptoms, but PD patients also have non-motor symptoms such as constipation and orthostatic hypotension. The pathological hallmark of PD is the presence of α-synuclein-containing Lewy bodies and neurites in the brain. However, the PD pathology is observed in not only the central nervous system (CNS) but also in parts of the peripheral nervous system such as the enteric nervous system (ENS). Since constipation is a typical prodromal non-motor symptom in PD, often preceding motor symptoms by 10-20 years, it has been hypothesized that PD pathology propagates from the ENS to the CNS via the vagal nerve. Discovery of pharmacological and other methods to halt this progression of neurodegeneration in PD has the potential to improve millions of lives. Astrocytes protect neurons in the CNS by secretion of neurotrophic and antioxidative factors. Similarly, astrocyte-like enteric glial cells (EGCs) are known to secrete neuroprotective factors in the ENS. In this article, we summarize the neuroprotective function of astrocytes and EGCs and discuss therapeutic strategies for the prevention of neurodegeneration in PD targeting neurotrophic and antioxidative molecules in glial cells. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 4 2021 Usefulness of Middle Colic Artery Transposition Technique for Hepatic Arterial Reconstruction in Conversion Surgery for an Initially Unresectable, Locally Advanced Pancreatic Cancer 543 548 EN Ryuichi Yoshida Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takahito Yagi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazuya Yasui Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuzo Umeda Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazuhiro Yoshida Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tomokazu Fuji Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kosei Takagi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kenjiro Kumano Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masashi Yoshimoto Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/62410 The outcomes of pancreatectomy with resection and reconstruction of the involved arteries for locally advanced pancreatic cancer following chemotherapy have improved in recent years. In pancreatic head cancers in which there is contact with the common and proper hepatic arteries, margin-negative resection requires pancreati-coduodenectomy, with the resection of these arteries and the restoration of hepatic arterial flow. Here, we describe a middle colic artery transposition technique in hepatic arterial reconstruction during pancreatoduo-denectomy for an initially unresectable locally advanced pancreatic cancer. This technique was effective and may provide a new option for hepatic artery reconstruction in such cases. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 4 2021 Assessment of the Concordance Rate between Intraoperative Pathological Diagnosis and the Final Pathological Diagnosis of Spinal Cord Tumors 455 460 EN Sosuke Muraoka Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kentaro Yamane Department of Intelligent Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Haruo Misawa Department of Orthopaedic Surgery, Okayama University Hospital Tomoyuki Takigawa Department of Orthopaedic Surgery, Okayama University Hospital Tomoko Tetsunaga Yoshiaki Oda Department of Orthopaedic Surgery, Okayama University Hospital Kazuo Nakanishi Department of Orthopaedic Surgery, Kawasaki Medical School Hospital Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takehiro Tanaka Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/62397 The intraoperative pathological diagnosis (IPD) plays an important role in determining the optimal surgical treatment for spinal cord tumors. The final pathological diagnosis (FPD) is sometimes different from the IPD. Here, we sought to identify the accuracy of the IPD of spinal cord tumors compared to the FPD. We retrospec-tively analyzed the cases of 108 patients with spinal cord tumors treated surgically in our institute; the IPD, FPD, mismatched cases, and concordance rate between the IPD and FPD were investigated. Five cases involved a mismatch between the IPD and FPD. The overall concordance rate was 95.4%, with 90.9% for extra-dural lesions, 98.5% for intradural extramedullary lesions, 84.2% for intramedullary lesions, and 100% for dumbbell-type tumors. The concordance rate of intramedullary lesions tended to be lower than that of other lesions (p = 0.096). A lower concordance rate was revealed for intramedullary lesions compared to the other lesions. Despite the IPD clearly remaining a valuable tool during operative procedures, surgeons should recog-nize the limitations of IPDs and make comprehensive decisions about surgical treatments. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 4 2021 Surgical Treatment of Epiretinal Membrane 403 413 EN Ryo Matoba Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuki Morizane Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Review 10.18926/AMO/62378 Epiretinal membrane (ERM) is a common retinal disease characterized by cellular proliferation and metaplasia that lead to the formation of a pathological fibrocellular membrane immediately superjacent to the inner retinal surface. The vast majority of ERMs are considered idiopathic. However, ERM formation can result from various primary intraocular diseases, including retinal breaks and detachment, retinal vascular diseases, and vitreoretinal inflammatory conditions. Although ERMs are generally asymptomatic or cause mild metamorphopsia and/or a modest decrease in visual acuity, some can cause severe macular distortion and macular edema, resulting in significantly impaired function. Surgical removal of ERM is the only treatment, and improvements in vitrectomy systems have enabled less invasive treatment. However, there are currently no standardized criteria for ERM surgery, and the indications for surgery are determined from the patient’s subjective symptoms. Another problem with ERM surgery is that not all patients show satisfactory postoperative recovery of visual function. Thus, further research is needed to determine the criteria for ERM surgery and methods to improve the postoperative prognosis. No potential conflict of interest relevant to this article was reported.

Elsevier BV Acta Medica Okayama 0959-8049 153 2021 Phase I dose-escalation study of endoscopic intratumoral injection of OBP-301 (Telomelysin) with radiotherapy in oesophageal cancer patients unfit for standard treatments 98 108 EN Yasuhiro Shirakawa Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroshi Tazawa Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shunsuke Tanabe Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Nobuhiko Kanaya Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazuhiro Noma Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takeshi Koujima Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hajime Kashima Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takuya Kato Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shinji Kuroda Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Satoru Kikuchi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shunsuke Kagawa Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kuniaki Katsui Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasuo Urata Oncolys BioPharma, Inc. Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Purpose: OBP-301 (Telomelysin) is an attenuated type-5 adenovirus that contains the human telomerase reverse transcriptase promoter to regulate viral replication. OBP-301 sensitises human cancer cells to ionising radiation by inhibiting DNA repair, and radiation enhances coxsackievirus and adenovirus receptor-mediated OBP-301 infection on the contrary. We assessed OBP-301 with radiotherapy in oesophageal cancer patients unfit for standard chemoradiation treatments.<br> <br> Methods: A phase I dose-escalation study of OBP-301 with radiotherapy was conducted in 13 histologically confirmed oesophageal cancer patients deemed unfit to undergo surgery or chemotherapy. Study treatment consisted of OBP-301 administration by intratumoural needle injection using a flexible endoscope on days 1, 18 and 32. Radiotherapy was administered concurrently over 6 weeks, beginning on day 4, to a total of 60 Gy.<br> <br> Results: Of the 13 patients, 7, 3 and 3 patients were treated with 10(10), 10(11) and 10(12) virus particles, respectively. Study group comprised 10 males and 3 females, with a median age of 82 years (range, 53-91 years). All patients developed a transient, self-limited lymphopenia. Distribution studies revealed transient virus shedding in the plasma. Eight patients had local complete response (CR); all of them exhibited no pathologically viable malignant cells in biopsy specimens, and 3 patients had a partial response. The objective response rate was 91.7%. The clinical CR rate was 83.3% in stage I and 60.0% in stage II/III. Histopathological examination revealed massive infiltration of CD8 thorn cells and increased PD-L1 expression.<br> <br> Conclusion: Multiple courses of endoscopic intratumoural OBP-301 injection with radiotherapy are feasible and provide clinical benefits in patients with oesophageal cancer unfit for standard treatments. (C) 2021 Elsevier Ltd. All rights reserved. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 3 2021 Presence of Microplastics in Four Types of Shellfish Purchased at Fish Markets in Okayama City, Japan 381 384 EN Ken-ichi Yamamoto Department of Cell Biology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiyuki Oshiki Department of Applied Chemistry, Graduate School of Natural Science and Technology, Okayama University Hiroko Kagawa Okayama University Hospital Masayoshi Namba Department of Cell Biology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masakiyo Sakaguchi Department of Cell Biology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Short Communication 10.18926/AMO/62234 The worldwide microplastic pollution in our environment is a matter of great concern. Harmful effects of plastics have been reported in various types of organisms including murine animals. We examined the presence of microplastics in four types of shellfish purchased from fish markets in Okayama, Japan and served to the public: short-neck clam (Ruditapes philippinarum, asari in Japanese), hard-shell clam (Meretrix lusoria, hamaguri), brackishwater clam (Cyrenidae, shijimi), and oyster (Crassostrea gigas, kaki). Our analyses demonstrated that approx. 3 pieces of microplastics were present per single shellfish, based on the division of the total number of pieces of microplastic obtained from all 4 types of shellfish by the total number of shellfish examined. Since health problems in humans due to microplastics have not yet been confirmed, further examinations of the effects of ingested microplastics are needed. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 3 2021 Relationships among Bone Metabolic Markers, Body Fat Composition and Carotid Intima–Media Thickness in Premenopausal Obese Women 373 379 EN Guzin F. Yaylali Department of Endocrinology and Metabolism, Pamukkale University Ozen Dedeoglu Department ofInternal Medicine, Pamukkale University Senay Topsakal Department of Endocrinology and Metabolism, Pamukkale University Duygu Herek Department of Radiology, Pamukkale University Hande Senol Department of Biostatistics, Pamukkale University Original Article 10.18926/AMO/62233 Osteocalcin (OC) is inversely related to body fat distribution and fasting glucose levels. We sought to observe the effect of OC on fat distribution and subclinical atherosclerosis as measured by carotid intima-media thickness (CIMT) in premenopausal obese women. In this prospective observational study, totally, 73 premenopausal obese women (aged 17-55 years) and 53 healthy women (aged 20-50 years) with normal weight were included as controls. Anthropometric measurements, total fat and fat ratio, insulin, fasting blood glucose, and OC levels were estimated. Ultrasonography was used to assess fat distribution, and fat thickness was measured in 4 regions. Subcutaneous fat (SCF), visceral fat (VF), and preperitoneal fat (PPF) thicknesses were considerably higher in obese subjects (p<0.01) than healthy controls, while OC levels were significantly lower. No correlation was observed between OC levels and SCF, VF, or PPF. In a multiple regression analysis, OC was significantly positively associated with SCF (p=0.04, Beta=0.284). No associations were observed between OC levels and VF, PPF, or CIMT. A significant association was observed between parathyroid hormone (PTH) and VF (p=0.021, Beta=0.284), and vitamin D levels were inversely associated with VF (p=0.002, r=−0.366). OC levels were lower in premenopausal obese women than normal-weight healthy controls, but OC exhibited no correlation with VF or PPF, and only a weak positive association with SCF. Additionally, VF was positively correlated with PTH and inversely correlated with vitamin D. These results suggest that OC may be an early indicator of lipid accumulation in te subcutaneous area and development of atherosclerosis. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 2 2021 Pyogenic Ventriculitis After Anterior Skull Base Surgery Treated With Endoscopic Ventricular Irrigation And Reconstruction Using a Vascularized Flap 243 248 EN Yusuke Tomita Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yosuke Shimazu Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Masato Kawakami Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Hiroshi Matsumoto Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kentaro Fujii Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Masahiro Kameda 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 Yasuki Suruga Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Tomoyuki Ota Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kazuhiko Kurozumi 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/61908 Ventriculitis is a rare, serious complication of neurosurgery. A 59-year-old man who had undergone a craniotomy for a paranasal adenocarcinoma, developed a right frontal cystic lesion. We performed a bifrontal craniotomy to remove the lesion. The dura was repaired with non-vascularized free fascia lata in watertight fashion. Ventriculitis occurred 3 days postoperatively. Ventricular drainage, craniectomy, and endoscopic irrigation were undertaken to remove an abscess. The dura and the resection cavity were reconstructed using a vascularized anterolateral thigh adipofascial flap. His symptoms disappeared, indicating that endoscopic irrigation and reconstruction can effectively address ventriculitis even in patients in critical clinical condition. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 2 2021 Long-term Survival with a Rare Advanced Primary Gastrointestinal Malignant Melanoma Treated with Laparoscopic Surgery/Immune Checkpoint Inhibitor 231 238 EN Motochika Endo Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shuya Yano Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroaki Asano Department of Surgery, Mitoyo general Hospital Sho Takeda Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuki Hamada Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshitaka Kondo Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shinji Kuroda Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kunitoshi Shigeyasu Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Satoru Kikuchi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takehiro Tanaka Department of Pathology, Okayama University Hospital Fuminori Teraishi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masahiko Nishizaki Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shunsuke Kagawa Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/61906 Targeted therapies for malignant melanoma have improved patients’ prognoses. A primary gastrointestinal malignant melanoma is very rare, with no standard treatment strategy. We treated a 78-year-old Japanese female with advanced primary gastrointestinal melanoma of the descending colon and gallbladder. We administered a multidisciplinary treatment: surgical resection of the descending colon and gallbladder tumors, resection of the metastatic lymph nodes behind the pancreas head, and immune checkpoint antibody-blockade therapy (nivolumab) for ~4 years. PET/CT demonstrated no recurrent lesion for > 3 years. Multidisciplinary therapies (e.g., surgery, chemotherapy, radiotherapy, target therapy, and immune checkpoint antibody-blockade therapy) can successfully treat primary gastrointestinal malignant melanoma. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 2 2021 Laparoscopic Hepatectomy for the Patient with Hemophilia A with High Titer Factor VIII Inhibitor 199 204 EN Tatsuo Matsuda Department of Gastroenterological Surgery,Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuzo Umeda Department of Gastroenterological Surgery,Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazuhiro Yoshida Department of Gastroenterological Surgery,Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tadakazu Matsuda Department of Surgery, Matsuda Hospital Masatoshi Uno Department of Internal Medicine, Kaneda Hospital Masaya Abe Department of Hematology and Oncology,Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Noboru Asada Department of Hematology and Oncology,Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshinobu Maeda Department of Hematology and Oncology,Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takahito Yagi Department of Gastroenterological Surgery,Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery,Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/61901 We present the first case of laparoscopic left lateral segmentectomy for hepatocellular carcinoma (HCC) in a patient with hemophilia A, acquired hepatitis C, and high-titer factor VIII inhibitor, which was confirmed by preoperative diagnosis. He underwent laparoscopic left lateral segmentectomy with the administration of recombinant activated factor VII. Surgery could be performed with reduced intraoperative hemorrhage. He experienced postoperative intra-abdominal wall hemorrhage, which was successfully managed with red cell concentrates transfusion and administration of recombinant activated factor VII. Laparoscopic hepatectomy can be applied for hemophilia patients with high titer inhibitors. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 2 2021 Lactoferrin-like Immunoreactivity in Distinct Neuronal Populations in the Mouse Central Nervous System 153 167 EN Shigeyoshi Shimaoka Department of Anatomy and Cell Biology, Division of Life Sciences, Osaka Medical and Pharmaceutical University Hitomi Hamaoka Department of Anatomy and Cell Biology, Division of Life Sciences, Osaka Medical and Pharmaceutical University Junji Inoue Department of Anatomy and Cell Biology, Division of Life Sciences, Osaka Medical and Pharmaceutical University Masato Asanuma Department of Medical Neurobiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ikuo Tooyama Molecular Neuroscience Research Center, Shiga University of Medical Science Yoichi Kondo Molecular Neuroscience Research Center, Shiga University of Medical Science Original Article 10.18926/AMO/61894 Lactoferrin (Lf) is an iron-binding glycoprotein mainly found in exocrine secretions and the secondary granules of neutrophils. In the central nervous system (CNS), expression of the Lf protein has been reported in the lesions of some neurodegenerative disorders such as Alzheimer’s disease, Parkinson’s disease, and amyotrophic lateral sclerosis, as well as in the aged brain. Lf is primarily considered an iron chelator, protecting cells from potentially toxic iron or iron-requiring microorganisms. Other biological functions of Lf include immunomodulation and transcriptional regulation. However, the roles of Lf in the CNS have yet to be fully clarified. In this study, we raised an antiserum against mouse Lf and investigated the immunohistochemical localization of Lf-like immunoreactivity (Lf-LI) throughout the CNS of adult mice. Lf-LI was found in some neuronal populations throughout the CNS. Intense labeling was found in neurons in the olfactory systems, hypothalamic nuclei, entorhinal cortex, and a variety of brainstem nuclei. This study provides detailed information on the Lf-LI distribution in the CNS, and the findings should promote further understanding of both the physiological and pathological significance of Lf in the CNS. 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.

Nature Research Acta Medica Okayama 2045-2322 11 1 2021 Exploratory classification of clinical phenotypes in Japanese patients with antineutrophil cytoplasmic antibody-associated vasculitis using cluster analysis EN Haruki Watanabe Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Ken-ei Sada Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Masayoshi Harigai Department of Rheumatology, Tokyo Women’s Medical University School of Medicine Koichi Amano Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University Hiroaki Dobashi Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University Yoshinari Takasaki Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine Shouichi Fujimoto Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki Tatsuya Atsumi Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Kunihiro Yamagata Department of Nephrology, Faculty of Medicine, University of Tsukuba Sakae Homma Department of Advanced and Integrated Interstitial Lung Diseases Research, School of Medicine, Toho University Yoshihiro Arimura Department of Nephrology and Rheumatology, Kyorin University School of Medicine Hirofumi Makino Okayama University Research Committee of Intractable Vasculitis Syndrome (JPVAS) & Research Committee of Intractable Renal Disease of the Ministry of Health, Labour, and Welfare of Japan A novel patient cluster in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) may be identified in Japan. We performed multiple correspondence and cluster analysis regarding 427 clinically diagnosed AAV patients excluding eosinophilic granulomatosis with polyangiitis. Model 1 included the ANCA phenotype, items of the Birmingham Vasculitis Activity Score, and interstitial lung disease; model 2 included serum creatinine (s-Cr) and C-reactive protein (CRP) levels with model 1 components. In seven clusters determined in model 1, the ANCA-negative (n=8) and proteinase 3-ANCA-positive (n=41) groups emerged as two distinct clusters. The other five myeloperoxidase-ANCA-positive clusters were characterized by ear, nose, and throat (ENT) (n=47); cutaneous (n=36); renal (n=256), non-renal (n=33); and both ENT and cutaneous symptoms (n=6). Four clusters in model 2 were characterized by myeloperoxidase-ANCA negativity (n=42), without s-Cr elevation (<1.3 mg/dL) (n=157), s-Cr elevation (<greater than or equal to>1.3 mg/dL) with high CRP (>10 mg/dL) (n=71), or s-Cr elevation (>= 1.3 mg/dL) without high CRP (<= 10 mg/dL) (n=157). Overall, renal, and relapse-free survival rates were significantly different across the four clusters in model 2. ENT, cutaneous, and renal symptoms may be useful in characterization of Japanese AAV patients with myeloperoxidase-ANCA. The combination of s-Cr and CRP levels may be predictive of prognosis. No potential conflict of interest relevant to this article was reported.

Springer Acta Medica Okayama 1618-2642 413 2021 Speciation of chromium in water samples using microfluidic paper-based analytical devices with online oxidation of trivalent chromium 3339 3347 EN Abdellah Muhammed Center for Environmental Science, College of Natural and Computational Sciences, Addis Ababa University Ahmed Hussen Center for Environmental Science, College of Natural and Computational Sciences, Addis Ababa University Takashi Kaneta Department of Chemistry, Graduate School of Natural Science and Technology, Okayama University Speciation of chromium (Cr) was demonstrated using microfluidic paper-based analytical devices (μ-PADs) that permit the colorimetric determination of hexavalent chromium (Cr(VI)) and trivalent chromium (Cr(III)) via online oxidation. The μ-PADs consist of left and right channels that allow the simultaneous measurements of Cr(VI) and total Cr based on the colorimetric reaction of Cr(VI) with 1,5-diphenylcarbazide (DPC). For the determination of Cr(VI), a sample solution was directly reacted with DPC in the left channels whereas total Cr was determined in the right channels, which permitted online oxidation in the pretreatment zone containing cerium (IV) (Ce(IV)) followed by a colorimetric reaction with DPC. We found that the online oxidation of Cr(III) proceeded 100% whereas Ce(IV) inhibited the reaction of Cr(VI) with DPC. Therefore, speciation can be achieved by measuring the Cr(VI) and total Cr in the left and right channels followed by the subtraction of Cr(VI) from total Cr. The limits of detection and quantification were 0.008 and 0.02 mg L−1 for Cr(VI) and 0.07 and 0.1 mg L−1 for Cr(III) or total Cr, respectively. The linear dynamic ranges were 0.02–100 mg L−1 and 0.1–60 mg L−1 for Cr(VI) and Cr(III), respectively. The RSDs were less than 7.5%. The results obtained using μ-PADs were in good agreement with those obtained via ICP-OES with recoveries of 92–108% for Cr(III) and 108–110% for Cr (VI) using μ-PADs, and 106–110% for total Cr using ICP-OES. Thus, the μ-PADs could potentially be utilized for the speciation of chromium in developing countries where environmental pollution and the availability of sophisticated instruments are significant problems. No potential conflict of interest relevant to this article was reported.

Nature Acta Medica Okayama 2041-1723 12 1 2021 Structure of photosystem I-LHCI-LHCII from the green alga Chlamydomonas reinhardtii in State 2 1100 EN Zihui Huang Department of Biophysics, and Department of Pathology of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine Liangliang Shen Photosynthesis Research Center, Key Laboratory of Photobiology, Institute of Botany, Chinese Academy of Sciences Wenda Wang Photosynthesis Research Center, Key Laboratory of Photobiology, Institute of Botany, Chinese Academy of Sciences Zhiyuan Mao Photosynthesis Research Center, Key Laboratory of Photobiology, Institute of Botany, Chinese Academy of Sciences Xiaohan Yi Department of Biophysics, and Department of Pathology of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine Tingyun Kuang Photosynthesis Research Center, Key Laboratory of Photobiology, Institute of Botany, Chinese Academy of Sciences Jian-Ren Shen Institute for Interdisciplinary Science, and Graduate School of Natural Science and Technology, Okayama University Xing Zhang Department of Biophysics, and Department of Pathology of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine Guangye Han Photosynthesis Research Center, Key Laboratory of Photobiology, Institute of Botany, Chinese Academy of Sciences Photosystem I (PSI) and II (PSII) balance their light energy distribution absorbed by their light-harvesting complexes (LHCs) through state transition to maintain the maximum photosynthetic performance and to avoid photodamage. In state 2, a part of LHCII moves to PSI, forming a PSI-LHCI-LHCII supercomplex. The green alga Chlamydomonas reinhardtii exhibits state transition to a far larger extent than higher plants. Here we report the cryo-electron microscopy structure of a PSI-LHCI-LHCII supercomplex in state 2 from C. reinhardtii at 3.42 Å resolution. The result reveals that the PSI-LHCI-LHCII of C. reinhardtii binds two LHCII trimers in addition to ten LHCI subunits. The PSI core subunits PsaO and PsaH, which were missed or not well-resolved in previous Cr-PSI-LHCI structures, are observed. The present results reveal the organization and assembly of PSI core subunits, LHCI and LHCII, pigment arrangement, and possible pathways of energy transfer from peripheral antennae to the PSI core. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 75 1 2021 Long-term Follow-up of Living-Donor Kidney Transplantation after Cadaveric Lung Transplantation 87 89 EN Toshio Shiotani Department of Organ Transplant Center, Okayama University Hospital Seiichiro Sugimoto Department of Organ Transplant Center, Okayama University Hospital Kota Araki Department of General Thoracic Surgery, Okayama University Hospital Yasuaki Tomioka Department of Organ Transplant Center, Okayama University Hospital Kentaroh Miyoshi Department of General Thoracic Surgery, Okayama University Hospital Shinji Otani Department of General Thoracic Surgery, Okayama University Hospital Masaomi Yamane Department of General Thoracic Surgery, Okayama University Hospital Shinichi Toyooka Department of General Thoracic Surgery, Okayama University Hospital Case Report 10.18926/AMO/61439 Although chronic kidney disease (CKD) commonly develops after lung transplantation (LT), living-donor kid-ney transplantation (LDKT) for CKD after LT is known to provide favorable outcomes. We describe the long-term follow-up findings of a patient who underwent LDKT after bilateral cadaveric LT. A 37-year-old male underwent LDKT for CKD 18 years after receiving bilateral cadaveric LT. He developed chronic lung allograft dysfunction (CLAD) 20 years after the LT; however, at 26 years after the initial LT, he is still alive with no pro-gression of CLAD or CKD. KT could be a viable option for CKD even after LT in Japan. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 6 2020 Soft Tissue Myoepithelioma of the Shoulder 531 535 EN Kazuhiko Hashimoto Department of Orthopedic Surgery, Kindai University Hospital Shunji Nishimura Department of Orthopedic Surgery, Kindai University Hospital Takaaki Chikugo Department of Pathology, Kindai University Hospital Ryosuke Kakinoki Department of Orthopedic Surgery, Kindai University Hospital Masao Akagi Department of Orthopedic Surgery, Kindai University Hospital Case Report 10.18926/AMO/61213 Soft tissue myoepitheliomas are often misdiagnosed due to their rarity. Herein, we describe a case of soft tissue myoepithelioma of the shoulder. A 72-year-old woman had a suspected sarcoma on her shoulder and under-went open biopsy. She was referred to our hospital, where the tumor was widely resected and the diagnosis of myoepithelioma was histologically confirmed. No recurrence has been observed in the 3 years since the sur-gery. Careful and prompt planning is necessary for the effective treatment of myoepithelioma. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 6 2020 Bilateral Approach for Thoracoscopic Esophagectomy in a Patient with Esophageal Cancer and Solitary Posterior Thoracic Para-aortic Lymph Node Metastasis 521 524 EN Yujiro Itazaki Department of Surgery, National Defense Medical College Hironori Tsujimoto Department of Surgery, National Defense Medical College Hidekazu Sugasawa Department of Surgery, National Defense Medical College Yoshihisa Yaguchi Department of Surgery, National Defense Medical College Shinsuke Nomura Department of Surgery, National Defense Medical College Nozomi Ito Department of Surgery, National Defense Medical College Manabu Harada Department of Surgery, National Defense Medical College Takao Sugihara Department of Surgery, National Defense Medical College Satoshi Tsuchiya Department of Surgery, National Defense Medical College Yusuke Ishibashi Department of Surgery, National Defense Medical College Keita Kouzu Department of Surgery, National Defense Medical College Yoji Kishi Department of Surgery, National Defense Medical College Hideki Ueno Department of Surgery, National Defense Medical College Case Report 10.18926/AMO/61211 We report a successful dissection of metastatic posterior thoracic para-aortic lymph node (No. 112aoP) via bilateral thoracoscopic surgery. With the anesthetized patient (a 73-year-old Japanese woman) in the prone position, two working ports were inserted for the left-side approach, and artificial pneumothorax was created. Thoracoscopic examination revealed a swollen LN posterior to the descending aorta. Fat and metastatic LNs posterior to the aorta were dissected from the aortic arch level to the diaphragm while preserving intercostal arteries. For the right-side approach, two working ports were inserted and a routine thoracoscopic esophagec-tomy was performed. Gastric conduit reconstruction was achieved laparoscopically. Operation time for the left thoracic procedure: 54 min; estimated blood loss: almost none. No recurrence was detected 24 months post-operatively. There are several surgical options for approaching No. 112aoP, including transhiatal, left thora-cotomy, and thoracoscopy. Although a wide dissection of the posterior thoracic para-aortic area has not been reported, it may be feasible and safe if the artery of Adamkiewicz and intercostal arteries are preserved. A min-imally invasive bilateral thoracoscopic approach for a thoracoscopic esophagectomy is safe and useful for esophageal cancer patients with solitary No. 112aoP metastasis. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 5 2020 Evaluation of Prognosis of Juvenile Differentiated Thyroid Carcinoma 401 406 EN Takahiro Tsukioki Department of Breast and Endocrine Surgery, Okayama University Hospital Tadahiko Shien Department of Breast and Endocrine Surgery, Okayama University Hospital Yusuke Ohtani Department of Breast and Endocrine Surgery, Okayama University Hospital Miwa Fujihara Department of Breast and Endocrine Surgery, Okayama University Hospital Yoko Suzuki Department of Breast and Endocrine Surgery, Okayama University Hospital Yukiko Kajihara Department of Breast and Endocrine Surgery, Okayama University Hospital Minami Hatono Department of Breast and Endocrine Surgery, Okayama University Hospital Kengo Kawada Department of Breast and Endocrine Surgery, Okayama University Hospital Mariko Kochi Department of Breast and Endocrine Surgery, Okayama University Hospital Takayuki Iwamoto Department of Breast and Endocrine Surgery, Okayama University Hospital Hirokuni Ikeda Department of Breast and Endocrine Surgery, Okayama University Hospital Naruto Taira Department of Breast and Endocrine Surgery, Okayama University Hospital Hiroyoshi Doihara Department of Breast and Endocrine Surgery, Okayama University Hospital Original Article 10.18926/AMO/60799 Differentiated thyroid carcinoma (DTC) in juvenile patients is often an extensive and aggressive disease with a high frequency of recurrence. However, the prognosis is excellent, with a low mortality rate even when advanced disease is present, although prognostic factors and treatment strategy remain uncertain. Between April 2004 and March 2017, 33 juvenile patients (< 30 years old) were diagnosed with DTC and treated at our institution. We retrospectively investigated prognosis and factors including sex, reason for discovery, treatment, pathological factors and treatment progress to clarify the risk factors. All patients underwent curative surgical treatment. Pathologically, lymph node metastasis was identified in 25 patients (75%). Thirteen patients (39%) had bilateral cervical metastasis. In addition, 9 (27%) had more than 10 metastatic lymph nodes. The 2 patients with more than 20 metastatic lymph nodes were treated with radioactive iodine (RAI). Five patients (15%) had local recurrences and received surgery. There have been no further recurrences or deaths. However, no factors were determined to significantly predict the recurrence of juvenile DTC. Local recurrent disease was treated with surgery and/or RAI until remission, and survival was excellent in juvenile DTC. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 5 2020 Clinical Relevance of Serum Prolactin Levels to Inflammatory Reaction in Male Patients 381 389 EN Koichiro Yamamoto Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshihisa Hanayama Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kou Hasegawa Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazuki Tokumasu Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tomoko Miyoshi Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hideharu Hagiya Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroko Ogawa Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Mikako Obika Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Koichi Itoshima Department of Laboratory Medicine, Okayama University Hospital Fumio Otsuka Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/60797 To clarify the relevance of prolactin (PRL) to clinical parameters in patients who visited our general medicine department, medical records of 353 patients in whom serum PRL levels were measured during the period from 2016 to 2018 were retrospectively reviewed. Data for 140 patients (M/F: 42/98) were analyzed after excluding patients lacking detailed records and patients taking dopaminergic agents. Median serum PRL levels were significantly lower in males than females: 6.5 ng/ml (IQR: 4.2-10.3) versus 8.1 ng/ml (5.9-12.9), respectively. Pain and general fatigue were the major symptoms at the first visit, and past histories of hypertension and dyslipidemia were frequent. Male patients with relatively high PRL levels (≥ 10 ng/ml) had significantly lower levels of serum albumin and significantly higher levels of serum LDH than those with low PRL (< 10 ng/ml). There were significant correlations of male PRL level with the erythrocyte sedimentation rate (R=0.62), serum LDH level (R=0.39) and serum albumin level (R=−0.52), while the level of serum CRP (R=0.33) showed an insignificant but weak positive correlation with PRL level. Collectively, these results show that PRL levels had gender-specific relevance to various clinical factors, with PRL levels in males being significantly related to inflammatory status. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 4 2020 The Late Phase/Early Phase Ratio of Pancreatic CT Values as a Novel Predictor of Pancreatic Fistula after Distal Pancreatectomy 351 358 EN Masashi Utsumi Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Hideki Aoki Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Takayuki Yabuki Department of Radiology, National Hospital Organization, Iwakuni Clinical Center Seiichi Nagahisa Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Seitaro Nishimura Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Yuta Une Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Yuji Kimura Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Megumi Watanabe Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Fumitaka Taniguchi Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Takashi Arataa Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Koh Katsuda Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Kohji Tanakaya Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Yumiko Sato Department of Pathology, National Hospital Organization, Iwakuni Clinical Center Original Article 10.18926/AMO/60374 Post-operative pancreatic fistula (POPF) remains the most common complication after distal pancreatectomy (DP). In this retrospective study, we reviewed the data from patients who underwent DP between 2008 and 2019 in our institute to determine whether the late phase/early phase ratio (L/E ratio) by preoperative computed tomography (CT) scan in the pancreas could predict POPF occurrence after DP. We examined the relationship between preoperative or intraoperative factors and the occurrence of POPF after DP using statistical methods in 23 males and 21 females with a mean age of 73. The mean L/E ratio was significantly lower in the POPF group than the non-POPF group (p=0.035). The L/E ratio had moderate diagnostic accuracy, with a calculated optimal cutoff value of 0.77. In univariate analysis, a significant association was noted between POPF and stump thickness ≥ 16.9, body mass index ≥ 27.5, and L/E ratio ≤ 0.77. In the multivariate analysis, the L/E ratio (odds ratio, 5.96; p=0.036) was an independent risk factor for POPF. Our findings suggest that the pancreatic L/E ratio may predict the occurrence of POPF after DP. This measure may be useful in preoperative risk stratification, patient counseling, and perioperative patient management, improving clinical outcomes after DP. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 4 2020 Recurrence of Solitary Fibrous Tumor/Hemangiopericytoma Could Be Predicted by Ki-67 Regardless of Its Origin 335 343 EN Yumiko Yamamoto Department of Diagnostic Pathology, Kochi University Yoshihiro Hayashi Department of Equipment of Support Planning Office, Kochi University Ichiro Murakami Department of Diagnostic Pathology, Kochi University Original Article 10.18926/AMO/60372 Since the discovery of the NAB2-STAT6 gene fusion in 2013, solitary fibrous tumor (SFT) and hemangiopericytoma (HPC) have been considered the same disease. STAT6 nuclear stain is approved as a highly sensitive and specific marker to diagnose SFT/HPC from other tumors with similar histology. As the next step, detection of fusion variants that may predict clinical malignancy of SFT/HPC has been attempted. However, no fusion variants with a clear relation to malignancy have been identified. In this study, the clinical and histological backgrounds of 23 Japanese patients diagnosed with SFT/HPC from 2000 to 2019 at Kochi University Hospital were examined to identify factors potentially related to recurrence. A significant relationship to recurrence was detected for mitosis ≥ 1/10 HPF (400×), necrosis, and Ki-67>5%. These findings indicate that a deliberate investigation of histological features such as mitosis and necrosis is crucial for the clinical observation of SFT/ HPC patients. In addition, Ki-67 was revealed to be a useful parameter to predict recurrence in SFT/HPC patients. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 4 2020 Cytotoxic Effects of Alcohol Extracts from a Plastic Wrap (Polyvinylidene Chloride) on Human Cultured Liver Cells and Mouse Primary Cultured Liver Cells 327 334 EN Ken-ichi Yamamoto Department of Cell Biology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroko Kagawa Okayama University Hospital Sakae Arimoto Division of Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Xian Wen Tan Department of Cell Chemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kento Yasui Department of Cell Biology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiyuki Oshiki Department of Applied Chemistry, Graduate School of Natural Science and Technology, Okayama University Masakiyo Sakaguchi Department of Cell Biology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/60371 An increasing accumulation of microplastics and further degraded nanoplastics in our environment is suspected to have harmful effects on humans and animals. To clarify this problem, we tested the cytotoxicity of two types of plastic wrap on human cultured liver cells and mouse primary cultured liver cells. Alcohol extracts from plastic wrap, i.e., polyvinylidene chloride (PVDC), showed cytotoxic effects on the cells. Alcohol extracts of polyethylene (PE) wrap were not toxic. The commercially available PVDC wrap consists of vinylidene chloride, epoxidized soybean oil, epoxidized linseed oil as a stiffener and stabilizer; we sought to identify which component(s) are toxic. The epoxidized soybean oil and epoxidized linseed oil exerted strong cytotoxicity, but the plastic raw material itself, vinylidene chloride, did not. Our findings indicate that plastic wraps should be used with caution in order to prevent health risks. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 4 2020 Relationship Between Partial Carbon Dioxide Pressure and Strong Ions in Humans: A Retrospective Study 319 325 EN Satoshi Isoyama Department of Anesthesiology and Resuscitation, Okayama University Hospital Satoshi Kimura Department of Anesthesiology and Resuscitation, Okayama University Hospital Hiroshi Morimatsu Department of Anesthesiology and Resuscitation, Okayama University Hospital Original Article 10.18926/AMO/60370 Little is known about the role of a strong ions in humans with respiratory abnormalities. In this study, we investigated the associations between partial carbon dioxide pressure (pCO2) and each of sodium ion (Na+) concentrations, chloride ion (Cl−) concentrations and their difference (SIDNa-Cl). Blood gas data were obtained from patients in a teaching hospital intensive care unit between August 2013 and January 2017. The association between pCO2 and SIDNa-Cl was defined as the primary outcome. The associations between pCO2 and [Cl−], [Na+] and other strong ions were secondary outcomes. pCO2 was stratified into 10 mmHg-wide bands and treated as a categorical variable for comparison. As a result, we reviewed 115,936 blood gas data points from 3,840 different ICU stays. There were significant differences in SIDNa-Cl, [Cl−], and [Na+] among all categorized pCO2 bands. The respective pCO2 SIDNa-Cl, [Cl−], and [Na+] correlation coefficients were 0.48, −0.31, and 0.08. SIDNa-Cl increased and [Cl−] decreased with pCO2, with little relationship between pCO2 and [Na+] across subsets. In conclusion, we found relatively strong correlations between pCO2 and SIDNa-Cl in the multiple blood gas datasets examined. Correlations between pCO2 and chloride concentrations, but not sodium concentrations, were further found to be moderate in these ICU data. 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.

