下部直腸癌におけるMRIを用いた歯状線浸潤の診断精度

Purpose: To retrospectively assess the accuracy of magnetic resonance imaging (MRI) in predicting dentate line invasion in low rectal cancer. Materials and methods: Eighty-one patients with primary rectal cancer were assessed by dynamic contrast-enhanced MRI. The location of the dentate line was assessed on MRI in 27 patients with upper-mid rectal cancer. Two observers independently evaluated the distance between the distal tumor edge and the MRI-defined dentate line in 54 patients with low rectal cancer, and the imaging and histological findings were compared. Results: The MRI-defined dentate line was 24.0 ± 3.8 mm above the anal verge in patients with upper-mid rectal cancer. The dentate line invasion status agreed with the histological findings in 49/54 (91%) patients (κ = 0.72 [95% CI 0.50-0.95]) for observer 1, and in 51/54 (94%) patients (κ = 0.83 [0.65-1.00]) for observer 2 in patients with low rectal cancer. Interobserver agreement was good (κ = 0.83 [0.65-1.00]). The MRI-derived distance between the distal tumor edge and the dentate line had significant correlation with the histological distance (r = 0.86 for reader 1 and 0.75 for observer 2). Conclusion: MRI demonstrates high accuracy in predicting dentate line invasion in low rectal cancer.博士（医学）・甲第748号・令和2年6月30日© Japan Radiological Society 2020© 2020 Springer Nature Switzerland AG. Part of Springer Nature.This is a post-peer-review, pre-copyedit version of an article published in Japanese journal of radiology. The final authenticated version is available online at: http://dx.doi.org/10.1007/s11604-020-00933-5

Impact of lifestyle and psychosocial factors on the onset of hypertension after the Great East Japan earthquake: a 7-year follow-up of the Fukushima Health Management Survey

Natural disasters force many evacuees to change several aspects of their lifestyles. This longitudinal study aimed to investigate whether factors such as living environment and lifestyle factors were related to new-onset hypertension in survivors of the Great East Japan Earthquake over a long-term follow-up of up to 7 years after the earthquake. The present study examined data collected from 29,025 Japanese participants aged 39-89 years, sourced from general health checkups and the Fukushima Mental Health and Lifestyle Survey, which was conducted in 13 communities between 2011 and 2018. A total of 10,861 participants received follow-up examinations. During a median follow-up of 4.3 years, 3744 participants (1588 men, 41.4%; 2,156 women, 30.7%) had newly developed hypertension. Heavy drinking (adjusted hazard ratio 1.38, 95% confidence interval 1.21-1.57, p < 0.001) and obesity (adjusted hazard ratio 1.27, 95% confidence interval 1.19-1.37, p < 0.001) were significantly associated with new-onset hypertension after the disaster in multivariate-adjusted analysis. Furthermore, experiencing evacuation after the disaster was also significantly associated with the risk of new-onset hypertension in men (adjusted hazard ratio 1.14, 95% confidence interval 1.02-1.27, p = 0.016). The present study indicated that lifestyle factors, such as drinking and obesity, and evacuation experience in men had significant effects on the risk of new-onset hypertension in the long term after the earthquake

Relationship between Psoriasis and Prevalence of Cardiovascular Disease in 88 Japanese Patients

Psoriasis is a systemic inflammatory disease known to affect survival in the presence of cerebral or cardiovascular comorbidities. However, no clear guidelines have been defined regarding the extent of vascular lesion testing that should be performed in patients with psoriasis. We therefore performed coronary computed tomography angiography (CCTA) in 88 Japanese patients with psoriasis who visited Kansai Medical University Hospital between 2015 and 2019 and determined the ankle–brachial pressure index (ABI) for 44 of these patients. CCTA abnormalities were found in 39 of the 88 patients, and a need for treatment was identified in 14 patients. The prevalence of cardiovascular lesions in these patients was 15.9%, significantly higher than that in the healthy Japanese population (6.38% according to the Suita Study). In the 44 patients with results for both ABI and CCTA, the rates of CCTA vascular lesions were significantly higher in cases with ABIs indicating hard vessels or above than in cases with supple, normal, or slightly stiff vessels. This is the first report to show a correlation between CCTA and ABI in psoriasis patients. ABI was considered useful as a preliminary test before CCTA. The univariate analysis of the abnormal and normal CCTA groups showed that the prevalence differed significantly among patients with psoriatic arthritis, erythrodermic psoriasis, older age, pre-existing conditions, drinking, and hypertension. The multivariate analysis showed correlations with arthritic or erythrodermic psoriasis

Characterization of a Novel Glucosamine-6-Phosphate Deaminase from a Hyperthermophilic Archaeon

