Kurume Medical Journal最新文献

{"title":"Virtual Reality in Surgical Training: A Comprehensive Study on Educational Efficacy, Memory Enhancement, and Mental State for Clinical Clerkship Students.","authors":"Atsushi Nanashima, Yoji Hirano, Hiroaki Kubo, Shunsuke Tamura, Kazuhiro Higuchi, Kengo Kai, Takeomi Hamada","doi":"10.2739/kurumemedj.MS7312012","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS7312012","url":null,"abstract":"<p><p>Virtual Reality (VR) is increasingly used in surgical education. This study examines the impact of VR-integrated training on learning, memory, and psychological responses. A prototype VR system with immersive OR views was tested on 67 clinical clerkship students. OR experiences followed the simulation. Thirty-two questionnaires covered surgical procedures and systems. Mood and personality were assessed using POMS-2, focusing on Total Mood Disturbance (TMD), fatigue-inertia (FI), vigor-activity (VA), and friendliness (F). VR modestly increased interest in surgery (~3.4/5) but training confidence stayed low (2.2/5). Understanding of abdominal surgery improved (2.6/5), with 96% correctly identifying the sterile field. Robotic roles were partially grasped; DCS understanding remained low (2.3/5). VR users better located OR equipment but 22% experienced nausea and 46% disliked the design. Compared to non-VR peers, they had lower procedural knowledge (p<0.01), but reported less stress and improved teamwork awareness (p<0.01). Mood analysis showed increased TMD and FI, decreased VA and F (all p<0.01), and reduced anxiety (TA). Personality traits (low neuroticism, high extraversion) were linked to stronger emotional reactions. VR sickness (51%) correlated with cognitive confusion and higher TMD (p<0.01). This VR approach enhances surgical understanding and team role awareness, offering experiential value in preclinical training.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Necrotizing Fasciitis After Cesarean Section: A Case Report.","authors":"Yushi Morishita, Takuya Shimomura, Aki Tetsuo, Riko Sugiyama, Takashi Seike, Kanako Gondo, Masanori Kawano, Jongmyung Park, Daizo Hori, Atsumu Terada","doi":"10.2739/kurumemedj.MS7312011","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS7312011","url":null,"abstract":"<p><p>Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft-tissue infection requiring prompt diagnosis and aggressive surgical intervention. Although approximately 20% of NF cases arise from postoperative infections, its occurrence after cesarean delivery is extremely rare, with an estimated incidence of 0.18%. We report a case of a 35-year-old primigravida with no significant medical history who underwent emergency cesarean section for non-reassuring fetal status. On postoperative day (POD) 6, she developed fever, elevated inflammatory markers, and uterine tenderness consistent with intrauterine infection. Subsequently, erythema and induration developed at the surgical site, and despite antibiotic therapy, her condition progressed to blistering and skin necrosis. Imaging revealed gas formation and fluid collection at the incision site. Emergency surgical debridement confirmed NF involving tissues from the epidermis to the rectus fascia. Methicillin-resistant Staphylococcus aureus was isolated from wound cultures, and intravenous meropenem and vancomycin were administered. Hyperbaric oxygen therapy and negative-pressure wound therapy were applied sequentially, followed by delayed wound closure. The patient recovered well and was discharged on POD51. Although rare in obstetric practice, NF should be considered when cesarean wound infections fail to respond to standard therapy.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management and Outcomes of Acute Coronary Syndrome during and after the COVID-19 Pandemic in Kurume City: A Multicenter Observational Study.","authors":"Masaharu Nakano, Yoshiaki Mitsutake, Tomohiro Kawasaki, Hideki Tashiro, Atsushi Kato, Nagisa Morikawa, Shuhei Kawasaki, Taro Katsuki, Takumi Yoshiga, Kazunori Yamaji, Takashi Ishimatsu, Masahiro Sasaki, Naoki Itaya, Takaharu Nakayoshi, Ken-Ichiro Sasaki, Yoshihiro Fukumoto","doi":"10.2739/kurumemedj.MS7312009","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS7312009","url":null,"abstract":"<p><strong>Background: </strong>The impact of the coronavirus disease 2019 (COVID-19) pandemic on acute coronary syndrome (ACS) care has varied widely across regions. Data from stable regional healthcare systems remain limited, particularly regarding potential delayed effects after the acute pandemic phase.