BMC Acta Medica Okayama 1471-2369 21 2020 Pembrolizumab-induced hypothyroidism caused reversible increased serum creatinine levels: a case report 113 EN Natsumi Matsuoka Department of Nephrology, Rheumatology, Endocrinology and Metabolism,Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kenji Tsuji Department of Nephrology, Rheumatology, Endocrinology and Metabolism,Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Eiki Ichihara Department of Hematology, Oncology, Allergy and Respiratory Medicine,Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Takayuki Hara Department of Nephrology, Rheumatology, Endocrinology and Metabolism,Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kazuhiko Fukushima Department of Nephrology, Rheumatology, Endocrinology and Metabolism,Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kishio Toma Department of Nephrology, Rheumatology, Endocrinology and Metabolism,Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Shinji Kitamura Department of Nephrology, Rheumatology, Endocrinology and Metabolism,Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kenichi Inagaki Department of Nephrology, Rheumatology, Endocrinology and Metabolism,Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Hitoshi Sugiyama Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Jun Wada Department of Nephrology, Rheumatology, Endocrinology and Metabolism,Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Background</br> The advent of immune checkpoint inhibitors (ICIs) has significantly improved the prognosis of patients with advanced malignancies. On the other hand, these drugs might cause immune-related adverse events (irAEs) including endocrinopathies and nephropathies. Thyroid dysfunction is one of the most common irAEs. For ICIs-induced nephropathies, most cases are due to tubulointerstitial nephritis, which might require steroid treatment. Here, we report a patient with non-small cell lung cancer treated with ICI who developed increased serum creatinine (s-Cr) levels due to ICIs-induced hypothyroidism.</br> Case presentation</br> A 57-year-old Asian man with refractory non-small cell lung cancer under ICIs therapy (pembrolizumab, an anti-programmed cell death-1 monoclonal antibody) developed increased s-Cr levels 5 months after the pembrolizumab initiation. His laboratory data, renal biopsy, and Gallium-67 scintigraphy findings denied pembrolizumab-induced tubulointerstitial nephritis. His renal function was correlated with thyroid function. Despite the increase of s-Cr levels, serum cystatin C levels were normal, which could be explained by the hypothyroidism. Levothyroxine treatment improved renal function as well as thyroid function. Then pembrolizumab was resumed, and both his thyroid and renal function remained normal level. Ultimately, we concluded that the increased s-Cr levels were caused by pembrolizumab-induced hypothyroidism.</br> Conclusion</br> All clinicians involved in ICI treatment need to recognize the possible increase in s-Cr levels caused by ICIs-induced hypothyroidism, and we propose monitoring serum cystatin C levels to differentiate ICIs-induced hypothyroidism from tubulointerstitial nephritis before invasive renal biopsies or steroid treatment, which are recommended by the prescribing information for pembrolizumab, are performed. No potential conflict of interest relevant to this article was reported.

Elsevier Acta Medica Okayama 09215093 790 2020 Microstructure-dependent hydrogen diffusion and trapping in high-tensile steel 139418 EN Mitsuhiro Okayasu Graduate School of Natural Science and Technology, Okayama University Jun Motojima Graduate School of Natural Science and Technology, Okayama University In this work, the hydrogen embrittlement (HE) characteristics of high-tensile steel sheets with different microstructural characteristics were investigated. The sheets were fabricated via cold rolling (CR), water quenching (WQ), baking hardening (BH), and low-temperature annealing (LT), and their HE characteristics were clarified by examining the relationships between the microstructural characteristics and the severity of HE. Severe HE occurred in the WQ sample with hydrogen trapping at the boundaries of the retained austenite phases, resulting in intergranular and cleavage-like brittle failure. A reduction in HE was realized after the BH and LT processes. In these cases, hydrogen trapping was divided between the ε-carbide in the lattice spacings and at the boundaries of retained austenite, resulting in a mixed ductile/brittle failure mode. The extent of HE in the CR sample was similar to those in the BH and LT samples. However, the trapping sites were different; hydrogen trapping in the CR sample occurred in the slip band and around dislocations, resulting in delamination-like brittle failure on the slip planes. The extent of HE was also affected by the strain rate. More severe HE occurred in both the WQ and BH samples loaded slowly at 0.01 mm min−1 compared to the samples loaded 1.0 mm min−1 (i.e., intergranular failure). In this case, HE was affected by the large amount of hydrogen atoms trapped at the boundaries of the retained austenite phases. The hydrogen atoms in the lattice structure and ε-carbide migrated to the boundaries via dislocation movement. The extent of deterioration in tensile strength was two times higher in the samples loaded at the higher speed of 1.0 mm min−1 compared to those loaded at 0.01 mm min−1. Finally, the hydrogen trapping and failure mechanisms on the nano and atomic scales were discussed based on the results of the microstructural analyses. No potential conflict of interest relevant to this article was reported.

Elsevier Acta Medica Okayama 01604120 138 2020 Enhanced expression of nicotinamide nucleotide transhydrogenase (NNT) and its role in a human T cell line continuously exposed to asbestos 105654 EN Shoko Yamamoto Department of Hygiene, Kawasaki Medical School Suni Lee Department of Hygiene, Kawasaki Medical School Hidenori Matsuzaki Department of Life Science, Faculty of Life and Environmental Science, Prefectural University of Hiroshima Naoko Kumagai-Takei Department of Hygiene, Kawasaki Medical School Kei Yoshitome Department of Hygiene, Kawasaki Medical School Nagisa Sada Department of Biophysical Chemistry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yurika Shimizu Department of Pathophysiology-Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tastsuo Ito Department of Hygiene, Kawasaki Medical School Yasumitsu Nishimura Department of Hygiene, Kawasaki Medical School Takemi Otsuki Department of Hygiene, Kawasaki Medical School The effects of asbestos fibers on human immune cells have not been well documented. We have developed a continuously exposed cell line model using the human T-lymphotropic virus 1 (HTLV-1)-immortalized human T cell line MT-2. Sublines continuously exposed to chrysotile (CH) or crocidolite (CR) showed acquired resistance to asbestos-induced apoptosis following transient and high-dose re-exposure with fibers. These sublines in addition to other immune cells such as natural killer cells or cytotoxic T lymphocytes exposed to asbestos showed a reduction in anti-tumor immunity. In this study, the expression of genes and molecules related to antioxidative stress was examined. Furthermore, complexes related to oxidative phosphorylation were investigated since the production of reactive oxygen species (ROS) is important when considering the effects of asbestos in carcinogenesis and the mechanisms involved in resistance to asbestos-induced apoptosis. In sublines continuously exposed to CH or CR, the expression of thioredoxin decreased. Interestingly, nicotinamide nucleotide transhydrogenase (NNT) expression was markedly enhanced. Thus, knockdown of NNT was then performed. Although the knockdown clones did not show any changes in proliferation or occurrence of apoptosis, these clones showed recovery of ROS production with returning NADPH/NADP+ ratio that increased with decreased production of ROS in continuously exposed sublines. These results indicated that NNT is a key factor in preventing ROS-induced cytotoxicity in T cells continuously exposed to asbestos. Considering that these sublines showed a reduction in anti-tumor immunity, modification of NNT may contribute to recovery of the anti-tumor effects in asbestos-exposed T cells. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 2 2020 Incarcerated Amyand’s Hernia 171 174 EN Atsushi Okita Department of Surgery, Yakage Town National Health Insurance Hosptial Osamu Yoshida Department of Surgery, Yakage Town National Health Insurance Hosptial Masakazu Murakami Department of Surgery, Yakage Town National Health Insurance Hosptial Case Report 10.18926/AMO/58277 A 76-year-old Japanese man was transferred to our hospital to undergo rehabilitation after traffic accident-related injuries. Seven days post-admission, he presented with abdominal pain and an 8-cm lump in the right inguinal region. He was diagnosed with an incarcerated inguinal hernia and underwent elective surgery the day after manual reduction. He had a normal vermiform appendix which was observed to have adhered to the right indirect hernia sac. An appendectomy and hernia repair using lightweight mesh were performed. We discuss the surgical management of this rare incarcerated Amyand’s hernia and the relevant literature. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 2 2020 The Efficacy of Mirabegron for the Relief of Ureteral Stent-Related Symptoms 145 150 EN Hideo Otsuki Department of Urology, Abiko Toho Hospital Tomoya Yamasaki Department of Urology, Abiko Toho Hospital Shunsuke Hori Department of Urology, Abiko Toho Hospital Hiroshi Aoki Department of Urology, Abiko Toho Hospital Takeo Kosaka Department of Urology, Keio University Shinya Uehara Department of Urology, Kawasaki Medical School General Medical Center Kei Fujio Department of Urology, Abiko Toho Hospital Original Article 10.18926/AMO/58273 To investigate the efficacy of mirabegron for lower urinary tract symptoms in patients with an indwelling ureteral stent after ureterorenoscopic lithotripsy. This was a prospective follow-up study of 76 patients with stent-related symptoms (SRSs). Patients with upper urinary calculi who were pre-stented for > 2 weeks before lithotripsy were examined for the presence of SRSs by tests including the International Prostate Symptom Score (IPSS), OAB Symptom Score (OABSS), and urinary bother and pain measured by a Visual Analogue Scale (VAS) before lithotripsy. Mirabegron (50 mg/day) was prescribed post-lithotripsy for 2 weeks. SRSs were assessed at the time of stent removal. The IPSS scores improved significantly from 16.2 to 14.3 (p<0.001) and the IPSS-QoL scores decreased significantly from 5.0 to 4.6 (p=0.012). The OABSS scores improved significantly from 7.7 to 6.8 (p=0.006), and the urinary urgency scores (OABSS-Q3) decreased significantly from 3.24 to 2.68 (p<0.001). The number of nocturia episodes decreased significantly from 2.5 to 2.2 (p=0.045). Urinary bother and pain assessed by the VAS declined from 4.2 and 3.1 to 3.8 (p=0.15) and 2.5 (p=0.075), respectively. Mirabegron significantly improved SRSs and the number of nocturia episodes due to a ureteral stent. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 2 2020 Mucinous Carcinoma of the Breast: Clinicopathological Features and Long-term Prognosis in Comparison with Invasive Ductal Cancer; A Single Hospital’s 30+-Year Experience 137 143 EN Hiroshi Isozaki Department of Surgery, Oomoto Hospital Yasuhisa Yamamoto Department of Surgery, Oomoto Hospital Kunihiko Sakai Department of Surgery, Oomoto Hospital Tatuo Sho Department of Surgery, Oomoto Hospital Kiyohiro Ishihara Department of Surgery, Oomoto Hospital Shigeki Murakami Department of Surgery, Oomoto Hospital Sasau Matsumoto Department of Surgery, Oomoto Hospital Takehiro Takama Department of Surgery, Oomoto Hospital Original Article 10.18926/AMO/58272 Mucinous carcinoma (MC) of the breast is a rare and special type of malignancy, with a substantial amount of extracellular mucin. We compared the clinicopathological features and the long-term survival of MC patients with those of invasive ductal carcinoma-no special type (IDC-NST) patients, and we examined prognostic factors of MC. A total of 116 patients with mucinous carcinoma and 3,258 patients with IDC-NST who underwent surgery at our hospital (1977-2008) were enrolled. The 10-year overall survival rate and breast cancer-specific survival rate (BSS) of the MC patients (88.3%, 93.7%) were both significantly higher than those of IDC-NST patients (81.6%, 85.0%) (p=0.015, p=0.005, respectively). A Cox regression analysis demonstrated that MC tended to be an independent prognostic factor (hazard ratio 0.44, p=0.098). The BSS of the MC patients with positive lymph node (LN) metastasis was significantly poorer than that of the patients without it, by univariate analysis (p=0.002). The tumor size in the MC patients with positive LN metastasis (mean 3.2 cm) was significantly larger than that in the patients without it (mean 1.9 cm) (p=0.0004). Although a Cox regression analysis revealed no independent factor, MC patients with positive LN metastasis should be treated for advanced invasive ductal breast cancer. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 74 2 2020 Association between Histological Types and Enhancement of Dynamic CT for Primary Lung Cancer 129 135 EN Shogo Fukuma Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takayoshi Shinya Department of Radiology, Okayama University Hospital Junichi Soh Department of General Thoracic Surgery, Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ryuichiro Fukuhara Department of Pediatric Radiology, Okayama University Hospital Nanako Ogawa Department of Radiology, Okayama University Hospital Fumiyo Higaki Department of Radiology, Okayama City General Medical Center Takehiro Tanaka Department of Pathology, Okayama University Hospital Eiki Ichihara Department of Allergy and Respiratory Medicine, Okayama University Hospital Takao Hiraki Department of Radiology, Okayama University Hospital Shinichi Toyooka Department of General Thoracic Surgery, Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Susumu Kanazawa Department of Radiology, Okayama University Hospital Original Article 10.18926/AMO/58271 The aim of this study was to explore enhancement patterns of different types of primary lung cancers on 2-phase dynamic computed tomography (CT). This study included 217 primary lung cancer patients (141 adenocarcinomas [ADs], 48 squamous cell carcinomas [SCCs], 20 small cell lung carcinomas [SCLCs], and 8 others) who were examined using a 2-phase dynamic scan. Regions of interest were identified and mean enhancement values were calculated. After excluding the 20 SCLCs because these lesions had different clinical stages from the other cancer types, the mean attenuation values and subtractions between phases were compared between types of non-small cell lung carcinomas (NSCLCs) using the Kruskal–Wallis test. Late phase attenuation and attenuation of the late minus unenhanced phase (LMU) of SCCs were significantly higher than those of ADs (p<0.05). To differentiate SCC and AD in the late phase, a threshold of 80.21 Hounsfield units (HU) gave 52.9% accuracy. In LMU, a threshold of 52.16 HU gave 59.3% accuracy. Dynamic lung CT has the potential to aid in differentiating among NSCLC types. No potential conflict of interest relevant to this article was reported.

Elsevier Acta Medica Okayama 1323-8930 65 4 2016 Effect of prostaglandin D2 on VEGF release by nasal polyp fibroblasts 414 419 EN Kengo Kanai Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Mitsuhiro Okano Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tazuko Fujiwara Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shin Kariya Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takenori Haruna Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ryotaro Omichi Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Sei-ichiro Makihara Department Otorhinolaryngology, Kagawa Rosai Hospital Yuji Hirata Department Otorhinolaryngology, Kagawa Prefectural Central Hospital Kazunori Nishizaki Department Otorhinolaryngology, Kagawa Prefectural Central Hospital Background: Vascular endothelial growth factor (VEGF) is known to be associated with the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP). VEGF is produced by a variety of cells including fibroblasts. It was recently reported that prostaglandin (PG) E-2 induces VEGF release by nasal polyp fibroblasts. However, little is known regarding possible regulation of VEGF by other PGs. We have reported that molecules that regulate PGD(2) metabolism play roles in the pathogenesis of CRS including in local eosinophilia and type 2 cytokine production. In the present study, we sought to determine whether PGD(2) regulates VEGF release by nasal polyp fibroblasts. <br/> Methods: Nasal polyp fibroblasts were established from nasal polyps. These fibroblasts were stimulated with serial dilutions of PGD(2) or PGD(2) receptor (DP/CRTH2)-selective agonists in the presence or absence of receptor-selective antagonists. The concentration of VEGF in the culture supernatants was determined using ELISA. <br/> Results: 5 mM of PGD(2) significantly induced VEGF release by nasal polyp fibroblasts. VEGF release was also obtained by stimulation with a DP receptor-selective, but not with a CRTH2 receptor-selective agonist. In addition, PGD(2)-induced VEGF release was significantly inhibited by pre-treatment with DP receptor-selective antagonists. In contrast, pre-treatment with a CRTH2 receptor-selective antagonist significantly enhanced PGD(2)-induced VEGF release. <br/> Conclusions: PGD(2) stimulates VEGF production via DP but not CRTH2 receptors in nasal polyp fibroblasts. Copyright (C) 2016, Japanese Society of Allergology. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license. No potential conflict of interest relevant to this article was reported.

Japanese Society for Dental Materials and Devices Acta Medica Okayama 0287-4547 38 5 2019 Cavity Adaptation of Composite Restorations Prepared at Crown and Root: Optical Assessment Using SS-OCT 779 789 EN Rima Zakzuk Alshahni Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University Yasushi Shimada Department of Operative Dentistry, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuan Zhou Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University Masahiro Yoshiyama Department of Operative Dentistry, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Alireza Sadr Department of Restorative Dentistry, University of Washington, School of Dentistry Yasunori Sumi Division of Oral and Dental Surgery, Department of Advanced Medicine, National Center for Geriatrics and Gerontology, National Hospital for Geriatric Medicine Junji Tagami Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University Evaluation of gap formation at the interfaces of a two-step self-etching adhesive with/without pre-etching was performed using sweptsource optical coherence tomography (SS-OCT). Round cavities were prepared in bovine incisors at the middle (MC) and cervical (CC) thirds of the crown and the cervical third of the root (CR). Clearfil SE bond was directly applied to one group (SE) and another (PA) was pretreated with K-etchant gel. Following restoration by flowable composite resin, the teeth were thermally challenged and stored for 2 months. Interfacial gaps observed in the cross-sectional OCT images were analyzed and the bottom cavities exhibited increased gaps compared to the margin and dentin-enamel junction (DEJ). The CR site had a larger gap than at MC and CC in the SE group. DEJ separation at the MC was significantly smaller than that at CC in both groups. Therefore, gap formation depends on the cavity region, location, and bonding protocol. No potential conflict of interest relevant to this article was reported.

Elsevier Acta Medica Okayama 13238930 2020 Serum IgG4 as a biomarker reflecting pathophysiology and post-operative recurrence in chronic rhinosinusitis EN Aiko Oka Department of Otorhinolaryngology, International University of Health and Welfare Graduate School of Medicine Takahiro Ninomiya Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medical Sciences, University of Fukui Tazuko Fujiwara Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Soshi Takao Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasuharu Sato Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yuka Gion Division of Pathophysiology, Okayama University Graduate School of Health Sciences Akira Minoura Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine Shin-ichi Haruna Department of Otorhinolaryngology, Head & Neck Surgery, Dokkyo Medical University Naohiro Yoshida Department of Otolaryngology, Jichi Medical University Saitama Medical Center Yasunori Sakuma Department of Otorhinolaryngology, Yokohama City Medical Center Kenji Izuhara Division of Medical Biochemistry, Department of Biomolecular Sciences, Saga Medical School Junya Ono Shino-Test Co., Ltd. Masami Taniguchi Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital Takenori Haruna Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takaya Higaki Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shin Kariya Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takahisa Koyama Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tetsuji Takabayashi Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medical Sciences, University of Fukui Yoshimasa Imoto Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medical Sciences, University of Fukui Masafumi Sakashita Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medical Sciences, University of Fukui Masanori Kidoguchi Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medical Sciences, University of Fukui Kazunori Nishizaki Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shigeharu Fujieda Department of Otorhinolaryngology Head & Neck Surgery, Faculty of Medical Sciences, University of Fukui Mitsuhiro Okano Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Background: Type 2 chronic rhinosinusitis (CRS), especially eosinophilic CRS (ECRS), is an intractable upper airway inflammatory disease. Establishment of serum biomarkers reflecting the pathophysiology of CRS is desirable in a clinical setting. As IgG4 production is regulated by type 2 cytokines, we sought to determine whether serum IgG4 levels can be used as a biomarker for CRS.<br/> Methods: Association between the serum IgG4 levels and clinicopathological factors was analyzed in 336 CRS patients. Receiver operating characteristics (ROC) analysis was performed to determine the cut-off value of serum IgG4 levels that can be used to predict the post-operative recurrence.<br/> Results: Serum IgG4 levels were significantly higher in patients with moderate to severe ECRS versus those with non to mild ECRS. The levels were also significantly higher in asthmatic patients and patients exhibiting recurrence after surgery compared to controls. ROC analysis determined that the best cut-off value for the serum IgG4 level to predict the post-operative recurrence was 95 mg/dL. The corresponding sensitivity and specificity were 39.7% and 80.5%, respectively. When we combined the two cut-off values for the serum IgG4 and periostin, patients with high serum levels of either IgG4 or periostin exhibited a high post-operative recurrence (OR: 3.95) as compared to patients having low serum levels of both IgG4 and periostin.<br/> Conclusions: The present results demonstrate that the serum IgG4 level is associated with disease severity and post-operative course in CRS. In particular, the combination of serum IgG4 and periostin could be a novel biomarker that predicts post-operative recurrence. No potential conflict of interest relevant to this article was reported.

Vietnam National University Acta Medica Okayama 24682179 4 4 2019 Mechanical and fatigue properties of long carbon fiber reinforced plastics at low temperature 577 583 EN Mitsuhiro Okayasu Graduate School of Natural Science and Technology, Okayama University Yuki Tsuchiya Graduate School of Natural Science and Technology, Okayama University The mechanical properties of long unidirectional (UD) and crossply (CR) carbon fiber reinforced plastics (CFRPs) were investigated at a low temperature (−196 °C). The CFRPs were fabricated from 60 vol.% carbon fiber and epoxy resin. The bending strength of the UD-CFRP was approximately twice that of the CR-CFRP. The high strength of the UD-CFRP was directly attributed to the amount of carbon fiber oriented along the loading direction: 60% for UD-CFRP compared with 30% for CR-CFRP. The low-temperature (−196 °C) tensile and fatigue strengths of the UD-CFRP were over 1.5 times greater than those at room temperature (20 °C). This was attributed to the increased epoxy strength at low temperatures along with the internal compressive stress arising from the different thermal expansion coefficients of the carbon fiber and epoxy. Both the epoxy strength and internal compressive strength were employed as factors in a compound law to numerically estimate the low-temperature tensile strength. This work presents a systematic analysis for changes in the CFRP material properties at low temperatures. No potential conflict of interest relevant to this article was reported.

LWW Acta Medica Okayama 0017-9078 110 5 S2 2016 Evaluation of IAEA Clearance Concept for Low-level Radioactive Waste from a Radioisotope Research Institute S81 S87 EN Yasuhiro Yumoto Department of Radiation Research, Shikata Laboratory Okayama University Advanced Science Research Center (RIC) Shigeru Okada Department of General Medicine, Okayama University Graduate School, Medicine, Dentistry and Pharmacological Research Ikuo Kinno Department of Radiation Research, Shikata Laboratory Okayama University Advanced Science Research Center (RIC) Tomohiro Nagamatsu Department of Radiation Research, Shikata Laboratory Okayama University Advanced Science Research Center (RIC) Kazuhiro Nouso Department of Gastroenterology and Hepatology, Okayama University, Graduate School Medicine, Dentistry and Pharmacological Science Eiichi Nakayama Department of Radiation Research, Shikata Laboratory Okayama University Advanced Science Research Center (RIC) The clearance of solid low-level radioactive laboratory waste (LLRW) after decay-in-storage (DIS) obtained from a research institute and thoroughly separated using the separation and classification protocols presented in this study was evaluated.<br/> METHOD:<br/> The radioisotope (RI) content of incinerated LLRW from the specified RI research group (group A); the RI content of LLRW obtained in fiscal year 2000, which contained radionuclides with half-lives of less than 164 d (LLRW2); and the RI content of the LLRW reported in group A's disposal records were compared. The LLRW2 and LLRW of group A were incinerated after 2 y of decay-in-storage and immediately after storage, respectively.<br/> RESULTS:<br/> The highest ratio of the RI of incinerated LLRW to the value in the disposal records was 2.52 for ⁵¹Cr. The radioactivities of radionuclides in both the LLRW2 and LLRW for ³⁵S, ⁴⁵Ca, ⁵¹Cr, ¹²⁵I, ³²P, ³³P, and ⁹⁹mTc and the incinerated ash after 1 y later of decay-in-storage were below the clearance level defined by the RS-G-1.7 of the International Basic Safety Standard without contamination by ³H and ¹⁴C. These remains contained very small amounts of some long-half-life radionuclides of natural origin after 7 y of decay-in-storage.<br/> CONCLUSION:<br/> This LLRW separation protocol was effective for the separation of ³H and ¹⁴C. LLRW2 after 2 years of DIS and its incinerated ash after one year later of DIS were below the clearance level for radioactivity and radioactivity concentration. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 5 2019 Phase II Trial Using Romidepsin after Gemcitabine, Dexamethasone, and Cisplatin Therapy in Elderly Transplant-Ineligible Patients with Relapsed/Refractory Peripheral T-Cell Lymphoma: Study Protocol 469 474 EN Satoshi Yamasaki Department of Hematology and Clinical Research Institute, NHO Kyushu Medical Cente Akiko Kada Department of Clinical Trials and Research, Clinical Research Center, NHO Nagoya Medical Center Hirokazu Nagai Department ofHematology and Oncology Research, NHO Nagoya Medical Center Isao Yoshida Department of Hematologic Oncology, NHO Shikoku Cancer Center Ilseung Choi Department of Hematology, NHO Kyushu Cancer Center Akiko M. Saito Department of Clinical Trials and Research, Clinical Research Center, NHO Nagoya Medical Center Hiromi Iwasakia Department of Hematology and Clinical Research Institute, NHO Kyushu Medical Cente Clinical Study Protocol 10.18926/AMO/57379 Romidepsin is an important therapeutic option for patients with peripheral T-cell lymphoma (PTCL). However, the timing of romidepsin administration remains controversial. Romidepsin was launched in Japan as a consolidation therapy agent after conventional salvage chemotherapy with gemcitabine, dexamethasone, and cisplatin (GDP). GDP therapy will be administered every 3 weeks. If complete response, partial response, or stable disease is confirmed after 2-4 GDP cycles, romidepsin will be administered every 4 weeks. The primary endpoint is a 2-year progression-free survival rate. Patients participating in this study and undergoing treatment can expect results similar to or better than those of conventional therapies. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 5 2019 Comparison of Two Different Drugs for Overactive Bladder, Solifenacin and Mirabegron: A Prospective Randomized Crossover Study 387 392 EN Miyabi Inoue Miyabi Urogyne Clinic Teruhiko Yokoyama Yokoyama Urological Clinic Original Article 10.18926/AMO/57368 To assess the efficacy and safety of 2 drugs for overactive bladder (OAB), solifenacin and mirabegron. Fortyseven female OAB patients were randomized into 2 groups. Twenty-three patients were initially prescribed solifenacin for 4 weeks, followed by mirabegron for 4 weeks (group S). The other 24 patients were initially prescribed mirabegron for 4 weeks, followed by solifenacin for 4 weeks (group M). Evaluations included clinical determination of the OAB symptom score (OABSS), International Prostate Symptom Score (IPSS), and Visual Analog Scale. The IPSS significantly improved after the administration of solifenacin in both groups. The OABSS significantly improved in both groups after 4 weeks. In group M, the OABSS after eight weeks was significantly improved compared to that after 4 weeks. However, in group S, it was not significantly improved. Twelve patients experienced adverse events during the solifenacin treatment, while 2 patients experienced adverse events during the mirabegron treatment. Both solifenacin and mirabegron led to improved OAB symptoms. Switching from mirabegron to solifenacin significantly improved the OABSS. However, mirabegron led to fewer adverse events than solifenacin. We recommend that mirabegron be prescribed first for OAB patients. If patients are not satisfied with mirabegron, solifenacin should be used. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 5 2019 Histidine-rich Glycoprotein Modulates the Blood-vascular System in Septic Condition 379 382 EN Hidenori Wake Department of Pharmacology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Review 10.18926/AMO/57366 Histidine-rich glycoprotein (HRG) is a 75 kDa glycoprotein synthesized in the liver whose plasma concentration is 100-150 μg/ml. HRG has been shown to modulate sepsis-related biological reactions by binding to several substances and cells, including heparin, factor XII, fibrinogen, thrombospondin, plasminogen, C1q, IgG, heme, LPS, dead cells, bacteria, and fungi. Therefore, reduction of plasma HRG levels in sepsis leads to dysregulation of coagulation, fibrinolysis, and immune response, resulting in disseminated intravascular coagulation and multiple organ failure. This review summarizes the binding and functional properties of HRG in sepsis. No potential conflict of interest relevant to this article was reported.

