Journal of Nippon Medical School最新文献

{"title":"Pilot Study of the Composite Graft Constructed from Two Saphenous Veins with a Single Inflow Source in Coronary Artery Bypass Grafting with Atherosclerotic Ascending Aorta.","authors":"Makoto Shirakawa, Atsushi Hiromoto, Jiro Honda, Yosuke Ishii","doi":"10.1272/jnms.JNMS.2026_93-205","DOIUrl":"10.1272/jnms.JNMS.2026_93-205","url":null,"abstract":"<p><strong>Background: </strong>This pilot study aimed to evaluate early outcomes of a composite graft constructed from two saphenous veins (SVs) with a single inflow source in coronary artery bypass grafting (CABG) for patients with an atherosclerotic ascending aorta. The analysis focused on prevention of embolic events and early graft patency.</p><p><strong>Methods: </strong>The analysis included 17 patients who underwent CABG using the left internal thoracic artery (LITA) to the left anterior descending artery (LAD), combined with a composite graft constructed from two saphenous veins (SVs) with a single inflow source. The SV composite graft was anastomosed to non-LAD coronary territories.</p><p><strong>Results: </strong>Intraoperative flow and pulsatility index values of the SV grafts were satisfactory. No major complications, including new cerebrovascular embolic events, were observed. The early patency rate of SV anastomoses was 90%; all four occlusions among the total 40 anastomoses occurred in the Y-shaped composite graft.</p><p><strong>Conclusions: </strong>A composite graft constructed from two SVs with a single inflow source appears to reduce the risk of embolic events by minimizing manipulation of the atherosclerotic ascending aorta. However, the configuration of the proximal SV anastomoses may affect early graft patency. Specifically, the risk of early failure appears to be higher in the Y-shaped configuration than in the V-shaped configuration.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 2","pages":"115-121"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846264","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":"Postoperative Delirium in Surgical Patients in Intensive and Non-Intensive Care Units: Incidence, Risk Factors, and Prognostic Significance.","authors":"Yuki Genda, Hiroshi Mase, Shunichi Yasuda, Takuya Nishino, Tomoki Mizuno, Makiko Yamamoto, Hiroki Yamaguchi, Masashi Ishikawa","doi":"10.1272/jnms.JNMS.2026_93-207","DOIUrl":"10.1272/jnms.JNMS.2026_93-207","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium (POD) is a common complication that is associated with adverse outcomes. However, differences between surgical patients in intensive care unit (ICUs) and non-ICUs are unclear. This study investigated POD incidence, prognostic significance, and risk factors in ICU and non-ICU settings.</p><p><strong>Methods: </strong>We retrospectively analyzed data from 20,338 adults who underwent general anesthesia at Nippon Medical School Hospital between July 2021 and March 2025. Patients were classified as ICU (n=2,451) and non-ICU patients (n=17,887). POD was defined by an Intensive Care Delirium Screening Checklist score of ≥4 or prescription of antipsychotics. Logistic regression was used to identify risk factors, and Kaplan-Meier analysis assessed 180-day mortality. Subgroup analysis evaluated differences between early (≤2 days) and late (3-7 days) POD.</p><p><strong>Results: </strong>The overall incidence of POD was 4.4% (889/20,338) and was higher in ICU patients (19.1%) than in non-ICU patients (2.3%; p<0.001). POD was positively associated with 180-day mortality in both groups (p<0.001). Among non-ICU patients, survival was worse among patients with late POD than among those with early POD (p<0.001), whereas onset timing had no impact in ICU patients. Risk profiles differed: advanced age, higher American Society of Anesthesiologists class, and cerebrovascular disease were associated with POD in non-ICU patients, while male sex and dialysis were significant factors for ICU patients. Excessive positive fluid balance and prolonged operative time increased POD risk in both groups, but gradients were steeper in non-ICU patients.</p><p><strong>Conclusions: </strong>POD was independently positively associated with excess mortality across settings, but the risk factors and prognostic implications varied. These findings highlight the need for ward-specific preventive strategies and tailored perioperative management.