Journal of Nippon Medical School最新文献

{"title":"Interest in Osteoporosis among Nurses and Physicians before Introduction of a Fracture Liaison Service: A Questionnaire-Based Study.","authors":"Yasuyuki Kitagawa, Kazuma Miura, Yuki Katano, Daiki Saito, Daisuke Fukuhara, Naoto Kotani, Shoko Sasaki, Naoya Takabayashi, Yosuke Shinozuka, Tokifumi Majima","doi":"10.1272/jnms.JNMS.2025_92-107","DOIUrl":"10.1272/jnms.JNMS.2025_92-107","url":null,"abstract":"<p><strong>Background: </strong>Osteoporosis-related fragility fractures such as proximal femoral and vertebral fractures are associated with decreased activities of daily living and a shorter life span. Many persons with osteoporosis do not receive testing or treatment. Introducing fracture liaison services (FLSs) to hospitals is an effective approach for reducing this treatment gap. Understanding interest in osteoporosis among nurses and physicians, their knowledge of osteoporosis, and their thoughts on team medicine for treatment of osteoporosis might be helpful when implementing FLSs.</p><p><strong>Methods: </strong>An FLS had not been introduced at our hospital. We conducted a questionnaire survey of nurses and physicians at our hospital regarding their interest in osteoporosis, their knowledge of osteoporosis, and their thoughts on team medicine for osteoporosis.</p><p><strong>Results: </strong>About half of the nurses and physicians were interested in osteoporosis. About 70% of nurses and physicians believed that team medicine was necessary for treating osteoporosis, and 50-60% believed that it should be introduced in the hospital. Only 5% of nurses and 18% of physicians had knowledge of FLSs.</p><p><strong>Conclusion: </strong>Staff perceptions of team care for osteoporosis were generally supportive in our hospital. However, the introduction of an FLS to the hospital required educational activities for staff. The results of this survey will be helpful to other hospitals introducing FLSs.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"92 1","pages":"29-36"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588387","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":"Incidence and Clinical Significance of Ischemic Stroke Following Cardiac Catheterization.","authors":"Hiroki Goda, Yukichi Tokita, Keisuke Inui, Shunichi Nakamura, Yoshiaki Kubota, Koji Murai, Koji Kato, Yasuhiro Nishiyama, Seiji Okubo, Hitoshi Takano, Kazumi Kimura, Kuniya Asai","doi":"10.1272/jnms.JNMS.2025_92-408","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2025_92-408","url":null,"abstract":"<p><strong>Background: </strong>Ischemic stroke (IS) is one of the most serious complications after cardiac catheterization. This study aimed to investigate the incidence of IS in patients undergoing cardiac catheterization as well as the risk factors and neurological prognosis of IS.</p><p><strong>Methods: </strong>We retrospectively analyzed the data of consecutive 2,848 patients (age 69.1 ± 11.1 years, 2,118 men) who underwent cardiac catheterization from January 2011 to December 2013 to determine the incidence and clinical outcomes of IS.</p><p><strong>Results: </strong>Thirteen patients (0.46%) developed IS after cardiac catheterization, necessitating treatment in the stroke care unit. Multivariate analysis identified five unmodifiable risk factors (age, atrial fibrillation, current smoking, prior stroke, and prior coronary artery bypass graft surgery) and two modifiable risk factors (additional internal thoracic artery angiography and the transbrachial approach) associated with IS. The initial National Institutes of Health Stroke Scale score was 6.9 ± 9.3 at the onset of IS, which improved to 3.1 ± 8.2 at the time of discharge. Five patients demonstrated complete recovery at discharge (modified Rankin Scale [mRS] score = 0), seven demonstrated residual neurological deficit (mRS = 2.7 ± 1.7, including two cases of severe deficit), and one patient died in hospital (mRS = 6).</p><p><strong>Conclusions: </strong>Although rare, IS following cardiac catheterization is associated with significant morbidity and mortality. Avoiding unnecessary internal thoracic artery angiography and the brachial approach may reduce the incidence, and appropriate use of anticoagulants or thrombolytics may improve the prognosis and decrease residual neurological deficits.