Elsevier Acta Medica Okayama 13238930 68 2 2019 Significance of IgG4-positive cells in severe eosinophilic chronic rhinosinusitis 216 224 EN Takahisa Koyama Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shin Kariya Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasuharu Sato Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuka Gion Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takaya Higaki Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takenori Haruna Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tazuko Fujiwara Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Akira Minoura Department of Public Health, Showa University School of Medicine Soshi Takao Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yorihisa Orita Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Kengo Kanai Department of Otorhinolaryngology-Head & Neck Surgery, Kagawa Prefectural Central Hospital Masami Taniguchi Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital Kazunori Nishizaki Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Mitsuhiro Okano Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Background: IgG4 production is regulated by type 2 (IL-4 and IL-13) and regulatory (IL-10) cytokines involved in the pathophysiology of chronic rhinosinusitis (CRS). We sought to determine the pathophysiological characteristics of IgG4-positive cells in sinonasal tissues in CRS, especially eosinophilic CRS (ECRS).<br/> Methods: IgG4-positive cells in uncinate tissues (UT) and nasal polyps (NP) were examined by immunohistochemistry. Associations between the number of IgG4-positive cells and clinicopathological factors were analyzed. Receiver operating characteristics (ROC) analysis was performed to determine the cut-off value of IgG4-positive cells in tissue that can predict the post-operative course.<br/> Results: IgG4 was mainly expressed in infiltrating plasma and plasmacytoid cells, and the number of IgG4-positive cells was significantly higher in NP, especially those from severe ECRS patients, than in UT. In CRS patients, the number of IgG4-positive cells significantly and positively correlated with blood and tissue eosinophilia, radiological severity, and serum level of total IgE. The number of infiltrating IgG4-positive cells was significantly higher in patients with a poor post-operative course (sustained sinus shadow 6 months after surgery) than in those with a good one. The number of IgG4-positive cells in NP could discriminate patients with a good or a poor post-operative course (area under the curve: 0.769). Also, 73.3% sensitivity and 82.5% specificity were achieved when the cut-off value was set at 17 cells/high-power field.<br/> Conclusions: Our results suggest that the local expression of IgG4 on cells may be used as a biomarker that reflects the pathophysiology of CRS, including the post-operative course. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 4 2019 Construction and Characterization of a PGN_0297 Mutant of Porphyromonas gingivalis: Evidence of the Contribution of PGN_0297 to Gingipain Activity 315 323 EN Shintaro Ono Department of Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masaaki Nakayama Department of Oral Microbiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masato Tachibana Department of Oral Microbiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Abu Saleh Muhammad Shahriar Department of Oral Microbiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Wang Heling Department of Oral Microbiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shogo Takashiba Department of Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Naoya Ohara Department of Oral Microbiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/56933 The periodontal pathogen Porphyromonas gingivalis shows colonial pigmentation on blood agar and produces gingipains (Kgp, RgpA, and RgpB), cysteine proteases involved in an organism’s virulence and pigmentation. We showed previously that deletion of the PGN_0300 gene abolished the pigmentation activity and reduced the proteolytic activity of gingipains. The role of the PGN_0297 gene, which consists of an operon with the PGN_0300 gene, is unclear. Herein we examined the effect of PGN_0297 gene deletion on the pigmentation and proteolytic activities and transcriptional levels of gingipains. A PGN_0297 gene deletion mutant (ΔPGN_0297) did not exhibit the pigmentation. The proteolytic activity of the gingipains was decreased in the culture supernatant and on the cell surface of ΔPGN_0297. The mutant ΔPGN_0297 failed to attenuate Akt phosphorylation at Thr308 and Ser473, but both phosphorylations were attenuated in the wild-type and its complementation strain. The deletion of PGN_0297 gene did not substantially affect the transcriptional levels of the gingipain genes kgp, rgpA, and rgpB. Taken together, these results indicate that PGN_0297 is closely involved in the secretion and maturation of gingipains. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 4 2019 Tuberosity-overlapping Fixation of the Humeral Shaft in Humeral Head Replacement Surgery 299 305 EN Takaaki Hiranaka Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences Keiichiro Nishida Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences Taizo Konishiike Department of Orthopaedic Surgery, Japanese Red Cross Okayama Hospital Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences Motohiko Mikasa cDepartment of Orthopaedic Surgery, Matsudo Orthopaedic Hospital Original Article 10.18926/AMO/56931 The fixation technique of bony fragments is crucial for the bone union of the tuberosities after humeral head replacement (HHR) for a comminuted fracture of the proximal humerus. To increase the bone union rate, we reduce tuberosities to overlap on the humeral shaft by approx. 1 cm and fix them with cable wire. Herein, we retrospectively investigated the clinical and radiographic outcomes of our procedure. Twenty-six patients who underwent cementless HHR for the treatment of comminuted fractures of the proximal humerus were investigated. The Constant-Murley score, active shoulder mobility, and bone union rate were evaluated. The mean duration of follow-up was 56.3 months (range 24-197). At the final follow-up, the average Constant-Murley score was 58 (range 40-76). Forward elevation was 126° on average (range 35°-180°). Twenty-three cases (88%) showed bone union between the tuberosities and the shaft at an average follow-up of 4.1 months (range 4-5 months) after surgery. Non-union was noted in 1 case, and bone resorption was noted in 2 cases. The bone union rate and the clinical outcome of our procedure were relatively favorable No potential conflict of interest relevant to this article was reported.

John Wiley Acta Medica Okayama 16394488 43 4 2019 Method to Suppress Isobaric and Polyatomic Interferences for Measurements of Highly Siderophile Elements in Desilicified Geological Samples 611 633 EN Xiaoyu Zhou The Pheasant Memorial Laboratory for Geochemistry and Cosmochemistry, Institute for Planetary Materials, Okayama University Ryoji Tanaka The Pheasant Memorial Laboratory for Geochemistry and Cosmochemistry, Institute for Planetary Materials, Okayama University Masahiro Yamanaka The Pheasant Memorial Laboratory for Geochemistry and Cosmochemistry, Institute for Planetary Materials, Okayama University Chie Sakaguchi The Pheasant Memorial Laboratory for Geochemistry and Cosmochemistry, Institute for Planetary Materials, Okayama University Eizo Nakamura The Pheasant Memorial Laboratory for Geochemistry and Cosmochemistry, Institute for Planetary Materials, Okayama University Sample decomposition using inverse aqua regia at elevated temperatures and pressures (e.g., Carius tube or high‐pressure asher) is the most common method used to extract highly siderophile elements (HSEs: Ru, Rh, Pd, Re, Os, Ir, Pt and Au) from geological samples. Recently, it has been recognised that additional HF desilicification is necessary to better recover HSEs, potentially contained within silicate or oxide minerals in mafic samples, which cannot be dissolved solely by inverse aqua regia. However, the abundance of interfering elements tends to increase in the eluent when conventional ion‐exchange purification procedures are applied to desilicified samples. In this study, we developed an improved purification method to determine HSEs in desilicified samples. This method enables the reduction of the ratios of isobaric and polyatomic interferences, relative to the measured intensities of HSE isotope masses, to less than a few hundred parts per million. Furthermore, the total procedural blanks are either comparable to or lower than conventional methods. Thus, this method allows accurate and precise HSE measurements in mafic and ultramafic geological samples, without the need for interference corrections. Moreover, the problem of increased interfering elements, such as Zr for Pd and Cr for Ru, is circumvented for the desilicified samples. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 3 2019 Safety of Surgical Treatment for Elderly Patients with Gallbladder Carcinoma 241 246 EN Masashi Utsumi Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Hideki Aoki Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Seitaro Nishimura Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Yuta Une Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Hajime Kashima Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yuji Kimura Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Fumitaka Taniguchi Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Takashi Arata Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Koh Katsuda Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Kohji Tanakaya Department of Surgery, National Hospital Organization, Iwakuni Clinical Center Original Article 10.18926/AMO/56867 Gallbladder carcinoma (GBC) is a common malignancy with a poor prognosis. With the average life expectancy increasing globally, the incidence of GBC is predicted to increase as well. We investigated the safety and feasibility of surgical treatment for elderly patients with GBC. We retrospectively compared clinical pathological data and treatment outcomes in 45 consecutive GBC patients (23 patients ≥ 75 years [elderly group] and 22 patients < 75 years [younger group]) who underwent curative resection at the Iwakuni Center from January 2008 to December 2017. The proportion of preoperative comorbidities and anticoagulant use was significantly higher in the elderly group. The American Society of Anesthesiologists score was higher in the elderly versus the younger group, and the elderly group had significantly shorter operation times. Reduced activities of daily living was more common in the elderly versus younger group. The percentage of radical resection and overall 3-year survival (66.6% younger vs. 64.4% elderly) were similar between the groups. Controlling Nutritional Status (CONUT) score ≥ 3 and R0 resection were identified as prognostic factors for overall survival rate among all patients. After careful patient selection, 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.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 3 2019 Geriatric Trauma in Patients ≧85 Years Old in an Urban District of Japan 197 203 EN Takeshi Nishimura Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiromichi Naito Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shigenari Matsuyama Hyogo Emergency Medical Center Satoshi Ishihara Hyogo Emergency Medical Center Atsunori Nakao Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shinichi Nakayama Hyogo Emergency Medical Center Original Article 10.18926/AMO/56861 Japan's population has been skewing toward the elderly, but the outcomes of advanced elderly trauma are not clear. Here we compared the outcomes of very elderly trauma patients (≧85 years old) with those of 65- to 84-year-old trauma patients. We retrospectively reviewed the medical records of patients treated at Hyogo Emergency Medical Center from August 2010 to August 2016; 631 patients were entered in the study. We divided them into the younger geriatrics (YG group, 65-84 years old: n=534) and older geriatrics (OG group, ≧85 years old: n=97). The group’s patient characteristics, mortality, 1-year survival rate, and Barthel index were tabulated and compared. The patients’ mean age was 75.6±7.5 years. There was no significant difference in mortality between the YG and OG groups (9.6% vs. 15.1%, odds ratio [OR] 1.73; 95% confidence interval [CI] 0.93-3.23, p=0.083). The 1-year survival rate (94.4% vs. 77.8%, OR 0.19, 95% CI 0.07-0.51; p<0.01) and Barthel index (Median score; 100 (IQR: 85-100) vs. 80 (IQR: 15-95), OR 0.98, 95% CI 0.97 to 0.99, p<0.01) differed significantly between the groups. Our study did not find a significant difference in-hospital mortality between patients in the YG group and those in the OG group. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 3 2019 Anti-N-Methyl-D-Aspartate Receptor Encephalitis in Psychiatry 189 195 EN Shinji Sakamoto Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroki Kawai Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuko Okahisa Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ko Tsutsui Department of Neuropsychiatry, Akita University Graduate School of Medicine Takashi Kanbayashi Department of Neuropsychiatry, Akita University Graduate School of Medicine Keiko Tanaka Department of Animal Model Development, Brain Research Institute, Niigata University Yutaka Mizuki Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Manabu Takaki Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Norihito Yamada Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Review 10.18926/AMO/56860 Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a recently-discovered autoimmune disorder in which antibodies target NMDAR in the brain. The number of reported cases of anti-NMDAR encephalitis has increased rapidly. Anti-NMDAR encephalitis can be mistakenly diagnosed as psychiatric disorders because many patients present with prominent psychiatric symptoms and visit psychiatric institutions first. Thus, psychiatrists should cultivate a better understanding of anti-NMDAR encephalitis. In this review, we present the mechanisms, epidemiology, symptoms and clinical course, diagnostic tests, treatment and outcomes of patients with anti-NMDAR encephalitis. Furthermore, we discuss the diversity of clinical spectra of anti-NMDAR encephalitis, and demonstrate a differential diagnosis of psychiatric disease from the perspective of psychiatry. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 2 2019 Thyroid Function Decline and Diet in Female High School Long-distance Runners 127 133 EN Yukari Iwasaki Graduate School of Health Sciences, Okayama University Kimiko Miyahara Faculty of Health Care, Department of Nutrition, Kiryu University Nobuyuki Miyatake Department of Hygiene, Faculty of Medicine, Kagawa University Mikiya Nakatsuka Graduate School of Health Sciences, Okayama University Original Article 10.18926/AMO/56648 We aimed to clarify the state of thyroid function in female high school long-distance runners. We evaluated the associations between thyroid function and menstrual condition, bone mineral density (BMD), nutritious status, and body composition. The subjects’ height and weight were measured, along with fat percentage, fat mass, muscle mass, and BMD with dual-energy X-ray absorptiometry. A nutrition and dietary survey measured the subjects’ intake of energy and nutrients based on meals provided at the subjects’ dorm for 3 days in July of 2016 and 2017. Blood parameters including thyroid hormone and estradiol were measured. Most of the subjects (81.3%) were underweight (body mass index <18.5). The thyroid hormone free T3 value was decreased, but TSH was not increased and was similar to that observed in individuals with anorexia nervosa. In our subjects, thyroid hormone was associated with BMD and nutritional intake. To improve the menstruation abnormality of female athletes and to increase their bone density, the athletes’ weight should be managed by proper nutrient intake and the maintenance of their thyroid function. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 1 2019 Flap Reconstruction for Esophageal Perforation Following Anterior Cervical Plate Fixation 77 80 EN Mio Morita Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Hiroshi Matsumoto Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Yasuhiro Shirakawa Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Kazuhiro Noma Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Shunsuke Tanabe Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Case Report 10.18926/AMO/56462 Anterior cervical plate fixation is a common surgical treatment for cervical spine trauma, disc herniation, or cervical spondylosis. Esophageal perforation following anterior cervical plate fixation is a rare but serious complication. Management of esophageal perforation is controversial; however, we suggest treating most cases surgically because this condition is slow to heal and often fatal. We managed 2 cases of esophageal perforation following anterior cervical plate fixation by flap reconstruction with the pectoralis major muscle in one case and a jejunal free flap in the other. Here, we report our experience and review the surgical indications. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 1 2019 Histidine-rich Glycoprotein Could Be an Early Predictor of Vasospasm after Aneurysmal Subarachnoid Hemorrhage 29 39 EN Atsushi Matsumoto Department of Neurological Surgery, Kagawa University Faculty of Medicine Takehiro Nakamura Department of Medical Technology, Kagawa Prefectural University of Health Sciences Aya Shinomiya Department of Neurological Surgery, Kagawa University Faculty of Medicine Kenya Kawakita Emergency Medical Center, Kagawa University Hospital Masahiko Kawanishi Department of Neurological Surgery, Kagawa University Faculty of Medicine Keisuke Miyake Department of Neurological Surgery, Kagawa University Faculty of Medicine Yasuhiro Kuroda Emergency Medical Center, Kagawa University Hospital Richard F. Keep Department of Neurosurgery, University of Michigan Takashi Tamiya Department of Neurological Surgery, Kagawa University Faculty of Medicine Original Article 10.18926/AMO/56456 Cerebral vasospasm (CVS) is a major contributor to the high morbidity and mortality of aneurysmal subarachnoid hemorrhage (aSAH) patients. We measured histidine-rich glycoprotein (HRG), a new biomarker of aSAH, in cerebrospinal fluid (CSF) to investigate whether HRG might be an early predictor of CVS. A total of seven controls and 14 aSAH patients (8 males, 6 females aged 53.4±15.4 years) were enrolled, and serial CSF and serum samples were taken. We allocated these samples to three phases (T1-T3) and measured HRG, interleukin (IL)-6, fibrinopeptide A (FpA), and 8-hydroxy-2’-deoxyguanosine (8OHdG) in the CSF, and the HRG in serum. We also examined the release of HRG in rat blood incubated in artificial CSF. In contrast to the other biomarkers examined, the change in the CSF HRG concentration was significantly different between the nonspasm and spasm groups (p<0.01). The rat blood/CSF model revealed a time course similar to that of the human CSF samples in the non-spasm group. HRG thus appears to have the potential to become an early predictor of CVS. In addition, the interaction of HRG with IL-6, FpA, and 8OHdG may form the pathology of CVS. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 73 1 2019 The Role of Kallikrein-Related Peptidases in Atopic Dermatitis 1 6 EN Shin Morizane Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Review 10.18926/AMO/56452 Excessive protease activity is a characteristic abnormality that affects the epidermal barrier in patients with atopic dermatitis (AD). Kallikrein-related peptidases (KLKs) are excessively expressed in AD lesions, and it is suggested that the abnormal action of KLKs is involved in the skin barrier dysfunction in AD. In other words, overexpressed KLKs disrupt the normal barrier function, and due to that breakdown, external substances that can become antigens of AD easily invade the epidermis, resulting in dermatitis, coupled with the induction of Th2 cytokines. Further investigations are required to elucidate the role of KLKs in AD; this knowledge could contribute to the design of new therapeutic and prophylactic drugs for AD. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 72 6 2018 Changes in Serum Biochemical Markers in Relation to Chief Complaints and Aging in General Medicine 553 562 EN Daisuke Omura Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Asuka Sato Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kosuke Oka Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshihisa Hanayama Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroko Ogawa Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Mikako Obika Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Fumio Otsuka Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/56372 To clarify potential relationships between chief complaints of patients and laboratory data with a focus on aging-related changes, we retrospectively analyzed the data of 843 patients who visited a general medicine department for the first time. Their chief complaints were classified into 8 major symptoms: visceral pain, somatic pain, fever, cough, dizziness, fatigue, appetite loss, and edema. We compared the laboratory data obtained from the patients with complaints with the data of symptom-free (control) patients. The serum sodium and potassium levels in the fever group were decreased compared to those in the control group. In the fever group, the serum sodium level was inversely correlated with age. The ratio of serum urea nitrogen to creatinine (UN/Cr) was increased in the appetite-loss group. There were significant age-dependent increases in the UN/Cr ratio in the appetite-loss and edema groups. Of note, serum levels of free thyroxin were lower in the dizziness group compared to the control group. In addition, the free thyroxin level was inversely correlated with age in the dizziness group but not in the asymptomatic control group. Collectively, the results indicated that osmolality-related laboratory data are strongly associated with individual primary symptoms at the first visit regardless of the final diagnosis. The consideration of age-dependent changes of these markers is helpful for diagnosing latent disorders based on various primary symptoms. No potential conflict of interest relevant to this article was reported.

American Physical Society Acta Medica Okayama 24699926 81 6 2010 Spin textures in condensates with large dipole moments 063623 EN J. A. M. Huhtamaki Department of Physics, Okayama University M. Takahashi Department of Physics, Okayama University T. P. Simula Department of Physics, Okayama University T. Mizushima Department of Physics, Okayama University K. Machida Department of Physics, Okayama University We have solved numerically the ground states of a Bose-Einstein condensate in the presence of dipolar interparticle forces using a semiclassical approach. Our motivation is to model, in particular, the spontaneous spin textures emerging in quantum gases with large dipole moments, such as Cr-52 or Dy condensates, or ultracold gases consisting of polar molecules. For a pancake-shaped harmonic ( optical) potential, we present the ground-state phase diagram spanned by the strength of the nonlinear coupling and dipolar interactions. In an elongated harmonic potential, we observe a helical spin texture. The textures calculated according to the semiclassical model in the absence of external polarizing fields are predominantly analogous to previously reported results for a ferromagnetic F = 1 spinor Bose-Einstein condensate, suggesting that the spin textures arising from the dipolar forces are largely independent of the value of the quantum number F or the origin of the dipolar interactions. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 71 2 2017 Outcome of Radiation Monotherapy for High-risk Patients with Stage I Esophageal Cancer 127 133 EN Yasuhiro Shirakawa Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazuhiro Noma Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Naoaki Maeda Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shunsuke Tanabe Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine,Dentistry and Pharmaceutical Sciences Shinji Kuroda Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine,Dentistry and Pharmaceutical Sciences Shunsuke Kagawa Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine,Dentistry and Pharmaceutical Sciences Kuniaki Katsui Department of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Norihisa Katayama Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Susumu Kanazawa Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/54981 Currently, chemoradiation is the most widely used nonsurgical treatment for esophageal cancer. However, some patients, particularly the very elderly or those with severe vital organ dysfunction, face difficulty with the chemotherapy component. We therefore examined the outcome of radiation therapy (RT) alone for patients with esophageal cancer at our facility. Between January 2005 and December 2014, 84 patients underwent RT at our hospital, and 78 of these patients received concomitant chemotherapy. The remaining 6 patients underwent RT alone; these patients were considered to be high-risk and to have no lymph node metastasis (stage I). Five of them received irradiation up to a curative dose: 4 showed a complete response (CR) and 1 showed a partial response (PR). Of the patients exhibiting CR, 3 are currently living recurrence-free, whereas 1 patient underwent endoscopic submucosal dissection (ESD) as salvage therapy for local recurrence, with no subsequent recurrence. High-risk stage I esophageal cancer patients can be treated radically with RT alone under certain conditions. In the future, to broaden the indications for RT monotherapy to include some degree of advanced cancers, a novel concurrent therapy should be identified. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 70 6 2016 Urinary Cross-linked N-terminal Telopeptide of Type I Collagen Levels of Infants with Osteogenesis Imperfecta and Healthy Infants 435 439 EN Miho Yamashita Department of Pediatrics, Okayama University Hospital Kosei Hasegawa Department of Pediatrics, Okayama University Hospital Yousuke Higuchi Department of Pediatrics, Okayama University Hospital Takayuki Miyai Department of Pediatrics, Okayama University Hospital Ayumi Okada Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroyuki Tanaka Department of Pediatrics, Okayama Saiseikai General Hospital Hirokazu Tsukahara Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/54805 The urinary cross-linked N-terminal telopeptide of type I collagen (uNTx) levels in infantile osteogenesis imperfecta (OI) have not been well studied. Here we investigated the levels of uNTx in infants with OI and healthy infants. We collected spot urine samples from 30 infants with OI (male/female, 14/16; Sillence classification, I/II/III/IV: 15/3/6/6; age, 5.2±4.4 months) and 120 healthy infants (male/female, 75/45; age, 5.1±4.1 months) for the measurement of uNTx levels. The uNTx levels of the OI infants were significantly lower than those of the healthy infants (mean±SD, 1,363.7±530.1 vs. 2,622.2±1,202.6 nmol BCE/mmol Cr; p＜0.001). The uNTx levels of the infants with type I OI were significantly lower than those of the age-matched healthy infants, although an overlap was observed between the 2 groups. Among the 1-month-old infants, the uNTx levels of the infants with types I, III or IV OI were significantly lower than those of the healthy infants, without overlap (1,622.5±235.8 vs. 3,781.0±1,027.1 nmol BCE/mmol Cr; p＜0.001). These results indicate that uNTx levels are significantly lower in infants with OI than in healthy infants, and they suggest that uNTx might be useful as a reference for diagnosing OI. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 128 3 2016 3 年間の内視鏡所見の変化を観察できた食道異所性皮脂腺の1 例 201 205 EN Masaya Iwamuro 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 Keita Harada Department of Endoscopy, Okayama University Hospital Hiromitsu Kanzaki Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Keisuke Hori Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masahide Kita Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Seiji Kawano Department of Endoscopy, Okayama University Hospital Yoshiro Kawahara Department of Endoscopy, Okayama University Hospital Takehiro Tanaka Department of Pathology, Okayama University Hospital Kazuhide Yamamoto Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences A 43-year-old Japanese woman was diagnosed with ectopic sebaceous glands in the esophagus by esophagogastroduodenoscopy and biopsy. At the age of 46, typical ectopic sebaceous glands were recognized in the upper esophagus, whereas yellowish white granules were faintly observed in the lower esophagus. Esophagogastroduodenoscopy examinations were repeated when she was 47 and again at 50 years old, and the lesions in the lower esophagus had become more evident over the ensuing 3 years. Esophageal ectopic sebaceous glands are relatively infrequent, and there have been few case reports describing the progression of the endoscopic features. We also report the clinical and endoscopic features of the five similar cases with pathologically proven ectopic sebaceous glands in the esophagus. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 128 2 2016 アディポカイン「バスピン」の同定とメタボリックシンドロームにおける意義 103 109 EN Jun Wada Department of Nephrology, Rheumatology, Endocrinology and Metabolism, 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 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 127 2 2015 基底膜ツールキットとしてのXV/XV�V型コラーゲン遺伝子の機能 103 109 EN Toshitaka Oohashi No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 127 1 2015 免疫疲弊分子PD-1，CTLA-4 63 65 EN Shingo Eikawa No potential conflict of interest relevant to this article was reported.

岡山大学教育学部 Acta Medica Okayama 0471-4008 110 1999 磁気共鳴スペクトロスコピー法による脳障害の評価 ―神経遊走障害の検討― 29 34 EN Satoshi Sanada Takashi Asano Eiji Oka Michiko Kawahara Katsumi Sakae Norio Hiraki Shunsuke Ohtahara 10.18926/bgeou/52429 Proton Magnetic Resonance Spectroscopy (1H-MRS) can be used to detect cerebral metabolites including N-acetylaspartate (NAA)，creatine (Cr) and choline (Ch). Hence，clinical applications of this method for neuropediatric diseases can be expected. However，regarding neuronal migration disorders，there have been only a few reported studies. We therefore examined the lH-MRS in six patients with migration disorders，ages ranged from 8months to 28years 10months with a mean of 10years 10months. Investigation was performed using Magnetom H15 (Siemens) with a repetition time of 1500 msec and an echo time of 270msec. The ratio of NAA/Cr，Ch/Cr were examined. The volume of interest with the size of 2 × 2 × 2 〜 3 × 3 × 5cm3 was chosen in the area including lesions，and a contralateral area without lesions was also investigated. Results were as follows. 1) The ratio of NAA/Cr was low in the area with lesions in all 6cases; 1.41，1.95，2.27 and 1.71 in cases with heterotopic gray matter，0.99 in one case with polymicrogyria，an d 1.30 in one case with hemimegalencephaly，contrasted with a contralataral area without lesions: 1.89， 2.89，2.87，2.55，3.26，2.03，respectively. 2) The ratio of Ch/Cr showed no consistent difference between the area including lesions and contralataral area without lesions. Our findings of a decreased NAA/Cr ratio can be inferred to reflect the decreased numbers of neuronal cell population，or reduced metabolism in the lesions. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 125 3 2013 薬物相互作用 (28―過活動膀胱治療薬の薬物相互作用） 259 262 EN Yusuke Haruta Yoichi Kawasaki Yoshihisa Kitamura Toshiaki Sendo 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 125 3 2013 GBR12909の情動行動への影響：脳内自己刺激行動の Runway法を用いた動機付け行動と，抗うつ様行動および依存様行動の区別 205 209 EN Satoru Esumi Hidenori Sagara Akihiko Nakamoto Yoichi Kawasaki Yutaka Gomita Toshiaki Sendo No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 125 2 2013 子宮広間膜裂孔ヘルニアによる絞扼性イレウスの１例 139 143 EN Minoru Haisa Ryo Sakai Eisuke Kurihara Atsushi Teramoto Kazuhiko Shouga Shintarou Mitsuoka Mamoru Nishimura Yuuki Satou Jiro Nanba A 41-year-old woman was admitted to our hospital because of lower abdominal pain. She had no history of laparotomy. An abdominal CT scan at the time of admission indicated closed-loop intestinal obstruction of the small intestine within the pelvis and deviation of the uterus to the right. We diagnosed this as a strangulated internal hernia and decided to conduct an emergency operation. The ileum had herniated through a defect in the broad ligament of the uterus. The strangulated intestinal loop, which was about 25cm long, was released, and the defect of the broad ligament was closed. The postoperative course was uneventful. The differential diagnosis of intestinal obstruction should include internal hernia, especially in the absence of a previous laparotomy. An abdominal CT scan is quite useful for the preoperative and prompt diagnosis of internal hernia through a defect in the broad ligament of the uterus. No potential conflict of interest relevant to this article was reported.

Springer Japan KK Acta Medica Okayama 1341-9625 18 1 2013 Could salvage surgery after chemotherapy have clinical impact on cancer survival of patients with metastatic urothelial carcinoma? 110 115 EN Kensuke Bekku Takashi Saika Yasuyuki Kobayashi Ryo Kioshimoto Taiki Kanbara Yasutomo Nasu Hiromi Kumon The clinical impact of salvage surgery after chemotherapy on cancer survival of patients with metastatic urothelial carcinoma is controversial. We aimed to verify the clinical role of salvage surgery by analyzing the long-term outcome in patients with urothelial carcinoma treated by chemotherapy. Between 2003 and 2010 at a single institution, 31 of 47 patients (66%) with metastatic urothelial carcinoma showed objective responses (CR in 4, PR in 27) after multiple courses of cisplatin/gemcitabine/paclitaxel-based chemotherapy, and a cohort of patients with partial response (PR) were retrospectively enrolled. Twelve (10 male and 2 female, median age 64.0 years) of 27 patients with PR underwent salvage surgeries after the chemotherapy: metastatectomy of residual lesions (10 retroperitoneal lymph nodes, 2 lung), and 6 radical surgeries for primary lesions as well. Progression-free survival and overall patient survival rates were analyzed retrospectively and compared with those of patients without salvage surgery. All 12 patients achieved surgical CR. Pathological findings of metastatic lesions showed viable cancer cells in 3 patients. In univariate analysis, sole salvage surgery affected overall survival in 27 patients with PR to the chemotherapy (P = 0.0037). Progression-free survival and overall survival rates in patients with salvage surgery were better than those in 15 PR patients without the surgery (39.8 vs. 0%, and 71.6 vs. 12.1% at 3 years, P = 0.01032 and 0.01048; log-rank test). Salvage surgery for patients with residual tumor who achieve partial response to chemotherapy could have a possible impact on cancer survival. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 125 1 2013 一次治療でセツキシマブ不耐となった後，三次治療での再使用により奏功した進行大腸癌の一例 51 55 EN Ryo Inada Takeshi Nagasaka Yoshiko Mori Yuzo Umeda Nobuhito Kubota Tatsuya Morikawa Yoshitaka Kondo Futoshi Uno Yu Sadamori Takahito Yagi Toshiyoshi Fujiwara 　A 55-year-old man who had been diagnosed with rectal cancer with multiple liver metastases and lymph node metastases on colonoscopy and computed tomography (CT) was referred to Okayama University Hospital for treatment. Based on the diagnosis of non-curative rectal cancer, we planned to perform systematic chemotherapy after surgical resection. We performed a low anterior resection of a 36×35 mm upper rectal moderately differentiated adenocarcinoma with wil-type KRAS. After the resection, a FOLFIRI regimen with cetuximab was given as the first-line chemotherapy. Although metastatic lesions in the liver showed shrinkage, we decided to switch regimens because of intolerable adverse events. A modified FOLFOX6 regimen with bevacizumab was administered as the second-line treatment. There were no signs of disease progression until eight months later, when positron emission tomography (PET)/CT scans revealed that the new metastatic lesions appeared. As the third-line treatment, an irinotecan with cetuximab regimen was administered, leading to a good response for over 12 months. 　We experienced a successful rechallenge with cetuximab for a case with metastatic rectal cancer. For patients with wild-type KRAS colorectal cancer, rechallenge with cetuximab-based chemotherapy can be an effective therapeutic option. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 125 1 2013 予後不良な経過をたどったBRAF遺伝子変異を伴うStage �W大腸癌の１例 47 50 EN Ryo Inada Takeshi Nagasaka Kiyoto Takehara Masahiro Sugihara Yoshiko Mori Yuzo Umeda Nobuhito Kubota Tatsuya Morikawa Yoshitaka Kondo Futoshi Uno Yu Sadamori Takahito Yagi Toshiyoshi Fujiwara 　A 79-year-old woman visited a previous hospital with a complaint of general fatigue. The patient was diagnosed with cecal cancer with multiple liver metastases and lymph node metastases on colonoscopy, abdominal ultrasonography and CT scan, and was referred to our division for treatment. Based on the diagnosis of non-curative colonic cancer, we planned to perform systematic chemotherapy after local surgical treatment. We performed an ileocecal resection, and the specimen showed poorly differentiated adenocarcinoma with mutation in the BRAF oncogene. After the surgical treatment, the tumor grew rapidly and the patient died from cancer on the 19th postoperative day without having the opportunity to undergo chemotherapy. 　Multiple genetic and epigenetic alterations in oncogenes and tumor suppressor genes are involved in the process of colorectal carcinogenesis. Some of the alterations have been identified as predictive and prognostic biomarkers. A mutation in the BRAF oncogene was reported to be associated with a very unfavorable prognosis in colorectal cancers. Some of the cases with rapid progression are suggested to have the BRAF oncogene mutation. According to our experience, chemotherapy before surgical treatment might improve the prognosis of cases with the BRAF mutation. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 124 3 2012 術前化学療法により壁が菲薄化し組織学的寛解（pCR）となった巨大嚢胞内乳癌の１例 243 247 EN Takako Imada Junji Matsuoka Takayuki Motoki Takayuki Iwamoto Masako Oomori Sigemichi Iha Toshie Hongo Noriko Henmi Mikio Makabe Hiromi Nogami 　A 31-year-old woman presented to our hospital because of a lump 5cm in diameter in her right breast. Ultrasonography revealed a multilocular cystic mass with partial thickening of the wall and the septum. Core needle biopsy (CNB) of the septum confirmed invasive ductal carcinoma. The patient was administered neoadjuvant chemotherapy consisting of 12 cycles of weekly paclitaxel followed by 4 cycles of FEC (5FU, Epilubicin and cyclophosphamide). While the thickness of the wall and septum became thinner, the tumor size did not change in diameter. She underwent right mastectomy and sentinel node biopsy. Post-surgical histopathological findings showed a pathological complete response (pCR).<br> 　We report a rare case of invasive ductal carcinoma presenting a multilobular phenotype which showed pCR by neoadjuvant chemotherapy despite no size reduction of the tumor. No potential conflict of interest relevant to this article was reported.

