Vol.18 リニューアル後の様子①

other periodica

滋賀医大病院ニュース 第68号 (2025/3)

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Contribution of Immunoscore to Survival Prediction in Pancreatic Ductal Adenocarcinoma

滋賀医科大学博士（医学）Background/Aim: The presence of tumor-infiltrating lymphocytes (TILs) has been demonstrated as a prognostic factor in colorectal cancer after surgical resection of malignancy, but knowledge on their role in pancreatic cancer is lacking. The Immunoscore (IS) assesses TILs at the core of the tumor (CT) and invasive margin (IM) and is being evaluated as a new concept in tumor immunity. The aim of this study was to evaluate the relationship between IS and prognosis in PDAC. Patients and Methods: The IS was analyzed by immunohistochemistry using surgical tissue blocks from 131 patients with pancreatic ductal adenocarcinoma (PDAC) who underwent surgery to investigate the relationship between immune cell infiltration into the tumor and prognosis in PDAC. Results: A high IS in both CT and IM of the tumor was significantly associated with prolonged overall survival (OS) (p<0.01) and relapse-free survival (RFS) (p<0.01). In multivariate logistic regression models adjusted for clinical pathology data, IS predicted survival and recurrence (p<0.01 and p<0.01, respectively). Moreover, in patients who received preoperative chemotherapy, a high IS was statistically significantly associated with longer OS and RFS (p<0.01 and p<0.01, respectively). Conclusion: The immunohistochemically assessed IS might be a useful prognostic marker for patients with PDAC who underwent primary tumor resection.令和6年度doctoral thesi

シンケイ シッカン ニ オケル Rループ

相補鎖間の結合による二本鎖がDNAの基本的な構造であるが、片方のDNAがRNAと塩基の対をなし二本鎖を作ると、相補鎖側のDNAが塩基対を作ることなく外れて一本鎖になる.　この状態をR-ループ構造という.　近年、Rループが細胞機能やゲノムDNAの安定性に重要な機能を持っていることが次々と報告されている.　遺伝子発現の際にDNA配列からRNAが転写されるとRループが生じる.　Rループは遺伝子発現やDNA複製、転写終始において制御されており、Rループ制御の乱れが原因となる疾患の分子機構が明らかにされている.　本総説ではゲノムにおけるRループの機能とRループ制御に関わる因子について述べ、それら因子の機能不全が原因となる神経疾患の例を紹介する.The basic structure of DNA is double strand formed by bonds between complementary strands, but when one DNA pairs bases with RNA to form a hybrid double strand, the DNA on the complementary strand separates without forming base pairs. This is called R-loop structure. In recent years, it has been reported that R-loops have important cellular function and genomic DNA stability. R-loops occur when RNA is transcribed from DNA during gene expression. Formation of R-loops is regulated in gene expression, DNA replication, and transcription termination, and the molecular mechanisms of diseases caused by disturbances in R-loop regulation have been reported. Here, we review the functions of R-loops in the genome and the factors involved in R-loop regulation and introduce examples of neurological diseases caused by dysfunction of R-loop formation and factors involved in it.departmental bulletin pape

Evaluation of Ischemic Time and Complications in Free Jejunum Transfer

滋賀医科大学博士（医学）Microsurgery. 2024 Sep;44(6):e31237.令和6年度thesi

Comparison of postoperative adjuvant platinum-based chemotherapy and no further therapy after radical surgery in intermediate-risk early-stage cervical cancer

滋賀医科大学博士（医学）Objective To identify a relatively high-risk population in postoperative intermediate-risk cervical cancer and evaluate the effect of platinum-based adjuvant chemotherapy (CT). Methods We retrospectively reviewed the medical records of patients with stage IA2-IIA cervical cancer who had been treated with radical hysterectomy and pelvic lymphadenectomy and classified as the intermediate-risk group for recurrence by postoperative pathological examination from January 2007 to December 2018 at 3 medical centers in Japan. First, patients with intermediate-risk were stratified by histological type and the number of intermediate-risk factors (IRF; large tumor diameter, lymph vascular space invasion, and deep cervical stromal invasion) and then divided into 2 groups: high and low-risk population (estimated 5-year recurrence-free survival [RFS] rate with no further therapy [NFT] <90% and ≥90%, respectively). Second, the efficacy of CT for the high-risk population was evaluated by comparing RFS and overall survival (OS) between the patients receiving CT and those with NFT. Results In total, 133 patients were included in the analysis. Among patients with squamous cell carcinoma (SCC) with all IRF or those with non-SCC with 2 to 3 IRF, the 5-year estimated RFS was <90% when treated with NFT. In this population, adjuvant CT was significantly superior to NFT regarding RFS (log-rank, p=0.014), although there was no statistical difference in OS. Conclusion Patients with SCC with all 3 IRFs and those with non-SCC with 2 to 3 IRFs were at high risk for recurrence. Adjuvant CT is a valid treatment option for these populations.令和6年度doctoral thesi

