Alfacalcidol-Induced Kidney Injury in Patients with Severe Motor and Intellectual Disabilities.

Patients with severe motor and intellectual disabilities (SMID) often experience insufficient physical activity, leading to osteoporosis. The active form of vitamin D is commonly prescribed for the prevention or treatment of osteoporosis. We observed four cases of kidney injury believed to be associated with the administration of 1α-OH vitamin D (alfacalcidol) preparations. This study employed a case series design to investigate change in kidney function in SMID patients following administration or discontinuation of alfacalcidol. We retrospectively analyzed data of 23 SMID patients (sex: 10 males, 13 females; age range: 27 to 74 y), and assessed kidney function, serum calcium, and albumin levels. Data was grouped into A: 16 cases collected both before starting alfacalcidol administration and during alfacalcidol administration; and into B: 11 cases collected during alfacalcidol administration and after discontinuation of alfacalcidol administration. Of the 23 patients, four were assigned into both group A and group B. Of the 16 cases in group A, six showed ≥30% decreased kidney function. Of the 11 cases in group B, the median values of modified Cr-eGFR were 43.0 and 65.1 mL/min/1.73 m2, respectively (p=0.008), indicating a significant improvement in kidney function. It is essential for practitioners to understand that osteoporosis may ordinarily occur in SMID patients due to reduced bone stimulation. Thus caution must be exercised when administering active vitamin D preparations to this population, as they carry a risk of kidney organ damage despite having no direct effect on bone health.

Optimal Body Weights for Adults with Severe Motor and Intellectual Disabilities.

Determining the optimal body weight for individuals with severe motor and intellectual disabilities (SMID) lacks a standardized approach. In this study, we aimed to develop a formula to estimate the ideal body weight for each SMID patient, considering factors such as reduced muscle and bone mass. We analyzed data from 111 SMID patients (56 male, 55 female; age range 20 to 73 y) who underwent blood tests measuring creatinine (Cr) and cystatin C (cysC) for clinical reasons between Feb. 2018 and Feb. 2023. To create the optimal body weight formula, we utilized three variables: height, estimated glomerular filtration (eGFR)-Cr, and eGFR-cysC. The validity of the formula was assessed by comparing the measured triceps subcutaneous fat thickness (TSF) to the reference TSF (%TSF), evaluating how accurately it reflects the appropriate physique. The derived optimal body weight formula is as follows: Optimal body weight=(height)2×(18.5-25.0)×{1-0.41×(1-eGFR-cysC/eGFR-Cr)}×0.93. Our formula demonstrated validity when using %TSF as an indicator. Establishing a method to determine optimal body weight in SMID patients, considering their low muscle and bone mass, is crucial for accurate nutritional assessment and subsequent nutritional management.

Evaluation of eGFRs to Calculate Kidney Function in Adults with Severe Motor and Intellectual Disabilities.

Introduction: The gold standard for evaluating kidney function is kidney inulin clearance (Cin). However, this procedure is difficult to perform in patients with neuromuscular disabilities and/or bladder dysfunction. We aimed to develop a simpler method for determining the estimated glomerular filtration rate (eGFR) using equations and values for three biomarkers: serum creatinine (sCr), serum cystatin C (cysC), and serum beta-2 microglobulin (ß2MG). This study evaluated three eGFR equations in patients with severe motor and intellectual disabilities (SMID). Methods: We evaluated the equations using data of 18 adult SMID patients with a clinical need for creatinine clearance (Ccr). We compared the results of each equation with Ccr-based eGFR instead of Cin using mean error (ME), root mean square error (RMSE), and P30. Results: Based on eGFR, the ME values of Cr, cysC, ß2MG, and Ccr were 74.5, 2.3, and 6.5 mL/min/1.73 m2, RMSE values, 92.3, 25.7, and 33.4 mL/min/1.73 m2; and P30, 16.7%, 77.8%, and 72.2%, respectively. Conclusions: eGFR-Cr cannot be used to reliably assess kidney function in adult SMID patients. It is better to use eGFR-cysC to evaluate kidney function in this patient population.

Objective assessment of laparoscopic suturing skills using a motion-tracking system.

