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Difficulties Nurses Report in Caring for Patients with Bone Metastases and Their Expectations after Participating in a Bone Metastasis Cancer Board: A Questionnaire Study. 护士在护理骨转移患者时遇到的困难及其参加骨转移癌症委员会后的期望:一项问卷调查研究。
IF 1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-05-21 Epub Date: 2024-03-02 DOI: 10.1272/jnms.JNMS.2024_91-210
Tsunemi Kitagawa, Yasuyuki Kitagawa, Yoichiro Aoyagi, Tokifumi Majima

Background: Patients with bone metastases often face physical, mental, and social challenges that require multidisciplinary management. To improve treatment and practice, we conducted a questionnaire survey to assess nurses' opinions of problems related to caring for patients with bone metastases. In addition, we investigated nurses' perceptions of bone metastases after participating in a Bone Metastasis Cancer Board (BMCB).

Methods: An anonymous questionnaire survey on problems in bone metastasis treatment and the BMCB was conducted. The respondents were nurses with more than 1 year of clinical experience working in wards where patients with bone metastases were admitted.

Results: The number of valid responses was 224. Almost all the nurses felt anxiety about the risk of pathological fracture and paralysis while caring for patients with bone metastases. To reduce this anxiety, about 90% of the nurses supported the suggestion that "patients should be referred to an orthopedic surgeon in advance to obtain opinions on load restrictions". Nurses who had participated in the BMCB had higher expectations regarding treatment, multidisciplinary collaboration, and sharing and accumulating knowledge and experience.

Conclusion: To improve treatment and nursing care for patients with bone metastases, it is important to make regular BMCB meetings more functional and to actively consult with specialists.

背景:骨转移患者通常面临身体、精神和社会方面的挑战,需要多学科的管理。为了改善治疗和实践,我们进行了一项问卷调查,以评估护士对护理骨转移患者相关问题的看法。此外,我们还调查了护士参加骨转移癌委员会(BMCB)后对骨转移的看法:方法:我们就骨转移治疗和骨转移癌委员会中存在的问题进行了匿名问卷调查。调查对象为在收治骨转移患者的病房工作一年以上、具有临床经验的护士:有效回答数为 224 个。几乎所有护士都对护理骨转移患者时发生病理性骨折和瘫痪的风险感到焦虑。为减轻这种焦虑,约 90% 的护士支持 "应提前将患者转诊至骨科医生处,以获得有关负荷限制的意见 "的建议。参加过 BMCB 的护士对治疗、多学科合作以及分享和积累知识和经验有更高的期望:结论:为改善骨转移患者的治疗和护理,必须使 BMCB 定期会议发挥更大作用,并积极向专家咨询。
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引用次数: 0
Oxidative Stress and Antioxidant Capacity in Patients with Endometrioma. 子宫内膜瘤患者的氧化应激和抗氧化能力。
IF 1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-05-21 Epub Date: 2024-03-02 DOI: 10.1272/jnms.JNMS.2024_91-204
Go Ichikawa, Yasuyuki Negishi, Ryo Tsuchiya, Lilika Higuchi, Tatsunori Shiraishi, Mariko Ikeda, Hanako Kaseki, Rimpei Morita, Shunji Suzuki

Background: Endometriosis has several clinical features, including dysmenorrhea, infertility, and endometrioma (EMO). Although oxidative stress status is closely related to endometriosis, it is unclear how the balance between oxidative stress capacity and antioxidant capacity correlates with treatment of or factors that worsen endometriosis. In this study, we used peritoneal fluid from patients with EMO to investigate the role of oxidative stress capacity and antioxidant capacity.

Materials and methods: Participants with EMO (n = 30) and without EMO (uterine myoma, n = 13) were enrolled. All peritoneal fluid samples were collected at the beginning of surgery. We evaluated oxidative stress capacity and antioxidant capacity in peritoneal fluid samples by using the diacron-reactive oxygen metabolites (d-ROM) and biological antioxidant potential (BAP) tests, respectively. The d-ROM and BAP values and the d-ROM/BAP ratio were measured, and their correlations with the CA125 level, revised American Society for Reproductive Medicine (r-ASRM) score, and tumor size were analyzed.

Results: The d-ROM/BAP ratio was significantly higher in patients with EMO than in those without EMO. In addition, the d-ROM/BAP ratio was positively correlated with CA125 level and r-ASRM scores in patients with EMO.

