Publications by authors named "Kazuyuki Saito"

125 Publications

Unexpected death in a young child associated with anomalous aortic origin of the left main coronary artery without physical exertion: A case of an anomalous coronary artery with highly abundant elastic fibers.

Leg Med (Tokyo) 2021 Nov 15;53:101965. Epub 2021 Sep 15.

Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, Tokyo, Japan.

Sudden death due to anomalous aortic origin of a coronary artery is far less common among young children in the absence of exercise stress. This report describes the case of a 2-year-old boy with a lower respiratory tract infection who suffered sudden cardiac arrest in his bed at home. The autopsy revealed that the left coronary artery (LCA) originated from the right sinus of Valsalva with an acute angle takeoff and traveled between the aorta and the pulmonary trunk (an interarterial course). Upon histological examination, the LCA, before reaching its major branches, was located adjacent to the outside of the aortic wall without an intramural passage, and the arterial wall was composed almost exclusively of elastic fibers without media containing smooth muscle cells throughout the entire length of the abnormal running. Screening tests for respiratory virus infection detected enterovirus in the lung tissue. In association with an acute angle takeoff and interarterial course, the wall structure with highly abundant elastic fibers that are more flexible tissues among blood vessel components might suggest their vulnerability to compression during the great vessels' systolic expansion in the sympathetic activation induced by the viral infection, leading to fatal myocardial ischemia without physical exertion.
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http://dx.doi.org/10.1016/j.legalmed.2021.101965DOI Listing
November 2021

Three millimeter needlescopic splenectomy using three-port technique: report of three cases.

J Surg Case Rep 2021 Aug 12;2021(8):rjab305. Epub 2021 Aug 12.

Department of Surgery, Saitama Medical Center, Dokkyo Medical University, Saitama, Japan.

We report our experience with needlescopic splenectomy (NS) for the surgical treatment of idiopathic thrombocytopenic purpura using a 3-mm needlescope with three ports. One patient was male and two were females, and their mean age was 58 years. The patient was placed in the right lateral decubitus position. The first 12-mm port was introduced through the lateral margin of the left rectus abdominis muscle, and the other two 3-mm ports were inserted in the left upper quadrant. NS was performed by a standard technique under the observation of 3.3-mm needlescope. The surgical procedure was successfully completed in all the patients. The mean duration of surgery, intra-operative bleeding volume and post-operative hospital stay were 176 min, 70 ml and 4.7 days, respectively. There were no particular peri-operative complications in spite of dense adhesions or simultaneous laparoscopic procedures. Our method is safe and feasible with low morbidity and without impairing cosmetic benefits.
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http://dx.doi.org/10.1093/jscr/rjab305DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8359901PMC
August 2021

Aseptic meningitis after vaccination of the BNT162b2 mRNA COVID-19 vaccine.

Neurol Sci 2021 Nov 11;42(11):4433-4435. Epub 2021 Aug 11.

Department of Neurology, Nissan Tamagawa Hospital, Seta 4-8-1, Setagaya, Tokyo, 158-0095, Japan.

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http://dx.doi.org/10.1007/s10072-021-05543-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8354782PMC
November 2021

Projections of surface air temperature required to sustain permafrost and importance of adaptation to climate change in the Daisetsu Mountains, Japan.

Sci Rep 2021 07 30;11(1):15518. Epub 2021 Jul 30.

Earth System Division, National Institute for Environmental Studies, Tsukuba, Japan.

Permafrost is known to occur in high mountainous areas such as the Daisetsu Mountains in Japan, which are located at the southernmost limit of the permafrost distribution in the world. In this study, areas with climatic conditions suitable for sustaining permafrost in the Daisetsu Mountains are projected using bias-corrected and downscaled climate model outputs and statistical relationships between surface air temperatures and permafrost areas. Using freezing and thawing indices, the size of the area in the Daisetsu Mountains where climatic conditions were suitable for permafrost were estimated to be approximately 150 km in 2010. Under the RCP8.5 scenario, this area is projected to decrease to about 30 km by 2050 and it is projected to disappear by around 2070. Under the RCP2.6 scenario, the area is projected to decrease to approximately 20 km by 2100. The degradation of mountain permafrost could potentially affect the stability of trekking trails due to slope displacement, and it may also have deleterious effects on current alpine ecosystems. It is therefore important to accurately monitor changes in the mountain ecosystem environment and to implement measures to adapt to an environment that is projected to change significantly in the future.
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http://dx.doi.org/10.1038/s41598-021-94222-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8324894PMC
July 2021

Dissecting lesions in a culprit artery of a hemorrhagic focus in the basal ganglia: Histopathological analysis by serial sectioning.

Neuropathology 2021 Aug 21;41(4):301-305. Epub 2021 Mar 21.

Department of Forensic Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.