BACKGROUND: Laparoscopic suturing skills are important for advanced laparoscopic surgery. However, objective assessment of these skills has not yet been established. The aim of this study was to assess the laparoscopic suturing skills of novice and experienced surgeons using an electromagnetic motion-tracking system. METHODS: A total of 18 surgeons, who were all right-handed, were divided into the following two groups according to their experience as an operator in laparoscopic surgery: 9 novice surgeons (fewer than 10 laparoscopic procedures) and 9 experienced surgeons (more than 50 laparoscopic procedures). The subjects performed an intracorporeal suturing task in an inanimate box laparoscopic trainer while the movements of their forceps were evaluated using an electromagnetic motion-tracking system. Their laparoscopic skills were assessed on the basis of the time, path length, and average speed of the forceps in each hand. RESULTS: Experienced surgeons completed the suturing task significantly faster than novice surgeons did. The left path length was significantly shorter for experienced surgeons than for novice surgeons, whereas the right path lengths did not differ. The right average speed of knot tying was significantly faster for experienced surgeons than for novice surgeons, whereas the left average speeds did not differ. CONCLUSIONS: Evaluation of psychomotor skills in laparoscopic suturing using an electromagnetic motion-tracking system revealed better results for experienced surgeons than for novice surgeons in terms of the time taken, left path length, and right speed of knot-tying. Furthermore, surgical proficiency due to experience can affect surgical dexterity of each hand differently. The present study also demonstrates the efficacy of this system for objective evaluation of laparoscopic suturing skills.

Gastro-pancreaticostomy using a tube stent as a less invasive palliative treatment for malignant obstructive pancreatitis.

Surgical palliation of malignant obstructive pancreatitis poses a considerable burden to patients, especially those with extensive disease. We herein present a novel technique for performing gastro-pancreaticostomy using a tube stent as a less invasive palliative treatment for malignant obstructive pancreatitis. The main pancreatic duct was punctured via the wall of the pyloric antrum. After the insertion of a guidewire, a double pigtail-type tube stent with side holes was inserted into the main pancreatic duct through the wall of the pyloric antrum. This technique was useful as a means of accomplishing less invasive palliative treatment, and has the potential to improve the quality of life for patients with malignant obstructive pancreatitis.

Characteristics and treatment of congenital esophageal stenosis: A retrospective collaborative study from three Japanese children's hospitals.

BACKGROUND/PURPOSE: There is no consensus on treatment strategy of congenital esophageal stenosis (CES). This study aimed to assess appropriateness of the treatment we have provided to patients with CES over the past four decades. METHODS: We carried out a retrospective chart review of 83 CES patients treated at three children's hospitals between 1973 and 2015. Each patient underwent an initial treatment with either surgery or a series of dilation that was followed by surgery if dilation failed to improve esophageal transit. Demographic data, course of treatment, outcomes, and complications were analyzed. RESULTS: During this initial treatment, 19 and 64 patients underwent surgery and dilation, respectively. Out of the 64 patients who underwent dilations as an initial treatment, 26 patients eventually required surgery. Out of all patients who required surgery (19 initial treatments + 26 failed dilations), 29 had tracheobronchial remnants and 16 had fibromuscular hypertrophy. Six patients experienced esophageal perforation during dilation and ten experienced anastomotic leakage after surgery. No patients had swallowing difficulties at the latest follow up, 141(9-324) months. CONCLUSIONS: Dilation is recommended as an initial therapy, especially if histological diagnosis of CES is uncertain. Persistent swallowing difficulties after 2 series of dilation may be an indication for surgery. LEVELS OF EVIDENCE: level IV.

Prognostic nutritional index: a tool to predict the biological aggressiveness of gastric carcinoma.

PURPOSE: The prognostic nutritional index (PNI), which is calculated based on the serum albumin concentration and the peripheral blood lymphocyte count, has been used to assess the immunological and nutritional condition of patients with digestive diseases. However, its value as an indicator of aggressiveness in gastric carcinoma has not been fully investigated. METHODS: Two hundred and forty-eight cases of gastric carcinoma were studied with regard to the relationship between the preoperative PNI value and the clinicopathological characteristics of the patients. RESULTS: A lower preoperative PNI value significantly correlated with greater tumor depth, lymph node metastasis, lymphatic permeation, and venous invasion. Moreover, the PNI value proved to be an independent prognostic indicator in gastric carcinoma. CONCLUSION: The PNI value can be a useful tool to predict the prognosis of patients with gastric carcinoma.

