Masahiro Umeda

Ultra‐high‐field 7‐T ¹ H‐MRS resolves the bis‐allylic resonance at 2.8 ppm, a marker present only in fatty acids (FAs) with two or more double bonds, enabling distinction between monounsaturated (MUFA) and polyunsaturated fatty acids (PUFAs) in IMCL that is not achievable at 3 T. The objective of this study was to determine the relative proportions of saturated (SFA), MUFA, and PUFA in IMCL in vivo using 7‐T ¹ H‐MRS. To further improve the precision of this fitting, we acquired high‐resolution 600‐MHz ¹ H‐NMR spectra of representative FA species and incorporated their chemical shifts as prior knowledge in the spectral fitting model. Five predominant FAs—oleic, palmitic, linoleic, and α‐ and γ‐linolenic acids, which together represent the major FA species in human skeletal muscle triglycerides—were analyzed via 600‐MHz NMR to determine precise chemical shifts for methyl (–CH ₃ ), allylic (–CH ₂ –CH=CH–), and bis‐allylic (=CH–CH ₂ –CH=) protons. The NMR spectra revealed distinct shifts: linoleic acid (0.891, 2.044, and 2.782 ppm), oleic acid (0.878 and 2.002 ppm), palmitic acid (0.880 ppm), α‐linolenic acid (0.976, 2.064, and 2.807 ppm), and γ‐linolenic acid (0.889, 2.074, and 2.808 ppm). These values were subsequently fitted to in vivo 7‐T ¹ H‐MRS spectra (range of 0.90–5.55 ppm) acquired from the tibialis anterior of 11 healthy volunteers. Using specialized analysis software, IMCL peaks for methyl (0.90 and 1.00 ppm), allylic (2.02 and 2.06 ppm), and bis‐allylic (2.78 and 2.82 ppm) protons were incorporated into the spectral fitting model, enabling improved characterization of FA composition. The mean relative composition of intramyocellular FAs was 36% palmitic acid, 27% oleic acid, and 23% linoleic acid (including α‐ and γ‐linolenic acids). Our findings demonstrate that incorporating NMR‐derived prior knowledge enables chemically specific fitting of intramyocellular FA peaks, allowing distinction between SFA, MUFA, and PUFA components within the intramyocellular compartment—information that cannot be obtained from biopsy‐based homogenate analysis.

Purpose: Acupuncture is believed to significantly modify neural circuits in the brain. However, the effects of moxibustion stimulation remain unclear. Therefore, we used functional MRI to investigate brain activation sites induced by moxibustion stimulation using an electric moxibustion device that mimics Japanese Tonetsu-kyu half-grain-sized direct moxibustion.Methods: Twenty-two healthy adult participants underwent 6 rounds of 7-s moxibustion stimulations on the right acupuncture point ST36 using electric moxibustion during functional MRI measurement. The maximum output temperature of electric moxibustion was 67.5°C. However, the contact surface temperature was adjusted to 58.6 ± 0.1°C using cooking wrap to avoid small burns caused by heating. The ON time was divided into 3 periods: ON1, 2s from the start of moxibustion stimulation (45°C); and ON3, 3s after the completion of stimulation. Each block was designed with all options other than ON set to OFF.Results: Common and different activations were observed in all ON times. During stimulation, common activation was observed in the insula, S1, and supramarginal gyrus. Activation in the central operculum, frontal operculum and supplementary motor area was observed only in the ON1 condition, while activation in the frontal pole, cerebellum, and right S2 was observed only in the ON2 condition. Using electric moxibustion that mimics a grain-sized direct moxa cone, common and different activations were confirmed from the start of output to 45°C and above 45°C, and the activation was sustained after the completion of stimulation.Conclusion: This study showed that moxibustion could affect almost the same areas of pain-related regions. Based on the findings of this study, further research on moxibustion-induced brain activation may help elucidate the mechanism of its therapeutic effects.