In a hypertensive hemorrhagic focus of the basal ganglia, the culprit arteries have been reported to be associated with dissecting lesions, whose topographical relationship to the rupture sites remains to be clarified. Herein we describe multiple dissecting lesions in the culprit artery of hypertensive hemorrhage of the basal ganglia. A 1.0 × 0.8 × 0.8 cm-sized bleeding globe was confirmed at a left lenticulostriate artery and histologically analyzed by serial sectioning. Three independent dissecting lesions were identified in the culprit artery. They were situated near the bifurcations, ranging from 240 to 3200 μm in length. The dissections mainly occurred between the intima and media with disruption of the internal elastic lamina (IEL), forming a fresh thrombus within the false lumen. Two rupture sites causing the cerebral hematoma were confirmed away from the dissecting lesions. One was situated close but not adjacent to the longest dissecting lesion; the other, measuring approximately 150 μm in diameter, was adjacent to the bifurcation of an artery. The histopathological findings suggest that the dissecting lesion resulted from medial detachment following IEL disruption in the process of arterial rupture of the culprit artery. We conclude that this was a secondary manifestation during the rupture rather than a cause of the arterial rupture.
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http://dx.doi.org/10.1111/neup.12736DOI Listing
August 2021

Estimating included animal species in mixed crude drugs derived from animals using massively parallel sequencing.

Sci Rep 2021 03 18;11(1):6257. Epub 2021 Mar 18.

Department of Forensic Medicine, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.

We developed a method that can detect each animal species of origin for crude drugs derived from multiple animal species based on massively parallel sequencing analysis of mitochondrial genes. The crude drugs derived from animals investigated in this study were Cervi Parvum Cornu and Trogopterorum feces, which are derived from a mix of different animal species, two chopped cicada sloughs, and two commercial Kampo drugs. The mitochondrial 12S rRNA, 16S rRNA, and cytochrome oxidase subunit I gene regions were amplified and sequenced using MiSeq. The ratios of haplotype to total number of sequences reads were calculated after sequence extraction and trimming. Haplotypes that exceeded the threshold were defined as positive haplotypes, which were compared with all available sequences using BLAST. In the Cervi Parvum Cornu and Trogopterorum feces samples, the haplotype ratios corresponded roughly to the mixture ratios, although there was a slight difference from mixture ratios depending on the gene examined. This method could also roughly estimate the compositions of chopped cicada sloughs and Kampo drugs. This analysis, whereby the sequences of several genes are elucidated, is better for identifying the included animal species. This method should be useful for quality control of crude drugs and Kampo drugs.
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http://dx.doi.org/10.1038/s41598-021-85803-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7973747PMC
March 2021

Modeling the minus two base pair stutter ratio of the D1S1656 locus: A sequence-based mixture distribution model.

Forensic Sci Int Genet 2021 03 24;51:102450. Epub 2020 Dec 24.

National Research Institute of Police Science, 6-3-1 Kashiwanoha, Kashiwa, Chiba, Japan.

In this study, we propose a stutter ratio for a minus two base pair stutter (-2bpSR) model of the D1S1656 locus in capillary electrophoresis (CE)-based short tandem repeat (STR) typing. DNA from a total of 108 Japanese individuals was analyzed via massively parallel sequencing to investigate the length of the longest uninterrupted stretch of two base repeat motif (2bpLUS value) within repetitive structures involving the flanking region. Additionally, -2bpSR data was collected using the GlobalFiler Kit on a 3500xL Genetic Analyzer. As a result of sequencing analysis, all alleles were classified into two types by their 2bpLUS values. The -2bpSR differed significantly between the types. Then, we modeled the -2bpSR with a mixture log-normal distribution using the classification of alleles based on the 2bpLUS values. Furthermore, probabilities of the sequence type within each repeat number in the mixture log-normal distribution model were estimated using logistic regression for each of the five major detected populations. This study is expected to enable interpretation of STR typing while considering minus two base pair stutter at the D1S1656 locus.
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http://dx.doi.org/10.1016/j.fsigen.2020.102450DOI Listing
March 2021

[A case of the successful treatment of severe myoclonus with Lance-Adams syndrome by add-on perampanel showing long term effects].

Rinsho Shinkeigaku 2021 Jan 15;61(1):18-23. Epub 2020 Dec 15.

Department of Neurology, Nissan Tamagawa Hospital.

Perampanel is an α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor antagonist that has been marked as an antiepileptic drug for partial-onset and primary generalized tonic-clonic seizures. There have been some recent reports of perampanel being effective against cortical myoclonus by Lafora disease and Unverricht-Lundborg disease. We herein report a 49-year-old man who presented with myoclonus due to Lance-Adams syndrome (LAS) after cardiopulmonary arrest caused by a severe bronchial asthma attack. Perampanel was very effective against myoclonus induced by LAS even in the chronic state, over 10 years after the remote onset. Perampanel should be considered for the treatment of extremely refractory myoclonus due to LAS.
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http://dx.doi.org/10.5692/clinicalneurol.cn-001477DOI Listing
January 2021

Early gastric cancer with splenic artery aneurysm successfully treated with laparoscopic distal gastrectomy after endovascular coil embolization: A case report.

Asian J Endosc Surg 2021 Jul 14;14(3):590-593. Epub 2020 Dec 14.

Department of Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan.

