Juntendo Iji Zasshi最新文献

Objectives: Laparoscopic surgery is widely performed for acute appendicitis. We started conventional 3-port laparoscopic appendectomy (CLA) in 1995 and introduced single-incision laparoscopic appendectomy (SILA) in 2009. This study compared perioperative outcomes between SILA and CLA to evaluate the usefulness of SILA.

Design: Retrospective observational study.

Methods: The study included 568 patients who underwent emergency or semi-emergency surgery for acute appendicitis (327 by CLA and 241 by SILA) at our hospital between January 2009 and December 2020. Perioperative outcomes were compared between SILA and CLA after adjusting for patient demographics by propensity score matching (PSM).

Results: PSM gave a matched sample of 224 patients in each of the CLA and SILA groups. There were significant differences between the two groups in time to initiation of oral intake, frequency of postoperative analgesic use, and length of postoperative hospital stay. Time to oral intake was significantly shorter in the SILA group (p = 0.02). Frequency of use of all analgesics, flurbiprofen axetil, and loxoprofen sodium was significantly higher in the SILA group (p < 0.01, p = 0.04, p < 0.01, respectively). The length of postoperative hospital stay was significantly shorter in the SILA group (p < 0.01). The incidence of postoperative complications did not differ significantly between the two groups.

Conclusions: Although SILA required significantly more postoperative analgesics than CLA, pain could be controlled by oral analgesics, and patients could be discharged earlier. Postoperative complications were comparable between the two groups. SILA was a safe and feasible procedure for adult acute appendicitis.

Chronic kidney disease (CKD) attributed to diabetes, termed diabetic kidney disease (DKD), is increasing with the rising global prevalence of diabetes. Patterns of DKD onset and progression have shifted in recent years because of population aging and advances in the treatment of diabetes. Prevention of the onset and progression of micro/macro-albuminuria is possible through comprehensive and strict management of lifestyle, blood glucose, blood pressure, and lipids in people with diabetes and early DKD. Renin-angiotensin system (RAS) inhibitors have also been shown to effectively slow the progression of CKD in people with diabetes and micro/macro-albuminuria. However, the effect of improving kidney outcomes with RAS inhibitors in people with advanced DKD is limited, and the residual risk remains very high. A recent rapid expansion of treatment options include sodium-glucose co-transporter-2 inhibitors, non-steroidal mineralocorticoid receptor antagonists, and glucagon-like peptide-1 receptor agonists, which have demonstrated additional protective effects for the kidneys when used in addition to the standard therapy with RAS inhibitors, even in people with advanced DKD. Early diagnosis and therapeutic intervention can be expected to delay progression to end-stage kidney failure. This perspective outlines the diagnostic and therapeutic evolution of DKD to date.

Trauma-induced coagulopathy (TIC) is characterized by dynamic changes in fibrinolysis, which can significantly impact patient outcomes. These changes typically manifest in two phases: hyperfibrinolysis followed by fibrinolysis suppression. In the early stages of TIC, there is often an overwhelming release of tissue plasminogen activator, which leads to excessive fibrinolysis. This hyperfibrinolytic state results in rapid clot breakdown, leading to uncontrolled bleeding and increased mortality. Following the hyperfibrinolytic phase, the fibrinolysis system is suppressed rapidly due to the increased production of plasminogen activator inhibitor-1, leading to fibrinolysis shutdown. This is a state where clot breakdown is significantly reduced, which can contribute to thromboembolic complications and multi-organ failure. Tranexamic acid, a plasmin inhibitor, effectively regulates hyperfibrinolysis as long as it is used in the appropriate hyperfibrinolytic phase. In summary, TIC involves a complex interplay between hyperfibrinolysis and fibrinolysis shutdown, with the balance between these states being crucial for patient survival. Effective management of TIC requires an understanding of these dynamic changes to tailor therapeutic interventions appropriately.

Objectives: After the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) outbreak, a state of emergency was imposed to stop the spread of infection, resulting in restrictions on routine medical examinations. As a result, there has been a decline in cancer screening and detection. However, it is uncertain how many more cancer cases among routine outpatients have been detected recently.

