Juntendo Iji Zasshi最新文献

Objective: To evaluate the effect of emergency medicine training credentials and years of medical experience on various clinical parameters in emergency medicine practice.

Methods: A cross-sectional study was conducted at Juntendo University Nerima Hospital between 1 April 2019 and 31 March 2020. All patients who were transported by ambulance, were examined by emergency physicians, and underwent computed tomography (CT) or magnetic resonance imaging (MRI) in the emergency department were included. For these cases, data on the attending physician's qualification status and experience (specialist, nonspecialist with 1-2 years of experience, or nonspecialist with 3-4 years of experience), clinical parameters, and imaging were collected. The primary outcome was the patient's total length of stay (LOS) in the emergency department.

Results: A total of 3,784 patients were included in the study. Patients attended by nonspecialists with 1-2 years of experience had a significantly longer time from arrival to assessment and LOS, especially in mild and severe cases and cases requiring head and abdominal CT imaging.

Conclusion: Our findings suggest that for physicians with minimal work experience, mentorship and effective training using triage flow and medical examination protocols may help to reduce LOS in the emergency department.

Background/objective: Patients with polymyalgia rheumatica experience flares and require a lengthy course of glucocorticoid treatment. Ultrasound application is often used for diagnosing polymyalgia rheumatica. This study aimed to determine whether polymyalgia rheumatica diagnosed with ultrasound complementation has a more favorable clinical course compared with that of only clinically diagnosed patients.

Methods: In this cohort study, we retrospectively identified 152 patients with polymyalgia rheumatica from January 2008 to December 2018. We extracted patients' clinical and ultrasound information, and hazard ratio and propensity-score matched analyses were performed.

Results: Among 152 patients with polymyalgia rheumatica, the flare, methotrexate add-on, and C-reactive protein normalization rates were 15.9 (95% confidence interval, 8.8-23.1)/100 person-years, 9.3 (3.6-15.0) /100 person-years, and 70.3 (61.3-79.2) /100 person-months, respectively. Age (p=0.01), C-reactive protein levels (p=0.03), and absence of peripheral joint pain (p=0.03) were significantly different between 81 and 71 patients with and without ultrasound complementation, respectively. The hazard ratio showed that ultrasound complementation did not contribute to the clinical course; flare, methotrexate add-on, and C-reactive protein level normalization yielded values of 0.88 (p=0.64), 1.93 (p=0.056), and 0.94 (p=0.72), respectively. Propensity-score-matched analysis showed a similar clinical course between 51 pairs: flare (p=0.45), methotrexate add-on (p=0.15), and C-reactive protein normalization (p=0.94).

Conclusions: Age, C-reactive protein, and involved joint distribution were factors leading to ultrasound complementation at the time of polymyalgia rheumatica diagnosis. Ultrasound complementation at PMR diagnosis is useful for differential diagnosis but may not affect the clinical course after GC introduction.

Objective: Insulin-like growth factor 1 (IGF-1) protects neuronal-cell damage by ischemia. Although neuronal cells have been reported to produce IGF-1, the molecular mechanisms remains obscure. Dexmedetomidine (DEX) protects neuronal cells from ischemic damage. We investigated the involvement of IGF-1 in the effect of DEX pretreatment on neuronal ischemic damage using an in vitro mouse hippocampal neuron model.

Materials: We used Dexmedetomidine and cryopreserved passaged mouse hippocampal neuronal HT22. Other reagents in this study were analytical grade.

Methods: Ischemia-reperfusion was modeled using the in vitro oxygen-glucose deprivation/reoxygenation (OGD/R). The effect of DEX was examined by incubating cells in DEX-containing medium for 1 hour prior to OGD/R. The cell damages were evaluated by lactate dehydrogenase (LDH) release. The amount of released IGF-1 were evaluated quantitatively by ELISA. The degree of Akt phosphorylation was evaluated by western blotting.

Results: OGD/R loading promoted LDH release from neuronal cells, while DEX pretreatment suppressed the LDH release. IGF-1 release from them was primed by DEX pretreatment under OGD/R condition, but not under normal conditions. Akt was activated in DEX-pretreated cells following OGD/R loading. IGF-1 neutralizing antibody (αIGF-1) eliminated the above effects of DEX pretreatment. However, IGF-1 receptor expression in neuronal cells was not affected by DEX pretreatment prior to OGD/R loading.

