Journal of Nippon Medical School最新文献

{"title":"Comment on \"Usefulness of the Palliative Prognostic Index in Predicting Prognosis when Considering the Transition from Hospital to Home Care in Patients with Terminal Stage Cancer\".","authors":"Hitoshi Kanno","doi":"10.1272/jnms.JNMS.2026_93-204","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2026_93-204","url":null,"abstract":"","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 2","pages":"209-210"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in Exhibited Emotions between Junior Residents and Senior Doctors: Using an Artificial Intelligence-Based Imaging Analysis Tool.","authors":"Naoto Matsuda, Sonoko Kirinoki, Gen Takagi","doi":"10.1272/jnms.JNMS.2026_93-213","DOIUrl":"10.1272/jnms.JNMS.2026_93-213","url":null,"abstract":"<p><strong>Background: </strong>Students and junior residents often rely on subjective methods and evaluations to learn medical interviewing. Although facial expressions correlate with therapeutic outcomes, no study has systematically analyzed facial expressions in medical education. This study aimed to investigate the differences in facial expressions between senior physicians and junior residents during medical interviews using an artificial intelligence (AI)-based facial expression analysis tool.</p><p><strong>Methods: </strong>Healthcare professionals at the Dokkyo Medical University Saitama Medical Center were recruited between November 2017 and October 2018. The medical interview duration was compared between junior and senior physicians. Facial emotions were analyzed using \"Kokoro Sensor,\" an AI-based tool that classifies facial expressions into seven emotions-anger, contempt, disgust, fear, joy, sadness, and surprise-based on the proportion of frames classified as each emotion.</p><p><strong>Result: </strong>Thirteen physicians participated, resulting in 20 video recordings from 8 junior residents and 19 from 5 senior physicians. The mean interview time was 18.95 ± 8.959 minutes for junior residents and 11.79 ± 8.073 minutes for senior physicians (p = 0.004). The percentage of time physicians' faces were recognized by the Kokoro Sensor (indicating when doctors looked at patients) was 9.4% for junior residents and 21.6% for senior physicians (p = 0.012). Emotional analysis showed a significant difference in the expression of surprise: 4.9% for junior residents and 15.9% for senior physicians (p = 0.011).</p><p><strong>Conclusion: </strong>Facial emotion analysis revealed differences in facial expressions between junior residents and senior physicians during medical interviews. The findings suggest that an AI-based facial expression analysis tool can be used in education for both students and residents.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 2","pages":"190-196"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Indication of Adjuvant Therapy Based on Oncotype DX Recurrence Score in Relation to Clinical and Pathological Factors, and Survival: A Retrospective Analysis of Real-World Use.","authors":"Hideki Asakawa, Asuka Nakamura, Yuki Yanagawa, Takashi Shigekawa, Hiroyuki Takei","doi":"10.1272/jnms.JNMS.2026_93-307","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2026_93-307","url":null,"abstract":"<p><strong>Background: </strong>Oncotype DX is an important tool for guiding perioperative treatment in estrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative breast cancer. Real-world retrospective studies are essential for validating its clinical utility.</p><p><strong>Methods: </strong>We retrospectively evaluated the association of Oncotype DX Recurrence Score (ODRS) with clinical and pathological characteristics, chemotherapy regimen, and recurrence-free survival (RFS) in consecutive patients with ER-positive/HER2-negative primary breast cancer.</p><p><strong>Results: </strong>A total of 133 patients underwent Oncotype DX testing to determine the need for adjuvant chemotherapy. Mean age was 49.2 years, 67.7% of the patients were premenopausal, and 50.4% had nodal metastases. Mean ODRS was 19.5. Patients were categorized into three risk groups: low (ODRS 0-15, 40.6%), intermediate (16-25, 36.1%), and high (≥26, 23.3%). ODRS was significantly correlated with histologic grade, ER, PgR, and Ki-67. Endocrine therapy alone was administered to all low-risk patients. Chemotherapy was administered to 20.8% of patients at intermediate risk and 67.7% of patients at high risk. Multivariate analysis confirmed that ODRS was the strongest predictor of chemotherapy administration. During a median follow-up of 30.4 months, three distant recurrences occurred (in two intermediate-risk patients and one high-risk patient). No recurrence was observed in the low-risk group. RFS was worse in higher ODRS categories.