JMA journal最新文献

{"title":"Two Cases of Malignant Melanoma with Long-term Survival after the Appearance of Brain Metastases.","authors":"Kyosuke Oishi, Natsumi Fushida, Jiro Nishio, Ko Fujii, Motoki Horii, Kyoko Shimizu, Shintaro Maeda, Yasuhito Hamaguchi, Takashi Matsushita","doi":"10.31662/jmaj.2024-0400","DOIUrl":"10.31662/jmaj.2024-0400","url":null,"abstract":"<p><p>Brain metastases from malignant tumors are generally known to have a poor prognosis. One of the major reasons for this is the lack of efficacy of anti-tumor drugs compared to other organs. One of the major reasons for this is the lack of efficacy of anti-tumor drugs compared to other organs. Malignant melanoma is a highly malignant tumor that occurs mainly in the skin and is relatively prone to brain metastasis. In this case report, we report two cases of malignant melanoma with brain metastases that were treated with a combination of radiotherapy and chemotherapy and had long-term survival. Case 1 was a 51-year-old Japanese man with primary melanoma of the chest; the pathological staging was pT4aN1aM0, stage IIIC. He developed multiple brain metastases two years and three months after the initial resection. Case 2 was a 23-year-old Japanese woman with primary melanoma of the upper extremities; the pathological staging was pT1bN1aM0, stage IIIA. She developed brain metastases one year and nine months after the initial resection. Both patients had positive BRAF gene mutations in their primary tumors. The combination of BRAF inhibitors, immune checkpoint inhibitors, and stereotactic radiotherapy resulted in long-term survival of more than 5 years for Case 1 and more than 6 years for Case 2. With advances in chemotherapy and radiotherapy, the prognosis for patients with brain metastases, not only malignant melanoma, is expected to improve further in the future. Although rare, malignant melanoma is known to occur in various organs other than the skin. We report this case because we believe that our case report will be of interest to physicians who treat the above organs.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"654-657"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144909","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":"Venous Thrombus Calcification over Time.","authors":"Yusuke Namba, Koji Tokioka, Yusuke Kawai","doi":"10.31662/jmaj.2025-0033","DOIUrl":"10.31662/jmaj.2025-0033","url":null,"abstract":"","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"627-629"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144911","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":"Children Comorbidity Score, a Simple Predictor for In-hospital Mortality: A Nationwide Inpatient Database Study in Japan.","authors":"Kayo Ikeda Kurakawa, Akira Okada, Takaaki Konishi, Nobuaki Michihata, Miho Ishimaru, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga, Toshimasa Yamauchi, Masaomi Nangaku, Takashi Kadowaki, Satoko Yamaguchi","doi":"10.31662/jmaj.2024-0333","DOIUrl":"10.31662/jmaj.2024-0333","url":null,"abstract":"<p><strong>Introduction: </strong>Utilizing a nationwide inpatient database in Japan, we aimed to develop a novel comorbidity score for pediatric patients to predict in-hospital mortality-the Children Comorbidity Score (CCS)-based on the International Classification of Diseases, 10th Revision (ICD-10) codes.</p><p><strong>Methods: </strong>We retrospectively analyzed pediatric patients hospitalized between 2010 and 2017 using the Japanese Diagnosis Procedure Combination database. Eighty percent of the data was used as a training set, where we applied Lasso regression to a model with 56 candidate comorbidity categories to predict in-hospital mortality. We employed the 1-standard-error rule in Lasso regression to derive a parsimonious model and forced the entry of 12 categories of pediatric Complex Chronic Conditions (CCC). Thus, we developed the CCS, an integer-based comorbidity score using the selected variables with nonzero coefficients. The remaining 20% of the data was used as the test set, where we evaluated the CCS's predictive performance using C-statistics, calibration, and decision curve analysis, comparing it with two other scores: a CCC-based score using ICD-10 codes and the Charlson Comorbidity Index (CCI).</p><p><strong>Results: </strong>Among 1,968,960 pediatric patients, we observed 6,492 (0.33%) in-hospital mortalities. The developed integer-based CCS, utilizing 10 comorbidity categories via variable selection by Lasso regression, had better discrimination ability (C-statistics, 0.720 [95% confidence intervals (CI), 0.707-0.734]) than the CCC (0.649 [0.636-0.662]) and CCI (0.544 [0.533-0.555]). The superior discrimination of the CCS was consistent across all age categories, sexes, and body mass index categories. The CCS showed good calibration, with a calibration slope of 1.027 (95% CI, 0.981-1.073). Decision curve analysis indicated that the CCS provided the highest net benefit compared to either of the reference models.</p><p><strong>Conclusions: </strong>The ICD-10-based CCS outperformed conventional comorbidity scores in predicting in-hospital mortality and would be useful in comorbidity assessment among pediatric inpatients.