Splenic artery aneurysm (SAA) is a relatively rare disease. Most patients with SAA have no symptoms, and detection is incidental detection. The incidence of rupture is not particularly high, but the mortality rate of ruptured SAAs is high. The main treatment for gastric cancer is gastrectomy with lymph node dissection, with dissection around the celiac artery suggested to be the most important. A 68-year-old woman with early gastric cancer in the lesser curvature of the lower gastric corpus was referred to our hospital. CT showed no remarkable findings except for a saccular SAA (diameter, 1.5 cm). We planned laparoscopic distal gastrectomy. However, because the SAA was close to the surgical field and its saccular shape created a rupture risk, we performed interventional radiology for SAA before surgery. One month later, laparoscopic distal gastrectomy with D1+ was performed successfully. The patient has remained disease-free in the 51 months since the operation.
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http://dx.doi.org/10.1111/ases.12905DOI Listing
July 2021

A case of anti-AQP4 antibody-positive neuromyelitis optica spectrum disorder with MRI-proven lesions in lumbar nerve roots.

Mult Scler Relat Disord 2020 Nov 2;46:102557. Epub 2020 Oct 2.

Department of Neurology, Nitobe Memorial Nakano General Hospital, 4-59-16 Chuo, Nakano-ku, Tokyo 164-8607, Japan.

Neuromyelitis optica spectrum disorder (NMOSD) affects the central nervous system but is rarely reported to cause peripheral nervous system damage. We report a case of a 57-year-old woman with numbness and muscle weakness of the left lower limb during the course of 12 years of anti-AQP4 antibody-positive NMOSD. Lumbar magnetic resonance imaging (MRI) showed a contrast effect on the left L4, L5, and S1 nerve roots, which is a highly unusual presentation. Although radiculopathy without myelopathy is unusual in AQP4-positive NMOSD, the MRI-confirmed nerve root lesions in our case indicate that it can occur.
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http://dx.doi.org/10.1016/j.msard.2020.102557DOI Listing
November 2020

Model improvement and future projection of permafrost processes in a global land surface model.

Prog Earth Planet Sci 2020 13;7(1):69. Epub 2020 Nov 13.

International Arctic Research Center, The University of Alaska Fairbanks, 2160 Koyukuk Dr, Fairbanks, AK 99775-7340 USA.

To date, the treatment of permafrost in global climate models has been simplified due to the prevailing uncertainties in the processes involving frozen ground. In this study, we improved the modeling of permafrost processes in a state-of-the-art climate model by taking into account some of the relevant physical properties of soil such as changes in the thermophysical properties due to soil freezing. As a result, the improved version of the global land surface model was able to reproduce a more realistic permafrost distribution at the southern limit of the permafrost area by increasing the freezing of soil moisture in winter. The improved modeling of permafrost processes also had a significant effect on future projections. Using the conventional formulation, the predicted cumulative reduction of the permafrost area by year 2100 was approximately 60% (40-80% range of uncertainty from a multi-model ensemble) in the RCP8.5 scenario, while with the improved formulation, the reduction was approximately 35% (20-50%). Our results indicate that the improved treatment of permafrost processes in global climate models is important to ensuring more reliable future projections.
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http://dx.doi.org/10.1186/s40645-020-00380-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666023PMC
November 2020

Needs Assessment for Supports to Promote Pediatric Clinical Research Using an Online Survey of the Japanese Children's Hospitals Association.

JMA J 2020 Apr 7;3(2):131-137. Epub 2020 Apr 7.

Department of Education for Clinical Research, National Center for Child Health and Development, Tokyo, Japan.

Introduction: Infrastructure and the capacity to conduct clinical research in pediatrics have not been fully established in Japan. To elucidate the physicians' perspectives on clinical research, level of experience, existing barriers, and requests for support, we conducted a survey at 34 children's hospitals in Japan.

Methods: In January 2016, an online survey with 13 questions was sent to approximately 2000 physicians working in 34 pediatric hospitals belonging to the Japanese Association of Children's Hospitals and Related Institutions.

Results: Of the 360 respondents, 318 (88.3%) had presentations at academic conferences, and 261 (72.5%) had publications in academic journals, in the previous year. The most common study designs of clinical research conducted were case reports and case series. The most requested supports were for statistical analysis, followed by study design, grant application, and English-language editing. Younger physicians were more likely to prefer educational lectures ( < 0.001), whereas experienced physicians were more likely to request support for conducting statistical analysis ( = 0.002). Whereas physicians who had ever led a clinical trial requested support for the development of study protocol ( = .013), those without this experience preferred support for literature review ( = .002) and consultation services for study design ( = .027).

Conclusions: The requests for supports were different, depending on the physicians' years after graduation and experience level in clinical research. In order to enhance clinical research in pediatrics, it is essential to provide appropriate types and levels of educational and support programs.
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http://dx.doi.org/10.31662/jmaj.2019-0037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7590392PMC
April 2020

Recurrent Cerebral Venous Thrombosis Treated with Direct Oral Anticoagulants in a Japanese Man with Hereditary Protein C Deficiency.

J Stroke Cerebrovasc Dis 2021 Jan 31;30(1):105320. Epub 2020 Oct 31.