</p><p><strong>Methods: </strong>We conducted a retrospective, population-based observational study of percutaneous coronary intervention (PCI)-treated ACS in Kurume City, Japan, across three periods: pre-pandemic (2019), pandemic (2020-2021), and post-restriction (2022). PCI data were collected from all four PCI-capable hospitals in the region. The primary endpoint was in-hospital mortality among ACS patients. Secondary endpoints included ACS subtype distribution and use of mechanical circulatory support (MCS).</p><p><strong>Results: </strong>A total of 4,694 PCI procedures were performed between 2019 and 2022, including 1,692 for ACS. Annual PCI volume and the proportion performed for ACS (34.1%-38.6%) remained stable. The proportion of ST-segment elevation myocardial infarction was higher in 2020 and remained elevated in 2022 compared with 2019 (p=0.015). In-hospital mortality among ACS patients was comparable during the pandemic years but increased significantly in 2022 (7.4% vs 2.3%-4.0%; p=0.0006), even after excluding post-cardiac arrest syndrome. Rates of MCS use did not differ significantly across years. Emergency medical transport times increased modestly.</p><p><strong>Conclusion: </strong>In this regional healthcare system, the COVID-19 pandemic did not substantially disrupt emergent coronary revascularization or worsen short-term outcomes of PCI-treated ACS during the acute phase. However, in-hospital mortality increased in the post-restriction period, suggesting delayed cardiovascular consequences of the pandemic.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes of Low-Grade Appendiceal Mucinous Neoplasms in a Single Institution.","authors":"Yutaro Nakagawa, Mitsuaki Morimoto, Sohsuke Hara, Kouta Kawabata, Masato Kitano, Ryo Yamazaki, Katsuzo Hanaoka, Ren Nakamura, Kazune Komiya, Fuminori Ishii, Kenji Maki, Shuhei Ito, Yasushi Yoshida, Tomoaki Noritomi","doi":"10.2739/kurumemedj.MS7312008","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS7312008","url":null,"abstract":"<p><strong>Objectives: </strong>Low-grade appendiceal mucinous neoplasm (LAMN) is a rare tumor with limited malignant potential but a risk of pseudomyxoma peritonei (PMP) if perforation occurs. We aimed to characterize clinicopathological features, assess recurrence risk, and evaluate postoperative surveillance.</p><p><strong>Methods: </strong>We retrospectively reviewed 44 patients with pathologically confirmed LAMN who underwent surgery at our institution between 2010 and 2025. Clinicopathological factors, recurrence, and surveillance strategies, including tumor markers and computed tomography (CT), were analyzed. Recurrence-free survival (RFS), overall survival (OS), and disease-specific survival were calculated.</p><p><strong>Results: </strong>Median age was 64 years. Preoperative tumor marker elevation was uncommon. Risk factors included pT4 in 14 patients (33%), extra-appendiceal mucin in 1 (2.3%), positive margin in 1 (2.3%), and perforation in 15 (34.1%). Over a median 36-month follow-up, no recurrences or PMP occurred; one death from an unrelated cause was observed, resulting in 5-year RFS and OS of 97.7%. No disease-specific deaths occurred. Median annual CT frequency was 1.7 (42 mSv). The estimated annual copayment for follow-up examinations was approximately ¥7,200 per patient.</p><p><strong>Conclusions: </strong>Surgically resected LAMN showed favorable mid-term outcomes. However, given the limited follow-up and absence of events, the findings should be interpreted cautiously as preliminary insights into postoperative surveillance.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilot Study Investigating the Safety and Efficacy of Metallic Stent Insertion for Ileocolonic Anastomotic Strictures Related to Crohn's Disease: A Study Protocol.","authors":"Rintaro Moroi, Kotaro Nochioka, Hideya Iwaki, Daisuke Okamoto, Hiroshi Nagai, Yusuke Shimoyama, Takeo Naito, Yoichi Kakuta, Atsushi Masamune","doi":"10.2739/kurumemedj.MS7312006","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS7312006","url":null,"abstract":"<p><strong>Introduction: </strong>Lower gastrointestinal tract stenoses are commonly treated with surgery or endoscopic balloon dilation. We conducted a clinical trial to investigate a novel endoscopic treatment called radial incision and cutting (RIC). Although RIC has demonstrated a high technical success rate and has been shown to improve subjective symptoms, the relatively high rate of delayed bleeding in cases of ileocolonic anastomotic strictures due to Crohn's disease (CD) can be problematic. Herein, we report the design of a prospective, single-center, single-arm, exploratory pilot study to evaluate safety and feasibility of self-expandable metallic stent (SEMS) placement as an alternative dilation strategy for ileocolonic anastomotic strictures in CD, particularly in patients in whom delayed bleeding after RIC has been a clinical concern.