Outcomes of Surgery for Thoracic Myelopathy Owing to Thoracic Ossification of The Ligamentum Flavum in a Nationwide Multicenter Prospectively Collected Study in 223 Patients: Is Instrumented Fusion Necessary?

STUDY DESIGN: Prospectively collected, multicenter, nationwide study. OBJECTIVE: The aim of this study was to investigate recent surgical methods and trends, outcomes, and perioperative complications in surgery for thoracic ossification of the ligamentum flavum (T-OLF). SUMMARY OF BACKGROUND DATA: A prospective multicenter study of surgical complications and risk factors for T-OLF has not been performed, and previous multicenter retrospective studies have lacked details for these items. METHODS: Surgical methods, pre- and postoperative thoracic myelopathy (Japanese Orthopedic Association [JOA] score), symptoms, and intraoperative neurophysiological monitoring were investigated prospectively in 223 cases. Differences in these factors between fusion and nonfusion procedures for T-OLF were examined. The minimum follow-up period was 2 years after surgery RESULTS.: The mean JOA score was 6.2 points preoperatively, and 7.9, 8.2, and 8.2 points at 6 months, 1, and 2 year postoperatively, giving mean recovery rates of 35.0%, 40.9%, and 41.4% respectively. Posterior decompression and fusion with instrumentation was performed in 109 cases (48.9%). There were 45 perioperative complications in 30 cases (13.5%), with aggravation of motor disturbance in the lower extremities being most common (4.0%, n = 9). Patients treated with fusion had a significantly higher BMI, rate of gait disturbance, ossification occupation rate of OLF at computed tomography, and intramedullary high intensity area at magnetic resonance imaging (P < 0.01). The preoperative JOA score was lower (P < 0.05) and the JOA recovery rate at 1 year after surgery was significantly higher in cases treated without fusion (44.9% vs. 37.1%, P < 0.05). CONCLUSION: The high rate of surgery with instrumentation of 48.9% reflects the current major trend toward posterior instrumented fusion surgery for T-OLF. Fusion surgery with instrumentation may be appropriate for patients with severe OLF and preoperative myelopathy. A further prospective study of long-term outcomes is required with a focus on optimal surgical timing and the surgical procedure for T-OPLL. LEVEL OF EVIDENCE: 3.

Tumor ablation therapy of liver cancers with an open magnetic resonance imaging-based navigation system.

BACKGROUND: As minimally invasive treatments for liver cancers, percutaneous ablation therapies represent a valid alternative to liver resections, especially in patients with poor liver function. Recently, image-guided surgical and interventional procedures using open magnetic resonance imaging (MRI) have been introduced. METHODS: We performed percutaneous ablation therapy for 51 nodules of liver cancer in 34 patients using a navigation system based on open MRI. During the ablation therapy, the ultrasonography (US) probe, needle, and tumor were displayed on the MR image. Immediately after the procedure, the therapeutic effect was evaluated by open MRI. RESULTS: In all cases, percutaneous puncture into the tumors was successful, even in the case of tumor undetectable by US. Mean fiducial registration error was approximately 3 mm. MR images captured after the procedure clearly demonstrated the ablated area. No mortality or major complications occurred, except for mild hemorrhage, pyrexia, and ascites. CONCLUSIONS: We developed a novel navigation system integrating US and MR images using open MRI for percutaneous ablation therapy of liver cancers. The presented system allows a safe and accurate approach to liver cancers, especially certain tumors that cannot be adequately visualized by US, and an evaluation of therapeutic results immediately after the procedures.

Construct validity for eye-hand coordination skill on a virtual reality laparoscopic surgical simulator.

BACKGROUND: This study was carried out to investigate whether eye-hand coordination skill on a virtual reality laparoscopic surgical simulator (the LAP Mentor) was able to differentiate among subjects with different laparoscopic experience and thus confirm its construct validity. METHODS: A total of 31 surgeons, who were all right-handed, were divided into the following two groups according to their experience as an operator in laparoscopic surgery: experienced surgeons (more than 50 laparoscopic procedures) and novice surgeons (fewer than 10 laparoscopic procedures). The subjects were tested using the eye-hand coordination task of the LAP Mentor, and performance was compared between the two groups. Assessment of the laparoscopic skills was based on parameters measured by the simulator. RESULTS: The experienced surgeons completed the task significantly faster than the novice surgeons. The experienced surgeons also achieved a lower number of movements (NOM), better economy of movement (EOM) and faster average speed of the left instrument than the novice surgeons, whereas there were no significant differences between the two groups for the NOM, EOM and average speed of the right instrument. CONCLUSIONS: Eye-hand coordination skill of the nondominant hand, but not the dominant hand, measured using the LAP Mentor was able to differentiate between subjects with different laparoscopic experience. This study also provides evidence of construct validity for eye-hand coordination skill on the LAP Mentor.

