Nagoya Journal of Medical Science

Increasing evidence suggests that the pathogenesis of neurodegenerative diseases including amyotrophic lateral sclerosis (ALS) is not restricted to the neurons but attributed to the abnormal interactions of neurons and surrounding glial and lymphoid cells. These findings led to the concept of non-cell autonomous neurodegeneration. Neuroinflammation, which is mediated by activated glial cells and infiltrated lymphocytes and accompanied by the subsequent production of proinflammatory cytokines and neurotoxic or neuroprotective molecules, is characteristic to the pathology in ALS and is a key component for non-cell autonomous neurodegeneration. This review covers the involvement of microglia and astrocytes in the ALS mouse models and human ALS, and it also covers the deregulated pathways in motor neurons, which are involved in initiating the disease. Based on the cell-type specific pathomechanisms of motor neuron disease, targeting of neuroinflammation could lead to future therapeutic strategies for ALS and could be potentially applied to other neurodegenerative diseases.

The increase in contraceptive use in Afghanistan has been frustratingly slow from 7.0% in 2003 to 11.3% in 2012. Data on contraceptive use and influencing factors were obtained from Afghanistan Health Survey (AHS) 2012, which had been collected through interview-led questionnaire from 13,654 current married women aged 12–49 years. Odds ratio (OR) and 95% confidence interval (CI) of contraceptive use were estimated by logistic regression analysis. When adjusted for age, residence, region, education, media, and wealth index, significant OR was obtained for parity (OR of 6 or more children relative to 1 child was 3.45, and the 95%CI 2.54–4.69), number of living sons (OR of 5 or more sons relative to no son was 2.48, and the 95%CI 1.86–3.29), wealth index (OR of the richest households relative to the poorest households was 2.14, and the 95%CI 1.72–2.67), antenatal care attendance (OR relative to no attendance was 2.13, and the 95%CI 1.74–2.62), education (OR of secondary education or above relative to no education was 1.62, and the 95%CI 1.26–2.08), media exposure (OR of at least some exposure to electronic media relative to no exposure was 1.15, and the 95%CI 1.01–1.30), and child mortality experience (OR was 0.88, and the 95%CI 0.77–0.99), as well as age, residence (rural/urban), and region. This secondary analysis based on AHS 2012 showed the findings similar to those from the previous studies in other developing countries. Although the unique situation in Afghanistan should be considered to promote contraceptive use, the background may be common among the areas with low contraceptive use.

To determine the efficacy of computed tomography (CT) attenuation of cystic lesions measured on an image browsing system to distinguish abscess from hematoma in women with acute abdomen. The medical records of female patients of reproductive age with acute abdomen who were treated over a 7-year period in a single center and who had undergone laparotomy or laparoscopic surgery and preoperative pelvic CT scanning were retrospectively analyzed to identify those with hematoma or abscess cyst formation. Nineteen patients with tubo-ovarian abscess (abscess group) and six patients with hematoma (hematoma group) formation in the pelvis were included in the analysis. The preoperative CT images of the tubo-ovarian cyst were retrospectively investigated on the basis of cyst attenuation. CT attenuation of the cyst measured by both two gynecologists could be used to clearly distinguish inflammatory disease with abscess formation from bleeding disease with hematoma. CT attenuation on a picture archiving and communication system can distinguish hematoma from abscess in women with acute abdomen. This may significantly contribute to making differential diagnosis without interpretation by a medical radiologist.

Ferritin iron, hemosiderin iron, total iron stores and transformation rate were determined by serum ferritin kinetics. The transformation rate between ferritin and hemosiderin is motivated by the potential difference between them. The transformer determines transformation rate according to the potential difference in iron mobilization and deposition. The correlations between transformation rate and iron stores were studied in 11 patients with chronic hepatitis C (CHC), 1 patent with treated iron deficiency anemia (TIDA), 9 patients with hereditary hemochromatosis (HH) and 4 patients with transfusion-dependent anemia (TD). The power regression curve of approximation showed an inverse correlation between transformation rate and ferritin iron, hemosiderin iron in part and total iron stores in HH. Such an inverse correlation between transformation rate and iron stores implies that the larger the amount of iron stores, the smaller the transformation of iron stores. On the other hand, a minimal inverse correlation between transformation rate and ferritin iron and no correlation between transformation rate and hemosiderin iron or total iron stores in CHC indicate the derangement of storage iron metabolism in the cells with CHC. Radio-iron fixation on the iron storing tissue in iron overload was larger than that in normal subjects by ferrokinetics. This is consistent with the inverse correlation between transformation rate and total iron stores in HH. The characteristics of iron turnover between ferritin and hemosiderin were disclosed from the correlation between transformation rate and ferritin iron, hemosiderin iron or total iron stores.

