Neuroprotective Effects of Lutein in the Retina

Although a large variety of pharmaceutical therapies for treating disease have been developed in recent years, there has been little progress in disease prevention. In particular, the protection of neural tissue is essential, because it is hardly regenerated. The use of nutraceuticals for maintaining the health has been supported by several clinical studies, including cross-sectional and interventional studies for age-related macular disease. However, mechanistic evidence for their effects at the molecular level has been very limited. In this review, we focus on lutein, which is a xanthophyll type of carotenoid. Lutein is not synthesized in mammals, and must be obtained from the diet. It is delivered to the retina, and in humans, it is concentrated in the macula. Here, we describe the neuroprotective effects of lutein and their underlying molecular mechanisms in animal models of vision-threatening diseases, such as innate retinal inflammation, diabetic retinopathy, and light-induced retinal degeneration. In lutein-treated mouse ocular disease models, oxidative stress in the retina is reduced, and its downstream pathological signals are inhibited. Furthermore, degradation of the functional proteins, rhodopsin (a visual substance) and synaptophysin (a synaptic vesicle protein also influenced in other neurodegenerative diseases such as Alzheimer’s disease and Parkinson’s disease), the depletion of brain-derived neurotrophic factor (BDNF), and DNA damage are prevented by lutein, which preserves visual function. We discuss the possibility of using lutein, an antioxidant, as a neuroprotective treatment for humans

ショクドウガン シュジュツチュウ ニ シンシツ サイドウ オ ショウジ キュウメイシエタ イチレイ

The patient was６０years old, man. He is in the hospital with diabetes and spinal cord injury, admitted passing disorder, diagnosed with advanced esophageal cancer, and introduced to our hospital. Start the chemotherapy following systemic examination became operative after completion chemotherapy. Chest operation is carried out under full thoracoscopy, the end without any problems. Abdominal operation is done laparoscopy, towing the thoracic esophagus into the abdominal cavity, who developed ventricular fibrillation in a few minutes after the esophageal hiatus became a release. Immediately start cardiopulmonary resuscitation, underwent defibrillation, it was restored to the normal waveform. It was restarted operation. Reconstruction using a gastric tube, in the chest wall before route, was anastomosis in the neck. The postoperative course good, rather than after-effects and postoperative complications, and it was discharged on day ３４. Esophageal cancer surgery is a highly invasive surgical procedure, there is a high frequency of arrhythmia will develop. We ventricular fibrillation develop in the esophagus resection surgery, and that a reported rare example that was life-saving

Natural Course of Pachychoroid Pigment Epitheliopathy

PURPOSE: To investigate the natural course of pachychoroid pigment epitheliopathy (PPE). DESIGN: A retrospective cohort study. SUBJECTS: From the Kyoto central serous chorioretinopathy (CSC) cohort consisting of 548 patients with CSC as of September 2020, we included consecutive unilateral patients with acute or chronic CSC between January 2013 and December 2016. METHODS: All patients underwent complete ophthalmic examination, including multimodal imaging such as fundus autofluorescence, spectral-domain optical coherence tomography, and fluorescein angiography/indocyanine green angiography and/or optimal coherence tomography angiography. The fellow eyes of eyes diagnosed with CSC were screened for PPE, and their natural course was evaluated. We also evaluated the association of ARMS2 rs10490924, CFH rs800292, TNFRSF10A rs13278062, and GATA5 rs6061548 genotypes with the natural course. MAIN OUTCOME MEASURES: Incidence of CSC, pachychoroid neovasculopathy, and pachychoroid geographic atrophy (GA). RESULTS: In total, 165 patients with unilateral CSC (mean age, 55.7 ± 12.6 years; female, 22.4%) were included from the Kyoto CSC cohort. Among them, 148 (89.7%) were diagnosed as having PPE in their non-CSC eye. Survival analysis revealed that 16.8% of PPE eyes developed CSC during the 6-year follow up, whereas non-PPE eyes did not. Although genetic factors did not have significant association with CSC development (P > 0.05, log-rank test), choroidal vascular hyperpermeability (CVH) and subfoveal choroidal thickness (SFCT) were significantly associated with CSC incidence (P = 0.001, log-rank test). Survival analysis showed that eyes without CVH and eyes with SFCT < 300 μm did not develop CSC during the 6-year follow-up. Pachychoroid neovasculopathy developed in only 1 eye with PPE during a follow-up of 46.4 months. Pachychoroid GA did not develop in any of the studied eyes. CONCLUSIONS: This study revealed a natural history of PPE in a relatively large Japanese cohort. Choroidal vascular hyperpermeability and SFCT were significant risk factors for the development of CSC in PPE eyes. Although the current results cannot be generalized for all eyes with PPE, these findings present an important clinical implication

Toward standardization of “reasonable accommodation” for students with disabilities by evaluating its validity