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"92 4","pages":"360-367"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994731","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":"Wear It Exactly as You See It: Promoting Proper PPE Donning through Visual Layout Optimization.","authors":"Jun Hirai","doi":"10.1272/jnms.JNMS.92-409","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.92-409","url":null,"abstract":"","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"92 4","pages":"310-312"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994687","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":"Sentinel Lymph Node Detection, Location, and Number on SPECT/CT Can Help Predict Pathological Axillary Lymph Node Metastasis in Women with Breast Cancer.","authors":"Meishi Hankyo, Ryusuke Murakami, Hiroyuki Takei, Keiko Yanagihara, Tomoko Kurita, Takashi Sakatani, Ryuji Ohashi, Shinichiro Kumita","doi":"10.1272/jnms.JNMS.2025_92-208","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2025_92-208","url":null,"abstract":"<p><strong>Background: </strong>Use of radiocolloids for sentinel lymph node (SLN) detection in breast cancer (BC) offers the advantage of utilizing single-photon emission computed tomography/computed tomography (SPECT/CT). This study explored whether SPECT/CT findings can predict pathological axillary lymph node (ALN) metastasis.</p><p><strong>Methods: </strong>A consecutive series of patients with invasive BC (clinical stage, T1-3, N0, and M0) who underwent SLN biopsy (SLNB) using SPECT/CT between January 2011 and December 2016 were included. SLN detection, location, and number on SPECT/CT, number of excised SLNs, and clinical and pathological characteristics were analyzed in relation to pathological ALN metastasis.</p><p><strong>Results: </strong>Data from 408 patients (412 cases) with BC were analyzed. Patient age ranged from 28 to 93 years (mean: 59). SPECT/CT identified one to four SLNs (mean: 1.3) in 407 cases (98.8%) and no SLNs in 5 cases (1.2%). Of the 407 cases with at least one identified SLN, SLNs were solely in level I of the axilla in 394 cases (96.8%), both in and outside level I in 12 (2.9%), and solely outside of level I in 1 (0.2%). The number of ALNs removed via SLNB ranged from one to eight (mean: 2.0). SPECT/CT findings, including absence of SLN detection (P<0.001), SLN locations outside of axillary level I (P<0.001), and an increased number of SLNs (P=0.034), as well as removal of ≥3 SLNs (P=0.028), were significantly correlated with pathological ALN metastasis.</p><p><strong>Conclusions: </strong>SLNB with SPECT/CT yields useful information on pathological ALN metastasis in BC patients.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"92 2","pages":"170-180"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121639","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":"Neonatal Intensive Care for Preterm Very Low-Birth-Weight Infants at a Medical School-Affiliated Neonatal Intensive Care Unit.","authors":"Yoshio Shima, Keishi Yoshida, Tamaho Suzuki, Makiko Mine, Masanori Abe, Takashi Matsushima, Makoto Migita","doi":"10.1272/jnms.JNMS.2025_92-307","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2025_92-307","url":null,"abstract":"<p><strong>Background: </strong>The standard of care in Japan for preterm very low-birth-weight (VLBW) infants has long been at the highest level internationally, owing to advances in technology and the perinatal medical system throughout the country.</p><p><strong>Methods: </strong>To identify issues for further improvement of outcomes for preterm VLBW infants in our neonatal intensive care unit (NICU), perinatal care practice was reviewed by analyzing data from medical records on pregnancy complications and management and infant mortality and morbidity.</p><p><strong>Results: </strong>Data from 250 preterm VLBW infants, excluding those with severe congenital anomalies, were analyzed. There were 49 cases (19.6%) of cumulative morbidity, including infants who died before discharge and those who had major complications such as bronchopulmonary dysplasia, intraventricular hemorrhage/periventricular leukomalacia, and retinopathy of prematurity. The prevalence remained constant throughout the study period. Infants born via medically indicated preterm birth had a higher cumulative morbidity rate than those born via spontaneous preterm birth. Small-for-gestational-age status was the only factor significantly associated with cumulative morbidity in multivariate analysis. Of all the infants, 69 (47.3%) completed a course of antenatal corticosteroids (ACS).</p><p><strong>Conclusions: </strong>The quality of neonatal intensive care for preterm VLBW infants in our NICU was consistent with outcomes for top-ranked NICUs in Japan. Critical issues in improving outcomes for these infants include determining the optimal timing of delivery by comprehensively assessing fetal well-being and promoting ACS.