JMA journal最新文献

{"title":"Potential of Artificial Intelligence in Addressing Japan's Clinical Research Disconnection.","authors":"Yudai Kaneda, Akihiko Ozaki","doi":"10.31662/jmaj.2024-0084","DOIUrl":"10.31662/jmaj.2024-0084","url":null,"abstract":"<p><p>In February 2023, a report from the Japanese Ministry of Education, Culture, Sports, Science and Technology highlighted that half of the assistant professors at university hospitals spend five hours or less per week on research, with 15% not engaging in research at all. This disconnect between clinical practice and research may be exacerbated by work-style reforms predicting difficulties in allocating time for student guidance and dedicated research at Japanese university hospitals. This study proposes the integration of artificial intelligence (AI) tools, such as ChatGPT, to streamline administrative duties and enhance research productivity, suggesting a need for immediate development of ethical guidelines for AI use in healthcare to improve efficiency and patient care quality.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 3","pages":"952-953"},"PeriodicalIF":1.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12328900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapidly Progressive Impaired Consciousness in Cervical Intramedullary Spinal Cord Abscess: A Case Report.","authors":"Yuma Hiratsuka, Yasufumi Ohtake, Hirohiko Nakamura","doi":"10.31662/jmaj.2024-0385","DOIUrl":"10.31662/jmaj.2024-0385","url":null,"abstract":"<p><p>Intramedullary spinal cord abscesses rarely cause impaired consciousness without intracranial infection. We report the case of a 65-year-old woman who presented with neck pain and right upper limb weakness. She developed rapidly progressive impaired consciousness within three days of admission. Initial magnetic resonance imaging revealed a right-sided intramedullary lesion at C4-C5 with surrounding edema extending to the brainstem. Brain imaging showed no abnormalities. An initial diagnosis of a spinal cord tumor was made. Follow-up imaging demonstrated lesion expansion with ring enhancement. The patient subsequently developed impaired consciousness and quadriplegia. Emergency surgery revealed and drained a spinal cord abscess, with cultures growing α-hemolytic Streptococcus. The patient's consciousness improved quickly after surgery. Previously undiagnosed type 2 diabetes was identified during admission. Despite extensive investigation, no obvious source of infection was found. Antibiotic therapy with ampicillin was continued for one month. Imaging at two months showed complete resolution of the abscess. The patient regained independent walking ability after rehabilitation, with only slight residual right arm weakness. No recurrence was observed during ten years of follow-up. This case demonstrates that a cervical spinal cord abscess can cause impaired consciousness through brainstem edema without intracranial infection. Early surgical intervention combined with appropriate antibiotics may lead to favorable outcomes.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 3","pages":"1000-1004"},"PeriodicalIF":1.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12329000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between Postoperative Complications and Nutrition-Related Indices including Prealbumin in Postoperative Gastric Cancer Patients.","authors":"Keisuke Morikawa, Hiroyuki Takemura, Kana Kitayama, Shogo Inaba, Haruka Imaoka, Yu Hashitsume, Yuta Suzuki, Kazuyuki Tabira","doi":"10.31662/jmaj.2025-0017","DOIUrl":"10.31662/jmaj.2025-0017","url":null,"abstract":"<p><strong>Introduction: </strong>Several studies have reported an association between postoperative complications and nutritional indices. Among these, serum prealbumin (PAB) levels have recently attracted attention as an indicator of nutritional status. However, the nutritional index most strongly associated with postoperative complications remains unclear. This study aimed to investigate the relationship between postoperative complications and nutrition-related indices, including PAB, in patients who underwent surgery for gastric cancer.</p><p><strong>Methods: </strong>A total of 108 patients who underwent gastric cancer surgery were classified into 2 groups based on the presence or absence of postoperative complications. PAB, serum albumin (ALB), Controlling Nutritional Status (CONUT) score, and Prognostic Nutritional Index (PNI) were used as preoperative nutrition-related indices. The relationship between postoperative complications and nutrition-related indices was examined using multivariate logistic regression analyses.