JOURNAL OF MEDICAL INVESTIGATION最新文献

Water is the main component of cells, tissues, and organs, and plays vital roles in macronutrient hydrolysis and overall cell function regulation. While low water intake may be sufficient for hydration, several studies suggest that most children fail to meet water intake guidelines, leading to underhydration as indicated by elevated hydration biomarkers. We conducted a cross-sectional observational study to examine water intake and output among high school students, comparing non-athletes and athletes. We enrolled 26 non-athletes and 28 athletes in this study. Water balance was assessed by water intake from foods and beverages, metabolic water production, and non-renal water loss (NRWL). Moreover, urine was compared. Increases of total water intake from food and beverage consumption in athletes were significantly higher than those in non-athletes. Furthermore, urinary output was lower and NRWL was 2-3 times higher in athletes than non-athletes. These findings suggest that large NRWL induces hypohydration in athletes. J. Med. Invest. 72 : 42-46, February, 2025.

Purpose: We aimed to determine the association between sarcopenia and frailty in Japan's hyperaged society.

Methods: We investigated the incidence of sarcopenia and frailty among 423 community-dwelling older adults (304 women and 119 men ; mean age : 77.0 years). Interviews, Kihon Checklist (KCL) assessments, physical function tests, and anthropometric measurements were performed at baseline. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria, with a KCL score of ≥7 indicating frailty.

Results: Eight patients (1.9%) had sarcopenia alone, 113 (26.7%) had frailty alone, and 26 (6.1%) had both sarcopenia and frailty. The instrumental activities of daily living (IADL) scores were significantly higher in all groups. Logistic regression analysis showed the association of sarcopenia and frailty with IADL. The receiver operating characteristic curves of the total KCL and IADL scores were analyzed to determine the cutoff value for assessing sarcopenia with frailty. The cutoff value for the total KCL score was 7.000, while that for the KCL-IADL score was 2.000.

Conclusion: Approximately 6.1% of patients were diagnosed with sarcopenia with frailty using the KCL. These conditions were found to impair IADL. Hence, interventions addressing both frailty and sarcopenia may help prevent the decline in IADL. J. Med. Invest. 72 : 139-147, February, 2025.

This study examined the mental health and related factors such as social comparison orientation, self-compassion, and perfectionism of 57 graduate trainees aspiring to become psychologists in comparison with 80 graduate students with other majors. The results showed that "Opinion comparison" subscale of social comparison orientation was significantly higher among trainees than among non-trainees, and higher among women than among men in both trainees and non-trainees. Social comparison orientation positively affects depressive symptoms, anxiety symptoms, and social function impairment among trainees but has no effect among non-trainees. Perfectionism was higher among first-year trainees than among second-year trainees, whereas no gradebased differences existed among non-trainees. Perfectionism positively affected social function impairment among non-trainees but not among trainees. However, self-compassion negatively affected depressive symptoms, anxiety symptoms, and social function impairment among both trainees and non-trainees. Furthermore, 89% of the trainees blamed themselves during practical training, expressing that both the trigger and content of selfblame were related to hesitation, anxiety, and lack of confidence. Overall, the results suggest that trainees should aim for personal growth over perfection, enhance their self-compassion rather than blaming themselves, and should not engage in social comparison. J. Med. Invest. 72 : 217-223, February, 2025.

The aim of this study was to investigate the association between phase angle (PhA) at admission and functional outcomes at discharge in patients with acute ischemic stroke. This single-center, prospective cohort study measured PhA and skeletal muscle index (SMI) in patients with acute ischemic stroke using bioelectrical impedance analysis (BIA). Functional outcomes were assessed using the modified Rankin Scale (mRS) at discharge, with mRS scores of 3-5 difined as poor functional outcomes. The association between PhA or SMI and poor functional outcomes was analyzed for male and female patients. This study included 287 patients (195 males, 92 females). Logistic regression indicated that PhA, but not SMI, was independently correlated with poor functional outcomes at discharge (males : OR : 0.58, 95% confidence interval [CI] : 0.34-0.98, p = 0.041, females : OR : 0.31, 95% CI : 0.12-0.80, p = 0.015). Receiver operating characteristic curve analysis determined PhA cutoff values for poor functional outcomes : 4.70 in males (sensitivity : 0.627, specificity : 0.680, area under curve [AUC] : 0.674) and 3.70 in females (sensitivity : 0.467, specificity : 0.830, AUC : 0.712). PhA was identified an independent predictor of poor functional outcomes at discharge in patients with acute ischemic stroke, and it was superior to SMI in this regard. J. Med. Invest. 72 : 148-155, February, 2025.

Objective: ACE ratio in the serum is a more sensitive indicator of zinc nutrition than serum zinc concentration. In this study, we examined the effects of zinc supplementation in combination with difructose anhydride (DFA) that enhances zinc absorption in the intestine on serum zinc concentration and ACE ratio in patients with refractory taste impairment.

Methods: Twenty patients with refractory taste impairment were enrolled. The patients received 34 mg of zinc in combination with 2.0 g of DFA orally every day for three months. Taste impairment was evaluated using visual analogue scale (VAS).

Results: After zinc supplementation with DFA (zinc with DFA), ACE ratio was significantly decreased, but serum zinc concentration was not increased in patiens with refractory taste impairment. Although VAS score was not changed in the patients after zinc with DFA, we divided the patients into two groups : 14 responders and 6 non-responders. ACE ratio in responders, but not in non-responders was significantly decreased after zinc with DFA. However, serum zinc concentration was not changed in both responders and non-responders after zinc with DFA.

Conclusion: The present findings suggest that malabsorption of zinc in the intestine is the primary cause of zinc deficiency in patients with refractory taste impairment. J. Med. Invest. 72 : 156-160, February, 2025.

