チュウキョウ ダイガク シャカイ カガク ケンキュウジョ アーカイブズ ケンキュウ プロジェクト ヘン チホウ コウキョウ ダンタイ ニ オケル コウブンショ カンリ セイド ノ ケイセイ ゲンジョウ ト カダイ

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トドウフケン ニオケル コウブンショ ノ ヒョウカ センベツ ホウホウ ノ ゲンジョウ ブンセキ レコード スケジュール ホウシキ ドウニュウ ジョウキョウ ノ ルイケイカ ニヨル ハアク ノ ココロミ

The Public Records and Archives Management Act come into effect in 2011. This law was the first to introduce the records scheduling system in Japan. The system has since spread to the prefectures. However, few local public entities have adopted the system.This paper aims to analyze the current status and issues of appraisal of public records in Japanese Prefectural. Because of this, this study classifies appraisal systems of public records in Japanese Prefectural by timing and subject

Peritumoral radiomics features on preoperative thin-slice CT images can predict the spread through air spaces of lung adenocarcinoma

The spread through air spaces (STAS) is recognized as a negative prognostic factor in patients with early-stage lung adenocarcinoma. The present study aimed to develop a machine learning model for the prediction of STAS using peritumoral radiomics features extracted from preoperative CT imaging. A total of 339 patients who underwent lobectomy or limited resection for lung adenocarcinoma were included. The patients were randomly divided (3:2) into training and test cohorts. Two prediction models were created using the training cohort: a conventional model based on the tumor consolidation/tumor (C/T) ratio and a machine learning model based on peritumoral radiomics features. The areas under the curve for the two models in the testing cohort were 0.70 and 0.76, respectively ( = 0.045). The cumulative incidence of recurrence (CIR) was significantly higher in the STAS high-risk group when using the radiomics model than that in the low-risk group (44% vs. 4% at 5 years;  = 0.002) in patients who underwent limited resection in the testing cohort. In contrast, the 5-year CIR was not significantly different among patients who underwent lobectomy (17% vs. 11%;  = 0.469). In conclusion, the machine learning model for STAS prediction based on peritumoral radiomics features performed better than the C/T ratio model

Prevalence, reasons, and timing of decisions to withhold/withdraw life-sustaining therapy for out-of-hospital cardiac arrest patients with extracorporeal cardiopulmonary resuscitation

Background　Extracorporeal cardiopulmonary resuscitation (ECPR) is rapidly becoming a common treatment strategy for patients with refractory cardiac arrest. Despite its benefits, ECPR raises a variety of ethical concerns when the treatment is discontinued. There is little information about the decision to withhold/withdraw life-sustaining therapy (WLST) for out-of-hospital cardiac arrest (OHCA) patients after ECPR. Methods　We conducted a secondary analysis of data from the SAVE-J II study, a retrospective, multicenter study of ECPR in Japan. Adult patients who underwent ECPR for OHCA with medical causes were included. The prevalence, reasons, and timing of WLST decisions were recorded. Outcomes of patients with or without WLST decisions were compared. Further, factors associated with WLST decisions were examined. Results　We included 1660 patients in the analysis; 510 (30.7%) had WLST decisions. The number of WLST decisions was the highest on the first day and WSLT decisions were made a median of two days after ICU admission. Reasons for WLST were perceived unfavorable neurological prognosis (300/510 [58.8%]), perceived unfavorable cardiac/pulmonary prognosis (105/510 [20.5%]), inability to maintain extracorporeal cardiopulmonary support (71/510 [13.9%]), complications (10/510 [1.9%]), exacerbation of comorbidity before cardiac arrest (7/510 [1.3%]), and others. Patients with WLST had lower 30-day survival (WLST vs. no-WLST: 36/506 [7.1%] vs. 386/1140 [33.8%], p ConclusionFor approximately one-third of ECPR/OHCA patients, WLST was decided during admission, mainly because of perceived unfavorable neurological prognoses. Decisions and neurological assessments for ECPR/OHCA patients need further analysis

Impact of functional studies on exome sequence variant interpretation in early-onset cardiac conduction system diseases