Department of Clinical Laboratory Sciences, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.

We herein report a case involving a 32-year-old Japanese man with recurrent cerebral venous thrombosis due to hereditary protein C deficiency. He was admitted to our hospital with impaired consciousness. Brain magnetic resonance imaging demonstrated high intensities diffusely along the bilateral sulci and magnetic resonance venography revealed left transverse sinus and superior sagittal sinus stenoses. His father had a history of cerebral infarction and venous thrombosis. The protein C activity level examined by chromogenic synthetic substrate assay was markedly reduced. He was diagnosed with protein C deficiency, and a genetic analysis revealed a heterozygous mutation at exon 3 c.199G>A,p.Glu67Lys on the protein C gene. Four months later, at his second admission, he had transient aphasia, and his protein C activity was under 10%. We switched warfarin to the direct oral anticoagulants edoxaban. He remains fully recovered with no adverse events after the administration of edoxaban for a year. Direct oral anticoagulants may be a new tool for treating cerebral venous thrombosis due to hereditary protein C deficiency.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105320DOI Listing
January 2021

Future projection of greenhouse gas emissions due to permafrost degradation using a simple numerical scheme with a global land surface model.

Prog Earth Planet Sci 2020 2;7(1):56. Epub 2020 Oct 2.

International Arctic Research Center, 739, The University of Alaska Fairbanks, 2160 Koyukuk Dr, Fairbanks, AK 740 99775-7340 USA.

The Yedoma layer, a permafrost layer containing a massive amount of underground ice in the Arctic regions, is reported to be rapidly thawing. In this study, we develop the Permafrost Degradation and Greenhouse gasses Emission Model (PDGEM), which describes the thawing of the Arctic permafrost including the Yedoma layer due to climate change and the greenhouse gas (GHG) emissions. The PDGEM includes the processes by which high-concentration GHGs (CO and CH) contained in the pores of the Yedoma layer are released directly by dynamic degradation, as well as the processes by which GHGs are released by the decomposition of organic matter in the Yedoma layer and other permafrost. Our model simulations show that the total GHG emissions from permafrost degradation in the RCP8.5 scenario was estimated to be 31-63 PgC for CO and 1261-2821 TgCH for CH (68 percentile of the perturbed model simulations, corresponding to a global average surface air temperature change of 0.05-0.11 °C), and 14-28 PgC for CO and 618-1341 TgCH for CH (0.03-0.07 °C) in the RCP2.6 scenario. GHG emissions resulting from the dynamic degradation of the Yedoma layer were estimated to be less than 1% of the total emissions from the permafrost in both scenarios, possibly because of the small area ratio of the Yedoma layer. An advantage of PDGEM is that geographical distributions of GHG emissions can be estimated by combining a state-of-the-art land surface model featuring detailed physical processes with a GHG release model using a simple scheme, enabling us to consider a broad range of uncertainty regarding model parameters. In regions with large GHG emissions due to permafrost thawing, it may be possible to help reduce GHG emissions by taking measures such as restraining land development.
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http://dx.doi.org/10.1186/s40645-020-00366-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532133PMC
October 2020

Long-term outcomes and safety of radical transmediastinal esophagectomy with preoperative docetaxel, cisplatin, and 5-fluorouracil combination chemotherapy for locally advanced squamous cell carcinoma of the thoracic esophagus.

World J Surg Oncol 2020 Sep 22;18(1):252. Epub 2020 Sep 22.

Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minami-Koshigaya, Koshigaya City, Saitama, Japan.

Background: It is unknown whether transmediastinal esophagectomy (TME) is an acceptable surgical procedure for locally advanced esophageal squamous cell carcinoma (ESCC). Therefore, we investigated the feasibility of long-term survival after TME with neoadjuvant docetaxel, cisplatin, and 5-fluorouracil combination chemotherapy (DCF therapy).

Methods: This retrospective, observational study included locally advanced resectable ESCC. All patients received two cycles of preoperative DCF therapy (60 mg/m of docetaxel and cisplatin on day 1 and 700 mg/m/day of 5-FU on days 1-5 in each cycle) followed by radical TME. The main outcomes were survival and the rate of adverse events of chemotherapy and surgery.

Results: Sixteen patients were included in this study. All patients received two cycles of DCF therapy, followed by surgery. The median follow-up duration of the 16 patients was 35.4 months. The 2-year overall survival (OS) was 93.3% (95% confidence interval [CI], 61.3-99.0), and the 3-year OS was 78.8% (95% CI, 47.3-92.7). The 2-year and 3-year relapse-free survivals were both 73.3% (95% CI, 43.6-89.1). Leukopenia and neutropenia occurred in most patients; however, they were controllable. Fifteen patients completed TME, and one was converted to open transthoracic esophagectomy because of tracheal injury. Three-field dissection was performed for 12 of 16 patients (75%), and R0 resection was achieved in 15 of 16 patients (93.8%). Three cases of grade IIIb chylothorax were observed. There was no mortality in this study.