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"92 3","pages":"262-267"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555938","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":"Prognostic Factors for Mortality in Maintenance Hemodialysis Patients Infected with SARS-CoV-2.","authors":"Jun Hirai","doi":"10.1272/jnms.JNMS.2025_92-313","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2025_92-313","url":null,"abstract":"","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"92 3","pages":"307-308"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555939","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":"Role of Extracellular Signal-Regulated Kinase 2 in the Etiology of Tinnitus Caused by Moderate Noise Overexposure in Mice.","authors":"Hirotaka Suzuki, Takeshi Matsunobu, Takaomi Kurioka, Masato Fujioka, Shogo Endo, Yasushi Satoh, Kimihiro Okubo","doi":"10.1272/jnms.JNMS.2025_92-305","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2025_92-305","url":null,"abstract":"<p><strong>Background: </strong>Acoustic trauma is a common cause of acute sensorineural hearing loss associated with tinnitus; however, the underlying molecular mechanisms remain unclear. Extracellular signal-regulated kinase 2 (ERK2), a member of the mitogen-activated protein kinase family, is crucial in cellular signaling, especially in the nervous system, where it helps regulate neuroprotection, neurogenesis, and neuronal plasticity. ERK2 is activated in the cochlea by acoustic stimuli and plays a protective role in cochlear hair cells (HCs), which are the primary sensory receptors for hearing. However, the significance of ERK2 expression in HCs associated with development and etiology of tinnitus is largely unexplored.</p><p><strong>Methods: </strong>To investigate the role of ERK2 in tinnitus development, the gap detection test (GAP) was used to evaluate HC-specific ERK2-conditional knockout mice (HC-E2CKO) exposed to moderate acoustic stimuli.</p><p><strong>Results: </strong>Both control and HC-E2CKO mice showed normal prepulse inhibition levels (<0.6) before and after auditory damage, indicating normal functioning of sensorimotor gating pathways, excluding gross sensorimotor deficits. This confirmed that the animals were eligible for the GAP. HC-E2CKO mice showed a transient increase in the GAP ratio, indicating tinnitus development, 1 week after noise exposure, although the hearing threshold was not significantly elevated. The GAP ratio returned to normal after 2 weeks. In contrast, control mice did not exhibit elevation in hearing threshold and the GAP ratio remained normal.</p><p><strong>Conclusion: </strong>Our findings suggest that ERK2 in the inner ear plays a role in tinnitus onset or perception after acoustic stress, potentially through inhibitory mechanisms.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"92 3","pages":"253-261"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555940","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 Experience with Triplet Therapy for High-Volume Metastatic Castration-Sensitive Prostate Cancer: A Retrospective Cohort Study from a Japanese Academic Hospital.","authors":"Jun Akatsuka, Go Kimura, Mami Takadate, Hiroya Hasegawa, Hikaru Mikami, Kotaro Obayashi, Hayato Takeda, Yuki Endo, Shogo Imai, Yuka Toyama, Yoichiro Yamamoto, Yukihiro Kondo","doi":"10.1272/jnms.JNMS.2025_92-212","DOIUrl":"10.1272/jnms.JNMS.2025_92-212","url":null,"abstract":"<p><strong>Background: </strong>Prostate cancer (PCa) significantly contributes to male cancer mortality. Triplet therapy shows promise for metastatic castration-sensitive prostate cancer (mCSPC), but real-world data are limited. This study aimed to evaluate the clinical outcomes of triplet therapy in real-world patients with mCSPC at an academic hospital in Japan.</p><p><strong>Methods: </strong>We retrospectively analyzed the efficacy and safety of triplet therapy, comprising androgen deprivation therapy, docetaxel, and darolutamide, in patients with mCSPC at Nippon Medical School Hospital. Clinical outcomes, adverse events (AEs), prostate-specific antigen (PSA) responses, and progression to castration-resistant prostate cancer were assessed.</p><p><strong>Results: </strong>Between January 2023 and June 2024, we identified 14 Japanese patients with mCSPC who received triplet therapy. All patients presented with synchronous high-volume metastases as defined by the CHAARTED criteria. The median follow-up period was 7.9 months. In terms of efficacy, all 14 patients achieved PSA reduction of > 90%, while 13 of them achieved reductions of > 99%. AEs were reported in all patients, with grade 3 or higher AEs occurring in 10 patients. One patient permanently discontinued treatment and 4 patients temporarily interrupted therapy due to AEs. During follow-up, biochemical progression was observed in 2 patients and radiological progression in 2 patients. Subsequent therapies were selected based on each patient's clinicopathological and genetic characteristics, with considerable variability in treatment approaches following progression.