Reappraisal of the Cerebral Blood Flow Measured Using 123I-I-iodoamphetamine Single-photon Emission Computed Tomography in Normal Subjects and Patients with Alzheimer’s Disease and Dementia with Lewy Bodies

Purpose: Our aim was to re-evaluate the usefulness of perfusion single-photon emission computed tomography (SPECT) for the diagnosis of AD and DLB.Methods: A total of 1,232 patients, including 180 cognitively normal subjects (NSs), 148 patients with amnestic mild cognitive impairment (aMCI), 802 patients with AD and 102 patients with dementia with Lewy bodies (DLB) were enrolled. A voxelbasedstereotactic extraction estimation analysis was used to assess hypoperfusion areas using the cut-off value of 20% for the “extent %” and >2 hypoperfused lesions.Results: The top 10 areas with hypoperfusion in AD were the angular gyrus, supramarginal gyrus, precuneus, superior occipital gyrus, inferior parietal lobule, middle temporal gyrus, superior parietal lobule, inferior temporal gyrus, superior temporal gyrus. and posterior cingulate, while DLB had 6 areas in common with AD. The respective sensitivity and specificity for differentiating AD from NSs were 84.2% and 78.9% for 50-59 years old, and 91.8% and 70.0% for 60-69 years old, butthose values decreased from 70 years old. The respective sensitivity and specificity in DLB patients were 100% and 75.6% for 50-69 years old, 84.6% and 70.1% for 70-79 years old and 81.4% and 77.1% for 80-89 years old. In aMCI patients, the 1-year change in the MMSE scores was -2.38±2.02 (n=16) in patients with abnormal SPECT images and -0.67±1.81 (n=18) in those with normal SPECT images (P<0.02).Conclusions: Our study confirms that perfusion SPECT is still a valid alternative for the diagnosis of AD and DLB when fluorodeoxyglucose-PET is unavailable

ヘキチ イリョウ キョテン ビョウイン ニオケル センモン ガイライ ノ カンジャ ジュリョウ ドウコウ ニ オヨボス エイキョウ

There were few reports about the role of medical specialists in community medicine organizations such as hospitals in rural area where the number of doctors is insufficient. The aim of this study was to investigate the effect of a medical specialist for collagen vascular diseases having started periodically ambulatory care in the medical institution of the area where the specialist was absent. We examined the trend of outpatients with a collagen vascular disease about moving the hospital comparing before and after the specialist started to work in the medical institution. The number of outpatients with a collagen vascular disease in the medical institution became 95 at 3 years and a half after the specialist started to work there. There were many transfer patients from medical institutions other than the area, and the distance from their home to the hospital was shortened by changing the hospital in most of patients. The ambulatory care performed periodically and continuously by the specialist in a community medicine organization showed significances that patients became to receive the special medical care by the specialist

ゼンシッカン オ タイショウ トスル リハビリテーション ノ ガイネン : シッカン ニ カカワラナイ ソウキ ドウニュウ ノ ユウコウセイ

The right Japanese translation of rehabilitation is a “return” and is not the meaning “training.” It is a cure aiming at returning to the state before suffering from the illness in the body, soul, and social environment. Therefore, the rehabilitation should be performed to not only bone and joint diseases and apoplexy but also other diseases or states including infectious diseases and the state after surgery. Patients who are compulsorily stayed on the bed for a long time, especially in an acute care ward, easily become bedridden with various complications such as gait or eating disorder. It is important to try for all the staff in connection with medical care to have a rehabilitation concept, and to return a patient to the former condition falling ill

Atopic Dermatitis in Mouth Breathers

As mouth breathing is associated with asthma and otitis media, it may be associated with other diseases. Therefore, this population-based cross-sectional study evaluated the association of mouth breathing with the prevalences of various diseases in children. Preschool children older than 2 years were included. A questionnaire was given to parents/guardians at 13 nurseries in Tokushima City. There were 468 valid responses (45.2%). We defined a subject as a mouth breather in daytime (MBD) if they had 2 or more positive items among the 3 following items: “breathes with mouth ordinarily,” “mouth is open ordinarily,” and “mouth is open when chewing.” We defined subjects as mouth breathers during sleep (MBS) if they had 2 or more positive items among the following 3 items: “snoring,” “mouth is open during sleeping,” and “mouth is dry when your child gets up.” The prevalences of MBD and MBS were 35.5%and 45.9%, respectively. There were significant associations between MBD and atopic dermatitis (odds ratio [OR]: 2.4, 95% confidence interval [CI]: 1.4–4.2), MBS and atopic dermatitis (OR: 2.4, 95% CI: 1.3–4.2), and MBD and asthma (OR: 2.2, 95% CI: 1.2–4.0). After adjusting for history of asthma and allergic rhinitis; family history of atopic dermatitis, asthma, and allergic rhinitis; and nasal congestion; both MBD (OR: 2.6, 95% CI: 1.3–5.4) and MBS (OR: 4.1, 95% CI: 1.8–9.2) were significantly associated with atopic dermatitis. In preschool children older than 2 years, both MBD and MBS may be associated with the onset or development of atopic dermatitis

