Fukushima Journal of Medical Science最新文献

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm driven by the BCR::ABL tyrosine kinase. Tyrosine kinase inhibitors (TKIs) have significantly improved the outcome of CML patients. Dasatinib, a second-generation TKI, is highly effective but associated with off-target effects, including pulmonary toxicities. While pleural effusion induced by dasatinib has been linked to therapeutic efficacy, its role remains controversial. Severe pulmonary complications, such as diffuse alveolar hemorrhage (DAH), can lead to treatment failure and increased mortality. We report a 72-year-old man with de novo blast-phase CML on clopidogrel who developed respiratory failure due to DAH 16 days after initiating dasatinib and prednisolone as induction therapy. Immediate steroid pulse therapy with methylprednisolone (1,000 mg/day for three days) was administered, and both dasatinib and clopidogrel were discontinued. Maintenance prednisolone (1 mg/kg/day) was then tapered by 10 mg per week. The patient's symptoms and radiographic findings improved without recurrence during tapering. This case highlights the importance of early recognition and management of severe complications like DAH in patients receiving dasatinib. Careful monitoring is essential to mitigate the risk of life-threatening respiratory failure and optimize CML treatment outcomes.

Purpose: Since the nuclear power plant accident in Fukushima, there has been anxiety about the effects of radiation exposure on future generations, specifically that the effects of radiation exposure may be inherited by descendants. We explored the relationship between health literacy and knowledge of the genetic effects of radiation exposure on this anxiety in both men and women.

Methods: In August 2016, a mail survey was conducted among 2,000 Fukushima residents aged 20-79 years. The objective variable was a true/false question, "No genetic effects have been observed among second- and third-generation atomic bomb survivors of Hiroshima and Nagasaki." The explanatory variable was the Critical and Communicative Health Literacy (CCHL) scale score. We also asked about variables including attributes of age, sex, affiliation with an organization or group, and media used for information about radiation.

Results: There were 861 valid responses (43.4%). Logistic regression analysis revealed that both men and women with higher CCHL scores were more knowledgeable about genetic effects. Men who were older and women who used government publications were knowledgeable about genetic effects, but men who belonged to community groups and women in evacuation areas who used private national broadcast TV or word-of-mouth were not knowledgeable about genetic effects.

Conclusions: CCHL was significantly associated with knowledge about genetic effects of radiation exposure. For men and women in Fukushima, the results suggest that improvement in health literacy is necessary to select media that disseminate accurate information. For men, recommendations regarding suitable sources of information cannot be ascertained through this study, because the source of information for men was not significantly associated with KOGEORE by multivariate logistic regression analysis.

Objectives: To identify predictors of prolonged severe urinary incontinence after robot-assisted radical prostatectomy (RARP), perioperative clinical parameters were investigated.

Methods: Participants were 299 patients who underwent RARP at our institute.　Prolonged severe urinary incontinence was defined as a 1-h (one-hour) pad test >50 g/h and/or use of >3 pads/day at 12 months after RARP.　The cohort was divided into severe and non-severe urinary incontinence groups according to this criterion.　Perioperative clinical parameters were compared between groups to identify predictors for prolonged severe urinary incontinence after RARP.

Results: Twenty-seven patients (9.0%) were categorized into the severe urinary incontinence group.　The remaining 272 patients (91.0%) were categorized into the non-severe urinary incontinence group.　Univariate analysis revealed prolonged severe urinary incontinence as significantly associated with older age (P=0.011), high BMI (P=0.001), lymph node dissection (P=0.003), non-preservation of nerves (P=0.039), non-preservation of fascia of the levator ani muscle (P=0.009), and high risk in the D'Amico risk classification (P=0.010).　Multivariate analysis revealed prolonged severe urinary incontinence as significantly correlated with high BMI (P=0.009) and high risk in the D'Amico risk classification (P=0.007).

Conclusions: High BMI and D'Amico high-risk status are associated with prolonged severe urinary incontinence after RARP.

