JMA journal最新文献

{"title":"Association between Acute Care Accessibility and in-Hospital Mortality among Patients with Acute Ischemic Stroke.","authors":"Yusuke Sasahara, Yasufumi Gon, Eisuke Hida","doi":"10.31662/jmaj.2024-0249","DOIUrl":"10.31662/jmaj.2024-0249","url":null,"abstract":"<p><strong>Introduction: </strong>Acute ischemic stroke (AIS) can lead to sequelae or death if not treated promptly. Patients residing in areas with limited acute care access may not receive prompt treatment; however, the association between accessibility to acute care and discharge outcomes in patients with AIS remains controversial. This study aimed to clarify the association between acute care density index (ACDI) and home-to-hospital distance and in-hospital mortality in patients with AIS.</p><p><strong>Methods: </strong>Using the Japanese registry of all cardiac and vascular diseases-diagnosis procedure combination database, we examined 525,689 patients (from April 2015 to March 2020). Hospital accessibility was assessed using ACDI and home-to-hospital distance. The patient residences were classified as urban, rural, or depopulated.</p><p><strong>Results: </strong>In urban areas, ACDI was associated with in-hospital mortality, with adjusted odds ratios for Q2, Q3, and Q4 compared with Q1 of 1.16 (95% confidence interval: 1.02-1.31), 1.23 (1.10-1.39), and 1.35 (1.19-1.53), respectively. Similar trends were observed in rural areas. In depopulated areas, home-to-hospital distance exceeding the median was associated with a reduction in in-hospital mortality, with adjusted odds ratios for Q3 and Q4 compared with Q1 of 0.84 (0.74-0.95) and 0.78 (0.68-0.89), respectively.</p><p><strong>Conclusions: </strong>A lower ACDI was associated with higher in-hospital mortality in both urban and rural areas, whereas longer home-to-hospital distance was not necessarily associated with higher in-hospital mortality.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"417-429"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144753","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":"Symptomatic Expanding Porencephalic Cyst after Evacuation of Intracerebral Hematoma in an Adult: A Case Report.","authors":"Yoshiaki Takamura","doi":"10.31662/jmaj.2024-0189","DOIUrl":"10.31662/jmaj.2024-0189","url":null,"abstract":"<p><p>Porencephalic cysts are very rare in adults. Herein, we present a case of an 88-year-old man with a symptomatic expanding porencephalic cyst after intracerebral hematoma evacuation. He was admitted because of disturbed consciousness and right hemiparesis. A computed tomography (CT) showed a large subcortical hematoma in the left parietal lobe. Hematoma evacuation was performed, his consciousness level improved but gradually deteriorated. Follow-up CT revealed a new cystic lesion with perifocal edema at the hematoma site, with progressive expansion of the cyst. Cyst drainage and -peritoneal shunt placement were performed on postoperative day 14; consequently, his symptoms improved. Considerably, a porencephalic cyst have developed because the cerebrospinal fluid flowed into the closed hematoma cavity from the ventricle owing to the osmotic pressure difference between the ventricle and the hematoma cavity.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"637-640"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144836","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":"Letters and Opinions by Early-career Writers.","authors":"Soichiro Saeki","doi":"10.31662/jmaj.2025-0038","DOIUrl":"10.31662/jmaj.2025-0038","url":null,"abstract":"","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"669-670"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144853","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":"Natural Reservoir of <i>Trypanosoma cruzi</i> Found in Triatomines Targeting Humans: Results from Nation-wide Vector Surveillance in El Salvador.","authors":"Yu Michimuko-Nagahara, Yu Nakagama, Marvin Stanley Rodriguez, Natsuko Kaku, Yuko Nitahara, Katherine Candray, Evariste Tshibangu-Kabamba, Shinjiro Hamano, Kenji Hirayama, Akira Kaneko, Junko