American Institute of Physics. Acta Medica Okayama 0021-8979 108 4 2010 Bulk and surface physical properties of a CrO₂ thin film prepared from a Cr₈O₂₁ precursor 043916-1 043916-4 EN K. Iwai Y. Muraoka T. Wakita M. Hirai T. Yokoya Y. Kato T. Muro Y. Tamenori We have prepared a CrO(2) thin film by chemical vapor deposition from a Cr(8)O(21) precursor and studied the bulk and surface physical properties. The CrO(2) thin film is grown on a TiO(2) (100) substrate by heating of a Cr(8)O(21) precursor and TiO(2) (100) substrate together in a sealed quartz tube. The prepared film is found from x-ray diffraction analysis to be an (100)-oriented single phase. The magnetization and resistivity measurements indicate that the film is a ferromagnetic metal with a Curie temperature of about 400 K. Cr 3s core-level and valence band photoelectron spectroscopy spectra reveal the presence of a metallic CrO(2) in the surface region of the film. Our work indicates that preparation from a Cr(8)O(21) precursor is promising for obtaining a CrO(2) thin film with the metallic surface. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 124 2 2012 術前診断し得た大網裂孔ヘルニアの一例―本邦報告203例の臨床病理学的検討― 149 153 EN Yuji Kimura Kazuhide Iwakawa Manabu Nishie Masaru Inagaki Hiromi Iwagaki Transomental hernia often develops into strangulated ileus. We report on an 81-year-old man with strangulated ileus due to transomental hernia, diagnosed preoperatively by abdominal CT. The patient was referred to our surgical division because of progressive abdominal pain and vomiting. He had no history of laparotomy. An abdominal CT scan showed dilated small intestinal loops with intraluminal air and strangulated small intestinal loops with engorged mesenteric vessels. We diagnosed this as a strangulated internal hernia due to transomental hernia and conducted an emergency laparotomy. The jejunum had herniated through an abnormal hiatus of the greater omentum to the peritoneal cavity. The strangulated intestinal loop, about 15 cm long, was released and the postoperative course was uneventful. In the absence of a previous laparotomy, the differential diagnosis of intestinal obstruction should include internal hernia. An abdominal CT scan is useful for the preoperative and prompt diagnosis of transomental hernia. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 124 1 2012 S-1/CDDP術前化学療法により組織学的CRが得られた幽門狭窄合併進行胃癌の１例 63 66 EN Masahiko Nishizaki Yasuhiro Fujiwara Yasuhiro Chouda Takashi Kanazawa Motoki Ninomiya Toshiyoshi Fujiwara A 59-year-old man with epigastric discomfort and anorexia was referred to our hospital. Endoscopy revealed a type 3 advanced gastric cancer with pyloric stenosis diagnosed as a poorly differentiated adenocarcinoma in the biopsy specimens. A gastrojejunal bypass operation was performed because of direct invasion to the pancreas. The patient was treated by three courses of neoadjuvant chemotherapy with S-1/CDDP. Follow-up abdominal CT scan revealed that the primary tumor had become smaller, suggesting that a partial response had been achieved. Distal gastrectomy with D2 lymphadenectomy was performed. The histopathological examination showed no residual cancer cells in the primary lesion or dissected lymph nodes. Final chemotherapy efficacy was evaluated as Grade 3. The patient was treated with S-1 for one year after the gastrectomy and lymphadenectomy and has been followed up for 18 months without evidence of recurrence. No potential conflict of interest relevant to this article was reported.

社団法人日本腎臓学会 Acta Medica Okayama 0385-2385 32 4 1990 抗ヒト腎モノクローナル抗体を用いた尿中及び血中のGBM抗原の測定 第2編 365 372 EN Yasuaki Mino Using a monoclonal antibody (Mab-G3) recognizing glomerular basement membrane (GBM), we assayed GBM antigen (G3-Ag) in the urine and serum of renal disease patients by sandwich ELISA. The subjects included normal control (NOR), minimal change nephrotic syndrome (MCNS), IgA nephropathy (IgA), membranous nephropathy (MN), membranoproliferative glomerulonephritis (MPGN) and chronic renal failure (CRF). The urine and serum was used as the material. With urinary G3-Ag, there were no statistically significant differences among the NOR, MCNS, IgA, MN, MPGN and CRF groups. Although no correlation was observed with proteinuria, hematuria, serum creatinine, serum β2 microglobulin and urinary NAG, urinary G3-Ag showed a significant (p<0.05) increase in excretion in the group of progressive CRF patients with s-Cr more than 1.0 mg/dl/month as compared to the stationary CRF group with s-Cr<1.0 mg/dl/month. Serum G3-Ag showed lower values in almost all cases, and there were no significant differences among the renal disease groups. The above findings led us to believe that the assay of urinary G3-Ag was useful in determining the degree of GBM disorder. It was also presumed that assay of renal antigens in urine and serum with the respective anti-human renal monoclonal antibodies could be a new tool in diagnosing renal diseases. No potential conflict of interest relevant to this article was reported.

日本移植学会 Acta Medica Okayama 0578-7947 24 5 1989 ラット皮膚細胞に対する natural cytotoxicity (SCMC) の検討―natural cytotoxicity 細胞(NC)とキラー細胞(KC)との比較 455 465 EN Hideo Fujimoto We have reported that normal rat spleen cells show spontaneous cell-mediated cytotoxicity (SCMC) against rat skin epidermal cells and that the cold target inhibition assay reveals that NC and immune spleen cells belonged to different cell populations. This time, we attempted to separate NC and KC from skin allografted immune spleen cells by using Percoll sedimentation and compare their cytotoxicity with that of normal spleen cells. Normal and skin grafted immune spleen cells were fractionated by 30-50% (grading by 5%) Percoll, and each fraction was used as an effector in the (51)Cr release cytotoxicity assay with the target of allogeneic or syngeneic rat tail epidermal cells. The results were; Fr. 40% as NC and Fr. 50% as KC population. Cytotoxicity of nonadherent cells to the plastic dish and nylon wool column showed approximately the same distribution. Cold target inhibition assay was then performed with each fraction, confirming the results in our previous report. Each fraction was treated with antiasialo GM1 serum and complement and drastic elimination of the cytotoxicity was seen only in Fr. 40%. In addition, cytotoxicity of Fr. 40% and Fr. 50% of 0, 1, 2, 3, 4, 7, 10, 13 and 16th days, following the syngeneic and allogeneic skin graft, was mointored in order to determine the kinetics of NC and KC activities. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 123 3 2011 軟部腫瘍診療ガイドライン 231 235 EN Yuki Morimoto Toshifumi Ozaki No potential conflict of interest relevant to this article was reported.

