Mita Hospital

Background: Major depressive disorder (MDD) is often accompanied by generalized anxiety disorder (GAD), a comorbidity linked to greater illness burden and potentially poorer outcomes. Repetitive transcranial magnetic stimulation (rTMS) and intermittent theta-burst stimulation (iTBS) are established treatments for MDD, yet the impact of comorbid GAD and concomitant medications remains unclear. This study aimed to compare rTMS/iTBS treatment outcomes between patients with MDD with and without comorbid GAD, and to examine the association between concomitant psychotropic medication use, stimulation protocol, and treatment response in a real-world clinical setting. Methods: We conducted a retrospective observational analysis using registry data from 108 patients (MDD + GAD: n = 36; MDD only: n = 72). Patients received either Left-iTBS or Right-rTMS. Baseline severity, percentage change in Montgomery-Åsberg Depression Rating Scale (MADRS) and Hamilton Depression Rating Scale (HAMD-17) scores, response, and remission were assessed. Logistic and linear regression models adjusted for age, sex, and baseline severity were applied. Sensitivity analyses stratified by stimulation protocol and benzodiazepine (BDZ) use were performed. Results: Baseline severity did not differ between groups. MADRS reduction was numerically lower in the comorbid GAD group (48.3% vs. 52.7%, p = 0.09), whereas HAMD-17 reduction was comparable. Response and remission rates did not differ significantly. Medication use and stimulation protocol did not show statistically significant independent associations with outcomes. Sensitivity analyses confirmed equivalent outcomes between Left-iTBS and Right-rTMS. BDZ users showed a non-significant trend toward lower MADRS improvement and remission. Conclusions: rTMS/iTBS produced substantial clinical improvement and was well tolerated in both patients with MDD and those with MDD comorbid with GAD. Although comorbid anxiety showed a modest tendency to attenuate MADRS score reduction, overall response and remission rates were comparable between groups. Neither concomitant medications nor stimulation protocol significantly affected treatment outcomes, while the potential influence of BDZ exposure warrants further investigation.

Cushing's disease (CD) is a rare but serious endocrine disorder caused by excessive cortisol secretion due to adrenocorticotropic hormone-secreting pituitary tumors. Despite recent developments in diagnostic criteria and treatment options, CD remains associated with substantial comorbidities and mortality. Early and accurate diagnosis is thus essential. Both the Korean Endocrine Society (KES) and Japan Endocrine Society (JES) guidelines are intended to standardize diagnostic approaches to CD, and they share common principles; however, notable differences exist, particularly in biochemical testing thresholds and imaging recommendations. This consensus statement integrates clinical evidence and expert practice from both the KES and JES to establish harmonized recommendations for biochemical evaluation, imaging, and differential testing. This unified framework is intended to enhance diagnostic precision and improve clinical outcomes across East Asian populations.

A 65-year-old woman with no significant medical history was incidentally found to have a well-circumscribed lesion in the inferior vena cava on computed tomography. Despite unremarkable clinical findings and inconclusive preoperative assessments, she underwent surgical resection for diagnostic and therapeutic purposes. Complete excision was achieved, and histopathological analysis revealed a benign tumor with abundant melanin pigmentation. No recurrence was observed during 1 year of follow-up without adjuvant therapy. This case highlights the importance of surgical intervention for both diagnosis and treatment in managing tumors of the inferior vena cava.

Lateropulsion, a tendency of the body to lean or fall to one side without weakness or limb ataxia, is most often associated with lateral medullary infarction but may also occur with pontine, cerebellar, thalamic, or midbrain lesions. Isolated body lateropulsion due to midbrain infarction, however, is rare. We report an 86-year-old woman who developed acute lateropulsion without ocular, sensory, or motor deficits. Diffusion-weighted MRI showed a small infarct in the right rostral paramedian midbrain, medial to the red nucleus. Her symptoms improved with rehabilitation. The lesion location suggests selective disruption of the vestibulo-thalamic pathway, highlighting its role in postural control and its vulnerability to a small lesion. Recognizing this presentation facilitates accurate lesion localization in midbrain infarction.

PurposeWhen 2 heterozygous variants are detected in autosomal recessive disease genes, determining whether they are in cis or in trans is essential. Subcloning polymerase chain reaction products or complementary DNA is limited by variant distance (up to 10 kb) and complementary DNA availability. Droplet digital polymerase chain reaction, effective up to 100 kb, faces probe design challenges. We used replication cycle reaction (RCR), which replicates large DNA fragments based on E. coli chromosome replication, to phase widely spaced heterozygous variants.MethodsCircular DNA molecules were formed by ligating CRISPR/Cas9-cleaved genomic fragments with an oriC-AmpR cassette, then amplified by RCR. Using a genomic DNA (gDNA) sample that is previously analyzed by long-read sequencing, we optimized reaction conditions (including gDNA to oriC-AmpR cassette ratios) and validated phasing accuracy via electrophoresis and Sanger sequencing. Finally, we applied this method to 7 patients harboring 2 heterozygous pathogenic variants (4.3-152 kb apart).ResultsRCR amplified genomic regions up to 104 kb. Lower gDNA-to-cassette ratios favored monoallelic amplification, enabling straightforward phasing, whereas higher ratios yielded biallelic products requiring transformation-based allele separation. For variants 152 kb apart, an intervening single-nucleotide variant enabled phased reconstruction. Ultimately, RCR confirmed compound heterozygosity in all 7 patients.ConclusionThis method effectively phases multiple heterozygous variants across large genomic distances.

Various meniscal repair techniques, including all-inside, outside-in, and inside-out methods, have been developed; however, they require complex maneuvers with each method, and there are limitations to the suture material. This report presents an arthroscopic inside-out technique for meniscal repair using a suture-gripping method with a suture shuttle, which allows insertion of the needle into the meniscus from inside the knee and withdrawal of the suture from outside the knee. This technique allows free gripping of the suture, making it possible for the suture to pass more accurately than with the standard outside-in technique, and enables a more flexible meniscal repair than that achieved with the standard inside-out technique. This technique overcomes the limitations of other techniques and offers flexibility in suture materials and methods. Furthermore, this technique is effective for suturing the anterior portion of the meniscus because the suture shuttle is more compact and flexible than the devices used in other techniques. This article aims to describe the benefits of this technique for suturing meniscal tears in a more flexible, straightforward, and minimally invasive manner.