Journal of Nippon Medical School最新文献

Neuropsychiatric disorders such as multiple sclerosis, Alzheimer's disease, and autism spectrum disorder exhibit significant sex differences in prevalence, progression, and response to treatment. Emerging evidence suggests that oligodendrocytes (OLs) and oligodendrocyte precursor cells (OPCs) play pivotal roles in these pathologies via mechanisms involving neuroinflammation, energy metabolism, and hormonal modulation, resulting in distinct functional outcomes. Specifically, female OPCs display higher proliferative and migratory capacities, whereas male OPCs are more prone to differentiation and myelination, thus contributing to robust myelin integrity. Dysregulation of these cells disrupts myelination and exacerbates disease progression. Addressing sex-specific gene expression in OPCs and OLs is therefore considered crucial for the development of targeted therapeutic strategies. This review highlights the significance of sex differences in the proliferation and differentiation of OPCs, as well as gene expression changes in OPCs and OLs, and emphasizes their contribution to the pathophysiology of neuropsychiatric disorders. Improved understanding of these differences is vital for advancing personalized sex-specific treatments and improving the clinical outcomes of neuropsychiatric disorders.

Background: Cancer pain distresses pediatric patients, affects quality of life, and is a psychological burden for families. The purpose of this study was to clarify the role of pharmacists in assisting children with cancer pain and their families.

Methods: Between February and May 2024, a nationwide questionnaire survey was conducted among hospital pharmacists from the Japanese Society for Pharmaceutical Palliative Care and Sciences. The survey examined pharmacist involvement with children <15 years of age with cancer pain and their families, particularly in pain assessment, explaining analgesic use, and managing psychological, social, and spiritual pain.

Results: Of 2,720 pharmacists, 219 (8.1%) responded, 57 of whom (26.0%) had pediatric palliative care experience. Most pharmacists performed pain assessments, provided analgesic explanations (86.0%), and intervened in psychological, social, and spiritual pain (54.4%). Among those who intervened, more than 90% either communicated with patients and their families or listened to their concerns. Pharmacists with ≥5 years of experience were significantly more involved in psychological, social, and spiritual pain than were those with <5 years of experience (odds ratio, 3.46; 95% confidence interval, 1.04-11.54). However, most pharmacists reported difficulties in pain assessment and providing analgesic explanations; the main reasons were "due to patient age and comprehension" (87.0%) and "reluctance to initiate opioid analgesics by patients or their families" (68.3%), respectively.

Conclusions: Pharmacists were actively engaged in pain management for children with cancer and their families. However, most reported difficulties, particularly in pain assessment and analgesic explanations. Therefore, educational programs should be developed to facilitate effective pain management.

Peripapillary hyperreflective ovoid mass-like structures (PHOMS) are a novel, incompletely understood finding in several optic nerve disorders. We describe PHOMS in two Japanese men. Both underwent general ophthalmologic examination as well as multimodal imaging, including visual field testing, fundus photography, spectral-domain optical coherence tomography (SD-OCT), OCT angiography (OCTA), B-scan ultrasonography, fundus autofluorescence (FAF) imaging, and fluorescence angiography. Case 1 was a 31-year-old man with normal pupillary reactions and normal visual acuity in both eyes. SD-OCT revealed PHOMS-oval hyperintense lesions-around the right optic disc. OCTA showed a vascular complex in the PHOMS, and FAF showed a blurry area of hypoautofluorescence at the optic disc. Case 2 was a 61-year-old man who, after undergoing several examinations, was diagnosed as having primary open angle glaucoma with a tilted disc. During a comprehensive examination, a color change was detected at the nasal side of the optic disc in his left eye; SD-OCT revealed PHOMS. One of these two Japanese patients with PHOMS had no other ophthalmic conditions, while the other had glaucoma with a tilted optic disc. Although SD-OCT and OCTA were essential in diagnosing PHOMS, multimodal imaging is required in order to rule out other disorders.

Background: The effects of helicopter emergency medical services on the treatment of cerebral infarction remains unclear. We investigated the effects of helicopter transport on outcomes in patients with cerebral infarction.

Methods: This study included 1,246 patients with cerebral infarction who were assigned to two groups: patients transported by "Doctor-Heli" (DH group) and patients transported by ground ambulances (GA group). Cerebral performance category (CPC), overall performance category (OPC), and in-hospital mortality were evaluated. Multivariate logistic regression analysis was used to adjust for background factors and evaluate a subgroup of patients with severe cerebral infarction (i.e., a National Institutes of Health Stroke Scale (NIHSS) score >10).

Results: The DH group included more patients with severe cerebral infarction. No difference was observed in the interval from illness onset to recombinant tissue plasminogen activator treatment between the groups; however, the interval from illness onset to interventional radiology (IR) was significantly shorter in the DH group. The DH group had a lower CPC than the GA group, but there was no significant difference in OPC. Multivariate logistic regression analysis showed that the odds ratio of DH transport for OPC1-2 was 2.33. Subgroup analysis of severe cases yielded odds ratios of 2.19 and 2.62 for CPC1-2 and OPC1-2 respectively.

Conclusion: The DH group included patients with severe cerebral infarction living in remote areas and provided with emergency IR treatment. This analysis suggested that DH transport improves OPC and CPC, particularly in patients with an NIHSS scores of >10.