</p><p><strong>Conclusions: </strong>Real-world data demonstrate that ODRS correlates with key pathological characteristics and can guide adjuvant therapy selection, independent of menopausal status or nodal involvement. This suggests that ODRS is useful in tailoring chemotherapy decisions in ER-positive/HER2-negative breast cancer.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 3","pages":"225-235"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Pathologically Negative Sentinel Lymph Nodes and Recurrence-Free Survival in Women with Invasive Breast Cancer Treated with Neoadjuvant Chemotherapy.","authors":"Phanchaporn Wongmaneerung, Hiroyuki Takei, Tomoko Kurita, Meishi Hankyo, Megumi Sano, Keiko Yanagihara, Takashi Sakatani, Ryuji Ohashi, Ryusuke Murakami, Shinichiro Kumita","doi":"10.1272/jnms.JNMS.2026_93-111","DOIUrl":"10.1272/jnms.JNMS.2026_93-111","url":null,"abstract":"<p><strong>Background: </strong>The accuracy and safety of sentinel lymph node (SLN) dissection (SLND) have not been established for women with invasive breast cancer (BC) who underwent neoadjuvant chemotherapy (NAC). The purpose of this study was to identify factors that predict pathologically negative axillary lymph node (ALN) status and recurrence-free survival (RFS) in women with invasive BC and clinically negative ALN after NAC followed by SLND.</p><p><strong>Methods: </strong>The analysis included patients with BC (T1-4, N0-1, M0) treated with NAC who had clinically negative ALNs after NAC followed by SLND between January 2018 and May 2022. Age, clinical tumor size, clinical ALN status, estrogen receptor (ER), progesterone receptor, human epidermal growth factor receptor 2 (HER2), molecular subtype, histological grade, Ki67, all at baseline, and pathologic tumor size after NAC were analyzed for correlations with pathological ALN metastasis and RFS.</p><p><strong>Results: </strong>SLND identified at least one SLN (blue or radioactive node) in all of 112 consecutive patients. Multivariable analysis showed that age >50 years, clinically negative ALN, histologic grade II or III, ER negativity, triple negative subtype (all at baseline), and pathologically invasive tumor size of ≤2.0 cm after NAC showed a significant correlation with pathologically negative ALN. HER2 positivity and pathological complete response of the primary tumor were significantly correlated with favorable RFS.</p><p><strong>Conclusions: </strong>These predictors of pathologically negative ALN and RFS after NAC are useful for planning appropriate surgical and adjuvant treatment for BC patients.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 1","pages":"49-59"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147437963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep-Related Eating Disorder among Japanese Psychiatric Outpatients Receiving Ultra-Short-Acting Benzodiazepine Receptor Agonists: A Cross-Sectional Pilot Study.","authors":"Kengo Shimoda, Haruki Saito, Amane Tateno, Takeshi Sakayori, Tsuyoshi Nogami","doi":"10.1272/jnms.JNMS.2026_93-209","DOIUrl":"10.1272/jnms.JNMS.2026_93-209","url":null,"abstract":"<p><strong>Background: </strong>Sleep-related eating disorder (SRED) is a parasomnia characterized by involuntary nocturnal eating with amnesia, which can result in serious injuries, weight gain, and metabolic complications. Reports implicate the use of ultra-short-acting benzodiazepine receptor agonists (USBZRAs)-especially zolpidem-in SRED, but the magnitude of this risk in psychiatric patients remains unclear.</p><p><strong>Methods: </strong>We performed a cross-sectional observational survey at two Japanese hospitals of 157 psychiatric outpatients receiving one of four USBZRAs (triazolam, zopiclone, zolpidem, or eszopiclone) for ≥7 days. High-dose USBZRA therapy was defined as the maximum recommended dose per package insert. SRED was assessed using an International Classification of Sleep Disorders-based checklist. A Firth bias-reduced logistic regression model with four prespecified clinically relevant variables was employed due to the limited number of events.</p><p><strong>Results: </strong>Fourteen patients met SRED criteria (8.9%; 95% CI, 4.9-14.4). Zolpidem use (adjusted odds ratio [aOR] 5.98; 95% CI, 1.57-33.58) and high-dose USBZRA therapy (aOR 4.87; 95% CI, 1.56-17.51) were independently associated with SRED. Age (aOR 0.98; 95% CI, 0.94-1.02) and female sex (aOR 0.75; 95% CI, 0.22-2.87) were not significant.