Nakajima-Shimada, Yoko Onizuka, José Eduardo Romero, José Ricardo Palacios, Carmen Elena Arias, William Mejía, Ricardo Cardona Alvarenga, Yasutoshi Kido","doi":"10.31662/jmaj.2024-0182","DOIUrl":"10.31662/jmaj.2024-0182","url":null,"abstract":"<p><strong>Introduction: </strong>Chagas disease is one of the most critical of the neglected tropical diseases in Latin America where it poses a serious public health issue. However, the current burden of vectorial transmission from natural reservoirs to humans is unclear. This study aimed to clarify the active mode of transmission to humans disentangled from the feeding pattern of <i>Triatoma dimidiata</i> (<i>T. dimidiata</i>) infected by <i>Trypanosoma cruzi</i> (<i>T. cruzi</i>).</p><p><strong>Methods: </strong>A total of 1,376 <i>T. dimidiata</i> specimens were collected across the 14 departments of El Salvador. From these specimens, 135 midgut samples from 37 households in eight departments were positive for <i>T. cruzi</i> (n = 135/1,376; 9.8% [95% confidential interval (CI): 8.35%-11.5%]). Using a universal vertebrate primer, vertebrate blood sources were positively identified by next-generation sequence analysis of deoxyribonucleic acid (DNA) extracted from the midgut contents of <i>T. dimidiata.</i></p><p><strong>Results: </strong>A total of 13 vertebrates were detected as blood sources; humans, and five domestic, three synanthropic, and four sylvatic species. Triatomines identified as having fed on human blood accounted for approximately 67% (n = 90/135 [95% CI: 58.3%-74.1%]) of the samples analyzed.</p><p><strong>Conclusions: </strong>In this study, a holistic understanding of the feeding patterns of <i>T. cruzi</i>-positive <i>T. dimidiata</i> in El Salvador is dated. The detection of human DNA in the midgut contents of <i>T. dimidiata</i> indicated the possibility of active vectorial transmission to humans.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"432-443"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144857","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":"Periorbital Purpura as a Key Diagnostic Clue in Immunoglobulin Light Chain Amyloidosis.","authors":"Kazuki Miyaue, Hiroki Isono","doi":"10.31662/jmaj.2024-0357","DOIUrl":"10.31662/jmaj.2024-0357","url":null,"abstract":"","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"609-610"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144858","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":"Treatment Resistant Patients with Metabolic Dysfunction-associated Steatohepatitis: Long-term Follow-up Prospective Study.","authors":"Masayuki Tsujisaki, Takenori Takamura, Hideyasu Takagi, Seiya Nakahara, Mamiko Suwa, Hideto Itoh, Noriyuki Akutsu, Shigeru Sasaki, Hiroshi Nakase","doi":"10.31662/jmaj.2024-0371","DOIUrl":"10.31662/jmaj.2024-0371","url":null,"abstract":"<p><strong>Introduction: </strong>Many treatments for patients with metabolic dysfunction-associated steatohepatitis (MASH) have been proposed; however, most studies showed the results for a single medication and a short duration of treatment. The long-term outcomes of the multidrug therapies remain indeterminate. We conducted a study to investigate the usefulness of multidrug combination therapy for every kind of MASH patient and the differences between treatment-sensitive and treatment-resistant patients.</p><p><strong>Methods: </strong>Fifty-one patients (middle-aged, in their 40s to 60s, metabolic generation) with MASH-determined fibrosis staging were enrolled. Primary treatment (weight control and medication of vitamin E and sodium-glucose cotransporter 2 inhibitor (SGLT2i)) was done and then pemafibrate treatment was added.