<ORGINAL ARTICLE>Evaluation of the Relationship between a Face Anxiety Scale and the State-Trait Anxiety Inventory

我々は簡単に短時間で患者の不安の程度を把握するために,我々が考案した顔不安スケール(Face Anxirty Scale FAS)を臨床で使用している。今回の研究はこのFASが不安をアセスメントする心理テスト,すなわちState-traitanxiety inventry (STAI)の得点に相関するのか検討した。FASとSTAIは歯科診療(口腔外科処置)前に待合室で実施し,患者自身に記入させた。尚,対象から対人恐怖症および自律神経失調症の患者は除外した。その結果,対象は33名(女性14名,男性19名),平均年齢は24.4才(19才から49才)。対象患者の多くは智歯の抜歯手術だった。歯科に関する既往歴は永久歯の抜歯経験が無い患者から歯科診療恐怖症の患者,精神鎮静法下に難抜歯の経験有る患者など,いろいろであった。今回は対象患者の約半数に対して,静脈内鎮静法(フルニトラゼパム投与)を施行した。特性不安はFASが0から2点,0.80±0 53(mean±S.D)であった。STAKA-trait)は32から64,43.46±8.29(mean±S.D.)となった。FASとSTAI(A-trait)の相関関係はFig2に示したように,Y=41.38+2.98X,R^2=0.04であった。歯科診療前の状態不安はFASが0から4点,平均1.94±1.35(mean±S.D )であった。STAI(A-state)は23から72,47.46±13.92(maen±S.D.)となった。FASとSTAI(A-trait)の相関関係はFig3に示したように,Y=30.22+8.87X,R^2=0.69(P <0.01)であった。以上の結果から,FASとSTAIの状態不安尺度は相関を認めた。従って,FASは歯科患者の状態不安を客観的,簡便に評価する事が認められた。また,我々が考案したFASは歯科治療に対する患者の不安評価方法として,有用性が示唆された。To determine the degree of fear of dental treatment in general, we applied a Face Anxiety Scale (FAS) for pre-operative levels of anxiousness. The FAS is valuable as it is easy and fast. The FAS assess anxiety at 6 levels, the lowest is 0, the highest 5. We assessed the pre-operative (minor dental surgery) anxiety of patients subject to intravenous sedeation, without psychosedation. To establish the reliability of the FAS, an evaluation of the relationship between the FAS and the State-trait anxiety inventory (STAI) was made. The pre-operative FAS ranged from 4 to 0 Anxiety with STAI (A-state) had a highest score of 72, and a lowest score of 23 The relationship between FAS and anxiety state with STAI was Y=30.22+8.87X,R^2=0.69(P<0 01). The FAS was significant correlated with state anxiety of STAI. The results suggest that FAS is a reliable measure for state anxiety in dental treatment

Benign giant mediastinal schwannoma presenting as cardiac tamponade in a woman: a case report

<p>Abstract</p> <p>Introduction</p> <p>Mediastinal schwannomas are typically benign and asymptomatic, and generally present no immediate risks. We encountered a rare case of a giant benign posterior mediastinal schwannoma, complicated by life-threatening cardiac tamponade.</p> <p>Case presentation</p> <p>We report the case of a 72-year-old Japanese woman, who presented with cardiogenic shock. Computed tomography of the chest revealed a posterior mediastinal mass 150 cm in diameter, with pericardial effusion. The cardiac tamponade was treated with prompt pericardial fluid drainage. A biopsy was taken from the mass, and after histological examination, it was diagnosed as a benign schwannoma, a well-encapsulated non-infiltrating tumor, originating from the intrathoracic vagus nerve. It was successfully excised, restoring normal cardiac function.</p> <p>Conclusion</p> <p>Our case suggests that giant mediastinal schwannomas, although generally benign and asymptomatic, should be excised upon discovery to prevent the development of life-threatening cardiopulmonary complications.</p

Hochuekkito (TJ-41), a Kampo Formula, Ameliorates Cachexia Induced by Colon 26 Adenocarcinoma in Mice

