著者

Junna Oba Hiroaki Taniguchi Masae Sato Reika Takamatsu Satoru Morikawa Taneaki Nakagawa Hiromasa Takaishi Hideyuki Saya Koichi Matsuo Hiroshi Nishihara

出版者

The Keio Journal of Medicine

雑誌

The Keio Journal of Medicine (ISSN:00229717)

巻号頁・発行日

vol.70, no.2, pp.35-43, 2021 (Released:2021-06-25)

参考文献数

52

被引用文献数

2 20

---

The year 2020 will be remembered for the coronavirus disease 2019 (COVID-19) pandemic, which continues to affect the whole world. Early and accurate identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is fundamental to combat the disease. Among the current diagnostic tests, real-time reverse transcriptase–polymerase chain reaction (RT-qPCR) is the most reliable and frequently used method. Herein, we discuss the interpretation of RT-qPCR results relative to viral infectivity. Although nasopharyngeal swab samples are often used for RT-qPCR testing, they require collection by trained medical staff. Saliva samples are emerging as an inexpensive and efficient alternative for large-scale screening. Pooled-sample testing of saliva has been applied for mass screening of SARS-CoV-2 infection. Current policies recommend isolating people with borderline cycle threshold (Ct) values (35<Ct <40), despite these Ct values indicating minimal infection risk. We propose the new concept of a “social cut-off” Ct value and risk stratification based on the correlation of Ct with infectivity. We also describe the experience of RT-qPCR screening of saliva samples at our institution. It is important to implement a scientific approach to minimize viral transmission while allowing economic and social activities to continue.

著者

Takeshi Miyamoto Eri Katsuyama Hiroya Kanagawa Atsuhiro Fujie Hiroya Miyamoto Shigeyuki Yoshida Tomoaki Mori Kana Miyamoto Yuiko Sato Tami Kobayashi Masaya Nakamura Morio Matsumoto Yuji Nishiwaki Hiroshi Hirose Takeshi Kanda Ikuo Saito Yoshiaki Toyama

出版者

The Keio Journal of Medicine

雑誌

The Keio Journal of Medicine (ISSN:00229717)

巻号頁・発行日

vol.65, no.2, pp.33-38, 2016 (Released:2016-06-25)

参考文献数

24

被引用文献数

11 13

---

Low serum 25-hydroxyvitamin D (25(OH)D) levels are implicated as a risk factor for hip and spine fractures. Studies of the relation between 25(OH)D levels and fractures have primarily involved elderly osteoporosis patients or patients with fractures; however, the serum 25(OH)D and parathyroid hormone (PTH) status in younger adult populations remains largely unknown. We evaluated serum 25(OH)D and intact PTH levels in 411 women aged 39–64 years who were not receiving medication for osteoporosis or other bone diseases. Serum 25(OH)D levels were positively correlated with age (P = 0.019), whereas intact PTH levels were inversely correlated with 25(OH)D levels (P < 0.001). Thus, low vitamin D levels with high intact PTH levels were more common in younger than in older women. Our data show that serum 25(OH)D insufficiency could be a more serious concern in the younger population than had been previously anticipated. Because serum 25(OH)D insufficiency is reportedly a risk factor for hip and spine fracture, the number of fracture patients could increase in the future, suggesting that we may need to correct the serum vitamin D/intact PTH status to prevent future osteoporosis.

著者

Junna Oba Hiroaki Taniguchi Masae Sato Reika Takamatsu Satoru Morikawa Taneaki Nakagawa Hiromasa Takaishi Hideyuki Saya Koichi Matsuo Hiroshi Nishihara

出版者

The Keio Journal of Medicine

雑誌

The Keio Journal of Medicine (ISSN:00229717)

巻号頁・発行日

pp.2021-0003-OA, (Released:2021-03-19)

参考文献数

52

被引用文献数

2 20

---

The year 2020 will be remembered for the coronavirus disease 2019 (COVID-19) pandemic, which continues to affect the whole world. Early and accurate identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is fundamental to combat the disease. Among the current diagnostic tests, real-time reverse transcriptase–polymerase chain reaction (RT-qPCR) is the most reliable and frequently used method. Herein, we discuss the interpretation of RT-qPCR results relative to viral infectivity. Although nasopharyngeal swab samples are often used for RT-qPCR testing, they require collection by trained medical staff. Saliva samples are emerging as an inexpensive and efficient alternative for large-scale screening. Pooled-sample testing of saliva has been applied for mass screening of SARS-CoV-2 infection. Current policies recommend isolating people with borderline cycle threshold (Ct) values (35<Ct <40), despite these Ct values indicating minimal infection risk. We propose the new concept of a “social cut-off” Ct value and risk stratification based on the correlation of Ct with infectivity. We also describe the experience of RT-qPCR screening of saliva samples at our institution. It is important to implement a scientific approach to minimize viral transmission while allowing economic and social activities to continue.