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"568-579"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144410","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":"Epithelioid Sarcoma Mimicking Mycotic Granulomatosis.","authors":"Yoichi Kaneuchi, Michiyuki Hakozaki, Takuya Nikaido, Yoshihiro Matsumoto","doi":"10.31662/jmaj.2024-0403","DOIUrl":"10.31662/jmaj.2024-0403","url":null,"abstract":"","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"611-612"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144781","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":"Associations between Health Interest Scale Dimensions and Obesity Risk: A Cross-sectional Study among Japanese Employees.","authors":"Yumiko Iwase, Rikuya Hosokawa","doi":"10.31662/jmaj.2024-0388","DOIUrl":"10.31662/jmaj.2024-0388","url":null,"abstract":"<p><strong>Introduction: </strong>Obesity affects over 2.5 billion adults globally in 2022, posing a significant public health challenge. In Japan, obesity, defined as a body mass index ≥25 kg/m², impacted 33.0% of men and 22.3% of women in 2020. Despite this, over 25% of Japanese adults report no intention to improve health habits.The Health Interest Scale (HIS) assesses health-related attitudes across three dimensions: health consciousness, health motivation, and health value. Although overall HIS scores are associated with health outcomes, the specific roles of these dimensions in obesity risk are unclear. This study examines the associations between each HIS dimension and obesity risk among Japanese corporate employees, supporting targeted interventions for sedentary, working-age populations.</p><p><strong>Methods: </strong>This cross-sectional study analyzed data from 2,260 employees of information technology-related companies in Japan, collected via health checkups and self-administered surveys in 2023. HIS scores (range: 0-36) were used as continuous variables. Logistic regression assessed associations between HIS subscale scores and obesity status, adjusting for demographic, occupational, and lifestyle factors and obesity-related diseases.</p><p><strong>Results: </strong>Higher scores on each HIS dimension were associated with lower obesity odds. Adjusted odds ratios per one-point increase were: health consciousness, 0.84 (95% confidence interval: 0.81-0.88); health value, 0.85 (0.81-0.89); and health motivation, 0.91 (0.87-0.95). Male sex, short sleep (<7 hours), and sedentary occupations were associated with increased obesity odds (all p < 0.001). The associations remained significant after adjustment for obesity-related diseases. Additionally, stronger associations were observed among participants with obesity-related diseases in univariate analysis.</p><p><strong>Conclusions: </strong>This study identified significant associations between the three HIS dimensions and obesity risk, which remained robust after adjusting for obesity-related diseases. Stronger associations were observed across all HIS dimensions in participants with obesity-related diseases. These findings underscore the importance of tailored interventions targeting HIS dimensions, particularly health consciousness and health value, to reduce obesity risk in sedentary, working-age populations.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"453-464"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144793","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":"Big Data Science on T Cell Receptor-mediated Immune Regulation.","authors":"Kazuyoshi Ishigaki","doi":"10.31662/jmaj.2024-0304","DOIUrl":"10.31662/jmaj.2024-0304","url":null,"abstract":"<p><p>T cell receptors (TCRs) have a highly diverse sequence pattern resulting from the random recombination of gene components in the thymus. This diversity enables TCRs to distinguish between a wide range of self and non-self-antigens, thereby shaping the reactivity of the acquired immune system. Self-responsiveness arising from impaired TCR-based self-discrimination is a crucial trigger for the development of autoimmune diseases. The immunological importance of TCR research is evident, yet traditional experimental and analytical techniques have not fully captured the vast information contained within the TCR repertoire. However, recent advancements in massive parallel sequencing, efficient library preparation pipelines, single-cell experiment platforms, and genome engineering are poised to transform our understanding of TCR diversity, sparking interest in the field. These advancements have made it possible to \"read through\" the entire TCR repertoire and partially identify their cognate antigens. In parallel, methods for efficiently analyzing large datasets of comprehensive TCR sequences have also progressed. These innovations in experimental and analytical techniques are leading TCR research in new directions, such as using TCR as a real-time biomarker, exploring the link between TCR and T cell differentiation, and investigating TCR genetic regulation. This review will cover recent updates on big data science related to TCR-mediated immune regulation.