Conclusion: Combined neoadjuvant DCF and TME for locally advanced ESCC was safe and less invasive than traditional therapies and had a satisfactory long-term prognosis.
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http://dx.doi.org/10.1186/s12957-020-02023-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7510302PMC
September 2020

Bloodstain examination and DNA typing from hand-washed bloodstains on clothes.

Leg Med (Tokyo) 2020 Nov 15;47:101758. Epub 2020 Jul 15.

Department of Forensic Medicine, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo, Tokyo 113-8421, Japan.

We investigated whether bloodstain examination and DNA typing can be performed on washed bloodstains on clothes. Blood was dropped onto T-shirts made from 100% cotton or 100% polyester. After drying, the T-shirts were hand-washed with handwashing soap, dishwashing detergent, laundry detergent, soap, or just water until the bloodstains could not be seen. After drying the T-shirts, DNA and RNA were extracted simultaneously from the bloodstained areas using commercial kits. RNA was reverse-transcribed to DNA, and then the detection of the mRNAs for HBB, ACTB, and 18S rRNA was examined. DNA was quantified via real-time PCR, and then STR typing was performed with a commercial kit. The luminol and leucomalachite green tests were used as preliminary bloodstain tests, and an immuno-chromatography kit was used to identify human bloodstains. DNA could be extracted from all washed bloodstains, but more DNA was extracted from cotton T-shirts than from polyester T-shirts. STR typing was successful for all bloodstains without issues such as PCR inhibition. In the human bloodstain identification test using mRNA, almost all bloodstains produced a Ct value for HBB and all bloodstains produced a Ct value for 18S rRNA, whereas few bloodstains produced a Ct value for ACTB. All bloodstains reacted positively to luminol, but some were negative for leucomalachite green. Most of the bloodstains did not react positively in the human bloodstain identification test using the immuno-chromatography kit. The results suggest that human bloodstain identification and DNA typing can still be performed after clothes with bloodstains are washed.
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http://dx.doi.org/10.1016/j.legalmed.2020.101758DOI Listing
November 2020

Estimation of the number of contributors to mixed samples of DNA by mitochondrial DNA analyses using massively parallel sequencing.

Int J Legal Med 2020 Jan 12;134(1):101-109. Epub 2019 Nov 12.

Department of Forensic Medicine, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.

We evaluated whether the number of contributors to mixed DNA samples can be estimated by analyzing the D-loop of mitochondrial DNA using massively parallel sequencing. The A- (positions 16,209-16,400) and B- (positions 30-284) amplicons in hypervariable regions 1 and 2, respectively, were sequenced using MiSeq with 2 × 251 cycles. Sequence extraction and trimming were performed using CLC Genomics Workbench 11 and the number of observed haplotypes was counted for each amplicon type using Microsoft Excel. The haplotype ratios were calculated by dividing the number of counted reads of the corresponding haplotype by the total number of sequence reads. Haplotypes that were over the threshold (5%) were defined as positive haplotypes. The number of larger positive haplotypes in either of the two amplicon types was defined as the number of contributors. Samples were collected from seven individuals. Seventeen mixed samples were prepared by mixing DNA from two to five contributors at various ratios. The number of contributors was correctly estimated from almost all of the mixed samples containing equal amounts of DNA from two to five people. In mixed samples of two or three people, the minor components were detected down to a ratio of 20:1 or 8:2:1. However, heteroplasmy, base deletions, and sharing of the same haplotypes caused incorrect estimations of the number of contributors. Although this method still has room for improvement, it may be useful for estimating the number of contributors in a mixed sample, as it does not rely on forensic mathematics.
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http://dx.doi.org/10.1007/s00414-019-02182-2DOI Listing
January 2020

The origin identification method for crude drugs derived from arthropods and annelids using molecular biological techniques.

J Nat Med 2020 Jan 6;74(1):275-281. Epub 2019 Sep 6.

Department of Forensic Medicine, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.

We evaluated whether the origins of crude drugs derived from arthropods and annelids could be identified using molecular biological techniques. DNA was extracted from 20 crude drugs prepared from different animals using a commercial kit with added phenol treatment. The target regions used to identify origin were the mitochondrial 16S ribosomal RNA (rRNA), 12S rRNA, and cytochrome oxidase subunit I (COI) gene regions. Extracted DNA was amplified by polymerase chain reaction, and then sequenced by the Sanger method. The aligned sequences were compared with all available sequences using BLAST to estimate the origins of the crude drugs. The origin of crude drugs used in this study could be estimated using this method. The COI region was the best for identifying origin among three regions examined, based on the success rate of PCR amplification and analysis. Moreover, the 12S rRNA region was also useful for origin identification, with the exception of the earthworm. However, the origin of some crude drugs could not be strictly identified due to matches to various species in all three regions. One likely cause was that the species of origin of a crude drug has not been registered in DNA databases. We found that even the same crude drug from the same pharmaceutical company had different origins by production lot or import source country. Therefore, this method is useful not only for DNA-based origin identification but also quality control of production lots.
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http://dx.doi.org/10.1007/s11418-019-01360-1DOI Listing
January 2020

Cardiac arrest induced by the intentional ingestion of boric acid and mirtazapine treated by percutaneous cardiopulmonary bypass: a case report.

