Fetal Heart Rate Patterns in Monochorionic Twins Following Acute Twin-Twin Transfusion

Background. We present here 2 cases of acute twin-twin transfusion occurred during vaginal labor in monochorionic-diamniotic twin pregnancies. Case. Fetal heart rate tracings showed tachycardia in the donor twin in the first case, while they showed reassuring patterns in both twins in the second case. Conclusion. These differences in changes of fetal heart rate in the donor twins following acute twin-twin transfusion may be resulted from the differences in amount of transfusion and elapsed time

小腸全摘後の再建法-逆蠕動胃管の有効性

金沢大学医学部研究課題/領域番号:57770800, 研究期間(年度):1982出典：研究課題「小腸全摘後の再建法-逆蠕動胃管の有効性」課題番号57770800（KAKEN：科学研究費助成事業データベース（国立情報学研究所）） （https://kaken.nii.ac.jp/ja/grant/KAKENHI-PROJECT-57770800/）を加工して作

Predictive value of heterogeneously enhanced MRI findings with CT evidence of calcification for severe motor deficits in spinal meningioma

OBJECTIVE: Spinal meningioma is mostly benign, but they can exhibit neurological deficit. The relationship between neurological impairment and its radiographic findings, including intratumor magnetic resonance imaging (MRI) gadolinium enhancement and calcification in computed tomography (CT) scan, has not been studied. The purpose of this study was to investigate the association of preoperative image findings with neurological status in spinal meningioma. METHODS: Patients histologically diagnosed with spinal meningioma (n = 24), with an average age of 65.4 years, were included. The patients were classified into 2 groups, the homogeneous and heterogeneous groups, based on the contrast-enhanced T1-weighted MRI findings. Further, baseline demographics (age, sex, presence of preoperative paralysis [manual muscle testing 3 or worse neurological deficit in upper and/or lower limbs], tumor level, tumor length, and tumor occupation ratio), histological findings (Ki-67 index and histological subtypes), and CT findings (presence of intratumor calcification and Hounsfield unit [HU] value) were examined. RESULTS: Preoperative paralysis was observed in 33.3% (8 of 24) of the patients. These patients exhibited frequent heterogeneous contrast-enhanced MRI findings than those without preoperative paralysis (57.1% vs. 14.3%, p = 0.040). Further, preoperative paralysis did not associate with tumor level, tumor length, tumor-occupied ratio, Ki-67 index, and histological subtypes. The heterogeneous group showed 100% intratumor calcification and higher maximum HU than the homogeneous group (1, 109.8 vs. 379.2, p = 0.001). CONCLUSION: The heterogeneous contrast-induced MRI findings in the spinal meningioma were significantly associated with preoperative neurological impairment. Moreover, the intratumor contrast-deficient region in the heterogeneously enhanced tumors reflected marked calcification. The tumor hardness due to calcification may be related to preoperative neurological deficit

先新第三系中の鉛直回転軸を持つ摺曲（屈曲）

Various folds (bends) with subvertical/vertical axes are widely developed in the pre-Neogene terranes of Southwest Japan. They are variable in shape, conical folds, accordion folds, megakink bands and so on, and some of them are associated with strike-slip faults. Their size ranges from several meters to 10km or more in half-wavelength. Their deformation style indicate that they were produced under a brittle condition in a shallow level of the crust. They are superimposed on the pre-existing structures, and are regarded to have been formed mostly during the Middle Miocene contemporaneously at the time of the clockwise-rotation of Southwest Japan. The presence of them, thus, suggests that the upper crust of island arc is easily deformable around subvertical/vertical rotation axes to form various folds (bends) and locally strike-slip faults during its rotation

Prevalence and predictive factors of difficult-to-treat rheumatoid arthritis: the KURAMA cohort

Difficult-to-treat rheumatoid arthritis (D2T RA) is a multifactorial condition in which disease activity of RA persists despite consecutive treatment with biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). To evaluate the prevalence and predictive risk factors of D2T RA in our institution, a single-center, retrospective study was conducted. Medical records of RA patients, who visited our hospital from 2011 to 2020 and had a follow-up of more than 6 months, were retrospectively reviewed. D2T RA was defined as RA with a disease activity score of 28 - erythrocyte sedimentation rate (DAS28-ESR) of 3.2 or higher at the last visit, despite the use of at least two b/tsDMARDs. A logistic regression model was used to identify risk factors. A total of 672 patients were enrolled. The mean age at disease onset was 52.1 years and females were dominant (76.3%). After a mean follow-up of 46.6 months, patients with D2T RA accounted for 7.9% of overall patients. Multivariate analysis identified high rheumatoid factor (RF) levels (≥156.4 IU/mL, odds ratio [OR]: 1.95), DAS28-ESR (OR: 1.24), and coexisting pulmonary disease (OR: 2.03) as predictive risk factors of D2T RA. In conclusion, high RF levels, high DAS28-ESR, and coexisting pulmonary disease at baseline can predict the development of D2T RA