Conclusions: Oxidative stress is correlated with factors that worsen EMO. The d-ROM/BAP test may be useful for assessing disease status in patients with EMO.

背景子宫内膜异位症有多种临床特征,包括痛经、不孕和子宫内膜瘤(EMO)。虽然氧化应激状态与子宫内膜异位症密切相关,但氧化应激能力和抗氧化能力之间的平衡与子宫内膜异位症的治疗或恶化因素之间的关系尚不清楚。在这项研究中,我们使用 EMO 患者的腹腔液来研究氧化应激能力和抗氧化能力的作用。所有腹腔液样本均在手术开始时采集。我们分别使用二电子反应氧代谢物(d-ROM)和生物抗氧化潜能(BAP)测试评估了腹腔液样本的氧化应激能力和抗氧化能力。结果EMO患者的d-ROM/BAP比值明显高于非EMO患者。此外,EMO 患者的 d-ROM/BAP 比值与 CA125 水平和 r-ASRM 评分呈正相关。d-ROM/BAP测试可用于评估EMO患者的疾病状态。
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引用次数: 0
Methylation of PLK-1 Potentially Drives Bendamustine Resistance in Leukemia Cells. PLK-1的甲基化可能导致白血病细胞对本达莫司汀产生抗药性
IF 1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-05-21 Epub Date: 2023-12-08 DOI: 10.1272/jnms.JNMS.2024_91-206
Toshikazu Itabashi, Takahiro Ueda, Ryohei Fukunaga, Takeshi Asano, Yasuhiko Itoh

Background: Drug resistance remains a significant impediment in leukemia treatment. While Bendamustine hydrochloride (BH) stands out as a promising therapeutic agent for non-Hodgkin's lymphoma and mantle cell lymphoma, the mechanisms of resistance to BH are not yet fully understood. Our study focuses on elucidating the mechanisms behind bendamustine resistance in leukemia cells, with a specific emphasis on epigenetics.

Methods: Bendamustine-resistant cells were cultivated from human B cell lymphoblastic leukemia cell lines through systematic and sustained exposure to bendamustine, using the limiting dilution method. Gene expression was assessed via real-time polymerase chain reaction, while the expression of the multidrug resistance protein 1 (MDR1) was evaluated using flow cytometry.

Results: Bendamustine-resistant leukemia cells exhibited a decreased RNA expression level for Polo-like kinase-1 (PLK-1). Notably, after treatment with the demethylating agent 5-aza-2'-deoxycytidine, PLK-1 gene expression surged significantly, enhancing bendamustine's cytotoxicity in the resistant leukemia cells. However, MDR1 expression, as determined by flow cytometry, remained consistent between parental and bendamustine-resistant leukemia cells.

Conclusions: Our findings indicate that the methylation of the PLK-1 gene plays a pivotal role in modulating PLK-1 expression and is central to the development of bendamustine resistance in leukemia cells.

背景:耐药性仍然是白血病治疗的一大障碍。虽然盐酸苯达莫司汀(BH)是治疗非霍奇金淋巴瘤和套细胞淋巴瘤的一种很有前景的药物,但对 BH 产生耐药性的机制尚未完全清楚。我们的研究重点是阐明白血病细胞对苯达莫司汀产生耐药性的机制,特别强调表观遗传学:方法:使用极限稀释法,从人类 B 细胞淋巴母细胞白血病细胞系中培养出苯达莫司汀耐药细胞,这些细胞系通过系统、持续地接触苯达莫司汀而产生耐药。基因表达通过实时聚合酶链反应进行评估,多药耐药蛋白1(MDR1)的表达则通过流式细胞术进行评估:结果:对苯达莫司汀耐药的白血病细胞表现出Polo-like kinase-1(PLK-1)的RNA表达水平下降。值得注意的是,在使用去甲基化药物 5-aza-2'-deoxycytidine 处理后,PLK-1 基因表达明显增加,从而增强了苯达莫司汀对耐药白血病细胞的细胞毒性。然而,通过流式细胞术测定的MDR1表达在亲代白血病细胞和苯达莫司汀耐药白血病细胞中保持一致:我们的研究结果表明,PLK-1基因的甲基化在调节PLK-1表达方面起着关键作用,是白血病细胞产生苯达莫司汀耐药性的核心。
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引用次数: 0
Clinicopathological Characteristics of Everolimus-Associated Interstitial Lung Disease: A Single-Center Consecutive Analysis. 依维莫司相关间质性肺病的临床病理特征:单中心连续分析
IF 1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-05-21 Epub Date: 2024-01-16 DOI: 10.1272/jnms.JNMS.2024_91-211
Yoshinobu Saito, Yasuhiro Terasaki, Takeru Kashiwada, Toru Tanaka, Hiroyuki Takei, Go Kimura, Yukihiro Kondo, Tetsuro Kawagoe, Akira Matsushita, Rintaro Noro, Yuji Minegishi, Koichiro Kamio, Masahiro Seike, Akihiko Gemma

