Tenshi Hospital

Severe hyponatremia is a common complication (21.6%) in patients with decompensated cirrhosis. It can sometimes manifest as a paraneoplastic syndrome, which may precede the diagnosis of cancer in 5% of cases. It can be associated with lung cancer (25 - 45%), colorectal cancer, breast cancer, or lymphomas. Hyponatremia reflects the complexity of the interactions between liver disease and oncological processes. In decompensated cirrhotic patients, hyponatremia is usually caused by the kidney´s inability to excrete free water, resulting in dilution of blood sodium. However, in the context of cancer, factors such as ectopic antidiuretic hormone secretion by tumors can exacerbate this condition. This inappropriate antidiuretic hormone secretion can lead to additional water retention, worsening the hyponatremia in these patients. We present two clinical cases that illustrate this relationship: a patient with liver metastases and a patient with pulmonary nodules, both with compensated cirrhosis as a chronic disease, who were admitted with severe hyponatremia. The management of these patients requires a multidisciplinary approach, searching for occult neoplasms and carefully normalizing sodium levels to prevent neurological complications. Early identification of hyponatremia is crucial due to its prognostic impact.

Background:Gestational diabetes mellitus, a glucose metabolism disorder during pregnancy, is linked to insulin resistance. Pregnancy elevates insulin resistance, and gestational diabetes mellitus increases fetal complication risks via excessive glucose transport. Current gestational diabetes mellitus diagnosis relies solely on blood glucose levels, which inadequately guide clinical management or insulin initiation. While homeostatic model assessment for insulin resistance and Matsuda index assess insulin resistance, their utility for insulin treatment evaluation in gestational diabetes mellitus is underexplored.Objectives:Insulin resistance indices with enhanced discriminatory power for gestational diabetes mellitus were evaluated to predict insulin therapy during pregnancy in women suspected of gestational diabetes.Design:This retrospective analysis utilized existing clinical data.Methods:Clinical data from 383 pregnant women with suspected abnormal glucose metabolism at Tenshi Hospital (Jan 2018–Sep 2021) were analyzed. Gestational diabetes mellitus was diagnosed using 75-g oral glucose tolerance test criteria. Evaluations included blood glucose, insulin levels, homeostatic model assessment for insulin resistance, and Matsuda index. The primary outcome was predicting the need for insulin treatment. Statistical analyses involved receiver operating characteristic curves and propensity score adjustment.Results:Body mass index, glycated hemoglobin, glucose/insulin levels, homeostatic model assessment for insulin resistance, quantitative insulin sensitivity check index, and Matsuda index differed between gestational diabetes mellitus and nongestational diabetes mellitus groups. Standalone Matsuda index (area under the curve = 0.714) outperformed homeostatic model assessment for insulin resistance (area under the curve = 0.618) for gestational diabetes mellitus discrimination; however, both exhibited poor model fit. Notably, the propensity score-adjusted composite Matsuda index (Matsuda index × BS0 × BS120) demonstrated superior performance for gestational diabetes mellitus diagnosis (area under the curve = 0.891) and for predicting insulin treatment (area under the curve = 0.785, lowest Bayesian information criterion, highest positive likelihood ratio), surpassing single indices and adjusted homeostatic model assessment for insulin resistance models.Conclusions:The propensity score-adjusted Matsuda index for sustained hyperglycemia (Matsuda index × BS0 × BS120) excelled in gestational diabetes mellitus diagnosis and insulin therapy prediction. This adjusted index offers superior model fit and predictive accuracy, potentially guiding appropriate insulin treatment decisions in suspected gestational diabetes mellitus cases.Trial registration:Tenshi Hospital Ethics Committee (approval number: 151; accepted on February 3, 2022).

Background and Aim: Hutchinson-Gilford Progeria Syndrome (HGPS) and progeroid laminopathies (PL) are rare genetic disorders characterized by accelerated aging and early onset cardiovascular complications. Despite recent advances in the genetic diagnosis of HGPS and PL and the advent of lonafarnib treatment, the epidemiology and clinical characteristics of these disorders in Asia remain unclear. This study aimed to assess the prevalence, clinical features, and diagnostic trends of the HGPS and PL in Japan.Methods: A nationwide two-step survey was conducted between July 2022 and January 2024, across 1,513 medical facilities.Results: The survey identified ten HGPS patients, including eight with a confirmed genetic diagnosis. Early onset features such as scleroderma-like skin changes, growth retardation, and joint contracture were important in facilitating an early and accurate diagnosis. Cardiovascular complications typically occurred during their teens, and abnormalities in lipid metabolism were frequently observed. Overlapping but distinct phenotypes have been noted in ZMPSTE24 deficiency and other laminopathies caused by LMNA pathogenic variants, such as Emery-Dreifuss muscular dystrophy. Four patients with definite HGPS and eight patients with progerin-related PL (definite HGPS, n = 4; uncertain HGPS, n = 2; ZMPSTE24 deficiency, n = 2) were reported alive on October 2023, and the prevalence of HGPS was estimated to be 1 in 15.5 to 31.1 million.Conclusions: This study provides updated epidemiological and clinical insights into HGPS and related laminopathies in Japan. The introduction of lonafarnib has the potential to extend survival, emphasizing the need to monitor for late-stage complications.

