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Supplementary Figure 1. STXBP4 expression is correlated with poor prognosis in patients with tumors expressing high ΔNp63 levels. Supplementary Figure 2. Causal networks associated with STXBP4 expression in lung SCC. Supplementary Figure 3. Depletion of PDGFRα suppresses the growth of lung SCC. Supplementary Figure 4. PDGFRA mRNA was significantly correlated with STXBP4 in the gene expression profiles of lung SCC patients. Supplementary Figure 5. PDGFRA expression is upregulated in STXBP4-transduced lung SCC cells. Supplementary Figure 6. STXBP4-depletion inhibits SCC tumorigenesis and modulates PDGF signaling in vivo. Supplementary Figure 7. STXBP4 promotes tumorigenesis through PDGFRA in lung SCC.

Purpose: Expression of the ΔN isoform of p63 (ΔNp63) is a diagnostic marker highly specific for lung squamous cell carcinoma (SCC). We previously found that Syntaxin Binding Protein 4 (STXBP4) regulates ΔNp63 ubiquitination, suggesting that STXBP4 may also be an SCC biomarker. To address this issue, we investigated the role of STXBP4 expression in SCC biology and the impact of STXBP4 expression on SCC prognosis.Experimental Design: We carried out a clinicopathologic analysis of STXBP4 expression in 87 lung SCC patients. Whole transcriptome analysis using RNA-seq was performed in STXBP4-positive and STXBP4-negative tumors of lung SCC. Soft-agar assay and xenograft assay were performed using overexpressing or knockdown SCC cells.Results: Significantly higher levels of STXBP4 expression were correlated with accumulations of ΔNp63 in clinical lung SCC specimens (Spearman rank correlation ρ = 0.219). Notably, STXBP4-positive tumors correlated with three important clinical parameters: T factor (P < 0.001), disease stage (P = 0.030), and pleural involvement (P = 0.028). Whole transcriptome sequencing followed by pathway analysis indicated that STXBP4 is involved in functional gene networks that regulate cell growth, proliferation, cell death, and survival in cancer. Platelet-derived growth factor receptor alpha (PDGFRα) was a key downstream mediator of STXBP4 function. In line with this, shRNA mediated STXBP4 and PDGFRA knockdown suppressed tumor growth in soft-agar and xenograft assays.Conclusions: STXBP4 plays a crucial role in driving SCC growth and is an independent prognostic factor for predicting worse outcome in lung SCC. These data suggest that STXBP4 is a relevant therapeutic target for patients with lung SCC. Clin Cancer Res; 23(13); 3442–52. ©2017 AACR.

Supplementary Information and Supplementary Figures Legends

Objective Almost no Japanese elderly patients have an advance directive (AD). Our aim was to determine whether or not the wish to receive intensive care in elderly patients with respiratory tract infection could be predicted from the prehospital data. Methods In this retrospective study, we reviewed patients ≥65 years of age with respiratory tract infection who had been transferred to our hospital by ambulance between September 2014 and August 2016. The patients were divided into two groups according to whether or not they wished to receive intensive treatment. We placed patients without a wish to receive intensive treatments (WITs) in Group A and patients with a WITs in Group B. We then analyzed parameters that could be determined in the prehospital phase and compared the findings between the groups. Results Thirty-seven patients were in Group A, and 67 patients were in Group B. None of the patients in this study had an AD. There were significant differences in the age, rate of residence in an extended care facility, frequency of inability to care for oneself fully, frequency of dementia, number of prescribed drugs, and Glasgow coma scale (GCS) on a univariate analysis. A logistic regression analysis showed that the inability to care for oneself fully [odds ratio (OR): 4.521, 95% confidence interval (CI): 2.024-10.096, p