Background: Everolimus, a mammalian target of rapamycin inhibitor used as an antineoplastic drug, is associated with a remarkably high incidence of interstitial lung disease (ILD). The clinical and pathological characteristics of ILD caused by everolimus have not been thoroughly investigated; therefore, we aimed to elucidate the features of everolimus-associated ILD.

Methods: We retrospectively reviewed the medical records of patients who received everolimus for cancer treatment at our hospital. Patient backgrounds were compared between the ILD and non-ILD groups. Chest computed tomography (CT), changes in biomarkers, and lung histopathological features were analyzed for ILD cases.

Results: Sixty-six patients were reviewed, and ILD developed in 19. There were no differences in patient demographics between the ILD and non-ILD groups. The severity of ILD was grade 1 (G1) in 9 and grade 2 (G2) in 10 cases. Chest CT showed organizing pneumonia (OP) or a hypersensitive pneumonia pattern. The levels of lactate dehydrogenase, C-reactive protein, Krebs von den lungen-6, and surfactant protein-D (SP-D) at the onset of ILD were significantly higher than those at baseline. Analysis of G1 and G2 ILD subgroups showed a higher SP-D levels in the G2 subgroup. Five patients underwent lung biopsies; all specimens demonstrated alveolitis with lymphocytic infiltration and granulomatous lesions, and some had OP findings.

Conclusions: Everolimus-associated ILD is mild and has a favorable prognosis. Patients with symptomatic ILD were more likely to have higher SP-D levels than those with asymptomatic ILD. Granulomatous lesions are an important pathological feature of everolimus-associated ILD.

背景:依维莫司是一种哺乳动物雷帕霉素靶点抑制剂,被用作抗肿瘤药物,但与间质性肺病(ILD)的高发病率相关。由依维莫司引起的间质性肺病的临床和病理特征尚未得到深入研究;因此,我们旨在阐明依维莫司相关间质性肺病的特征:方法:我们回顾性地查阅了本院接受依维莫司治疗的癌症患者的病历。比较了ILD组和非ILD组患者的背景。分析了ILD病例的胸部计算机断层扫描(CT)、生物标志物的变化以及肺组织病理学特征:结果:共对 66 例患者进行了复查,其中 19 例出现了 ILD。ILD组和非ILD组患者的人口统计学特征没有差异。9 例患者的 ILD 严重程度为 1 级(G1),10 例为 2 级(G2)。胸部 CT 显示组织性肺炎(OP)或超敏性肺炎模式。ILD 发病时的乳酸脱氢酶、C 反应蛋白、Krebs von den lungen-6 和表面活性蛋白-D(SP-D)水平明显高于基线水平。对G1和G2 ILD亚组的分析表明,G2亚组的SP-D水平较高。5名患者接受了肺部活检,所有标本均显示肺泡炎伴有淋巴细胞浸润和肉芽肿病变,部分标本有OP发现:结论:依维莫司相关的ILD症状轻微,预后良好。有症状的ILD患者的SP-D水平高于无症状的ILD患者。肉芽肿病变是依维莫司相关性ILD的一个重要病理特征。
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引用次数: 0
Changes in Treatment Conditions for Patients Receiving Hemodialysis at Nippon Medical School Hospital during the COVID-19 Pandemic. COVID-19 大流行期间日本医科大学附属医院血液透析患者治疗条件的变化。
IF 1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-05-21 Epub Date: 2024-03-02 DOI: 10.1272/jnms.JNMS.2024_91-207
Naoko Shimoda, Yukinao Sakai, Takuya Nishino, Sayuri Kawasaki, Akio Hirama, Tetsuya Kashiwagi, Masato Iwabu

Background: The COVID-19 pandemic has had an enormous impact on hemodialysis patients. This study investigated changes in hemodialysis treatment at our hospital after the start of the pandemic.