Caring demonstrates compassionate care for others through the process of "knowing person as caring" from the theoretical lens of Technological Competency as Caring in Nursing (TCCN). Physical therapists respect the individual needs and values of patients and builds deep relationships with patients and their families. In this process, it is essential to respect the dignity and humanity of the other person. This discussion paper aims to 1) extract the necessary elements of Locsin's TCCN theory from a physical therapy practice perspective;2) consider the usefulness of Locsin's TCCN theory in physical therapy practice using a narrative review process;3) examineknowing patients as caring in physical therapy using Carper's fundamental ways of knowing through the fictional vignette;and 4) evaluate Donabedian's structure, process, and outcome to assess the quality of healthcare as well as consider knowing patients and quality of caring regarding the mentioned fictional vignette. TCCN theory-based practice is essential for incorporating a caring attitude and the appropriate use of technology into the practice of physical therapy. Caring in physical therapy is the practice of patient-centered care through attentive learning and engagement with the patient. J. Med. Invest. 72 : 60-65 February, 2025.

Purpose: Type 1 Modic change (MC) is associated with chronic low back pain and attributed to segmental instability. However, the relationship between type 1 MC and segmental instability is unclear. This study sought to clarify the role of mechanical abnormalities in type 1 MC.

Method: Review of magnetic resonance images obtained for 727 patients over a 1-year period at our institution revealed 161 cases of type 1 MC. In 86 of these, the following indicators of mechanical abnormality could be evaluated on dynamic radiographs:segmental scoliosis (>5°), forward slippage (>1%), and posterior disc opening in flexion. Patients with one or more of these abnormalities were allocated to a mechanical group (n=62, 70%) and those with no abnormality to a non-mechanical group (n=26, 30%). The Pfirrmann grade of disc degeneration at the affected level was compared between the groups.

Results: Segmental scoliosis, slippage, and posterior opening was observed in 34, 21 and 37 cases, respectively. Severe disc degeneration (grade IV or V) was present in 43 cases (69%) in the mechanical group and in 12 cases (46%) in the non-mechanical group;the difference was statistically significant (p=0.04).

Conclusion: We propose that there are mechanical and non-mechanical variants of type 1 MC. J. Med. Invest. 72 : 385-389, August, 2025.

The onset age of amyotrophic lateral sclerosis (ALS) has been increasing, but recent trends remain unclear. This study examined changes in ALS onset age over the past decade. We analyzed 233 ALS patients diagnosed from 2011 to 2020 at Tokushima University Hospital. The Jonckheere-Terpstra test assessed the trend in onset age. We compared onset age between 2011-2015 (Group A) and 2016-2020 (Group B) using the Mann-Whitney U test. We also analyzed the annual proportion of patients with onset age ≥80 using Spearman's rank correlation. In Tokushima Prefecture, we evaluated annual increase rates of individuals aged ≥80 and ALS patients with onset age ≥80, using 2011 as baseline. Regression slopes were compared using a t test. Onset age showed a significant positive trend (p=0.04), and Group B had older onset age than Group A (p=0.048). The proportion of patients with onset age ≥80 increased significantly (ρ=0.69, p=0.03). No significant difference was found between regression slopes for the general elderly population and ALS patients with onset age ≥80 (p=0.49). These findings suggest that the onset age of ALS at Tokushima University Hospital has increased over the past decade. J. Med. Invest. 72 : 286-289, August, 2025.

Objectives: Malignant peripheral nerve sheath tumors (MPNSTs) are rare neoplasms requiring differentiation from benign neurogenic tumors on diagnostic imaging. We evaluated the diagnostic utility of texture analysis (TA) in distinguishing seven pathologically confirmed MPNSTs from eight schwannomas using magnetic resonance imaging (MRI), including T1- (T1WI) and T2-weighted imaging (T2WI), and apparent diffusion coefficient (ADC) maps. TA's performance was compared with that of conventional approaches using ADC values alone.

Methods: Tumors were segmented, and 90 texture features were extracted using LIFEx software. Significantly different features (p < 0.05) were identified using the Mann-Whitney U test and evaluated through receiver operating characteristic (ROC) analysis. ADC maps were used to measure the minimum, mean, and maximum ADC values, followed by ROC analysis.

Results: Two T2WI-based texture features (neighborhood grey-tone difference matrix Contrast and grey-level size zone matrix Grey Level Variance) demonstrated the highest diagnostic performance (area under the curve = 0.911 [95% confidence interval (CI):0.755-1.000]), comparable to the minimum and mean ADC values (area under the curve = 0.898 [95% CI:0.691-1.000]).

Conclusions: TA may help differentiate MPNSTs from schwannomas. T2WI-based TA offers a viable alternative when ADC maps are limited by magnetic susceptibility artifacts. J. Med. Invest. 72 : 367-374, August, 2025.

This study focused on ventilatory management during robot-assisted laparoscopic rectal resection in an obese patient, using electrical impedance tomography (EIT) to evaluate lung conditions. The case involved a 40s male with a history of smoking, obesity (BMI:31), and iodine allergy. General anesthesia was induced, and EIT was employed to assess positive end expiratory pressure (PEEP) during different surgical positions. The study found that the PEEP for supine positioning was 10-12 cmH2O for ventilatory conditions in which the anterior and posterior impedance changes were equal in patients, but during pneumoperitoneum and head lowering, a higher PEEP of 20 cmH2O was necessary to prevent lung collapse. This differed from conventional recommendations. Oxygenation was maintained, and the patient had no major complications. The study suggests that EIT may offer a noninvasive and bedside approach to evaluating ventilator settings, potentially changing perspectives on intraoperative ventilator management. J. Med. Invest. 72 : 447-450, August, 2025.