著者

Suzanne Shale

出版者

The Keio Journal of Medicine

雑誌

The Keio Journal of Medicine (ISSN:00229717)

巻号頁・発行日

vol.57, no.1, pp.37-44, 2008 (Released:2008-04-04)

参考文献数

4

被引用文献数

3 10

---

This paper derives from a grounded theory study of how Medical Directors working within the UK National Health Service manage the moral quandaries that they encounter as leaders of health care organizations. The reason health care organizations exist is to provide better care for individuals through providing shared resources for groups of people. This creates a paradox at the heart of health care organization, because serving the interests of groups sometimes runs counter to serving the needs of individuals. The paradox presents ethical dilemmas at every level of the organization, from the boardroom to the bedside. Medical Directors experience these organizational ethical dilemmas most acutely by virtue of their position in the organization. As doctors, their professional ethic obliges them to put the interests of individual patients first. As executive directors, their role is to help secure the delivery of services that meet the needs of the whole patient population. What should they do when the interests of groups of patients, and of individual patients, appear to conflict? The first task of an ethical healthcare organization is to secure the trust of patients, and two examples of medical ethical leadership are discussed against this background. These examples suggest that conflict between individual and population needs is integral to health care organization, so dilemmas addressed at one level of the organization inevitably re-emerge in altered form at other levels. Finally, analysis of the ethical activity that Medical Directors have described affords insight into the interpersonal components of ethical skill and knowledge.

著者

Yuji Kato Takashi Osada Nobuo Araki Shinichi Takahashi

出版者

The Keio Journal of Medicine

雑誌

The Keio Journal of Medicine (ISSN:00229717)

巻号頁・発行日

pp.2022-0034-CR, (Released:2023-09-23)

参考文献数

18

---

We encountered a-27-year-old female patient who developed refractory severe headache and photophobia after the first dose of COVID-19 vaccine. Despite her prior history of migraine, we diagnosed COVID-19 vaccine-induced aseptic meningitis. Symptoms were significantly resolved after methylprednisolone therapy. On reviewing the literature, we could find only nine similar cases, with over half of them affecting women aged 20–40 years. Although uncommon, aseptic meningitis should be suspected in patients with persistent or delayed onset of headache following COVID-19 vaccination.

著者

Timothy D. Minton

出版者

The Keio Journal of Medicine

雑誌

The Keio Journal of Medicine (ISSN:00229717)

巻号頁・発行日

pp.2014-0009-RE, (Released:2015-03-06)

参考文献数

22

被引用文献数

3

---

Few medical journals specifically instruct authors to use the active voice and avoid the passive voice, but advice to that effect is common in the large number of stylebooks and blogs aimed at medical and scientific writers. Such advice typically revolves around arguments that the passive voice is less clear, less direct, and less concise than the active voice, that it conceals the identity of the person(s) performing the action(s) described, that it obscures meaning, that it is pompous, and that the high rate of passive-voice usage in scientific writing is a result of conformity to an established and old-fashioned style of writing. Some of these arguments are valid with respect to specific examples of passive-voice misuse by some medical (and other) writers, but as arguments for avoiding passive-voice use in general, they are seriously flawed. In addition, many of the examples that stylebook writers give of inappropriate use are actually much more appropriate in certain contexts than the active-voice alternatives they provide. In this review, I examine the advice offered by anti-passive writers, along with some of their examples of “inappropriate” use, and argue that the key factor in voice selection is sentence word order as determined by the natural tendency in English for the topic of discourse (“old” information) to take subject position and for “new” information to come later. Authors who submit to this natural tendency will not have to worry much about voice selection, because it will usually be automatic.

