堀越 琢郎

Rigidity, a cardinal symptom of Parkinson's disease (PD), remains challenging to assess objectively. A torque-angle instrument was developed to quantify muscle tone, providing two parameters: bias difference and elastic coefficient. This study aimed to investigate the association of the instrument-measured rigidity with clinical assessments and brain function. In 30 patients with PD, the muscle tone in both arms was evaluated. Ten with wearing-off phenomenon were assessed twice, off and on condition. Twentynine patients underwent brain perfusion single-photon emission computed tomography (SPECT), and expression of PD-related covariance pattern (PDRP) was computed. Bias difference and elastic coefficient showed positive correlations with physician-rated rigidity (P < 0.002). Bias difference decreased after dopaminergic medication (P = 0.022) and was associated with lower body mass index (P = 0.012). Elastic coefficient positively correlated with the Unified PD Rating Scale Part III and PDRP scores (P < 0.044). Furthermore, the higher bias difference correlated with decreased sensory-motor cortex and increased substantia nigra perfusion (P < 0.001). The Torque-angle instrument is a viable tool for quantifying rigidity in PD. The bias difference reflects treatment responsiveness and is associated with the function in the sensory-motor cortex and substantia nigra. The elastic coefficient is indicative of overall Parkinsonism severity.

AIMS: To compare the effects of ipragliflozin, a sodium-dependent glucose transporter-2 inhibitor, and those of metformin on the visceral fat area (VFA), a prospective, multi-centre, open-label, blinded-endpoint, randomized, controlled study was undertaken. The generated data were used to examine the effects of ipragliflozin and metformin on indices of hepatic steatosis and liver fibrosis. MATERIALS AND METHODS: In total, 103 Japanese patients with type-2 diabetes (T2D), body mass index (BMI) of ≥22 kg/m2 and glycated haemoglobin level of 7%-10% were randomly administered ipragliflozin 50 mg or metformin 1000 mg for 24 weeks. Various parameters, including hepatic steatosis indices, fatty liver index (FLI), hepatic steatosis index (HSI), non-alcoholic fatty liver disease-liver fat score (NAFLD-LFS), liver fibrosis indices, AST to platelet ratio index (APRI) and fibrosis-4 (FIB-4) index, were compared in the sub-analyses. The correlations between changes in each index and VFA were evaluated. RESULTS: At baseline, patients demonstrated moderate hepatic steatosis, with FLI scores of 52.9 ± 26.6 and 57.8 ± 29.0 in the ipragliflozin and metformin groups, respectively. At 24 weeks, compared with metformin, ipragliflozin showed improvements in hepatic steatosis indices: FLI (-9.24 ± 10.7 vs. -3.45 ± 11.8, p = 0.013), HSI (-1.45 ± 2.32 vs. -0.45 ± 1.87, p = 0.021), NAFLD-LFS (-0.70 ± 1.46 vs. -0.04 ± 0.98, p = 0.011) and liver fibrosis index: APRI (-0.110 ± 0.323 vs. 0.033 ± 0.181, p = 0.010). In the ipragliflozin group, changes in FLI and HSI were correlated with VFA reduction (r = 0.340, p = 0.024; r = 0.367, p = 0.011, respectively). CONCLUSIONS: Compared with metformin, ipragliflozin improved multiple hepatic steatosis and liver fibrosis indices, suggesting that ipragliflozin exerts potential hepatoprotective effects in early-stage liver disease associated with T2D.

Abstract Background Dopamine transporter (¹²³I‐FP‐CIT) single‐photon emission tomography (SPECT) and ¹²³I‐meta‐iodobenzylguanidine (¹²³I‐MIBG) image play roles as indicative biomarkers in diagnosing patients with dementia with Lewy bodies (DLB). Brain‐ and body‐first subtypes of DLB were hypothesized implying that subset of DLB may have normal ¹²³I‐FP‐CIT or ¹²³I‐MIBG results, respectively. The purpose of this study was to explore the diagnostic sensitivity of two combination imaging modalities (¹²³I‐FP‐CIT SPECT and ¹²³I‐MIBG image) in patients with DLB and examine the clinical difference between brain‐ and body‐first subtype. Method Possible DLB patients, defined by the fourth consensus DLB criteria, who underwent both ¹²³I‐FP‐CIT SPECT and ¹²³I‐MIBG image was retrospectively collected. Semi‐automated software and their results were utilized to define abnormality for both scans. Demographic data, cognition, motor, and core features were compared between the brain‐first and body first DLB subgroups. Result Of the 114 patients with DLB, 66 underwent both scans. Mean (SD) age was 74.1 (7.1) years, male was predominant (62.1%), min‐mental state examination total score was 21.7 (4.8) and unified Parkinson’s disease rating scale motort subscore was 14.7 (4.8). Thirty‐six (54.5%) patients showed both abnormal scans and four patients (6.1%) were both normal scans. Seventeen patients (25.8%) showed abnormal ¹²³I‐FP‐CIT result with normal ¹²³I‐MIBG result (brain‐first DLB), nine patients (13.6%) showed normal ¹²³I‐FP‐CIT result with abnormal ¹²³I‐MIBG result (body‐first DLB). No clinical differences were observed between brain‐first and body‐first DLB subtypes. Conclusion Approximately 40% of DLB patients displayed normal result in either image. Normal results of a single imaging test may not refute the possibility of DLB. No clinical difference was observed between brain‐ and body‐first DLB subtypes.

The prognostic significance of unconventional histology (UH) subtypes including intraductal carcinoma of the prostate (IDC-P), ductal adenocarcinoma, and cribriform pattern has been investigated for prostate cancer (PCa). However, little is known about magnetic resonance imaging (MRI) features and the oncological impact of tumor localization in localized PCa with UH. Clinical data of 211 patients with acinar adenocarcinoma (conventional histology [CH]) and 82 patients with UH who underwent robotic-assisted radical prostatectomy (RARP) were reviewed. Patients with UH are more likely to be older and have higher Gleason grade group, higher Prostate Imaging-Reporting and Data System (PI-RADS) v2.1 score, and larger tumor volume (TV) than those with CH. Multivariate analysis identified the presence of UH as an independent prognostic factor for progression-free survival (PFS) (hazard ration (HR) 2.41, 95% confidence interval (CI) 0.22-0.79, P = 0.0073). No significant difference in PFS was seen regarding tumor localization (transition zone [TZ] or peripheral zone [PZ]) in patients with UH (P = 0.8949), whereas PZ cancer showed shorter PFS in patients with CH (P = 0.0174). PCa with UH was associated with higher progression than PCa with CH among resection margin (RM)-negative cases (P < 0.0001). Further, increased PI-RADS v2.1 score did not correlate with larger TV in UH (P = 0.991), whereas a significant difference in TV was observed in CH (P < 0.0001). The prognostic significance of UH tumor was independent of tumor localization, and shorter PFS was observed even in RM-negative cases, indicating an aggressive subtype with micro-metastatic potential. Furthermore, UH tumors are more likely to harbor a large TV despite PI-RADS v2.1 score ≤ 3. These findings will help optimal perioperative management for PCa with UH.