Assessment of anterolateral rotatory instability in the anterior cruciate ligament-deficient knee using an open magnetic resonance imaging system.

BACKGROUND: In the clinical evaluation of the anterior cruciate ligament-deficient knee, anterolateral rotatory instability is assessed by manual tests such as the pivot-shift test, which is subjective and not quantitative. HYPOTHESIS: The anterolateral rotatory instability in an anterior cruciate ligament-deficient knee can be quantified by our newly developed method using open magnetic resonance imaging. STUDY DESIGN: Controlled laboratory study. METHODS: Eighteen subjects with anterior cruciate ligament-deficient knees and 18 with normal knees were recruited. We administered the Slocum anterolateral rotatory instability test in the open magnetic resonance imaging scanner and scanned the sagittal view of the knee. The anterior displacements of the tibia at the medial and lateral compartments were measured. Furthermore, we examined 14 anterior cruciate ligament-deficient knees twice to assess intraobserver and interobserver reproducibility and evaluated the difference and interclass correlation coefficient of 2 measures. RESULTS: In the anterior cruciate ligament-deficient knee, displacement was 14.4 +/- 5.5 mm at the lateral compartment and 1.6 +/- 2.3 mm at the medial compartment; in the normal knee, displacement was 0.7 +/- 1.9 mm and -1.1 +/- 1.2 mm, respectively. The difference and interclass correlation coefficient between 2 repeated measures at the lateral compartment were 1.0 +/- 0.7 mm and .98 for intraobserver reproducibility and 1.1 +/- 0.7 mm and .91 for interobserver reproducibility. CONCLUSION: This method is useful to assess the anterolateral rotatory instability of the anterior cruciate ligament-deficient knee. CLINICAL RELEVANCE: This method can be used in the clinical assessment of anterior cruciate ligament stability, such as comparing studies of graft positions or 2-bundle anatomic reconstruction and the conventional 1-bundle technique.

Risk factors of abdominal surgery in patients with collagen diseases.

Patients with collagen diseases have been reported to demonstrate a greater risk when undergoing surgical operations. To determine the risk factors in abdominal surgery for patients with collagen diseases, 32 patients with collagen diseases who underwent abdominal surgery were analyzed for their clinical features and surgical results by comparing 26 cases from the favorable prognosis group (Group A) and 6 cases resulting in hospital death (Group B). The analysis revealed that emergent operations tended to result in worse outcomes (P = 0.011) than elective operations and that cases undergoing operations for collagen disease-related problems, including intestinal perforation and acute pancreatitis, also showed a worse postoperative course than those who underwent operations for problems unrelated to collagen diseases, such as carcinomas and cholelithiasis (P = 0.0006). The dose of steroids administered at the time of operation was also significantly higher in Group B than in Group A (P = 0.03). These results suggested that the patients with collagen diseases should be followed periodically not only for the primary disease but also for any potential surgical diseases to identify such diseases at an early stage and to avoid an emergent operation, and that patients treated with high doses of steroids also need intensive care after abdominal surgery.

Modulation of anti-apoptosis by endogenous IAP expression in MKN45 human gastric cancer cells.