著者

SHOSUKE OKAMOTO UTAKO OKAMOTO

出版者

The Keio Journal of Medicine

雑誌

The Keio Journal of Medicine (ISSN:00229717)

巻号頁・発行日

vol.11, no.3, pp.105-115, 1962 (Released:2009-03-27)

参考文献数

32

被引用文献数

122 140

---

1) A new potent inhibitor of the fibrinolytic system was found. Its chemical name was 1-(aminomethyl)-cyclohexane-4-carboxylic acid and abbrevi-ated as AMCHA in our laboratories.2) The inhibitory effect of AMCHA in vitro was far more potent than that of EACA when examined by the fibrinolytic system.3) The inhibitory effect of AMCHA given to rabbits intravenously or orally was also more potent than that of EACA when the effect was examined by the streptokinase activation test of blood samples taken at various intervals.4) Reversal by AMCHA of the accelerated fibrinolysis in circulatory blood produced in rabbits by streptokinase was demonstrated.

著者

多田隈 卓史

出版者

The Keio Journal of Medicine

雑誌

The Keio Journal of Medicine (ISSN:00229717)

巻号頁・発行日

vol.42, no.4, pp.180-182, 1993 (Released:2009-03-27)

参考文献数

4

被引用文献数

22 30

---

The human immune system acts a defence mechanism against exogenous or indigenous potentially harmful bodies, such as bacteria and viruses. The major histocompatibility complex (MHC class I and class II antigens) form key elements of legitimate body components, and the organization of MHC molecules allows T-lymphocytes to distinguish between legitimate and foreign bodies. On detection of a foreign component, T-cells activate the necessary pathways for destruction of the foreign body. Occasionally however the system breaks down and the result is a disease of an autoimmune nature. Both visible light and infrared low reactive-level laser therapy (LLLT) has been shown to act on immune system cells in a number of ways, activating the irradiated cells to a higher level of activity. Infrared LLLT has been shown to increase both the phagocytic and chemotactic activity of human Leukocytes in vitro, for example. This is an example of photobiological activation. Photobiological cell-specific destruction is also possible using doses of low incident laser energy on cells which have been photosensitized for the specific wavelength of the laser, such as in photodynamic therapy (PDT) for superficial cancers. LLLT has also been shown to act directly and selectively on the autoimmune system, restoring immunocompetency to immunoincompetent cells. Although much more research needs to be done, there are enough experimental and clinical data to show that the laser, and LLLT in particular, has a possibly exciting role both in immunobiological therapy for diseases of the immune system, and to activate and boost the normal reaction of the immune system components against harmful foreign bodies.

著者

Daiki Kaito Kazuki Matsumura Ryo Yamamoto

出版者

The Keio Journal of Medicine

雑誌

The Keio Journal of Medicine (ISSN:00229717)

巻号頁・発行日

pp.2020-0011-OA, (Released:2020-08-22)

参考文献数

83

被引用文献数

9

---

In late March 2020, we faced a nosocomial outbreak of novel coronavirus disease 2019 (COVID-19) at Keio University Hospital, Tokyo, Japan. Presently, COVID-19 is an unprecedented worldwide biohazard, and a nosocomial outbreak can occur in any hospital at any time. Therefore, we reviewed the literature regarding hospital preparedness, the initial management of COVID-19, and the surveillance of healthcare workers (HCWs) to find information that would be generally useful for physicians when confronted with COVID-19. In terms of hospital preparedness, each hospital should develop an incident management system and establish a designated multidisciplinary medical team. To initiate case management, COVID-19 should be suspected based on patient symptoms and/or high-risk history and then should be confirmed by viral testing, such as reverse transcription polymerase chain reaction (RT-PCR) analysis. Although some patients will become critically ill, the guidelines for respiratory failure and septic shock for non-COVID-19 cases can be followed for supportive treatment. Antiviral medications should be carefully selected because the available information is confused by the large volume of preprint literature and unreliable data. HCWs who have come into contact with patients with COVID-19 can generate new in-hospital clusters of COVID-19 cases. Quarantine following contact tracking with risk stratification is effective in preventing transmission, and the essentials of medical surveillance include monitoring different types of symptoms, delegation of supervision, and continuation of surveillance regardless of the RT-PCR results. Preparation for COVID-19 is recommended before the first COVID-19 case is encountered.