Cachexia, a major cause of cancer-related death, is characterized by depletion of muscle and fat tissues, anorexia, asthenia, and hypoglycemia. Recent studies indicate that secretions of proinflammatory cytokines such as interleukin-6 (IL-6) play a crucial role in cachexia development, and that these cytokines are secreted from not only cancer cells but also host cells such as macrophages. In this study, we investigated the therapeutic effects of hochuekkito, a Kampo formula, on cachexia induced by colon 26 adenocarcinoma in mice. Hochuekkito treatment did not inhibit tumor growth, but significantly attenuated the reduction in carcass weight, food and water intake, weight of the gastrocnemius muscle and fat tissue around the testes, and decrease of serum triglyceride level compared with controls. Furthermore, hochuekkito treatment significantly reduced serum IL-6 level and IL-6 expression level in macrophages in tissues surrounding the tumor. In vitro studies showed that hochuekkito suppressed the production of IL-6 by THP-1 or RAW264.7 macrophage cells, although it did not affect IL-6 production by colon 26 carcinoma cells. These results suggest that hochuekkito inhibits the production of proinflammatory cytokines, particularly IL-6, by host cells such as macrophages. Therefore, hochuekkito may be a promising anticachectic agent for the treatment of patients with cancer

Nationwide retrospective observational study of idiopathic dendriform pulmonary ossification : clinical features with a progressive phenotype

Background: Diffuse pulmonary ossification is a specific lung condition that is accompanied by underlying diseases. However, idiopathic dendriform pulmonary ossification (IDPO) is extremely rare, and the clinical features remain unclear. In this study, we aimed to report the clinical characteristics of IDPO. Methods: We conducted a nationwide survey of patients with IDPO from 2017 to 2019 in Japan and evaluated the clinical, radiological, and histopathological findings of patients diagnosed with IDPO. Results: Twenty-two cases of IDPO were identified. Most subjects (82%) were male, aged 22-56 years (mean (SD), 37.9 (9.1)) at diagnosis. Nearly 80% of the subjects were asymptomatic, and the condition was discovered during a medical check-up. However, 36% of the subjects showed a decline in forced vital capacity (%FVC) predicted <80% at diagnosis. The typical radiological features of high-resolution CT (HRCT) are calcified branching structures that are predominantly distributed in the lower lung fields without any other conspicuous finding. Histopathological analysis also showed dendriform ossified lesions from the intraluminal areas to interstitial areas. Notably, during the follow-up period of 20 years, disease progression was found in 88% on HRCT and more than 50% on pulmonary function tests (FVC and/or forced expiratory volume in 1s). Two cases with rapid decline of 10% /year in %FVC predicted were observed.)) at diagnosis. Nearly 80% of the subjects were asymptomatic, and the condition was discovered during a medical check-up. However, 36% of the subjects showed a decline in forced vital capacity (%FVC) predicted <80% at diagnosis. The typical radiological features of high-resolution CT (HRCT) are calcified branching structures that are predominantly distributed in the lower lung fields without any other conspicuous finding. Histopathological analysis also showed dendriform ossified lesions from the intraluminal areas to interstitial areas. Notably, during the follow-up period of 20 years, disease progression was found in 88% on HRCT and more than 50% on pulmonary function tests (FVC and/or forced expiratory volume in 1s). Two cases with rapid decline of 10% /year in %FVC predicted were observed. )) at diagnosis. Nearly 80% of the subjects wereasymptomatic, and the condition was discovered during a medical check-up. However, 36% of the subjects showed a decline in forced vital capacity (%FVC) predicted <80% at diagnosis. The typical radiological features of high-resolution CT (HRCT) are calcified branching structures that are predominantly distributed in the lower lung fields without any other conspicuous finding. Histopathological analysis also showed dendriform ossified lesions from the intraluminal areas to interstitial areas. Notably, during the follow-up period of 20 years, disease progression was found in 88% on HRCT and more than 50% on pulmonary function tests (FVC and/or forced expiratory volume in 1s). Two cases with rapid decline of 10% /year in %FVC predicted were observed. Conclusions: IDPO develops at a young age with gradually progressive phenotype. Further research and long-term (>20 years) follow-up are required to clarify the pathogenesis and clinical findings in IDPO

Role of FBXW7 in the quiescence of gefitinib-resistant lung cancer stem cells in EGFR-mutant non-small cell lung cancer