Methods: We analyzed data from the Diagnosis Procedure Combination (DPC) system. Data for inpatients receiving dialysis during collection periods A (before the COVID-19 pandemic) and B (after the start of the COVID-19 pandemic) were extracted and compared. The numbers of inpatients and new patients, the number of patients admitted (by department), duration of stay, mortality, place of residence, surgical procedures, and DPC classification were compared.

Results: There were no significant differences between periods in patient age, duration of hospital stay, number of new patients, number of ambulance transports, number of deaths, body mass index, comorbidities, laboratory variables before the first dialysis after hospitalization, or patient area of residence. Although differences were observed among the departments, the numbers of emergency dialysis inpatients and maintenance dialysis inpatients increased. The number of surgeries also increased overall, particularly for maintenance dialysis patients (p = 0.0273). The percentage of DPC III patients was significantly higher in period B (p = 0.0368).

Conclusions: The number of surgeries performed on maintenance dialysis patients and the overall DPC III rate significantly increased after the start of the COVID-19 pandemic at our hospital, suggesting that COVID-19 worsened the condition of maintenance dialysis patients and prolonged hospital stays.

背景:COVID-19 大流行对血液透析患者产生了巨大影响。本研究调查了大流行开始后我院血液透析治疗的变化:我们分析了诊断程序组合(DPC)系统中的数据。我们提取并比较了 A 收集期(COVID-19 大流行之前)和 B 收集期(COVID-19 大流行开始之后)接受透析的住院患者数据。比较了住院病人和新病人的数量、入院病人的数量(按科室)、住院时间、死亡率、居住地、手术程序和 DPC 分类:不同时期的患者在年龄、住院时间、新患者人数、救护车转运次数、死亡人数、体重指数、合并症、住院后首次透析前的实验室变量或患者居住地等方面均无明显差异。虽然各部门之间存在差异,但急诊透析住院病人和维持性透析住院病人的数量都有所增加。手术数量总体上也有所增加,尤其是维持性透析患者(P = 0.0273)。B 阶段的 DPC III 患者比例明显更高(P=0.0368):结论:我院在 COVID-19 大流行开始后,为维持性透析患者实施的手术次数和 DPC III 的总体比例显著增加,这表明 COVID-19 使维持性透析患者的病情恶化,并延长了住院时间。
{"title":"Changes in Treatment Conditions for Patients Receiving Hemodialysis at Nippon Medical School Hospital during the COVID-19 Pandemic.","authors":"Naoko Shimoda, Yukinao Sakai, Takuya Nishino, Sayuri Kawasaki, Akio Hirama, Tetsuya Kashiwagi, Masato Iwabu","doi":"10.1272/jnms.JNMS.2024_91-207","DOIUrl":"10.1272/jnms.JNMS.2024_91-207","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic has had an enormous impact on hemodialysis patients. This study investigated changes in hemodialysis treatment at our hospital after the start of the pandemic.</p><p><strong>Methods: </strong>We analyzed data from the Diagnosis Procedure Combination (DPC) system. Data for inpatients receiving dialysis during collection periods A (before the COVID-19 pandemic) and B (after the start of the COVID-19 pandemic) were extracted and compared. The numbers of inpatients and new patients, the number of patients admitted (by department), duration of stay, mortality, place of residence, surgical procedures, and DPC classification were compared.</p><p><strong>Results: </strong>There were no significant differences between periods in patient age, duration of hospital stay, number of new patients, number of ambulance transports, number of deaths, body mass index, comorbidities, laboratory variables before the first dialysis after hospitalization, or patient area of residence. Although differences were observed among the departments, the numbers of emergency dialysis inpatients and maintenance dialysis inpatients increased. The number of surgeries also increased overall, particularly for maintenance dialysis patients (p = 0.0273). The percentage of DPC III patients was significantly higher in period B (p = 0.0368).</p><p><strong>Conclusions: </strong>The number of surgeries performed on maintenance dialysis patients and the overall DPC III rate significantly increased after the start of the COVID-19 pandemic at our hospital, suggesting that COVID-19 worsened the condition of maintenance dialysis patients and prolonged hospital stays.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":" ","pages":"172-179"},"PeriodicalIF":1.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140023466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Human Adipose Tissue-Derived Stem Cells Inhibit Coronary Artery Vasculitis in a Mouse Model of Kawasaki Disease. 人脂肪组织衍生干细胞可抑制川崎病小鼠模型中的冠状动脉血管炎。
IF 1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-05-21 Epub Date: 2024-01-16 DOI: 10.1272/jnms.JNMS.2024_91-212
Ryohei Fukunaga, Takahiro Ueda, Ryosuke Matsui, Toshikazu Itabashi, Ryuji Fukazawa, Noriko Nagi-Miura, Yasuhiko Itoh

Background: Adipose tissue-derived mesenchymal stem cells (ADSCs) are used for the treatment of various diseases because of their rapid proliferation and high anti-inflammatory and tissue repair properties. Kawasaki disease is a systemic vasculitis with coronary arteritis and aneurysms occurring in pediatric patients. In this study, we examined serologically and pathologically whether the administration of human ADSCs (hADSCs) to a mouse model of Kawasaki disease could suppress vasculitis.