Objectives: To explore the outcomes of pregnant women with epilepsy and their neonates, including the incidence of neonatal withdrawal syndrome.

Methods: In total, 26 pregnancies in 20 mothers with epilepsy were retrospectively examined for the presence of complications before and during pregnancy, number of antiseizure medications taken, gestational weeks at delivery, mode of delivery, number of seizure episodes during pregnancy and postpartum, neonatal birth weight, Apgar score, pH of the umbilical cord arterial blood, neonatal abnormalities, and neonatal withdrawal syndrome.

Results: Overall, 25 of the 26 pregnancies resulted in live births, with 4 cases undergoing premature deliveries.　Ten cases underwent cesarean section, with only one case undergoing cesarean section due to the fear of experiencing seizure during vaginal delivery.　During pregnancy, two cases experienced one seizure episode.　The rate of small for gestational age was 8.0%, and three neonates had congenital abnormalities.　Withdrawal symptoms were observed in 75% of the neonates, but none of them obtained ≥8 points in the withdrawal checklist, the threshold for pharmacotherapy.

Conclusions: For women with epilepsy who receive medical management and establish good control prior to pregnancy, child birth may be relatively safe, with a low rate of neonatal withdrawal syndrome requiring pharmacotherapy.

Background: In 2020, 29 signs/symptoms as well as 26 diseases/disorders to be encountered during initial postgraduate training were defined in Japan. The purpose of this study was to determine the extent to which junior residents can encounter the signs/symptoms and diseases/disorders during general practice/family medicine training.

Methods: Junior residents who participated in general practice/family medicine training for four weeks between 2019 and 2022 were:enrolled in the study. They were each assigned to one of five medical institutions with full-time family doctors in Fukushima Prefecture. The rate of participants who encountered each sign/symptom and disease/disorder, as well as the number of signs/symptoms and diseases/disorders each participant encountered, were defined as outcomes and analyzed descriptively.

Results: Ninety junior residents participated in the study. More than half of the participants encountered 11 out of the 29 signs/symptoms, and each participant encountered an average of nine signs/symptoms. As for diseases/disorders, more than half of the participants encountered 11 out of the 26 diseases/disorders, with an average of 11 per participant.

Conclusion: General practice/family medicine training provided the junior residents with the opportunity to experience a wide range of signs/symptoms and diseases/disorders.

Objective: The Smart Gene^TM system enables the rapid polymerase chain reaction-based detection of Helicobacter pylori (H. pylori) in gastric juice and determines clarithromycin (CAM) resistance. This study evaluated the clinical utility of the Smart Gene^TM system for diagnosing and managing H. pylori infection.

Methods: H. pylori diagnosis was obtained using the Smart Gene^TM system and the effectiveness of individualized eradication therapy was evaluated. Treatment regimens were chosen based on CAM sensitivity in the Smart Gene^TM test.

Results: A total of forty-nine patients were assessed. Among them, 28 had H. pylori infection, while 3 had CAM resistance. Seventeen patients underwent H. pylori eradication therapy. Fourteen patients with CAM-sensitive strains underwent eradication therapy with vonoprazan (VPZ), amoxicillin (AMPC), and CAM. Two patients with CAM-resistant strains were treated with VPZ and AMPC, while one received VPZ, AMPC, and metronidazole. The eradication achievement rate was 100%. Of 31 outpatients, 61.5% began H. pylori eradication therapy on the same day as the Smart Gene^TM test.

Conclusion: Smart Gene^TM enables rapid diagnosis of H. pylori infection and the detection of CAM resistance, allowing for personalized eradication regimens.