BACKGROUND: This study was designed to clarify differences in apoptotic signal transduction between gastric cancer cells and leukemia cells. MATERIALS AND METHODS: In order to study apoptotic signal transduction of gastric cancer cells, MKN45 gastric cancer cells expressing the wild-type p53 gene and U937 myeloid leukemia cells expressing a mutated p53 gene were prepared. Cisplatin (CDDP) was used to induce apoptosis. We compared apoptotic signal transduction downstream to mitochondria between those two lines. RESULTS: In contrast to U937 cells, MKN45 gastric cancer cells revealed delayed response in release of mitochondrial cytochrome c into the cytosol following caspase 3 activation. In signal pathways downstream of caspase 3 cleavage, of the three substrates detected, poly (ADP-ribose) polymerase (PARP) and PKC (protein kinase c) delta were not activated in MKN45 cells compared with U937 cells, resulting in delayed appearance of DNA ladder formation during CDDP-induced apoptosis. MKN45 constitutively expressed cLAP1, regardless of CDDP treatment, compared with no expression in U937 Drug sensitivity testing showed that MKN45 was more resistant to CDDP than U937 cells. CONCLUSION: We demonstrated that there is a delayed mitochondrial response and incomplete activation of caspase 3 in MKN45 gastric cancer cells compared with U937 leukemia cells. In addition, there was endogenous cLAP1 expression in MKN45 cells, which may be a factor in the presumed anti-apoptotic system in these human gastric cancer cells.

Galectin-3 expression is a potent prognostic marker in colorectal cancer.

BACKGROUND: Galectin-3 is a beta-galactoside-binding protein whose expression has been correlated with progression and metastasis in colon cancer. It is expressed at elevated levels in a variety of neoplastic cells. The current study was designed to investigate, by clinicopathological analysis, the relationship between prognosis and galectin-3 expression, in colorectal cancer. PATIENTS AND METHODS: Galectin-3 expression was evaluated using immunohistochemical staining in 121 consecutive patients with colorectal cancer. The relationship between galectin-3 expression and clinicopathological factors was analyzed. RESULTS: Galectin-3-positive expression was detected in 79 patients (65%). The incidence of lymph node and distant metastasis in galectin 3-positive cancer was significantly higher than that in galectin-3-negative cases (p = 0.0007 and p = 0.014, respectively). Furthermore, cancers with galectin-3-positive expression revealed frequent venous invasion (p = 0.005) and lymphatic permeation (p = 0.041), larger size (p = 0.016) and deeper invasion to wall(p = 0.01) than in galectin-3-negative cases. While univariate analysis showed that survival in patients with galectin-3-positive expression was significantly poorer than in galectin-3-negative cases (p = 0.0027), galectin-3 expression was a prognostic factor independent of Dukes' stage and lymph node metastasis by multivariate analysis. CONCLUSION: We propose that galectin-3 expression is an independent factor for prognosis in colorectal cancer.

Amounts of Sr and Ca eluted from deciduous enamel to artificial saliva related to dental caries.

This study was performed to elucidate the relationship between dental caries and the levels of Sr and Ca eluted from enamel, and to examine whether these elements are useful as factors to assess caries risk. The available 103 (Sr) and 108 (Ca) samples were obtained among 111 collected deciduous teeth. The healthy regions of enamel were decalcified in artificial saliva at pH 6.2 and 5.5. The eluted levels of these elements from enamel were determined using atomic absorption spectrophotometry. Sr and Ca levels were not affected by the sex nor tooth type. Sr levels of the caries-experienced tooth (CE) group were 2.6-fold (pH 6.2) and 2.2-fold (pH 5.5) higher than those of the sound tooth (ST) group, respectively. Furthermore, the Sr levels were significantly higher in the teeth with treated than in those with untreated caries. Only at pH 6.2 was a significant difference found in Ca levels between the ST and CE groups. In the ST group, at pH 5.5, both the Sr and Ca levels significantly increased when the children had six or more carious teeth. The Sr and Ca elution levels were significantly inhibited in the teeth receiving fluoride application every 3 or 4 months compared to those that were not. These findings indicate that Sr can be an indicator of the acid resistance of teeth, and a useful factor to assess future caries risk.

Squamous cell carcinoma of the breast.

Squamous cell carcinoma (SCC) of the breast is comparatively rare. Because of the small number of investigations based on sufficient population size, its clinicopathological features have not been fully elucidated. We report herein a patient with SCC of the breast who underwent surgical resection and whose therapeutic options are now considered.

Al and Fe levels in mixed saliva of children related to elution behavior from teeth and restorations.