Methods: We retrospectively identified regular outpatients with no history of cancer treatment at the Juntendo University Hospital. The difference in the percentage of these patients who initiated cancer treatment within the following year, before and after the SARS-CoV-2 pandemic was analyzed.

Results: A total of 33,417, 32,579, and 30,303 regular outpatients with no history of cancer treatment were identified for fiscal years 2018, 2019, and 2020, respectively. The percentage of these patients with new cancer treatment within the following fiscal year was 454 (1.36%) for 2018, 440 (1.35%) for 2019, and 416 (1.37%) for 2021. There was no statistically significant difference in the percentage of patients initiating cancer treatments before and after the SARS-CoV-2 pandemic (2018 vs. 2020, 2019 vs. 2020, respectively P = 0.88, 0.81) among patients who regularly visited outpatients at our hospital.

Conclusions: The SARS-CoV-2 pandemic had no effect on the percentage of regular outpatients newly treated for cancer.

Objectives: This study focuses on mild-to-moderate severity cases to examine the triggers initiating kidney injury.

Materials: Patients aged ≥18 years with suspected heat-related illnesses at the Juntendo University Hospital Emergency and Primary Care Center between July and September 2020 and June and August 2022 were included.

Methods: Blood samples were obtained during their visit, and the patients were categorized into two groups based on their cystatin-based estimated GFR (eGFRcys) values: a kidney injury group (eGFRcys < 60 mL/min/1.73 m²) and a non-kidney injury group (eGFRcys ≥ 60 mL/min/1.73 m²). Inflammation, coagulation, and skeletal muscle damage markers were compared between the groups, and markers related to the early development of kidney injury were examined.

Results: Thirty-five patients were diagnosed with heat-related illnesses, and 10 were diagnosed with kidney injury. White blood cell count was higher in the kidney injury group (P < 0.01), whereas the levels of CRP and Interleukin-6 showed no significant difference between the groups. No statistically significant differences in coagulation markers were observed. In contrast, myoglobin, a marker of skeletal muscle damage, showed elevated levels in the kidney injury group (r = -0.80, P < 0.01) and demonstrated a stronger association with early kidney injury than creatine kinase (r = -0.38, P < 0.05).

Conclusions: The predominant mechanism of acute kidney injury in mild to moderate heat-related illnesses appears to be tubular damage caused by myoglobin. Measuring myoglobin levels is essential to identify and exclude patients at risk of acute kidney injury due to heat-related illnesses.

Objectives: The pelvic floor muscle (PFM) plays a major role in sexual and urinary functions. No objective method exists to measure the PFM in male. This study evaluated the reliability of male PFM volume using three-dimensional computed tomography (3D-CT).

Methods: PFMs of five patients aged 43-83 years were selectively extracted from thin-slice CT using a workstation to reconstruct stereoscopic images and measure PFM volume. Two raters measured the PFM volume three times in all patients to confirm the reliability of PFM volume measurement. Intra- and inter-rater correlation coefficients, i.e., intraclass correlation coefficient, were determined. The CT attenuation of PFMs was also evaluated.

Results: Raters 1 and 2 reported an average PFM volume of 46.4 ± 11.5 cm³ and 46.1 ± 12.5 cm³, respectively. The intra- and inter-rater correlation coefficients were 0.99 and 0.98, respectively. The average CT value of PFMs had a minimum of 13.7 Hounsfield Unit (HU) in the eldest male and a maximum of 38.9 HU in the youngest male.

Conclusions: Male PFMs could be selectively extracted using a workstation to reconstruct a stereoscopic image. The PFM volume measurement is feasible and highly reproducible. To our knowledge, this is the first study that standardizes the method for measuring the male PFM volume using 3D-CT and examines its reliability.