障害学生支援における合理的配慮の妥当性評価を行い，その結果で基準案を作成することを目的とする。障害学生支援または保健管理に携わるスタッフ７名が，仮想事例５事例（聴覚，肢体不自由，発達障害２例，内部障害）に対して，合理的配慮例（授業の情報保障，欠席時の対応，履修基準に関わること，連絡，実習（教育実習，臨床実習），グループ学習・実験，試験，生活支援にも係ること，課外活動，研修会など計80例）について，合理的配慮として妥当性を評価した。妥当性は９段階評価で採点し，「１点：妥当でない ←→５点：中間 ←→９点：妥当」とし，それぞれのスタッフが独立して絶対評価した。さらに，回答者は，全員の１回目の集計結果を見て，再度回答し，デルファイ法に準じて集約を試みた。その結果いずれの仮想事例においても共通して妥当性が「中位」以上とされた事項は，「病院受診のための欠席時には講義の資料が欲しい」，「レポート課題の期限延長」，「重要事項，急な予定変更は，学生用電子掲示板システムへの掲示又は文書で明示」，「事前に作業工程，制限時間，注意事項等を文書で具体的に明示」，「申請，書類作成等に関する助言」，「就労移行支援事業所と連携した就労支援」，「支援関係学生教職員に啓発講習会を開催」であった。その他個々の事例に応じたものがあった。支援の対象も，内容・範囲もますます多様となり，障害学生支援を，より効果的に実施するためには，本人・関係者間での建設的な相談・対話が重要である。その前提として，支援者側はどのような支援が必要であるかの一般的知識と，必要度の定量的評価も知っておくことが有用と考えられた。The purpose of this study was to evaluate the validity of the rational consideration of reasonable accommodations to be made for students with disabilities and to draft an appropriate standard. Seven health management or student support professionals involved in this study. Five fictional cases of disabilities (auditory impairment, physical disability, developmental disorder (2 cases), internal disability) and 80 examples of reasonable accommodations were prepared. The participants evaluated the validity of each example on a scale of 1 to 9. The results were revised and aggregated in accordance with the Delphi method. Examples of reasonable accommodations commonly evaluated as “moderately or highly valid” among the participants were as follows. “Providing lecture materials in absence due to hospital visit”, “Extending the deadline for submission of papers”, “Notification of schedule changes online or by sending notes”, “Prior notification in writing of processes, time limits, and precautions”, “Giving necessary advice on filling out application and other forms”, “Providing transition support for employment”, and “Holding workshops on disability support for faculty, staff, and students”. Constructive dialogue with students with disabilities is important to determine the most effective support methods. Moreover, it is also useful to know which reasonable accommodations are considered highly “valid” or “reasonable” based on quantitative evaluations.本研究の一部はJSPS科研費15K01683「心身の疾病・発達障害等のある学生への合理的配慮の基準に関する検討」の助成を受けた。また，本研究の一部は第46回中国四国大学保健管理研究集会（H28.8.26，広島市），第47回中国四国大学保健管理研究集会（H29.8.25，高知市），第55回全国大学保健管理研究集会（H29.11.29，沖縄県宜野湾市）において発表した

Role of PERK in mitochondrial function

Mitochondria play a central role in the function of brown adipocytes (BAs). Although mitochondrial biogenesis, which is indispensable for thermogenesis, is regulated by coordination between nuclear DNA transcription and mitochondrial DNA transcription, the molecular mechanisms of mitochondrial development during BA differentiation are largely unknown. Here, we show the importance of the ER-resident sensor PKR-like ER kinase (PERK) in the mitochondrial thermogenesis of brown adipose tissue. During BA differentiation, PERK is physiologically phosphorylated independently of the ER stress. This PERK phosphorylation induces transcriptional activation by GA-binding protein transcription factor α subunit (GABPα), which is required for mitochondrial inner membrane protein biogenesis, and this novel role of PERK is involved in maintaining the body temperatures of mice during cold exposure. Our findings demonstrate that mitochondrial development regulated by the PERK–GABPα axis is indispensable for thermogenesis in brown adipose tissue

チョウ カイテン イジョウショウ オ トモナッタ オウコウ ケッチョウガン ニ タイシテ フククウキョウ ホジョカ ケッチョウ セツジョジュツ オ シコウ シタ 1レイ

A ６４-year-old woman with complaint of intermittent abdominal pain for one year was admitted to our hospital. She had been diagnosed as transverse colon cancer by barium enema and colonoscopy at the former hospital. Abdominal enhanced CT showed that the duodenal third portion was not detected at the back of superior mesenteric vessel. She underwent laparoscopic surgery based on a diagnosis of transverse colon cancer with intestinal malrotation. We could perform laparoscopic-assisted transverse colectomy using abdominal enhanced CT which was effective for not only preoprerative diagnosis of accompany of intestinal malrotation but also anatomical anomalies of vessels. The right sided colon which was not fixed to the retroperitoneum in cases with intestinal malrotation could be pulled out easily from the small incision wound. We also considered that colectomy and dissection of its lymph nodes to these cases could be safety performed using by laparoscopy and through small laparotomy

ダイモウ ゲンパツ キョダイ GIST 1セツジョレイ

We report a case of giant gastrointestinal stromal tumor（GIST）primarily occurred in the greater omentum. A７８-year-old woman was referred to our hospital because of a giant abdominal tumor. Contrast-enhanced abdominal computed tomography（CT）showed a giant tumor measuring ２０×２４×１３cm in diameter in the abdominal cavity, consisting of heterogeneously enhanced solid and cystic lesions. Abdominal magnetic resonance imaging（MRI）after ３ weeks from the first medical examination showed the enlarged tumor measuring２４×２５×１７cm in diameter, the intensity of the solid lesion was low on T１weighted image, heterogeneously enhanced on T２weighted image and high on diffusion weighted image. At surgery, we confirmed the giant tumor continued to the omentum, and pressured the stomach, pancreas, and colon. The resected specimen weighed ８，３２５g containing of５，６４０ml of red-brown fluid. Histological examination showed the tumor consisted of proliferated spindle cells in a fascicular pattern and polynesic hemorrhage and necrosis. Immunohistochemically, the tumor cells were positive for c-kit and CD３４, and negative for S‐１００ protein and desmin, indicating a GIST in the greater omentum. The mitotic figures were in a４０／５０ high power field. In genetic testing, the tumor cells had exon１１mutation of c-kit gene. The woman started taking imatinib after operation and remains alive and recurrence-free