Conclusions: Our results demonstrate that neuronal cells primed with DEX under OGD/R conditions could release IGF-1 and potentially protect themselves via the IGF-1/Akt pathway. Consequently, it appears that neuronal cells activated by DEX have the capacity to self-protect from ischemic damage.

In 1985, when I entered the Graduate School of Science at Kyoto University, I began my research on cellular slime molds, a group of soil microorganisms. The cellular slime mold Dictyostelium discoideum is studied globally as a model organism for cell and developmental biology. I was conducting basic biological research into cell differentiation and migration using D. discoideum, and during this process, our research group made a discovery with potential implications for drug development. Specifically, we found that a chlorinated polyketide named differentiation-inducing factor 1 (DIF-1), derived from D. discoideum, exhibits antitumor activity. Based on this discovery, I began elucidating the mechanism of the antitumor action of DIF-1 and developing anticancer drugs using DIF-1 as a lead compound. During this period, in 1991, I obtained my Ph.D. in research related to D. discoideum cell differentiation, and subsequently served as a Japan Society for the Promotion of Science (JSPS) Special Research Fellow before joining the Institute for Molecular and Cellular Regulation (IMCR) at Gunma University in 1993. I then joined the Graduate School of Health and Sports Sciences at Juntendo University in 2015, where I have been until 2024. Throughout this period, I continued my research on DIF-1 and discovered that DIF-1 and its derivatives possess various biological activities ─ such as anti-diabetic, immunoregulatory, anti-bacterial, and anti-malarial activities ─ that could be applicable in drug development. In this review, I aim to present a segment of both our fundamental and applied research on D. discoideum and DIF-1.

Mitochondria not only generate adenosine triphosphate (ATP) and act as the powerhouse of the cell but also contribute to host defense by producing reactive oxygen species. Therefore, mitochondrial damage in sepsis directly results in a shortage of energy currency and dysregulation of the immune system. Other than those, mitochondrial damage results in the release of highly dangerous mitochondrial DNA, facilitating acidosis by modulating the metabolism and inducing programmed cell death, thereby facilitating disease progression in sepsis. Various forms of cell death are induced by mitochondrial damage. Aponecrosis is a secondary conversion from apoptosis to necrosis. Although apoptosis is initially intended, it cannot be completed due to ATP depletion from mitochondrial damage, ultimately leading to inflammatory necrosis. Besides such accidental cell death, programmed inflammation-inducing cell deaths such as necroptosis, ferroptosis, and pyroptosis are induced by mitochondrial damage in sepsis. Based on these findings, the regulation of mitochondrial damage holds promise for the development of new therapeutic approaches for sepsis.

Human breast milk is considered the optimal source of nutrition for infants and is recommended as the exclusive nutrient source for term infants during the first six months of life. Existing evidence strongly supports the direct benefits of breastfeeding, encompassing benefits for nutrition, gastrointestinal function, and protection against acute illness in both term and preterm infants. Previously, we demonstrated a notable reduction in a urinary marker of oxidative DNA damage in breastfed term and preterm infants compared to formula-fed infants. While long-term benefits of breastfeeding on neurodevelopmental outcomes and adult health have been reported, the effects may be relatively modest and limited.

Objective: Since there have been no studies for the prevention of job turnover among medical interpreters, this study examined the effects of social support, professional career maturity and stress coping on their attitudes toward job continuity intentions.

Design: A cross-sectional study was conducted to examine the relationships between social support, professional career maturity, stress coping and job continuity intentions.

Methods: Stress coping was measured by using a simplified stress coping scale (with 9 items and 1 factor structure). Social support was measured by defining the interpreters who answered "Yes" for "I have someone to talk to when I feel emotional stress". Professional carrier maturity was assessed by using, 12 career-related items. We defined those interpreters who responded "No" to "Have you ever wanted to quit medical interpreting due to emotional stress?" were to have job continuity intentions.

Results: The present study indicated that 14 (25.5%) of the interpreters did not intend to continue their occupation because of their psychological stresses. Compared to interpreters without social support, the odds ratio of job continuity intentions was 4.39 (95% confidence interval [CI] : 1.13-18.3) for those with social support. Moreover, in comparison with the interpreters with low professional career maturity, the odds ratio of job continuity intentions was significantly higher for those with high professional career maturity (odds ratio [OR] = 4.35; 95%CI: 1.12-21.8). However, there was an association found for stress coping.