A key step in amino sugar metabolism is the interconversion between fructose-6-phosphate (Fru6P) and glucosamine-6-phosphate (GlcN6P). This conversion is catalyzed in the catabolic and anabolic directions by GlcN6P deaminase and GlcN6P synthase, respectively, two enzymes that show no relationship with one another in terms of primary structure. In this study, we examined the catalytic properties and regulatory features of the glmD gene product (GlmD(Tk)) present within a chitin degradation gene cluster in the hyperthermophilic archaeon Thermococcus kodakaraensis KOD1. Although the protein GlmD(Tk) was predicted as a probable sugar isomerase related to the C-terminal sugar isomerase domain of GlcN6P synthase, the recombinant GlmD(Tk) clearly exhibited GlcN6P deaminase activity, generating Fru6P and ammonia from GlcN6P. This enzyme also catalyzed the reverse reaction, the ammonia-dependent amination/isomerization of Fru6P to GlcN6P, whereas no GlcN6P synthase activity dependent on glutamine was observed. Kinetic analyses clarified the preference of this enzyme for the deaminase reaction rather than the reverse one, consistent with the catabolic function of GlmD(Tk). In T. kodakaraensis cells, glmD(Tk) was polycistronically transcribed together with upstream genes encoding an ABC transporter and a downstream exo-β-glucosaminidase gene (glmA(Tk)) within the gene cluster, and their expression was induced by the chitin degradation intermediate, diacetylchitobiose. The results presented here indicate that GlmD(Tk) is actually a GlcN6P deaminase functioning in the entry of chitin-derived monosaccharides to glycolysis in this hyperthermophile. This enzyme is the first example of an archaeal GlcN6P deaminase and is a structurally novel type distinct from any previously known GlcN6P deaminase

Panniculitis in dermatomyositis: Two cases with antitranscriptional intermediary factor‐1 antibody as myositis‐specific antibody and review of the literature

Abstract Dermatomyositis (DM) is a systemic disease characterized by chronic inflammation in the skin and muscle. A variety of myositis‐specific autoantibodies (MSAs) are detected in patients with DM. These antibodies are associated with unique clinical subsets in DM. Panniculitis is a rare cutaneous manifestation of DM that most commonly presents as tender, erythematous subcutaneous nodules on the thighs, arms, and buttocks. We herein describe the clinical features of two DM‐associated panniculitis patients with anti‐TIF1 antibodies. Both are female patients and showed characteristic cutaneous features, including heliotrope rashes and Gottron's signs with muscle involvement. While one patient had a posterior mediastinum tumor, another had no cancer. Furthermore, to elucidate the clinical significance of anti‐TIF1 antibodies in DM patients with panniculitis, we analyzed all cases with detailed information on the clinical features, including MSAs. A PubMed search of keywords “panniculitis” and “DM” was conducted. We found 23 cases with the detection of MSAs. A review of these cases and our two cases revealed a predominance of female gender (80%) with a median age of 48 years. Anti‐MDA5 antibodies were detected in 11 patients (11/23, 48%), and anti‐TIF1 antibodies were observed in four patients, including the current cases (4/23, 17%). Anti‐Mi‐2 antibodies were observed in four patients (4/23, 17%). Each patient had anti‐NXP‐2 antibodies or anti‐SAE antibodies (2/23; 9%). Although the pathogenesis of panniculitis in DM remains unknown, differences in pathogenesis of DM‐associated panniculitis according to MSAs may exist. Accumulation of additional cases is required to clarify the relationship between panniculitis and MSAs

XPA Gene-Deficient, SCF-Transgenic Mice with Epidermal Melanin Are Resistant to UV-Induced Carcinogenesis

Photobiologic investigations have been performed using animals without epidermal melanocytes. We developed xeroderma pigmentosum group A gene-deficient (XPA (−/−)), stem cell factor transgenic (SCF-Tg) mice, which one defective in nucleotide excision repair and have epidermal melanocytes, and investigated protective effects of epidermal melanin against UV-induced injuries. When irradiated to UVB, XPA (−/−) mice developed greatly enhanced responses including acute inflammation, cyclobutane pyrimidine dimer (CPD) formation, keratinocyte apoptosis, depletion of Langerhans cells and immunosuppression of contact hypersensitivity, but XPA (−/−), SCF-Tg mice showed much less responses to the same dose of UVB. XPA (−/−), SCF-Tg mice did not develop skin cancers after repeated exposures to UVB for 30 wk at a total dose of 72 J per cm2, which induced a significant number of tumors even in wild-type, XPA (+/+) mice, and was lethal dose for XPA (−/−) mice. Dimethylbenz (α) anthracence (DMBA) induces DNA damages, which require XPA protein to be repaired. Topical application of DMBA produced a significant inflammation, CPD formation, apoptosis, immunosuppression, and skin cancers in XPA (−/−), SCF-Tg mice as well as XPA (−/−) mice. These findings indicate that epidermal melanin has a high ability to protect DNA damage by UVB radiation, and thereby, prevent UV-induced inflammation, immunosuppression, and carcinogenesis