The Ceramic Society of Japan Acta Medica Okayama 1882-0743 116 1350 2008 Chemical recycling of inorganic wastes by using phase separation of glass 220 223 EN Tokuro Nanba Shuhei Mikami Takuya Imaoka Shinichi Sakida Yoshinari Miura A chemical recycling process using phase separation of glass was applied to a granulated blast furnace slag with high CaO content. Glasses were prepared by adding B(2)O(3) to the slag in order to promote phase separation, and the glasses were heat-treated above glass transition temperature. In the subsequent acid-treatment, however, gelation due to the elution of SiO(2) phase containing CaO occurred, not obtaining high SiO(2) solids. Then, pretreatment was introduced to reduce CaO content in slag, where the raw slag was briefly washed in acid. The slag glasses prepared from the pretreated slag were commonly phase-separated by heat-treatment regardless of B(2)O(3) content. After subsequent acid-treatment, colorless insoluble solids were successfully recovered. The end products consist of 70-90 mass% SiO(2), and coloring ions such as Mn, Fe and Cr were almost completely removed from the slag glasses. Reutilization as raw materials for glass is expected. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 65 4 2011 Clinical Efficacy of Capecitabine and Cyclophosphamide (XC) in Patients with Metastatic Breast Cancer 231 237 EN Tadahiko Shien Hiroyoshi Doihara Keiko Nishiyama Hiroko Masuda Tomohiro Nogami Hirokuni Ikeda Naruto Taira Original Article 10.18926/AMO/46848 Combined low-dose therapy of oral capecitabine (Xeloda) and cyclophosphamide (XC) has been demonstrated to be useful for long-term control of lesions in patients with metastatic breast cancer (MBC) and is aimed at symptomatic alleviation and prolongation of survival. Here, a retrospective review was conducted of MBC patients administered XC at the Okayama University Hospital (OUH), to evaluate responses to XC, adverse events and time to progression (TTP). Twenty patients with MBC received XC between 2006 and 2009. With the exception of 2 elderly patients who were over the age of 70 at the initial examination, all of the patients had received prior treatment with an anthracycline and/or a taxane. No complete response (CR) cases were observed, but partial response (PR) was achieved in 6 patients (30%) and SD in 9 (45%), of whom 5 (20%) sustained SD status for >12 months. The median TTP was 6 months (range:3-27 mo.). Three patients developed Grade 3 adverse events (diarrhea, nausea and stomatitis), but no other patients developed adverse reactions causing interruption of the therapy. XC was safe even in previously treated and elderly MBC patients;moreover, it yielded remarkable clinical responses. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 40 5 1928 「グリコゲーン」染色ニ就テ (第1囘報告) 鹽基性及ビ酸性「テール」色素ヲ以テスル「グリコゲーン」染色ニ就テ 985 999 EN Kazue Yuien Während die histologische Untersuchung des Glykogens in tierischen Geweben von verschiedenen Seiten vielfach unternommen wurde, sind wir doch über den Färbe-Prozess desselben Bestandteils nur ungenügend unterrichtet. Daher habe ich mich mit diesem Thema beschäftigt und einige Ergebnisse erzielt, welche ich als meine erste Mitteilung veröffentlichen will. Sie lauten wie folgt: A. Ausser wenn das indirekte Färbungsverfahren nach A. Fischer, wobei ich übrigens anstatt der Kaliumbichromatlösung eine Lösung von Stibio-Kalium tartaricum mit gutem Erfolg brauchen konnte, verwendet wird, vermag man das Glykogen im Gewebe gleichgültig nicht mit basischen Teerfarbstoffen zu färben. Selbst wenn man dabei den Schnitt mit einer alkalischen Lösung vor-bzw. nachbehandelt, lässt sich diese Ingredienz nicht elektiv färben. B. Dagegen kann man mit manchen sauren Farbstoffen wie Säurefuchsin, Trypanblau, Bleu de Lyon, Anilinblau, Wasserblau usw. Glykogen direkt tingieren, u. z. mit gutem Erfolge. In diesem Falle färben sich aber auch die Zellkerne mehr oder weniger intensiv. C. Bei der indirekten Glykogenfärbung nach Fischer kann man anstatt der basischen auch manche saure Farbstoffe wie Säurefuchsin, Eosin, Azur II, Anilinblau etc. ohne Nachteil gut anwenden. D. Viele saure Farbstoffe, besonders Eosin, Orange G, Säurefuchsin, Trypanblau und Kongorot färben Glykogen stärker mit Hilfe der metallischen Beizen wie Al, Fe, Cr, Cu etc. E. Lässt man auf den Schnitt nach bzw. vor der Färbung eine Säurelöosung einwirken, so erhöht sich in der Regel die Färbungskraft der sauren Farbstoffe. Doch kann man diese Tatsache zur Glykogenfärbung nicht ausnützen, denn man erzielt dadurch nur eine allgemeine intensive Färbung, so dass Glykogen sich nicht scharf abhebt. Eine Ausnahme bildet die Glykogenfärbung mit Kongorot, welche durch eine Vor- bzw. Nachbehandlung mit Pikrinsäure sehr hübsch ausfällt. F. Die Färbung des Glykogens mit Kongorot ergibt sehr verschiedene Resultate je nach der Prozedur. 1. Wenn man einen mit Kongorot 10 Minuten lang gefärbten Schnitt in Äthyl-oder Methylalkohol legt und dann mit Xylol aufhellt, so erhält man ein vorzügliches Präparat für die Glykogenfärbung. Im allgemeinen wirkt reines Xylol auf die Glykogenfärbung besser als Karbolxylol. 2. Wenn ein mit Kongorot 10 Minuten lange gefärbter Schnitt in Methyl- oder Äthylalkohol gelegt und darauf der Wirkung des salzsäurehaltigen Alkohols unterworfen wird, so bekommt man ein Präparat von blauschwärzlichem Farbenton, worin aber Glykogen durch seine intensivere Färbung besonders ausgezeichnet ist. Dabei fällt die Kernfärbung viel günstiger aus, wenn man statt des Methylalkohols Äthylalkohol anwendet. 3. Wenn man einen mit Kongorot 10 Minuten lang gefärbten Schnitt zuerst in Wasser auswäscht und dann mit Alkohol entwässert, so ergibt sich die Glykogenfärbung immer sehr schlecht. Dies ist, m. E., darauf zurückzuführen, dass der absorbierte Farbstoff vom Glykogen leicht ins Wasser ausspringt und dadurch weggespült wird. 4. Dagegen kann man den nach Nr. 2 behandelten Schnitt ruhig in Wasser answaschen und dann mit Alkohol entwässern. In diesem Fall lässt sich ein gutes oder noch schöneres Präparat darstellen als bei den anderen Verfahren. 5. Durch Zusatz von Säure nehmen die mit Kongorot gefärbten Schnitte, wie gesagt, immer einen blauen Farbenton an. Dieser Farbenton verwandelt sich aber durch die Abspülung mit Leitungswasser wieder in die ursprüngliche rote Farbe, während dies bei der Auswaschung in reinem destilliertem Wasser keineswegs der Fall ist. Es liegt auf der Hand, dass der Umschlag der Farbe auf der alkalischen Reaktion des Leitungswassers beruht. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 48 1 1936 味覺ニ關スル實驗的研究(第1報)末梢味覺領域ニ於ケル轉機ニ就テ(附)識別閾ニ就テ 125 131 EN Tosio Kamei Renqvist hat für die Entstehung des Geschmackes an der peripheren Sinnesorgan folgende Gleichung aufgestellt: D · α · Cr1/n=Const. Wo D der Diffusionscoeffizient, Cr die Schwellenkonzentration für Geschmacksempfindung, α und 1/n die Adsorptionskonstanten sind. Die Ergebnisse meiner Untersuchung bezüglich seiner Gleichung lassen sich kurz, wie folgt, zusammenfassen. 1) Bei den Schwellenkonzentrationen für die Geschmacksempfindung bei einigen Zuckerarten ist D · α · Cr1/n constant und fast gleich gross. 2) Die bei der Schwelle des Geschmacksempfindung geltende Gleichung für Neutralsalze erhält die folgende Gestalt: D · Cr=Const. Verfasser schliesst aus seinen Versuchen über die Unterschiedsempfindlichkeit des Geschmackes, dass das Webersche Gesetz für den Geschmack ebenfalls gültig ist. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 49 4 1937 饑餓動物ノ濱崎「クローム」・耐酸性顆粒ニ及ボス核酸ノ影響ニ就テ 808 838 EN Nobuo Konishi In Heften hat Verf. zweimal eingehend über den Einfluss des Hungers auf die betreffenden Granula berichtet. Beim Hungern nehmen die Cr-säurefesten Granula allmahlich ab und verschwinden in der Regel nach 5- bis 13-tägigem Versuch. Hamazaki hat oft die Ansicht geäussert, dass die säurefesten Substanzen zu den Nukleoproteiden und ihren Spaltungsprodukten gehoren. Demgemäss wollte er die Wirkung der Nukleinsäure auf die Cr-säurefesten Granula des Hungernden Tieres prüfen und liess den Verf. diesbezügliche systematische Versuche vornehmen. In der ersten Reihe der Versuche bekamen die hungernden erwachsenen Kaninchen am dritten Tage des Hungers eine intravenöse Injektion nukleinsaurer Natrönlosung (1.0-1.5: 100.0), am vierten Tage bekamen sie dieselbe Injektion zum zweiten Male und 24 Stunden nach dieser letzten Injektion wurden sie durch Luftembolie getotet. In der zweiten Reihe wurde die erste Injektion am fünften Tage, die zweite am sechsten Tage verabreicht und 10 Stunden nach der letzten Injektion wurden die Versuchstiere getotet. In der dritten Reihe wurde nukleinsaures Natron per os appliziert. Als Kontrollversuche nahm Verf. intravenöse und perorale Darreichung von Traubenzuckerlosung und schliesslich intravenöse Injektion von physiologischer Köchsalzlosung vor. Die Resultate lassen sich wie folgt zusammenfassen: 1) Die durch Hunger verminderten bzw. verschwundenen Cr-säurefesten Granula konnen durch die intravenose Injektion des hefenukleinsauren Natrons wieder hergestellt werden. Ausserdem kann durch die Wiederholung derselben Injektion abnorme Steigerung der Granulazahl festgestellt werden. 2) Bei der abnormen Granulavermehrung ist zu beachten, dass die Organgewebe, die normalerweise keine oder nur etliche Granula fuhren-wie die Sammelrohrepithelien und die des dunneren Teils der Henleschen Schleife der Niere, das Knochenmark, die Drusenblaschenepithelien des Pankreas, das Kapsel-und Balkengewebe der Milz, das Interstitium des Hodens and der Leber u.a.-sehr deutlich die Cr-säurefeste Granula zeigen. 3) Die Perorale Darreichung des Hefenukleinsauren Natrons hat wenig Einfluss auf die Cr-säurefesten Granula der hungernden Tiere. 4) Die intravenose und perorale Darreichung von Traubenzucker kann eine leichte Vermehrung der Cr-säurefesten Granula der hungernden Tiere hervorrufen. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 49 2 1937 濱崎氏「クローム」・耐酸性顆粒ニ及ボス饑餓ノ影響ニ就テ（第1報） 236 262 EN Nobuo Konishi Seit drei Jahren hat sich Hamazaki mittels seines eigenen Forschungsverfahrens, welches in der Fixation mit Schwermetallsalzen und der Färbung durch KarbolfuchsinJod-Methode besteh, mit den säurefesten Substanzen beschäftigt und bis jetzt vier Arten von säurefesteu Granula nachgewiesen, nämlich Cr-säurefeste, Cu-säurefeste, Fe-säurefeste und Hg-säurefeste-Granula. Diese Granula stehen in so untrennbarer Beziehung zueinander, dass sie ein neues Stoffwechselsystem auszubauen gestatten. Unter ihnen gehoren die Cr-säurefesten Granula zu einer hoheren Stufe der in Frage kommenden Substanzen. Sie verbreiten sich in fast allen Parenchpmzellen der Organe und in mesenchymalen Geweben, insbesondere sind sie in Gehirn, Herzmuskel, Dünndarmepithelien, Skelettmuskeln, Nebennieren, Nieren und Leber reichlich vorhanden. Die biologische Untersuchung der Cr-säurefesten Granula muss also reizvoll und interessant sein. Für zukünftige Untersuchungen der Granula sind Hungerversuche als Grundlage unentbehrlich. Anlässlich des 26. Japanischen Pathologenkongresses haben Hamazaki und Konishi vorlaufig über das in Frage kommende Thema berichtet und nachher hat Verf. unter der Leitung von ao. Prof. Hamazaki diesbezügliche systematische Untersuchungen vorgenommen. Als versuchstiere wurden erwachsene gesunde Kaninchen, die mit Tohukasu ernährt worden waren, benutzt. Nach dem Beginn des Hungerns wurden sie am dritten, bzw. fünften, siebenten, zehnten, zwölften und schliesslich am dreizehnten Tage durch Luftembolie getötet. In jedem Falle wurden die 35 verschiedenen in der Tabelle angegebenen Arten von Geweben und Organen frisch mit Müller-Eisessig (100:5) drei Tage lang fixiert. Nach dem Auswaschen wurden Paraffinschitte hergestellt und diese nach Hamazakis Karbolfuchsin-Jod-Methode behandelt (s. Virch. Arch. Bd. 295). Als Kontrollfärbung wurden Hämatoxylin-Eosin-Färbung und Ciaccios Lipoidnachweis durchgeführt. Beim Hungern nehmen die Cr-säurefesten Granula allmählich ab und verschwiden sich in der Regel durch 5 bis 13 tägigen Versuch. Die Cr-säurefesten Granula des lockeren Bindegewebes, des glatten Muskelgewebes und des lymphadenoiden Gewebes sind im allgemeinen am wenigsten widerstandsfähig gegen Hungerwirkungen, und binnen 5 Tagen vermindern sie sich bis zum Verschwinden. Die Granula des Herzens und des Zentralnervensystems sind ganz widerstandsfähig gegen Hungerwirkungen. Gegen das Endstadiums des Hungerns treten hie und da Degenerationsatrophien der Körperzellen auf und dann entstehen aus den betreffenden Zellkernen degenerativ viele Cr-säurefeste Granula. Am deutlichsten ist dieser Vorgang in den Mgenfundusdrüsen nachweisbar. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 50 9 1938 正常白鼠ノ濱崎氏耐酸性顆粒ノ研究（第2報）汞・耐酸性顆粒ニ就テ，殊ニ腺細胞核ノ耐酸性ニ就テ 1878 1892 EN Yukio Suga Durch eingehende Untersuchungen beim Kaninchen hat Hamazaki bereits klargemacht, daß die Hg-säurefesten Granula als Hauptbestandteil Purinbasen enthalten, und nicht nur vom histologischen, sondern auch vom morphologischen Standpunkt aus einen großen Unterschied von den 3 andern Hamazakischen. säurefesten Granula zeigen. Der Verfasser, der bei seinern letzten Untersuchungen der Cr-säurefesten Granula ausfuhrlich studied hatte, stellte diesmal systematische histologische Untersuchungen über die oben genannten charakteristischen Hg-säurefesten Granula an. Es ergaben sich folgende interestante Resultate: 1) Bei der Ratte kommen die Hg-säurefesten Granula in geringerer Zahl und in beschränkterer Verteilung vor als die Cr-säurefesten Granula. 2) Bei der Darstellung der Hg-säurefesten Granula ist das Lipoid im allgemeinen nicht so häufig fixierbar wie beim Nachweis der Cr-säurefesten Granula. 3) Bei der Fixation der Hg-säurefesten Granula werden eine amorphe säurefeste Substanz und ein merkuraffines Korperchen, welche in den 3 andern Hamazakischen säurefesten Granula nicht nachgewiesen werden konnen, dargestellt. Sie kommen in den Rattengeweben bei weitem nicht so haufig vor wie beim Kaninchen. 4) In den Kernen der Drüsenzellen, wie in den der Submaxillardräse, der Magenschleimhaut, des Leber- und Pankreasparenchyms, des Harnkanalchens, der Blinddarmschleimhaut und Hypophysenvorderlappens findet man die saurefesten Granula sehr oft. 5) Die säurefesten Granula im Zellkerne zeigen sich abwechselnd mit den Granula des betreffenden Protoplasmas, was darauf hindeutet, deß eine intime Korrelation zwischen den Funktionen der Zelle und des Kerns besteht. 6) Im allgemeinen kann man, abgesehen von den obengenannten Drüsenzellen, in Zellkernen keine saurefesten Granula nachweisen. Sie werden aber ausnahmsweise in Nervenzellen gefunden. Dies ist wahrscheinlich darauf zurückzufuhren, daß die Nervenzelle im postfoetalen Leben keine Kernteilung durchmachen kann. 7) Die säurefeste Substanz des Kerns findet sich am haufigsten im Kernkorperchen. Diese Tatsache stimmt mit der alten Theorie vollig uberein, daß das Kernkorperchen die Spaltungsprodukten der Kernsubstanz enthalt. 8) Im Myometrium der Ratte kann man diejenige Wanderzellen, die den Hamazakischen Glanzzellen sehr ahnlich sind, selten nachweisen. Nach Meinung des Verf. konmen dieselben Zellen unter bestimmten Bedingungen. auch in tierischen Geweben auftreten. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 50 7 1938 濱崎氏耐酸牲顆粒ト硅曹注射ニ依ルAmyloidosisトノ關係ニ就テ（第2報）濱崎氏銅及ビ汞・耐酸性顆粒ニ就テ 1444 1458 EN Kan-ichi Mihune Verfasser wünschte die Beziehung zwischen der Störung des EiweiBstoffwechsels und den säurefesten Substanzen experimentell zu untersuchen und, weiterhin den Zusammenhang der Amyloidsubstanz mit den Zerfallprodukten der Nucleoproteide klar zu machen. Über den EinfluB der Natriumsilikatinjektion auf die Hamazakischen säurefesten Granula hat Verfasser die Resultate seiner tierexperimentellen Untersuchungen durch den Nachweis der Cr-säurefesten Granula in seiner letzten Arbeit mitgeteilt. Nämlich, durch dauernde Injektiou der Silikatlosung ergibt sich im allgemeiuen eine deutliche Verminderung der Cr-säurefesten Granula, insbesondere in der Umgebung der Amyloidsubstanz, und in der letzteren finden sich weder säurefeste Granula noch säurefeste Substanz. Verfasser hat demnach angenommen, daB die Nucleinsäure, die wichtigste säurefeste Substanz in den Abbauprodukten der Nucleoproteide, unmittelbar an der Entstehung der Amyloidsubstanz nicht beteiligt sein kann. Dabei gibt es aber noch eine Möglichkeit, daß nicht die Nucleinsäure selbst, sondern ihre weiteren Spaltprodukte (Purinderivate) eine gewisse Rolle bei der Amyloidbildung spielen konnen. Demgemäß hat sich Verfasser weiter mit dem Einfluß der Natriumsilikatinjektiou auf die Cu-säurefesten Granula, welche hauptsächlich aus Mononucleotiden und Mononucleosiden bestehen, und auf die Hg-säurefesten Granula, deren Hauptbestandteile Purinbasen sind, beschäftigt. Die Resultate dieser Untersuchung sind, zusammengefaßt, folgende: Die Cu-säurefesten, Hg-säurefesten Granula und das säurefeste Lipoid findet man nicht in der Amyloidsubstanz, welche durch die Natriumsilikatinjektion erzeugt worden ist. Die Cu-saurefesten und Hg-säurefesten Granula zeigen auch eine deutliche Verminderung und sogar oft verschwinden sie in den durch die Amyloidsubstanz infiltrierten Geweben. Jedoch hat diese Verminderung der Cu-säurefesten Granula einen inuigen Zusammenhang mit dem Ernährungszustand des Orgauismus; bei gut genährten Tieren tritt diese Erscheinung nur undeutlich zutage. Im Gegeusatz zu den Cr-säurefesten und Cu-säurefesten Granula. verringern Bich die Hg-säurefesten Granula bei einem günstigen Ernährungszustand ebenfalls sehr deutlich. Aufgrund den oben genaunten Daten kann man wohl annehmen, daß sich weder Nucleinsäure noch Purinmononucleotide bis zu Purinbasen unmittelbar an der Amyloid- bildung beteiligen konnen. Während die braunen Abnutzungspigmente bei der Verhungerung des Kontrollversuches deutlich zunehmen, findet bei der experimentellen Silikatinjektion kaum eine Vermehrung derselben statt. Die Abnutzungspigmente entstehen, wie schon Hamazaki bestätigt hat, aus den endogenen säurefesten Granula, welche Spaltungsprodukte des KerneiweiBes sind. Deshalb ist es unwahrscheinlich, daß man, wie Gierke-Aschoff es tut, den Zellkernzerfall des betreffenden Organismus als eine der wichtigsten Ursachen der Amyloiderkrankung betrachten kann. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 50 4 1938 濱崎氏耐酸性顆粒ト硅曹注射ニ依ルAmyloidosisノ關係ニ就テ（第1報）「クローム」・耐酸性顆粒ニ就テ 879 894 EN Kan-ichi Mihune Die säurefesten Granula (Hamazaki), Abbauprodukt der Nueleoproteiae, werden in 4 Arten eingeteilt: namlich in Cr-säurefeste, Fe-säurefeste, Cu-säurefeste und Hgsaurefeste Granula. Nach Hamazaki bestehen die Cr-saurefesten Granula hauptsächelich aus Nucleinsäure und Mononucleotide. Obwohl die Entatehung der Amyloidsubstanz viel bestritten ist, doch hat die Literatur bisher kaum einheitlich ausgesagt, welche Rolle dabei das Nucleoproteid spielt. Gierke u. Aschoff legten groBen Wert auf die Zerspaltung des Kerns, und Letterer konnte durch die Nucleininjektion Amyloidablagerung hervortreten lassen. Verfasser wünschte die Beziehung zwischen den Storung des EiweiBstoffwechsels und den säurefesten Substanzen zu betrachten, und weiterhin den Zusammenhang der Amyloidsubstanz mit den Nucleoproteide klar zu machen. Demnach habe ich 2ccm 1%iger Silikatlosung pro kilo zehn Kaninchen täglich zweimal injiziert, und versohiedene Organe mittels des Forschungsverfahrens der Hamazakischen säurefesten Granula untersucht. Zur Kontrolle machte ich denselben Versuch an drei Kaninchen, welche nach 20-30 tägigem Hunger zur Untersuchung kamen. Aus der Untersuchung der einzelnen Organen ergaben sich folgende Befunde. Im Herzmuskel finden sich sparlich die Cr-säurefesten Granula, welche sich rundlich oder eckig gestalten, vor. Die Granula kommen um den Kerne herum oder in der Peripherie der Muskelfasern zum Vorschein. Hier und da, wo kein Granulum mehr vorhanden ist, farben sich die hyalinos degenerierten Muskelfasern diffus violett. In der Milz zeigen die Cr-säurefesten Granula eine deutliche Verminderung in gewohnlichen Fallen. Vor allem verschwanden sie in den Fallen, insofern die Amyloidsubstanz, in welcher man gar kein saurefestes Granulum finden kann, deutlich nachweisbar ist. In der Lunge kommt ein totales Verschwinden der Crsäurefesten Granula zustande. GroBhirn verliert die Cr-säurefesten Granula so deutlich, daB man diese in den Ganglienzellen der Rinde kaum, und feine Granula in den Pyramidenzellen des Hippocampus nur selten finden kann. Im Kleinhirn kommt eine deutliche Verminderung der Cr-säurefesten Granula zum Vorschein. Die degenerierten Purkinjeschen Zellen farben sich meist dick violett und zeigen spärliche feine Cr-säurefeste Granule. Auch in der Zunge vermindern sich zwar die Cr-saurefesten Granula im Axialteile des Zungenmuskels ziemlich, befinden sich aber noch reichlich in der Peripherie der Muskelfasern. Im Magendrusenepithel vermindern sich die Cr-säurefesten Granula mehr oder weniger. Bei der Kontrolle nehmen die saurefesten Granula dagegen auBerordentlich zu und zeigen einen deutlichen zahlenmaBigen Unterschied von den Experimentsfällen. Die Cr-säurefesten Granula der Leber haben im hohen Grade abgenommen. Vor allem vermindern sich die Granula deutlich, falls das Amyloid abgelagert ist. Die Cr-säurefesten Granula in den Harnkanalchen nehmen ihre Zahl deutlich ab und verkleinern sich auffällend. Das Zwischenstück hat die groBte Menge von Granula, dessen Zelleib sich deswegen violett färbt; dann färbt sich die auf Bowmanschen Kapseln, Harnkanalchen, und Arterienwande abgelagerte Amyloidsubstanz, welche nicht mit dem Barytwasser abgeblasen wird, diffus violett. Die dauernde Injektion der Silikatlosung ergibt, kurz gefaBt, eine deutliche Verminderung der Cr-säurefesten Granula; vor allem handelt es sich wohl bei einer ganz deutlichen Verminderung, sogar oft einem Verschwinden, um die Ablagerung von Amyloidsubstanz, iu der die säurefeste Substanz nie eingeschlossen ist. Es ist Behr wahrscheinlich, daB, je mehr die Amyloidsubstanz abgelagert ist, desto weniger die Cr-säurefesten Granula am betreffenden Tiere auftreten. Beim dauernden Hungerversuch vermindern sich die säurefeste Granula ebenfalls beträchtlich ; aber diese Verminderung tritt nicht in so starken Maße ein als bei der Silikatinjektion ; auch ist die letztere von jener durch die Verteilung der Granule leicht zu unterschieden. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 50 3 1938 正常白鼠ニ於ケル濱崎氏耐酸性顆粒ノ研究（第1報）「クローム耐酸性顆粒」ニ就テ 535 555 EN Yukio Suga Hamazakische säurefeste Granula wurden bisher hauptsächlich an Kaninchen studiert. Hamazaki stellte eingehende systematische Untersuchungen über Cr-, Fe-, Cu-, and Hg-säurefeste Granula im Gewebe des gesunden Kaninchens an. Durch seine ununterbrochenen Beiträge Bind die grundlegenden Studien über die chemischen Eigenschaften der säurefesten Granula fast vollendet; das Problem über die Phylogenie sowie die Ontogenie solcher Granula steht dagegen zurzeit noch offen. Verfasser studierte an gesunden Ratten, welche als Versuchstiere neben Kaninchen am häufigsten benutzt wurden, vier Arten von säurefesten Granula. Die vorliegende 1. Mitteilung betrifft die Cr-säturefesten Granula, die von den vier Arten am interestantesten sind. Als Untersuchungsverfahren diente die Hamazakische Methode zum Nachweis säurefester Granula: Fixieren des frischen Gewebes in Müllerscher Flüssigkeit mit 5%igen Eisessig 3 Tage, Herstellung der Paraffinschnitte nach der Regel und Färben nach der Hamazakischen Karbolfuchsin-Jod-Methode. Zur Differenzierung der Granula gegen säurefestes Lipoid kam die Eraktionierungsmethode mit Barytwasser in Anwendung. Als Kontrollpräparate wurden Schnitte, die nach der Ciaccioschen oder der Regaudschen Fixierung mit Karbolfuchsin oder Ciacciosehem Sudam-III gefärbt waren, mikroskopisch untersucht. Die Resultate sind wie folgt: 1) Aus der Untersuchung der Hamazakischen Cr-säurefesten Granula in verschiedenen Organen der gesunden Ratte ergaben sich bemerkeuswerte histologische Befunde. 2) Im Vergleich zu Cr-säurefesten Granula des Kaninchens sind die der Ratte im allgemeinen grob, zum Konfluieren geneigt und unregelmässig geformt. Dies beruht wahrscheinlich darauf, dass in den betreffenden Granula Mononucleotide und Mononucleoside reichlicher als Nucleinsäure enthalten siud, und auch der Lipoidgehalt grösser ist. 3) Cr-säurefeste Granula im Gewebe bei Batten sind an Zahl bei weitem geringer als bei Kaninchen und säurefeste Lipoidgranula haben die Neigung, an ihrer Stelle in Erscheinung zu treten. 4) Von Cr-säurefesten Granula der Ratte gibt es ziemlich viele, die einen relativ starken Wiederstand gegen Barytwasser zeigen. Solche Granula schliessen reichlich adsorbiertes Lipoid in sich ein, stellen in allen Beschaffenheiten eine Übergangsform zwischen Cr-säurefesten Granula und säurefesten Lipoidgranula dar, und scheinen beim Steigern des Lipoidgehaltes in echte Lipoidgranula übergehen zu können. 5) Im Gewebe der Ratte können die Lipoidgranula nach der Fixierung der Cr-säurefesten Granula meist reichlicher und zwar auffallender als durch die Ciaccioschen Lipoidnachweismethode festgestellt werden. 6) Bei Ratten steht der Nucleinsäurestoffwechsel zum Lipoidumsatz in inniger Beziehung; im lipoidreichen Gewebe können sich beide Granula unter gewissen Bedingungen die einen in die andereu umwandeln. 7) Ebenso wie bei Kaninchen lassen sick Cr-säurefeste Granula auch bei Ratten nach der Ciaccioschen oder Regaudschen Fixiermethode in der Regel nicht fixieren, nur bei wenigen kann dies ausnahmsweise nach dem Ciaccioschen Verfahren geschehen. Nach der Meinung des Verfasser hängt die Fixierbarkeit solcher Granula vielleicht von ihrem Lipoidgehalt ab. 8) In Samenepithel erkennt man oft Cr-säurefeste Granula, die in morphologischer Hinsicht mit Mitochondria übereinstimmen. Solche Granula verschwinden durcb die Differenzierung mit Barytwasser und können im Regaudschen fixierten Material nach der Harbolfuchsin-Jod-Methode nicht dargestellt werden. Sie gehören daher zweifellos zu den echten Cr-säurefesten Granula und gelten, vom morphologischen Standpunkt aus gesehen, als Umwandlungsform der Mitochondria in gewissem Funktionszustand. 9) Durch die bisheriegen Studien konnte gar kein Verhältnis der Hamazakischen Cr-säiurefesten Granula zu Mitochondria nachgewiesen werden, dagegen konnte der Verfasser wohl ausnahmsweise im Samenepithel einen solchen Zusammenhang erkennen. 10) Bei Ratten finden sich im glatten Muskelgewebe und im Bindegewebe keine Cr-säurefeste Granula. Sie fehlen in der Regel auch in den Lymphocyten sowie in den Rindenzellen des Thymus. 11) Die Granula in histogenen Mastzellen der Ratte sind als dritte charakterische säurefeste Granule, auszusehen, welche weder zu den Cr-säurefesten Granula noch zu den säurefesten Lipoidgranula in Beziehung stehen. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 51 12 1939 濱崎氏耐酸性顆粒ノ實驗的生成竝ニ細胞核病理學知見補遺 第1篇 新鮮組織ノ無菌的保存法 其ノ2 銅・及ビ汞・耐酸性顆粒ニ就テ 2551 2563 EN Kanichi Mihune Verfasser wünschte den Abbauprozeb der Nucleoproteide durch die Fermente, welche in den frischen Geweben vorhanden sind, experimentell klar zu machen und hat demgemäB in seiner letzten Arbeit durch den Nachweis der Cr-säurefesten Granula über die Beziehung zwischen den Cr-säurefesten Granula und der Feulgenschen Reaktion berichtet. Diesmal untersuchte Verfasser die Cu- und Hg-säurefesten Granula unter gleichen Umständen und konnte weiterhin einige Beobachtungen über die Correlation der oben genannten 3 säurefesten Granula machen. Während die Gu-säurefesten Granula nach dem Abbauprozeb der Nucleinsäure am deutlichsten nach ca. 16-20 Stunden (22-37°C) auftreten, ergeben sich die Hg-säurefesten Granula am zahlreichsten nach ca. 20-24 Stunden (37°C) und die amorfe Hg-säurefeste Substanz vermehrt sich auch noch nach ca. 24 Stunden. Obwohl die oben genannten säurefesten Granula zum Teil an der Kernwand liegen, finden sie sich doch wohl hauptsächlich im Zelleib und zwar in dessen Peripherie. Dies ist nicht anders zu erklären als damit, daB die beiden säurefesten Granula mit dem Abbau der Nucleinsäure an derselben stelle wie die Cr-säurefesten Granula zutagetreten. Eine immer deutlicher werdende Abschwächung der Feulgenschen Reaktion trat kurz nach dem Versuche auf, trotz einer vorübergehenden Reaktionssteigerung im ganz frühen Stadium. Obwohl die Vermehrung der Cr-säurefesten Granula mehr oder weniger zeitliche Schwankungen aufwies, so kann man doch sagen, dab sie im allgemeinen ndch 8-16 Stunden (22-37°C) am deutlichsten ist. Die Cu-säurefesten Granula treten demnächst am deutlichsten nach ca. 16-20 Stunden (22-37°C) auf, dann folgen die Hg-säurefesten Granula und die säurefeste Substanz nach ca. 20-24 Stunden (37°C). Unter gleichen Bedingungen zeigen die Gu- und Hg-säurefesten Granula eine zeitliche Schwankung der experimentellen Resultate deutlicher als die Cr-säurefesten Granula. Nach den Abbaustufen der Nucleoproteide nämlich vermehren sich die 3 Arten säefester Granula in der eben beschriebenen Reihenfolge allmählich und dann vermindern sie sich mit der Zeit in derselben Reihenfolge. Die oben genannten Daten passen gut zu den Angaben Hamazkis, dab die Cr-, Cu- und Hg-säurefesten Granual jedes für sich häuptsachlich aus Purinderivaten von freier Nucleinsäure bis zu Purinbasen bestehen. Die Abschwächung der Feulgenschen Reaktion und die Vermehrung der Cr-säurefesten Granula kommen abwechselnd in inniger Beziehung zueinander vor; in solchen Geweben, welche überhaupt nur wenig mit nucleoproteidspaltenden Fermenten bedacht sind, sind diese Erscheinung nicht so deutlich. Diese Tatsache bestätigt die Meinung Hamazakis, dab das die Feulgensche Nuclealreaktion ergebende KerneiweiB nicht anderes ist als die mit Proteine verbundene Nucleinsäure, und daB die Cr-säurefesten Granula hauptpachlich aus freier Nucleinsäure bestehen. Die Abschwächung der Feulgenschen Reaktion und die Vermehrung der 3 Arten säurefester Granula zu bestimmmten Stunden stehen im Verhältnis mit der Höhe der Temperatur. Das säurefeste Lipoid, welches sich in aufbewahrten Geweben reichlich entwickelt, kann aus den lipoidhaltigen Mitochondria durch Resorption der säurefesten Substanzen entstehen, andrerseits aber auch aus den säurefesten Granula durch die Resorption des Lipoids. Die Zellkerndegeneration der aufbewahrten Geweben beginnt mit Chromatinentmischung (Hamazaki), dann geht sie durch das Stadium der Karyopyknose hindurch und endet schlieblich in Karyorrhexis. Das Stadium, in welchem die Feulgenschen Reaktion deutlich abgeschwächt erscheint und die Cr-säurefesten Granula deutlich auftreten, entsprich wohl dem Stadium des Endes der Pyknose bis zum Beginn der Karyorrhexis. In den aufbewahrten Geweben findet relativ selten ein Ubergang von der Chromatin-entmischung zur Chromatlyse und weiterhin zur Karyolyse statt, aber oft kommt unter bestimmten Bedingungen der Ubergang von der Karyopyknose zur Karyolyse vor. Obgleich die Feulgensche Reaktion in diesem Zustand , wie gewöhnlich, schwächer wird oder sogar ganz verschwindet, vermehren sich die Cr-säurefesten Granula merkwürdiger-weise nicht so deutlich. Wahrscheinlich ist dieses Phenomen durch die Wasserionen-konzentratiion den aufbewahrten Geweben bedingt. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 51 11 1939 二十日鼠氣管枝粘膜ニ於ケル濱崎氏特殊耐酸性顆粒ノ研究（第1報）健常成熟竝ニ幼若動物ニ於ケル之ガ組織像ニ就テ 2406 2425 EN Kunisige Matuda Im Jahre 1935 beschrieb Hamazaki in der Bronchialschleimhaut der Maus eine Art spezifischer säurefester Granula, die er bei seiner Hg-säurefesten Granula-Forschung zufällig gefunden hatte. Solche Granula zeigen morphologisch und biologisch sehr auffallende Eigentümlichkeiten. Sie kommen als schöne gröbere Tröpfchen an dem freien Rand der Epithelzellen zum Vorschein, und geben uns morphologisch den Eindruck von Sekretgranula. Sie sind durch andere gebräuchliche Färbungen nicht tingierbar. Es ist merkwürdig, daB man kein einziges solches Granulum bei anderen Säugetieren (wie Mensch, Affe, Kaninchen, Ratte, Meerschweinchen, Ziege und Schwein) vorfindet. Verfasser stellte systematische histochemische Untersuchungen über die spezifischen säurefesten Granula an um die Natur ihrer Grundsubstanz sowie ihre biologische Bedeutung klar zu machen. Als Versuchstiere wurden erwachsene gesundene Mäuse (11 Fälle) sowie unausgewachsene Mäuse (10 Fälle) benutzt. Frisches Lungengewebe würde mit der Hamazakischen Nachweismethode der Cr-, Cu-, Fe-und Hg-säurefesten Granula behandelt. An den mit KFJ-Methode gefärbten Schnitten wurde zum Teil Hämatoxylin-Nachfärbung ausgeführt, um den Zusammenhang der säurefesten Granula mit den betreffenden Zellkernen genau zu beobachten. Die Differenzierungsmethode durch verdünntes Barytwasser wurde dabei auch probiert. Zur Kontrollfärbung waren die Schnitte mit Hämatoxylin-Eosin oder Ciaccioscher Sudan III-Lösung gefärbt und nach der Ciaccioschen Methode Jixiertes Material mit der KFJ-Methode oder Ciaccioscher Sudan III-Lösung behandelt. Die Resultate lassen sich wie folgt zusammenfassen: 1) Bei der gesunden erwachsenen Maus sind die Hamazakischen speaifischen säurefesten Granula des Bronchialepithels immer mehr oder weniger nachweisbar, dagegen nie bei der unausgewachsenen. 2) Sie finden sicn reichtich in den Zylinderepithelzellen des Bronchiolus respiratorius (I Ordnung bis III Ordnung), aber kaum in gröBeren Bronchien, und gar nicht im kubischen respiratorischen Epithel. 3) In der Regel ergibt sich nur ein solches gröberes (3-6μ) Granulum im freien Rand bei der einzelnen Zelle, gelegentlich finden sich aber einige rundliche kleinere (1.5μ) nahe um den Kern hermn. 4) Diese Granula werden mit der Hg-Methode am deutlichsten und am reichlichsten fixiert, dann mit Cu-und Cr-, aber gar nicht mit der Fe-Methode. 5) Die Grundsubstanz der Granula ist wohl eine echte säurefeste Substanz, enthält aber eine mässige Menge von Lipoid, welches mit der Ciaccioschen Methode nicht fixierbar ist. 6) Es steht wohl auBer Zweifel, daB diese säurefesten Granula endogener Herkunft sind. Ihre Beschaffenheiten sind denen des Lipofuszins so ähnlich, daB sie mit der Hg-Methode am deutlichsten fixierbar sind, die alt gewordenen Granula eine bräunlicbe Eigenfarbe bekommen und daB ihre Zahl im allgemeinen mit dem Alter der Tiere zunimmt. 7) Aus den morphalogischen Befunden ist es wohl denkbar, daB diese Granula mit besbimmter physinlogischer Funktion als eine Art von Sekretmasse ins Bronchiallumen abgesondert werden, was bei den gewöhnlichen säurefesten Granula noch nicht nachgewiesener Ausgang ist. 8) Im mit Hg-Fixierungsgemisch gehärteten Material finden wir die Granula, welche im Begriff stehen, sich abzusondern, am deutlichsten, weniger aber bei dem mit Cu-, und nie bei dem mit Cr-Fixationsgemisch gehärteten. 9) Diese Granula werden, von den betreffenden Zellkernen produziert, und zwar die gröberen sind nichts anderes als die totale säurefeste Umwandlung des Kerns. 10) Was die kleineren betriffts,o kann man annehmen, daß sie　aus der vom Kem ausgetretenen Chromatinmasse gebildet werden, ähnlich wie der bekannte Vorgang der Kernsekretion, welcher schon van Dimitrowa, Krabbe und Berg nachgewiesen wurde. 11) Im Schleimhautepithel des Seitenbronchus und des Bronchiolus tritt auch eine ähnliche Sekretion der säurefesten Substanz aus dem Kern sowie eine sänrefest Deegeneration des Kerns zu tage, aber dieser letztere verschiebst ich weder zum Zellrand noch geht er in einen schönen Tropfen über. 12) Bei den jungen Mäusen zeigen sich die spezifischen säurefesten Granula am deutlichsten durch Cr-Fixierungsgemisch in der Schleimhaut des Bronchiolus resp., aber bei keiner der vier Fixiermethoden kann man die ringförmigen sowie blaß bräunlichen Granula, die bei erwachsenen Mäusen in Erscheinung zu treten pflegen, darstellen. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 51 11 1939 正常白鼠ニ於ケル濱崎氏耐酸性顆粒ノ研究（第3報）鐵・竝ニ銅・耐酸性顆粒ニ就テ 2379 2398 EN Yukio Suga Hamazaki hat bereits auf Grund seiner chemischen Unterschungen fest9estellt, daB Cr-säurefeste Granula hauptsächlich aus freier tierischer Nucleinsäure, Fe-säurefeste Granula hauptsächlich aus Purinmononcleotiden Cu-säurefeste Granula hauptsächlich aus Purinmononucleosiden und Hg-säurefeste Granula zum gröBten Teil aus Prinbasen entsanden sind. Verfasser hat bei gesunden weiBen Ratten die oben genannten säurefesten Granula in der Hauptsaehe vom histologisehen Gesichtipunkt aus untersuehb und berichtete schon in seiner Mitteilung über die Befunde an Gr-säurefesten Granula und in seiner Zweiten Mitteilung über die an Hg-säuresesten Granula. In der vorliegenden Mitteilung handelt es sich histologische Befunde an Hamazakischen Fe- und Cu-säurefesten Granula in verschiedenen Organen und Geweben von gesunden weiBen Ratten, worüber im folgenden kurz zusammenfassend berichtet sei: 1) Fe- und Cu-säurefeste Granula haben im allgemeinen eine groBe morphologische Ahnlichkeit; jede dieser zwei Arten ist jedoch als selbständige Granula anzusehen, weil man in einem bestimmten Gewebe einen deutlichen morphologischen Unterschied zwischen ihnen finden kann. 2) Im Vergleich zu den Fe-säurefesten Granula enthalten die Cu-säurefesten Granula eine gröBere Menge Lipoid. Sie sind meistens grob und rundlich. 3) Cu-saurefeste Granula bzw. Substanzen, die von einem Harnkanälchen ausgesondert werden, sind ein Bestandteil des Harns. 4) Auf Grund des oben Gesagten stimmt Verf. der Hamazakischen Ansicht zu, daB die Gu-säurefesten Granula den Hg-säurefesten Grannula am ähnlichsten sind und deshalb als eine dem Endprodukte des Stoffwechsels sehr nahe stehende Substanz anzusehen sind. 5) Die Histiocyten in den Alveolarsepten der weiBen Ratten, anders als die in anderen Geweben, enthalten zahlreiche Cu-säurefeste Granula, sodaB sie beim Stoffwechsel der säurefesten Substanzen, eine spezifische Rolle spielen. 6) Im geschiehteten Plattenepithel sind im allgemeinen nur wenige säurefeste Substanzen vorhanden, mit Ausnahme der Cu-säurefesten Substanzen, welche in der Schleimhaut des Vordermageas in einer bestimmten Lagebeziehung zu dem Histon stehen. Die Oben genanten 4 Arten von säurefesten Granula bzw. Substanzen Hamazakis zeigen bei weiBen Ratten je nach der Art des Schwermetalls, die zur Fixstion des Gewebs dient, einen deuulichen morphologischen Unterscheid; die säurefester Lipoidgranula weisen aber, unabhängig vom Fixations verfahren, ein fast gleiohes Gewebsbild auf. Es besteht kein Zweifel darüber, daB die säurefesten Granula in verschiedenen Geweben, sowohl bei weiBell Ratten wie bei KaninChen, die säurefesten Granula von Exogen sind und demgemaB die von Eudogen produzierten säurefesten Granula äuBerst selten sind. Wenn man aber die Herkunft der säaurefesten Granula überaupt und ihre biologische Bedeutung genauer untersuchen will, so ist die Forschung der endogenen säurefesten Granula durchaus nicht entbehrlich. Gr-säurefeste Granula werden an der Schleimhaut des untern Teils des Osophagus, an der Schleimhaut des Magens sowie des Dünndarms und an den Leberzellen im Zellkerne Naehgewiesen: Fe- sowie Cu-säurefeste Granula zeigen sich ebenfalls im Zellkerne der Lymphdrüse, der Vorderfiornzelle des Rückenmarks, der Basalzelle der Zumgenschleimhaut, der Epithelzelle des vorderen Magenteils und der Leberzelle. Was die säurefesten Granula, die um den Zellkern umschrieben sind, anbetteifft, so sind sie überall zu bemerken. Wie bereits in der 2. Mitteilung berichtet wurde, wiesen die Hg-säurefesten Granula in der Drüsenzelle einen beachtenswerten spezifischen Befund auf (Cf. 2. Mitt.). Alle solche in einer bostimmten Positionsbeziehug zum Zellkerne stehenden Granula scheinen sich nicht nur als. ein Nualeinstoffwech selprodukt, sondern als eine solche Substanz zu prasensieren, die zu einem bestimten physiologischen Zweck durch die physiologiscFhuen ktione rzeugtw ird. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 51 9 1939 濱崎氏耐酸性顆粒ノ實驗的生成竝ニ細胞核病理學知見補遺 第1篇 新鮮組織ノ無菌的保存法 其ノ1 「クローム・耐酸性顆粒」トFeulgen氏反應 1842 1857 EN Kanichi Mihune Eine Art Autoferment, welches nach dem Tod des Organismus Kerneiweiß abbaut, ist schon von Salkowski, Schmaus und Albrecht u.a. experimentell nachgewiesen worden. Es spaltet Nucleoproteide und Purinkörpern in aseptisch aufbewahrten frischen Geweben. Hamazaki behauptct, daß die Cr-, Cu- und Hg-saurefesten Granula jedes für sich hauptsächlich aus Purindcrivaten von freler Nucleinsäure bis zu Purinbasen bestehen und daß das Feulgensche Nuclealreaktion ergebende Kerneiweiß nicht anderes als mit Proteinen verbundene Nucleinsäure ist. Verfasser wünschte die Beziehung zwischen den Nucleoproteidabbauprozessen durch die Fermente, welche in den frischen Geweben sind, und dem Schicksal der oben genannten 3 säurefesfesten Granula experimentell zu untersuchen. Als Material benutzte er Herz, Milz, Lymphdrüsen, Magen, Leber und Niere von gesunden Kaninchen. In der ersten Untersuchungsreihe bewahrte er die alle Organe bei 0°, 22°, und 37°C auf, fixierte sie nach 8, 16 und 24 Stunden durch das Fixationsmittlel für Cr-, Cu-und Hg-säurefeste Granula und untersuchte jedesmal die säurefesten Granula und Feulgensche Reaktion. In der zweiten experimentellen Untersuchungsreihe untersuchte er die oben angegebenen Organgewebe, welche bei 37°C aufbewahrt wurden, alle 4 bis 30 Stunden, um das zeitliche Verhältnis genauer als bei der ersten Untersuchungsreihe zu betrachten. Um die Beziehung zwischen säaurefesten Granula und Lipoid klarzustellen führte er zugleich das Ciacciosche Fixationsverfahren und Färbung aus. Die Resultate des Experiments seien hier zusammenfassend angegeben. Obgleich die Vermehrung der Cr-säaurefesten Granula mehr oder weniger zeitliche Schwankungen aufwies, so kann man doch sagen, daß sie im allgemeinen nach 8-16 Stunden (22-37°C) am deutlichsten ist, d.h. nach ungefähr 12-16 Stunden in Herz und Niere, aber nach ungefähr 8-12 Stunden in Milz, Lymphdrüsen, Magen und Leber. Die Cr-säurefesten Granula lassen sich nach der genannten Zeit im Protoplasma oder in der Umgebung des Kernes erkennen. Später vermindern sie sich allmählich in der Umgebung des Kernes und treten mehr in der Peripherie des Zelleibes auf, wo sie allmählich mit dem Lipoid, welches sich bei der Autolyse auch deutlich vermehrt, zusammenfließt, um schließlich zu säurefestem Lipoid zu werden. Letzteres färbt sich durch die Karbolfuchsinjodmethode rötlichviolett, durch das Ciacciosche Verfahren orangegelb, und zeigt gegen Differenzierung durch Barytwasser auffallenden Widerstand. Nach 20 Stunden verringert sich dieses säurefeste Lipoid allmahlich auch und ist nach ungefähr 30 Stunden kaum mehr nachzuweisen. Bei der Hämatoxylineinfarbung treten regressive Veränderungen der Zellkerne ebenfalls ungefähr nach 8-12 Stunden auf. Eine immer deutlicher werdende Abschwäachung der Feulgechen Reaktion trat kurz nach dem Versuch auf, abgesehen von einer vorübergehenden Reaktionssteigerung im ganz früheren Stadium. Zu bemerken ist dabei, daß die Reaktionsstärke mit der Vermehrung der Cr-säurefesten Granula immer herabgesetzt worden ist. Nach ungefähr 30 Stunden zeigen sich regressive Kernveränderungen sehr deutlich und die Feulgensche Reaktion fällt schon früuh negativ aus. während die Färbbarkeit durch Hämatoxylin nocch weiter abnimmt. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 52 10 1940 夏期流行性腦炎屍ニ於ケル「ケトエノール顆粒」ノ研究 2535 2547 EN Yukio Hamazaki Kunisige Matuda Die phylogenetischen Studien der Ketoenolsubstanz (KES) wurden schon von Hamazaki (bei Kaninchen, Meerschweinchen, Affe, Ziege und Schwein), Suga (Ratte), Sigemori (Kröte) und Watanabe (Huhn) eingehend ausgeführt. Was die ontogenetischen Forschungen der KES anbelangt, erschienen auch Veröffentlichungen von Hiramoto hinsichtlich des Foetus von Menschen und Kaninchen. Seit langer Zeit beabsichtigten wir, die KES im gesunden sowie im pathologischen Gewebe des Menschen zu erforschen Es bot sich jetzt die erste Gelegenheit, welche uns die Untersuchungen der KES bei Encephalitis epidemica ermöglichte. Das Material wurde mit Hamazakischem Cr-und CuFixierungsgemisch gehärtet und nach der Regel wurden Paraffinschnitte hergestellt und dann nach der Karbolfuchsin-Jod-Methode (KFJ-Methode) gefärbt. Für die Darstellung des Ketoenollipoides Wurde die Differenzierungsmethode mittels Barytwassers ausgeführt. Das Alter, der Zeitablauf nach dem Tod und hauptsächliche Krankheitsveränderungen der einzelnen Fälle sind aus der Tabelle 1 ersichtlich. Aber es ist sehr bedauerlich, dass wir auf die Untersuchung des Gross-und Kleinhirns, weil sie für die nosologische Untersuchung der Encephalitis benutzt wurden, verzichten mussten. Die Ergebnisse lassen sich wie folgt zusammenfassen: 1) Verfasser untersuchten Cr-und Cu-Ketoenolgranula (KEG) bei menschlichem Material der Encephalitis epidemica im Okayama Distrikt. 2) Im allgemeinen nehmen die auf die KFJ-Methode positiv reagierenden Granula in verschiedenen Organen an Zahl und Färbbarkeit ab. 3) Wenn man aber die KFJ-Methode nach der Differenzierung mittels Barytwassers ausführt, dann nehmen die Granula zum grüssten Teil an Farbbarkeit deutlich zu. 4) Indessen ist zu bemerken, dass die feinen Granula, welche vor der Behandlung mittels Barytwassers nicht wahrnehmbar sind reichlich und deutlich vorkommen. 5) Aus den oben erwähnten Tatsachen künnen wir schliessen, dass die Granula in verschiedenen Organen der Encephalitis epidemica ausgedehnt in ergiebige fettige Degeneration geraten. 6) Die nicht verfettenden KEG sind geringiügig und finden sich vorzüglich im Innern des Kcrns oder anhaftend an der Kernmembran. 7) Bei einem Fall, welcher klinisch irrtümlich als Encephalitis epidemica diagnostiziert wurde, war die fettige Degeneration der KEG geringgradig zu finden. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 52 9 1940 二十日鼠氣管枝粘膜ニ於ケル濱崎氏特殊耐酸性顆粒ノ研究（第IV報）本顆粒ノ人工氣胸ニ對スル態度ニ就テ 2192 2202 EN Kunisige Matuda In der letzten Mitteilung berichtete Verf. eingehend über das Verhalten der spezifischen säurefesten Granula gegen Eingriffe mit Äther und anderen verschiedenen pharmazeutischen Gasen. Die Wirkungen dieser Gase greifen dabei die Granula fast direkt an. Diesmal wurde die Untersuchung mit künstlichem, einseitigem Pneumothorax bei Mausen durchgefuhrt, um die Einflüsse auf die Granula bei den durch mechanische Schädigung verursächten Veranderungen des betreffenden Organs sowie bei den allgemeinen Veränderungen des Organismus festzuatellen. Beim Experiment wurden die Mäuse von fast gleicher Grösse (15-20g) in 2 Gruppen eingeteilt. Bei den Mausen der I. Gruppe wurde Rippenresektion ausgeführt: nämlich eine rechtsseitige Rippe wurde in der unteren Gegend der Vorderbrust ca. 3-4mm lang durchgeschnitten und mit Pinzette oder Schere wurde die Granulation jeden Tag beseitigt, um damit den Wundverschluss vermeiden zu können. Die Versuchstiere wurden 2, 4, 6, 8, 15, 22, 29, 32 und 36 Tage nach der Operation getötet. Bei den Mäusen der II. Gruppe wurde Luftinjektion in die Pleurahöhle ausgeführt: an der gleichen Stelle der Brust (rechts, vorn, unten) wie bei der Rippenresektion liess man Luft in die Pleurahöhle mit einer Spritze solange einströmen, bis der intrathorakale Druck sich mit dem atmosphärischen ausglich; nach je 3 Tagen wiederholte man die Lufteinspritzung in der gleichen Weise und tötete die Tiere 7 Tage (nach zweimaliger Lufteinspritzungen), 10 Tage (3 mal) und 13 Tage (4 mal) nach der ersten Lufteinspritzung. Ausserdem wurden der Pneumothorax von 50 Tagen Dauer auf erstere Methode und die Pneumothorax von 25 sowie 39 Tagen Dauer auf letztere Methode geprüft. Die Materialien beider Gruppen wurden nach der Hamazakischen Methode mit Cr-, Cu- und Hg-Fixierungsgemisch gehärtet und danach Paraffinschnitte hergestellt. Bei der Färbung kamen die KFJ-Methode, zum Teil Anilinwasser-Dahlia-Methode und Hämatoxylin-Eosin-Färbung zur Anwendung. Schlüsse. 1) Beim künstlichen, einseitigen Pneumothoran der Maus nehmen die spezifischen säurefesten Granula der Bronchialschleimhaut im allgemeinen an Zahl ab. Die zahlenmässige Abnahme der Granula ist bei der behandelten Brustseite viel deutlicher. 2) Beim Pneumothorax durch Rippenresektion scheint die Abnahme der Granula hochgradiger zu sein als bei dem durch Lufteinspritzung. 3) Beim künstlichen Pneumothorax nehmen die Cr-, Cu- und Hg-Granula in jedem experimentellen Fall in fast gleichem Masse miteinander an Zahl zu oder ab, dabei sieht man in dieser Beziehung keine bestimmte Ordnung wie bei der Ätherinhalation. 4) Beim kunstlichen Pneumothorax zeigen sich bei den Granula Zerfall und Schwund in mannigfaltigen Verlaufen, aber diese Veranderungen kommen relativ langsam und leichtgradig zustande. 5) Die Wiederherstellung der Granula geschieht auch relativ langsam und ein Teil der gröberen scheint von dem unmittelbaren Übergang des säurefest umgewandelten Kerns herzurühren. 6) Ein Teil der durch Pneumothorax beeinflussten Granula geht in braunes Pigment über. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 52 8 1940 二十日鼠氣管枝粘膜ニ於ケル濱崎氏特殊耐酸性顆粒ノ研究（第III報）本顆粒ノ藥物學的刺激ニ對スル態度ニ就テ 1851 1872 EN Kunisige Matuda In der I Mitteilung berichtete Verfasser über die histologischen Bilder der Hamazakischen spezifischen säurefesten Granula in der Bronchialschleimhaut der Maus, und in der II Mitteilung über die karyopathologischen Forschungen; diesmal aber handelt es sich um die morphologischen Veränderungen infolge von Anwendung verschiedener pharmakologischen Substanzen. Beim Experiment teilte Verf. die Mäuse in 3 Gruppen ein. Die Maus der I Gruppe brachte er in einer bestimmten Glocke unter, und liess sie dort 10 Minuten lang Ätherdampf inhalieren. Dann tötete er sie in den verschiedenen Zeitabschnitten nach dem Erwachen. Bei der II Gruppe narkotisierte man sie in der Glocke mit Äther 10 Minuten lang. Die Narkose wurde 2 bis 5 Mal wiederholt mit je 1 stündigem Abstand, und alle Tiere wurden 40 Minuten nach dem letzten Erwachen getötet. Bei III wurde langzeitige Narkose von 25 Minuten 1 und 2 Mal versucht und die Tiere ganz gleich wie bei der II Gruppe behandelt. Als Kontrolle wurde eine 8 Minuten dauernde Chloroformnarkose 1 und 2 Mal ausgeführt, ausserdem wurden Formol-Gas-(15 und 30 Minuten) und Nitrogen-Gas-Inhalation (7 Minuten), welche ganz andersartige Gift-Gasp sind, angewandt und die Tiere je 1 Stünden nach der Inhalation getötet. Da die spezifischen säurefesten Granula, wie schon in der I Mitteilung berichtet wurde, vermuten lassen, dass es sich morphologisch um eine Art von Sekretgranula handelt, stellte Verf. Untersuchungen hinsichtlich der Wirkung des Pilokarpins und Atropins auf die Granula an. Er injizierte daher den Mausen pro 20g 0.1 sowie 0.3cc 0.1%iger Pilokarpinlosung und auch 0.01%iger Atropinlosung in der gleichen Weise und tötete sie 25 Minuten nach der Injektion. Das Lungengewebe wurde mit dem Hamazakischen Cr.