Effect of Catechol-O-Methyltransferase Genotype on Self-Reported Efficacy and Activity Changes in the Brain Prefrontal Area in Response to a Caffeine Placebo / 医薬品情報学

Objective: The placebo effect can enhance the response to treatment, even in the absence of pharmacological ingredients. One possible factor explaining the likelihood of the placebo effect in individuals is genetic polymorphisms in neurotransmitters. This study focused on gene polymorphisms in the catechol-O-methyltransferase (COMT) as an interindividual variable of the placebo effect.Design・Methods: All 120 participants were explained the effects of caffeine, including its ability to ameliorate drowsiness and increase concentration, and then given a placebo (lactose). The onset of the placebo effect was measured in terms of the degree of caffeine-reduced sleepiness using subjective indices of the Stanford Sleepiness Scale (SSS) and a feeling of drowsiness-Visual Analogue Scale (VAS). The mechanism of the placebo effect was objectively examined in terms of changes in cerebral blood flow in the prefrontal cortex of the brain. In addition, we investigated participants’ susceptibility to the placebo effect by examining genetic polymorphisms in COMT.Results: After taking the drug, sleepiness on the SSS and VAS was significantly improved (p＜0.001), although there was no change in prefrontal cortex activity. Among the 120 participants, 63 had a Val/Val-type polymorphism in COMT (52.5%), 45 had a Val/Met-type (37.5%), and 12 had a Met/Met-type (10.0%). There were no significant differences among COMT gene polymorphisms in the subjective measures of SSS and VAS. However, there was a tendency for the cerebral blood flow changes to be larger in the left hemisphere of the brain in individuals with the Met/Met type.Conclusion: There seems to be a relationship between prefrontal cortex activity and genetic polymorphisms. In particular, there may be a correlation between the expression of a placebo effect and COMT gene polymorphisms.

A Case of Effective Zone 0 TEVAR Using Squid-Capture Assisted in situ Stent-Graft Fenestration, for Endoleak from the Fenestration of Najuta / 日本心臓血管外科学会雑誌

We report the case of a 76-year-old man who developed type IA endoleak through the fenestration after 1-debranch TEVAR using a Najuta endograft. The patient was admitted with expansion of the aneurysm after TEVAR, for additional therapy. Type IA endoleak through a fenestration has remained a significant clinical concern and its treatment is challenging. We performed Zone 0 TEVAR using the “Squid-Capture” technique assisted in situ stent-graft fenestration. Cerebral vessels were perfused by a percutaneous cardiopulmonary support system during in situ stent-graft fenestration, and the cerebral branch was clamped at the proximal site. It is difficult to operate the catheter inside the endoskeleton structure of a Najuta endograft, but several innovations were effective. Test dilation of the balloon catheter was performed to ensure that the wire did not interfere with the endoskeleton. Avoiding interference with the endoskeleton is important. The Squid-Capture technique allows safe and secure puncture of the graft. The operation was completed successfully. After this procedure, the endoleak disappeared. It is considered to be a useful method for treatment of endoleak through the fenestration.

A Case Report of a Team Approach for a Rheumatoid Arthritis Patient with Above-knee Amputation to Acquire Activities of Daily Living with a Prosthetic Leg / The Japanese Journal of Rehabilitation Medicine

A 70-year-old woman with rheumatoid arthritis underwent above-knee amputation due to osteomyelitis after right total knee arthroplasty. After the surgery, the patient started rehabilitation for wearing a prosthetic leg. However, the patient could not wear the prosthesis by herself because of severe upper limb impairment due to bilateral finger joint deformity and muscle weakness associated with the rheumatoid arthritis. Therefore, physical therapists and prosthetists/orthotists collaborated to determine movements that could be performed, even with muscle weakness, using assistive devices such as a Velcro strip handle with the prosthesis and a prosthetic liner stand. Subsequently, repetitive training was performed in an environment similar to the setting of the patient's prosthesis use at home. Consequently, although no change in upper limb function was observed, the patient had increased independence during prosthesis attachment. As she had difficulty wearing and removing her trousers/underwear while wearing the prosthesis, she performed movements using assistive devices and made changes to the order of movements. Six months after the surgery, she could wear the prosthesis and perform self-care correctly by herself and return home. Therefore, to maximize function that enables independence after amputation, helping patients learn how to put on the prosthesis using a team approach is important.

A Case Report of a Team Approach for a Rheumatoid Arthritis Patient with Above-knee Amputation to Acquire Activities of Daily Living with a Prosthetic Leg / The Japanese Journal of Rehabilitation Medicine

A 70-year-old woman with rheumatoid arthritis underwent above-knee amputation due to osteomyelitis after right total knee arthroplasty. After the surgery, the patient started rehabilitation for wearing a prosthetic leg. However, the patient could not wear the prosthesis by herself because of severe upper limb impairment due to bilateral finger joint deformity and muscle weakness associated with the rheumatoid arthritis. Therefore, physical therapists and prosthetists/orthotists collaborated to determine movements that could be performed, even with muscle weakness, using assistive devices such as a Velcro strip handle with the prosthesis and a prosthetic liner stand. Subsequently, repetitive training was performed in an environment similar to the setting of the patient's prosthesis use at home. Consequently, although no change in upper limb function was observed, the patient had increased independence during prosthesis attachment. As she had difficulty wearing and removing her trousers/underwear while wearing the prosthesis, she performed movements using assistive devices and made changes to the order of movements. Six months after the surgery, she could wear the prosthesis and perform self-care correctly by herself and return home. Therefore, to maximize function that enables independence after amputation, helping patients learn how to put on the prosthesis using a team approach is important.