C3 glomerulopathy (C3G) is a type of complement-associated glomerulopathy caused by a defect in the alternative complement pathway and is regarded as a rare disease. We report a 14-year-old boy with C3G and Sjögren's syndrome (SS) whose school urinary screening revealed abnormalities, but the diagnosis was delayed because he refused to consult a medical institution. Histopathological examination revealed histologic features of membranoproliferative glomerulonephritis. He was diagnosed with C3G and Sjögren's syndrome based on proteinuria, the histopathological findings, high levels of antibodies against SS-A, and lymphocytic infiltration around the salivary glands. He was treated with combination therapy, consisting of methylprednisolone pulse, prednisolone, and mycophenolate mofetil. At 3 months after treatment, urinary protein excretion was decreased and hematuria had disappeared, and improvement in hypocomplementemia and the levels of antibodies against SS-A were observed. The course of our case suggests that the management of patients with C3G should take into consideration the possibility of the coexistence of SS, and that those with positive findings on school urine screening should be encouraged to visit a medical institution.

Purpose: Recurrent respiratory papillomatosis (RRP) is associated with low-risk types of human papillomavirus (HPV). With HPV DNA testing, the oral rinse of RRP patients may be a useful liquid biopsy, as previously shown in patients with oropharyngeal cancer.

Methods: Oral rinse, along with palatine and pharyngeal tonsil swabs, were collected from seven patients with persistent RRP. HPV DNA detection was performed using polymerase chain reaction, followed by genotype identification.

Results: HPV DNA was detected in five of seven oral rinse samples, but not in any palatine or pharyngeal tonsil swabs. HPV6 was identified in four of the five HPV-positive oral rinses, which was consistent with the RRP tissues.

Conclusion: HPV DNA can be detected in oral rinses from patients with RRP, suggesting the utility of the oral rinse as a liquid biopsy. In contrast, neither the palatine nor the pharyngeal tonsils were reservoirs of HPV in study patients with RRP.

A 50-year-old woman presented with a pancreatic tumor and multiple hepatic tumors identified via computed tomography (CT). The patient had undergone surgical resection for colon cancer 6 years earlier, followed by resection of a metastatic lung tumor 3 years ago. In the current presentation, primary pancreatic cancer with metastatic hepatic tumors was initially suspected. However, the possibility of previously resected colon cancer metastasizing to the pancreas also had to be considered. CT findings alone could not make this distinction. Therefore, endoscopic ultrasound-guided fine-needle aspiration was performed. Histopathological examination of the pancreatic tumor indicated adenocarcinoma, with features similar to those of the previously resected colon cancer. Immunohistochemical staining was negative for cytokeratin 7 but positive for cytokeratin 20, caudal-type homeobox 2, and special AT-rich sequence-binding protein 2. These findings indicated a pancreatic metastasis of colonic origin. In addition, a percutaneous ultrasound-guided biopsy of one of the hepatic tumors had histopathological findings that were similar to those of the pancreatic tumor. Hence, the patient was diagnosed with pancreatic and hepatic metastases from the previously resected colon cancer. Chemotherapy was initiated after this diagnosis.

Aim: To clarify the frequency and characteristics of patients with attention deficit hyperactivity disorder (ADHD) born with low birth weight (LBW), very low birth weight (VLBW), small for gestational age (SGA), or preterm, we examined the clinical characteristics of ADHD patients.

Methods: We collected data for 168 ADHD children, and the patients were retrospectively divided into each group according to birth weight, height, and gestational age.

Results: 1) Patients with ADHD born with LBW, VLBW, SGA, or preterm accounted for 10.1%, 3.0%, 3.6%, or 6.5% of all patients, respectively. 2) ADHD-RS scores for hyperactivity disorder and the frequency of patients requiring ADHD drugs in the LBW infant group were higher than those in the non-LBW infant group. 3) ADHD-RS scores for hyperactivity disorder and total in the VLBW infant group were higher than those in the non-VLBW infant (birth weight:1,500-2,500 g) group. 4) The ADHD scores for attention-deficit and trouble score at the most recent follow-up patients born with SGA were higher than for non-SGA patients.

Conclusions: These results suggest that it is necessary to pay attention to the appearance of neurodevelopment disorders such as ADHD when monitoring the progress of patients born with LBW or VLBW, and it is important to provide more appropriate management and therapeutic guidance for patients born with VLBW or SGA.