Vitamin D deficiency promotes intracranial aneurysm rupture.

Intracranial aneurysm rupture causes severe disability and high mortality. Epidemiological studies show a strong association between decreased vitamin D levels and an increase in aneurysm rupture. However, the causality and mechanism remain largely unknown. In this study, we tested whether vitamin D deficiency promotes aneurysm rupture and examined the underlying mechanism for the protective role of vitamin D against the development of aneurysm rupture utilizing a mouse model of intracranial aneurysm. Mice consuming a vitamin D-deficient diet had a higher rupture rate than mice with a regular diet. Vitamin D deficiency increased proinflammatory cytokines in the cerebral arteries. Concurrently, vitamin D receptor knockout mice had a higher rupture rate than the corresponding wild-type littermates. The vitamin D receptors on endothelial and vascular smooth muscle cells, but not on hematopoietic cells, mediated the effect of aneurysm rupture. Our results establish that vitamin D protects against the development of aneurysmal rupture through the vitamin D receptors on vascular endothelial and smooth muscle cells. Vitamin D supplementation may be a viable pharmacologic therapy for preventing aneurysm rupture.

Optimal methods for estimating sports vision in kendo athletes.

This study investigated whether the eight standard tests of sports vision used in Japan appropriately reflect sports vision; whether all eight tests are necessary; and if not, which combination yields the optimal model. Participants were kendo practitioners (exercise group, n = 41) and those with no exercise habits (non-exercise group, n = 65). The performance of the two groups on all eight tests were compared. The groups differed in static visual acuity, kinetic visual acuity, and eye/hand coordination. A high correlation (r = 0.75) was observed between static visual acuity and kinetic visual acuity, while contrast sensitivity was moderately correlated with static visual acuity and kinetic visual acuity (r = 0.6), and dynamic visual acuity was moderately correlated with eye/hand coordination (r = - 0.66). Logistic regression analysis indicated that it is not necessary to conduct all eight tests; the optimal model included static visual acuity, visual reaction time, and eye/hand coordination. Our results suggest that static visual acuity, visual reaction time, and eye/hand coordination are sufficient for assessing visual function in kendo practitioners. For other sports, it may be possible to construct discriminative models using the same method and determine which aspects of visual function and which training methods to emphasise in a given sport.

Combination therapy with gemcitabine and nab-paclitaxel for locally advanced unresectable pancreatic cancer.

The aim of the present study was to investigate the early treatment outcomes of combined gemcitabine and nab-paclitaxel treatment for locally advanced unresectable pancreatic cancer (LURPC). The subjects comprised 7 patients with LURPC receiving the abovementioned combination therapy at the Hirosaki University Hospital (Hirosaki, Japan) between January and September, 2015. The clinicopathological factors, adverse events and response to treatment were investigated. To determine whether the cases were unresectable, the National Comprehensive Cancer Network guidelines, version 2. 201,) were applied. The patients underwent a median of 4 (range, 2-7) courses of treatment. The response to treatment was evaluated using the Response Evaluation Criteria In Solid Tumors. The subjects included 1 male and 6 female LURPC patients, with a median age of 71 years (range, 59-78 years). The tumor was located in the head and body of the pancreas in 6 and 1 patients, respectively. No patients achieved a complete response, 5 achieved a partial response, 2 had stable disease, and none exhibited progressive disease. The response rate was 71%. The mean tumor diameter decreased significantly from 35 mm (range, 24-60 mm) prior to treatment to 22 mm (range, 20-35 mm) following treatment. Two patients were downstaged. The mean carbohydrate antigen (CA) 19-9 values decreased significantly from 767 U/ml (range, 14-1,977 U/ml) prior to treatment to 35 U/ml (range, 14-123 U/ml) following treatment. Adverse events classified as grade ≥3 occurred in 4 patients (57%): 3 patients (43%) suffered from neutropenia and 1 patient (14%) developed bilateral cellulitis of the lower extremities. No patients experienced an increase in disease severity, and all were able to continue treatment following temporary withdrawal or dosage reduction. Therefore, combined treatment with gemcitabine and nab-paclitaxel had favorable tumor-reducing effects and was not associated with severe adverse events, suggesting that this is a useful therapeutic strategy for patients with LURPC.

The Dramatic Recovery of a Patient with Biguanide-associated Severe Lactic Acidosis Following Thiamine Supplementation.

Biguanides are a drug of choice for the treatment of type 2 diabetes mellitus. Although they can cause lactic acidosis in susceptible patients with predisposing risk factors, the incidence of lactic acidosis is reported to be very low when they are used properly. We herein present a case of biguanide-associated severe lactic acidosis complicated with thiamine deficiency that was provoked without predisposing factors for thiamine deficiency. Diabetic patients taking biguanide may be predisposed to thiamine deficiency, even when there is no evidence of risk factors, and the high-dose administration of thiamine may be essential in the treatment of this otherwise under-recognized disorder.

Postcontraction hyperemia after electrical stimulation: potential utility in rehabilitation of patients with upper extremity paralysis.

The purpose of this study was to compare postcontraction hyperemia after electrical stimulation between patients with upper extremity paralysis caused by upper motor neuron diseases and healthy controls. Thirteen healthy controls and eleven patients with upper extremity paralysis were enrolled. The blood flow in the basilic vein was measured by ultrasound before the electrical stimulation of the biceps brachii muscle and 30 s after the stimulation. The stimulation was performed at 10 mA and at a frequency of 70 Hz for 20 s. The mean blood flow in the healthy control group and in upper extremity paralysis group before the electrical stimulation was 60 ± 20 mL/min (mean ± SD) and 48 ± 25 mL/min, respectively. After the stimulation, blood flow in both groups increased to 117 ± 23 mL/min and 81 ± 41 mL/min, respectively. We show that it is possible to measure postcontraction hyperemia using an ultrasound system. In addition, blood flow in both groups increased after the electrical stimulation because of postcontraction hyperemia. These findings suggest that evaluating post contraction hyperemia in patients with upper extremity paralysis can assess rehabilitation effects.

[Study of unresectable pancreatic cancer - successful resections after gemcitabine-based chemotherapy].

Pancreatic ductal adenocarcinoma( PDAC) is an extremely malignant tumor and carries a poor prognosis. Therefore, PDAC should be treated with multiple modalities. Chemotherapy has proven effective in some cases of unresectable (UR) PDAC, and there are published reports of cases in which curative surgery could be performed after chemotherapy. We examined the cases from January 2010 through November 2012 in which initially UR PDAC could be treated surgically after chemotherapy. Whether or not each cancer was resectable was evaluated according to the National Comprehensive Cancer Network (NCCN) guidelines. We performed surgery in 7 of the 25 patients initially diagnosed as UR during this period. The cancer proved inoperable in 2 of these 7 patients: 1 patient with peritoneal dissemination and 1 with locally advanced tumor. Some reports have suggested that resection after chemotherapy for UR pancreatic cancer improved the prognosis in patients relative to those in whom surgery was not attempted. From our experience, we believe that it very important for patients undergoing chemotherapy for UR pancreatic cancer to consider surgical treatment.