J Med Case Rep 2019 May 16;13(1):147. Epub 2019 May 16.

Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan.

Background: Mirtazapine has a good tolerability and safety profile that demonstrates several benefits over other antidepressants and it is associated with few fatalities. Boric acid is an odorless white powder that is generally not recognized as a poisonous substance. We report a case of cardiac arrest induced by the intentional ingestion of mirtazapine, boric acid, and sennosides, by a patient who required percutaneous cardiopulmonary bypass.

Case Presentation: Our patient was a 49-year-old Japanese woman with a history of depression; she was found in an unconscious state after ingesting boric acid (unknown amount), mirtazapine (1950 mg), and sennosides (780 mg). On arrival, she was in a deep coma with marked hypotension induced by atrial fibrillation, tachycardia, and diffuse hypokinetic cardiac motion. She had systemic diffuse erythema. Her serum concentrations of boric acid and mirtazapine on arrival were 560.49 mg/L and 1270 ng/mL, respectively. She experienced repeated cardiac arrest, and was therefore treated with tracheal intubation, mechanical ventilation, percutaneous cardiopulmonary bypass, and continuous hemodialysis filtration. Stable circulation and respiration and a normal kidney function were finally obtained and she was transferred to a local medical facility in a persistent unconscious state.

Conclusions: This is the first case of a return of spontaneous circulation after cardiac arrest induced by the intentional ingestion of boric acid and mirtazapine, requiring percutaneous cardiopulmonary bypass for survival. To maintain cerebral perfusion during percutaneous cardiopulmonary bypass, even in a prolonged state of cardiac arrest induced by overdose, is medically, ethically, and economically challenging.
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http://dx.doi.org/10.1186/s13256-019-2079-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521468PMC
May 2019

Posterior Reversible Encephalopathy Syndrome and Reversible Cerebral Vasoconstriction Syndrome after Rapid Blood Transfusion.

Intern Med 2019 Aug 17;58(15):2225-2230. Epub 2019 Apr 17.

Department of Neurology, Nissan Tamagawa Hospital, Japan.

We herein report a case of posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) that occurred immediately after blood transfusion. A 64-year-old Japanese woman was diagnosed with liver cirrhosis due to hepatitis B 2 years ago. She was admitted to our hospital with hemorrhagic shock due to esophageal variceal rupture. She was hospitalized with rapid blood pumping transfusion, after which consciousness disorder appeared, and her blood pressure suddenly increased. Magnetic resonance imaging revealed PRES and RCVS. We speculated that hypoalbuminemia and blood transfusion might have been involved in the development of PRES and RCVS.
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http://dx.doi.org/10.2169/internalmedicine.1768-18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709318PMC
August 2019

The origin of p40-negative and CDX2-positive primary squamous cell carcinoma of the stomach: case report.

World J Surg Oncol 2019 Mar 19;17(1):53. Epub 2019 Mar 19.

Department of Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan.

Background: Primary gastric squamous cell carcinoma (SCC) is a very rare disease. The origin of this tumor remains unclear, although there are some hypotheses. A 60-year-old man consulted a previous physician complaining of upper abdominal pain. Esophagogastroduodenoscopy revealed type 2 gastric cancer, and the patient was referred to our hospital. After close examination, the patient was diagnosed as cStage IIA gastric adenocarcinoma, and distal gastrectomy was performed. Histochemical studies showed typical findings of SCC, and the tumor was surrounded by intestinal metaplasia. Immunohistochemical examination was positive for cytokeratin (CK) 5/6 and caudal-type homeobox protein 2 (CDX2) and negative for p63/p40.

Conclusion: The results of immunostaining for CK5/6 supported that this tumor was SCC, but the question why p63/p40 were negative and CDX2 was positive still remained. Concerning about the origin of p63/p40 and CDX2, it was suggested that the tumor cells were not derived from ectopic squamous epithelium but from intestinal metaplasia. And tumor cells looked like homogeneous and squamous metaplasia was not observed. These findings supported the idea that these tumor cells arose from stem cells in the intestinal metaplasia of the stomach.
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http://dx.doi.org/10.1186/s12957-019-1594-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6425685PMC
March 2019

Case of herpes zoster with herpetic folliculitis complicated with meningitis: Immunohistochemistry.

J Dermatol 2019 08 19;46(8):e268-e270. Epub 2019 Mar 19.

Department of Dermatology, Aichi Medical University, Nagakute, Japan.

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http://dx.doi.org/10.1111/1346-8138.14851DOI Listing
August 2019

Sudden unexpected death due to coronary thrombosis associated with isolated necrotizing vasculitis in the coronary arteries of a young adult.

Forensic Sci Med Pathol 2019 Jun 27;15(2):252-257. Epub 2019 Feb 27.

Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, 4-21-18 Otsuka, Bunkyo-ku, Tokyo, 112-0012, Japan.