</p><p><strong>Results: </strong>Among the participants, 84 were classified into the uncomplicated group and 24 into the complicated group. Multivariate logistic regression analysis revealed significant associations between all nutrition-related indices and postoperative complications, including PAB (odds ratio [OR], 0.808; 95% confidence interval [CI]: 0.716-0.911, p = 0.001), CONUT score (OR, 1.338; 95% CI: 1.095-1.635, p = 0.004), ALB (OR: 0.364, 95% CI: 0.157-0.845, p = 0.019), and PNI (OR: 0.931, 95% CI: 0.870-0.997, p = 0.042). Among these, PAB showed the strongest association, followed by CONUT, ALB, and PNI.</p><p><strong>Conclusions: </strong>All nutritional indicators were associated with postoperative complications. Our findings suggest that PAB and CONUT scores may serve as useful predictors of postoperative complications in patients with gastric cancer.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 3","pages":"825-831"},"PeriodicalIF":1.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12328891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between Subjective Hearing Loss and Work-related and Somatic Issues in the Working-age Population: A Large-scale Internet-based Cross-sectional Study.","authors":"Jun Suzuki, Yuta Kobayashi, Hiyori Takahashi, Hiroki Tozuka, Shunsuke Takai, Ryoukichi Ikeda, Takahiro Tabuchi, Yukio Katori","doi":"10.31662/jmaj.2024-0430","DOIUrl":"10.31662/jmaj.2024-0430","url":null,"abstract":"<p><strong>Introduction: </strong>Hearing loss is a major problem that negatively impacts human life worldwide. Although factors associated with hearing loss have been widely studied, the impact of hearing loss on social aspects such as work performance in the working-age population remains unclear. To investigate the social and somatic problems associated with hearing loss in working-age individuals, we analyzed data from the Japan COVID-19 and Society Internet Survey (JACSIS), including a questionnaire concerning social aspects, mental health, physical health, and subjective hearing loss.</p><p><strong>Methods: </strong>We used the JACSIS 2023 data set, which includes data from 33,000 participants. After excluding participants with inappropriate responses and including those aged 20-64 years, data from 20,691 participants were used for further analysis. We compared various characteristics of the hearing loss group (moderate-to-severe subjective hearing loss) with those of the control group (no subjective hearing loss).</p><p><strong>Results: </strong>A total of 13,745 participants (male: 6,461; female: 7,284) were included in the control group, and 313 participants (male: 150; female: 163) were included in the hearing loss group. Multivariate logistic regression analysis revealed that both male and female participants in the hearing loss group exhibited higher incidences of tinnitus, presenteeism, somatic symptoms, and dyslipidemia compared with the control group. Additionally, subjective hearing loss was one of the independent explanatory variables for presenteeism in the working-age population.</p><p><strong>Conclusions: </strong>Our findings indicate significant associations between moderate-to-severe subjective hearing loss and various work-related and somatic factors in a working-age population, and encourage future research to assess whether subjective hearing loss independently contributes to presenteeism in the working-age population.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 3","pages":"753-765"},"PeriodicalIF":1.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12328264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the COVID-19 Pandemic on Health Check-ups before and after the COVID-19 Downgrade and Employees' Mental Health at Health Check-up Facilities: The Third Nationwide Survey of Healthcare Facilities in Japan Society of Ningen Dock and Preventive Medical Care.","authors":"Satoko Yamaguchi, Tomofumi Atarashi, Akira Okada, Reiko Inoue, Shigeru Nasu, Toshimasa Yamauchi, Yasuji Arase, Takao Aizawa, Masaomi Nangaku, Takashi Kadowaki","doi":"10.31662/jmaj.2024-0337","DOIUrl":"10.31662/jmaj.2024-0337","url":null,"abstract":"<p><strong>Introduction: </strong>Preventive programs, including cancer and diabetes screenings, were disrupted globally by the coronavirus disease 2019 (COVID-19) pandemic and had not returned to pre-pandemic levels even in 2021-2022. In Japan, COVID-19 was downgraded to the lowest-risk category under the Infectious Diseases Control Law in May 2023. However, whether participation in health check-ups recovered after this downgrade remains unclear. Additionally, understanding the impact of the pandemic on employees' mental health and attrition is crucial for maintaining services in future pandemics. To address these issues, we conducted a nationwide survey.</p><p><strong>Methods: </strong>A questionnaire survey was conducted between December 16, 2023, and February 21, 2024, targeting member facilities of Japan Society of Ningen Dock and Preventive Medical Care. The questionnaires covered COVID-19-related rules before and after the downgrade, the negative impact on employees' mental health, and whether employee resignations increased compared to the pre-pandemic period. Participants also provided data on the number of health check-up examinees from 2019 to 2023.