</p><p><strong>Methods: </strong>The major inclusion criteria include age 18-80 years, ileocolonic anastomotic strictures after surgery for CD, and a history of endoscopic balloon dilation or RIC for such strictures. We will employ a SEMS designed for malignant biliary stenosis and conduct SEMS placement in five participants. The primary outcome is the safety of SEMS placement, assessed by determining the frequency of adverse events of special interest, including delayed bleeding and perforation. The secondary outcomes include the technical success rate of SEMS placement, procedure duration, improvement in subjective symptoms, SEMS migration rate, success rate of SEMS removal 1 week after placement, and duration of hospitalization. Subjective symptom improvement is evaluated using the visual analog scale, and long-term results are analyzed using descriptive statistics, Student's t-test, and Kaplan-Meier curves.</p><p><strong>Conclusion: </strong>This exploratory study provides useful information regarding the safety of SEMS placement for ileocolonic anastomotic strictures due to CD, which may contribute to further investigation.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anger among Mental Healthcare Nurses in Japan: In the Context of Workplace Violence.","authors":"Tetsuya Ishida, Misari Oe, Yudai Kobayashi, Kyoko Odawara, Hiromi Chiba, Michiko Matsuoka, Motohiro Ozone","doi":"10.2739/kurumemedj.MS7312001","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS7312001","url":null,"abstract":"<p><p>Anger may arise following harmful experiences such as violence, and managing anger may be crucial for the mental health of those working in environments prone to physical or verbal abuse, such as psychiatric wards. Although anger is a basic emotion, research concerning anger is limited. To examine the association between anger and mental health status in the context of workplace violence, we distributed a questionnaire to 569 psychiatric nurses in Japan. Compared to studies conducted outside Japan, these nurses' mean scores on the Dimensions of Anger Reaction-5 (DAR-5) scale were lower. A multivariate analysis revealed that the following significantly predicted higher levels of anger: working in a chronic care ward, psychological distress, secondary traumatic stress, and the experience of workplace violence. These findings highlight the importance of conducting further research on anger related to workplace trauma.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Sheehan Syndrome Due to Postpartum Hemorrhage with Hypoglycemia 9 Hours After Cesarean Section: A Case Report and Literature Review.","authors":"Yusuke Tanabe, Megumi Muto, Masaharu Kabashima, Wakana Nakahara, Chikayo Watanabe, Kenji Ashida, Yusuke Kurokawa, Naoko Koga, Y U Okamura, Masato Yokomine, Takashi Horinouchi, Masatoshi Nomura, Naotake Tsuda","doi":"10.2739/kurumemedj.MS7312003","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS7312003","url":null,"abstract":"<p><p>Sheehan syndrome is a pituitary injury caused by a postpartum hemorrhage that results in hormonal deficiency. Although typically diagnosed later, it rarely presents in the immediate postpartum period. A 35-year-old woman (gravida 4, para 2) underwent emergency cesarean section for placenta previa at 34 weeks of gestation. The total blood loss was estimated to be 4,000 mL. She developed symptomatic hypoglycemia (blood glucose level, 45 mg/dL), followed by drowsiness and hypothermia at 9 h postoperatively. Endocrinological evaluation at 20 h postoperatively showed an adrenocorticotropic hormone level of <1.5 pg/mL, cortisol level of 1.15 µg/dL and free thyroxine level of 0.60 ng/dL. She was diagnosed with acute Sheehan syndrome and was promptly treated with hydrocortisone and levothyroxine. The patient's symptoms resolved rapidly. Multiple anterior pituitary hormone insufficiencies were confirmed. This case underscores the importance of recognizing hypoglycemia as a potential early manifestation of acute Sheehan syndrome, allowing a timely diagnosis and improving clinical outcomes.