Purpose: Expression of the ΔN isoform of p63 (ΔNp63) is a diagnostic marker highly specific for lung squamous cell carcinoma (SCC). We previously found that Syntaxin Binding Protein 4 (STXBP4) regulates ΔNp63 ubiquitination, suggesting that STXBP4 may also be an SCC biomarker. To address this issue, we investigated the role of STXBP4 expression in SCC biology and the impact of STXBP4 expression on SCC prognosis. Experimental Design: We carried out a clinicopathologic analysis of STXBP4 expression in 87 lung SCC patients. Whole transcriptome analysis using RNA-seq was performed in STXBP4-positive and STXBP4-negative tumors of lung SCC. Soft-agar assay and xenograft assay were performed using overexpressing or knockdown SCC cells. Results: Significantly higher levels of STXBP4 expression were correlated with accumulations of ΔNp63 in clinical lung SCC specimens (Spearman rank correlation ρ = 0.219). Notably, STXBP4-positive tumors correlated with three important clinical parameters: T factor (P < 0.001), disease stage (P = 0.030), and pleural involvement (P = 0.028). Whole transcriptome sequencing followed by pathway analysis indicated that STXBP4 is involved in functional gene networks that regulate cell growth, proliferation, cell death, and survival in cancer. Platelet-derived growth factor receptor alpha (PDGFRα) was a key downstream mediator of STXBP4 function. In line with this, shRNA mediated STXBP4 and PDGFRA knockdown suppressed tumor growth in soft-agar and xenograft assays. Conclusions: STXBP4 plays a crucial role in driving SCC growth and is an independent prognostic factor for predicting worse outcome in lung SCC. These data suggest that STXBP4 is a relevant therapeutic target for patients with lung SCC. Clin Cancer Res; 23(13); 3442–52. ©2017 AACR.

Ileal perforation by an accidental ingestion of a blister pill pack is rare. A detailed history of the present illness is the initial key to proceed appropriate investigations. Computed tomography is the gold standard for diagnosis of the disease.

Objective The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score is a diagnostic tool for necrotizing soft tissue infection (NSTI), which is validated and is considered to have high diagnostic value. However, some experts criticize LRINEC score for consisting of laboratory test results only. Methods In this single-center retrospective study, we created a new scoring system (NSTI assessment score; NAS), which also incorporated vital signs as another diagnostic tool for NSTI using cases from our hospital and also evaluated diagnostic accuracy of LRINEC score. We identified NSTI predictors by comparing 24 NSTI patients and 80 non NSTI patients using uni- and multivariate logistic regression analysis, and created NAS based on odds ratio of variables which are statistically significant in the multivariate model. Results We identified mean arterial pressure, C-reactive protein, hemoglobin, serum creatinine, and glucose as a predictor for NSTI. The maximum value of NAS was 11 points with the cut-off value of 6. Sensitivity, specificity, positive predictive value, and negative predictive value of the NAS for diagnosis of NSTI were 87.5%, 91.3%, 75.0%, and 96.1%, respectively. Area under the receiver operating characteristic curve was 0.926 (0.851–1.00) for the NAS and 0.903 (0.833–0.973) for the LRINEC score, and they were not statistically different (p = 0.167). Conclusion The NAS has high diagnostic accuracy in predicting NSTI, and is comparable with the LRINEC score. The NAS needs to be validated in other cohorts in the future.

Case We report a case of post-traumatic hypopituitarism in a 9-year-old boy who was injured in a car accident. Outcome Post-traumatic hypopituitarism might be caused by moderate to severe head trauma, and while this possibility has recently drawn attention in adults, few reports are available regarding children. Our patient experienced head and facial injury, resulting in post-traumatic hypopituitarism. Six hours after injury he suffered from diabetes insipidus and hormone replacement therapy was started. On day 12 he underwent facial fracture reduction under general anesthesia. On day 24 he was discharged from the hospital. One year after the injury, secretory function and water dehydration tests suggested the possibility of post-traumatic hypopituitarism. Conclusion We experienced a child case of post-traumatic hypopituitarism. Emergency physicians should pay attention to the possibility of post-traumatic hypopituitarism in cases of traumatic brain injury.