Coronary arteritis is an uncommon cause of sudden death in non-atherosclerotic coronary diseases, and is mostly associated with systemic vasculitis or systemic autoimmune diseases; therefore, sudden death due to isolated coronary arteritis rarely occurs. The case described in this report is that of a 34-year-old man with no significant personal medical history who died suddenly after presenting with nausea. Postmortem examination revealed a significant infiltration of lymphocytes predominantly on the adventitia and periadventitial tissues of the coronary arteries in the epicardium. The lymphocytic infiltrate partially extended to the thickened intima with fibrosis, destructing the media and internal elastic lamina, and the lumen was occluded by a thrombus in the left main stem and left anterior descending branch. The arterial walls exhibited focal fibrinoid necrosis with regression in the intima and fibrous scars with angiogenesis in the media and adventitia. Focal myocardial infarction was detected in the left ventricle as a fibrotic change of the myocardium. No findings associated with vasculitis were discerned in the aorta, other peripheral arteries, or major organs. Laboratory tests of postmortem blood samples returned negative results for antinuclear antibodies, cryoglobulin, immunoglobulin G4, and cytoplasmic anti-neutrophil cytoplasmic antibodies for myeloperoxidase and proteinase 3. These autopsy findings suggest that the sudden death was caused by isolated necrotizing vasculitis that is assumed to be polyarteritis nodosa localized at the coronary arteries. However, pathological characteristics may not be exactly the same between isolated necrotizing vasculitis in the coronary arteries and polyarteritis nodosa.
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http://dx.doi.org/10.1007/s12024-019-00099-1DOI Listing
June 2019

[Subcortical calcification on CT in Borden type III intracranial dural arteriovenous fistula].

Rinsho Shinkeigaku 2019 Feb 31;59(2):93-97. Epub 2019 Jan 31.

Department of Neurology, Nissan Tamagawa Hospital.

We herein report a 67-year-old female who presented with progressive dementia and disturbance of consciousness. Brain CT showed multiple subcortical calcifications with edema. Enhanced CT showed multiple abnormal vessels in the left hemisphere. Electroencephalography indicated diffuse spike and slow wave complex, so non-convulsive status epilepticus was diagnosed. Cerebral angiography revealed several feeder arteries with retrograde leptomeningeal venous drainage. We diagnosed her with Borden type III cerebral dural arteriovenous fistulas. Trans-arterial embolization with n-butyl-2-cyanoacrylate was performed, and she has experienced no epileptic attacks for at least ten months. Calcification changes are sometimes seen in Borden type II dural arteriovenous fistulas but not in aggressive types, such as Borden type III. It is important to suspect dural arteriovenous fistulas when we encounter patients with progressive dementia or/and epilepsy with cerebral calcification lesions, as this may be a treatable disease condition.
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http://dx.doi.org/10.5692/clinicalneurol.cn-001200DOI Listing
February 2019

Laparoscopic Transhiatal Thoracic Duct Ligation for Chylothorax after Esophagectomy.

Thorac Cardiovasc Surg 2019 Oct 22;67(7):606-609. Epub 2019 Jan 22.

Department of Surgery, Saitama Medical Center, Dokkyo Medical University, Koshigaya, Saitama, Japan.

In esophagectomy for thoracic esophageal cancer, chylothorax may develop at a certain frequency. For chylothorax, conservative treatment is selected first, but if it is not improved, thoracic duct (TD) ligation is considered. In general, transthoracic approach is chosen to reach the TD. However, it is sometimes difficult to identify the TD due to adhesion in the thoracic cavity. Hence, we selected a laparoscopic transhiatal approach to the TD. We introduce the procedure of our laparoscopic transhiatal TD ligation technique.
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http://dx.doi.org/10.1055/s-0038-1677507DOI Listing
October 2019

[A case of antisynthetase syndrome with anti-EJ antibody complicated by pericarditis].

Rinsho Shinkeigaku 2019 Jan 29;59(1):21-26. Epub 2018 Dec 29.

Department of Neurology, Nitobe Memorial Nakano General Hospital.

A 69-year-old man was admitted with neck muscle weakness, symmetric proximal muscle weakness, skin rash and elevated serum creatine kinase levels. Muscle biopsy showed perifascicular necrosis and perimysial alkaline phosphatase activity. Chest CT revealed interstitial lung disease and colorectal cancer was diagnosed on colonoscopy. He was serologically positive for anti-EJ antibody, leading to the diagnosis of antisynthetase syndrome (ASS). After laparoscopic low anterior resection of the rectum, he received intravenous methylprednisolone (1,000 mg/d for 3 days) followed by oral prednisolone (50 mg/d). Although his muscle weakness improved after corticosteroid therapy, he developed pericardial effusion with resultant asymptomatic hypotension and arrhythmia possibly due to pericarditis. Corticosteroid monotherapy was insufficient to control the disease, and, we decided to use oral cyclosporin concurrently. After this combined therapy started, pericardial effusion and arrhythmia were improved. We should keep in mind that pericarditis can occur in patients with anti-EJ antibody-positive ASS, and early combined therapy with corticosteroid and immunosuppressive drugs for ASS may improve the patient's prognosis.
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http://dx.doi.org/10.5692/clinicalneurol.cn-001140DOI Listing
January 2019

Characteristics of a Surgical Snare Using Microwave Energy.