Conclusions: Strengthening social support and helping professional career development were the important factors for medical interpreters to be able to continue their careers.

In daily clinical practice, assessing anatomical findings and the presence or absence of ischemia is pivotal for determining the need for percutaneous coronary intervention. However, concurrently, comprehending vulnerability can greatly assist in predicting future cardiovascular events and formulating preventive strategies for individual patients. This review aims to describe the vulnerability of coronary artery plaques, primarily focusing on vulnerable plaques through pathological, morphological, and physiological viewpoints. Our review emphasizes the usefulness of coronary imaging modalities for the diagnosis of vulnerable plaques and the assessment of their rupture risk, as well as the possibility of percutaneous coronary intervention as a management strategy for plaque stabilization. Our findings show that there have been sporadic accounts of the potential of preventing cardiovascular events through early invasive treatments in patients with moderate or greater ischemia and utilizing new-generation stents to seal lipid core plaques. Thus, it is anticipated that direct intervention targeting coronary plaques, coupled with strict low-density lipoprotein-cholesterol lowering therapy, can play a vital role in suppressing future cardiovascular events and archiving zero perioperative myocardial infarction.

Objectives: This study aimed to assess the effect of the spinal circuit of repetitive magnetic stimulation (rPMS) on the soleus muscle among healthy subjects.

Methods: Nineteen healthy adults were included in this study. Intermittent rPMS was applied to the left soleus muscle for 20 minutes. We applied different intensity rPMS (high-intensity, low-intensity, and non-stimulation) in different three days. RI (reciprocal inhibition) from the tibialis anterior to the soleus muscle with an inter-stimulus interval (ISI) of 2ms and 20ms was assessed before, immediately after and 30 minutes at each session.

Results: Two factor repeated measure ANOVA test showed a significant interaction (F_2,33 = 9.688, p < 0.001) between tasks and time in the RI ratio 2ms. Post-hoc analysis showed that RI ratio 2ms significantly differed from those immediately after, and 30 min after high-intensity rPMS (p = 0.001 and p = 0.003, respectively). A significant difference was observed between high-intensity rPMS and non-stimulation immediately after the stimulation (p = 0.003). However, no significant difference was found in the RI ratio 20ms between all the intensities (p > 0.05).

Conclusion: This study demonstrates that high-intensity rPMS can effectively modulate spinal circuits, as evidenced by the decreased RI in healthy individuals. This suggests the potential use of rPMS as a therapeutic intervention for patients with muscle weakness. Disinhibition of the RI may lead to a more effective contraction of the target muscle. This effect could be expected to strengthen the muscles and alleviate paralysis, making it a promising avenue for future research and clinical applications in the field of rehabilitation. Further investigation is warranted to explore the precise mechanisms underlying the observed effects and to optimize the parameters of rPMS for specific clinical populations.

Objectives: We started Helicobacter pylori (H. pylori) screening program of students at Juntendo university in 2020. We report the current status of H. pylori screening program and the outcomes of H. pylori screening program.

Methods: The students of the School of the Faculty of Health Sciences of Juntendo University enrolling in the spring of 2020-2022 were recruited for this study. The anti-H. pylori antibody test was used for detecting H. pylori infection. An individual with a serum anti-H. pylori antibody titer of less than 3 U/ml was considered to be negative for H. pylori infection. If the antibody titer was 3 U/ml or higher, the subject was considered to be possibly infected and recommended to visit a hospital for further testing. Esophagogastroduodenoscopy and 13C urea breath test were performed for diagnosing H. pylori infection at the hospital. Eradication therapy was performed, and the eradication assessment were performed at least 8 weeks after the end of eradication therapy.

Results: Seven hundred twenty-eight students were screened for H. pylori from 2020 to 2022. Fifty-seven students were recommended to visit a hospital based on the anti-H. pylori antibody serum test. Forty-seven students visited Juntendo university hospital. Eleven of the 47 students were positive for H. pylori and all of them students received eradication therapy. H. pylori eradication was successful in nine of the 11 students.

Conclusions: The H. pylori screening program for university students at Juntendo university has been successfully initiated with nine successful eradications since its inception in 2020.