</p><p><strong>Conclusions: </strong>The observed prevalence aligns with earlier reports, confirming that nearly one in eleven psychiatric outpatients receiving USBZRAs experiences SRED. Our study extends prior work by showing that SRED risk is highest at the maximum recommended dose, and especially with zolpidem. The wide confidence intervals reflect the small number of events and should be interpreted as hypothesis generating rather than definitive. These findings support limiting USBZRA dosage, favoring lower-risk hypnotics, and actively screening for nocturnal eating. This pilot study warrants validation in larger cohorts.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 2","pages":"153-160"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Phase II Study of Short Hydration without Diuretics for Cisplatin-Based Chemotherapy\".","authors":"Gota Fujisawa, Keisuke Baba, Narikazu Boku","doi":"10.1272/jnms.JNMS.2026_93-305","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2026_93-305","url":null,"abstract":"","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 3","pages":"286-287"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraosseous Pneumatocyst of the Scapula: Report of Two Cases.","authors":"Yasuyuki Kitagawa, Kazuma Miura, Daisuke Fukuhara, Naoto Kotani, Shoko Sasaki, Yosuke Shinozuka, Ryu Tsunoda, Tokifumi Majima","doi":"10.1272/jnms.JNMS.2026_93-202","DOIUrl":"10.1272/jnms.JNMS.2026_93-202","url":null,"abstract":"<p><p>An intraosseous pneumatocyst is a gas-containing cystic bone lesion that is not associated with infection or bone necrosis due to vertebral compression fracture. The most common sites are the pelvis and spine, but it is reported rarely in other sites. To our knowledge, only two cases of intraosseous pneumatocyst in the scapula have been reported. Herein, we report two cases of intraosseous pneumatocyst of the scapula, in a 41-year-old woman and a 51-year-old man. Neither patient had shoulder symptoms, and the lesions were found incidentally during imaging studies. Plain X-rays revealed cystic lesions with sclerotic rims, located from the scapular neck to the glenoid, adjacent to the shoulder joint. Plain X-rays of the 51-year-old male patient showed osteoarthritis of the shoulder, including joint space narrowing and osteophyte formation. CT was used for diagnosis in both cases. The patients remained pain-free throughout the follow-up period (10 years and 6 months, respectively). Their lesion sizes were unchanged, and radiolucency was reduced at the final follow-up. The shoulder joint has the largest range of motion in the human body; thus, the vacuum phenomenon may occur when the shoulder is elevated or externally rotated. We speculate that gas was produced in an intraosseous ganglion or subchondral cyst, the likely pre-existing lesions, after the vacuum phenomenon occurred in the shoulder joints of these patients.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 2","pages":"201-206"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy Transiently Normalized Platelet Counts in Essential Thrombocytosis.","authors":"Shunsuke Homma, Satoshi Wakita, Masahiro Sakaguchi, Shunsuke Yui, Koiti Inokuchi, Hiroki Yamaguchi","doi":"10.1272/jnms.JNMS.2026_93-411","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2026_93-411","url":null,"abstract":"<p><strong>Background: </strong>Outcomes of pregnancies complicated by essential thrombocytosis (ET) are worse than those of normal pregnancies. Aspirin, heparin, and interferon (IFN)-α are well-tolerated during pregnancy and prescribed in accordance with the risk of thrombosis. However, some evidence suggests that platelet count decreases during ET-complicated pregnancies.</p><p><strong>Methods: </strong>We retrospectively analyzed changes in platelet count in ET-complicated pregnancies.</p><p><strong>Results: </strong>Platelet count decreased during pregnancy without IFN-α use, and 83% of pregnant women had a platelet count of ≤450×10⁹/L. Furthermore, all pregnant women achieved a platelet count of ≤600×10⁹/L. One the basis of revised IPSET-thrombosis score, risk was classified as low or very low. Aspirin use starting in early pregnancy was associated with a higher rate of successful delivery, even in patients with prior miscarriage.</p><p><strong>Conclusions: </strong>These findings suggest that platelet counts decrease in selected low-risk and very-low-risk ET-complicated pregnancies and that cytoreductive therapy with IFN-α may be avoidable in some cases. These results should be interpreted cautiously because of the small sample size and retrospective study design.