Diagnostics (Basel) 2018 Dec 15;8(4). Epub 2018 Dec 15.

Center for Frontier Medical Engineering, Chiba University, Chiba 263-8522, Japan.

Currently, minimally invasive treatments that insert various treatment devices into an endoscope are actively being performed. A high-frequency (HF) snare is commonly used as an energy device inserted into an endoscope. However, using a high-frequency snare, problems usually occur, such as the obstruction of the visual field caused by smoke. On the other hand, microwave heating produces less smoke and provides a better visual field. In this study, a snare using microwave energy inserted into an endoscope is proposed, and its characteristics are evaluated.
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http://dx.doi.org/10.3390/diagnostics8040083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6315949PMC
December 2018

Establishment of widely applicable DNA extraction methods to identify the origins of crude drugs derived from animals using molecular techniques.

J Nat Med 2019 Jan 29;73(1):173-178. Epub 2018 Oct 29.

Department of Forensic Medicine, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.

We established widely applicable DNA extraction methods to identify the origins of crude drugs derived from animals. Twenty-one samples including 17 kinds of crude drug derived from animals were examined. DNA was extracted from most of the crude drugs by adjustment of the QIAamp DNA Mini Kit. DNA extraction was performed successfully using phenol to remove impurities after applying a proteinase treatment. DNA extraction was performed successfully by decalcification treatment using ethylenediaminetetraacetic acid (EDTA), before applying the proteinase treatment for crude drugs having high calcium content, such as those from oyster shell and cuttlefish bone. DNA could not be extracted from sea-ear shell using the EDTA decalcification treatment, but was extracted successfully using a TBONE EX KIT. The mitochondrial 16S ribosomal RNA (rRNA) gene region was amplified, and Basic Local Alignment Search Tool (BLAST) analysis was performed after sequencing. Polymerase chain reaction (PCR) products of approximately 600 bp in length were obtained from all samples except donkey glue, one of the two seahorses, and longgu. Drug origins were determined in all samples by sequence analysis based on the BLAST results, and match rates were >97 %. Moreover, 16 samples had a match rate >99 %. Our DNA extraction methods were widely applicable to evaluation of many crude drugs derived from animals, and proved very useful for identifying the origins of such drugs.
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http://dx.doi.org/10.1007/s11418-018-1261-3DOI Listing
January 2019

Non-specific peaks generated by animal DNA during human STR analysis: Peak characteristics and a novel analysis method for mixed human/animal samples.

Forensic Sci Int Genet 2018 11 25;37:73-80. Epub 2018 Jul 25.

National Research Institute of Police Science, 6-3-1 Kashiwanoha, Kashiwa 277-0882, Japan.

Forensic human identification (HID) laboratories occasionally encounter non-specific peaks generated by non-human DNA. Casework samples for human short tandem repeat (STR) profiling may be contaminated by animal DNA because of the specific environment or situation from which they were obtained. Validation studies for HID kits have reported that non-specific peaks generated from some animals are observed near the human amelogenin peak. In this study, we first revealed that DNA sequences associated with the non-specific peaks generated from animal DNA differ from one animal family to the other. However, non-specific peaks cannot be analyzed using the remainder of polymerase chain reaction (PCR) products left over from conventional HID kits when human and animal DNA are mixed. To overcome this issue, we have developed a novel analysis method of using non-specific peaks generated from animal DNA in human STR profiling to identify the source of contaminating animal DNA at the family level. The method applied here is termed as blocking PCR, which involves selective animal DNA re-amplification by blocking nontarget human amelogenin DNA amplification using an oligonucleotide probe that specifically binds to human amelogenin using the remaining PCR product from the HID kit. Our data demonstrated that HID and family discrimination among animals that are often encountered in forensic contexts could be performed simultaneously. This study enabled recovery of more information from limited quantities of casework samples contaminated with animal DNA, which would be useful for forensic HID scientists.
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http://dx.doi.org/10.1016/j.fsigen.2018.07.020DOI Listing
November 2018

Anti-neutral glycolipids antibody-positive combined central and peripheral demyelination mimicking encephalomyeloradiculoneuropathy phenotype.

Clin Neurol Neurosurg 2018 09 3;172:90-92. Epub 2018 Jul 3.

Department of Neurology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan. Electronic address:

We herein report the first combined central and peripheral demyelination (CCPD) case originally diagnosed as multifocal acquired demyelinating sensory and motor neuropathy followed by CNS impairments with a long lag time (160 days after first attack). The anti-neutral glycolipids antibodies, especially anti-lactosylceramide antibodies but not anti-NF155 antibodies typical for CCPD were detected in the acute phase of sera and cerebrospinal fluid (CSF) and disappeared in the recovery phase. This case strongly illustrated the significance of examining anti-neutral glycolipids antibodies in future anti-NF 155 antibodies-negative CCPD cases.
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http://dx.doi.org/10.1016/j.clineuro.2018.06.046DOI Listing
September 2018
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