Methods: Candida albicans water-soluble fractions were intraperitoneally injected into DBA/2 mice for 5 consecutive days to generate a mouse model of Kawasaki disease. The model mice were intravenously administered hADSCs or phosphate-buffered saline (PBS). Serum samples collected on days 15 and 29 were used to compare cytokine levels. Mouse hearts dissected on day 29 were subjected to hematoxylin and eosin and immunohistological staining using Galectin-1 (Gal-1), a protein involved in cardiovascular homeostasis, and CD44, a cell-surface marker of hADSCs.

Results: Comparison of inflammation-related cytokines showed a significant decrease in IL-1α expression at day 15 (P<0.05) and IL-6 expression at day 29 (P<0.01) in the hADSCs-treated group compared to the PBS group. Evaluation by hematoxylin and eosin staining showed decreased inflammatory cell infiltration and a tendency towards increased Gal-1 expression in the hADSCs group. CD44 expression was not observed in both the groups. The survival curve showed that the hADSCs group had a significantly longer survival time (P<0.05).

Conclusions: The present experimental results indicate that hADSCs have an early anti-inflammatory effect, and that Gal-1 may be involved in preventing inflammation and reducing tissue damage.

背景:脂肪组织间充质干细胞(ADSCs)具有快速增殖、高度抗炎和组织修复的特性,因此被用于治疗各种疾病。川崎病是一种全身性血管炎,多发于儿童患者,伴有冠状动脉炎和动脉瘤。在这项研究中,我们从血清学和病理学角度研究了在川崎病小鼠模型中应用人 ADSCs(hADSCs)能否抑制血管炎:方法:将白色念珠菌水溶性部分连续5天腹腔注射给DBA/2小鼠,以产生川崎病小鼠模型。给模型小鼠静脉注射 hADSCs 或磷酸盐缓冲液(PBS)。第 15 天和第 29 天采集的血清样本用于比较细胞因子水平。第29天剖开的小鼠心脏进行苏木精和伊红染色,并使用Galectin-1(一种参与心血管稳态的蛋白质)和CD44(一种hADSCs的细胞表面标志物)进行免疫组织学染色:结果:与炎症相关的细胞因子比较显示,IL-1α的表达在第15天时显著下降(PC结论:本实验结果表明,hADSCs具有早期抗炎作用,Gal-1可能参与了预防炎症和减少组织损伤的过程。
{"title":"Human Adipose Tissue-Derived Stem Cells Inhibit Coronary Artery Vasculitis in a Mouse Model of Kawasaki Disease.","authors":"Ryohei Fukunaga, Takahiro Ueda, Ryosuke Matsui, Toshikazu Itabashi, Ryuji Fukazawa, Noriko Nagi-Miura, Yasuhiko Itoh","doi":"10.1272/jnms.JNMS.2024_91-212","DOIUrl":"10.1272/jnms.JNMS.2024_91-212","url":null,"abstract":"<p><strong>Background: </strong>Adipose tissue-derived mesenchymal stem cells (ADSCs) are used for the treatment of various diseases because of their rapid proliferation and high anti-inflammatory and tissue repair properties. Kawasaki disease is a systemic vasculitis with coronary arteritis and aneurysms occurring in pediatric patients. In this study, we examined serologically and pathologically whether the administration of human ADSCs (hADSCs) to a mouse model of Kawasaki disease could suppress vasculitis.</p><p><strong>Methods: </strong>Candida albicans water-soluble fractions were intraperitoneally injected into DBA/2 mice for 5 consecutive days to generate a mouse model of Kawasaki disease. The model mice were intravenously administered hADSCs or phosphate-buffered saline (PBS). Serum samples collected on days 15 and 29 were used to compare cytokine levels. Mouse hearts dissected on day 29 were subjected to hematoxylin and eosin and immunohistological staining using Galectin-1 (Gal-1), a protein involved in cardiovascular homeostasis, and CD44, a cell-surface marker of hADSCs.</p><p><strong>Results: </strong>Comparison of inflammation-related cytokines showed a significant decrease in IL-1α expression at day 15 (P<0.05) and IL-6 expression at day 29 (P<0.01) in the hADSCs-treated group compared to the PBS group. Evaluation by hematoxylin and eosin staining showed decreased inflammatory cell infiltration and a tendency towards increased Gal-1 expression in the hADSCs group. CD44 expression was not observed in both the groups. The survival curve showed that the hADSCs group had a significantly longer survival time (P<0.05).</p><p><strong>Conclusions: </strong>The present experimental results indicate that hADSCs have an early anti-inflammatory effect, and that Gal-1 may be involved in preventing inflammation and reducing tissue damage.</p>","PeriodicalId":56076,"journal":{"name":"Journal of Nippon Medical School","volume":" ","pages":"218-226"},"PeriodicalIF":1.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139486189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Performance of a Large Language Model on Japanese Emergency Medicine Board Certification Examinations. 大型语言模型在日本急诊医学委员会认证考试中的表现。
IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-05-21 Epub Date: 2024-03-02 DOI: 10.1272/jnms.JNMS.2024_91-205
Yutaka Igarashi, Kyoichi Nakahara, Tatsuya Norii, Nodoka Miyake, Takashi Tagami, Shoji Yokobori