Case A 66 year-old woman who presented with sudden lower abdominal pain was transferred to our emergency room. Vital signs were stable on arrival at the hospital, but immediately became unstable. Systolic/diastolic blood pressure and heart rate were 66/33 mmHg and 70 b.p.m., respectively. Computed tomography scanning showed splenic artery aneurysm rupture and extravasation. The patient was treated non-operatively and definitively by endovascular therapy comprising resuscitative endovascular occlusion of the aorta for hemodynamic control, N-butyl cyanoacrylate, and metallic coils as an embolization material. Outcome On admission day 3, she was enrolled in another department and admission day 54, she was discharged. Conclusion Although resuscitative endovascular occlusion of the aorta and N-butyl cyanoacrylate is known to be effective, the use of resuscitative endovascular occlusion of the aorta with transcatheter arterial embolization and N-butyl cyanoacrylate for non-traumatic bleeding has not previously been reported. By combining and adapting these devices, their applications in endovascular management may be increased.

OBJECTIVE This study was conducted to determine whether a policy of not attempting to resuscitate patients who are 80 years of age and older with cardiopulmonary arrest on arrival is justifiable. METHODS The protocol of this study was approved without the need for informed consent by the research ethics board of Gunma University Hospital. We prospectively analyzed patients with cardiopulmonary arrest on arrival that was due to an intrinsic reason who were taken to Gunma University Hospital between January 2013 and March 2014. The patients were divided into two groups: patients who were less than 80 years of age (L group) and those aged 80 years and older (H group). We compared the patients' characteristics, including the etiology of cardiac arrest, and the prognosis between the two groups. RESULTS A total of 103 patients with cardiopulmonary arrest on arrival were enrolled. There were no significant differences in the patients' characteristics, such as age, sex, witness and bystander cardiopulmonary resuscitation, and transportation time between the two groups. The return of spontaneous circulation was obtained in 14 patients (25.5%) in the L group and in 9 patients (18.8%) in the H group; however, no significant difference was seen between the two groups. Two patients in the L group were in good neurological condition when they were discharged; however, the other patients did not survive. CONCLUSION Even patients 80 years of age and older can be resuscitated to spontaneous circulation. We do not endorse a policy that recommends not performing cardiopulmonary resuscitation based solely on the age of the patient.

Aim To determine the formula that predicts the injury severity score from parameters that are obtained in the emergency department at arrival. Methods We reviewed the medical records of trauma patients who were transferred to the emergency department of Gunma University Hospital between January 2010 and December 2010. The injury severity score, age, mean blood pressure, heart rate, Glasgow coma scale, hemoglobin, hematocrit, red blood cell count, platelet count, fibrinogen, international normalized ratio of prothrombin time, activated partial thromboplastin time, and fibrin degradation products, were examined in those patients on arrival. To determine the formula that predicts the injury severity score, multiple linear regression analysis was carried out. The injury severity score was set as the dependent variable, and the other parameters were set as candidate objective variables. IBM spss Statistics 20 was used for the statistical analysis. Statistical significance was set at P

Aim We evaluated the usefulness of fibrin degradation products and D-dimer levels in blood to predict return of spontaneous circulation in patients with cardiopulmonary arrest on arrival compared with anion gap and albumin-corrected anion gap. Methods We retrospectively reviewed the medical records of patients with cardiopulmonary arrest on arrival who had been transferred to the emergency department of our hospital in 2012. Patients were divided into two groups: patients with return of spontaneous circulation (ROSC(+) group), and those without (ROSC(−) group). The levels of anion gap, albumin-corrected anion gap, fibrin degradation products and D-dimer measured on arrival were compared between the two groups. Results Fifty-three patients could be analyzed. The anion gap and albumin-corrected anion gap levels were significantly better in the ROSC(+) group than in the ROSC(−) group (anion gap, 28.7 mmol/L [median] versus 39.1 mmol/L; albumin-corrected anion gap, 31.1 mmol/L versus 40.9 mmol/L). The fibrin degradation product and D-dimer levels were significantly lower in the ROSC(+) group than in the ROSC(−) group (fibrin degradation products, 32.1 μg/mL versus 157.4 μg/mL; D-dimer, 9.9 μg/mL versus 37.4 μg/mL). The area under receiver operating characteristic curves to evaluate the relationship with return of spontaneous circulation of anion gap, albumin-corrected anion gap, fibrin degradation products, and D-dimer were 0.664, 0.667, 0.714, and 0.707, respectively. Conclusion Fibrin degradation products and D-dimer levels might be more useful as predictors of return of spontaneous circulation than anion gap and albumin-corrected anion gap.