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"338-344"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144796","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":"Methylation Risk Scores in Psychiatric Disorders: Advancing Epigenetic Research in Mental Health.","authors":"Kazutaka Ohi, Daisuke Fujikane, Kentaro Takai, Ayumi Kuramitsu, Yukimasa Muto, Shunsuke Sugiyama, Toshiki Shioiri","doi":"10.31662/jmaj.2024-0329","DOIUrl":"10.31662/jmaj.2024-0329","url":null,"abstract":"<p><p>DNA methylation is an epigenetic modification implicated in psychiatric disorders influenced by both genetic and environmental factors. Methylation risk scores (MRSs) have emerged as a tool for quantifying accumulated epigenetic modifications and assessing the predisposed risk for certain common disorders. This narrative review introduces the MRS application in psychiatric disorders, including schizophrenia (SCZ), bipolar disorder (BD), social anxiety disorder (SAD), and panic disorder (PD), while also discussing the current limitations and ethical considerations in psychiatric research. MRSs are calculated from epigenome-wide association studies (EWASs) for psychiatric disorders in various tissues from blood and brain and reflect methylation patterns associated with the psychiatric disorder risk. MRSs provide a perspective of how the cumulative methylation patterns at specific CpG sites may contribute to the onset of psychiatric disorders. In SCZ and BD, MRSs derived from both blood and brain tissues have shown distinct methylation profiles that differentiate these disorders, particularly in patients with a high genetic SCZ risk. MRSs are also used to assess the impact of environmental factors, such as early-life adversity and chronic stress, on psychiatric outcomes. In SAD and PD, where epigenetic studies are relatively limited, MRSs revealed both shared and distinct epigenetic features between anxiety disorders, with specific methylation changes associated with social avoidance in SAD patients. MRSs can serve as biomarkers, providing a valuable understanding of both genetic predispositions and environmental influences on gene regulation. However, the lack of large-scale EWAS datasets and standardized summary statistics remains as a limitation. To address this issue, this review provides a list of publicly available raw intensity data (IDAT) files from psychiatric epigenetic studies that can help facilitate future research by providing the raw data necessary for conducting independent EWASs and MRS calculations. As the field advances, careful consideration must be given to the ethical implications of MRS applications, particularly in clinical intervention and prevention. While MRSs hold promise for future personalized medicine applications, informing treatment decisions based on an individual's methylation profile, caution is warranted regarding their predictive utility and effect size limitations. This review emphasizes the importance of MRSs in advancing psychiatric research, bridging the gap between genetic risk and environmental factors.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"363-370"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144855","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":"Development of Modified Japanese Versions of Questionnaires to Assess Physical and Cognitively Stimulating Activities.","authors":"Shoya Matsumoto, Tomomi Satoh, Mitsuru Shinohara, Reo Kawano, Keisuke Suzuki, Janina Krell-Roesch, Michio Ide, Hirotaka Watada, Masahiro Akishita, Hidenori Arai, Izumi Kondo, Yonas E Geda, Naoyuki Sato","doi":"10.31662/jmaj.2024-0153","DOIUrl":"10.31662/jmaj.2024-0153","url":null,"abstract":"<p><strong>Introduction: </strong>Lifestyle factors such as physical and cognitively stimulating activities may protect against various diseases. However, only a few simple and validated questionnaires assess the lifestyle factors in Japan. Thus, we aimed to create Japanese versions of such questionnaires for assessing physical and cognitively stimulating activities. This study examined their inter-rater reliability and test-retest reproducibility.</p><p><strong>Methods: </strong>We developed a Japanese version of questionnaires by translating the English questionnaire that assesses the frequency of several physical and cognitively stimulating activities. Additionally, the Japanese version assesses the duration of engagement in physical activities, and we have added mental activities such as meditation and Zen practice. The inter-rater reliability and test-retest reproducibility of evaluating the frequency, duration, frequency × duration of each physical activity, and frequency of each cognitively stimulating activity were tested in healthy volunteers.</p><p><strong>Results: </strong>The study included 48 participants aged 25-67 years. We observed good inter-rater reliability and test-retest reproducibility for the physical and cognitively stimulating activity questionnaires. As a pilot approach, we calculated the Total Physical Activity Score (metabolic equivalents·min/week) with an intraclass correlation coefficient (ICC) (2,1) of 0.818 (95% confidence interval, 0.698-0.894), indicating good test-retest reproducibility.</p><p><strong>Conclusions: </strong>The Japanese versions of questionnaires used to assess the frequency and duration of physical and cognitively stimulating activities generally have good inter-rater reliability and test-retest reproducibility. While introducing the duration of engagement might enable the estimation of the Total Physical Activity Score, further validation using objective measures of activities and other self-reported physical activity questionnaires is necessary, which is a limitation of this study.