Background: Emergency physicians need a broad range of knowledge and skills to address critical medical, traumatic, and environmental conditions. Artificial intelligence (AI), including large language models (LLMs), has potential applications in healthcare settings; however, the performance of LLMs in emergency medicine remains unclear.

Methods: To evaluate the reliability of information provided by ChatGPT, an LLM was given the questions set by the Japanese Association of Acute Medicine in its board certification examinations over a period of 5 years (2018-2022) and programmed to answer them twice. Statistical analysis was used to assess agreement of the two responses.

Results: The LLM successfully answered 465 of the 475 text-based questions, achieving an overall correct response rate of 62.3%. For questions without images, the rate of correct answers was 65.9%. For questions with images that were not explained to the LLM, the rate of correct answers was only 52.0%. The annual rates of correct answers to questions without images ranged from 56.3% to 78.8%. Accuracy was better for scenario-based questions (69.1%) than for stand-alone questions (62.1%). Agreement between the two responses was substantial (kappa = 0.70). Factual error accounted for 82% of the incorrectly answered questions.

Conclusion: An LLM performed satisfactorily on an emergency medicine board certification examination in Japanese and without images. However, factual errors in the responses highlight the need for physician oversight when using LLMs.

背景 急诊医生需要广泛的知识和技能来应对危急的医疗、创伤和环境状况。人工智能(AI),包括大型语言模型(LLMs),在医疗环境中具有潜在的应用价值;然而,LLMs 在急诊医学中的表现仍不明确。方法 为了评估 ChatGPT 所提供信息的可靠性,向一名 LLM 提供了日本急诊医学协会在其董事会认证考试中设置的问题,为期 5 年(2018-2022 年),并通过编程让其回答两次。结果 在 475 道基于文本的问题中,法学硕士成功回答了 465 道,总体正确率为 62.3%。对于没有图片的问题,正确率为 65.9%。对于有图像但未向 LLM 解释的问题,正确率仅为 52.0%。无图像问题的年正确率为 56.3% 至 78.8%。基于情景的问题(69.1%)的正确率高于独立问题(62.1%)。两种回答之间的一致性很高(kappa = 0.70)。在回答错误的问题中,事实错误占 82%。然而,答题中的事实错误凸显了医生在使用 LLM 时进行监督的必要性。
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引用次数: 0
Safety and Feasibility of Laparoscopic Liver Resection with the Clamp-Crush Method Using the BiSect. 使用 BiSect 采用钳夹法进行腹腔镜肝脏切除术的安全性和可行性。
IF 1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-03-09 Epub Date: 2023-12-08 DOI: 10.1272/jnms.JNMS.2024_91-112
Masato Yoshioka, Tetsuya Shimizu, Junji Ueda, Mampei Kawashima, Toshiyuki Irie, Takahiro Haruna, Takashi Ohno, Yoichi Kawano, Yoshiaki Mizuguchi, Akira Matsushita, Nobuhiko Taniai, Hiroshi Yoshida

Background: Various energy devices are available for resection of the liver parenchyma during laparoscopic liver resection (LLR). We have historically performed liver resections using the Cavitron Ultrasonic Surgical Aspirator (CUSA). More recently, we have used new bipolar forceps (BiSect; Erbe Elektromedizin GmbH, Tübingen, Germany) to perform clamp-crush dissection with good results. The BiSect is a reusable bipolar forceps with a laparoscopic dissecting forceps tip and both an incision mode and coagulation mode. We evaluated the perioperative clinical course of patients who underwent LLR using the clamp-crush method with the BiSect compared with the CUSA.