Purpose The reliable parameter, which can be obtained easily and quickly, is necessary to predict the return of spontaneous circulation (ROSC) of patients with cardiopulmonary arrest (CPA) in the emergency situation. In this study, we evaluated the significance of albumin corrected anion gap (ACAG) for the prediction of ROSC in patients with CPA. Patients and methods In 166 patients with CPA between January 2009 and December 2010, 132 patients could be analyzed retrospectively. We compared acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment(SOFA) score, anion gap (AG) and ACAG levels between patients with/without ROSC and evaluated the significance of AG and ACAG to predict ROSC in patients with CPA. Results Both AG and ACAG were significantly lower in patients with ROSC than in patients without ROSC. Both AG and ACAG had the relation with APACHE II and SOFA scores, however, coefficients of correlation with APACHE II and SOFA score were higher in ACAG (r = 0.506) than in AG (r = 0.482). The sensitivity, specificity, positive predictive value, and negative predictive value of ACAG for the prediction of ROSC in patients with CPA were better than those of AG. Conclusion Our study shows that both AG and ACAG have the relation with ROSC and ACAG is better to predict the ROSC following CPR in patients with CPA compared with AG. ACAG can be easily obtained in the emergency situation, and ACAG is a useful parameter to predict ROSC in patients with CPA.

Purpose To find factors that predict the requirement of packed red blood cells (pRBC) transfusion in patients with blunt trauma on arrival at the hospital. Methods We conducted blood tests in trauma patients whose trauma severity was suspected as being 3 and over in the Abbreviated Injury Scale. Patients were divided into the blood transfusion (BT) and control groups according to the requirement of pRBC transfusion within 24 h after arrival. Results We analyzed 347 patients (BT group, n = 14; control group, n = 333). On univariate analysis, there were significant differences in Glasgow Coma Scale (GCS), rate of positive FAST (focused assessment with sonography for trauma) finding, hematocrit, international normalized ratio of prothrombin time, activated partial thromboplastin time, fibrinogen (Fib), and level of fibrin degradation products (FDP). On multivariable analysis, positive FAST finding, GCS, Fib, and FDP influenced the requirement of pRBC transfusion. In the area under the receiver operating characteristic curve analysis, Fib and FDP were markers that predicted the requirement of pRBC transfusion. The FDP/Fib ratio had a better correlation with the requirement of pRBC transfusion than FDP or Fib. Conclusions The FDP/Fib ratio can be easily measured and may be a predictor of the need for pRBC transfusion.

【背景・目的】 群馬大学医学部附属病院では, 2005年春より女性専用外来を開設した. 当外来の現状および課題を検討するため, 受診者を対象に受診背景・患者満足度に関し調査を行った.【対象と方法】 対象は2006年6月14日から2008年2月29日の間に当外来を初診した女性患者42名であった. 担当医師および対象患者に対するアンケートをデータとして解析した.【結 果】 受診者の年齢は40代 (26％), 50代 (26％) が多く, 疾患は婦人科系疾患 (56％), 内科系疾患 (40％) が多かった. 他院受診歴のある者が多かった (84％). 初診時, 漢方薬処方率が高かった (53％). 患者の満足度は高かった.【結 語】 当院女性専用外来を受診する症例の背景として, 女性医師の診察を求めて受診する症例や多彩な症状・疾患に対する余裕を持った診療体制を望んで受診する症例が多かった. そのような症例の多くに女性専用外来の満足度は高かった.