著者

Satoru Yamada

出版者

The Keio Journal of Medicine

雑誌

The Keio Journal of Medicine (ISSN:00229717)

巻号頁・発行日

vol.66, no.3, pp.33-43, 2017 (Released:2017-09-26)

参考文献数

55

被引用文献数

2 7

---

Currently, the low-energy diet is the only recognized nutrition therapy for type 2 diabetes in Japan. However, in recent decades, many foreign scientific organizations have accepted various nutritional approaches to manage diabetes, such as the low-carbohydrate diet, the Mediterranean diet, diet approaches to stop hypertension (DASH), and the vegetarian diet. Moreover, growing evidence has called into question classical nutritional approaches such as the low-fat diet for the prevention of cardiovascular disease and the low-protein diet for the prevention of diabetic kidney disease. Similarly, the recommended nutrition therapy for diabetes may change in near future. Such changes in nutrition therapy must be dynamic and based on not only scientific evidence but also each patient’s narrative.

著者

Daigo Ochiai Hirotaka Masuda Yushi Abe Toshimitsu Otani Marie Fukutake Tadashi Matsumoto Kei Miyakoshi Mamoru Tanaka

出版者

The Keio Journal of Medicine

雑誌

The Keio Journal of Medicine (ISSN:00229717)

巻号頁・発行日

pp.2017-0019-IR, (Released:2018-03-06)

参考文献数

51

被引用文献数

10

---

Mesenchymal stem cells (MSCs) have generated great interest in the fields of regenerative medicine and immunotherapy because of their unique biological properties. Among MSCs, amniotic fluid stem cells (AFS) have a number of characteristics that make them attractive candidates for tissue engineering and cell replacement strategies, particularly for perinatal medicine. If various neonatal conditions, including birth asphyxia, preterm birth, and congenital abnormalities, which result in long-lasting severe impairments, could be predicted during pregnancy, it would allow collection of small samples of amniotic fluid cells by amniocentesis. In vitro culture of these autologous AFS during pregnancy would make them available for use soon after birth. Hypoxic-ischemic encephalopathy (HIE) and myelomeningocele (MMC) are neonatal conditions that cause permanent neurological disability, for which the treatment options are extremely limited. Experiments using animal models of HIE and MMC and human clinical trials have demonstrated that MSCs, including AFS, have beneficial effects on the central nervous system through paracrine influences, indicating that autologous AFS treatment may be applicable for intractable neurological diseases, including HIE and MMC, during the perinatal period. In this review, we focus on recent research related to the therapeutic potential of AFS for perinatal neurological diseases such as HIE and MMC.

著者

Jun Iwamoto Tsuyoshi Takeda Yoshihiro Sato

出版者

The Keio Journal of Medicine

雑誌

The Keio Journal of Medicine (ISSN:00229717)

巻号頁・発行日

vol.54, no.2, pp.55-59, 2005 (Released:2006-06-20)

参考文献数

28

被引用文献数

30 75

---

This paper reviews the interventions to stabilize calcium balance and bone metabolism and prevent bone loss in astronauts during space flight. Weightlessness during space flight results in calcium, vitamin D, and vitamin K deficiency, increases urinary calcium excretion, decreases intestinal calcium absorption, and increases serum calcium level, with decreased levels of serum parathyroid hormone and calcitriol. Bone resorption is increased, whereas bone formation is decreased. The loss of bone mineral density (BMD) in the spine, femoral neck and trochanter, and pelvis is 1.0-1.6% per month. High calcium intake and vitamin D supplementation during space flight does not affect bone metabolism, but prevents an elevation of serum calcium level through increased calcitriol level, while vitamin K counteracts the reduction in bone formation. However, there are no data to show the efficacy of pharmaceutical agents for prevention of development of osteoporosis in astronauts during flight, although the preventative effect of bisphosphonates, testosterone, and vitamin K2 on cancellous bone loss in the tibia or BMD loss in the hindlimb was reported in tail-suspended mature rats. It still remains uncertain whether these agents can prevent cortical bone loss caused by weightlessness in tail-suspended rats. Therefore, in addition to calcium, vitamin D, and vitamin K supplementation, agents that have both potent anti-resorptive and anabolic effects on cancellous and cortical bone may be needed to stabilize calcium balance and bone metabolism and prevent bone loss in astronauts duringspace flight.

