JMA journal最新文献

{"title":"Unraveling Causality: Innovations in Epidemiologic Methods.","authors":"Etsuji Suzuki","doi":"10.31662/jmaj.2024-0246","DOIUrl":"10.31662/jmaj.2024-0246","url":null,"abstract":"<p><p>For several decades, the counterfactual model and the sufficient cause model have shaped our understanding of causation in biomedical science and, more recently, the link between these two models has enabled us to obtain a deeper understanding of causality. In this article, I provide a brief overview of these fundamental causal models using a simple example. The counterfactual model focuses on one particular cause or intervention and gives an account of the various effects of that cause. By contrast, the sufficient cause model considers sets of actions, events, or states of nature which together inevitably bring about the outcome under consideration. In other words, the counterfactual framework addresses the question \"what if?\" while the sufficient cause framework addresses the question \"why does it happen?\" Although these two models are distinct and address different causal questions, they are closely related and used to elucidate the same cause-effect relationships. Importantly, the sufficient cause model makes clear that causation is a multifactorial phenomenon, and it is a \"finer\" model than the counterfactual model; an individual is of one and only one response type in the counterfactual framework, whereas an individual may be at risk of none, one, or several sufficient causes. Understanding the link between the two causal models can provide greater insight into causality and can facilitate the use of each model in appropriate contexts, highlighting their respective strengths. I will briefly present three topics of interest from our research: the relationship between the concepts of confounding and of covariate balance; distinctions between attributable fractions and etiologic fractions; and the identification of operating mediation and mechanism. It is important to scrutinize observed associations in a complementary manner, using both the counterfactual model and the sufficient cause model, employing both inductive and deductive reasoning. This holistic approach will better help us to unravel causality.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"323-337"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144910","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":"What Is Required for the Future of Medical Education and Healthcare?","authors":"Takaki Kobayashi, Soichiro Saeki","doi":"10.31662/jmaj.2024-0295","DOIUrl":"10.31662/jmaj.2024-0295","url":null,"abstract":"<p><p>The COVID-19 pandemic has profoundly transformed medical education, shaping students' career aspirations and impacting their mental well-being. A global survey among medical students conducted in 2023 revealed that over half of medical and nursing students are inclined toward nonclinical careers, while a substantial majority express concerns regarding their mental health. These insights underscore the urgent need to broaden educational trajectories beyond direct patient care and prioritize the psychosocial welfare of students. We explore the implications of these shifts, emphasizing the rising interest in public health and research as viable alternative career paths. Medical schools in Japan are increasingly introducing healthcare policy and administration courses, offering students opportunities to assume public health and research roles. Moreover, medical education must adapt to mitigate the pressures associated with future workloads and extensive academic demands by integrating digital technologies, such as artificial intelligence and virtual reality, into the curriculum. Furthermore, enhancing career guidance and expanding international exchange programs will cultivate a more versatile talent pool and equip students for diverse career trajectories in healthcare. By accommodating clinical and nonclinical interests and addressing student mental health, the future of medical education can elevate healthcare quality and advancing public health outcomes. Ultimately, a holistic and multifaceted approach to medical education is crucial for nurturing professionals adept at confronting the challenges of future pandemics and pioneering innovations in healthcare.