【目 的】 紹介状なしで受診する患者の現状を調査し, 患者の大学病院に対するニーズを把握する. 【対象と方法】 1年間に群馬大学医学部附属病院を紹介状なしで初診した患者数を調査. また, 総合診療部を受診した患者について専門科受診希望の有無, 具体的な受診希望専門科, 受診前の状況等を問診表から調査した. 【結 果】 紹介状なしで大学病院を受診した患者の11.6％は専門診療科受診希望を表明せず. 専門科希望者1,104人の内, 具体的に専門科がわからない患者は64.9％であった. 総合診療部初診者2,051人の内, 48.9％は同症状で他医療機関の受診歴があった. 【結 語】 患者はかならずしも専門科希望でなくとも大学病院を受診する. 一方, 専門科希望で受診しても具体的な専門科がわからないことは多い. 受診する前に同じ症状で他の医療施設を受診している患者が相当数おり, 患者からみると紹介機能は必ずしも十分に働いていない.

【目 的】 治療期／慢性期のがん患者, および非がん初診患者 (総合診療部外来初診患者のうち, がんの既往や疑いのない者) の倦怠感を比較し, 各々の特徴について考察する. 【対象・方法】 質問紙調査. 倦怠感はCFSを用いて測定し, 倦怠感以外の症状として発熱・嘔気・下痢・睡眠障害・疼痛・呼吸困難の有無を問うた. 有効回答が得られたがん患者283名, 非がん初診患者353名を分析の対象としt検定を行った. 【結 果】 がん患者ではその他の症状の有無により倦怠感に有意差があったが, 非がん初診患者では発熱と睡眠障害がある場合のみ有意差があった. 非がん初診患者は, その他の症状の有無に関わらず倦怠感は日常生活に著明な支障を表すレベルにあったが, 主訴に挙げた者はわずか4.8％であった. 【結 語】 がん患者の倦怠感は, その他の症状のコントロール状況が反映する. 非がん初診患者は主訴に挙げなくても倦怠感が強いことを考慮する必要がある.

これまで, リンパ浮腫への有効な治療法がなく, がん治療後の続発性リンパ浮腫に悩む患者が相当数いた. われわれは, 慢性的に経過しているリンパ浮腫患者に, フェルディー式の医療徒手リンパドレナージ (ML) 手技を含む複合的リンパ療法を行っている. この療法によって, 浮腫の改善と, それに伴うADLの改善が見られた. さらにボディーイメージの改善によって社会参加を取り戻しQOLの向上をもたらすことが出来た2事例を紹介する. 認定資格者によるML手技の適用と共に, 圧迫療法としての弾性包帯と弾性圧迫衣の活用, さらに自ら運動療法に取り組む過程で, セルフケア管理が出来るようになることを目指している. 継続的に自己管理が出来るようになると, 繰り返す蜂窩識炎を回避して, 家族と共に生活の質を維持していくことが可能である.

症例は37歳男性マリ人. 来日後7日目に発熱, 咽頭痛, 水様性下痢にて発症した. 血液検査では貧血と血小板減少を認め, 母国マリ共和国への渡航歴からマラリア感染を疑い, 末梢血塗末標本にて原虫を確認し, 熱帯熱マラリアと診断した. メフロキンを治療薬として選択し, 1,650mgの最大量投与にて治療を開始したところ, 速やかな解熱と全身状態の改善を認めた. 熱帯熱マラリアは容易に重症化や死亡に至る疾患であるため迅速な治療開始が必須であると同時に, 薬剤耐性マラリアを考慮した適切な治療薬の選択が重要である.

乾燥症状を伴う咽喉頭部の違和感や乾性咳嗽に蘇子降気湯が奏効した一例を経験したので報告する。症例は62歳の男性, X年10月頃から喉の乾燥感と咳嗽, 息苦しさを自覚し, 近医耳鼻科を受診した。咽喉頭に異常はなく投薬を受けたが症状は不変で, さらに食欲低下も出現したため, 和漢診療を希望して当科を受診した。当院でも耳鼻科と併診としたが, ガムテストで軽度の唾液分泌量の低下を認める以外に明らかな異常を認めず, 眼の乾燥症状もみられなかった。口腔乾燥症による咽頭の違和感と息苦しさと考えられ, 受診時から1カ月間, 麦門冬湯合半夏厚朴湯を投与したが不変であった。茯苓飲合半夏厚朴湯に転方後, 食欲は改善傾向となったが, 強い咽喉頭乾燥感は続いていた。そこで, 気逆が主病態と考え蘇子降気湯に転方した。投与1カ月後から乾燥感が軽減し, その後漸次息苦しさや咳嗽も消失, 投与11カ月で廃薬となった。乾燥症状の存在する咳嗽や息苦しさに対して, 本方の有用性が示唆された。