Accelerated hyperfractionated radiotherapy was performed as treatment for patients with T1 glottic cancer, and its utility was evaluated based on treatment outcomes and adverse effects. Fifty-eight men who had undergone radiotherapy were retrospectively reviewed. Tumor classification was Tis in 4 patients, T1a in 38, and T1b in 16. Histological examination revealed squamous cell carcinoma in 55 patients. Travel time from home to hospital was 0–1 hour for 24 patients, 1–2 hours for 9, and >2 hours for 25. Laser vaporization was performed prior to radiotherapy in 38 patients, and 19 patients received concurrent chemotherapy with an agent such as S-1. Patients were irradiated twice daily using an irradiation container. Most patients received a dose of 1.5 Gy/fraction up to a total of 60 Gy. The median overall treatment time was 30 days, with a median observation period of 59.6 months. A complete response was observed in all patients. The 5-year overall survival, disease-free survival, and local control rates were 97.2%, 93.2%, and 97.8%, respectively. Although grade 3 pharyngeal mucositis was observed in 2 patients, there were no other grade 3 or higher acute adverse events. As late toxicity, grade 2 laryngeal edema and grade 1 laryngeal hemorrhage were observed in 1 patient each, but no serious events such as laryngeal necrosis or laryngeal stenosis were observed. In conclusion, this treatment method brings excellent outcome and will substantially reduce the treatment duration among patients who need to stay at nearby hotels while undergoing treatment at hospitals in rural areas.

This study, a secondary analysis of data from Afghanistan Health Survey 2012, aimed to identify factors affecting maternal healthcare utilization in Afghanistan. Subjects were 5,662 women aged 15–49 years who had had one delivery in the two years preceding the survey. Odds ratio (OR) and 95% confidence interval (CI) were estimated by logistic regression analysis. The study found that 54.0% of mothers used antenatal care (ANC) at least one time, and 47.4% of births were assisted by skilled birth attendants (SBA). Adjusted OR of ANC use was 2.74 (95% CI, 2.08–3.60) for urban residency, 1.69 (95% CI, 1.26–2.27) for primary education relative to no education, 3.94 (95% CI, 3.51–4.42) for knowledge on danger signs of pregnancy, and 1.78 (95% CI, 1.47–2.15) for television and radio relative to no exposure. Adjusted OR of SBA utilization was 3.71 (95% CI, 2.65–5.18) for urban residency, 0.67 (95% CI, 0.48–0.91) for age <20 years relative to age 34–49 years, 1.43 (95% CI, 1.03–1.97) for secondary and higher education relative to no education, 1.83 (95% CI, 1.47–2.27) for para 1 relative to para ≥5, 6.66 (95% CI, 5.43–8.15) for ≥4 ANC visits relative to no visit, 1.37 (95% CI, 1.21–1.57) for knowledge of danger signs of pregnancy, 1.62 (95% CI, 1.38–1.90) for radio relative to no exposure, and 2.71 (95% CI, 2.25–3.27) for rich households relative to poor ones. Since women’s education and knowledge about danger signs of pregnancy were significant factors of both ANC and SBA, educating women may be an effective step in promoting safe maternal health.

Palau, similar to other Pacific island countries, is currently highly burdened with non-communicable diseases (NCDs). The WHO STEPS was launched in 2011 to comprehensively survey indicators for NCDs in the country. This paper aims to describe the prevalence of key NCD risk factors assessed by the survey. The WHO instrument, including behavioral, physical and biochemical measurements, was adopted to the nationwide survey for all residents aged 25 to 64 years. A cluster-based sampling method was performed to obtain a national representative data. Valid data from 2,184 individuals were selected for the analyses, of which 75% were Palauans and 19% were Filipinos. Prevalence of current cigarette smoking was 25% in men and 10% in women. Betel nut chewing with tobacco was prevalent particularly among Palauans (58% in men, 69% in women) compared to the other ethnic groups. In terms of all types of tobacco use, 60% of men and 58% of women were current users. Overweight or obesity was very common among Palauans (84% in men, 86% in women) as well as Filipinos (52% in men, 40% in women). Hypertension was found in 55% of men and 49% of women, with the stage 2 hypertension being 21% and 19%, respectively. The prevalence of diabetic level hyperglycemia was more than 20%. Raised total cholesterol was detected in 16% of men and 20% of women. This survey revealed an alarmingly high prevalence of NCD risk factors, especially tobacco use, obesity, hypertension and raised blood glucose. The data would be useful baseline information to develop effective NCD strategies in Palau.