フクマク ハシュ オ キタシタ アクセイド フメイナ シキュウ ヘイカツキン シュヨウ ノ 1レイ

悪性度不明な子宮平滑筋腫瘍は再発・転移をきたすことが知られているが、特に腹膜播種再発した症例の報告は乏しく、その治療方針は定まっていない。今回我々は初回の子宮全摘術から約13年、腹膜再発切除から約8年経過した後に腹膜へ再再発をきたした悪性度不明な子宮平滑筋腫瘍の1例を経験したため報告する。症例は68歳、女性。55歳時に両側付属器切除と子宮全摘術を受け、低異型度子宮肉腫と診断された。60歳時に骨盤内の10mm大の再発病巣を切除した。脾臓近傍に55mm×55mm×40mm大の境界明瞭で内部均一な増大傾向を示す腫瘤性病変を認めたことから子宮肉腫の再発を含めた診断かつ治療目的に手術の方針とした。開腹手術にて術前画像診断で指摘されなかった播種病変を認めたが、全ての病変を肉眼的に局所切除し得た。病理診断にて悪性度不明な子宮平滑筋腫瘍と診断された。術後1年経過して再発兆候を認めていない。悪性度不明な子宮平滑筋腫瘍は術後長期間を経て腹膜播種再発することがある。再発病変に対しては局所切除が可能であり、手術が勧められる。Smooth muscle tumor with uncertain malignant potential can recur and become metastatic; however, reports regarding its recurrence are scarce. Here we present a case of a 68-year-old woman with a smooth muscle tumor with uncertain malignant potential with peritoneal dissemination recurrence that occurred approximately 13 years after initial hysterectomy. The patient had a history of bilateral salpingo-oophorectomy and total hysterectomy for low-grade uterine sarcoma at the age of 55 years. The patient underwent open surgery for recurrence in the pelvis at the age of 60 years. At follow-up, abdominal computed tomography revealed a uniform tumor measuring approximately 55 mm × 55 mm × 40 mm near the spleen with a clear boundary. During laparotomy, peritoneal dissemination recurrence, which was not detected preoperatively, was revealed. All recurrent tumors were macroscopically removed. The patient was pathologically diagnosed with smooth muscle tumor of uncertain malignant potential. No recurrence was found at postoperative 1 year. Smooth muscle tumors with uncertain malignant potential may recur with peritoneal metastasis long after surgery. Based on our experience, we concluded that local resection is possible in such cases. Therefore, surgery is recommended for recurrent smooth muscle tumors with an uncertain malignant potential.departmental bulletin pape

High blood pressure and colorectal cancer mortality in a 29-year follow-up of the Japanese general population: NIPPON DATA80

Onco-hypertension has been proposed, although associations of high blood pressure (BP) with cancer risk remain inconsistent. We examined associations of high BP with risk of mortality from stomach, lung, colorectal, liver, and pancreatic cancers independent of possible confounders in an analysis that excluded deaths within the first 5 years of follow-up to consider the reverse causality. In a prospective cohort representative of the general Japanese population (1980-2009), we studied 8088 participants (mean age, 48.2 years; 56.0% women) without clinical cardiovascular disease or antihypertensive medication at baseline. Fine-Gray competing risks regression was used to estimate hazard ratios for 10 mmHg higher BP adjusted for confounders including smoking, alcohol-drinking, obesity, and diabetes mellitus. During 29-year follow-up, 159 (2.0%), 159 (2.0%), 89 (1.1%), 86 (1.1%), and 68 (0.8%) participants died from stomach, lung, colorectal, liver, and pancreatic cancers, respectively. We observed a positive association of high BP with risk of colorectal cancer mortality but not with mortality risks from any other cancers. The association with colorectal cancer mortality for systolic and diastolic BP was evident in those aged 30-49 years (hazard ratios 1.43 [95% confidence interval, 1.22-1.67] and 1.86 [1.32-2.62], respectively) but not in those aged 50-59 years and ≥60 years (P for age interaction <0.01 for systolic and diastolic BP). The associations with colorectal cancer mortality were similar in the analyses stratified by smoking, alcohol-drinking, obesity, and diabetic status. In conclusion, high BP among young to middle-aged adults was independently associated with risk of colorectal cancer mortality later in life.journal articl

Prevalence of depression or depressive state in patients with restless legs syndrome: A systematic review and meta-analysis

Restless legs syndrome (RLS) is a common sleep-related disorder characterized by limb discomfort and the urge to move them when at rest, especially in the evening or at night. Although depression is often linked to various conditions, no systematic review has assessed depression prevalence in patients with RLS after the latest diagnostic criteria revision. This systematic review and meta-analysis aimed to investigate the depression and depressive state prevalence among patients with RLS. We systematically searched databases up to November 2022 and performed meta-analyses of the depression prevalence using a random-effects model and a meta-regression analysis to explore the relationship between the prevalence and severity of depression and factors such as age and RLS severity. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we analyzed 24 studies with 2039 patients. The pooled depression or depressive state prevalence, mostly defined by questionnaire scores, was 30.39 %. Nine studies reported the proportion of patients taking antidepressants (pooled rate: 3.41 %). No specific factors related to the prevalence or severity of depression were identified in patients with RLS. These findings highlight the significant prevalence of depression and underscore the need for future research with standardized diagnostic interviews and consistent methodologies across multi-site studies.journal articl

Ambient Temperature Is Correlated With the Severity of Neonatal Hypoxic-Ischemic Brain Injury via Microglial Accumulation in Mice

滋賀医科大学博士（医学）Frontiers in pediatrics. 2022 May 6:10:883556.令和5年度thesi