和漢薬が奏効した線維筋痛症 (FMS) の二例を提示し, FMSの臨床像と甘草附子湯証との類似点を考察した。症例1は52歳, 女性で2001年左手関節痛を自覚, その後両側の肘, 肩, 足関節痛とその周囲の筋痛が出現。近医リウマチ科で精査を受けたが異常はなくFMSと診断された。NSAIDsが無効のため, 04年当科を紹介受診した。桂枝二越婢一湯加苓朮加防已黄耆湯葛根を投与, 内服2ヵ月で疼痛は半減。06年3月VASは20%となりNSAIDsは不要となった。症例2は58歳, 女性で10年前から左肘痛を自覚。2004年から項頸部痛や両側上肢, 肩の疼痛が出現し, 近医整形外科を受診。頸部X-rayや神経学的に異常がなかったためNSAIDsで経過観察となった。05年3月症状が不変のため4月に当科を紹介受診。炎症反応が陰性でACRのFMS分類基準に適合した。甘草附子湯の3ヵ月の服用でVASは30%となりADLは向上した。

A 79-year-old man with a history of gastrectomy with Billroth II reconstruction 27 years previously was admitted to our hospital due to recurrent pneumonia. Because he had dysphagia and had frequently developed pneumonia over the course of a year, enteral nutrition via nasogastric tube was initiated approximately six months before admission. The clinical and computed tomography findings showed that the cause of pneumonia was aspiration of tube feeding nutrients due to gastroesophageal reflux. To prevent gastroesophageal reflux, he was continuously kept in a 30-degree or greater reclining position. However, gastroesophageal reflux was seen at an injection rate of 50 ml/h or greater. After we inserted a nasogastric-jejunal feeding tube guided by endoscopy, gastroesophageal reflux, dumping syndrome and diarrhea were not seen up to an injection rate of 300 ml/h. Endoscopically guided nasogastric-jejunal feeding tube placement is a simple method and may be useful for patients with aspiration pneumonia due to postgastrectomy. Moreover, long-term postgastrectomy patients appear to tolerate the postopyloric injection of enteral nutrition. Because the number of elderly patients who have dysphagia with postgastrectomy is increasing, these findings provide a basis for treatment in elderly medical settings.

【背景・目的】 看護学生は, 短期間で幅広い専門的知識を習得しなければならず, 高い学習意欲が要求されている. 我々は実習に先立つ講義において, 試験出題部分をあらかじめ講義資料の中で明示することが, 看護学生の学習意欲に及ぼす影響を検討した. 【対象と方法】 2004年度入学の看護学科一年次の学生 (男性12名, 女性72名). 試験に出題する部分を講義資料のなかで明示し, 学習意欲について, Visual analogue scaleで定量化した. 【結 果】 試験出題部分を予告した今回の講義の方が, 予告をしない他の講義よりVisual Analogue Scaleを用いて定量した学習意欲が有意に高かった. 自由筆記の分析からは, 「実習で学習内容を実践するのが楽しみになった」など, 学習意欲に関する項目が抽出された. 【結 論】 試験出題部分の講義資料内での予告は, 看護学生の学習意欲を向上させる一手段として有用であると考えられた.