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 2","pages":"135-144"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846506","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":"Correlation of External Rotational Alignment of the Tibial Component with 2-Year Clinical Outcomes after Guided-Motion Total Knee Arthroplasty.","authors":"Tatsunori Kataoka, Norishige Iizawa, Tokifumi Majima, Makoto Hirao","doi":"10.1272/jnms.JNMS.2026_93-409","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2026_93-409","url":null,"abstract":"<p><strong>Background: </strong>Proper rotational alignment of the femoral and tibial components is critical for successful total knee arthroplasty (TKA). However, few studies have focused on the effect of external rotation of the tibial component on patient-reported outcomes after guided-motion TKA. This study assessed the association between tibial rotational alignment and patient-reported outcomes in patients with neutral alignment in all other planes.</p><p><strong>Methods: </strong>This retrospective cohort study at a regional institutional hospital analyzed data from patients who underwent primary TKA for knee osteoarthritis and had no postoperative coronal malalignment, malrotation of the femoral component, internal tibial rotation, or component rotational mismatch. Rotational alignment of the tibial component was evaluated using computed tomography, and its association with postoperative 2011 Knee Society Score was evaluated using Spearman correlation analysis.</p><p><strong>Results: </strong>The study included 32 knees from 32 patients. The tibial component was 4.8°±6.2° externally rotated postoperatively. An externally rotated tibial component was associated with a smaller flexion angle (at 6 months: r=0.37, p=0.04; at 2 years: r=0.43 p=0.02), lower objective score (at 2 years: r=0.32, p=0.02), symptoms (at 6 months: r=0.50, p=0.003), and satisfaction (at 6 months: r=0.37, p=0.04).</p><p><strong>Conclusions: </strong>Tibial rotational alignment may affect flexion angle and clinical outcomes of TKA. Excessive external rotation should be avoided in guided-motion prostheses. Future studies should attempt to identify thresholds for rotational alignment of the tibial component.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 4","pages":"311-317"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834904","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":"Real-World Cancer Genomic Profiling at a Cooperative Hospital for Cancer Genomic Medicine in Japan.","authors":"Ai Ikki, Masafumi Toyoshima, Tomoko Sahara, Maho Kuroda, Riku Watanabe, Ikuno Kawabata, Kay Uehara, Ryo Ohta, Hiromichi Sonoda, Shunji Suzuki, Takeshi Yamada","doi":"10.1272/jnms.JNMS.2026_93-208","DOIUrl":"10.1272/jnms.JNMS.2026_93-208","url":null,"abstract":"<p><strong>Background: </strong>Comprehensive genomic profiling (CGP) tests have been covered by insurance in Japan since 2019, and their use in cancer genomic medicine (CGM) has expanded since then. Although extensive data are available from core hospitals, real-world data from community-based cooperative hospitals are limited.</p><p><strong>Methods: </strong>Using data from 514 consecutive patients with advanced cancer who underwent CGP testing at our institution between June 2019 and March 2025, we investigated the proportion of cases receiving therapeutic recommendations, the rate of drug administration based on CGP test results, and the prevalence and management of presumed germline pathogenic variants (PGPVs).</p><p><strong>Results: </strong>The most common cancer sites were the pancreas (18.7%), breast (16.9%), bowel (14.6%), lung (12.8%), and prostate (12.5%). An expert panel made up of molecular oncologists recommended 360 targeted therapies for 311 patients (60.5% of the total cohort). Ultimately, 80 patients (15.6%) received matched therapy, among whom 56 received medication under health insurance coverage, 22 through clinical trials, and 2 via the patient-requested medical treatment system. PGPVs were identified in 68 patients (13.2%). After discussion by the expert panel, confirmatory germline testing was offered to patients with PGPVs, and subsequent germline testing confirmed pathogenic variants in 18 patients (3.5% of the total cohort).</p><p><strong>Conclusion: </strong>The proportion of patients who received targeted therapy at our cooperative hospital was comparable to proportions reported from core hospitals. However, disease progression was a significant barrier to accessing targeted therapies and genetic counseling. To maximize the benefits of CGM, the timing of CGP testing must be optimized and collaboration across departments and institutions must be strengthened.