Wakaba Hospital

Abstract To control infection with SARS-CoV-2 Omicron XBB subvariants, the XBB.1.5 monovalent mRNA vaccine has been available since September 2023. However, we have found that natural infection with XBB subvariants, including XBB.1.5, does not efficiently induce humoral immunity against the infecting XBB subvariants. These observations raise the possibility that the XBB.1.5 monovalent vaccine may not be able to efficiently induce humoral immunity against emerging SARS-CoV-2 variants, including a variety of XBB subvariants (XBB.1.5, XBB.1.16, XBB.2.3, EG.5.1 and HK.3) as well as BA.2.86. To address this possibility, we collected two types of sera from individuals vaccinated with the XBB.1.5 vaccine; those who had not been previously infected with SARS-CoV-2 and those who had been infected with XBB subvariants prior to XBB.1.5 vaccination. We collected sera before and 3-4 weeks after vaccination, and then performed a neutralization assay using these sera and pseudoviruses.

PurposeThe status of dupilumab self-injection at home is not well understood. We therefore aimed to identify the barriers to adherence to dupilumab self-injection.Patients and MethodsThis non-interventional open-label study was conducted between March 2021 and July 2021. Patients with atopic dermatitis, bronchial asthma, and chronic rhinosinusitis with nasal polyps receiving dupilumab, from 15 sites, were requested to complete a self-administered questionnaire regarding the frequency and effectiveness of dosing as well as their use and satisfaction with dupilumab. Barriers to adherence were assessed using the Adherence Starts with Knowledge-12.ResultsWe included 331 patients who used dupilumab for atopic dermatitis (n = 164), chronic rhinosinusitis with nasal polyps (n = 102), and bronchial asthma (n = 65). The median efficacy of dupilumab scored 9.3 on the visual analog scale. Overall, 85.5% of the patients self-injected dupilumab, and 70.7% perfectly complied with the established injection dates. The pre-filled pen was significantly superior to the conventional syringe in terms of usability, operability, ease of pushing the plunger, and patient satisfaction. However, the pre-filled pen caused more pain during self-injection than did the syringe. Multivariate logistic regression analysis showed that adherence decreased with longer dupilumab treatment duration (p = 0.017) and was not associated with age, sex, underlying disease, or device type. There was a difference in responses related to “inconvenience/forgetfulness” between the good and poor adherence groups.ConclusionThe pre-filled dupilumab pen was superior to the syringe in terms of usability, operability, ease of pushing the plunger, and satisfaction. Repetitive instructions are recommended for preventing poor adherence to dupilumab self-injection.

18F-fluoromisonidazole (18F-FMISO) is the most widely used positron emission tomography (PET) tracer for imaging tumor hypoxia. Previous reports suggested that the time from injection to the scan may affect the assessment of 18F-FMISO uptake. Herein, we directly compared the images at 2h and 4h after a single injection of 18F-FMISO. Twenty-three patients with or suspected of having a brain tumor were scanned twice at 2 and 4h following an intravenous injection of 18F-FMISO. We estimated the mean standardized uptake value (SUV) of the gray matter and white matter and the gray-to-white matter ratio in the background brain tissue from the two scans. We also performed a semi-quantitative analysis using the SUVmax and maximum tumor-to-normal ratio (TNR) for the tumor. At 2h, the SUVmean of gray matter was significantly higher than that of white matter (median 1.23, interquartile range (IQR) 1.10-1.32 vs. 1.04, IQR 0.95-1.16, p < 0.0001), whereas at 4h, it significantly decreased to approach that of the white matter (1.10, IQR 1.00-1.23 vs. 1.02, IQR 0.93-1.13, p = NS). The gray-to-white matter ratio thus significantly declined from 1.17 (IQR 1.14-1.19) to 1.09 (IQR 1.07-1.10) (p < 0.0001). All 7 patients with glioblastoma showed significant increases in the SUVmax (2.20, IQR 1.67-3.32 at 2h vs. 2.65, IQR 1.74-4.41 at 4h, p = 0.016) and the TNR (1.75, IQR 1.40-2.38 at 2h vs. 2.34, IQR 1.67-3.60 at 4h, p = 0.016). In the assessment of hypoxic tumors, 18F-FMISO PET for hypoxia imaging should be obtained at 4h rather than 2h after the injection.

Lombardが提起した二関節筋の働きを確かめる目的で, 大腿二頭筋長頭と腓腹筋のレバーアーム長を1体の遺体を対象にして調査した. 大腿二頭筋長頭のレバーアーム長は, 股・膝関節での角度が変化しても, 常に股側で膝側よりも大きく, 股関節屈曲角度が増大するにつれて増大した. 腓腹筋のレバーアーム長は, 膝・足関節角度が変化しても, 常に足側で膝側よりも大きく, 足底屈角度が増大するにつれて増大した. 遺体の下肢骨形状を抽出し, 縮尺版の木製脚伸展模型を作製し, 大腿二頭筋長頭および腓腹筋を模したゴムを装着し, 脚伸展が生じるか否かを確かめた. 大腿二頭筋長頭のゴム, 腓腹筋のゴムのいずれも, 脚伸展を生じた. 腓腹筋のゴムの方で膝伸展角速度が大きかった. 大腿二頭筋長頭と腓腹筋は, 足が固定される立位では, 脚伸展に作用することが示唆された. 腓腹筋の膝伸展作用は, 木製脚伸展モデルの膝関節角速度のデータから, 強力であろうと推測される.

We have diagnosed the extremely fragile plaque as motion of the plaque content, and have reported their clinical characteristics and therapeutic importance. A floating mass associated with motion of plaque content could also potentially cause an embolic stroke. However, the origin and pathogenesis of such floating masses have not yet been clarified. We have experienced five cases of patients who had symptoms of CVA and underwent pathological examination following carotid endarterectomy. The floating mass dominantly existed at the distal part of the plaque and was pathologically consistent with thrombus. The relation of hemostasis as well as the existence of a thrombotic core, in addition to the damaged surface membrane of the plaque, was suspected to play an important role in the mechanism of disease in such cases. Such abnormal hemodynamics could result in embolic stroke and should be treated surgically and as soon as possible.

〔目的〕本研究の目的は，脳卒中急性期の理学療法におけるHAL導入の効果を明らかにすることである．〔方法〕当院入院中の脳卒中患者の中で，HAL適用基準に適合するものを1）通常の理学療法に週2回HAL両脚型を用いるHAL群と，2）通常の理学療法のみを行う対照群の2群に任意に割り付け，HAL開始病日と終了病日における両群のパフォーマンス値を比較した．〔結果〕 HAL終了病日における10 m快適歩行速度のみHAL群で有意に速かった．〔結語〕脳卒中急性期におけるHALを用いた理学療法は，歩行能力の改善に有効だった．HALに備わる運動アシスト機能などの特徴が有効に働いた結果と考えられた．