This study was aimed to evaluate the relationship between serum interleukin-23 (IL-23) levels and ankylosing spondylitis (AS).Twenty male patients diagnosed with ankylosing spondylitis according to the 1984 modified New York criteria for AS and twenty male healthy controls were included in this study. The demographic characteristics, clinical and laboratory findings of the patients were recorded. Serum IL-23 levels, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured in both the AS and control groups. The Bath ankylosing spondylitis disease activity ındex (BASDAI), the Bath ankylosing spondylitis functional index (BASFI), and the Bath ankylosing spondylitis metrology index (BASMI) were evaluated as disease activity parameters. The AS patients were divided into two subgroups as active and inactive in respect of CRP, ESR levels and BASDAI scores. The mean serum IL-23 levels of the AS and control groups were 334.45±176.54 pg/ml and 166.49±177.50 pg/ml respectively, and there was a significant difference between the groups. Correlation analysis of serum IL-23 levels with clinical and laboratory parameters showed that there were positive correlations between serum IL-23 levels and the BASDAI, BASFI scores in total, active and inactive patients and the BASMI scores in total and inactive patients and negative correlations between serum IL-23 levels and ESR in inactive patients. It was shown that altered serum IL-23 levels were related to AS disease activity. Further studies in large patient series are necessary to investigate the role of IL-23 protein in etiopathogenesis of AS.

Retrospective analysis of demographic and clinical data of all patients starting dialysis over two years in our Department (n = 105) has been conducted. Factors such as type of dialysis treatment, reason of end-stage renal disease, Body Mass Index (BMI), laboratory tests results, number and cause of death during first year of dialysis were taken under consideration. Five patients have been excluded from the analysis of mortality (four received renal transplantation, one changed dialysis center). Twenty tree deaths have been noted during first year of dialysis treatment. Nine of them occurred during the first three months of therapy. The leading cause of death was cardio-vascular events (n = 14, 60.9%), the second was malignancy (8, 34,8%), one patient died due to catheter associated infection. Malignancy as a cause of end-stage renal disease, lack of outpatient nephrology care, acute mode of beginning renal replacement therapy and lack of erythropoiesis stimulating agents therapy were associated with higher risk of all-cause mortality during first year of dialysis. Being under the outpatient nephrology care, etiology of ESRD other than malignancy and erythropoiesis stimulating agents therapy were independently associated with better survival during this period of time. Other independent variables did not reach statistical significance. To conclude, in order to improve one year survival of dialysis patients, outpatient nephrology care with adequate amount of visits and associated dialysis therapy should be employed.

The purposes of this study on prostate cancer are to demonstrate the time course of International Prostate Symptom Score (IPSS) after intensity-modulated radiation therapy (IMRT) combined with androgen deprivation therapy (ADT) and to examine the factor associated with the IPSS change. This study included 216 patients treated with IMRT between 2006 and 2010. Patients were evaluated in three groups according to baseline IPSS as defined by the American Urological Association classification, where IPSSs of 0 to 7, 8 to 19, and 20 to 35 represent mild (n = 124), moderate (n = 70), and severe (n = 22) symptom groups, respectively. The average IPSSs ± standard deviation at baseline vs. those at 24 months after IMRT were 3.5 ± 2.1 vs. 5.1 ± 3.6 in the mild group (P < 0.001), 12.6 ± 3.4 vs. 10.0 ± 6.0 in the moderate group (P = 0.0015), and 23.8 ± 2.9 vs. 14.4 ± 9.1 in the severe group (P < 0.001). Among factors of patient and treatment characteristics, age, IPSS classification, pretreatment GU medications, and positive biopsy rates were associated with the IPSS difference between baseline and 24 months (P = 0.023, &kt; 0.001, 0.044, and 0.028, respectively). In conclusion, patients with moderate to severe urinary symptoms can exhibit improvement in urinary function after IMRT, whereas patients with mild symptoms may have slightly worsened functions. Age, baseline IPSS, GU medications, and tumor burden in the prostate can have an effect on the IPSS changes.