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 4","pages":"323-332"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periodontal Disease is a Risk Factor for Placenta-Mediated Pregnancy Complications.","authors":"Eriko Kikuchi, Asami Suzuki, Masako Hayashi, Atsuko Sekiguchi, Akihito Nakai, Shunji Suzuki","doi":"10.1272/jnms.JNMS.2026_93-408","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2026_93-408","url":null,"abstract":"<p><strong>Objective: </strong>Although periodontal disease is known to be associated with obstetric complications, evidence is limited regarding the relationship with placenta-mediated pregnancy complications (PMPCs), a major cause of maternal and fetal morbidity and mortality. This study investigated whether periodontal disease is a risk factor for PMPCs.</p><p><strong>Methods: </strong>We conducted a retrospective case-control study of inpatients with singleton pregnancies who underwent perinatal dental examinations at Nippon Medical School Tama Nagayama Hospital between September 2012 and August 2015. Medical records were reviewed for incident PMPCs, including preterm birth, preeclampsia, small for gestational age birth, placental abruption, and late pregnancy loss. Associations of periodontal disease with PMPCs were assessed using univariate and multivariate logistic regression analyses.</p><p><strong>Results: </strong>Among 262 inpatients, 130 (49.6%) developed PMPCs. The prevalence of periodontal disease was significantly higher among women with PMPCs than among those without PMPCs (90.0% vs. 75.0%, P = 0.002). Multivariate logistic regression analysis identified periodontal disease as an independent risk factor for PMPCs (adjusted odds ratio [aOR], 2.89; 95% confidence interval [CI], 1.41-5.88). Younger maternal age (<35 years; aOR, 1.75; 95% CI, 1.04-2.92) and a past history of PMPCs (aOR, 3.27; 95% CI, 1.47-7.27) were also significantly associated with PMPCs.</p><p><strong>Conclusion: </strong>Periodontal disease was independently associated with increased risk of PMPCs. Management of periodontal disease during pregnancy may help prevent PMPCs.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 4","pages":"304-310"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interferon Regulatory Factor Family Transcription Factor Expression in the Dorsal Root Ganglion of a Rat Model of Neuropathic Pain.","authors":"Yuji Watanabe, Motoyo Maruyama, Miki Yokoyama, Ryosuke Arakawa, Atsushi Sakai","doi":"10.1272/jnms.JNMS.2026_93-309","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2026_93-309","url":null,"abstract":"<p><strong>Background: </strong>Peripheral nerve injury induces neuroinflammation in the dorsal root ganglion (DRG), which is a major cause of neuropathic pain. Interferon regulatory factors (IRFs) are a family of transcription factors that regulate the expression of inflammatory genes. Although several IRFs affect nociceptive transmission in the spinal cord, their roles in the DRG remain largely unknown.</p><p><strong>Methods: </strong>Spinal nerve ligation (SNL) was used to develop a rat neuropathic pain model. Pain-related behaviors were assessed by the von Frey test and Plantar test. Gene expression levels of IRF family members were examined using quantitative PCR or immunofluorescence. IRF8 expression was downregulated by intrathecal administration of small interfering RNA (siRNA).</p><p><strong>Results: </strong>IRF1, IRF5, and IRF8 were upregulated 4 days after nerve injury, but their expression gradually declined thereafter. In contrast, IRF4 and IRF7 expression gradually increased during an observation period of 14 days. No significant changes were observed in the expression of IRF2, IRF3, IRF6, or IRF9 after injury despite a slight increase. IRF8, which exhibited the greatest change in expression, was expressed in DRG neurons of naïve rats, and its distribution was not altered by nerve injury. IRF8 knockdown alleviated mechanical allodynia but not thermal hyperalgesia in neuropathic pain.</p><p><strong>Conclusion: </strong>To our knowledge, these results are the first to show that multiple IRFs are upregulated in the DRG after peripheral nerve injury. The upregulated members of IRF family in the DRG after nerve injury may be involved in the pathophysiology of neuropathic pain.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 3","pages":"244-251"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}