OBJECTIVES: The levels of trace elements in mixed saliva were not well-defined. This study was performed to determine Al and Fe concentrations in mixed saliva of children and to investigate the relationship between these levels and dental caries. METHODS: Among 562 collected mixed saliva specimens, 514 and 548 samples for analyses of Al and Fe levels were obtained, respectively. The Al and Fe concentrations were determined using flameless atomic absorption spectrometry. RESULTS: The Al and Fe concentrations in children without a history of caries were 0.093±0.136 and 0.121±0.128 µg/mL, respectively. The Fe level depended on sex. The Fe level in girls who experienced caries was significantly higher than that without caries history. The Al and Fe levels were significantly higher in children with treated caries than children without caries history. The Fe concentrations were affected by restoration type. Composite resin increased the Fe level significantly especially in girls, and the Fe level was also higher in boys treated with both composite resin and metal restorations. In children without caries history, the Al level was inversely proportional to the number of deciduous teeth and increased with the number of permanent teeth. In contrast, the Fe level showed the reverse tendency. CONCLUSIONS: The Fe level in mixed saliva of children was influenced by the restoration type. It was suggested that Al was eluted more from sound permanent teeth than sound deciduous teeth, while Fe was eluted in the opposite manner.

Protein-bound polysaccharide-K reduces colitic tumors and improves survival of inflammatory bowel disease in vivo.

Protein-bound polysaccharide-K (PSK) is a biological response modifier that possesses antitumor effects against various tumors. Although an inflammatory response has been considered to play an important role in the development of colorectal cancer, the anti-inflammatory effect of PSK has yet to be elucidated. An inflammatory bowel disease (IBD)-induced colorectal tumor model with 1.2-dimethyl hydrazine (DMH) and dextran sodium sulfate (DSS) was used to examine the effects of PSK on tumor suppression and survival. Although 90% of the mice that were not treated with PSK developed colitic tumors, oral administration of PSK suppressed tumor formation by less than 30%. Although deaths associated with DSS-induced melena were observed, PSK significantly reduced mortality. In conclusion, the present study showed that PSK not only suppressed colorectal tumor formation in the DMH+DSS-induced IBD model, but also improved the survival rate, indicating that anti-inflammatory activity is one of the mechanisms for the antitumor effects of PSK.

A case of traumatic mesenteric bleeding controlled by only transcatheter arterial embolization.

We report a case of mesenteric hematoma following blunt abdominal trauma that was successfully treated with transcatheter arterial embolization (TAE) and did not require surgical repair. A 43-year-old man with blunt abdominal trauma caused in a factory accident was admitted with a stable general condition and laboratory data. On CT examination, a large mesenteric hematoma with extravasation of contrast media was observed. TAE was first attempted to control the bleeding. A superior mesenteric angiogram showed extravasation of contrast medium from a branch of the ileocolic artery and obstruction of the cecal branch. After successful TAE using microcoils, the distal portion of the cecal branch was still preserved via collateral circulation. No abdominal symptoms have occurred during the 7 months following TAE. In mesenteric injury cases with limited intestinal damage, TAE may therefore be a reasonable alternative to emergent laparotomy.

Suppressed MKP-1 is an independent predictor of outcome in patients with hepatocellular carcinoma.

OBJECTIVE: An increase in the activity of mitogen-activated protein kinases (MAPKs) has been correlated with a more malignant phenotype in several tumor models in vivo. This study was designed to clarify the expression of MKP-1 in surgically resected hepatocellular carcinoma (HCC). METHODS: We reviewed the cases of 77 patients who had undergone initial liver resection for HCC without preoperative treatment. Immunohistochemical analysis of MKP-1 was performed on paraffin-embedded tissues. The correlation between MKP-1 expression and clinical outcome was investigated. RESULTS: Tumor cells were immunohistochemically stained for MKP-1 expression, and the same levels as in normal hepatocytes were detected in 66 (85%) of 77 HCC patients, being decreased in 11 (15%) HCCs. Decreased MKP-1 expression significantly correlated with serum alpha-fetoprotein levels and tumor size (p<0.05). The disease-free survival rates in MKP-1-negative and -positive patients were 0 and 31.0% at 5 years, respectively (p<0.01). The survival rates after a surgical resection in MKP-1-negative and -positive patients were 18.2 and 65.5% at 5 years, respectively (p<0.01). CONCLUSIONS: The MKP-1 expression in HCC was an independent prognostic factor for outcome in HCC patients. In the future, it will be useful to explore whether the phosphatase expression might account for the response to HCC treatments targeting at MAPK activation.