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"580-583"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144913","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":"Design, Rational, and Baseline Characteristics of the SONIC-HF Multicenter Registry.","authors":"Nobuyuki Kagiyama, Kentaro Kamiya, Misako Toki, Hiroshi Saito, Kentaro Iwata, Yuya Matsue, Kenji Yoshioka, Kazuya Saito, Azusa Murata, Akihiro Hayashida, Junya Ako, Takeshi Kitai, Emi Maekawa","doi":"10.31662/jmaj.2024-0364","DOIUrl":"10.31662/jmaj.2024-0364","url":null,"abstract":"<p><strong>Introduction: </strong>Skeletal muscle mass and function are crucial for assessing physical frailty, sarcopenia, and cachexia, which significantly impact the prognosis of geriatric patients with heart failure (HF). Ultrasound-based assessment of skeletal muscles offers a non-invasive, real-time alternative to traditional methods. The <i>compariSON of various methods In evaluatIon of sarCopenia in patients with Heart Failure</i> study (SONIC-HF) aimed to evaluate the feasibility and prognostic impact of ultrasound-based muscle assessment in geriatric patients with HF.</p><p><strong>Methods: </strong>This multicenter, prospective cohort study enrolled patients with HF aged ≥65 years who could ambulate independently at discharge. Certified observers assessed muscle thickness (biceps, quadriceps, rectus femoris, and diaphragm) using ultrasound at rest and during contraction. The primary endpoint was all-cause mortality. Secondary endpoints included HF hospitalization, unplanned hospital visits, and cardiovascular and non-cardiovascular mortality.</p><p><strong>Results: </strong>Of the 692 enrolled patients (median age 81 [interquartile range 74-86] years, 57.6% women, left ventricular ejection fraction 45% [32%-60%]), ultrasound-based muscle assessments were completed in 606 patients. Interobserver reliability was excellent (intraclass correlation coefficient 0.84-0.99). Median muscle thicknesses at rest and during contraction were: diaphragm 1.9 (1.6-2.3) mm and 2.9 (2.3-3.8) mm; biceps 19.6 (15.9-23.1) mm and 25.3 (21.3-29.5) mm; quadriceps 19.0 (15.0-23.5) mm and 24.8 (19.9-29.5) mm; rectus femoris 9.7 (7.1-12.3) mm and 12.1 (9.6-15.0) mm. The median follow-up time was 733.5 (438-882) days.</p><p><strong>Conclusions: </strong>The SONIC-HF registry will provide valuable insights into the feasibility and prognostic implications of ultrasound-based muscle assessment in geriatric patients with HF.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"552-559"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144570","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":"Less-experienced Writers' Writing Letters: Some Concerns and Recommendations.","authors":"Shigeki Matsubara","doi":"10.31662/jmaj.2025-0015","DOIUrl":"10.31662/jmaj.2025-0015","url":null,"abstract":"","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"667-668"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144737","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":"Editorial for Innovative Artificial Intelligence System in the Children's Hospital in Japan.","authors":"Ryuji Hamamoto","doi":"10.31662/jmaj.2025-0076","DOIUrl":"10.31662/jmaj.2025-0076","url":null,"abstract":"","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"361-362"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144775","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 the Monocle Sign in Facial Nerve Palsy Caused by External Auditory Canal Cancer on 18F-fluorodeoxyglucose-positron Emission Tomography/Computed Tomography.","authors":"Reiko Yagi, Ken Yamagiwa, Tomoyuki Fujioka, Junichi Tsuchiya, Tomoaki Asamori, Takeshi Tsutsumi, Ukihide Tateishi","doi":"10.31662/jmaj.2024-0303","DOIUrl":"10.31662/jmaj.2024-0303","url":null,"abstract":"","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"615-616"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144815","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":"Spontaneous Intramuscular Hemorrhage in Anti-melanoma Differentiation-associated Gene 5 Antibody-positive Dermatomyositis.","authors":"Tomoyuki Mutoh, Hidetoshi Mitsui, Hiroshi Fujii","doi":"10.31662/jmaj.2024-0412","DOIUrl":"10.31662/jmaj.2024-0412","url":null,"abstract":"<p><p>Anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive dermatomyositis (DM) is characterized by mild or absent muscle involvement and unique skin lesions such as cutaneous ulceration and palmar papules, commonly associated with rapidly progressive interstitial lung disease (RP-ILD), causing fatal outcomes. Spontaneous intramuscular hemorrhage (SIH) is an extremely rare but severe complication that remains under-recognized in DM. Here, we report a case of multiple SIH in a 72-year-old Japanese woman with anti-MDA5 antibody-positive DM and RP-ILD. The patient initially presented with fever, fatigue, and