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 2","pages":"145-152"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846466","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":"Human Amnion-Derived Mesenchymal Stromal Cell Exosomes Promote Neuroprotection and Neurovascular Remodeling after Cerebral Ischemia.","authors":"Shiro Takahashi, Chikako Nito, Yuki Sakamoto, Hiroto Kodera, Takehiro Katano, Yoshitaka Miyagawa, Moeko Saito, Mashito Sakai, Satoshi Suda","doi":"10.1272/jnms.JNMS.2026_93-212","DOIUrl":"10.1272/jnms.JNMS.2026_93-212","url":null,"abstract":"<p><strong>Background: </strong>Ischemic stroke remains a leading cause of death and long-term disability worldwide, and effective neuroprotective therapies applicable to a broad patient population are still limited. Although mesenchymal stromal cell-derived exosomes (MSC-EXO) have emerged as promising cell-free therapeutic agents, evidence regarding exosomes derived from human amnion-derived mesenchymal stromal cells (AMSC-EXO) in cerebral ischemia remains scarce.</p><p><strong>Methods: </strong>Human AMSC-EXO were isolated from conditioned media of cultured human amnion-derived mesenchymal stromal cells and characterized by nanoparticle tracking analysis and exosomal marker expression. Male mice were subjected to middle cerebral artery occlusion and randomly assigned to receive intravenous AMSC-EXO or vehicle 24 h after ischemia. Neurological function, motor coordination, and spatial working memory were assessed at 3 and 14 days. Post-ischemic neuroinflammation, neuronal degeneration, and endothelial cell proliferation were evaluated by immunohistochemistry and enzyme-linked immunosorbent assay in a blinded manner.</p><p><strong>Results: </strong>Systemic administration of AMSC-EXO significantly improved neurological outcomes and motor performance after cerebral ischemia and enhanced spatial working memory. AMSC-EXO treatment markedly suppressed microglial activation and reduced the expression of pro-inflammatory cytokines, including tumor necrosis factor-α, interleukin-1β, and interleukin-6, in the ischemic brain. In addition, neuronal degeneration in the cortical infarct border zone was significantly attenuated. At later stages, AMSC-EXO significantly increased the number of proliferating endothelial cells, suggesting a potential involvement in neurovascular remodeling.</p><p><strong>Conclusion: </strong>Human AMSC-derived exosomes exert neuroprotective and neurovascular restorative effects after cerebral ischemia by suppressing post-ischemic neuroinflammation, reducing neuronal cell death, and promoting endothelial cell proliferation. AMSC-EXO represents a promising, scalable, and cell-free therapeutic strategy for ischemic stroke.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 2","pages":"179-189"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846669","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":"Fever of Unknown Origin in a Girl with Idiopathic Generalized Anhidrosis Diagnosed Based on a Discrepancy between Deep Body Temperature and Surface Body Temperature: A Case Report.","authors":"Sayaka Ide, Takeshi Asano","doi":"10.1272/jnms.JNMS.2026_93-201","DOIUrl":"10.1272/jnms.JNMS.2026_93-201","url":null,"abstract":"<p><p>Patients with acquired idiopathic generalized anhidrosis (AIGA) present with reduced sweating and impaired thermoregulation, which causes body temperature to increase quickly during exercise or in a hot environment. A 14-year-old girl was admitted with a variety of symptoms and prolonged fever of unknown origin. AIGA was diagnosed because of a discrepancy between deep body temperature (tympanic membrane) and body surface temperature (axillary), and she was treated. Careful history taking and physical examination are essential for patients with fever of unknown origin.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 2","pages":"197-200"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846736","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":"Zonular Apparatus Capsular Bag Insufficiency with Spontaneous Posterior Capsule Rupture.","authors":"Kohei Miyata, Natsuko Maeda, Shinichiro Kobayakawa","doi":"10.1272/jnms.JNMS.2026_93-107","DOIUrl":"10.1272/jnms.JNMS.2026_93-107","url":null,"abstract":"<p><strong>Background: </strong>Zonular apparatus capsular bag (ZACB) insufficiency causes late postoperative spontaneous in-the-bag intraocular lens (IOL) dislocation, a serious complication of cataract surgery. Spontaneous posterior capsule rupture (SPCR) with IOL dislocation is a rare complication. This study reports and discusses clinical features and outcomes of ZACB insufficiency with SPCR.</p><p><strong>Methods: </strong>We retrospectively reviewed 7 cases of SPCR that developed after cataract surgery at Nippon Medical School Musashi Kosugi Hospital between March 2021 and February 2025. Clinical records and surgical videos were examined to collect data on patient age, sex, associated systemic and ocular conditions, medications, dates of IOL implantation and explantation, signs and symptoms prompting explantation, and surgical outcomes. The stage of capsular rupture and location of intraocular lens dislocation were classified on the basis of intraoperative findings.