うつ症状が室温低値と血圧高値の関連に及ぼす影響

Objectives: Cold exposure accounts for more than 7% of all-cause mortality worldwide, and cold-induced blood pressure (BP) elevation and consequent cardiovascular events are partially responsible. For prevention, it is important to identify risk factors for exaggerated temperature-sensitivity of BP but this is not fully understood. This study investigated whether depressive symptoms affect the relationship between indoor temperature and BP. Methods: We conducted a cross-sectional analysis of 1076 community-based individuals who were at least 60 years of age. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale at a cutoff point of 4/5. We performed ambulatory BP monitoring and indoor temperature measurement on two consecutive days during the cold season in Nara, Japan. Results: When using daytime SBP as a dependent variable, multilevel linear regression analyses showed that lower daytime indoor temperature was significantly associated with higher daytime SBP in the depressive group (n = 216, β = -0.804, P < 0.001) but not in the nondepressive group (n = 860, β = -0.173, P = 0.120); moreover, a significant interaction between depression and daytime indoor temperature was observed (P = 0.014). These relationships were independent of potential confounders including age, gender, BMI, medications, and physical activity. Similar results were obtained for morning SBP, nocturnal SBP dipping, and morning BP surge. Conclusion: The results suggest that depressive participants are more likely to have cold-induced BP elevation than nondepressive participants. Further longitudinal studies are warranted to determine whether people with depressive symptoms are at a high risk for cold-related cardiovascular events.博士（医学）・甲第859号・令和5年3月15

A Case of Obstetrical DIC Probably Due to Uterine Type of Amniotic Fluid Embolism during Cesarean Section

A 42-year-old woman diagnosed as marginal placenta previa underwent cesarean section and bilateral tubal ligation under general anesthesia in 37th gestational week. Uterine contraction after delivery was good, but atonic bleeding progressed during tubal ligation. Oxytocic drugs were ineffective. We suspected obstetrical DIC and started treatment for DIC immediately, but the bleeding lasted. After total hysterectomy, she had stable vital signs. She broke away from DIC immediately after surgery. Intraoperative findings were satisfied the criteria for clinical uterine type amniotic fluid embolism (AFE). Although AFE indicates a bad prognosis, we saved her without any sequelae

Magnetic anisotropy driven by ligand in 4d transition metal oxide SrRuO3

The origin of magnetic anisotropy in magnetic compounds is a longstanding issue in solid state physics and nonmagnetic ligand ions are considered to contribute little to magnetic anisotropy. Here, we introduce the concept of ligand driven magnetic anisotropy in a complex transition-metal oxide. We conducted X ray absorption and X ray magnetic circular dichroism spectroscopies at the Ru and O edges in the 4d ferromagnetic metal SrRuO3. Systematic variation of the sample thickness in the range below 10 nm allowed us to control the localization of Ru 4d t2g states, which affects the magnetic coupling between the Ru and O ions. We found that the orbital magnetization of the ligand induced via hybridization with the Ru 4d orbital determines the magnetic anisotropy in SrRuO3

Treatment algorithm of ACTH deficiency

Objective : To examine diagnostic performance of corticotropin-releasing hormone (CRH) test combined with baseline dehydroepiandrosterone sulfate (DHEA-S) in patients with a suspect of central adrenal insufficiency. Methods : Patients (n=215) requiring daily or intermittent hydrocortisone replacement, or no replacement were retrospectively checked with their peak cortisol after CRH test and baseline DHEA-S. Results : None of 106 patients with the peak cortisol ≥ 17.5 μg / dL after CRH test required replacement, and all 64 patients with the peak cortisol < 10.0 μg / dL required daily replacement. Among 8 patients with 10.0 μg / dL ≤ the peak cortisol < 17.5 μg / dL and baseline DHEA-S below the reference range, 6 patients required daily replacement and 1 patient was under intermittent replacement. Among 37 patients with 10.0 μg / dL ≤ the peak cortisol < 17.5 μg / dL and baseline DHEA-S within the reference range, 10 and 6 patients were under intermittent and daily replacement, respectively. Conclusions : No patients with the peak cortisol ≥ 17.5 μg / dL required hydrocortisone replacement, and all patients with the peak cortisol below 10.0 μg / dL required daily replacement. Careful clinical evaluation was required to determine requirement for replacement in patients with 10.0 μg / dL ≤ the peak cortisol < 17.5 μg / dL even in combination with baseline DHEA-S