-, Cu.- und Hg.-Fixierungsgemisch, ausserdem ein anderes Stück mit Alkohol, der mit Cup. sul. völlig wasserfrei gemacht wurde, gehärtet, und nach der Regel stellte man Paraffinschnitte her. Die nach der Hämazakischen Methode hergestellten Präparate waren prinzipiell nach der KFJMethode gefärbt, ausserdem wurden Hämatoxylin-Eosin, Doppelfaibung nach KFJMethode und Hämatoxylin, auch Anilinwasser-Dahlia und Ciaccios Sudan III Färbung benutzt. Die mit Alkohol fixierten waren mit Brillant Azurin B tingiert. Zuerst untersuchte Verf. eingehend die durch die Ätherinhalation verursachten verschiedenen Ver. anderungen der Granula, dann verglich er diese mit den durch andere Mittel verursachten Veranderungen der Granula, und erzielte dabei folgende Resultate: 1) Wenn man die Maus Äther inhalieren lasst, zeigen die spezifischen säurefesten Granula die Neigung zu zerfallen bzw. sich aufzulosen und nehmen an Zahl ab, um allmählich im Schwund zu geraten. 2) Der Schwund spezifischer säurefester Granula wird je nach Zunahme der Inhalationsstunde deutlicher, seine Geschwindigkeit ist an der Hg.-Granula am grössten, dann kommen die Cr.-Granula. Ebenso erfolgt ihre Wiederherstellung in umgekehrter Reihenfolge. Die Cu.-Granula scheinen in ihrem Schwund am langsamsten zu sein und ihre Wiederherstellungszeit findet zwischen denjenigen der oben genannten beiden Granula statt. 3) Durch Ätherinhalation zeigen die Granula an Form und Färbbarkeit eine bestimmte Veränderung. An den Cu.-Granula sind morphologische Variationen sehr deutlich bemerkbar: es kommt nämlich in einem Tei dieser Granula eine wabige Struktur zum Vorschein, jedoch lösen sie sich allmählich auf. Was die Färbbarkeit anbelangt, so verlieren die Hg.-Granula sie zuerst am deutlichsten, dann die Cr.-Granula, aber an der Cu.-Granula konnen wir relativ geringe Veränderungen finden. 4) Bei der Ätherinhalation treten zahlreihe staubfeine Granula in der Bronchialschleimhaut auf, was normalerweise gar nicht stattfinden, und was zweifellos von dem Zerfall spezifischer säurefester Granula herrühren dürfte. 5) Im Cu.-Präparate sind diese feinen Granula am deutlichsten, sodann im Cr.-Präparate, im Hg.-Präparate jedoch findet man sie gar nicht. Es ist besonders bemerkenswert, dass diese feinen Granula dann am deutlichsten sind, wenn die Cr.-und Cu.-Granula an Zahl am geringsten sind, und sie sich allmählich mit der Wiederherstellung spezifischer säurefester Granula vermindern. 6) Vom morphologischen und histochemischen Standpunkt aus stimmen diese feinen Granula mit den Hamazakischen typischen säurefesten Granula überein ; es ist also höchstwahrscheilich, dass sie die Hauptbestandteile der spezifischen säurefesten Granula sind. Auf Grund diesmaliger Untersuchung, bei welcher der Zerfall spezifischer säurefester Granula klar zu sehen ist, können wir nicht irrtümlich annehmen, dass die spezifischen säurefesten Granula vielleicht mehr oder weniger Lipoid enthalten. 7) Bei der Chloroforminhalation zeigen die spezifischen Granula, wenn auch nicht so deutlich, eine ähnliche Veränderung wie die bei der Ätherinhalation. 8) Bei der Formol- und Nitrogen-Gas-Inhalation nehmen die spezifischen Granula im allgemeinen an Zahl ab, zuweilen werden sogar geringe feine Granula angetroffen ; die spezifischen Granula zeigen jedoch keine systematische Umformung wie beim Äther. Hieraus können wir schliessen, dass diese Veränderungen nur durch Ortreiz der Mittel verursacht wurden. 9) Bei der Injektion des Pilokarpine und Atropins konnte man keine sichere Wirkung auf die spezifischen säurefesten Granula wahrnehmen. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 52 8 1940 濱崎氏耐酸性顆粒ノ實驗的生成竝ニ細胞核病理學知見補遺（第3篇）新鮮組織ノ有機溶媒浸漬實驗 1802 1812 EN Kanichi Mihune Verfasser hat die experimentelle Aufbewhrung der in Chloroform antiseptisch eingetauchten frischen Kaninchengewebe bearbeitet. Das von ihm wahrgenommene histologische Bild der säurefesten Granula ist deutlich verschieden von dem Fall, welcher einfach aseptisch im Brutofen aufbewahrt worden war. Daher unternahm er es, systematische Untersuchungen in Bezug auf diesen interessanten Befünd auszufuhren, um die Ursache dafur festzustellen. Ausser mit Chloroform beschäftigte er sich mit Tetrachlorkohlenstoff, Aether und Aether-alkohol bei 37°C, fixierte sie nach 1, 2, 4, 8, 12, 24, 48 und 72 Stunden durch das Fixationsmittel fur Cr-saurefeste Granula und untersuchte jedesmal die säurefesten Granula. Die Resultate des Experiments seien hier zusämmenfassend angegeben. Durch die Anwendung von Chloroform, Tetrachlorkohlenstoff und Aether wird das säurefeste Lipoid aus dem frischen Gewebe extrahiert, indem die echten säurefesten Granula, welche bei Aufbewahrung durch Kerndegeneration entstanden waren, im Gewebe zurückbleiben. Jedoch passt sich diese Methode nicht der histologischen Untersuchung an, weil zugleich eine Umformung der säurefesten Granula stattfindet. Bei Anwendung des Aether-Alkoholgemisches lassen sich keine echten säurefesten Granula nachweisen. Die saurefesten Granula zeigen bei dieser Aufbewahrung ein sehr merkwurdiges Bild, welches von niemand vorher wahrgenommen wurde. Sie lassen sich von Beginn an im Protoplasma als diffus zerstreute, relativ feinere, unscharf begrenzte Granula erkennen. Obwohl die Vermehrung der Cr-saurefesten Granula in allen Organen, welche mit Tetrachlorkohlenstoff aufbewahrt worden waren, mehr oder weniger zeitliche Schwankungen aufweist, so kann man doch sagen, dase sie im allgemeinen nach 1 Stund (37°C) am deutlichsten ist. Jedoch vermindern sie sich nicht so deutlich bis zu 24 Stunden, im weitern Zeitverlauf jedoch vermindern sie sich allmahlich. Die auffallenden Unterschiede zwischen dem diesmaligen Versuch und dem fruheren ergeben sich vielleicht daraus, dass infolge von Auflosung der Fettsubstanzen durch Chloroform, Tetrachlorkohlenstoff und Aether die nucleoproteolytischen Fermente vom Protoplasma aus in den Kern hinein unmittelbar eintreten konnen und dann die Crsaurefesten Granula sehr rasch in Erscheinung treten. In den aufbewahrten Geweben tritt die Karyopyknose sehr deutlich auf, aber sie geht schnell zur Chromatolyse und weiterhin zur Karyolyse ohne Aufquellung des Kerns über, was man nach der Regel der Karyopathologie als einen ungewohnlichen Verlauf ansehen kann. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 52 7 1940 1側腎動脈結紮ニ因ル他側腎臟ニ於ケル濱崎氏耐酸性顆粒ノ消長ニ就テ 1635 1655 EN Kunisige Matuda Wenn die eine Seite von Geschwisterorganen künstlich exstirpiert oder ihre Arterie unterbunden wird, so ist es wohl denkbar, dass das anderseitige Organ morphologisch und funktionell eine gewisse kompensatorische Veränderung zeigen wird. Diese Tatsache ist schon bei der Kaninchenniere von Albu, Furuya und Ozawa nachgewiesen worden. Verfasser unterband die einseitige Nierenarterie des Kaninchens, und stellte durch die Hamazakische KFJ-Methode genaue histopathologische Untersuchungen an, um die durch die Ligatur erzeugte funktionelle Veränderung der anderseitigen Niere klar darzustellen und dadurch die Ausscheidungsstelle der saurefesten Substanz leicht erkennbar zu machen. Der Stoffwechsel saurefester Substanz, welchen Hamazaki neuerdings nachgewiesen hat, ist ganz spezifisch und ihr Endprodukt wird von der Niere aus im Harn ausgeschieden. Es interessiert dabei besonders festzustellen, dass welche morphologischen Veranderungen die säurefesten Granula verschiedener Nierenteile zeigen, und gleichzeitig in welchem Verhältnis diese Granula mit den durch die Ligatur verursachten histologischen Bildern der anderseitigen Niere stehen. Als Versuchstiere wurden 18 Kaninchen von ca. 2.5Kg. Körpergewicht benutzt. Man fixierte das Tier in Rückenlage, öffnete die Bauchhohle ohne Narkose, und schloss nach Unterbindung der linksseitigen Nierenarterie die Bauchdecke wieder. Jeweils 4, 8, 12, 16, 20 und 24 Stunden nach der Operation wurden 2 Kaninchen, ausserdem 2 Tiere 10 Tage nach der Operation, durch Luftembolie getötet. Die rechtsseitige Niere war in dreifacher Weise mit dem Hamazakischen Cr-, Cu- und Hg-Fixierungsmittel gehärtet, ein anderes Stuck derselben in Alkohol, der mit Cup. sulf. völlig wasserfrei gemacht wurde, 3 Tage lang gelegt und Paraffinschnitte hergestellt worden. Die nach der Hamazakischen Methode fixierten Präparate waren mit der KFJ-Methode sowie Hämatoxylin-Eosin gefarbt, auch die Differenzierung mit Barytwasser ausgeführt. Die mit Alkohol gehärteten Präparate waren mit Brillant Azurin B gefärbt. Ausserdem wurden als Kontrollversuch noch 4 Kaninchen benutzt, die 16 und 24 Stunden nach der Laparotomie, bei welcher einfach die Baucheingeweide blossgelegt und herumgerührt waren, getötet waren. Ergebnisse: 1) Wenn die einseitige Nierenarterie unterbunden wird, so zeigt die Verteilung säurefester Granula im anderseitigen Nierengewebe eine anffallende Veranderung. 2) 4 und 8 Stunden nach der Operation nehmen die säurefesten Granula meist in den Zwischen-und Hauptstücken zu, wo man normalerweise reichliche Granula zu finden pflegt. 3) Diese Granula sitzen näher an dem freien Epithelrand als an dem Basalteil. Sie quellen auf, konfluieren miteinander und losen sich deutlich auf; eine gewisse Anzahl von ihnen nimmt seinen Weg in das Kanälchenlumen. 4) Nach 16 und 24 Stunden nehmen die Granula an dieser Stelle allmahlich ab, und dann kommen abnorme eigentümliche säurefeste Granula im Epithel des Zwischen-und Schaltstücks, Sammelröhrehens und selten auch im Epithel des Ductus papillaris zum Vorschein. 5) In diesem Stadium werden in den Epithelzellen der Haupt-und Zwischenstücke merkwürdige regressive Kerndegenerationen, nämlich Chromatinentmischung, Chromatolyse, Chromatinauslaugung und Kernhydrops, sowie Trübeschwellung des Protoplasmas nachgewiesen, was vielleicht die durch die Überbelastung der betreffenden Funktion erzeugte Zelldegeneration sein dürfte. 6) Die in den Schaltstucken und Sammelrohrchen abnorm vorkommenden säurefesten Granula sind besonders reichlich in den einzeln verstreuten speaifischen Epithelzellen zu finden. Diese Zellen sind rundlich angeschwollen, ihre Kerne bisweilen von den Granula verdeckt, und in regressive Degenerationen verwandelt. 7) Diese Zellen sind, wenn durch das Hamazakische Cr-Fixierungsmittel gehärtet, mit Hämatoxy-lin-Eosin Färbung durch ihre auffallende Acidophilität leicht unterscheidbar. 8) 10 Tage nach der Operation sind diese spezifischen Zellen noch weiter nachweisbar, aber ihre Anschwellung sowie Kerndegeneration ist nicht mehr deutlich. Ausserdem nehmen hierbei die Bilder der Haupt- und Zwischenstücke wieder ein fast nomales Aussehen an. 9) Daraus dürfte sich die Annahme ergeben, dass die Ebstein- und Nicolaierschen Uratzellen teilweise mit den oben beschriebenen angeschwollenen Zellen übereinstimmen. 10) Wie bei der normalen Niere ist das Ausscheidungsbild an Cu-säurefester Substanz ganz deutlich. 11) Aus den oben angeführten Tatsachen kann man vielleicht den Ausscheidungsvorgang an säurefester Substanz etwa folgendermassen annehmen : bewegen sich die säurefesten Granula zum Bürstenrand, dann konfluieren sie in gröberen Sekretgranula miteinander und ordnen sich wie ein Rosenkranz an. Allmählich quellen und lösen sich die Granula zur amorphen säurefesten Substanz auf, um schliesslich in das Harnkanälchen überzugehen. Normalerweise bestehen diese Sekretgranula aus Cu-und Hg-säurefester Substanz, aber es wurde bei dieser Untersuchung festgestellt, dass sie ausserdem auch Cr-säurefeste Substanz in sich einschliessen. 12) Die Stagnation der säurefesten Substanz im Nierengewebe tritt nach der Ordnung von Hg-, Cu-und Cr- Granula auf, und ihr Schwund beginnt in umgekehrter Folge. 13) Gewöhnlich finden wir im dicken Teil der Henleschen Schleife eine ziemlich grosse Anzahl der säurefesten Granula, aber sie scheinen keinen direkten Zusammenhang mit der Ausscheidung säurefester Substanz zu haben. 14) Die durch einseitige Arterienunterbindung verursachte regressive Degeneration der Kerne in den Epithelzellen der anderseitigen Niere stellt meist eine lytische Veränderung dar. Demgemäss kann man hierbei keine Zunahme der typischen, endogenen säurefesten Granula konstatieren. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 52 6 1940 蟾蜍 (Bufo vulgaris japonicus) ニ於ケル濱崎氏耐酸性顆粒ノ研究（第1報）三月蟾蜍「クローム」・耐酸性顆粒ニ就テ，特ニ其ノ内生的顆粒ノ産生及ビ脂肪化ニ就テ 1449 1470 EN Hukuhitiro Sigemori Heute steht es ausser Zweifel, dass Hamazaki's Karbolfuchsin-Jod-Methode, bei welcher eine Fixation durch Schwermetallsalzgemisch unbedingt nötig ist und als. die spezifische Nachweissmethode der Hamazakischen säurefesten Granula gilt, eine chemische Reaktion ist, und zwar eine Art von Ketonreaktion. Infolgedessen sind nun die chemischen Eigenschaften der saurefesten Granula klar geworden. Cr-säurefeste Granula bestehen hauptsächlich aus freier tierischer Nukleinsäure und auch aus Abbauprodukten, die deren Zuckerkomponente mit sich führen. Durch die unermüdlichen Forschungen Hamazaki's sind die grundlegenden Studien über die biochemischen Eigenschaften der säurefesten Granula und den Chemismus der KFJ-Methode fast vollendet, dagegen ist bis jetzt für die Forschung dieser Granula auf ontogenetischem und phyllogenetischem Gebiete noch wenig unternommen worden; die Studien über säurefeste Granula wurden bislang ausschliesslich an Mammalien, wie z.B. Kaninchen und Ratten, angestellt. Hamazaki brachte seine ausführlichen systematischen Untersuchungen der säurefesten Granula bei gesunden Kaninchen zu Ende. Er bestätigt, dass diese säurefesten Granula im Grunde etwas anderes sind als die verschiedenen schon bekannten Zellgranula und einer Art von karyogenen Granula zugehört. Konisi führte Hungerversuche bei Kaninchen durch und stellte fest, dass bei Hungern die Cr-säurefesten Granula allmählich abnehmen und in der Regel nach 5 bis 13 Tage langen Versuchen ganz verschwinden. Demnach ist es ganz sicher, dass diese durch Hunger zum verschwinden gebrachte Cr-säurefesten Granula zum Paraplasma gehören. Suga berichtete über säurefesten Granula bei normalen Ratten; bei diesen sind die Cr-säurefesten Granula im allgemeinen grob, zum Konfluieren geneigt und unregelmässig geformt sind. Er kommt daher zu der Ansicht, dass bei Ratten der Nukleinsäurestoffwechsel zum Lipoidumsatz in innigster Beziehung steht und dass sich in Lipoidreichen Geweben beide Granula unter gewissen Bedingungen die einen in die andern umwandeln können. Verfasser hatte Gelegenheit, unter der freundlichen Leitung von a.o. Prof. Hamazaki die säurefesten Granula bei Kröten zu studieren. In der I. Mitteilung berichtet Verf. uber seine eingehenden systematischen Untersuchungen der Cr-säurefesten Granula bei Märzkröten, besonders Entstehung und Verfettung ihrer endogenen Granula. Die Resultate lassen sich wie folgt zusammenfassen: 1) Bei Märzkröten steht der Stoffwechsel der säurefesten Substanz zum Lipoidumsatz noch in viel cngerer Beziehung als bei Mammalien. 2) In den Geweben der Märzkräten enthalten die Cr-säurefesten Granula eine grosse Menge Lipoid, einen Teil davon in der Form von säurefesten Lipoid umwandelt. 3) Bei Märzkröten lässt sich konstatieren, dass die reichlichen endogenen Cr-säurefesten Granula nach Austreten aus dem betreffenden Kern teilweise schnell verfetten und sogar schliesslich in säurefeste Granula übergehen. 4) In den verschiedenen Drüsenepithelien der Märzkräten bemerkt man überall mehr oder weniger endogene Granula, vor allem treten öfters alle 3 Arten von endogenen Granula in einer Zelle zusammen auf (Gehirn, Leber, Herz, Niere u.a.). Dabei beobachte Verf., dass der 3te Typus von endogenen säurefesten Granula einen relativ starkten Widerstand gegen Barytwasser und eine deutliche Affinität zu Sudan III hat. 5) Im Endstadium des Winterschlafes, wo in langerem Zeitraum keine Zufuhr von exogener säurefester Substanz stattfindet, kann man noch in den für das Leben sehr wichtigen Organen (Hirn, Herz, Leber, Niere u.a.) eine grosse Zahl Cr-säurefester Granula auffinden. 6) In den übrigen Organen und Geweben der Märzkröten ist die Farbenreaktion der Cr-säurefesten Granula im allgemeinen nicht so deutlich ; sie pflegen zu unscharfer Begrenzung zu neigen, und einen relativ starken Widerstand gegen Barytwasser zu zeigen. Dies beruht wahrscheinlich darauf, dass sich in den betreffenden Granula wasserlösliche Purinderivate relativ reichlich vorfinden und auch der Gehalt an säurefestem Lipoid grösser ist. 7) Nach Barytwasserdifferenzierung zeigen sich zuweilen die säurefesten Granula der Märzkröten ringförmig od. schaumig, und zuwar nimmt die Farbbarkeit ihrer durch Barytwasser unangriffenen Partien zu. Solche Granula hielt Verfasser für Granula, die säurefestes Lipoid sekundär an sich adsorbieren. 8) Bei Märzkröten beobachtet Verf. spärliche Abnutzungspigmente in Gehirn, Niere, und Dickdarmschlcimhaut. Diese Pigmente stammen wohl aus den Cr-säurefesten Granula, ebenso wie bei Mammalien. 9) Auch in Ovarium und Bidderschem Organ gehen die säurefesten Granula offenbar zu braunen Pigmentgranula über. 10) Bei Märzkröten beobachtete Verf. zeitweis durch Hämatoxylin metachromatisch dunkel verfärbte Granula, welche von Nukleinstoffwechselstörung der betreffenden Kerne herrühren können, in und ausserhalb der Kerne von Harnkanälchenepithelzellen sowie Lipoidzellen der Nebenniere. In solchen Zellen bemerkt man gleichzeitig ganz reichliche endogene Granula ; dies ist nicht anders zu erklären, als dass ein ganz, lnniger Zusammenhang zwischen Cr-säurefesten Granula und basophilen Granula besteht. 11) In unterem Abschnitt der Dünndarmschleimhaut finden sich eine Art von spezifischen säurefesten Granula, welche 5μ gross und nierenförmig sind, und eine starke Widerstandskraft gegen Barytwasser besitzen, ohne jedoch sudanophile Beschaffenheit zu zeigen. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 52 5 1940 濱崎氏耐酸性顆粒ノ實驗的生成竝ニ細胞核病理學知見補遺 第2篇 腎動脈結紮法 1092 1103 EN Kanichi Mihune Es ist lcicht verständlich, dass die Unterbindung der Art. renalis Nekrose des Nierengewebes verursacht. Anch ist schon in der Literatur darauf hingewiesen worden, dass durch autolytische Vorgange regressive Kerndegeneration bis zu Kernschwund, sowie körnigschollige Untwandlung des Protoplasmas im betreffenden Nierengewebe zustandekommen, wie dies Verf. bei aseptisch aufbewahten Geweben schon in seiner I. Mitteilung ausführlich erörtert hat. In dieser Mitteilung beschäftigt sich Verf. vom karynpathologischen Standpunkt aus mit dem Gewebstod und den Abbauprozessen der Kerneiweisse durch autolytische Fermente. Verf. hat bei erwachsenen gesunden Kaninchen linkseitige Arterienligatur des Nierenhilus vorgenommen; dann wurden die Tiere in Abständen von je vier Stunden bis 30 St. nach der Operation getötet. Darnach wurde die systernatische karyopathologische Untersuchungsniethode nach Hamazaki benutzt, d.h. Nachweis der Nucleoproteide durch Feulgensche Reaktion, das der Nucleinsäure und ihrer Abbauprodukte durch die KFJMethode, das des Histons durch Brillant A, B Färbung. Die Vermehrung der säurefesten Granula zeigt sich durch die genannte Methode im allgemeinen deutlicher als bei der aseptischen Aufbewahrung und das histologische Bild ist dort weit schöner als bei aseptischer Aufbewahrung. Ein Nachteil der Arterienunterbindung ist allerdings der Umstand, dass die histologischen Bilder der säurefesten Granula nach ihrer Lokalisation voneinander abweichen, aber wenn man einen bestimmten Herd topographisch ins Auge fast, so Jassen sich die zeitlichen Übergänge der Granula stufenweise ziemlich regelmässig verfolgen. Obwohl die Vermehrung der Cr-säurefesten Granula mehr oder weniger zeitliche Schwankungen aufweist, so kann man doch sagen, dass sie im allgemeinen nach 8-16 Stunden am deutlichsten ist. Die Cu-säurefesten Granula treten demnächst am deutlichsten nach ca. 12-20 Stunden auf, dann folgen die Hg-säurefesten Granula, und die säurefeste Substanz nach ca. 12-21 Stunden. Also, nach den Abbaustufen der Nucleoproteide vermehren sich die 3 Arten säurefester Granula in der eben beschriebenen Reihenfolge allmählich und dann vermindern sie sich mit der Zeit in derselben Reihenfolge. Die oben genannten Daten passen gut zu der Angabe Hamazaki's, dass nähmlich die Cr-, Cu- und Hg-säurefesten Granula, jede Art für sich, hauptsächlich aus Purinderivaten von freier Nucleinsaure bis zu Purinbasen bestehen. Trotz gleichen Bedingungen zeigen die Cu-und Hg-saurefesten Granula eine zeitliche Schwankung der experimentellen Resultate deutlicher als die Cr-saurefesten Granula. Das säurefeste Lipoid, welches sich bei der aseptischen Aufbewahrung reichlich entwickelt und von den lipoidhaltigen Mitochondria durch Resorption der säurefesten Substanz herrühren, ist diesmal überhaupt nirgends zu finden; es sind nur die durch Lipoidresorption verfetteten saurefesten Granula deutlich nachzuweisen. Im Gegensatz zu den säurefesten Granula trat kurz nach dem Versuche eine immer deutlicher werdende Abschwächung der Feulgenschen Reaktion auf, was man nur so erklären kann, dass fortlaufend Nucleoproteide in Purinderivate abgespaltet werden. Im Cytoplasma verhält sich die Zu-und Abnahme des Histons im allgemeinen wie die der Cr-säurefesten Granula, aber die Histonlyse (Hamazaki) tritt am deutlichsten nach ca. 16-20 Stunden auf. Es ist nicht wenig lehrreich, dass sich im Herde einer deutlichen Histonlyse zahlreiche staubfeine säurefeste Granula diffus vorfinden und so ein auffallendes histologisches Bild zu zeigen. Demgemäss müssen wir einen innigen Zusammenhang zwischen den beiden Substanzen annehmen. Bei der Histonlyse zeigt sich die Feulgensche Reaktion der Zellkerne sehr schwach; ihre Kernmembran reagiert nur mässigstark. Die Zellkerndegeneration des Nierenparenchyms beginnt mit Chromatinentmischung (Hamazaki), dann geht sie durch das Stadium der Karyopynose hindurch und endet schliesslich in Karyorrhexis. Das Stadium, in welchem die Feulgensche Reaktion deutlich abgeschwächt erscheint und die Cr-säurefesten Granula deutlich auftreten, entspricht wohl dem Stadium des Endes der Pyknose bis zum Beginn der Karyorrhexis. Obgleich die Feulgensche Reaktion in diesem Zustand, wie gewöhnlich, schwächer wird oder sogar ganz versehwindet, vermehren sich die Cr-säurefesten Granula merkwürdigerweise nicht so deutlich. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 53 11 1941 癌屍ニ於ケル濱崎氏「けとえのーる顆粒」ノ研究（第2報）汞・固定ニ依ル研究 2322 2333 EN Eigorô Kôsaka Der Verf., der den Vorgang des Nucleinstoffwechsels bei Leichen von Krebskranken histochemisch klarzulegen unternahm, hat in der vorhergehenden I. Mitteilung seine Studien über die Cr-Ketoenolgranula gründlich niedergelegt. Die Cr-Ketoenolgranula bestehen, chemisch betrachtet, aus den freien tierischen Nucleinsäuren und deren Spaltprodukten, welche Zucker enthalten. Im Gegensatz. dazu sind die Hg-Ketoenolgranula, die der Verf. diesmal zur Untersuchung verwendete, Endprodukte des Stoffwechsels der Ketoenolsubstanz und bestehen vorwiegend aus Purinbasen. Vor kurzem hat Hamazaki über die Hg-Ketoenolgranula im Krebsgewebe eine umfangreiche histochemische Darstellung gegeben. Der Verf. untersuchte in Sektionsfällen von Krebskranken ausführlich die Hg-Ketoenolgranula systematisch und morphologisch, und zwar nicht nur bei Krebsgeweben, sondern auch bei verschiedenen Organen des ganzen Kørpers und gelangte zu nachstehenden Schlussfolgerungen: In den verschiedenen Organen der Krebsleichen sind die Hg-Ketoenolgranula in mannigfaltiger Form anzutreffen: staubfein und rundlich, ahnähernd rundlich, eckig, schollig usw. Im Krebsgewebe kommen die Hg-Ketoenolgranula im allgemeinen in geringer Anzahl vor, jedoch sind sie, verglichen mit denselben Granula im normalen Muttergewebe, immer eher geneigt, sich zu vermehren. Im Vergleich zu den Granula bei normalen Geweben des Menschen zeigen sie in Herzmuskel, Milz, Trachea, Lunge, Kleinhirn, Zunge, Speiserøhre, Magen, Dickdarm, Pankreas, Nebennieren usw. eine Verringerung in äusserst starkem bzw. nur geringem Grade. In Grosshirn, Dünndarm, Niere usw. dagegen tritt die Verringerung in mässigem Masse auf. Solche quantitativen Schwankungen der Ketoenolgranula in den obengenannten verschiedenen Organen kann man nicht auf die vom Krebs hervorgerufenen Veränderungen allein zurückführen, da die Krebserkrankungen ausnahmslos entweder von sekundären Veränderungen oder von verschiedenen Komplikationen begleitet sind. Bei desquamierten Follikelepithelien der Schilddrüse verfallen die Kerne einer eigenartigen Kerndegeneration und erzeugen Ketoenolsubstanz. Des weiteren ist bemerkenswert: wenn krebsige Veränderungen in ausgedehntem Masse im Pfortadergebiete aufgetreten sind, so kommt bisweilen in den Leberzellen die Ketoenolsubstanz in gesteigerter Menge angehäuft zum Vorschein. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 53 9 1941 癌屍ニ於ケル濱崎氏「けとえのーる顆粒」ノ研究（第1報）「クローム固定」ニ依ル研究 1917 1931 EN Eigorô Kôsaka Seitdem die Ketoenolgranula von Hamazaki zum erstenmal entdeckt wurden, sind sie durch sorgfältige Untersuchungen von Hamazaki und seinen Mitarbeitern morphologisch und chemisch genau charakterisiert worden. Es stellte sich namentlich heraus, dass die Ketoenolgranula hauptsächtlich aus Nucleinsäure und Purinderivaten bestehen. Bezuglich der spezifischen Nachweismethode dieser Granula, der Karbolfuchsin-Jod-Methode, konnte man den Beweis erbringen, dass sie eine ketoenolbildende Reaktion darstellt. Hamazaki hat sich sodann in eingehenden Studien mit den einschlägigen Granula befasst und sich bemüht ihr Wesen aus Verschiedenen Vorgängen, wie z.B. Purinumsatz usw. zu erklären. In Anbetracht der Beziehungen zwischen Krebs und Purinumsatz hat er in der letzten Zeit bei operativ erhaltenen Krebsgeweben die Hg-Ketoenolgranula (säurefeste Granula) auf das genaueste untersucht. Seine Mitarbeiter, Hiramoto und Nishii, haben sogar durch die Untersuchungen der Ketoenolsubstanzen im Harn der Krebskranken zur Kenntnis der betr. Granula vieles beigetragen. Was aber die Ketoenolgranula im menschlichen Gewebe anbetrifft, so sind sie noch wenig erforscht. Hamazaki hat neulich bei normalen Geweben und dann mit Matsuda bei Encephalitis epidemica die Ketoenolgranula untersucht; Konishi sowie Nakamura haben die betr. Granula im menschlichen Skelettmuskel untersucht. Der Verf. hat nun in Sektionsfallen von Krebskranken die Cr-Ketoenolgranula im Geschwulstgewebe und in verschiedenen Organen des ganzen Körpers untersucht und erhielt folgende Ergebnisse; Im Vergleich mit den normalen Geweben des Menschen sind die Organe der Krebskranken etwas reicher an Ketoenolgranula und zwar an eckigen Granula. Ausserdem sind in diesen Organen noch rundliche bzw. grob-rundliche und hohle Granula anzutref fen, die gegen die Differenzierung mittels Barytwassers einen starken Widerstand leisten Ziemlich gross ist die Zahl dieser Granula, die namentlich Übergangsformen zu den Ketoenollipoiden darstellen. Eine hochgradige Verfettung dieser Granula jedoch, die bei der Encephalitis epidemica stattfinden kann, wird nicht beobachtet. Im Vergleich mit den normalen Menschen zeigen die Granula der Krebskranken im Herzen, in der Aorta und im Kleinhirn fast keine Veränderungen an Zahl. In der Lunge, Zunge, im Magen, Dickdarm, in der Leber, in den Nieren, Nebennieren usw. ist eine kleine Verringerung der Granula erkennbar. In der Trachea, im Grosshirn, Oesophagus, im Pankreas usw. ist die Verringerung der Granula eine massige. In der Milz und im Dünndarm dagegen tritt die Verringerung in starkerem Mässe auf. In den Krebsgeweben sind in der Regel die Granula nur in kleiner Menge vorhanden. In den älteren oder nekrotisierenden Krebsgeweben nehmen die Granula an Zahl zu. Auf Grund dieser Beobachtungen nimmt der Verf. an, dass die in der bisherigen Literatur chemisch festgestellte Vermehrung der Nucleinsäure in den Krebsgeweben hauptsachlich als eine Vermehrung der Nucleproteide oder der Chromatinsubstanz ausgedeutet werden muss. Da die Leichen der an Krebs gestorbenen Menschen entweder sekundäre Veränderungen infolge von Tumoren erleiden oder Komplikationen mit andersartigen krankheiten zeigen, ist es nicht berechtigt, die quantitativen sowie qualitativen Schwankungen der Ketoenolgranula in den obengenannten verschiedenen Organen den vom Krebs hervorgerufenen Veränderungen allein zuzuschreiben. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 53 8 1941 「ヴイタミンA」缺乏食ニテ飼養サレタル白鼠ニ於ケル濱崎氏「けとえの-る顆粒」ノ消長ニ就テ（第1報）「くろ-む・けとえの-る顆粒」ニ就テ 1608 1623 EN Shuichi Takami Wie allgemein bekannt, ist das Vitamin-A fettlöslich und steht zun Fettumsatz in enger Beziehung. Es erscheint dem Verf. nicht ohne Interesse, Festzustellen, wie sich die Ketoenolsubstanzen in der Form von Ketoenollipoiden (KEL) bei durch Vitamin-A-Mangel der Nahrung hervorgerufenen Stoffwechselstörungen verhalten. Verf. hab an dem Verhalten der KEG in verschiedenen Organen von weissen Ratten, die mit Vitamin-A freier Kost ernährt worden waren, Untersuchungen angestellt und berichtet in der I. Mitteilung zunächst über die Schwankungen des Cr-KEG-Gehaltes. Bei den mit Vitamin-A freier Nahrung ernährten Ratten wird in jedem Organ gewöhnlich eine Vermehrung der KEG und eine Erschöpfung, eventuell eine beträchtliche Verringerung, der KEL beobachtet. Die Vermehrung der KEG kommt wohl daher, dass einerseits die KEG, welche vorher infolge ven Verfettung physiologisch als KEL betrachtet werden konnten, arihrem Fettgehalt einbüssen und dadurch zu ihrem alten Zustand zurückkehren, und dass anderseits auch die Zellkerne degenerieren. Unter den bis heute bekanntgewordenen pathologisch-histologischen Veranderungen infolge von Vitamin-A mangel der Nahrung stehen die fortgeschrittene Verhornung des Schleimhautepithels und die Epitheldegeneration des Samenkanälchens an der Vermehrung der KEG der betreffenden Organe in unmittelbare Beziehung. Die Zunahne der KEG bei den übrigen Organgeweben kann wohl durch die infolge dem Mangels an Vitamin-A eingetretenen Stoffwechselstörungen, insbesondere durch die Fettumsatzstörung, herbeigeführt werden. Bei Mangel an Vitamin-A tritt eine beträchtliche Zunahme der KEG bei Nebennieren, Milz, Lymphdrüsen, Kleinbirn, Rückenmark, Magen und Ovarien ein. Eine ziemlich starke Vermehrung wird bei Trachea, Grosshirnrinde, Harnblase und Hypophyse beobachtet. Eine Verringerung der KEG kann man nur bei Nieren und Chorioidea wahrnehmen. Bie KEL dagegen vermehren sich nirgends. Bei Nebennieren, Lunge, Milz, Gyrus hippocampi, Chorioidea, Kleinhirn, Zunge und Grosshirn verschwinden sie sogar vollständig. Bei Lymphdrüien, Grosshirnrinde, Rückenmark, Dünndarm, Leber, Nieren, Hoden, Ovarien und Brustdrüsen bleiben sie in verschwindend geringer Menge zurück. Ferner sei erwähnt, dass die KEG der Leberzellen an der Mittelachse des Zellbalkens dichtgedrängt in grosser Anzahl vorhanden, an dessen Randpartie aber fast gar nicht anzutreffen sind. Sie sind in der engsten Beziehung zu den Stammgefässen der Gallenkapillaren bandförmig angeordnet. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 54 12 1942 饑餓時ニ於ケル「銅ケトエノール顆粒」(濱崎)ノ研究（第1篇）饑餓ノ「銅ケトユノール顆粒」ニ及ボス影響ニ就テ 2037 2045 EN Naoaki Watanabe Vor kurzem hat Konighi durch Hungerversuche bei Kaninchen die Einflüsse von Hunger auf die Hamazakischen Cr-Ketoenolgranula (Cr-KEG) untersucht und konnte die biologische Bedeutupg der Cr-KEG feststellen. Nach den ausgedehntesten histochemischen Untersuchungen. von Hamazaki bestehen Cr-KEG hauptsächlich aus den Nucleinsauren, Fe-und Cr-KEG aus abbauprodukten der letzteren, Hg-KEG bestehen hauptsächlich aus den Purinbasen. Alle diese Granula bilden unter Beteiligung der Lipoide ein spezielles Stoffwechselsystem. Für die Feststellung biologischer Bedeutung der Ketoenolsubstanzen ist die Untersuchung der Cr-KEG, der Substanzen ersten Ranges im genannten Stoffwechselsystem, ohne Zweifel von Wichtigkeit; wenn man aber das Gesamtbild diesen Systems ins Tageslicht bringen wollte, darf man ausführliche Untersuchungen auch niedrigerer Spaltprodukte nicht vernaehlässigen. Darum hat der Verf. unter Leitung von a.o. Prof. Dr. Hamazaki Hungerversuche bei Kaninchen ausgeführt, um den Einfluss des Hungers auf die Cu-KEG festzustellen. Die Ergebnisse wareh wie folgt: 1) Der Einfluss von Hunger weist bei Cu-KEG von Kaninchen viel stärkere Schwankungen auf als bei Cr-KEG. 2) Cu-KEG sind Granula, die ins Paraplasma eingereiht werden müssen, da, sie im Hunger gleich Cr-KEG versch winden der Cu-KEG fin det in den lymphadenoide Geweben einschliesslich def Thymusdrüse am erheblichsten statt. 4) Cu-KEG verschwinden im Hunger in den meisten Fällen etwas schneller als Cr-KEG. 5) In der Tatsache, dass bei Gu-KEG nach 5 tägigem Hunger das Versch winden bezw. die Verringerung am stärksten stattfndet, sind die Cu-KEG im allgemeinen den Cr-KEG sehr ähnlich. 6) Die Ketoenollipoide stimmen mit denen der Cr-Fixation darin überein, dass sie im Hunger quantitativ nicht abnehmen, abgesehen davon, dass sie sich im Anfang des Hungers bisweilen einigermassen verringern. 7) Die Cu-Ketoenolsubstanzen, die frei ausserhalb der Zellen vorhanden sind, vermehren sich im Hunger etiwas stärker als bei normalen Zeit. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 54 10 1942 肉腫屍ニ於ケル濱崎氏「ケトエノール顆粒」ノ研究 1777 1791 EN Eigoro Kosaka Vorher hat der Verf. an den Leichen von Krebskranken die Hamazakischen Ketoenolgranula (KEG) eingehender untersucht und über die Ergebnisse ausführlich berichtet. Diesmal hat er bei Leichen von an Sarkom gestorbenen Kranken die KEG in den verschiedenen Organen erforscht und kam zu folgenden Eegebnissen: In den verschiedenen Organen und Sarkomgeweben der an Sarkom gestorbenen Menschen wurde weitgehende fettige Entartung der Cr- und Hg-KEG beobachtet. Diese fettige Entartung ging in den Meisten Fällen mit einer Vergrosserung und Umformung der KEG einher. Durch Differenzierung mittels Barytwassers wurden die KEG in der Farbreaktion erheblich gesteigert und zeigten bisweilen auch eine gewisse Vermehrung der feinen Granula. In der letzten Zeit haben Hamazaki und Matsuda über fettige Dageneration der KEG bei den der Encephalitis epidemica erlegenen Leichen berichtet Nach den Verf. erleiden dabei die KEG keine Veränderung in ihrer ürsprunglichen Form. Bei den Sarkom-Leichen trat die Verfettung der KEG in der Leber, Niere, Nebenniere und im Sarkomgewebe in sehr erheblichem Masse aus, während sie in den übrigen Organen nur in geringem Masse beobachtet wurde. Es scheint jedoch nicht ganz berechtigt zu sein, die erwöhnten Befunde vollständig dem Einfluss des Sarkoms zuzuschreiben, weil an den untersuchten Sarkom-Leichen auch noch verschiedene Komplikationen oder sekundäre Veränderungen festgestellt wurden. Ferner ist zu bemerken, dass das Gewebe des Rhabdomyom im Vergleich zu andersartigen Sarkomen an Ketoenolsubstanzen viel reichlichen war und dass beim Vorhandensein irgendeiner Geschwulst im Pfortadergebiet die KEG in der Leber reichlich angehäuft vorkamen. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 54 4 1942 「ヴイタミンA」缺乏食ニテ飼養サレタル白鼠ニ於ケル濱崎氏「けとえのーる顆粒」(耐酸性顆粒)ノ消長ニ就テ（第2報）汞竝ニ銅「けとえのーる顆粒」ニ就テ 618 628 EN Shuichi Takami In der vorhergehenden I. Mitteilung hat Verf. bei mit Vitamin-A freiem Futter ernährten Ratten das Verhalten der Cr-KEG untersucht und darüber Interessantes berichtet. Für die Erforschung der KEG ist abes die Untersuchung der Cr-KEG allein noch nicht vollauf hinreichend. Von den 4 Arten von KEG muss man, will man sich hinlängliche Kenntnisse vom Verhalten der KEG in den einzelnen Organen erwerben, wenigstens 3 Arten untersuchen, unter denen die im höchsten Range stehenden Cr- bezw. die dem niedrigsten Range zugehörigen Hg-KEG vertreten sein müssen. Darum will Verf hier nach dem vorangehenden Bericht über Cr-KEG den Bericht über seine Versuchsergebnisse bezüglich der Cu- und Hg-KEG geben. In den einzelnen Organen von mit Vitamin-A freier Kost ernährten weissen Ratten nehmen die mercuraffinen Substanzen im allgemeinen ab, was in den Herz- und-Skelettmuskeln in erheblichem Masse der Fall ist. Dabei verringern sich in verschiedenen Organen die Hg-KEG; nur in der Milz und Lunge, im Plexus chorioidei und im Dickdarm weisen sie eine quantitative Zunahme auf. Die Cu-KEG nehmen in der Regel an Menge ab, und zwar ist die Abnahme in Lunge. zunge, Leber und Nieren auffallend stark, in der Milz, in den Skelettmuskeln und im Pankreas ziemlich stark; in keinem der Organe wird irgendeine Zunahme der Granula beobachtet. Den Grund, warum die Hg- und Cu-KEG bei den mit Vitamin-A freier Nahrung ernahrten Ratten quantitativ abnehmen, während die Cr-KEG im allgemeinen zunehmen, muss man wohl einzig und allein in der infoige von Darniederliegen der Lebenskräfte der Tiere eintretenden Herabsetzung Vorgänge des oxydativen Abbaues suchen. Bei Anwendnng der Hg-fixation vermehren sich die Ketoenollipoide (KEL) in den meisten Organen, wahrend sie sich bei Anwendung der Cu-Fixation erheblich verringern. Die Ursache dieser gegensätzlichen Erscheinungen ist zwar noch nicht sicher festgestellt, es ist aber von Interesse fur uns, dass die KEL je nach der Verschiedenheit der Fixationsart hinsichtlich ihrer biologischen Bedeutung völlig verschieden in Erscheinung treten. Der auffälligste Befuud an den Hg-KEG ist die Erscheinung eigenartiger Granula. In jedem der Zellkerne sind eines oder einige davon aufgespeichert. Durch die Differen-zierung mittels Barytwassers treten sie in einem dunkelvioletten bezw. schwarzen Farbton als kleinschollige oder rundliche Granula sehr deutlich zutage. Diese eigenartigen Granula darf man wohl in den Bereich der Granula einreihen, die Hamazaki voreinigen Jahren im Zellkern der Krebsgewebe nachgewiesen hat. Sie lassen sich in zwei Arten einteilen: die eine färbt sich vor der Differenzierung in Barytwasser bereits hellviolett, während die andere erst nach der Differenzierung in Barytwasser in die Erscheinung tritt. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 55 8 1943 嗅球及ビ嗅粘膜ニ於ケル濱崎氏Ketoenol顆粒ノ研究（第5報）人體ニ就キテ 1101 1111 EN Takeshi Watanabe Der Verf., der vorher bei Kaninchen, Meerschweinchen, weissen Ratten und Mäusen die Hamazakischen Ketoenolgranula im Bulbus olfactorius und in der Riechschleimhaut untersuchte und daruber ausfuhrlich berichtete, hat diesmal im Anschluss an diese Untersuchungen Studien und Beschreibung derselben Granula bei den zur pathologischen Obduktion eingelieferten menschlichen Leichen vorgenommen, um schliesslich die Versuchsergebnisse beim menschlichen Material und den oben genannten Tieren zusammenfassend miteinander zu vergleichen. Als Material dienten die Leichen erwachsener Menschen, an denen seit dem vorletzten Jahre in unserem Institut eine pathologische Sektion ausgeführt worden war. Von diesen Leichen wählte der Verf. besonders 30 Fälle aus, in denen postmortale Veränderungen noch möglichst leichtgradig vorzufinden und keine Affektionen im Bereich der Nase festzustellen waren. Die Ergebnisse lassen sich folgendermassen zusammenfassen: 1. Die Ketoenolgranula im menschlichen Bulbus olfactorius treten durch CrFixierung am reichlichsten auf, weniger reichlich durch Fe-Fixierung. Sie verhalten sich also etwas anders als bei den genannten Tieren, bei denen sie durch Fe-Fixierung am reichlichsten auftraten. 2. Die menschliche Riechschleimhaut ist hinsichtlich des Gehaltes au Ketoenolgranula etwas ärmer als die der Kaninchen; sie treten aber gleich wie bei Kaninchen durch Fe-Fixierung am reichlichsten in Erscheinung. 3. In der Nasenschleimhaut der Regio respiratoria finden sich die Ketoenolgranula im Vergleich zu denen der Regio olfactoria in kleinerer Menge. Ihre Begrenzung ist viel versch wommener als bei den Tieren. 4. Die Ketoenollipoide lassen sich im Bulbus olfactorius im Gu-Gemisch am reichlichsten fixieren, weniger reichlich im Cr-, Hg- und Fe-Gemisch in dieser Reihenfolge. In der Begel sind sie in etwas grösserer Menge anzutreffen als bei den Tieren. In der Nasenschleimhaut finden sie sich im allgemeinen nur spärlich. 5. Die in den Nervenzellen des Bulbus olfactorius reichlich anzutreffenden Granula sind meistens grob, auf einer Seite der einzelnen Zelle dicht gedrängt vorhanden und stark geneigt, miteinander zu verschmelzen. Die Ketoenolsubstanzen in der Markscheide der Nervenfasern verlieren zum Unterschiede von denen der Tiere durch Differenzierung mittels Barytwassers fast vollständig ihre Färbbarkeit. 6. Aus alledem geht hervor, dass die Ketoenolgranula im Bulbus olfactorius und in der Riechschleimhaut meistens in geringerer Menge beim Menschen als bei den Tieren anzutreffen sind. Dies röhrt wohl davon her, dass der Geruchssinn bei Menschen und Tieren in der Entwicklung tiefgreifende Unterschiede aufzuweisen hat. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 55 7 1943 嗅球及ビ嗅粘膜ニ於ケル濱崎氏Ketoenol顆粒ノ研究（第4報）二十日鼠ニ就キテ 987 994 EN Takeshi Watanabe Der Verfasser, der in den letzten 3 Arbeiten die Hamazakischen Ketoenolgranula im Bulbus olfactorius und in der Riechschleimhaut des normalen Kaninchens, Meeerschweinchens und der normalen Ratte erforscht hatte, berichtet diesmal uber die folgenden Untersuchungsresultate der genannten Granula bei der normalen Maus. 1) Im Bulbus olfactorius der Maus zeigen sich Fe-Ketoenolgranula wie bei Kaninchen und Meersch weinchen am deutlichsten und reichlichsten; sie nehmen an Zahl in der Reihenfolge von Cr-, Cu- und Hg-granula ab. 2) In der Riechschleimhaut treten die Ketoenolgranula bei den durch Gr-und HgGemisch fixierten Praeparaten reichlich in die Erscheinung, die jedoch geringer sind und sich unregelmässiger als beim Bulbus olfactorius gestalten. Sie sind geringer als die des Kaninchens, aber fast gleich an Zahl mit denen des Meersch weinchens und der Ratte. 3) In der Riechschleimhaut sind die Ketoenolgranula geringer und undeutlicher als beim Kaninchen, Meersch weinchen etc. 4) Die Ketoenolgranula im Jacobsonschen Organ der Maus sind etwas reichlicher und deutlicher als die des Kaninchens etc. 5) Die Ketoenollipoide sind reichlich bei den durch Cr-Gemisch fixierten Praeparaten, denen die durch Cr-Gemisch fixierten folgen. 6) Es gibt einen besonderen Befund in den Riechdrüsenzellen, wo sich eine grosse Menge von rötlich violetter und grosscholliger Ketoenolsubstanz bei den durch Cr-, Cuund Hg-Gemisch fixierten Praeparaten zeigt. Diese Substanz äussert sich als diffuse Färbung der Zellkerne od. deckt die Kerne uber od. haftet an der Kernmembran an od. fullt sich im Zelleib miteinander einschmelzend. 7) An den Riechnervenfasern der Maus treten Ketoenolgranula reichlichor als bei den oben beschriebenen Tieren auf. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 55 7 1943 鮒 (Carassius Auratus) ニ於ケル濱崎「ケトエノール顆粒」ノ研究 第2報 鐵固定ニ依ル檢索 995 1005 EN Eigorô Takasaka Im Ansehluss an die vorhergehende I. Mitteilung hat der Verf. diesmal durch Anwendung der Fixation mittels Fe-Gemisches die Ketoenolgranula der Karausche untersueht. Bei der Karausche treten die Fe-Ketoenolgranula, im Vergleich zu den Cr-Ketoenolgranula in viel grösserer Menge auf, sind scharf abgesetzt und enthalten keine bläschenartigen Granula vermischt. Ebenso wie die Cr-Ketoenolgranula sind sie auch arm an Gehalt von Lipoiden. Sie sind von eckiger oder unregelmässig rundlicher Form, im allgemeinen regelmässig fein. Winter und Sommer rufen bei den Fe-Ketoenolgranula zahlenmäBig keinen grossen Unterschied in vielen Organen hervor. Im Hirnmark, im Mesonephros, im Hoden usw. nehmen sie aber im winter an Zahl wenn auch in geringfugigerem Masse als im Sommer zu. In der Leber hingegen zeigen sie die Tendenz, im Sommer etwas mehr als im Winter zuzunehmen. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 55 5 1943 鮒 (Carassius Auratus) ニ於ケル濱崎「ケトエノール顆粒」ノ研究（第1報）「クローム」固定ニ就テ 706 718 EN Eigorô Kôsaka Als Versuchstiere dienten insgesamt 38 männliche sowie weibliche Karauschen (Carassiusauratus) von verschiedener Grösse, welche im Winter Anfang Februar und im Sommer Anfang Juli in der Näbe der Stadt Okayama gefangen wurden. Bei 22 von diesen Karauschen wurde dann die Cr-Fixation ausgeführt, um an verschiedenen Organen dieser Fische die Hamazaki'schen Ketoenolgranula zu untersuchen. Die Cr-Ketoenolgranula verschiedener Organe der Karausche sind meistens rundlich oder unregelmässig rundlich gestaltet, weisen mehr oder weniger adhärente Beschaffenheit auf, enthalten Ketoenollipoide in nur verhältnismässig kleiner Menge und sind darum wenig resistent gegen Barytwasser-Differenzierung. Im Sommer zeigen die Cr-Ketoenolgranula der Leber, Milz, des Hodens und Darmkanals eine etwas grössere zahlenmäBige Zunahme als im Winter, Die Tatsache, dass die ebengenannten Organe für die Erhaltung der Individuen sowie der Art sämtlich von unentbehrlicher Wichtigkeit sind, legt den Schluss nahe, dass anch bei Karauschen die Cr-Ketoenolgranula biologisch eine sehr wichtige Rolle spielen. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 55 5 1943 嗅球及ビ嗅粘膜ニ於ケル濱崎氏Ketoenol顆粒ノ研究（第3報）白鼠ニ就キテ 697 705 EN Takeshi Watanabe Der Verf., der über die Untersuchungsergebnisse der Hamazakischen Ketoenolgranula im Bubus olfactorius und in der Riechschleimhaut des normalen Kaninchens und Meerschweinchens berichtet hatte, erforschte diesmal die genannten Granula bei der normalen Ratte. Es ergaben sich folgende interessante Resultate: 1) Im Bulbus olfactorius der Ratte sind Cu-Ketoenolgranula am deutlichsten und reichlichsten anzutreffen. 2) Die Ketoenolgranula in der Riechschleimhaut zeigen sich bei den durch Fe-Gemisch fixierten Praparaten am reichlichsten, dagegen bei den durch die anderen drei Gemische fixierten fast gleichartig spärlich. 3) In der respiratorischen Nasenschleimhaut sind Cr-Ketoenolgranula relativ reichlich vorhanden, denen dann Hg-Granula folgen. 4) Die Ketoenolgranula im Jacobsonschen Organ sind uberhaupt spärlich, aber bei den durch Fe- und Hg-Gemisch fixierten Präparaten sind sie relativ zahlreich. Diese Granula haben im allgemeinen unregelmässige und undeutliche Gestalt wie beim Kaninchen und Meerschweinchen. 5) Die Ketoenollipoide treten bei den durch Cr-Gemisch fixierten Präparaten relativ reichlich, im Gegensatz zu den bei Kaninchen und Meerschweinchen, in Erscheinung. 6) Die Cr-Ketoenolgranula in den Mitralzellen des Bulbus olfactorius sind meistens parallel zur Verlaufsrichtung der Neurofibrjllen im Wurzelabschnitt des Nervenfortsatzes gelagert. Sie zeigen sich hüllenatig od. granulaarrtig wie die Ketoenolsubstanz in den Nervenfasern. 7) Im Riechdrüsenepithel findet man bei den durch Hg-Gemisch fixierten Praparaten einen merkwürdigen Befund: im Basalteil der Drüsenzellen ist der Zelleib mit Metachondriagranula ausgefüllt, welche leicht violett und matt zum Vorschein kommen, sodann zeigt der Kern als helles Feld. Hie und da ist die Ketoenolsubstanz im Basalteil der übrigen Riechdrüsenzellen als Käppchen anzutreffen, welche sich dreieckig gestalten und mit ihrer Basis an der Kernmembrane anhaften. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 55 1 1943 饑餓時ニ於ケル「銅ケトエノール顆粒」（濱崎）ノ研究（第2篇）核酸給與ノ饑餓家兎「銅ケトエノール顆粒」ニ及ボス影響ニ就テ 85 93 EN Naoaki Watahabe In der letzten Zeit hat Konishi bei ausgehungerten Kaninchen festgestellt, dass verringerte oder verschwundene Cr-Ketoenolgranula (Cr-KEG) durch Einverleibiang von Nucleinsäure in erheblichem Masse wieder in die Erscheinung treten, woraus er geschlossen hat, dass diese Granule von der Nucleinsäure und ihren Spaltungsprodukten abstammen. Der Vert hat nun bei Hungerkaninchen den Einfluss ein verleibter Nucleinsäure auf die Cu-KEG untersucht. Die Methode bestand darin, dass 5 Tage lang ausgehungerten Kaninchen Wasserlösung des Nucleinsäuren Natriums intravenös injiziert oder such peroral verabreicht wurde. Als Kontrolle dienten die Kaninchen, denen Traubenzuckerlösung oder physiologische Kochsalziösung intravenös injiziert. worden war. Die Ergebnisse waren wie folgt: 1. Die Einflüsse der Nucleinsäureverabreichung auf die Cu-KEG des verhungerten Kaninchens werden in etwas starkere quaptitative Schwankungen versetzt als die Cr-KEG. 2. Durch intravenose Injektion der Nucleinsäurelösung werden bei ausgehungerten Tieren die abgenommenen oder verschwundenen Cu-KEG zwar wiederhergestellt, im Grad der Wiederherstellung aber steht dieser Fall gegen den der Cr-KEG etwas zuruck. 3. Durch perorale Darreichung derselben Losung werden bei Hungertierep die abgenommenen oder verschwundenen Cu-KEG wiederhergestellt. 4. Durch perorale Darreichung erweist sich die Nucleinsäurelösung, dass sie die Cu-KEG im Vergleich zu den Cr-KEG in stürkerem Masse wiederherstellt bezw. zur Vormehrung bringt. 5. Die Zunahme der Granula findet in der Regel in den an Granula stets reichen Organen, wie Grosshirn, Herz, Zunge, Niere usw., statt. 6. Durch die Injektion von Glykose werden die Cu-KEG zu einer gewissen Vermehrung gebracht. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 69 3 1957 色素蛋白に対する生体の反応 第一編 コンゴーロートを用いて作つた色素蛋白及び之を用いての血清学的研究 855 860 EN Shunzo Kamon The hydrophilic dye-proteins have been prepared combining oxen serum protein with Congo red (CR) in varied proportion. DPO No.1 (50 mg. of CR per 100 cc. of serum), 2 (100 mg. per 100 cc), 3 (500 mg per 100 cc), 4 (1500 mg. per 100 cc). The binding between protein and dye molecules proved to be fairly strong by the test using several protein-precipitating agents and electrochromatograph. 1) The paraenteral introduction of these dye-proteins proved to produce two sorts of antibodies, the antibodies to the normal serum protein and to the dye-protein. The antibody to the normal serum decreased as the quantity of dye bound to antigen increased, showing the increased production of the antibody specific to the dye-protein. 2) Antibody formation varied according to the varied root of the introduction of antigen. Subcutaneous and intraperitoneal injection resulted in the higher antigen production comparing to the intravenous injection. The dye-protein introduced were mainly found in the macrophages. 3) The sensitized animals showed a severe shock symptomes by the reinjection of antigen. From the results mentioned above it has been suggested that the responsibility for the antibody formation to the dye-protein will be attributed to the macrophages, in which cytoplasm the injected antigen is found in a mass. No potential conflict of interest relevant to this article was reported.