Methods: This single-center case control study involved patients with liver metastasis from colorectal cancer who underwent LLR using either the BiSect or CUSA at our hospital from January 2019 to December 2022. We performed the LLR using CUSA from January 2019 to early October 2020. After introduction of the BiSect in late October 2020, we used BiSect for the LLR. Before surgery, the three-dimensional liver was constructed based on computed tomography images, and a preoperative simulation was performed. We evaluated the results of LLR using the BiSect versus the CUSA and assessed the short-term results of LLR.

Results: During the study period, we performed partial liver resection using the BiSect in 26 patients and the CUSA in 16 patients. In the BiSect group, the median bleeding volume was 55 mL, the median operation time was 227 minutes, and the median postoperative length of hospital stay was 9 days. In the CUSA group, the median bleeding volume was 87 mL, the median operation time was 305 minutes, and the median postoperative length of hospital stay was 10 days. There were no statistically significant differences in the clinical course including bile leakage, bile duct stenosis, and post operative hospital stay between the two groups.

Conclusions: Compared with LLR using the CUSA, the clamp-crush method using the BiSect in LLR is a safe and useful liver transection technique. Further study should be conducted to clarify whether BiSect is safe and useful in LLR for patients with other tumor types and patients who undergo other procedures.

背景:在腹腔镜肝脏切除术(LLR)中,有多种能量设备可用于切除肝实质。我们一直使用 Cavitron 超声波手术抽吸器(CUSA)进行肝脏切除。最近,我们使用新型双极镊子(BiSect;Erbe Elektromedizin GmbH,德国图宾根)进行钳压解剖,效果良好。BiSect 是一种可重复使用的双极镊子,具有腹腔镜剥离镊的尖端,同时具有切割模式和凝固模式。我们评估了使用 BiSect 与 CUSA 进行钳夹法 LLR 患者的围手术期临床过程:这项单中心病例对照研究涉及2019年1月至2022年12月期间在我院使用BiSect或CUSA进行LLR的结直肠癌肝转移患者。我们在 2019 年 1 月至 2020 年 10 月初使用 CUSA 进行了 LLR。手术前,我们根据计算机断层扫描图像构建了三维肝脏,并进行了术前模拟。我们评估了使用 BisSect 与 CUSA 进行 LLR 的结果,并评估了 LLR 的短期效果:在研究期间,我们使用 BiSect 对 26 名患者进行了肝脏部分切除术,使用 CUSA 对 16 名患者进行了肝脏部分切除术。BiSect 组的中位出血量为 55 毫升,中位手术时间为 227 分钟,中位术后住院时间为 9 天。CUSA 组的中位出血量为 87 毫升,中位手术时间为 305 分钟,中位术后住院时间为 10 天。两组患者在胆汁渗漏、胆管狭窄和术后住院时间等临床病程方面的差异无统计学意义:结论:与使用 CUSA 的 LLR 相比,在 LLR 中使用 BiSect 的钳夹-挤压法是一种安全有效的肝横断技术。应开展进一步研究,以明确 BiSect 在其他类型肿瘤患者和接受其他手术的患者的 LLR 中是否安全和有用。
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引用次数: 0
Distribution of Splenic Arterial Flow and Segmental Spleen Volume for Partial Splenic Arterial Embolization. 部分脾动脉栓塞术的脾动脉血流和脾脏节段体积分布。
IF 1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-03-09 Epub Date: 2023-12-08 DOI: 10.1272/jnms.JNMS.2024_91-108
Junji Ueda, Yasuhiro Mamada, Nobuhiko Taniai, Masato Yoshioka, Akira Matsushita, Satoshi Mizutani, Yoichi Kawano, Tetsuya Shimizu, Tomohiro Kanda, Hideyuki Takata, Hiroyasu Furuki, Yuto Aoki, Mampei Kawashima, Toshiyuki Irie, Takashi Ohno, Takahiro Haruna, Hiroshi Yoshida

Introduction: The spleen is a lymphatic organ that manages immune surveillance of the blood, produces blood cells, and helps filter the blood, remove old blood cells, and fight infection. The normal splenic weight is approximately 65-265 g. This study evaluated spleen volume and segmental volume.