Paraplegia Caused by Multifocal Osteosarcoma With Spinal Lesions

Background: Multifocal osteosarcoma is a rare condition that may be either synchronous or metachronous. Spine involvement of multifocal osteosarcoma is very rare. Synchronous multifocal osteosarcoma is typically described as the occurrence of tumors at two or more sites in the absence of pulmonary metastases. Methods: A 55-year-old man initially presented with low back pain. Multiple osteosclerotic lesions were observed, primarily in the spine and pelvis, as well as in soft tissues. Lung lesions were observed, but they were relatively small at reference. Laboratory tests showed a markedly elevated alkaline phosphatase (ALP) level of 36, 416 U/L (normal range, 115-359 U/L). Based upon a diagnosis of osteosarcoma on biopsy, chemotherapy was administered, resulting in a decrease in ALP to 17, 833 U/L. Results: Decompression of the symptomatic compressed spinal cord and posterior spinal stabilization of T8-12 were performed. However, progressive extensions of multiple lesions to the spinal canal led to paraplegia with urinary dysfunction. Eleven months after the first visit to our hospital, the patient died due to multiple organ failure. Conclusions: Multifocal osteosarcoma accompanied by spinal lesions may lead to paraplegia, a clinical problem that negatively affects the quality of activities of daily living. Level of Evidence 4. Clinical Relevance: Multifocal osteosarcoma accompanied by spinal lesions may lead to paraplegia, a clinical problem that negatively affects the quality of life and activities of daily living

多変量解析を用いた万葉短歌の書式分類について : 『柿本人麻呂歌集』論として

田中登教授古稀記念特集

スパース正準判別分析に基づく万葉短歌の作者の分類とその特徴付け

万葉歌の研究において，歌の音の使用傾向から歌人の特徴を捉える場合がある．それぞれの歌人の使用している音の癖を読み取ろうとするものである．しかし，これまでは歌内で多く使用されている，もしくはほとんど使用されていない単一の音のみに着目した単変量的な解析や主観的な判断がほとんどであった．本論文では，複数の音を考慮に入れた統計解析を実行し，歌人の分類ならびにその音に基づいた特徴付けについて考察する．具体的には，まず，柿本人麻呂，山上憶良，大伴旅人の3 歌人の短歌に着目し，各短歌内で使用されている音節から特徴量を作成する．その後，得られたデータに対してスパース正準判別分析を適用することにより，歌人の分類と各歌人に特徴的な音節の選択を行う

A VCP modulator, KUS121, as a promising therapeutic agent for post-traumatic osteoarthritis

京大開発の薬剤「KUS121」の変形性膝関節症への効果を確認 --外傷性変形性関節症の治療薬として臨床応用へ--. 京都大学プレスリリース. 2020-12-17.Post-traumatic osteoarthritis (PTOA) is a major cause which hinders patients from the recovery after intra-articular injuries or surgeries. Currently, no effective treatment is available. In this study, we showed that inhibition of the acute stage chondrocyte death is a promising strategy to mitigate the development of PTOA. Namely, we examined efficacies of Kyoto University Substance (KUS) 121, a valosin-containing protein modulator, for PTOA as well as its therapeutic mechanisms. In vivo, in a rat PTOA model by cyclic compressive loading, intra-articular treatments of KUS121 significantly improved the modified Mankin scores and reduced damaged-cartilage volumes, as compared to vehicle treatment. Moreover, KUS121 markedly reduced the numbers of TUNEL-, CHOP-, MMP-13-, and ADAMTS-5-positive chondrocytes in the damaged knees. In vitro, KUS121 rescued human articular chondrocytes from tunicamycin-induced cell death, in both monolayer culture and cartilage explants. It also significantly downregulated the protein or gene expression of ER stress markers, proinflammatory cytokines, and extracellular-matrix-degrading enzymes induced by tunicamycin or IL-1β. Collectively, these results demonstrated that KUS121 protected chondrocytes from cell death through the inhibition of excessive ER stress. Therefore, KUS121 would be a new, promising therapeutic agent with a protective effect on the progression of PTOA