Single-Cell Analysis of the Multicellular Ecosystem in Viral Carcinogenesis by HTLV-1

成人T細胞白血病リンパ腫の多段階発がん分子メカニズムを解明 --難治性疾患の新規治療標的候補を複数同定--. 京都大学プレスリリース. 2021-09-07.Premalignant clonal expansion of human T-cell leukemia virus type-1 (HTLV-1)–infected cells occurs before viral carcinogenesis. Here we characterize premalignant cells and the multicellular ecosystem in HTLV-1 infection with and without adult T-cell leukemia/lymphoma (ATL) by genome sequencing and single-cell simultaneous transcriptome and T/B-cell receptor sequencing with surface protein analysis. We distinguish malignant phenotypes caused by HTLV-1 infection and leukemogenesis and dissect clonal evolution of malignant cells with different clinical behavior. Within HTLV-1–infected cells, a regulatory T-cell phenotype associates with premalignant clonal expansion. We also delineate differences between virus- and tumor-related changes in the nonmalignant hematopoietic pool, including tumor-specific myeloid propagation. In a newly generated conditional knockout mouse model recapitulating T-cell–restricted CD274 (encoding PD-L1) gene lesions found in ATL, we demonstrate that PD-L1 overexpressed by T cells is transferred to surrounding cells, leading to their PD-L1 upregulation. Our findings provide insights into clonal evolution and immune landscape of multistep virus carcinogenesis

Treatment responses and their predictors in patients with rheumatoid arthritis treated with biological agents

Biological agents represent an important advancement in for the treatment of rheumatoid arthritis (RA), but there is a subset of patients who do not improve despite therapy. This study aimed to determine the efficacy of biological agents for RA and to identify clinical factors that are associated with their response. We studied 98 patients with RA who started an initiating biological agent which was selected from infliximab, etanercept, adalimumab and tociliximab at 4 medical institutions. Etanercept was the most frequently used biological agent followed by infliximab although there was a difference in the selection of the biological agents among medical institutions. We found that etanercept achieved the highest treatment response, remission rate and drug survival rate. A high disease activity in the baseline disease activity score-c-reactive protein (CRP) was shown to be a negative predictor of the treatment response, and high patient global assessment was significantly less likely to achieve a good response. At week 4, decreases in 28 swollen joint counts and CRP were useful as predictors for sustaining the efficacy up to week 48. These data demonstrate that assessments of the disease activity at baseline and the early treatment response may be useful in predicting the efficacy and drug survival rate of biological agents

Community-based clinical education increases motivation of medical students to medicine of remote area : comparison between lecture and practice

In this study, we administered a questionnaire to medical students to evaluate the effect of community-based clinical education on their attitudes to community medicine and medicine in remote area. Questionnaires were given 4 times to all the students from first-year to sixth-year. Of 95 students, 65 students (68.4%) who completed all questionnaires, were used in this study. The intensity of students’ attitudes was estimated by using visual analogue scale. The intensity of interest, a sense of fulfillment and passion in medicine of remote area was significantly increased　after the community-based practice. On the other hand, the level of understanding in medicine in remote area was increased by the lecture not by the practice. The intensity of desire both to become a generalist and a specialist was significantly increased when the grade went up. Most of sixth-year students desired to have abilities of a generalist and a specialist simultaneously. This study shows that the community-based practice is more meaningful in increasing motivation in medicine in remote area than the lecture, and suggests that it is　important to prepare more courses to　experience community medicine to increase the number of physicians who desire to work in remote area

スマートフォン ト インターネット オ モチイタ トクシマ ケンリツ カイフ ビョウイン エンカク イリョウ シエン システム k-support ノ ドウニュウ

Because a specialist in general medical treatment lacked the Kaifu area of South Tokushima absolutely, we forced a limited doctor to many burdens and performed medical treatment while I always carried risks on my back for the disease except the specialty domain. A stroke specialist in particular is an absent medical depopulated area, and it is difficult to perform the rt-PA IV therapy that is a standard therapy for a stroke for the immediate nature period. Using remote video diagnosis treatment supporting system SYNAPSE ERm that was the smartphone application that FUJIFILM developed for the purpose of canceling these, we introduced smartphone and Tokushima Prefectural Kaifu Hospital remoteness medical treatment support system （k-support） by the Internet as area medical treatment support in February, 2013. This system can provide image information and patient information such as CT or the MRI to a tablet phone and the smartphone of Tokushima Prefectural Kaifu Hospital full-time employment doctors and the doctors who support it, and work in a House in real time. In other words, we can obtain necessary information without asking the when and where and can send appropriate instructions, advice to the Tokushima Prefectural Kaifu Hospital medical attendant from a specialist for it. After introduction, the treatment with this system in 58 emergency patients was carried out in seven months until August 31. The example letting the wide area present the smartphone such as this system and a remote medical treatment support system using the Internet in the medical depopulated area is the first trial in this country