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"498-505"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144623","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":"Enhancing Home Blood Pressure Management: Implementation of the Sacubitril/Valsartan Treatment in Practical Clinical Settings.","authors":"Tsugiyoshi Yamazaki","doi":"10.31662/jmaj.2024-0262","DOIUrl":"10.31662/jmaj.2024-0262","url":null,"abstract":"<p><strong>Introduction: </strong>Although the importance of home blood pressure (BP) management has been widely reported, the achievement rate of home BP targets remains low in Japan. Sacubitril/valsartan is a novel antihypertensive agent with potent antihypertensive effects. Despite its theoretical advantages, the real-world clinical application of sacubitril/valsartan in optimizing home BP management remains underexplored. The aim of this study was to evaluate the effect of switching from azilsartan treatment to sacubitril/valsartan treatment on the achievement of home BP targets and to refine hypertension management strategies in practical clinical settings.</p><p><strong>Methods: </strong>A cohort of 55 patients, with a mean morning home systolic BP of 135 mmHg or more was enrolled for an 8-week treatment phase with azilsartan and calcium-channel blockers. Morning BP, pulse rate (PR), estimated glomerular filtration rate, and B-type natriuretic peptide, serum potassium, serum uric acid (UA), and hemoglobin A1c levels were assessed at baseline and then at 8, 24, and 48 weeks after switching from 20 mg azilsartan to 200 mg sacubitril/valsartan.</p><p><strong>Results: </strong>At 48 weeks after switching to sacubitril/valsartan, there was a 60% increase in the rate of attainment of home systolic BP targets. Sacubitril/valsartan significantly reduced the mean systolic BP (from 143.6 ± 7.0 mmHg to 131.4 ± 8.7 mmHg), diastolic BP (from 86.9 ± 12.3 mmHg to 80.2 ± 10.7 mmHg), PR (from 74.8 ± 11.0 bpm to 72.1 ± 10.1 bpm), and serum UA (from 5.9 ± 1.1 mg/dL to 5.5 ± 0.9 mg/dL) within the first 8 weeks (all p < 0.01). These effects were maintained for 48 weeks.</p><p><strong>Conclusions: </strong>The switch from azilsartan to sacubitril/valsartan treatment resulted in a significant improvement in the achievement of home BP targets, which is consistent with our goal of refining hypertension management strategies in practical clinical settings.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"479-485"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144778","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":"A Case of Long-undiagnosed Classic Kaposi's Sarcoma with Extensive Skin Eruptions.","authors":"Kouhei Takehara, Yasuhito Hamaguchi, Kou Fujii, Motoki Horii, Natsumi Fushida, Tasuku Kitano, Shintaro Maeda, Kyosuke Oishi, Katsushige Taniuchi, Takashi Matsushita","doi":"10.31662/jmaj.2024-0161","DOIUrl":"10.31662/jmaj.2024-0161","url":null,"abstract":"<p><p>Kaposi's sarcoma (KS) is a chronic, multifocal lymphoangioproliferative tumor that occurs mainly in older individuals in the Mediterranean region. KS is often observed as a malignant tumor in patients with acquired immunodeficiency syndrome, and classic KS is rare. An 82-year-old man was referred to our department with bilateral lower-leg edema with purpura and small nodules. When the patient was in his mid-50s, edema with purpura appeared in his lower extremities without any specific trigger. Eight years earlier (in his mid-70s), the purpura lesions gradually turned nodular. A similar skin rash appeared on the forearms and back of the hands two years earlier. Physical examination revealed diffuse brown pitting edema over the entirety of the lower extremities and extending from the dorsum of the bilateral hands to the elbows. Multiple purple-red, elastic, hard nodules ranging from a few millimeters to about 1 cm were localized and fused over the edema. Histological examination of the forearm nodule revealed proliferation of collagen fibers and cellular infiltration in the dermis. The intricately proliferating cells in the dermis were spindle-shaped with round nuclei. Immunohistochemical staining revealed spindle-shaped cells positive for CD31, CD34, and D2-40. These cells were positive for human herpesvirus (HHV)-8 and negative for human immunodeficiency virus (HIV) antigens and antibodies. He was diagnosed with classic KS. We proposed chemotherapy, but he refused to receive any treatment. Our patient did not receive any immunosuppressive therapy, and the HIV test result was negative. Therefore, immunosuppressive status may not be involved in the development of KS in our patient. He had opportunities to consult dermatologists but was never diagnosed with KS. A skin biopsy helps diagnose KS; thus it should be considered when a patient experiences long-standing, slowly progressive, unexplained leg edema accompanied by a skin rash.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"630-632"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144812","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}