【目 的】 動脈硬化症では, 脈波速度 (PWV) は増大し, 高感度CRP (hsCRP) やインターロイキン6 (IL-6) 等の炎症マーカーも高値を示す. 本研究では, 健康な地域住民において, PWVと炎症マーカーとの関連性を検討した. 【対象と方法】 対象は, 2003年8月から2004年1月までに群馬県吉岡町の健康相談に参加した地域住民109名であった. 動脈硬化の進展度を反映する上腕―足首PWV (baPWV) を計測するとともに, hsCRP, IL-6の血中濃度を測定し, baPWVと炎症マーカーの相関関係の有無を検討した. 【結 果】 baPWVは, hsCRP及びIL-6との間に有意な正の相関を示した. また, baPWVが13.7 m/sec以上の参加者ではIL-6が有意に高値であった. 【結 語】 健常人においても血管壁の炎症が潜在的な動脈硬化を惹起する可能性が示唆された. IL-6は初期段階の動脈硬化の予知に有用と思われた.

Background: Although the effect of copper on bone has been tested in animals and healthy subjects, no studies concerning the effect of copper supplementation on bone metabolism in patients with copper deficiency have been reported because of the rarity of these patients. This study was conducted to investigate the effect of copper supplementation on bone metabolism in copper-deficient patients. Method: This study included 10 patients (83.7 ± 8.3 years) with dietary copper deficiency under long-term bed rest for more than 12 months. They had their diets supplemented with copper sulfate (3 mg/day) over 12 weeks in addition to their diet of only one kind of enteral food with a low concentration of copper. Serum copper and ceruloplasmin, urinary deoxypyridinoline (DPD) and collagen-type 1 N-telopeptide (NTX) (biomarkers of bone resorption), serum osteocalcin (OC) and bone-specific alkaline phosphatase (Bone ALP) (biomarkers of bone formation) were analyzed at baseline, 4 and 12 weeks after copper supplementation. Results: DPD and NTX excretion were significantly increased 4 weeks after copper supplementation (p = 0.009 and p = 0.013, respectively). Serum bone ALP and OC were not significantly changed 12 weeks after copper supplementation (p = 0.051 and p = 0.594). Conclusions: In patients with nutritional copper deficiency, bone resorption markers are increased with copper supplementation.

Background: It has not been established as to which side the biopsy (instrument) channel should be placed in the tip of a front-viewing upper gastrointestinal (GI) endoscope to allow an en-face approach to lesions on various aspects of the stomach wall. Methods: Using a front-viewing two-channel endoscope, we identified a difference in endoscopic views during biopsy between lower-right and lower-left channels. Colored marks were distributed on the lesser curvature (LC), greater curvature (GC), anterior wall (AW), and posterior wall (PW) in the ‘stomach’ of a dummy for mock-performance of upper GI endoscopy. When biopsy forceps through the different channels touched the marks, an endoscopic photograph was taken. Furthermore, when biopsy specimens were obtained from PW lesions in several patients, endoscopic views were compared between the two biopsy channels. Results: In the dummy study, no remarkable difference was detected in targeting the marks on AW, LC, or GC of the stomach. The dummy and the patient study showed that the lower-right approach could target PW lesions with a more adequate endoscopic view than from the lower left. The lower-left approach targeted PW lesions on the higher body with a nearly blinded endoscopic view. Specimens from PW of the upper body, which could be precisely obtained under direct visual control through the lower-right channel, were no smaller than those obtained using the channel on the lower left. Conclusion: The present study suggests that the lower-right channel may be preferable to the lower-left channel in the tip of a front-viewing upper GI endoscope.

To identify risk factors of urinary tract infection (UTI) in geriatric patients, the levels of serum uric acid, serum creatinine, and urine pH were compared between pyuria-positive and -negative patients in a geriatric ward. The level of serum uric acid was higher with lower urine pH level in the pyuria-negative patients than in positive patients. The level of serum creatinine was relatively higher in the pyuria-negative patients than in the positive patients. Even after matching for serum creatinine, serum uric acid was significantly higher in the pyuria-negative male patients. The results in the present study proposed an interesting hypothesis about backgrounds for UTI in geriatric patients. The relationships among serum uric acid, serum creatinine, urine pH, and pyuria should be examined further in a larger population and in experimental studies.

