Treatment of ruptured posterior cerebral artery aneurysm：3 cases report

後大脳動脈瘤は全脳動脈瘤の0.7〜３％と比較的稀で，他部位の脳動脈瘤に比較し紡錘状動脈瘤や巨大動脈瘤が多い特徴がある。治療には開頭クリッピング術やバイパス併用のアプローチが取られるが，術野が深いなど治療難易度は高く近年では血管内治療も選択される機会が多くなった。今回くも膜下出血で発症した破裂後大脳動脈瘤３症例を経験したので報告する

Virus infection and children

Following the lead of Dr. Toru Nakao and Emeritus Professor Shunzo Chiba, we have conducted epidemiological and virological research on viral infections frequently observed in children. The present report is an overview of the research we have conducted. Amongst our research, we have demonstrated that the genetic evolution of the respiratory syncytial virus (RSV) undergoes both geographical and temporal clustering. Additionally, we have shown that the cytomegalovirus (CMV), a DNA virus, is widely disseminated under very stable genetic conditions. We have also clarified the situation concerning the genetic evolution of rotaviruses collected in Sapporo. In addition, we have attempted to identify the virulence-associated genome mutations of murine and human rotaviruses. Furthermore, we have indicated how the considerable genetic mutations of human parvovirus B19 could be associated with outbreaks of exanthema infectiosum every few years. Finally, we have examined viral reactivation in patients who underwent allogeneic hematopoietic stem cell transplantation and identified human herpesvirus 6 as a prominent pathogen causing important clinical events in these patients

Reduction of HbA1c levels by fucoxanthin-enriched akamoku oil possibly involves the thrifty allele of uncoupling protein 1 (UCP1): a randomised controlled trial in normal-weight and obese Japanese adults

海藻由来のカロテノイド色素であるフコキサンチンの摂取はHbA1cを改善し，その効果は肥満や糖尿病発症のリスクが高いUCP1-3826A/G多型（G/G型）保有者において著しいことを示した

Examination of outcome and prognostic factors of GEM＋CDDP（GC）therapy for unresectable biliary tract cancer

切除不能胆道癌患者の予後は現在でも不良であり，有効な化学療法の開発が必要である。これまで切除不能胆道癌に関して行われてきた化学療法の臨床試験は，単群の試験や小規模な比較試験が殆どで，大規模な第Ⅲ相試験の報告は最近まで皆無であった。その背景には，①胆道癌に対して高い有効性が確認された化学療法薬がなかった。②閉塞性化膿性胆管炎等化学療法以外のマネージメントが必要で，臨床試験の成績への影響がある。③欧米では，胆道癌患者数がアジア圏に比べ少なく，関心が低い。といった理由が推測される。こうした状況の中で，塩酸ゲムシタビン（略称：GEM），テガフール・ギメラシル・オテラシルカリウム（略称：TS-1）が保険適応となった。更に，英国と本邦において，GEM 単剤とGEM＋シスプラチン（略称：CDDP）併用療法（GC 療法）の比較試験結果が報告された。その結果，GC 療法は，現在本邦での切除不能胆道癌に対する標準治療となっている。GC 療法が保険収載され５年が経過しており，一般市中病院での切除不能胆道癌に対するGC 療法の，中・長期成績を検証する必要がある

Treatment results about mechanical thrombectomy for acute ischemic stroke due to large vessel occlusion

我が国では急性期脳梗塞に対して2005年より経静脈血栓溶解薬であるアルテプラーゼ（rt-PA）が導入され，急性期脳梗塞の標準治療となってきた。その後さまざまなランダム化比較試験（RCT）で内科的治療単独群に比べ血管内手術による血栓回収術を追加した群で転帰良好となることが報告されている１?３）。そのような血栓回収デバイスの一つとして2011年６月よりPenumbra システムの使用が認可され，現在までも高い再開通率が報告されている。今回当院でPenumbra システムを使用した脳主幹動脈閉塞による急性期脳梗塞症例の治療成績について検討したので報告する

Acupuncture’s evidences: even slight stimuli could alter body functions, suggesting a “resetting” effect

Once the acupuncture had mushroomed after the visit of former president Richard M. Nixon to China in 1972 1, 2）, quite a few researchers denied the effects, concluding with theatrical placebo 3-7）. We showed, however, the acupuncture’s evidences and propose a new interpretation of the mechanism, a “resetting” effect. Even slight stimuli, such as needle-patches, could affect our body function: heart rate variability (HRV) and pupillary light reflex. In addition, the treatments significantly reduced the variations observed before the treatment. As for the frequency domain analysis using FFT (fast Fourier transform), the total power of the frequency domain was reduced as compared with that of placebo case after the treatment. Base on the evidence presented here, the homeostasis could be awakened by the slight stimuli of the insertion of the needle and thereafter the subsequent relief of the stress could make the homeostasis more ffective, resulting in returning to the initial condition, so-called healthy status. This phenomenon looks like that computer systems become normal by pressing the resetting switch. The “resetting” effect of acupuncture is thought to be useful idea in elucidating the mechanism hereafter

Are ADC histogram metrics repeatable?

Purpose: The present study evaluated the repeatability of apparent diffusion coefficient (ADC) histogram metrics in clinical MRI.Methods: Twelve patients who underwent head MRI in our hospital from May to July in 2016 were included in the present study. All patients gave informed consent. Two sequential diffusion-weighted images with echo planar imaging (DWI-EPI) in the identical positioning were obtained. The b-factors of 0 and 1000 or 1500 s/mm2 were used, three orthogonal motion proving gradients (MPGs) were applied, and synthesized images were generated. The regions of interest (ROIs) were ssigned at the lesions on the 1st DWI and pasted onto the 2nd at the same size and location. Voxel-wise ADC was calculated by fitting the signal intensity change of each voxel into a mono-exponential curve. ADCs calculated from 1st and 2nd DWI were defined as ADC-1st and ADC-2nd, respectively. To investigate the repeatability of voxel-wise ADC in each lesion, ADC-1st and ADC-2nd were compared using Wilcoxon matched-pairs signed rank test and linear regression. To onsider repeatability of ADC histogram metrics for all lesions, minimal, 25%, median, 75%, maximum, mean, skewness, and kurtosis of ADC-1st and ADC-2nd for each lesion were compared using linear regression and Bland-Altman plot.Results: For repeatability of voxel-wise ADC, significant differences were observed between ADC-1st and ADC-2nd in 5 lesions. Linear regression did not show significance of the slope in 5 lesions. As for repeatability of ADC histogram metrics, all ADC histogram metrics except skewness and kurtosis showed significance of the slope in linear regression (p<0.0001) and high repeatability in Bland-Altman plot.Conclusion: The histogram metrics of voxel-wise ADC like minimum, 25%, median, 75%, maximum, and mean show high repeatability, but skewness and kurtosis did not