Methods: 121 patients who underwent enhanced CT at our center were analyzed. The spleen was divided into upper, middle, and lower segments according to arterial flow area, and the volume of each segment was measured. Patients were classified into two groups as those with and without liver cirrhosis, and differences in the distribution of the segments in these groups was evaluated.

Results: The mean upper, middle, and lower spleen segmental volume ratios were 35.4%, 37.0%, and 27.6%, respectively. In the liver cirrhosis group, the segmental splenic volume ratios for the upper, middle, and lower segments were 34.5%, 38.5%, and 28.0%, respectively, indicating that these ratios remain similar regardless of liver cirrhosis status.

Conclusion: The present findings on segmental spleen volume are useful for estimating infarction volume in cases of partial splenic arterial embolization.

引言脾脏是一个淋巴器官,负责管理血液的免疫监视、制造血细胞,并帮助过滤血液、清除老旧血细胞和抗感染。正常脾脏重量约为 65-265 克。本研究对脾脏体积和节段体积进行了评估。根据动脉血流面积将脾脏分为上段、中段和下段,并测量各段的体积。将患者分为有肝硬化和无肝硬化两组,并评估这两组患者脾脏节段分布的差异:结果:平均上、中、下脾段体积比分别为 35.4%、37.0% 和 27.6%。在肝硬化组中,上、中、下脾段体积比分别为 34.5%、38.5% 和 28.0%,这表明无论肝硬化状况如何,这些比率都是相似的:结论:目前关于脾脏节段体积的研究结果有助于估计部分脾动脉栓塞病例的梗死体积。
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引用次数: 0
Molecular Mechanisms of Macroautophagy, Microautophagy, and Chaperone-Mediated Autophagy. 大自噬、微自噬和伴侣介导的自噬的分子机制。
IF 1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-03-09 Epub Date: 2023-06-02 DOI: 10.1272/jnms.JNMS.2024_91-102
Hayashi Yamamoto, Takahide Matsui

Autophagy is a self-digestive process that is conserved in eukaryotic cells and responsible for maintaining cellular homeostasis through proteolysis. By this process, cells break down their own components in lysosomes. Autophagy can be classified into three categories: macroautophagy, microautophagy, and chaperone-mediated autophagy (CMA). Macroautophagy involves membrane elongation and microautophagy involves membrane internalization, and both pathways undergo selective or non-selective processes that transport cytoplasmic components into lysosomes to be degraded. CMA, however, involves selective incorporation of cytosolic materials into lysosomes without membrane deformation. All three categories of autophagy have attracted much attention due to their involvement in various biological phenomena and their relevance to human diseases, such as neurodegenerative diseases and cancer. Clarification of the molecular mechanisms behind these processes is key to understanding autophagy and recent studies have made major progress in this regard, especially for the mechanisms of initiation and membrane elongation in macroautophagy and substrate recognition in microautophagy and CMA. Furthermore, it is becoming evident that the three categories of autophagy are related to each other despite their implementation by different sets of proteins and the involvement of completely different membrane dynamics. In this review, recent progress in macroautophagy, microautophagy, and CMA are summarized.

自噬是真核细胞中保留的一种自我消化过程,负责通过蛋白质分解维持细胞的平衡。通过这一过程,细胞分解溶酶体中的自身成分。自噬可分为三类:大自噬、微自噬和伴侣介导的自噬(CMA)。大自噬涉及膜伸长,微自噬涉及膜内化,这两种途径都会经历选择性或非选择性过程,将细胞质成分运送到溶酶体中降解。而 CMA 则是选择性地将细胞质物质纳入溶酶体,而不发生膜变形。这三类自噬都与各种生物现象有关,并与人类疾病(如神经退行性疾病和癌症)相关,因此备受关注。阐明这些过程背后的分子机制是理解自噬的关键,最近的研究在这方面取得了重大进展,特别是大自噬的启动和膜伸长机制以及微自噬和 CMA 的底物识别机制。此外,越来越明显的是,这三种类型的自噬尽管由不同的蛋白质实现,并涉及完全不同的膜动力学,但它们之间是相互关联的。本综述总结了大自噬、微自噬和CMA的最新进展。
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引用次数: 0
期刊
Journal of Nippon Medical School
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