Post-operative silent DWI hyperintensities are potential risk factors for cognitive dysfunction. Microsurgical clipping offers high occlusion rates and low recurrence, and temporary occlusion is often essential to safely dissect aneurysms. However, addressing these DWI changes is crucial for improving outcomes and minimizing complications. This study aimed to determine the optimal temporary occlusion time for ICA aneurysm treatment. A retrospective analysis was performed on 267 cases of ICA aneurysms. Clinical outcomes and factors associated with post-operative DWI hyperintensities were analyzed. The post-operative DWI hyperintensities were classified as either perforating artery infarction or 'other' infarction. Of 267 cases, post-operative DWI hyperintensity signals were observed in 38 cases (14.2%), including two symptomatic cases. Temporary occlusion was performed in 239 cases (89.5%), and retrograde suction and decompression (RSD) in 65 cases (24.3%). Multi-variate analysis revealed a significant association between maximum temporary occlusion duration (per 1-min increment) and perforator infarction (OR: 1.29, 95% CI [1.07-1.54]). Temporary occlusion under 5min presented the lowest risk of DWI changes, while risks significantly increased beyond 12.5min. Poor outcomes (mRS ≥ 2) were noted in 6 patients (2.2%). Adjunct techniques such as temporary occlusion or RSD used in microsurgical clipping, allow for safer manipulation of ICA aneurysms and dissection of surrounding structures, enabling complete aneurysmal neck clipping. However, post-operative DWI hyperintensities particularly in the perforator infarction may be observed in cases with prolonged temporary occlusion. This study highlights the safety of temporary occlusion when performed for less than 5min intervals for the treatment of ICA aneurysms.

Acute myeloid leukemia (AML) is an aggressive hematological malignancy with genetic alterations. The FMS-like tyrosine kinase 3 (FLT3) gene is frequently mutated in adult de novo AML, with two types of mutations: internal tandem duplication (ITD) and point mutations in the tyrosine kinase domain. This study aimed to investigate the impact of FLT3 inhibitors and hematopoietic cell transplantation (HCT) on survival outcomes in patients with FLT3-ITD AML in a real-world setting. We retrospectively analyzed 139 patients with FLT3-ITD-positive AML between 2012 and 2021. The median age was 63 years. In the propensity score-matched cohort, FLT3 inhibitors improved overall survival (OS) compared with patients treated without FLT3 inhibitors (3-year OS: 33.7% vs. 25.8%, p = 0.021). Patients who underwent HCT had superior outcomes to those without HCT (3-year OS: 45.3% vs. 2.2%, p < 0.0001). The combination of FLT3 inhibitors and HCT resulted in the highest OS and relapse-free survival (RFS) rates (3-year OS: 62.4%; 3-year RFS: 44.4%). Disease status before transplantation did not predict the prognosis, but use of FLT3 inhibitors increased survival in patients without complete remission before HCT. These results demonstrate the clinical impact of FLT3 inhibitors on survival outcomes in patients with FLT3-ITD-positive AML, particularly when combined with HCT. FLT3 inhibitors can improve the prognosis of AML with FLT3 mutations, especially in patients who undergo HCT.

&lt;div&gt;Abstract&lt;p&gt;&lt;b&gt;Purpose:&lt;/b&gt; On the basis of the results of our preliminary trial suggesting that aberrant crypt foci (ACF) could be eradicated by short-term administration of sulindac, in the present study, we explored the feasibility of using ACF as surrogate markers for chemoprevention of colorectal cancer.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Experimental design:&lt;/b&gt; Randomly assigned to sulindac (300 mg daily), etodolac (400 mg daily), and placebo groups were 189 subjects without polyps or who had undergone polypectomy. Drugs were administered for 2 months. ACF in the rectal region were counted by magnifying endoscopy. Occurrence of polyps was evaluated at 12 months. A planned interim analysis was conducted.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Results:&lt;/b&gt; ACF number at 2 months was significantly suppressed in the sulindac group (&lt;i&gt;P&lt;/i&gt; = 0.0075), but not in the etodolac group (&lt;i&gt;P&lt;/i&gt; = 0.73). In the sulindac group, the numbers of adenomas plus hyperplastic polyps (total polyps) and adenomas at 12 months were significantly (&lt;i&gt;P&lt;/i&gt; = 0.02) and marginally (&lt;i&gt;P&lt;/i&gt; = 0.064) lower, respectively, in comparison with the placebo group; no such difference was observed in the etodolac group. In analysis of only polypectomized subjects, the numbers of total polyps and adenomas in the sulindac group were even more markedly lower, with &lt;i&gt;P&lt;/i&gt; values of 0.014 and 0.034, respectively. A similar tendency was confirmed by analyses of the incidence of polyps at 12 months. Suppression rates of total polyps and adenomas in ACF responders to sulindac were significantly greater than in nonresponders. In all groups, compliance was more than 90% and no intolerable adverse effects were observed.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Conclusions:&lt;/b&gt; ACF may be useful as surrogate lesions for chemoprevention of colorectal cancer. &lt;i&gt;Clin Cancer Res; 17(11); 3803–11. ©2011 AACR&lt;/i&gt;.&lt;/p&gt;&lt;/div&gt;

Concrete is a material with low tensile strength and fracture resistance. One way to improve these properties is through the insertion of synthetic fibers such as carbon fibers into the concrete. This work determined the stress intensity factor for concrete with aligned carbon fibers (laminate) using an analytical model and finite element methods – macro-mechanical analysis of the composite laminate using the ABAQUS finite element package. Symmetrical laminate models were used with carbon fibers ranging from ± 15° to ± 75°. A single-edge notch bending specimen geometry was used to determine the KI of the laminates. The mechanical properties of the laminate were obtained through analytical models of the laminate theory. Results indicate that the fiber angles influence the stress intensity factor. The behavior is practically linear and a strong correlation was observed between the angle of the fibers and the KI through Pearson’s r. The laminate with a fiber angle of ± 75° showed a higher KI value compared to the others (x14 about ± 15°). Comparisons of the analytical and numerical results showed good agreement in the determined KI.