Patients develop a number of oral complications during cancer treatments. Oral bacteria are associated with the onset of dental focal infections and the progression of oral mucositis. Dental focal infections are frequently associated with the systemic onset of bacteremia, sepsis, and pneumonia. The degeneration of oral function with these complications may become an obstacle to cancer treatments. Although comprehensive oral management, including oral care, the removal of dental focal infections, and improvements in oral function with dentures, is conducted for cancer patients in Japan, few studies have assessed its efficacy. The aim of the present study was to investigate the incidence of dental/oral complications in cancer patients with perioperative oral managements (POMs) based on a large number of case series with a multicenter retrospective analysis. The medical records of cancer patients with POMs were retrospectively reviewed and the incidence of oral complications and efficacy of oral management were investigated. A total of 2744 cancer patients with POMs (1684 males and 1080 females, mean age 65.9 ± 13.0 years) were included and investigated in the present study. Among these patients, 2097 (76.4%) started POM before the initiation of cancer treatments, with 2130 (77.6%) receiving oral care only and 391 (14.2%) being subjected to invasive treatments, such as tooth extraction. The incidence of dental focal infections during the period of cancer treatments was 8.2%. The most frequent infection was acute periodontitis, including alveolar abscesses (112 patients, 4.1%). The incidence of grade 2 and 3 oral mucositis was 2.8%. Prolonged fever was observed in 113 patients (4.1%), with 7 having dental focal infections (6.2%). These incidence rates were lower than those reported previously. Based on analyses of a large number of patients, the present results support the efficacy of oral management in cancer patients. However, further studies are needed to establish adequate oral management guidelines for cancer patients.

Treatment strategies of medication-related osteonecrosis of the jaw (MRONJ) are controversial. Recently, surgical treatment has been reported as superior to nonsurgical treatment, but the contribution discontinued antiresorptive agent use during MRONJ treatment remains unclear. This study aimed to evaluate the efficacy of drug holidays and treatment strategies in MRONJ cases. Four-hundred and twenty-seven patients with MRONJ treated at nine hospitals from 2009 to 2017 were included in this multicenter retrospective study. Multivariate Cox regression analysis showed that the primary disease (osteoporosis or malignant tumor), diabetes, serum albumin, and treatment method (surgical or nonsurgical) were significantly correlated with the cure rate. The cumulative 1-year cure rates in the surgical and nonsurgical treatment groups were 64.7% and 18.2%, respectively. However, discontinuing antiresorptive agents did not influence the treatment outcome in the cohort overall, or in 230 patients after performing propensity score matching among the discontinuation and continuation groups. When stratifying by treatment method, antiresorptive agent discontinuation significantly increased the cure rate in patients with osteoporosis who underwent nonsurgical treatment. In patients with malignant tumors undergoing nonsurgical therapy, discontinuing the antiresorptive agent was associated with a better treatment outcome, but not with statistical significance. In contrast, drug holidays showed no effect on improving outcomes in patients with both osteoporosis and malignant tumors who underwent surgical therapy. Thus, regardless of the primary disease, discontinuing antiresorptive agents during treatment for MRONJ may not be necessary and may be helpful in some cases. Future prospective trials should examine this question further.

今回われわれは，切除困難な舌小細胞癌頸部リンパ節転移に対し，セツキシマブ＋FP併用療法施行後，局所切除が可能となった1例を経験したので報告する。 患者は74歳男性。右側舌と右顎下部の腫瘤形成を主訴に当科を受診した。画像検査で内頸動脈を広範囲に取り巻く右ルビエールリンパ節転移があり，切除困難例と判断し，セツキシマブ＋FP併用療法を施行した。 全身療法施行後，左側根治的頸部郭清術変法，下顎区域切除を含む腫瘍切除術に加え，咽頭後リンパ節郭清を施行した。術後はS-1併用放射線療法を施行したが，術後9ヶ月で頸部および肺に腫瘤性病変がみられたため，頸部腫瘤の切除術を施行し，小細胞癌の確定診断を得た。姑息的化学療法を施行するも奏効せず，術後1年7ヶ月に永眠となった。

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