</p><p><strong>Results: </strong>The anterior capsule rim and zonule were intact in 5 SPCR cases, with the exchanged IOL fixated in the sulcus. Two cases of SPCR exhibited both anterior and posterior capsule dislocation requiring intrascleral IOL fixation. The average age of the patients was 52 years (range: 29-83 years; 6 men, 1 woman), and 5 (4 men, 1 woman) had atopic dermatitis. Time since the initial cataract surgery ranged from 10 to 20 years (mean, 13.8 years).</p><p><strong>Conclusions: </strong>Most SPCR cases were associated with atopic dermatitis, with minor trauma possibly contributing to ZACB insufficiency. Capsule morphology was preserved in most SPCR cases, with the exception of posterior capsule rupture.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 1","pages":"12-16"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438024","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 \"Distribution of Splenic Arterial Flow and Segmental Spleen Volume for Partial Splenic Arterial Embolization\".","authors":"Hitoshi Kanno","doi":"10.1272/jnms.JNMS.2026_93-403","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2026_93-403","url":null,"abstract":"","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 4","pages":"345-346"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834853","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 the ESCORT Study: Atrial Fibrillation Detection by Pulse Checking Remains Challenging.","authors":"Eitaro Kodani","doi":"10.1272/jnms.JNMS.2026_93-404","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2026_93-404","url":null,"abstract":"","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 4","pages":"347-348"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834886","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":"Long-Term Outcomes of Colorectal Endoscopic Submucosal Dissection: Recurrence and Metachronous Cancer.","authors":"Rieko Shimojima, Hiroyuki Kato, Yoshihiro Furuichi, Tomoyuki Fujiwara, Shirei Kobayashi, Shunichi Shiozawa, Koichiro Sato","doi":"10.1272/jnms.JNMS.2026_93-406","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2026_93-406","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic submucosal dissection (ESD) is widely used to treat colorectal tumors, and long-term outcomes after ESD have increasingly been reported. Post-treatment endoscopic surveillance is essential for detecting local recurrence and metachronous cancer. However, although the incidence of metachronous cancer after ESD has been reported, the detailed clinicopathological characteristics remain unclear. To determine the incidence and clinicopathological characteristics of metachronous cancer, we evaluated long-term outcomes after colorectal ESD.</p><p><strong>Methods: </strong>This retrospective study analyzed data on clinicopathological characteristics, procedural details, adverse events, and long-term outcomes for 486 patients (577 lesions) who underwent colorectal ESD between November 2005 and April 2017. Rates of local recurrence and metachronous cancer, and the clinicopathological characteristics of metachronous cancer, were investigated.</p><p><strong>Results: </strong>The en bloc resection rate was 96.1%, and the curative resection rate was 93.5%. Delayed major bleeding occurred in 10 patients (1.7%). Additional colectomy with lymph node dissection was performed in 22 patients (3.3%). Local residual carcinoma was identified in four patients, and lymph node metastasis was observed in one patient with poorly differentiated adenocarcinoma. One patient with deep submucosal invasion and vascular invasion developed lung metastasis 31 months after ESD despite the absence of local residual carcinoma and lymph node metastasis. In addition, a patient with a rare 6-mm rectal neuroendocrine tumor developed liver metastasis 17 months after ESD. Local recurrence was observed in two lesions (0.4%) within 1 year after ESD, and both lesions were successfully treated by endoscopic resection. No recurrence was observed after complete and curative resection. During surveillance colonoscopy, 11 cases of metachronous cancer were detected. All were non-polypoid lesions and more than half were located in the right colon.</p><p><strong>Conclusions: </strong>As was noted in previous studies, ESD for colorectal tumors yielded a high en bloc resection rate and favorable long-term outcomes, with a low incidence of local recurrence. Early surveillance colonoscopy is recommended after histologically incomplete resection to detect local recurrence. Long-term surveillance colonoscopy should focus on detecting metachronous cancer, particularly slightly elevated (type 0-IIa) lesions.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"93 4","pages":"288-296"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834968","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}