Morinomiya Hospital

Background Post-stroke aphasia is considered a language network disorder, and neuroimaging may help understand network alterations. However, the prediction of aphasia recovery remains challenging. Objective We aimed to explore biomarkers for aphasia recovery using a novel clinically feasible method, which we previously reported as useful for evaluating motor recovery, that included the phase synchrony index (PSI) obtained from resting-state 19-channel electroencephalography. Methods This longitudinal observational study included patients with left frontal ischemic lesions admitted for post-acute rehabilitation. We recorded electroencephalograms at the time of admission. Recovery was defined as a change in composite speech score. Based on electrode settings, we focused on 4 language-related networks: (1) left front-temporal, (2) right front-temporal, (3) inter-frontal, and (4) inter-temporal networks. We first evaluated the correlation between these network PSIs and recovery scores and then the predictive potential of our method using the receiver operating characteristic curve and multivariable regression analyses. Results We enrolled 24 patients. Electroencephalograms were recorded for a median of 37.0 days after the stroke. The median speech therapy time was 53.7 hours. Inter-temporal PSI (gamma band) was significantly positively correlated with recovery scores (ρ = .642; 95% confidence interval = 0.311-0.834; P = .017). The PSI could predict patients with good recovery (sensitivity = 84.6%; specificity = 90.9%), and the inter-temporal PSIs were useful in predicting recovery (adjusted R2 = .545). Conclusions Our results revealed an association between the posterior language network adaptive response and speech recovery in patients with frontal lesions. The PSI may reflect post-stroke network alterations and may be a biomarker of aphasia recovery.

Many patients with pituitary neuroendocrine tumours (PitNETs) containing beta (β) thyroid-stimulating hormone (TSH)-immunopositive cells, without syndrome of inappropriate secretion of TSH (SITSH), show a significant reduction in TSH levels following surgical removal of the tumour-like functioning thyrotroph PitNET. We evaluated the pathophysiological and clinical characteristics of TSH-positive cells in PIT1-lineage PitNETs in patients without the syndrome of inappropriate secretion of TSH. Retrospective cohort study. Overall, 165 patients diagnosed with PIT1-lineage PitNETs without SITSH between April 2018 and July 2023 at Moriyama Memorial Hospital were reviewed. They were categorised into three groups based on the rate of βTSH-immuno-positive cells in their PitNETs: strongly positive group with 10% or more βTSH-immuno-positive cells, weakly positive group with less than 10%, and negative group. Clinical data from these groups were compared. Patient age, sex, and tumour size did not differ significantly among the groups. Most of the weakly positive cases had acromegaly, whereas many of the strongly positive cases had clinically nonfunctioning tumours. Preoperative TSH levels were slightly higher in strongly positive cases than in the other groups but fell within the normal range postoperatively, whereas postoperative TSH levels were significantly lower across all groups. The degree of TSH reduction postoperatively was significantly higher in the strongly positive group. In the strongly positive group, TSH levels decreased significantly after surgery, whereas no such decrease was observed in the other two groups, suggesting that thyrotrophs in strongly positive PitNETs are TSH-producing, similar to clinically functioning thyrotroph PitNETs.

BackgroundBone metastases are frequently observed in advanced cancer, and bone modifying agents are used to prevent or treat skeletal-related events. Zoledronic acid is contraindicated in patients with severe renal impairment (Ccr < 30 mL/min), but it is not completely known whether denosumab can be used in them. We aimed to determine the association between renal function and hypocalcemia development during denosumab treatment.MethodsWe included patients with solid cancer and bone metastases who started denosumab treatment between April 2017 and March 2019. They were classified into four groups based on creatinine clearance (Ccr; mL/min): normal (Ccr ≥ 80), mild (50 ≤ Ccr ˂80), moderate (30 ≤ Ccr ˂50), and severe (Ccr ˂30). Hypocalcemia was evaluated using the Common Terminology Criteria for Adverse Events (v5.0) based on the albumin-adjusted serum calcium levels; its incidence (stratified by renal function) and risk factors were investigated using a Chi-square test and logistic regression analysis.ResultsOf 524 patients (age: 69 ± 11 years; 303 men), 153 had a normal renal function and 222, 117, and 32 had mild, moderate, and severe renal dysfunction. The albumin-adjusted serum calcium level was higher than the measured (total) calcium level in most patients. The incidence of grade ≥ 1 hypocalcemia was 32.0% in the normal group and 37.4%, 29.9%, and 62.5% in the mild, moderate, and severe renal dysfunction groups, respectively. It was, therefore, higher in the severe renal dysfunction groups than in the normal group (P = 0.002). The incidence of grade ≥ 3 hypocalcemia did not differ significantly among the groups. Pre-treatment low serum calcium levels and severe renal dysfunction were risk factors for hypocalcemia.ConclusionsEvaluating denosumab-induced hypocalcemia required albumin adjustment, and its incidence was high among patients with severe renal dysfunction. Reduced serum calcium levels and severely impaired renal function were associated with an elevated hypocalcemia risk.

腹部大動脈瘤に対するEVARでは「10年以上の生命予後が期待される症例はEVARより外科手術を考慮する」がクラスIIbで推奨され，胸部大動脈瘤に対するTEVARでは解剖学的要件を満たす下行大動脈瘤に対するTEVARがクラスIで推奨され，B型大動脈解離に対するTEVARでは将来拡大が予測されるHigh risk uncomplicated症例はPreemptive TEVARがクラスIIaで推奨されている。

Introduction:Although favorable results of fluoropolymer-based drug-eluting stent (FP-DES) treatment for femoropopliteal lesions have been reported, it is unclear whether minimal lumen area (MLA) after FP-DES implantation affects clinical outcomes. This study aimed to reveal the association between intravascular ultrasound (IVUS)-evaluated MLA and the 1-year risk of restenosis and aneurysmal degeneration after FP-DES implantation for femoropopliteal lesions.Methods:A subanalysis of the CAPSICUM (Contemporary outcomes After Paclitaxel-eluting peripheral Stent implantation for symptomatic lower limb IsChemia with sUperficial feMoral or proximal popliteal lesion) study analyzed 718 limbs in 686 patients with available IVUS-evaluated MLA data. The association of MLA with the 1-year risk of restenosis and aneurysmal degeneration was analyzed using the generalized propensity score method.Results:The 1-year incidence rate of restenosis was estimated to be 8.8% (95% CI, 6.1% to 12.5%) for the upper quartile of MLA (21.1 mm2) versus 14.3% (95% CI, 10.7% to 18.7%) for the lower quartile of MLA (15.2 mm2), with an odds ratio of 0.58 (95% CI, 0.36 to 0.93; p = 0.024), whereas the 1-year incidence rate of aneurysmal degeneration was 23.8% (95% CI, 19.5% to 28.8%) for the upper quartile versus 16.8% (95% CI, 12.6% to 22.0%) for the lower quartile, with an odds ratio of 1.55 (95% CI, 1.04 to 2.32; p = 0.031).Conclusion:A large MLA after FP-DES implantation for femoropopliteal lesions was associated with decreased restenosis risk but increased aneurysmal degeneration risk. These findings suggest that MLA is a valuable predictor of clinical outcomes.