abnormal liver function, leading to a provisional diagnosis of autoimmune hepatitis. Following a 3-week moderate-dose prednisolone treatment, bilateral thigh hematomas suddenly developed without trauma or anticoagulant therapy. Laboratory findings revealed elevated creatine kinase and ferritin levels, reduced factor XIII (F13) activity, and anemia. Computed tomography (CT) imaging showed hematomas in multiple muscles and ILD. Although high-dose prednisolone administration gradually ameliorated the intramuscular hemorrhage, skin manifestations indicative of DM and dyspnea on exertion emerged after tapering prednisolone. Exacerbation of ILD was observed on CT imaging. Comprehensive analysis detected anti-MDA5 and anti-Ro52 antibodies without anti-F13 autoantibody, eventually leading to the diagnosis of anti-MDA5 antibody-positive DM with SIH and RP-ILD. Despite aggressive immunosuppressants, she died of RP-ILD-related respiratory failure. This case highlights the importance of considering DM as a differential diagnosis and investigating cutaneous manifestations indicative of DM in cases where the SIH etiology is unclear. Evaluation of myositis-specific and myositis-associated autoantibodies is crucial to ensure adequate diagnosis when SIH associated with DM is highly suspected.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"641-645"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144829","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":"Raccoon Eye Caused by Dialysis-related Amyloidosis.","authors":"Yuri Furuhashi, Tomotaka Takanosu, Masahiro Miki, Hiroko Kikuchi","doi":"10.31662/jmaj.2024-0376","DOIUrl":"10.31662/jmaj.2024-0376","url":null,"abstract":"","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"620-621"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144864","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":"Cerebral Fat Embolism Syndrome.","authors":"Daichi Motomura, Tomotaka Takanosu","doi":"10.31662/jmaj.2024-0345","DOIUrl":"https://doi.org/10.31662/jmaj.2024-0345","url":null,"abstract":"","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"602-605"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144366","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":"Contribution to Establishing a Foundation for Promoting Cancer Control in Japan by Providing Precise Cancer Information and Establishing a Research Infrastructure-Secondary Publication.","authors":"Tomotaka Sobue","doi":"10.31662/jmaj.2024-0379","DOIUrl":"10.31662/jmaj.2024-0379","url":null,"abstract":"<p><p>At the beginning of 2000, the National Cancer Center had little involvement in cancer statistics. In addition, cancer incidence data were collected by regional cancer registries (approximately 30 prefectures have on-site registries), but the problems were that (1) the completeness of the registration was low, (2) the registration method was not standardized, and (3) usage was limited. In the Third Comprehensive Strategic Cancer Research Project (2004-2013), Field 7, \"Research on Developing Cancer Surveillance System and Disseminating Cancer Information,\" was added, and we could build a system to aggregate the latest cancer statistical data from Japan and provide it as content for cancer information services. In addition, within the Regional Cancer Registry Research Group, we promoted the standardization of population-based cancer registry methods through \"formulation and dissemination of standard registration forms\" and \"development and dissemination of standard registry systems.\" We believe that these factors served as the basis for the smooth transfer to the National Cancer Registry under the Cancer Registry Promotion Act, which was enacted in 2013. In contrast, to take over the function of Hisamichi's \"Evaluation of the Effectiveness of New Cancer Screening Methods\" report published in 2001, the Ministry of Health, Labour and Welfare Cancer Research Grant \"Research on the Establishment of Appropriate Methods for Cancer Screening and Evaluation Methods\" group, which started in 2003, formulated the guideline development procedure and updated the guidelines, and the work of updating the guidelines was subsequently taken over by the National Cancer Center. This remains an important mechanism to ensure that cancer screening methods that do not have a scientifically confirmed balance between benefits and harms are not introduced into policy.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"317-322"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144563","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}