JMA journal最新文献

Introduction: We examined the obstetric and neonatal outcomes of using mechanical methods (i.e., insertion of Dilapan as the synthetic equivalent in the cervical canal) for cervical ripening in cases with premature rupture of the membranes (PROMs) at term.

Methods: The criteria for inclusion in this retrospective observational study were as follows: PROM, singleton pregnancy, cephalic presentation, gestational age of 37-41 weeks, and a Bishop score of 0-2 at the beginning of induction. During the study period, 85 women met the criterion, and mechanical methods were used for cervical ripening following PROM. We examined the rate of cesarean delivery, number of days from the start of induction to delivery, umbilical artery pH, the incidence of clinical intrauterine infection, and neonatal infection.

Results: In cases of using mechanical methods following PROM at term, the number of days from the start of induction to delivery was 2.1 ± 2 days. The rate of cesarean delivery was 26% (22/85). The incidence of clinical intrauterine infection during labor was 7% (6/85), while there were no cases of neonatal infection. In addition, the incidence of maternal fever after the third postoperative day was 1% (1/85).

Conclusions: The current results suggest the potential clinical utility of mechanical cervical ripening methods following PROM at term.

Introduction: Many patients with cancer experience physical and/or psychological distress when undergoing Comprehensive Cancer Genome Profiling (CGP) after being diagnosed with cancer. However, not all of these patients necessarily visit palliative care clinics. This study aimed to clarify the extent to which patients who underwent the CGP test experience physical and emotional distress.

Methods: The "Ease of Living Questionnaire" was administered to 75 patients who visited our CGP outpatient clinic between November 2022 and July 2023, and patient backgrounds were investigated.

Results: Of the 75 patients, 8 (16%) had physical symptoms graded as ≥3/5, and five had visited a palliative care outpatient clinic. On the other hand, 14 patients (28%) had psychological symptoms graded as ≥6/10, but only eight visited the palliative care outpatient clinic.

Conclusions: Several patients who underwent CGP examinations at our hospital experienced physical and psychological distress, suggesting a strong need for palliative care. However, the number of patients who undergo interventions by palliative care physicians is not necessarily high. It is important to take advantage of the fact that CGP outpatient clinics provide sufficient time for healthcare professionals to meet with patients and their families, as well as to seek to connect patients in need of palliative care with appropriate palliative care CGP outpatient clinics in the future.

Introduction: Unplanned pregnancy is associated with maternal-infant abuse. We investigated the association between unplanned pregnancy and maternal abusive behaviors and whether this relationship is mediated by bonding impairment.

Methods: We analyzed data from a sample of mothers with 3-4-month-old infants in Japan (n = 5,706). Multivariable logistic regression models were used to assess the associations among unplanned pregnancy, bonding impairment, and maternal-infant abuse. Causal mediation analysis was conducted to estimate the mediating effect of bonding impairment on the relationship between unplanned pregnancy and maternal-infant abuse.

Results: Among mothers who engaged in infant abuse, 24.8% reported an unplanned pregnancy, compared to 17.7% among those who did not. Unplanned pregnancy was significantly associated with an increased risk of maternal-infant abuse in a multivariable analysis (adjusted odds ratio [OR] = 1.36; 95% confidence interval [CI], 1.02-1.80). After adjusting for bonding impairment as a mediator, the association was attenuated (OR = 1.28; 95% CI, 0.96-1.70). Causal mediation analysis revealed a natural direct effect of unplanned pregnancy on maternal-infant abuse (OR = 1.28; 95% CI, 0.96-1.70), as well as a natural indirect effect through bonding impairment as a mediator (OR = 1.06; 95% CI, 1.03-1.09). Bonding impairment accounted for 20.1% of the association between unplanned pregnancy and maternal-infant abuse.

Conclusions: Bonding impairment partially mediates the relationship between unplanned pregnancy and maternal-infant abuse.