</p><p><strong>Results: </strong>Regarding responses to the step-by-step multidrug therapy, patients with MASH were divided into 3 groups, with use of 3 markers-alanine aminotransferase (ALT) (hepatitis), elasticity value (E value, liver stiffness measurement) (hepatitis/fibrosis), and type IV collagen (fibrosis); group 1: sensitive to primary treatment (n = 35), group 2: resistant to primary treatment and sensitive to pemafibrate treatment (n = 11), and group 3: resistant to both treatments (n = 5).To determine the parameters related to treatment resistance, the baseline levels of parameters_-obesity (body mass index), metabolic factor (visceral fat, controlled attenuation parameter), diabetes mellitus (DM) (glycated hemoglobulin (HbA1_c), fasting immunoreactive insulin), lipid metabolism (triglyceride), and hepatitis (ALT)-were compared between treatment-sensitive group 1+group 2 and treatment-resistant group 3. However, none of them had differences statistically. The same analysis showed that type IV collagen, E value, FIB-4 index (age (year) x AST (IU/L)/platelet count (10⁴/L) x ALT (IU/L)^1/2), and MASH fibrosis had differences statistically.</p><p><strong>Conclusions: </strong>The most effective treatment for patients with MASH could not be determined, according to the baseline levels of characteristics; however, weight control and step-by-step multidrug therapies made it possible to stabilize more than 90% of patient conditions and to solve MASH without worsening fibrosis. Since high levels of liver fibrosis-related markers affected the treatment resistance, MASH treatments should be started in an early stage while the levels of each marker are still low; type IV collagen <5.3 ng/mL, E value <13.7 kPa, FIB-4 index <1.89 and MASH fibrosis stage 2 or less.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"540-551"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144905","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":"Biological and Clinical Relevance of Genetic Alterations in Peripheral T-cell Lymphomas.","authors":"Yuta Ito, Yasunori Kogure, Keisuke Kataoka","doi":"10.31662/jmaj.2024-0405","DOIUrl":"10.31662/jmaj.2024-0405","url":null,"abstract":"<p><p>Peripheral T-cell lymphoma (PTCL) is a heterogeneous group of mature T-cell neoplasms with different clinical, biological, and molecular features. These include PTCL, not otherwise specified, nodal T follicular helper cell lymphomas (nTFHLs), anaplastic large cell lymphoma (ALCL), extranodal natural killer (NK)/T-cell lymphoma (ENKTL), and adult T-cell leukemia/lymphoma (ATLL). Over the past decade, several genetic studies using targeted, whole-exome, and more recently whole-genome sequencing have identified numerous driver alterations in PTCLs. These alterations include mutations, copy number alterations, and structural variations (SVs) involving T-cell receptor/NF-κB (such as <i>PLCG1</i>, <i>VAV1</i>, and <i>CD28</i>) and JAK/STAT (<i>JAK3</i> and <i>STAT3</i>) pathway components, epigenetic regulators (<i>TET2</i>, <i>DNMT3A</i>, and <i>ARID1A</i>), immune-associated molecules (<i>HLA-A/B</i>, <i>CD58</i>, and <i>PD-L1</i>), and tumor suppressors (<i>TP53</i> and <i>CDKN2A</i>), which are shared among various PTCL subtypes. Conversely, subtype-specific alterations, such as <i>RHO</i>A G17V and <i>IDH2</i> R172 mutations in nTFHLs; <i>ALK</i> fusions in ALCL; <i>DDX3X</i> and <i>MSN</i> mutations in ENKTL; and <i>PRKCB</i>, <i>CIC,</i> and <i>CCR4</i> mutations in ATLL. Regarding the clinical relevance of genetic alterations, combining genetic information with clinical factors has been reported to improve prognostic stratification in several subtypes of PTCLs, such as ENKTL and ATLL. Additionally, several genetic alterations may have the potential to predict a response to a specific molecularly targeted agent, such as <i>ALK</i> fusions for ALK inhibitors, <i>PD-L1</i> SVs for immune checkpoint inhibitors (including anti-PD-1 antibodies), and mutations in epigenetic regulators for histone deacetylase inhibitors and hypomethylating agents. In this study, we summarize the current understanding of somatic alterations in various subtypes of PTCLs and highlight their clinical utility.