岡山大学理学部地球科学教室 Acta Medica Okayama 1340-7414 17 1 2010 A note on compositional variation of olivine and pyroxene in thermally metamorphosed ultramafic complexes from SW Japan 1 5 EN Toshio Nozaka 10.18926/ESR/42457 This short article presents some diagrams showing the compositional variations of primary and metamorphic olivine, orthopyroxene and clinopyroxene in peridotites and serpentinites from thermally metamorphosed ultramafic complexes in SW Japan. In contrast to olivine, which shows a gradual change of chemical composition corresponding with metamorphic grade, orthopyroxene and clinopyroxene show clear differences in composition between primary and metamorphic phases. Compared with primary pyroxenes, even though their compositions could be variable depending on original rock composition, metamorphic orthopyroxene and metamorphic clinopyroxene is clearly deficient in Cr(2)O(3) and CaO, and in Cr(2)O(3) and Al(2)O(3), respectively. These characteristics are useful for the discrimination between the pyroxenes of different origin. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 71 9-1 1959 沃度酸曹達による網膜変性症の組織化学的研究 第2報 クロームケトエノール物質並びにD. N. A. の変化に就て 5695 5704 EN Yasuta Koyama The author studied on the early histochemical changes of the peculiar retinal degeneration of the rabbit treated with intravenous injection of 5% solution of sodium iodate as the preceding report. The Cr-K E S (chrmo-keto-enol substance of HAMAZAKI), chief constituents of which are nucleotides of D N A, in the pigment epithelium and outer segments of rods begins to diminish gradually after 12 hrs. D N A decreases as the pigment epithelium and visual cells degenerate. In general, the Cr-K E S diminishes and disappears earlier than the Hg-K E S in the pigment epithelium and in visual cells. The authers that sodium iodate acts rather indirectly on the metabolism of the D N A and related substances in the outer layers of the retina. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 71 8-2 1959 根治的胃癌リンパ節廓清手術時における自律神経切断の肝，膵外分泌および消化吸収能におよぼす影響に関する実験的ならびに臨床的研究 第3編 根治的胃癌リンパ節廓清手術時における自律神経切断の消化吸収能におよぼす影響に関する臨床的研究 5265 5270 EN Haruo Yoshimura The effecs on digestion and absorption produced by a radical operation of stomach cancer with complete removal of the regional lymphnodes, studied by means of the patients subjected to the same operation, whose digestion and absorption was tested by Cr O ratio method. At the same time, for comparison, the same test was performed on patients subjected to simple gastrectomy and healthy men, with the following conclusion. 1. In patients after simple gastrectomy, absorption of fat and protein goes not so well as in healthy persons. 2. In patients after airadical operation of stomach cancer with complete removal of the regional lymphnodes, absorption of fat and protein is well performed as in patients after simple gastrectomy. 3. In patients after redical operation of stomach cancer and in those after simple gastrectomy, absorption of carbohydrate is carried on with almost the same rate, i. e. more than 99%, as in healthy persons. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 101 3-4 1989 ハロセンによる肝腎グアニジノ化合物代謝の変動に関する実験的研究 371 377 EN Michio Kitaura A metabolic relationship between the liver and kidney exists in combination with the urea cycle. In patients with acute renal or hepatic insufficiency, certain variations among several guanidino compounds are relevant to the condition of the liver or kidney. An experimental model of rats exposed to inhaled halothane was evaluated for metabolic changes in the liver and kidney by measuring guanidino compound levels using high performance liquid chromatography. As a result, no significant difference in serum ornithine carbamoyltransferase (OCT) activities were observed among all groups. In the liver, concentrations of creatine (CR) and guanidinobutyric acid (GBA) were significantly elevated immediately after inhalation of halothane without any accompanying changes in guanidinoacetic acid (GAA) and argnine (ARG). In the kidney, ARG and GAA were significantly decreased without any accompanying changes in CR and GBA. No significant difference in serum GC levels was observed among the groups. The inhalation of halothane appers to change the concentrations of GAA, ARG and CR in the liver and kidney. It also appers that inhalation of halothane caused GBA to appear in the blood, indicating a possible association of halothane with hepatotoxicity. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 122 2 2010 便中メチル化DNA検出による消化器がんスクリーニング：消化器がんを非侵襲的にスクリーニングすることは可能か？ 107 112 EN Takeshi Nagasaka Noriaki Tanaka Dong-Sheng Sun Yoshio Naomoto Nagahide Mastubara Takahito Yagi Toshiyoshi Fujiwara No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 64 3 2010 Relationship between Estimated Glomerular Filtration Rate (eGFR) and Metabolic Syndrome in Japanese 203 208 EN Nobuyuki Miyatake Kenichi Shikata Hirofumi Makino Takeyuki Numata Original Article 10.18926/AMO/40013 We investigated the link between renal function as evaluated by estimated glomerular filtration rate (eGFR) and metabolic syndrome in Japanese. A total of 11,711 Japanese subjects, aged 20-79 years, were recruited in a cross-sectional clinical investigation. From this group, we further investigated the data on 1,576 subjects. eGFR was calculated using serum creatinine (Cr), age and sex. The diagnosis of metabolic syndrome was based on the Japanese criteria. In the first analysis, 288 men (7.8%) and 498 women (6.2%) were diagnosed with reduced eGFR (<60ml/min). eGFR was not correlated with anthropometric, body composition parameters in either sex. In the second analysis, in subjects without medications, 132 men (20.8%) and 15 women (1.6%) were diagnosed with metabolic syndrome. eGFR was lower in men with abdominal obesity and in women with hypertension was than in those without. Among Japanese not taking medications, lower eGFR may be a characteristic of men with abdominal obesity and of women with hypertension. No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 70 10 2004 Structure and magnetic properties of the single-molecule magnet [Mn11CrO12(O2CCH3)(16)(H2O)(4)]center dot 2CH(3)COOH center dot 4H(2)O: magnetization manipulation and dipolar-biased tunneling in a Mn11Cr/Mn-12 mixed crystal EN Hidekazu Hachisuka Kunio Awaga Toshihiko Yokoyama Takeji Kubo Takao Goto Hiroyuki Nojiri <p>The structural and magnetic properties of the single-molecule magnet [Mn11CrO12(O2CCH3)(16)(H2O)(4)].2CH(3)COOH.4H(2)O (Mn11Cr) are studied through the analysis of a Mn11Cr/Mn-12 (approximate to1:1) mixed crystal, where Mn-12 is [Mn12O12(O2CCH3)(16)(H2O)(4)].2CH(3)COOH.4H(2)O. X-ray absorption spectra reveal that the Cr ion in Mn11Cr is in the +3 valence state and occupies a specific Mn3+ site in the Mn-12 skeleton. High-frequency electron paramagnetic resonance (EPR) spectra are well explained by assuming that Mn11Cr is in a ground spin-state of S=19/2 with nearly the same EPR parameter set as for Mn-12. The lower spin quantum number results in lower barrier height (56.8 K) compared to Mn-12. The magnetization curves indicate a coercive field of 0.95 T for Mn11Cr at 1.8 K, nearly half that for Mn-12. Quantum tunneling of magnetization (QTM) in Mn11Cr is observed below the blocking temperature T-B, with the same field interval as for Mn-12. The magnetization of Mn11Cr and Mn-12 in the mixed crystal can be independently manipulated by utilizing the difference between their coercive fields. The resonance fields of QTM in Mn11Cr are significantly affected by the magnetization direction of Mn-12, suggesting the effect of dipolar-biased tunneling.</p> No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 68 2 2005 On-line preconcentration using dual mini-columns for the speciation of chromium(III) and chromium(VI) and its application to water samples as studied by inductively coupled plasma-atomic emission spectrometry 388 393 EN Takashi Sumida Tamami Ikenoue Kazuhide Hamada Akhmad Sabarudin Mitsuko Oshima Shoji Motomizu <p>On-line preconcentration system for the selective, sensitive and simultaneous determination of chromium species was investigated. Dual minicolumns containing chelating resin were utilized for the speciation and preconcentration of Cr(III) and Cr(VI) in water samples. In this system, Cr(III) was collected on first column packed with iminodiacetate resin. Cr(VI) in the effluent from the first column was reduced to Cr(III), which was collected on the second column packed with iminodiacetate resin. Hydroxyammonium chloride was examined as a potential reducing agent for Cr(VI) to Cr(III). The effects of pH, sample flow rate, column length, and interfering ions on the recoveries of Cr(III) were carefully studied. Five millilitres of a sample solution was introduced into the system. The collected species were then sequentially washed by 1 M ammonium acetate, eluted by 2 M nitric acid and measured by ICP-AES. The detection limit for Cr(III) and Cr(VI) was 0.08 and 0.15 mu g l-1, respectively. The total analysis time was about 9.4 min. The developed method was successfully applied to the speciation of chromium in river, tap water and wastewater samples with satisfied results. </p> No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 22 1 2006 Speciation of chromium in seawater by ICP-AES with dual mini-columns containing chelating resin 161 164 EN Takashi Sumida Akhmad Sabarudin Mitsuko Oshima Shoji Motomizu <p>A method for the preconcentration and speciation of chromium in seawater was developed. On-line preconcentration and determination were carried out by using inductively coupled plasma atomic emission spectrometry (ICP-AES) with dual mini-columns containing a chelating resin. In this system, Cr(III) was collected on the first column. The effluent containing residual chromium from the first column was collected on the second column after passing through a reduction-switching unit, in which the reducing agent was introduced, or not, for the reduction of Cr(VI) to Cr(Ill). Cr(VI) was determined as the difference between the concentration of pre-reduced Cr(VI) and Cr(III) in the effluent from the first column. The detection limits for Cr(III) and Cr(VI) were 0.04 and 0.09 mu g l(-1), respectively.</p> No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 55 1 2001 Experimental study of fast and ultrafast T2-weighted imaging sequences using AMI-25 superparamagnetic iron oxide (SPIO). 41 50 EN Hironori Kurokawa Izumi Togami Masatoshi Tsunoda Yoshio Hikari Article 10.18926/AMO/32028 <p>The objective of this study was to evaluate fast and ultrafast T2-weighted images (T2WI), including echo planar imaging (EPI), using an AMI-25 agar phantom. Image quality for conventional spin echo (CSE) and turbo spin echo (TSE) was almost equivalent. In high-resolution TSE, image quality was highest due to the use of a 512 x 256 matrix. Half-Fourier single-shot turbo SE (HASTE) was associated with blurring of images, and turbo-gradient SE (TGSE) showed a deterioration of image quality. EPI also suffered from poor image quality because this method is very sensitive to magnetic field inhomogeneity. CSE showed good signal-to-noise ratio (S/N) and contrast ratio (CR), but also required the longest imaging times. Among the TSE sequences, TSE with a short echo train length (ETL) was superior in terms of S/N. The CR of EPI and fast low angle shot (FLASH) images were improved in proportion to the effective echo time (TE). At present, TSE is inferior to CSE in terms of S/N and CR. However, taking into consideration scanning time, TSE with a short ETL is thought to be suitable for routine examinations. Effective TE is an important factor in gradient echo (GRE) examinations.&#60;/P&#62;</p> No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 40 3 1986 Aclarubicin in the treatment of elderly patients with acute nonlymphocytic leukemia. 175 177 EN Isao Takahishi Seiichi Yorimitsu Masamichi Hara Toshihiro Inagaki Hiroyuki Nakada Noriko Sekito Naoki Hayashi kenichi Nonaka Eijiro Ohmoto Kouzaburo Uchida Michihiro Takizawa Ikuro Kimura Hiroshi Sanada Tomiro Adachi Teruhiko Tsubota Koichi Kitajima Article 10.18926/AMO/31932 <p>Thirteen previously untreated patients aged 70 and above with acute nonlymphocytic leukemia were treated with aclarubicin (ACR) alone. Among 10 cases (3, acute myelocytic leukemia; 4, acute myelomonocytic leukemia; 2, acute monocytic leukemia; and one, acute erythroleukemia) in which an evaluation was possible, 5 cases (3, acute myelomonocytic leukemia; and 2, acute monocytic leukemia) obtained complete remission (CR). The CR rate was 83% in 6 patients with acute myelomonocytic leukemia or acute monocytic leukemia. The median CR duration and survival was 7.5 and 10 + months, respectively. Although side effects of the drug on digestive system such as nausea, vomiting and anorexia were observed in all patients, they were controllable by conventional treatments. The results suggest that ACR is effective for the clinical management of elderly patients with acute nonlymphocytic leukemia, especially those with acute myelomonocytic leukemia or acute monocytic leukemia.</p> No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 53 3 1999 Urinary excretion of type I collagen cross-linked N-telopeptides, bone mass and related lifestyle in middle-aged women. 133 140 EN Chie Masatomi Kaori Imai Da-Hong Wang Satoru Ikeda Kazuhisa Taketa Shinji Takata Shohei Kira Article 10.18926/AMO/31637 <p>The relationship between past and present lifestyle and urinary excretion of type I collagen cross-linked N-telopeptides (NTx) was studied in 61 Japanese females aged 34-59, with a view toward using NTx excretion rates as a predictor of future osteoporosis. Bone mineral density (BMD) of the lumbar spine, the speed of sound (SOS) and broadband ultrasound attenuation (BUA) of the os calcis, urinary NTx, serum osteocalcin (BGP) and bone-specific alkaline phosphatase (BAP) were measured. Stiffness index (stiffness) was calculated from SOS and BUA. The subjects were asked whether they took regular exercise in their childhood and teen years (in elementary, junior-high, senior-high school and college), the past (20-40 years of age) and present adulthood. Regular calcium intake, smoking habits, alcohol and other beverage consumption and milk consumption were also covered in the questionnaire. The mean NTx values of premenopausal and postmenopausal group were 22.2 and 56.0 nM bone collagen equivalents (BCE)/mM urinary creatinine (Cr), respectively. The group which did not exercise regularly between the ages of 20 and 40 had a higher mean NTx value (40.9 nMBCE/mMCr) than the group which did exercise regularly (22.7 nMBCE/mMCr). In multiple regression analyses, age, stiffness and exercise in past adulthood could explain 43.5% of the NTx variance. For prevention of bone metabolic increases around menopause, habitual exercise in early adulthood seems to be effective.</p> No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 31 1 1977 COP, a new alloy for surgical implants 71 80 EN Yoshifumi Sunami Eijiroo Ishikawa Article 10.18926/AMO/30844 <p>Today Vitallium is used for surgical implants. It is a casting alloy which, with advances in casting technology, is also used commercially for making instruments of fairly complex shape. Because of its expense, however, it is not widely used in Japan. Instead, a series of 18-8 Mo alloys are used in Japan even though of insufficient strength. Used over a long period of time in the body, especially for the purpose of preserving structual functions as part of the human skeleton, it often corrodes, resulting in either abnormalities in tissue cells or, because of its insufficient strength, danger of bending and breaking with aging. In spite of a marked advance in fracture treatment, we have hardly any suitable materials for making instruments appropriate to the internal fixation of fractures in Japan. We, therefore, conducted various experiments to develop an alloy with sufficient corrosive resistance and strength that could be formed into a complex shape to take the place of Vitallium alloy, finally succeeding in developing an alloy we call &#34;COP&#34;. The characteristic properties of COP may be summarized as follows: 1. The main components are 20% Cr, 20% Ni, 20% Co and 4% Mo aside from 0.2% P. 2. As it contains &#34;P&#34;, it shows a marked age-hardening. In its molten state its machinability is excellent, and later it can readily be hardened by heat-treatment. 3. It has not only a marked yield point and tensile strength but also has toughness in elongation and reduction of area, showing a strength which surpasses Vitallium. 4. Its corrosive resistance is great. 5. Its cost is far cheaper than Vitallium.</p> No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 50 3 1996 Regulation of Interleukin-2 Receptor y Chain mRNA Expression in Human Monocytic Cell Line THP-1 145 150 EN Hiroyuki Yanai Tadashi Yoshino Kiyoshi Takahashi Yoshifumi Ninomiya Tadaatsu Akagi Article 10.18926/AMO/30509 <p>Circulating hepatitis C virus (HCV) particles can be fractionated by means of differential flotation centrifugation. It is reported that in the bottom fraction HCV is in the form immune complexes, whereas in the top, it is free of antibodies. We evaluated the significance of circulating complex and free HCV in chronic hepatitis C, and assessed the relationship in terms of the response to interferon (IFN) therapy. We examined sera before, just after, and 1 year after administering IFN to 18 patients with chronic hepatitis C, 10 of whom responded (group CR), and 8 did not (group NR). The amounts of virus were similar between both groups before therapy. After differential flotation centrifugation with 1.063 g/ml of NaCl, the top and bottom fractions were assayed for HCV RNA. Before therapy, HCV RNA was detected in the top fraction in 1 of 10 in group CR, and in 6 of 8 in group NR (P &#60; 0.05, chi-square test). HCV RNA was positive in the bottom fraction of all samples. In a follow-up study of group NR, HCV RNA was detected in the top fraction in 3 of 8 just after IFN therapy, and in 7 of 8 after 1 year. This study suggests that the presence of HCV in the top fraction can predict a poor response to IFN therapy.</p> No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 49 3 1995 Increased urinary excretion of non-albumin antigen detected with YO-2, a novel monoclonal antibody, in diabetic patients. 153 159 EN Taiji Yonei Shinobu Watarai Yoshio Okada Tatsuji Yasuda Takao Tsuji Article 10.18926/AMO/30404 <p>Monoclonal antibodies were raised against urine proteins from diabetic patients. An antibody, YO-2, stained three protein bands with apparent molecular weights of 66, 49, and 36 kDa. These bands were not reactive with an anti-human albumin antibody. The urine levels of YO-2-reactive antigen in the normal control were 0.97 +/- 0.37 U/g-Cr (units per gram of urine creatinine) (mean +/- SD). Those of the normo-, micro-, and macroalbuminuric diabetic patients, respectively, were 1.38 +/- 1.36, 2.87 +/- 2.07, and 3.92 +/- 3.33 U/g-Cr. They were significantly higher in the micro- and macroalbuminuric patients. The urine levels of YO-2-reactive antigen had no significant correlation with the urine albumin levels and hemoglobin A1c. We concluded that; a) monoclonal antibody YO-2 recognized a non-albumin urine antigen increasingly excreted in diabetic patients with nephropathy, b) recent glycemic control of diabetes would not significantly affect the urinary excretion rate of YO-2-reactive antigen, and c) the excretion rate and probably the mechanism of YO-2-reactive protein differed from those of albumin. The urine levels of YO-2-reactive antigen could be a clinical marker of diabetic nephropathy.</p> No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 2010 Mn-Cr age of monomict ureilites: implications for Cr isotopic structure of the early inner solar system EN Akane Yamakawa No potential conflict of interest relevant to this article was reported.