著者

TADAYOSHI KOBAYASHI YONOSUKE WATANABE

出版者

The Keio Journal of Medicine

雑誌

The Keio Journal of Medicine (ISSN:00229717)

巻号頁・発行日

vol.1, no.3, pp.215-232, 1952 (Released:2009-03-27)

参考文献数

17

被引用文献数

3

---

1) The authors reported four cases of kernicterus occurred in Japan.2) The incidence of kernicterus is very low in Japan. Only twelve cases of kernicterus, including the cases reported above, have been reported in Japan.3) Of the four cases reported above, two cases were associated with ery-throblastosis fetalis and in another two cases erythroblastosis fetalis could be reasonably excluded.4) Of the twelve cases of kernicterus reported in Japan, ten cases were not associated with erythroblastosis fetalis (83%). It is supposed that such high incidence of kernicterus without erythroblastosis fetalis would be related to some racial specifities.5) In agreement with W. W. Zuelzer and R. T. Mudgett(16), some differences were noticeable between the cases of kernicterus with erythroblastosis fetalis and those without erythroblastosis fetalis concerning the clinical and pathologic-anatomic findings.6) The formation of the characteristic giant cells was observed in the liver in three cases. These giant cells were considered to originate from both liver cells and Kupffer cells. These giant cells differ from megakaryocyte and the giant cell seen in the liver of syphilitic newborn. Only a few descriptions about giant cell formation in the liver, which was thought to be identical with that seen in the cases reported above, were available. The pathological significance of these giant cells is not clear, but there are some evidences showing that these giant cells are occasionally formed in the liver of newborns with severe icterus.7) The role of a specific icteric pigment in pathogenesis of kernicterus cannot be excluded.I would like to express our gratitude to Dr. T. Furuhata, professor of medical juris-prudence, Tokyo University School of Medicine, for his invaluable help for the determination of blood group and to Dr. M. Furuta and Dr. S. Kambe, pathologists to ABCC in Hiroshima, who kindely permit us to examine their slides of the cases of kernicterus.

著者

Rebecca L. Mccarthy Marianne De brito Edel O’toole

出版者

The Keio Journal of Medicine

雑誌

The Keio Journal of Medicine (ISSN:00229717)

巻号頁・発行日

pp.2023-0012-IR, (Released:2023-09-28)

参考文献数

61

---

Pachyonychia congenita (PC) is a rare, autosomal dominant inherited disorder of keratinization that is characterized by a triad of focal palmoplantar keratoderma, plantar pain, and hypertrophic nail dystrophy. It can be debilitating, causing significantly impaired mobility. PC is diagnosed clinically alongside identification of a heterozygous pathogenic mutation in one of five keratin genes: KRT6A, KRT6B, KRT6C, KRT16, or KRT17. Each keratin gene mutation is associated with a distinct clinical phenotype, with variable age of onset and additional features, which has allowed classification by genotype. Additional features include pilosebaceous cysts, follicular hyperkeratosis, natal teeth, oral leukokeratosis, hidradenitis suppurativa, itching, and neurovascular structures. Although classed as rare, the prevalence of PC is likely to be underestimated. There is no cure or specific treatment for PC at present. Current treatments are limited to conservative measures to reduce plantar friction and trauma, mechanical debridement, topical treatments, and treatments for associated features or complications, most commonly infection. However, through active research in collaboration with PC Project, a patient-advocacy group, and the International PC Research Registry, a global registry of PC patients, there are now many new potential therapeutic options on the horizon. This review summarizes the clinical features associated with PC and highlights the current and future treatment of its manifestations.

著者

YASUO IKEDA

出版者

The Keio Journal of Medicine

雑誌

The Keio Journal of Medicine (ISSN:00229717)

巻号頁・発行日

vol.26, no.4, pp.213-222, 1977 (Released:2009-03-27)

参考文献数

14

被引用文献数

15 16

---

Effects of Ibuprofen, a non-steroidal anti-inflammatory drug, on platelet function were studied. Similar to aspirin, Ibuprofen inhibited both platelet release reaction and aggregation in vitro. However, the alteration of platelet function induced by the administration of a therapeutic dose of Ibuprofen in vivo was observed after 2 hours of its administration and disappeared usually within 24 hours. Aspirin-induced changes in platelet function have been known to continue as long as 7 days after a single dosage of aspirin. Prolongation of bleeding time was also noted with Ibuprofen. The platelet dysfunction thus induced by Ibuprofen was easily restored by washing the platelets in vitro, while aspirin-induced one remained unchanged by the same procedure. These results may suggest that Ibuprofen is responsible for easy bruises in its users and the mechanism by which induces the platelet dys-function is somewhat different from that by aspirin.