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"345-353"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144365","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":"Association between Sarcopenic Obesity and Changes in Skeletal Muscle Mass and Quality in Patients with Stroke Who Undergo Convalescent Rehabilitation.","authors":"Ryo Shiraishi, Nami Shiraishi, Haruhiko Sato, Takuya Tanaka, Keita Shimizu, Kota Okumura, Kou Suzuki, Takahiro Ogawa","doi":"10.31662/jmaj.2024-0370","DOIUrl":"10.31662/jmaj.2024-0370","url":null,"abstract":"<p><strong>Introduction: </strong>Sarcopenic obesity substantially affects the recovery of physical function in patients with stroke. However, few studies have investigated the relationship between changes in skeletal muscle mass (SMM) and skeletal muscle quality (SMQ) and sarcopenic obesity diagnosed using the Japanese Working Group on Sarcopenic Obesity (JWGS) diagnostic criteria in patients with stroke who undergo rehabilitation. Therefore, this study aimed to investigate the relationship between sarcopenic obesity and changes in SMM and SMQ in patients with stroke who undergo rehabilitation.</p><p><strong>Methods: </strong>Patients with stroke admitted to a rehabilitation ward in a single center in Japan were enrolled in this retrospective cohort study. The inclusion criteria were age 40-75 years and hospitalization for rehabilitation therapy due to stroke. The exclusion criteria were length of hospital stay <14 days and missing clinical data. Data were collected from medical records. Classification of sarcopenic obesity was based on the JWGS diagnostic criteria. The outcomes were the change in SMM and phase angle (PhA) from admission to discharge. Multiple regression analysis was used to investigate the relationship between sarcopenic obesity and changes in SMM and PhA after adjustment for confounding factors.</p><p><strong>Results: </strong>A total of 173 patients were analyzed. 8 patients (3 male and 5 female) were diagnosed with sarcopenic obesity using the JWGS criteria. Multiple regression analysis revealed that sarcopenic obesity was negatively associated with changes in SMM (β: -0.281, 95% confidence interval [CI]: -0.449 to -0.113, p < 0.001) and PhA (β: -0.189, 95% CI: -0.367 to -0.010, p = 0.038).</p><p><strong>Conclusions: </strong>Sarcopenic obesity is negatively associated with changes in SMM and SMQ in patients with stroke who undergo rehabilitation, highlighting the importance of evaluating sarcopenic obesity in patients with stroke from an early stage.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"517-525"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144760","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":"Forearm Magnetic Resonance Imaging Findings in Epidemic Myalgia.","authors":"Remon Sato, Naohiro Uchio, Hirotaka Takagi, Hideyuki Matsumoto","doi":"10.31662/jmaj.2024-0425","DOIUrl":"10.31662/jmaj.2024-0425","url":null,"abstract":"","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"624-626"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144784","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":"Funding Trends in Japan Agency for Medical Research and Development (AMED): Focus on Psychiatry.","authors":"Yuji Yamada, Megumi Haga, Yutaka Matsuoka","doi":"10.31662/jmaj.2024-0391","DOIUrl":"10.31662/jmaj.2024-0391","url":null,"abstract":"<p><p>The Japan Agency for Medical Research and Development (AMED) was established in April 2015 as a funding agency for medical research and development. AMED has been striving to ensure the provision of state-of-the-art medical services and the advancement of a society characterized by health and longevity. Furthermore, AMED facilitates the seamless integration of research projects, spanning the spectrum from basic to applied research and practical applications. The current article presents an overview of the trends observed in awarded projects related to psychiatric disorders. Consequently, there was a considerable rise in the number of projects pertaining to medical devices, particularly within the domain of digital mental health. It is anticipated that an increased number of social implementation studies will obtain regulatory approval under the Pharmaceutical and Medical Device Act.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"385-394"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144789","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}