</p><p><strong>Results: </strong>We emailed 1,381 facilities, of which 856 responded (response rate: 62.0%). An additional 124 facilities responded via the Society's website, yielding a total of 980 participants. While cancer screenings by local governments returned to pre-pandemic levels in 2023, gastric cancer screenings remained low. Nearly 30% of facilities reported a negative impact of the pandemic on employees' mental health, which was associated with factors such as being annexed to hospitals and employees' complaints about strict COVID-19-related rules. This negative impact was strongly linked to increased employee resignations.</p><p><strong>Conclusions: </strong>While overall cancer screening rates recovered, gastric cancer screenings remained below pre-pandemic levels. Furthermore, the negative impact on employees' mental health was significantly associated with increased attrition, highlighting the need for mental health support for those engaged in preventive medicine to maintain services during future pandemics.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 3","pages":"911-924"},"PeriodicalIF":1.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12328909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methotrexate-associated Hodgkin Lymphoma Occurring Decades after Methotrexate Initiation.","authors":"Takahiro Kobayashi, Yosuke Ono, Nobutaka Hirooka","doi":"10.31662/jmaj.2025-0117","DOIUrl":"10.31662/jmaj.2025-0117","url":null,"abstract":"","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 3","pages":"998-999"},"PeriodicalIF":1.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12328426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phase Angle Evaluated by a Bioimpedance Analysis Is Closely Related to Diabetic Nephropathy and Peripheral Neuropathy in Patients with Type 2 Diabetes.","authors":"Hiroyuki Ito, Sayuri Miura, Toshiko Mori, Shun Miura, Chiaki I, Suzuko Matsumoto, Hideyuki Inoue, Shinichi Antoku, Tomoko Yamasaki, Michiko Togane, Moka Sugahara, Chizuko Yukawa","doi":"10.31662/jmaj.2025-0071","DOIUrl":"10.31662/jmaj.2025-0071","url":null,"abstract":"<p><strong>Introduction: </strong>The phase angle (PhA), calculated through bioimpedance analysis (BIA), is a measure of skeletal muscle quality and cellular integrity. This study aimed to explore the relationship between PhA and diabetic microangiopathy in patients with type 2 diabetes.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of 556 adult Japanese outpatients with type 2 diabetes who underwent body composition evaluation using BIA. Clinical characteristics, including diabetic microangiopathy (retinopathy, nephropathy, and neuropathy), were assessed for their association with PhA. Furthermore, in 23 patients who underwent a second BIA assessment, we examined the relationship between changes in PhA and glycated hemoglobin (HbA1c) levels longitudinally. Statistical methods employed included Wilcoxon's signed-rank test, regression analyses, and trend tests.</p><p><strong>Results: </strong>PhA was significantly lower in patients with diabetic microangiopathy compared to those without it. It was positively correlated with the skeletal muscle mass index (SMI) and negatively correlated with the extracellular water-to-total body water ratio. Multiple regression analysis revealed that sex, age, nephropathy, peripheral neuropathy, hemoglobin, serum albumin, and low-density lipoprotein cholesterol levels were significant explanatory variables for PhA. In the longitudinal analysis, changes in HbA1c levels showed a significant negative correlation with changes in PhA, however, no association was observed between changes in HbA1c and changes in SMI.</p><p><strong>Conclusions: </strong>PhA is significantly associated with age, malnutrition, and diabetic microvascular complications, and may provide insights into muscle and tissue health in patients with type 2 diabetes. Further research is required to examine causal relationships and explore potential interventions to preserve muscle quality in diabetic patients.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 3","pages":"925-935"},"PeriodicalIF":1.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12328276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional Differences and Mortality-associated Risk Factors among Older Patients with Septic Shock: Administrative Data Analysis with Multilevel Logistic Regression Modelling.","authors":"Shinichiro Yoshida, Akira Babazono, Ning Liu, Reiko Yamao, Reiko Ishihara","doi":"10.31662/jmaj.2024-0331","DOIUrl":"10.31662/jmaj.2024-0331","url":null,"abstract":"<p><strong>Introduction: </strong>Variations in intensive care unit (ICU) policies and physician characteristics influence mortality, potentially leading to regional differences in mortality rates. Previous studies have not specifically focused on septic shock or older patients and have lacked consideration of the context effect. We hypothesized that regional variability in mortality exists among older patients with septic shock and investigated factors associated with mortality.