著者

Masahiro Fukuyama Yohei Sato Jun Hayakawa Manabu Ohyama

出版者

The Keio Journal of Medicine

雑誌

The Keio Journal of Medicine (ISSN:00229717)

巻号頁・発行日

vol.66, no.1, pp.9-13, 2016 (Released:2017-03-25)

参考文献数

20

被引用文献数

3 4

---

Cutaneous metaplastic synovial cysts (CMSCs) are rare tumors typically comprising a solitary, well-circumscribed cystic mass that is not connected to the joint. Synovial cysts have been reported predominantly by orthopedists or pathologists; however, the presence of CMSC is not generally well recognized by dermatologists. Herein, we report a CMSC in a 68-year-old woman receiving systemic corticosteroid therapy for the treatment of eosinophilic granulomatosis with polyangiitis (EGPA). We attempt to delineate the clinical characteristics of this unusual neoplasm by reviewing the literature, focusing especially on dermatological descriptions. Histologic examination of the surgical specimen in the current case revealed that the cystic wall was lined with layers of flattened synovial cell-like cells and connective tissues, mimicking the synovial membrane. Positive immunoreactivity of the lining cells against vimentin was detected, but no immunoreactivity against cytokeratin, carcinoembryonic antigen (CEA), CD68, or S-100 was detected. The pathogenesis of CMSC remains unclear, but it has been tightly linked to direct traumatic stimuli or relative tissue fragility, which potentially accounts for CMSC development in our case. Most CMSCs reported by dermatologists are located on the extremities, whereas those described by other specialists tend to be distributed more globally. Preoperative diagnoses are often either epidermal cyst or suture/foreign body granuloma. Incomplete surgical excision of usual synovial cysts may lead to local recurrence, which has been reported in oral and maxillofacial surgery, but not in dermatologic surgery. This fact could be explained by the technical difficulties of surgical excision related to anatomical location. Dermatologists need to be aware of CMSC, and CMSC should be included in the differential diagnosis of subcutaneous cysts.

著者

Kazuo Isozumi

出版者

The Keio Journal of Medicine

雑誌

The Keio Journal of Medicine (ISSN:00229717)

巻号頁・発行日

vol.53, no.1, pp.7-11, 2004 (Released:2005-06-17)

参考文献数

24

被引用文献数

15 18

---

Obesity is widely recognized as a risk factor for coronary artery disease, but opinion is divided regarding whether it is an independent risk factor for cerebrovascular disease; even now there is no common view. In this study, the review sought to focus on a prospective study, but since obesity and non-obesity basically cannot be randomly assigned, randomized controlled trials (RCT) are non-existent. Accordingly, a cohort study (a method of clinical study in which the obesity group is actively followed up for comparison with the non-obesity group in regard to cerebrovascular disease) was mainly conducted. For reference, retrospective case-control studies are also shown. As a result, most epidemiological surveys on the relation between simple obesity and cerebrovascular disease denied any relation. That is, obesity alone, determined only on the basis of height and weight as shown by BMI (body mass index), etc., cannot be an independent risk factor for cerebrovascular disease; obesity can become a risk factor only when accompanied by hypertension, hyperlipidemia, impaired glucose tolerance, etc. Recently, however, most papers conclude that abdominal obesity is a risk factor for cerebral infarction, provided that there are no data confirming that obesity is a risk factor for hemorrhagic cerebrovascular disease (cerebral hemorrhage and subarachnoid hemorrhage).