Diabetes mellitus, characterized by high blood glucose due to inadequate insulin action, comprises two main types: type 1, an autoimmune disease, and type 2, marked by insulin resistance. This review provides a comprehensive overview of diabetes management and treatment advancements. Effective diabetes management includes maintaining blood glucose levels within normal ranges and monitoring HbA1c, a marker reflecting average glucose levels over the past few months. Historically, the discovery of insulin in 1921 revolutionized diabetes treatment, significantly extending patient life expectancy. Current treatment strategies encompass diet, exercise, and pharmacotherapy. The diet involves a balanced intake of carbohydrates, proteins, and fats, while exercise, including aerobic and resistance training, improves insulin sensitivity and glucose control. Pharmacotherapy options include insulin therapy and oral hypoglycemic agents, like metformin and empagliflozin, each with specific mechanisms of action. Innovative treatments include SGLT2 inhibitors and GLP-1 receptor agonists, which aid in glucose control and offer additional benefits like weight loss and improved cardiovascular outcomes. Continuous glucose monitoring (CGM) and insulin pumps represent technological advancements enhancing glycemic control through real-time monitoring and automated insulin delivery. We must pay attention to diabetes-related stigma, which we should overcome by advocacy. The diabetes education programs at Juntendo University Hospital aim to improve patient self-management through comprehensive diet, exercise, and medication education. We emphasize the importance of integrating the latest research and societal support to enable diabetic patients to lead healthy, fulfilling lives.

The occurrence of the metabolic syndrome and its related diseases such as diabetes are steadily rising in our modern society. Modern food choices and the more sedentary lifestyles largely contribute to this shift in our society's health. Fasting has been practiced for religious purposes all over the world long time before science showed the benefits of it. The effects of fasting on glucose and fat metabolism are of great interest. Fasting triggers a cascade of changes in the hormonal, microbiome and enzymatic environments, leading to shifted glucose and fat metabolisms. Fasting-induced metabolic function changes are affected by several factors such as sex hormones, lipid-released hormones, growth hormone, insulin, and the gut microbiome, leading to lipolysis and the release of FFA into the bloodstream. The purpose of this review is to summarize the newest research results on the specific pathways fasting triggers to improve metabolic functions and understand the potential applications of fasting as prevention/treatment of several metabolic conditions.

Society 5.0, proposed as part of the 5th Science and Technology Basic Plan by Japan's National Institute of Advanced Industrial Science and Technology, is a human-centered society where cyberspace and physical space are integrated, to resolve social challenges and promote economic growth. In Society 5.0, medicine will undergo extensive digital transformation (DX), and digital health technology is expected to expand markedly, becoming part of routine clinical practice. Prompt diagnosis of dry eye disease (DED) and uninterrupted monitoring of such patients with healthcare barriers is currently an unmet need. DX of DED evaluation and management can boost the current quality of DED care. Software as Medical Devices (SaMDs), i.e., software programs developed through evidence-based research to provide diagnostic, therapeutic, and preventive services, and particularly medical devices based on smartphone applications (apps), have attracted attention. We have striven to actualize the DX of ophthalmic care and evaluation, denoted by our ongoing development of SaMDs to assist DED diagnosis. To illustrate healthcare using the Internet of Medical Things, we here present the research and development process of our smartphone app-based SaMD for DED diagnosis assistance.

As lipid/lipoprotein research elucidated the mechanism of atherosclerosis, lipid/lipoprotein tests were developed for simple and rapid screening, diagnosis, and management of dyslipidemic patients. In 1988, the Centers of Disease Control and Prevention (CDC) in the United States initiated a global standardization program for lipid/lipoprotein testing through the Cholesterol Reference Measurement Laboratory Network (CRMLN), in which the chemical lipid measurements were adopted as reference measurement procedures (RMPs). In 2010, an American group questioned the accuracy of the direct LDL-C and HDL-C assays, causing a great deal of confusion. Our two comparative studies evaluating the direct LDL-C and HDL-C assays have removed reagents with poor analytical performance from the market and demonstrated that the assays are currently accurate enough for clinical use. Because these traditional chemical methods require a high level of technical expertise, RMP are shifting from chemical reaction-based methods to mass spectrometry-based methods. We are now working on the standardization of lipoprotein(a) using the mass spectrometry-based method as an RMP.