【背景・目的】他病院でがん診断または治療を受けているにもかかわらず, 主治医の診療情報提供書を持たず, 自らすすんで大学病院を受診した患者の動機を明らかにした.【対象と方法】総合診療部を受診したがん患者52名から受診動機を聴取し, 内容分析を行った.【結果】患者の大学病院受診の動機は, 1) 現在の診断・治療の妥当性についての相談 (30.8%), 2) 新たな症状が出現したことへの不安 (30.8%), 3) 病状が改善しないことによる不安 (19.2%), 4) 高度医療への希望・期待 (9.6%), 5) 経過観察を希望 (9.6%) の5カテゴリーにまとめられた.【結語】患者は, 現在の治療・病状に対する不安, 新たな症状が出現したことによる不安が多く, 大学病院に対し最先端の高度医療提供への期待があることが明らかになった.

遷延化した帯状疱疹後神経痛 (post herpetic neuralgia: PHN) に対し烏薬順気散料が奏効した一例を経験した。症例は76歳, 女性。既往に糖尿病はあるが, 食事療法でコントロール良好。主訴は右頬部痛。2002年10月, 右頬部の帯状疱疹に罹患し近医に入院, アシクロビルの点滴静注を受け皮疹は消失したが, 同部位のピリピリする疼痛が持続した。PHNの診断でカルバマゼピン内服に加え, 星状神経節ブロックを受けたが痛みは不変であった。Visual analogue scale (VAS) では10cm中7cmの評価であった。5ヵ月間同レベルの疼痛が持続したため, 和漢診療を目的に●●●●当科紹介受診。受診時身体所見では, 右三叉神経第2枝領域を中心とした, ピリピリする自発痛があったが, 味覚や頭頸部の触覚は正常であった。疼痛は持続性で強さには日内変動があり, 疲労時に増強する傾向にあった。烏薬須気散料を投与して1ヵ月後には疼痛が軽減しはじめ, 2ヵ月後にはVAS 2cmとなった。3ヵ月後, 疲労時以外の疼痛はほぼ消失した。その後も再発はみられていない。本症例の経験から遷延化したPHNにおいても烏薬須気散料を鑑別に挙げる必要性が示唆された。

The clinical background of purple urine bag syndrome (PUBS) has not yet been well characterized. In previous reports, clinical, biochemical, or bacteriological analyses were carried out using urine or bacteria from a limited number of patients. Other than one report, we are not aware of any case-control studies that compared the clinical, biochemical, or bacteriological background between patients with and without PUBS. To examine the risk of PUBS, we carried out a case-control study. Twenty-six patients, in three long-term care wards, who had been catheterized for more than 3 months with the same types of balloon catheters and who had the same type of disposable plastic urine bags were enrolled as the PUBS-positive case group (14 patients; 2 men and 12 women), and as the PUBS-negative control group (12 patients; 4 men and 8 women) were enrolled. The data for urine tests (pH, sugar, protein, leukocyte counts, and bacterial yields and species) were compared for the two groups. A relatively higher prevalence of PUBS was observed in female and alkaline-urine-producing patients. Bacteriological studies, using fresh urine collected through the catheter, showed that the bacterial counts were significantly higher, by 1 to 2 logs, in most samples from the case group than those from the control group (P = 0.012). Although a total of 66 bacterial strains, belonging to 12 separate species, were isolated from the urine accumulated in bags, no causative relationship between bacterial species and PUBS was observed. These data suggest that a higher bacterial yield in urine acts as the most important factor in PUBS, in combination with other facilitating factors, such as female-specific ones and the alkaline condition of urine.

Background : The “hall-ward” in Ninosawa Hospital that admits 25 patients all together is rare and precious material.Methods : We examined merits and demerits of “hall-ward” using a questionnaire given to the nursing staffs.Results : Most staffs considered “little oppressiveness” and “being well-lighted by broad windows” as patients' merits, and “little concealment during clothes-change” and “noisiness” as patients' demerits. “Well-understanding between patients and staffs” and “easy in observing patients” were considered to be merits affecting the nursing staff.Conclusions : These merits of the “hall-ward” highlighted the primary importance of an adequate area and capacity for one bed, fairly high ceiling, broad windows, and a well-designed arrangement of wards.