著者

Meigen Liu Junichi Ushiba

出版者

The Keio Journal of Medicine

雑誌

The Keio Journal of Medicine (ISSN:00229717)

巻号頁・発行日

vol.71, no.4, pp.82-92, 2022 (Released:2022-12-25)

参考文献数

68

被引用文献数

5

---

Because recovery from upper limb paralysis after stroke is challenging, compensatory approaches have been the main focus of upper limb rehabilitation. However, based on fundamental and clinical research indicating that the brain has a far greater potential for plastic change than previously thought, functional restorative approaches have become increasingly common. Among such interventions, constraint-induced movement therapy, task-specific training, robotic therapy, neuromuscular electrical stimulation (NMES), mental practice, mirror therapy, and bilateral arm training are recommended in recently published stroke guidelines. For severe upper limb paralysis, however, no effective therapy has yet been established. Against this background, there is growing interest in applying brain–machine interface (BMI) technologies to upper limb rehabilitation. Increasing numbers of randomized controlled trials have demonstrated the effectiveness of BMI neurorehabilitation, and several meta-analyses have shown medium to large effect sizes with BMI therapy. Subgroup analyses indicate higher intervention effects in the subacute group than the chronic group, when using movement attempts as the BMI-training trigger task rather than using motor imagery, and using NMES as the external device compared with using other devices. The Keio BMI team has developed an electroencephalography-based neurorehabilitation system and has published clinical and basic studies demonstrating its effectiveness and neurophysiological mechanisms. For its wider clinical application, the positioning of BMI therapy in upper limb rehabilitation needs to be clarified, BMI needs to be commercialized as an easy-to-use and cost-effective medical device, and training systems for rehabilitation professionals need to be developed. A technological breakthrough enabling selective modulation of neural circuits is also needed.

著者

Hidekazu Suzuki

出版者

The Keio Journal of Medicine

雑誌

The Keio Journal of Medicine (ISSN:00229717)

巻号頁・発行日

pp.2020-0006-OA, (Released:2020-07-01)

参考文献数

90

被引用文献数

3 7

---

In 2016, the Rome criteria were updated as Rome IV, and only minor changes were introduced for functional dyspepsia (FD). The major symptoms of FD now include not only postprandial fullness, but also epigastric pain and burning, and early satiation at above the “bothersome” level. Investigations into the effect of meal ingestion on symptom generation have indicated that not only postprandial fullness and early satiety but also epigastric pain and burning sensation and nausea (not vomiting) may increase after meals. Helicobacter pylori infection is considered to be the cause of dyspepsia if successful eradication leads to sustained resolution of symptoms for more than 6 months, and such a condition has been termed H. pylori-associated dyspepsia. Prompt esophagogastroduodenoscopy and H. pylori “test and treat” may be beneficial, especially in regions with a high prevalence of gastric cancer, such as east Asia. In terms of treatment, acotiamide, tandospirone, and rikkunshito are newly listed in Rome IV as treatment options for FD. Clinical studies in the field of FD should be strictly based on the Rome IV criteria until the next Rome V is published in 2026.

著者

Sae Aratani Takeshi Matsunobu Takahiro Kawai Hirotake Suzuki Norihiro Usukura Kimihiro Okubo Yukinao Sakai

出版者

The Keio Journal of Medicine

雑誌

The Keio Journal of Medicine (ISSN:00229717)

巻号頁・発行日

vol.70, no.1, pp.19-23, 2021 (Released:2021-03-25)

参考文献数

21

被引用文献数

1 4

---

Proton pump inhibitors (PPIs) are widely used medicines worldwide. However, a rare etiology of syndrome of inappropriate secretion of antidiuretic hormone (SIADH) related to PPI was recently reported. Therefore, the putative role of PPIs in SIADH cannot be underestimated. A 78-year-old Japanese woman was admitted to our hospital for treatment of left Bell’s palsy. On admission, the patient was oriented with normal laboratory data, including a serum Na level of 135 mEq/L. Oral glucocorticoids and a proton pump inhibitor were initiated in combination with oral valaciclovir. Six days later, the patient’s consciousness became impaired. Laboratory data showed a serum Na level of 103 mEq/L, a urine Na level of 64.8 mEq/L, a urine K level of 43.6 mEq/L, and a urine osmolality of 450 mOsm/kg H2O. The patient met the criteria for SIADH. The initial treatment included water restriction and 3% hypertonic saline administration. The cessation of PPI significantly improved the urine diluting capacity and concomitantly increased serum Na, which indicated that the use of PPI had been responsible for the etiology of SIADH. The present case illustrates that physicians need to be aware of the uncommon adverse effects of PPI, such as SIADH.