Several recent studies suggest that cancer stem cells (CSCs) are involved in intrinsic resistance to cancer treatment. Maintenance of quiescence is crucial for establishing resistance of CSCs to cancer therapeutics. F-box/WD repeat-containing protein 7 (FBXW7) is a ubiquitin ligase that regulates quiescence by targeting the c-MYC protein for ubiquitination. We previously reported that gefitinib-resistant persisters (GRPs) in EGFR-mutant non-small cell lung cancer (NSCLC) cells highly expressed octamer-binding transcription factor 4 (Oct-4) as well as the lung CSC marker CD133, and they exhibited distinctive features of the CSC phenotype. However, the role of FBXW7 in lung CSCs and their resistance to epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors in NSCLC is not fully understood. In this study, we developed GRPs from the two NSCLC cell lines PC9 and HCC827, which express an EGFR exon 19 deletion mutation, by treatment with a high concentration of gefitinib. The GRPs from both PC9 and HCC827 cells expressed high levels of CD133 and FBXW7, but low levels of c-MYC. Cell cycle analysis demonstrated that the majority of GRPs existed in the G0/G1 phase. Knockdown of the FBXW7 gene significantly reduced the cell number of CD133-positive GRPs and reversed the cell population in the G0/G1-phase. We also found that FBXW7 expression in CD133-positive cells was increased and c-MYC expression was decreased in gefitinib-resistant tumors of PC9 cells in mice and in 9 out of 14 tumor specimens from EGFR-mutant NSCLC patients with acquired resistance to gefitinib. These findings suggest that FBXW7 plays a pivotal role in the maintenance of quiescence in gefitinib-resistant lung CSCs in EGFR mutation-positive NSCLC

〓

The change to cardiovascular system of non-hypertensive (NH group) and hypertensive patients (HT group) were examined using a rate pressure product (RPP) during dental treatment of elderly patients aged a mean of 70.4 years. 1. The RPP in the NH group was significantly higher than in the HT group during local anesthesia and dental treatment. 2. The RPP in the NH group was significantly higher than that in the HT group during dental treatment without local anesthesia. 3. There were no significantly changes in RPP between the monitored and sedation groups of the HT group. The results suggested that changes in the cardiovascular system was markedly high during dental treatment for non-hypertensive patients. Therefore, local anesthesia must be carefully chosen for such patients. Intravenous sedation with diazepam is suitable for elderly patients because of safety during dental treatment. Even in elderly non-hypertensive patients, changes in RPP may occur, therefore, blood pressure, heart rate, and ECG should be monitored during dental treatment

〓

We have actively used intravenous sedation with monitored conscious sedation care for cases of dental and minor oral surgical procedures under local anesthesia. Additional administration (time of injection and volume) of midazolam by intravenous injection was made to maintain optimum sedation during surgery, from the post-investigative stage of clinical cases to achieve satisfactory sedation during operation. Subjects for the statistical study provided dental treatment or surgery consent to the application of midazolam intravenous sedation, and 24 cases of ASA ps class I or II patients are included. Midazolam in intravenous injection by titration at the first injection established a standard of 0.075 mg/kg. Intravenous injection was established at 0.015 mg/kg/min. As a result, 0.072 ± 0.015 (mean ± SD) mg/kg midazolam was needed to ensure conscious and optimum sedation by a first injection. However, additional midazolam was injected before and after the local anesthesia injection (first additional administration 56%, second additional administration 46%). The main reasons for additional midazolam administration were, increase in state anxiety assessment, stressors in the operation, movement, and speaking clearly. It is necessary to provide the first additional administration of 0.022 ± 0.009 mg/kg midazolam, 29.3 ± 6.1 minutes after the first injection. The second additional administration was 0.035 ± 0.015 mg/kg, 50.0 ± 9.7 minutes after the first injection. Operations for 6 cases of first attempt establishment lasted 33.8 ± 22.8 minutes. The 11 cases which needed a first additional administration had operation times of 46.4 ± 22.2 minutes, and 7 cases which needed a second additional administration had operation times of 63.3 ± 15.7 minutes. The results showed that the additional injection of one third of the first intravenous injection resulted in an extension of sedation for 50 minutes during operation. Taking account of time for sterilization and for the local anesthesia to take effect midazolam appears suitable for about 30 minute operation times