</p><p><strong>Conclusions: </strong>While PSA responses were favorable and tolerability was generally high, progression patterns and subsequent therapies varied widely, highlighting the need for close monitoring and individualized treatment in patients with mCSPC receiving triplet therapy.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"92 2","pages":"204-215"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121632","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":"Excimer Laser Penetrates Deeper into Hair Follicles and Activates More Melanocyte Lineage Cells than Excimer Light.","authors":"Yoshiaki Ibuchi, Saeko Ozaki, Yuki Inoue, Hidehisa Saeki, Yoko Funasaka","doi":"10.1272/jnms.JNMS.2025_92-110","DOIUrl":"10.1272/jnms.JNMS.2025_92-110","url":null,"abstract":"<p><strong>Background: </strong>Both ultraviolet B (UVB) phototherapy with 308-nm excimer light and excimer laser devices are widely used to treat vitiligo. While the devices share the 308-nm wavelength, they have distinct characteristics. Notably, the excimer laser exhibits laser properties (monochromatic coherent light) and unique device specifications (a high frequency of 400 Hz and a remarkably high irradiance of 83 million mW/cm²). This study compared excimer light and laser irradiation, focusing on the depth of penetration into hair follicles and the effects on activation of melanocyte lineage cells, including melanocyte stem cells (McSCs) and melanoblasts.</p><p><strong>Methods: </strong>We irradiated the dorsal skin of mice with both devices at 1,000 mJ/cm². Samples taken at 15 min and 3, 24, and 72 h after irradiation were used for immunostaining analysis. We evaluated penetration depth by using the staining pattern of cyclobutane pyrimidine dimers (CPDs), induction of apoptosis by using a terminal deoxynucleotidyl transferase-mediated deoxy-uridine triphosphate nick end-labeling (TUNEL) assay, and activation of melanocyte lineage cells by using fluorescent double immunostaining for TRP2 and β-catenin.</p><p><strong>Results: </strong>The excimer laser induced significantly more CPDs in the deeper regions of hair follicles while causing significantly faster removal of CPDs and less apoptosis in the epidermis. Moreover, the percentage of TRP2-positive cells with nuclear β-catenin in the follicles was significantly higher with the excimer laser.</p><p><strong>Conclusions: </strong>As compared with excimer light, the excimer laser penetrated more deeply into hair follicles, resulted in fewer epidermal side effects, and activated significantly more melanocyte-lineage cells.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"92 1","pages":"52-60"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588377","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":"Prognostic Implications of Postoperative Serum CYFRA Levels in Upper Tract Urothelial Carcinoma.","authors":"Yuki Endo, Jun Akatsuka, Hayato Takeda, Masato Yanagi, Yuka Toyama, Kotaro Obayashi, Hikaru Mikami, Shunsuke Ikuma, Hiroya Hasegawa, Mami Takadate, Honami Inoue, Tsutomu Hamasaki, Go Kimura, Yukihiro Kondo","doi":"10.1272/jnms.JNMS.2025_92-404","DOIUrl":"https://doi.org/10.1272/jnms.JNMS.2025_92-404","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines lack recommendations for serum tumor markers in patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU). This study assessed the potential of the postoperative serum C-terminus of cytokeratin 19 (CYFRA21-1, CYFRA) level, hereafter referred to as poCY, as a predictor of early progression in patients treated with RNU.</p><p><strong>Methods: </strong>Overall, 117 patients were categorized into the high group (HG) or low group (LG) based on a poCY cutoff level of 3.5 ng/mL after excluding those who did not meet the inclusion criteria. Kaplan-Meier curves and log-rank tests were used to measure cancer-specific survival (CSS) and progression-free survival (PFS) rates. Multivariate analysis was performed using the Cox proportional hazards model.</p><p><strong>Results: </strong>During a median follow-up of 34 months, the 5-year CSS and PFS rates were 79% and 66%, respectively. The HG had a significantly worse CSS and 2-year PFS than the LG. Multivariate analyses identified poCY and lymph node involvement (LNI) as independent prognostic factors. Regarding the 2-year PFS, poCY, LNI, and resection margin status (RM) emerged as independent prognostic factors.</p><p><strong>Conclusions: </strong>poCY, LNI, and RM predicted early progression following RNU in patients with UTUC. Patients with elevated poCY may benefit from adjuvant chemotherapy, irrespective of their pathological findings.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":"92 4","pages":"321-330"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994697","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}