</p><p><strong>Methods: </strong>Administrative medical claims data were analyzed. Participants were enrolled from April 2015 to March 2020 in Fukuoka Prefecture, Japan. ICU physicians were classified based on board certification in intensive care medicine as either \"intensivists\" or \"ICU-dedicated physicians\". The primary outcome was 28-day mortality after ICU admission. Data from all ICUs in Fukuoka Prefecture and 9 secondary medical areas were analyzed. We calculated and compared the 28-day mortality rates across regions. Multilevel logistic regression analyses were conducted to adjust for the context effect.</p><p><strong>Results: </strong>Among the 1,238 participants, mortality across regions ranged from 18.3% to 41.4%. Based on multilevel logistic analyses, age, sex, postsurgical admission, and the number of ICU beds per intensivist were significantly associated with mortality. The adjusted odds ratio from the multilevel analysis for having no intensivists versus having ≥1 intensivist per 4 ICU beds was 1.99 (95% confidence interval 1.15-3.44, p = 0.01).</p><p><strong>Conclusions: </strong>After accounting for the regional context effect, our analysis confirmed regional mortality variability in mortality among older patients with septic shock. Mortality was influenced by whether ICU physicians are board-certified in intensive care medicine. These findings suggest that sufficient commitment in terms of time, intensity, and knowledge is crucial to reducing mortality in older patients with septic shock.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 3","pages":"708-717"},"PeriodicalIF":1.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12329006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use and Evaluation of Generative Artificial Intelligence by Medical Students in Japan.","authors":"Izuki Amano, Kisho Obi-Nagata, Ayane Ninomiya, Yuki Fujiwara, Noriyuki Koibuchi","doi":"10.31662/jmaj.2024-0375","DOIUrl":"10.31662/jmaj.2024-0375","url":null,"abstract":"<p><strong>Introduction: </strong>Generative artificial intelligence (AI) has become more accessible due to technological advancements. While it can support more efficient learning, improper use may lead to legal issues or hinder self-directed learning. Medical education is no exception, as generative AI has the potential to become a powerful tool. However, its practicality remains uncertain. Therefore, we investigated how generative AI is perceived among medical students and utilized within the realm of medical education.</p><p><strong>Methods: </strong>In January 2024, we conducted a study with 123 second-year medical students who had completed a physiology course and laboratory training at Gunma University, Japan. Students used ChatGPT (Chat Generative Pre-trained Transformer) 3.5 (OpenAI) for four tasks and evaluated its responses. A survey on the use of generative AI was also conducted. Responses from 117 participants were analyzed, excluding six non-participants.</p><p><strong>Results: </strong>Among the students, 41.9% had used ChatGPT. The average scores for tasks 1-4 were 6.5, 4.6, 7.4, and 6.2 out of 10, respectively. Although 13% had a negative impression, 54 students found it challenging to apply for medical purposes. However, 64.1% expressed a willingness to continue using generative AI, provided its use extended beyond medical contexts.</p><p><strong>Conclusions: </strong>Nearly 60% of students had never used generative AI before, which is consistent with general usage trends. Although they were impressed by the speed of generative AI responses, many students found that it lacked precision for medical studies and required additional verification. Limitations of generative AI, such as \"hallucinations,\" were evident in medical education. It remains important to educate students on AI literacy and their understanding of the potential issues that generative AI could bring about.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 3","pages":"730-735"},"PeriodicalIF":1.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12328371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced Application of Transthyretin in Gastric Cancer Management.","authors":"Masayuki Urabe","doi":"10.31662/jmaj.2025-0225","DOIUrl":"10.31662/jmaj.2025-0225","url":null,"abstract":"","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 3","pages":"832-833"},"PeriodicalIF":1.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12329025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}