Background: Osteoporosis-related fragility fractures such as proximal femoral and vertebral fractures are associated with decreased activities of daily living and a shorter life span. Many persons with osteoporosis do not receive testing or treatment. Introducing fracture liaison services (FLSs) to hospitals is an effective approach for reducing this treatment gap. Understanding interest in osteoporosis among nurses and physicians, their knowledge of osteoporosis, and their thoughts on team medicine for treatment of osteoporosis might be helpful when implementing FLSs.

Methods: An FLS had not been introduced at our hospital. We conducted a questionnaire survey of nurses and physicians at our hospital regarding their interest in osteoporosis, their knowledge of osteoporosis, and their thoughts on team medicine for osteoporosis.

Results: About half of the nurses and physicians were interested in osteoporosis. About 70% of nurses and physicians believed that team medicine was necessary for treating osteoporosis, and 50-60% believed that it should be introduced in the hospital. Only 5% of nurses and 18% of physicians had knowledge of FLSs.

Conclusion: Staff perceptions of team care for osteoporosis were generally supportive in our hospital. However, the introduction of an FLS to the hospital required educational activities for staff. The results of this survey will be helpful to other hospitals introducing FLSs.

Background: Use of radiocolloids for sentinel lymph node (SLN) detection in breast cancer (BC) offers the advantage of utilizing single-photon emission computed tomography/computed tomography (SPECT/CT). This study explored whether SPECT/CT findings can predict pathological axillary lymph node (ALN) metastasis.

Methods: A consecutive series of patients with invasive BC (clinical stage, T1-3, N0, and M0) who underwent SLN biopsy (SLNB) using SPECT/CT between January 2011 and December 2016 were included. SLN detection, location, and number on SPECT/CT, number of excised SLNs, and clinical and pathological characteristics were analyzed in relation to pathological ALN metastasis.

Results: Data from 408 patients (412 cases) with BC were analyzed. Patient age ranged from 28 to 93 years (mean: 59). SPECT/CT identified one to four SLNs (mean: 1.3) in 407 cases (98.8%) and no SLNs in 5 cases (1.2%). Of the 407 cases with at least one identified SLN, SLNs were solely in level I of the axilla in 394 cases (96.8%), both in and outside level I in 12 (2.9%), and solely outside of level I in 1 (0.2%). The number of ALNs removed via SLNB ranged from one to eight (mean: 2.0). SPECT/CT findings, including absence of SLN detection (P<0.001), SLN locations outside of axillary level I (P<0.001), and an increased number of SLNs (P=0.034), as well as removal of ≥3 SLNs (P=0.028), were significantly correlated with pathological ALN metastasis.

Conclusions: SLNB with SPECT/CT yields useful information on pathological ALN metastasis in BC patients.

Background: Ischemic stroke (IS) is one of the most serious complications after cardiac catheterization. This study aimed to investigate the incidence of IS in patients undergoing cardiac catheterization as well as the risk factors and neurological prognosis of IS.

Methods: We retrospectively analyzed the data of consecutive 2,848 patients (age 69.1 ± 11.1 years, 2,118 men) who underwent cardiac catheterization from January 2011 to December 2013 to determine the incidence and clinical outcomes of IS.

Results: Thirteen patients (0.46%) developed IS after cardiac catheterization, necessitating treatment in the stroke care unit. Multivariate analysis identified five unmodifiable risk factors (age, atrial fibrillation, current smoking, prior stroke, and prior coronary artery bypass graft surgery) and two modifiable risk factors (additional internal thoracic artery angiography and the transbrachial approach) associated with IS. The initial National Institutes of Health Stroke Scale score was 6.9 ± 9.3 at the onset of IS, which improved to 3.1 ± 8.2 at the time of discharge. Five patients demonstrated complete recovery at discharge (modified Rankin Scale [mRS] score = 0), seven demonstrated residual neurological deficit (mRS = 2.7 ± 1.7, including two cases of severe deficit), and one patient died in hospital (mRS = 6).

Conclusions: Although rare, IS following cardiac catheterization is associated with significant morbidity and mortality. Avoiding unnecessary internal thoracic artery angiography and the brachial approach may reduce the incidence, and appropriate use of anticoagulants or thrombolytics may improve the prognosis and decrease residual neurological deficits.

Background: The standard of care in Japan for preterm very low-birth-weight (VLBW) infants has long been at the highest level internationally, owing to advances in technology and the perinatal medical system throughout the country.

Methods: To identify issues for further improvement of outcomes for preterm VLBW infants in our neonatal intensive care unit (NICU), perinatal care practice was reviewed by analyzing data from medical records on pregnancy complications and management and infant mortality and morbidity.

Results: Data from 250 preterm VLBW infants, excluding those with severe congenital anomalies, were analyzed. There were 49 cases (19.6%) of cumulative morbidity, including infants who died before discharge and those who had major complications such as bronchopulmonary dysplasia, intraventricular hemorrhage/periventricular leukomalacia, and retinopathy of prematurity. The prevalence remained constant throughout the study period. Infants born via medically indicated preterm birth had a higher cumulative morbidity rate than those born via spontaneous preterm birth. Small-for-gestational-age status was the only factor significantly associated with cumulative morbidity in multivariate analysis. Of all the infants, 69 (47.3%) completed a course of antenatal corticosteroids (ACS).

Conclusions: The quality of neonatal intensive care for preterm VLBW infants in our NICU was consistent with outcomes for top-ranked NICUs in Japan. Critical issues in improving outcomes for these infants include determining the optimal timing of delivery by comprehensively assessing fetal well-being and promoting ACS.