岡山大学環境管理センター Acta Medica Okayama 0917-1533 21 1999 誘導結合プラズマ―質量分析法による環境水中の微量金属の定量 4 10 EN Kyue-Hyung Lee Mitsuko Oshima Toshio Takayanagi Shoji Motomizu Trace metals in water samples, such as tap water, river water, and sea water, were determined by inductively coupled plasma-mass spectrometry (ICP-MS). ICP-MS has sufficient sensitivity to detect even below the concentrations of ppt level, and therefore the samples were not pretreated with a concentration column. Practical samples were diluted by lo-fold with ultrapure water and measured directly by ICP-MS. The measuring time of one sample was 2.5 min, and the data for 30 elements were obtained simultaneously. The concentrations of heavy metals, such as Cr, Mn, Co, Ni, Cu, Zn, As, Cd, Sb, and Pb, in the water samples were in the ranges of 0.05~82ng/ml. Zasu river and Sibukawa (sea water) contained various kinds of metals, and the concentration ranges were spread in a wide range; for example, Mg was 25700 ppb and In was 2 ppt. ICP-MS is found to be a useful and a powerful instrument for trace amounts of elements, and can be applied satisfactorily to the environmental water analysis. No potential conflict of interest relevant to this article was reported.

岡山大学保健環境センター環境安全部門 Acta Medica Okayama 0917-1533 29 2007 ガラスの分相現象を利用した高炉水砕スラグの再資源化技術の開発 11 15 EN Shinichi Sakida Syuuhei Mikami Tokuro Nanba Toshinari Miura A novel recycling process of blast furnace slag was developed in order to obtain colorless silica−rich solids by using phase separation of borosilicate glass. B(2)O(3) was added to blast furnace slag to promote the phase separation. The slag glasses were heat-treated above glass transition temperatures. The slag glass prepared from blast furnace slag gelled after the heat treatment and the subsequent three types of acid treatment. The ratios of SiO(2) component in the gels were 40 - 60mass%. On the other hand, phase separation was observed on the surface of the slag glasses prepared from pre-treated slag by 2.5N HCI after the heat treatment. After soaking in acid, they did not gel and changed to insoluble colorless solids. According to compositional analyses, it was found that the insoluble colorless solids contained 70 - 90mass% SiO(2). No colored ions such as Cr, Mn, and Fe were confirmed in the remaining insolubles by optical absorption measurement. Therefore, the colorless silica-rich solids were successfully obtained in the present process. The end products obtained in the present process are expected as material of glass. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 122 1 2010 Focal adhesion kinase (FAK) と Insulin-like growth factor-I receptor (IGF-IR) に対するデュアルチロシンキナーゼ阻害剤の食道腺癌における抗腫瘍効果 17 25 EN Nobuyuki Watanabe Munenori Takaoka Kazufumi Sakurama Yasuko Tomono Shinji Hatakeyama Osamu Ohmori Takayuki Motoki Yasuhiro Shirakawa Tomoki Yamatsuji Minoru Haisa Junji Matsuoka David G. Beer Hitoshi Nagatsuka Noriaki Tanaka Yoshio Naomoto No potential conflict of interest relevant to this article was reported.

日本分析化学会 Acta Medica Okayama 0525-1931 38 3 1989 ヨウ化物イオンとクリスタルバイオレットを用いる銅の吸光光度定量 103 108 EN Koichi Yamamoto Shoji Motomizu 硫酸酸性溶液中でCu(2+)に対して過剰のI(-)が存在すると,I(-)は酸化されて三ヨウ化物イオン(I(-)(3))となり,Cu(2+)はジヨード銅(I)酸イオン(CuI(-)(2))となる.生成したI(-)(3),CuI(-)(2)はクリスタルバイオレット(CV(+))の存在下でイオン会合体となり,トルエンに抽出される.このトルエン相の607nmにおける吸光度を測定すれば,銅を定量することができる.検量線より算出した見掛けのモル吸光係数は1.7×10(5)1 mol(-1)cm(-1)であった.Fc(III),Cr(III),Co(II)などの酸化性及び還元性物質の共存は定量を妨害するが,その他多くのイオンは多量共存しても妨害とはならない.更に抽出化学種について検討した結果,主な抽出種はI(-)(3)とCV(+)の1:1のイオン会合体であり,大部分の銅イオンは水相に残っていることを確認した.これらのことから,本抽出系では銅(II)イオンは触媒的作用をしているものと結論された. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 70 3 1958 Diamoxの抗痙攣効果に関する研究 第5編 Diamoxの脳髄ケトエノール顆粒に及ぼす影響 957 964 EN Yoshimasa Kawahara No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 72 3 1960 乳児の硫黄代謝に関する研究 第1編 乳汁，屎及び尿中の総硫黄定量法の考案並びに各種乳汁中の総硫黄量 821 830 EN Gibun Hamada There are numerous articles concerning the estination of total sulfur in organic substances and yet the results obtained hitherto are not by any means quite satisfactory. The gratest difficulty encountered in the estination of sulfur seems to lie in the insufficient ashing of the substance. Therefore, the author studied various ashing metheds and finally modified Bethge's wet ashing in the following manner: 1, Ammoniated vanadium (NH(4)VO(3)) is added as an oxidizing catalyst. 2. As an indicator of the complete oxidation potassium chromate (K(2)Cr(2)O(7)) is used. 3. The ratio of acid mixture is set in the proportion of three parts perohloric acid to two parts nitric acid. 4. The reduction mixture is placed into an ampule filled with pitrogan immediately after it is prepared and is sealed tightly, and the quantity of the mixture to be added is increased. By the modified method mentioned above it has been possible to raise the recovery rate of sulfur added as much as 95.4 per Gent, proving that this method is sufficiently useful for the estimation of the total sulfur in milk, urine and faces. In the estimations of total sulfur of various milk such as breast milk, milk on the market and 18% solution of regulated powered milk the average contents of total sulfur have been found to be 11.7 mg and 31.8 mg per dl respectively. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 88 1-2 1976 ウニ卵の発生に及ぼす重金属の影響 39 50 EN Tetuhide Murakami Masashi Hayakawa Toshitake Fujii Takehito Hara Yoshiaki Itami Akira Kishida Isamu Nisida The effects of heavy metals, such as Hg, Pb, Cu, Cd, As, Sn, Cr, Mn, Ni and Zn on the two developing sea urchin eggs. Temnopleurus and Hemicentrotus were investigated. The results obtained were as follows. 1. The development of fertilized eggs was inhibited when embryos were exposed to 10(-6) M of HgCl(2) and CuCl(2) and to 10(-4) M of CrCl(2) and NiCl(2) in Herbst's artificial seawater from fertilization until the formation of the blastula larva. 2. Chlorate and acetate of heavy metals were dissolved in filtered seawater. The morphological differences of embryo were not observed until the formation of the pluteus larva in the two solutions. Inhibitory effects were observed when embryos were exposed to seawater at concentrations of 10(-7) M of Hg and Cu, to 10(-6) M of Cd, and to 10(-5) M of Pb, Ni and Zn. At a concentration of 10(-4) M of Cd there were no visible effects until the appearance of swimming blastula larva, but larva development was strongly inhibited at time of bonification from pluteus larva, and there was no further later development. In 10(-6) M Hg, Cr, and Ni, the larvae were structural abnonal and shaped like Apollo. In 10(-7) M of Hg exogastrula embryos were produced. 3. Threshold concentration of complete inhibition on the early development of sea urchin embryos was at 10(-6) M of Hg, 10(-5) M of Cu, Cr, Ni, and Zn, 10(-3) M of Mn. In the case of Cd 10(-5) M, complete inhibition didn't occur until the pluteus larva stage. 4. Only additive effects were obtained on the developing sea urchin eggs when two heavy metals were combined in filtered seawater. A high frequency of morphological abnormalities were formed such as exogastrula and Apollo shaped pluteus especially in coupling of Hg and Cu or Cd and Zn. 5. There were no visible effects in filtered sewage from fertilization to the formation of the pluteus larva. When embryos were exposed to acetate salts of Hg, Cu, Cd, and Zn in filtered sewage, there were 10 fold inhibitory effects on development. But formation of skeleton in the pluteus larva was found in filtered sewage containing Cd. 6. Only additive effects were observed on sea urchin embryo when combined with Hg, Cu, Cd, and Zn in filterd sewage. But the abnormalities were decreased in all cases. Inhibition of bonification were reduced in mixture of Cd and filtered sewage. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 90 3-4 1978 同種腫瘍移植に於けるCellular CytotoXiCityに及ぼすBCG―腫瘍混合接種の影響 369 377 EN Noriaki Tanaka The effects of tumor-BCG mixture to the cellular cytotoxicity of the regional lymph node and the spleen were observed in BALB/c mice received allogeneic tumor cells. This tumor cells, when grafted subcutaneously, were normally enhanced in 40% of BALB/c mice and 100% of A/St mice, but failed to grow when injected as a mixture with tumor and BCG. By injection of tumor-BCG mixture, the development and decline of the cytotoxicity((51)Cr release assay) to the tumor cells was accelerated, but the magnitude of the peak activity was diminished. Possible mechanisms by which the decreased activity induced of complete tumor suppression were examined. The result showed that immunized lymphocytes with non-immune macrophages exhibited a significatly increased cytotoxicity as compared with immunized lymphocytes in the abscence of macrophages. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 90 3-4 1978 同種腫瘍移植に対するcellular cytotoxicity 二つのin vitro assayの比較 355 367 EN Noriaki Tanaka A microcytotoxicity assay (MCA) and a (51)Cr release cytotoxicity assay (CRA) for cell mediated immunity to the allogeneic tumor were done in parallel with same reagents used for both assays. Therefore, CRA was modified in which monolayer culture cells were used as target cells and MCA was devised in which the adherent surviving target cells after the interaction with effector cells were assessed by (51)Cr uptake (so called (51)Cr post-labeling assay...CPLA). Under standard conditions, CPLA detected a significant activity of weakly sensitized lymphocytes which was not detected by CRA. Reactivity of lymph node cells after the tumor transplantation was tested simultaneously in CRA, CPLA and the macrophage migration inhibition test (MIT). The data showed that CPLA detected immune reactivity for longer period than CRA, and as long as MIT. The lytic activity of lymph node cells 8 days after immunization was monitored by a long term CRA (40-hours' incubation). The cytotoxicity value for late 20 hr was remarkably higher than for early 20 hr. This in vitro activation of sensitized lymphocytes indicated a peak at 8 days and then declined, dissappeared at 14 days. When both assays were done under same condition, CPLA detected a moderate activity which was not detected by CRA. This result means that CPLA could detect immune responses which inhibit tumor cell growth without killing them. Both assays detected primarily a T lymphocyte-mediated activity. The CPLA also detected a weak non T-cell activity in anti-θ plus complement-treated alloimmune lymph node. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 89 5-6 1977 静電型心尖拍動トランスデューサーの試作およびその有用性 713 720 EN Yoshihisa Ishii Kazuhiro Hirano Tatsuya Kawai Daiji Saito Shoichi Haraoka Apexcardiogram by mean of non-invasive method may be more usefull provided that the technique for the transducer attachment was easier and reprodusable. In this report, some attempts on the transducer of apexcardiogram were described. A precordial electrode was placed about 1.5 mm above the chest wall of a patient. The electrostatic capacitance between the electrode and chest wall was transmitted to the CR oscillator and it modulated the frequency of pulse train generated with the oscillator. The signals were led to a conventional D.C. recorder or a cathode ray oscilloscope. There was no remarkable differences of the wave pattern between the apexcardiogram obtained by our method and by conventional piezoelectric transducer in normal cases. In some patients, however, some differences were observed especially in the depth of O-wave. The depth of O-wave increased in accordance with a rise in pressure of the transducer to the chest wall using the conventional method. The observations suggest that the A/E-O ratio might be varied depending on attaching pressure of the transducer to the chest wall. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 91 9-10 1979 Rauscher Virus性マウス白血病における溶血性貧血に関する研究 第2編 網内系機能の変動について 1259 1268 EN Ichiro Mizukawa Using Rauscher leukemia virus, changes in the reticuloendothelial phagocytic activity were studied by a carbon clearance method and a heat-damaged (51)Cr-labelled red blood cell method. With the carbon clearance method, after virus infection, phagocytic activity was slightly increased in the early stages, but decreased gradually during later stages. With the (51)Cr-labelled RBC method, in the early stages, phagocytic activity of liver and spleen was slightly increased and during the later stages accelerated markedly in the liver in contrast to supressed activity in the spleen. It was suggested that an early increase of phagocytic activity observed by both methods was a response to viral infection. Significantly accelerated phagocytic activity seen in the liver during later stages with the (51)Cr method may have been related to the hemolytic anemia associated with Rauscher leukemia. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 91 9-10 1979 ヒツジ赤血球を標的細胞とするヒト末梢白血球のAntibody-Dependent Cell-Mediated Cytotoxicity (ADCC) 第2編 Sjogren症候群ならびに慢性関節リウマチ患者白血球のADCC活性とErythrophagocytosis 1117 1125 EN Yukinobu Ichikawa Antibody-dependent cell-mediated cytotoxicity (ADCC) and antibody-dependent erythrophagocytosis (ADEP) of peripheral blood leukocytes in patients with Sjogren's syndrome (SjS) or rheumatoid arthritis (RA) were investigated using (51)Cr-labelled sheep red blood cells as target cells. The Lymphocytes (phagocyte depleted fraction, PDF) in healthy controls showed higher ADCC activities (58.6±9.9%) than the phagocyte-contaminated crude lymphocyte fraction (CLF) (49.1±10.9%). There was no statistically significant difference between the ADCC activities of PDF in patients with SjS (55.9±13.5%) or RA (58.8±9.6%) and those in healthy controls, although decreased ADCC activity was observed in some patients with SjS. ADCC activities of CLF in patients with SjS (61.2±14.3%) or RA (59.3±6.9%) were significantly higher than those of CLF in healthy controls. Decreased ADEP activity of monocytes in CLF was demonstrated in patients with SjS (17.9±9.4%) compared with healthy controls (37.2±10.6%), and increased ADCC activity of CLF in patients with SjS was dependent on decreased ADEP activity of contaminating monocytes. Decreased ADEP activity of monocytes in patients with RA was also suggested by these results. It was speculated that the decreased Fc-receptor function of peripheral blood monocytes, demonstrated in these patients, had originated from aberrant cell-mediated immunity in these diseases, since these Fe-receptor functions in patients with SjS did not correeate with the following conditions: associated diseases, erythrocyte sedimentation rate, titer of serum rheumatoid factor, lymphocyte count of peripheral blood, or treatment with anti-inflammatory drugs including prednisolone. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 91 9-10 1979 ヒツジ赤血球を標的細胞とするヒト末梢白血球のAntibody-Dependent Cell-Mediated Cytotoxicity (ADCC) 第1編 Erythrophagocytosisを中心とした基礎的検討 1101 1115 EN Yukinobu Ichikawa Antibody-dependent cell-mediated cytotoxicity (ADCC) of human peripheral leukocytes was investigated using (51)Cr-labelled sheep red blood cells (SRBC) sensitized with rabbit anit-SRBC antibody as target cells. ADCC (lysis of target cells without erythrophagocytosis) was mediated by the lymphocytes. On the other hand, phagocytes including monocytes and granulocytes showed antibody-dependent erythrophagocytosis (ADEP). ADCC of the lymphocytes was augumented by the enrichment of Fc-receptor bearing or Nylon-wool column passing cells. Phagocytes showed rapid ADEP, and granulocytes released (51)Cr-radioactivity originating from target cells into the culture medium in a short time, whereas the monocytes released little radioactivity during the incubation period. The monocytes inhibited ADCC of the lymphocytes competitivelly through ADEP, since decreased ADCC activity of monocyte-contaminated crude lymphocyte fraction was recovered by elimination of contaminating monocytes. Antibody-independent erythrophagocytosis of SRBC was mediated by monocytes, but not by granulocytes. Both ADCC of lymphocytes and ADEP of phagocytes were dependent on IgG-antibody, IgM-antibody did not participate in these phenomena. ADEP of monocytes was detected at 10(-2)-10(-6) dilution of IgG-antibody fraction (original hemmagglutination titer; × 1600), and ADCC of lymphocytes and ADEP of granulocytes were detected at 10(-2)-10(-4) and 10(-2)-10(-3) dilution of this antibody fraction, respectively. Soluble cytotoxic factors were not released from lymphocytes, monocytes or granulocytes in this assay system, because no cytotoxic activity on (51)Cr-labelled human erythrocytes used as an adjacent cell was demonstrated by any leukocyte fraction in the presence of antibody-coated SRBC. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 94 1-2 1982 抗腫瘍抗体結合抗癌剤に関する研究 第1編 抗腫瘍抗体結合Neocarzinostatin(NCS-immune IgG)の補体依存細胞障害作用とcapping抑制効果 9 15 EN Yuji Sato In the previous paper, we reported that Neocarzinostatin (NCS) could bind covalently to rabbit anti-tumor IgG (Immune IgG) without losing its pharmacological activity. In this study, the complement dependent cytotoxicity and capping inhibition of the conjugate were evaluated. When antibody activity was measured by (3)H-TdR uptake inhibition and (51)Cr release tests in the presence of human complement, the cytotoxicity of the conjugate was significantly reduced in contrast to the antibody binding activity tested by immunofluorescence. In addition, an anti-complement immunofluorescent test showed that NCS-immune IgG fixed less complement on NALL-1 cells than immune IgG. These results indicate that complement fixing sites of NCS-immune IgG are damaged during chemical conjugation. The capping experiment demonstrated that NCS-immune IgG interfered with the capping of antigens on the NALL-1 cell surface, and that the capping inhibiting activity was almost the same degree as that of free NCS. This unique advantage of NCS-immune IgG may be useful for inhibiting the immunological escape of tumor cells from antibody attack in vivo. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 96 9-10 1984 肺癌の診断と治療に関する研究 第2編 進展期肺癌症例におけるCyclophosphamide, Vincristine, Methotrexate, Procarbazine併用療法に関する研究 961 972 EN Ken-ichi Machida One hundred and thirteen patients with advanced lung cancer were treated with a four-drug combination chemotherapy consisting of cyclophosphamide, vincristine, methotrexate and procarbazine. Of those, ninety three (80 men and 13 women) patients were evaluated. Of 41 patients with small cell carcinoma, 10 (24%) achieved complete response (CR) and 18 (44%) achieved partial response (PR). The median duration of response was 5 months. The median survival time from initiation of chemotherapy was 11.3 months for patients with limited disease and 8 months for those with extensive disease. Responders lived significantly longer than non-responders; median survival time was 14 months for complete responders, 10.3 months for partial responders, and 6 months for non-responders. Of 52 patients with non-small cell carcinoma, 2 achieved CR and 15 achieved PR: The overall response rate was 33% ; with a response rate of 30% (8/27) for adenocarcinoma, 30% (6/20) for squamous cell carcinoma, and 60% (3/5) for large cell carcinoma. The median survival time was 13 months for patients with stage �V, and 8 months for those with stage �W. Responders with non-small cell carcinoma displayed a tendency toward longer survival periods; the median survival time was 8.3 months for responders compared with 6 months for non-responders. Myelosuppressive toxicity remained within acceptable limits, with 8.8% incidence of leucocytepenia (1,000/cmm) and 6.7% incidence of thromobocytepenia (50,000/cmm) in repeated courses. These resuts indicate that this regimen is useful for the treatment of advanced lung cancer. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 96 9-10 1984 血液系細胞の放射線障害とビスコクラウリン型アルカロイドに関する研究 第2編 X線照射後のマウス造血組織に及ぼすセファランチンの効果 891 899 EN Sosuke Iida After a whole-body irradiation at a single dose of 500R, mice were injected intraperitoneally with 0.1mg of cepharanthin (CR)every day for 20days. Endogenous spleen colonies (CFU-S) were counted on Day 10, and the spleen and thymus weight was measured, peripheral leukocytes counted and hematocrit value determined for 30days after the irradiation. The number of CFU-S increased remarkably in CR injected mice compared with control mice. Decreased spleen weight by irradiation recovered in excess by Day 30. In CR administered mice, the spleen weight increased transitorily along with the proliferation of CFU-S. After irradiation, the recovery of thymus weight was delayed compared with the spleen. Therefore, the effect of CR administration was not clear. Peripheral leukocytes decreased in number successively essively up to Day 10 and recovered linearly from Day 20 through Day 30, especially in CR injected mice. The hematocrit value was reduced to a minimum on Day 10 and almost recovered by Day 20 in irradiated mice. CR had no effect on the hematocrit value. The effect of cepharanthin was discussed in relation to radiation damage of hemopoietic tissue. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 93 1-2 1981 急性白血病寛解導入療法に関する研究 第2編 5剤併用療法(NCDVP療法, NCyclo-cDVP療法)による難治性急性白血病の寛解導入に関する検討 15 24 EN Masaaki Tokioka In this study, the clinical effectiveness of 5 drugs as combination chemotherapy, NCDVP (N:neocarzinostatin C: cytosine arabinoside D:daunorubicin V:vincrisitine P: prednisolone) and NCyclo-cDVP (Cyclo-c:cyclocytidine), for refractory acute leukemia was evaluated. Twenty patients (12 patients relapsed and 8 patients with the first induction failure) were entered in this study; 14 patients with acute non-lymphocytic leukemia (ANLL) and 6 patients with acute lymphocytic leukemia (ALL). Their ages ranged from 15 y.o. to 73 y.o. (median:39 y.o.) and the ratio of males to females was 15 to 5. Doses and administration methods were: N, 1,400u/m(2)/day, was administered by i.v. drip on day 3, 4, 5 and 6 and C, 40-80mg/m(2)/day, was administered by i.v. drip from day 1 to day 6. D, 20-25mg/m(2)/day, was administered by i.v. bolus on day 3 and 5 and V, 1.4mg/m(2)/day, i.v. bolus on day 2. P, 20-40mg/m(2)/day, was administered by i.v. drip or p.o. from day 1 to day 6. The treatment was repeated with at least a 7 days resting period. All patients were adequatedly treated and 9 of them, 45%, obtained complete remission (CR). One patient showed partial remission. On the basis of types of leukemia, 7 of 14 patients with ANLL, 50%, and 2 of 6 patients with ALL, 33%, achieved CR. In order to obtain CR, one or 2 courses of the treatment were required (median:1.4 courses) and the duration of CR ranged from 2 to 38 weeks (median:6 weeks). In peripheral blood, the nadir of white blood cell counts, neutrophils and thrombocytes was 600/cmm, 200/cmm and 24,000/cmm, respectively and the number of days to this nadir was 12 days for white blood cell counts, 11 days for neutrophils and 13 days for thrombocytes. The nadir of bone marrow nucleated cell counts was 7,800/cmm and the number of days to nadir was 10 days. As toxic manifestations, digestive side effects were marked, but were tolerable. Eight patients showed alopetia and 4 patients complained of pain in the parotid gland. One patient complained of a sense of numbness in the fingers. Toxic effects on liver function were recognized in 5 patients, one of whom died of fulminant hepatitis. The treatment of refractory acute leukemia is one of the major problems in the clinical management of leukemia. The results of the 5 drug combination chemotherapy presented here suggests its effectiveness in refractory acute leukemia in man. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 93 1-2 1981 急性白血病寛解導入療法に関する研究 第1編 NCMP two step療法による成人急性非リンパ性白血病の寛解導入に関する検討 1 13 EN Masaaki Tokioka The clinical effectiveness of a new protocol, the NCMP (N:neocarzinostatin C:cytosine arabinoside M:6- mercaptopurine P:prednisolone) two-step regimen was studied in 19 patients with acute non-lymphocytic leukemia (ANLL). All patients were previously untreated and ages ranged from 15 to 75 y.o. (median:54 y.o.). The ratio of male to female was 11 to 8. The doses and administration-routes of antileukemic agents were: N, 1,400u/m(2)/day, was administrated by i.v. drip on day 1, 2, 3 and 4 (Regimen 1) and N, 4,000u/m(2)/day, i.v. drip on day 1 and 2 (Regimen 2). C, 60-100mg/m(2)/day, was administered by i.v. drip and M, 60-100mg/m(2)/day, was given p.o. daily. P, 20-40mg/m(2)/day, was also given p.o. daily. As the first step, antileukemic agents were administrated until peripheral blood cell counts and bone marrow nucleated cell counts decreased to less than 1,200/cmm and 15,000/cmm, respectively. Treatment with or without N as the second step was started about 3-7 days after the first step treatment. Eighteen patients were adequately treated by the NCMP two-step regimen and 12 of 18 patients, 66.7%, obtained complete remission (CR). On the basis of the types of leukemia, CR was achieved in 11 of 16 patients with AML, 68.8%, and 1 of 2 patients with AMoL, 50%. The ratio of CR was higher in younger patients (less than 49 y.o.) than in elderly patients (more than 50 y.o.). These ratios were 85.7% and 54.5%, respectively. On the basis of therapeutic regimens, 8 of 11 patients, 72.7%, achieved CR by Regimen 1 and 4 of 7 patients, 57.1%, by Regimen 2. The duration of CR ranged from 1.0 to 39.5+M (median:11.5 M). The survivals from the diagnosis of leukemia were from 13 to 41+M (median:12.1 M) in all patients and from 4.2 to 41+M (median:16.4 M) in responders. As toxic manifestations, digestive side effects such as anorexia, 68.4%, and nausea and vomiting, 21.1%, were marked, but were tolerable. These results indicate that the NCMP two-step regimen is an effective induction chemotherapy for ANLL. No potential conflict of interest relevant to this article was reported.