Aims The genetic cause of cardiac conduction system disease (CCSD) has not been fully elucidated. Whole-exome sequencing (WES) can detect various genetic variants; however, the identification of pathogenic variants remains a challenge. We aimed to identify pathogenic or likely pathogenic variants in CCSD patients by using WES and 2015 American College of Medical Genetics and Genomics (ACMG) standards and guidelines as well as evaluating the usefulness of functional studies for determining them. Methods and Results We performed WES of 23 probands diagnosed with early-onset (<65 years) CCSD and analyzed 117 genes linked to arrhythmogenic diseases or cardiomyopathies. We focused on rare variants (minor allele frequency < 0.1%) that were absent from population databases. Five probands had protein truncating variants in EMD and LMNA which were classified as “pathogenic” by 2015 ACMG standards and guidelines. To evaluate the functional changes brought about by these variants, we generated a knock-out zebrafish with CRISPR-mediated insertions or deletions of the EMD or LMNA homologs in zebrafish. The mean heart rate and conduction velocities in the CRISPR/Cas9-injected embryos and F2 generation embryos with homozygous deletions were significantly decreased. Twenty-one variants of uncertain significance were identified in 11 probands. Cellular electrophysiological study and in vivo zebrafish cardiac assay showed that 2 variants in KCNH2 and SCN5A, 4 variants in SCN10A, and 1 variant in MYH6 damaged each gene, which resulted in the change of the clinical significance of them from “Uncertain significance” to “Likely pathogenic” in 6 probands. Conclusions Of 23 CCSD probands, we successfully identified pathogenic or likely pathogenic variants in 11 probands (48%). Functional analyses of a cellular electrophysiological study and in vivo zebrafish cardiac assay might be useful for determining the pathogenicity of rare variants in patients with CCSD. SCN10A may be one of the major genes responsible for CCSD. Translational Perspective Whole-exome sequencing (WES) may be helpful in determining the causes of cardiac conduction system disease (CCSD), however, the identification of pathogenic variants remains a challenge. We performed WES of 23 probands diagnosed with early-onset CCSD, and identified 12 pathogenic or likely pathogenic variants in 11 of these probands (48%) according to the 2015 ACMG standards and guidelines. In this context, functional analyses of a cellular electrophysiological study and in vivo zebrafish cardiac assay might be useful for determining the pathogenicity of rare variants, and SCN10A may be one of the major development factors in CCSD

The expression of transporter OATP2/OATP8 decreases in undetectable hepatocellular carcinoma by Gd-EOB-MRI in the explanted cirrhotic liver

Purpose: The aim of this study is to evaluate the detectability of hepatocellular carcinoma (HCC) in the explanted cirrhotic liver using gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-MRI) and the degree of organic anion transporter OATP2/OATP8 (OATP1B1/1B3) HCC which could not be preoperatively detected by multi-detector computed tomography (MD-CT) and Gd-EOB-MRI. Methods: Eleven patients (HBV 3, HCV 7, nonBnonC 1) out of 145 recipients of liver transplantation were analyzed. The detectability by each imaging modality and the expression of OATP2/OATP8 of HCC were analyzed using the whole liver thin sliced histological and immunohistochemical examination retrospectively. Results: The imaging examination detected 17 lesions of HCC by MDCT and/or Gd-EOB-MRI. Only one lesion detected by Gd-EOB-MRI had well differentiated and minute (7 mm) HCC. However, the histological examination revealed newly 11 lesions and one false-positive lesion of HCC in the explanted livers. The median diameter of the preoperatively undetectable HCC by imaging was 8 mm (2-12). The histological characteristic of the preoperatively undetectable HCC was well differentiated HCC (10/11). The accuracy rate in MDCT and Gd-EOB-MRI was 53.6 % (15/28) and 57.1 % (16/28). The rate of positive predictive value in MDCT and Gd-EOB-MRI was 93.7 % (15/16) and 94.2 % (16/17), respectively. The expression of OATP2/OATP8 in the preoperatively undetectable HCC was negative in nine lesions, was weak positive in two lesions. Conclusions: The detectability of Gd-EOB-MRI is almost equal to MDCT in a cirrhotic liver. Small HCCs were difficult to detect even with Gd-EOB-MRI. The transporter of OATP2/OATP8 was less expressed in the preoperatively undetectable HCCs