Sarcopenia, defined as the loss of muscle mass accompanied by weakness, is an important factor leading to frailty and is a growing concern in the aging Japanese society. Muscle mass can be calculated by dualenergy X-ray absorptiometry (DXA), but results differ between devices produced by different manufactures. Thus, cross-calibration is needed to compare body composition results in multicenter trials or when scanners are replaced. The purpose of this study was to perform an in vivo calibration of total body scans between pencil-beam (DPX-NT, GE Healthcare) and fan-beam (QDR-4500C, Hologic Inc.) DXA units. A total 30 subjects (15 women, 15 men, mean age = 35 years, range 22–49 years) were recruited. The lumbar bone mineral density (BMD), femoral neck BMD, appendicular fat and lean body mass, and the appendicular skeletal muscle mass index (ASMI) were highly correlated (r = 0.979–0.993, r² = 0.889–0.977). The conversion formulas were as follows: lumbar BMD, Y = –0.08 + 1.16X (X = QDR-4500C, Y = DPX-NT), femoral neck BMD, Y = –0.015 + 1.11X, and ASMI Y = 0.92 + 0.90X. There is excellent comparability between the DPX-NT and the QDR-4500C DXA units. However, cross-calibration equations are required to assess muscle volume, fat, and ASMI in multicenter studies investigating sarcopenia.

Early-stage TB meningitis has no specific symptoms in patients, potentially leading to delayed diagnosis and consequently worsening prognosis. The authors present the fatal case with a delayed diagnosis of tuberculous (TB) meningitis with dementia as the presenting symptom after intramedullary spinal cord tumor resection. The medical records, operative reports, and radiographical imaging studies of a single patient were retrospectively reviewed. A 77-year-old man who underwent thoracic intramedullary hemangioblastoma resection for 2 times. The postoperative course was uneventful, but 1.5 months after surgery, the patient suffered from dementia with memory loss and diminished motivation and speech in the absence of a fever. No abnormalities were detected on blood test, brain computed tomography and cerebrospinal fluid (CSF) analysis. A sputum sample was negative for Mycobacterium tuberculosis in the QuantiFERON®-TB Gold (QFT-G) In-Tube Test and the tuberculin skin test was also negative. The patient was diagnosed with senile dementia by a psychiatrist. However, the patient’s symptoms progressively worsened. Despite the absence of TB meningitis findings, we suspected TB meningitis from the patient’s history, and administered a four-drug regimen. However the patient died 29 days after admission, subsequently M. tuberculosis was detected in the CSF sample. This case is a rare case of TB meningitis initially mistaken for dementia after intramedullary spinal cord tumor resection. Symptoms of dementia after intramedullary spinal cord tumor resection should first be suspected as one of TB meningitis, even if the tests for meningitis are negative. We propose that anti-tuberculosis therapy should

Here we describe a novel technique for single stent horizontal reconstruction and coil embolization for a broad-necked large basilar artery (BA) apex aneurysm. A previously healthy 77-year-old woman presented with a broad-necked large BA apex aneurysm. Due to difficulty accessing the right posterior cerebral artery (PCA), we abandoned the Y-stent technique. Instead, we decided to navigate the stent through the BA to the left PCA making a loop of the stent delivery catheter inside the aneurysm in an “alpha” fashion. The procedure outcome was excellent without any complications. Alpha horizontal stent delivery via an antegrade approach for coil embolization of broad-necked large BA apex aneurysms may provide an effective therapeutic alternative, if other techniques are not feasible.

Carbon ion radiotherapy has recently emerged as an alternative choice of treatment for malignant tumors of the head and neck. However, it is still in the infant stages and its influence on subsequent salvage surgery remains unclear. Here we report the case of a 43-year-old woman who underwent salvage surgery for left frontal bone osteosarcoma recurrence following carbon ion radiotherapy. Tumor resection was performed with a wide margin including the tissue considered to have been damaged by carbon ion radiotherapy. The dural defect was reconstructed using a fascia lata graft and pedicled galeal pericranial flap. The soft tissue defect was reconstructed using an anterolateral thigh flap anastomosed to the ipsilateral neck interposed by the radial forearm flap. As the patient developed no postoperative wound complications, she was able to initiate adjuvant chemotherapy early. Carbon ion radiotherapy is useful for its focused distribution and strong biological effects. Although the affected field may be limited, its high potency may severely damage adjacent normal tissue and lead to serious postoperative complications. Despite these concerns, satisfactory results were achieved in this case.