The Tohoku journal of experimental medicine
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Tohoku J. Exp. Med. · Mar 2020
ReviewImaging Brain Mechanisms of Functional Somatic Syndromes: Potential as a Biomarker?
When patients present with persistent bodily complaints that cannot be explained by a symptom-linked organic pathology (medically unexplained symptoms), they are diagnosed with 'functional' somatic syndromes (FSS). Despite their prevalence, the management of FSS is notoriously challenging in clinical practice. This may be because FSS are heterogeneous disorders in terms of etiopathogenesis. ⋯ This was coupled with dysfunctional inhibitory influence of the medial prefrontal cortex (mPFC) and pregenual anterior cingulate cortex (pACC) on stress regulation systems, resulting in the activated autonomic nervous system (ANS) and neuroendocrine system stimulated by corticotropin-releasing hormone (CRH). IBS subjects with higher alexithymia, a risk factor for FSS, showed stronger activity in the insula during rectal distention but reduced subjective sensitivity. Reduced top-down regulation of the ANS and CRH system by mPFC and pACC, discordance between the insula response to stimulation and subjective sensation of pain, and stronger threat responses in hypervigilance-related areas may be a candidate brain-based biomarker.
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Tohoku J. Exp. Med. · Mar 2020
Better Retention of Abatacept Is Associated with High Rheumatoid Factor: A Five-Year Follow-Up Study of Patients with Rheumatoid Arthritis.
Recently, biological disease-modifying antirheumatic drugs (bDMARDs) have revolutionized the treatment of rheumatoid arthritis (RA) and provided patients with a higher chance of achieving clinical remission. Among them, abatacept (ABT), which selectively inhibits T cell activation through blocking costimulation signal, has been reported efficacious in controlling disease activity. Previous studies have shown that ABT has a high retention rate of up to three years with tolerable adverse events; however, it remains unclear whether this is maintained in the longer term. ⋯ Receiver operating characteristics analysis showed that patients with high RF (≥ 45 IU/mL) had better retention rate of ABT. In conclusion, ABT shows high retention rate among patients with positive RF. The present study may provide better insights when selecting bDMARDs.
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Tohoku J. Exp. Med. · Mar 2020
Saline Solution Irrigation of the Bile Duct after Stone Removal Reduces the Recurrence of Common Bile Duct Stones.
Common bile duct (CBD) stone is a relatively common but potentially life-threatening disease. Endoscopic sphincterotomy (EST) has been performed as standard therapy for CBD stones, but the rate of recurrence of CBD stones is high. Risk factors have been poorly defined, and no effective means for the prevention of the recurrence of CBD stones have been established so far. ⋯ Mechanical lithotripsy caused cholangiography-negative small residua. Notably, saline solution irrigation of the bile duct reduced the recurrence of CBD stones. These results demonstrate that subsequent biliary irrigation after stone removal may prevent the recurrence of CBD stones by clearing small residual fragments.
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Tohoku J. Exp. Med. · Mar 2020
Observational StudyFetal Biparietal Diameter as a Potential Risk Factor for Emergency Cesarean Section due to Labor Arrest.
Labor arrest is the most common indication for emergency cesarean section (ECS). Increased biparietal diameter (BPD) has been reported as a risk factor for ECS due to labor arrest in different countries, but it is unclear whether this relationship is relevant in Japan. Considering the difference in maternal physique according to race and ethnicity, we retrospectively evaluated the association between ECS due to labor arrest and BPD, measured by ultrasonography < 7 days before term deliveries in Japanese women. ⋯ The optimal BPD cut-off value for predicting ECS due to labor arrest was 94 mm (area under the curve, 0.61; sensitivity, 53.1%; specificity, 65.1%). Despite the significant association with ECS, BPD is not useful to predict ECS due to labor arrest. Thus, mothers should be encouraged for attempting vaginal deliveries, even in the case of having babies with large fetal BPD.
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Tohoku J. Exp. Med. · Mar 2020
Case ReportsPost-Traumatic West Syndrome due to Abusive Head Trauma in Two Infants with Different Brain Imaging Findings.
Abusive head trauma (AHT), commonly known as shaken baby syndrome, is a cranial injury of infants and young children. AHT is an important cause of morbidity and mortality in young children, particularly those younger than 12 months of age. We describe two patients who developed West syndrome, which is a severe epilepsy syndrome composed of the triad of infantile spasms, hypsarrhythmia on electroencephalography, and developmental arrest or regression, possibly attributable to AHT. ⋯ AHT may be an important risk factor for postnatal West syndrome. It is noteworthy that evidence of AHT was found only after West syndrome onset, as in Case 2. The onset of West syndrome may contribute to the finding that AHT had occurred earlier.