Desmoplastic small round cell tumor of the ovary: A case report with a new modality of treatment and review of the literature

Abstract Objective Desmoplastic small round cell tumor (DSRCT) is a rare intraabdominal neoplasm that grows along serosal surfaces and is primarily found in young men. To Keywords date, only 16 cases of ovarian DSRCT have been previously reported in women in the English literature, and no large population-based studies on this topic exist. Case Report We report the case of a 19-year-old virgo with unremarkable past medical history, initially presented with abdominal fullness. After being treated with the optimal treatment modality (primary and secondary surgical debulking, unique chemotherapy, protocol and adjuvant radiotherapy), the patient has remained without tumor disease for 40 months. Conclusion Although the best therapy for patients with DSRCT has yet to be determined, combining complete surgical resection, adjuvant chemotherapy, and radiotherapy is required to prolong survival and to achieve proper quality of life.

Physical Therapy for a Patient with Parkinson's Disease Treated With Levodopa/Carbidopa Intestinal Gel: A Case Report / 日本農村医学会雑誌

A 60-year-old woman with Parkinson disease (PD) treated by Levodopa / carbidopa intestinal gel (LCIG) began physical therapy (PT). Before inducing LCIG therapy, she had six hours off time a day, and she have not walked outside for six years due to the fear of off time freezing. Scores for depression and anxiety on the Hospital Anxiety and Depression Scale (HADS) were 14 and 11, respectively. Symptoms of depression and anxiety as well as impaired endurance and balance were confirmed. While maintaining LCIG treatment, physical therapy (PT) was started with a focus on tasks to improve endurance and balance. Activity goals were decided with the patient. She stopped experiencing episodes of off time four months after PT was introduced and her HADS scores for depression and anxiety decreased to 6 and 3, respectively. She achieved the activity goals she had set, and outings became part of her daily routine. When introducing PT alongside LCIG treatment, patients and therapists should decide the activity goals together and work on activities that address the problems identified by the pre-PT assessment.

Bronchial Schwannoma Masquerading as Cause of Hemoptysis in a Patient with Pulmonary Embolism / General Medicine

A 78-year-old woman who had a history of left deep venous thrombosis was referred to our hospital with a sudden hemoptysis. Thoracic computed tomography showed a solitary pulmonary nodule in the right lower lobe. Based on her medical history of deep venous thrombosis, she was tentatively diagnosed as having pulmonary embolism and successfully treated by inserting an inferior vena cava filter and anticoagulant therapy with warfarin [Please confirm whether previous sentence is correct]. However, the lung nodule on thoracic computed tomography was still depicted four months later. With suspicion of a malignant tumor, including possible lung cancer, a right segmentectomy was performed. Pathological assessment of the resected specimen showed the tumor was derived from the right bronchial wall, but was not ruptured into the intratracheal lumen, as well as coexistence with intraalveolar hemorrhage near the tumor. The lung nodule was diagnosed as bronchial schwannoma. Thus, the origin of the hemoptysis was found to be pulmonary embolism due to deep vein thrombosis, and not by bronchial schwannoma, which was also present in the lung.

EFFECT OF MAXIMAL EXERCISE ON NADPH OXIDASE ACTIVITY OF NEUTROPHILS AND RELATION TO SUPEROXIDE-GENERATING ACTIVITY BY CELL-SYSTEM IN HUMAN PERIPHERAL BLOOD / 体力科学

The purpose of this study was to examine reduced nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity, - a generated superoxide - of neutrophils in human peripheral blood after maximal exercise. Ten healthy male college students (20.2 ± 0.4 yr, 170.5 ± 1.3 cm, 62.8 ± 1.9 kg) participated after giving written informed consent. They performed an incremental exercise to volitional exhaustion using a bicycle ergometer. Peripheral blood was collected before exercise (Pre), just after exercise (Post) and 1-hour after exercise (Post-1h). Phorbol 12-myristate 13-acetate (PMA)-stimulated and opsonaized zymosan (OZ)-stimulated superoxide-generating activity of neutrophils was measured by the cytochrome c reduction assay. NADPH oxidase activity was measured by a cell-free system. NADPH oxidase activity significantly decreased in Post-1h compared with Pre and Post. A similar tendency was seen in PMA-stimulated activity, but not in OZ-stimulated activity. A strong positive relationship between NADPH oxidase activity and PMA-stimulated activity was found in Pre and this relationship attenuated after exercise. NADPH oxidase activity was not related to OZ-stimulated activity at any time points. We concluded that NADPH oxidase activity decreased after exhaustive maximal exercise in human peripheral neutrophils, and suggest that PMA-stimulated activity, relatively - speaking, reflects NADPH oxidase activity; but OZ-stimulated activity is independent of NADPH oxidase activity.