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TL1A-DR3 Signaling in Inflammatory Bowel Disease: From Pathogenesis to Therapeutic Targeting.","authors":"Kozo Tsuruta, Shinichiro Yoshioka, Hidetoshi Takedatsu","doi":"10.2739/kurumemedj.MS7312004","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS7312004","url":null,"abstract":"<p><p>TNF-like cytokine 1A (TL1A) and its receptor DR3 form a key regulatory axis within mucosal immunity, integrating signals that promote Th1/Th17 responses, modulate innate lymphoid cells, and influence epithelial repair. Beyond inflammation, TL1A directly activates intestinal fibroblasts and contributes to extracellular matrix deposition, positioning the TL1A-DR3 pathway as a central driver of both chronic inflammation and fibrosis in inflammatory bowel disease (IBD). Genetic variants in TNFSF15, which encodes TL1A, further support a causal role, linking increased TL1A expression with susceptibility to Crohn's disease, ulcerative colitis, and fibrostenotic complications. Recent clinical trials of TL1A-neutralizing antibodies, including afimkibart, tulisokibart, and duvakitug, have demonstrated encouraging efficacy and safety in moderate-to-severe IBD, with emerging biomarker strategies suggesting potential for personalized treatment. Collectively, current evidence highlights TL1A blockade as a promising dual-pathway therapeutic approach targeting inflammation and fibrotic remodeling, with ongoing studies expected to define its long-term impact on disease modification.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developmental and Healing Processes of Uterine Artery Pseudoaneurysm After Non-Traumatic Delivery Followed by Transarterial Embolism: Sequential Observations in a Case Depicting Using Superb Microvascular Imaging.","authors":"Megumi Muto, Yusuke Kurokawa, Asako Kuhara, Takashi Horinouchi, Masato Yokomine, Toshiyuki Yoshizato, Naotake Tsuda","doi":"10.2739/kurumemedj.MS7312002","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS7312002","url":null,"abstract":"<p><p>We report a case of uterine artery pseudoaneurysm in which the developmental process of pseudoaneurysm was, for the first time to our knowledge, depicted using superb microvascular imaging (SMI). The patient became pregnant naturally and had an uneventful pregnancy. At 41 weeks of gestation, she spontaneously delivered a neonate and placenta, which had been attached to the posterior uterine wall. On the seventh postpartum day, SMI demonstrated a flow signal measuring 3×12 mm running straight through the posterior myometrium perpendicular to the endometrium, suggesting dilation of the radial artery. On the eighth postpartum day there was a moderate amount of vaginal bleeding. Color Doppler ultrasonography showed turbulent flow measuring 8 mm in diameter, located in the same posterior myometrial location as found on the previous day and bulging into the cavity. This finding indicated an uterine artery pseudoaneurysm, which was confirmed by pelvic arterial angiography. A follow-up SMI, three days after embolization, revealed the absence of the pseudoaneurysm, and normal radial arterial flows were restored by the 13th day after embolization.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital Absence of the Left Common Iliac Artery: A Case Report.","authors":"Suzuka Watanabe, Yoko Tabira, Joe Iwanaga, Rarinthorn Samrid, Seiichi Inoue, Hisashi Nakamura, R Shane Tubbs, Koichi Watanabe","doi":"10.2739/kurumemedj.MS7312005","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS7312005","url":null,"abstract":"<p><p>Anatomical variations in the iliac vasculature are rarely encountered, but they do have important clinical implications, particularly in surgical and interventional procedures. During a routine dissection course at Kurume University School of Medicine in 2016, a Japanese female anatomical donor who was 98 years of age at death was found to have a congenital absence of the left common iliac artery. Instead, the abdominal aorta bifurcated into the right common iliac artery and directly into the left internal and external iliac arteries at the level of the fifth lumbar vertebra. This variation likely resulted from an unusual fusion pattern during embryonic development. Understanding such anatomical variations is crucial for safe and effective clinical practice.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}