Introduction: Oral frailty, defined as an age-related decline in oral function, represents a significant risk factor for adverse health outcomes, though it can be mitigated through early intervention. The Oral Frailty Five-item Checklist (OF-5), introduced in 2023, assesses oral frailty using 5 indicators: reduced number of teeth, difficulty chewing, difficulty swallowing, dry mouth, and low articulatory oral motor skills. Designed for use beyond dental clinics, the OF-5 has demonstrated predictive validity for physical frailty and mortality. Similarly, the Oral Frailty Index-8 (OFI-8) comprises 8 items evaluating oral health, social participation, and dental habits.

Methods: This study compared the OF-5 and OFI-8 tools and investigated their associations with physical and biological markers. A cross-sectional analysis was conducted on 270 Japanese participants aged ≥65 years (median age: 78 years). The assessments included blood tests, physical measurements, and grip strength evaluation. Participants were categorized by sex and oral frailty risk based on OF-5 scores (non-frailty: ≤1; frailty: ≥2).

Results: Oral frailty, defined as an OF-5 score ≥2, was observed in 40.7% of the participants (33.8% in men and 47.4% in women). Both the OF-5 and OFI-8 scores were higher in women than in men. Sex-specific differences in physical and biological markers were evident; men exhibited higher grip strength, whereas women had a higher prevalence of anemia and osteoporosis. Women were also more likely to report reduced masticatory ability and lower levels of social participation. A high concordance rate of over 80% was observed between oral frailty (OF-5 score ≥2) and high-risk oral frailty (OFI-8 score ≥4).

Conclusions: These findings highlight the utility of subjective questionnaires in assessing oral frailty and emphasize the need for longitudinal studies to evaluate their predictive accuracy for physical frailty.

Pseudo-mesenteric cysts are exceptionally rare lesions, with limited reports of surgical management. This case highlights the novelty of enucleating a large infected pseudo-mesenteric cyst without intestinal resection, emphasizing its clinical significance. We report the case of a 64-year-old man who presented with acute abdomen. Computed tomography revealed a cystic lesion approximately 17 cm in size with an enhanced capsule in the sigmoid mesentery. Emergency surgery was warranted due to severe inflammation and inferior vena cava compression. Initial laparoscopy ruled out appendiceal abnormalities, and laparotomy was performed. Careful dissection along the thickened cyst wall, as seen on preoperative imaging, enabled complete enucleation without the need for intestinal resection. This case demonstrates successful enucleation of a giant pseudo-mesenteric cyst, a rare surgical challenge, highlighting the importance of meticulous surgical planning and technique.

Introduction: This study examines patient behavior in Tokyo, Japan, during the early phase of the coronavirus disease 2019 (COVID-19) pandemic.

Methods: As part of a prospective cohort study on gastric cancer screening participants, we conducted a cross-sectional survey from April 2021 to March 2022. The survey included 1,554 participants (40.5% men, median age: 62, age range: 32-92). Specifically, we investigated whether participants continued hospital follow-up visits and underwent medical checkups and disease prevention screenings during the initial state of emergency in Japan (April to May 2020). We also explored changes in daily life and the psychological effects of COVID-19.

Results: During the state of emergency, 12.7% of men and 20.4% of women discontinued follow-up visits, with the primary reason being a desire to avoid human contact. Additionally, 6.5% of men and 14.2% of women ceased medical checkups and screenings. Among women, those who reported increased time spent on housework and family care, or experienced heightened stress and conflicts with housemates, were significantly more likely to discontinue or delay follow-up visits or treatment (odds ratio [OR] 1.55 [1.08-2.23], OR 1.53 [1.06-2.21]).

Conclusions: Our findings indicate that some middle-aged and elderly Japanese residents in urban areas avoided healthcare services to reduce the risk of COVID-19 infection. A subset of individuals continued this behavior even after the pandemic subsided. It is crucial to prioritize regular checkups for managing chronic illnesses and preventing new conditions. Effective communication strategies should be developed in collaboration with national and local governments.

Sensor-augmented pumps (SAPs) and automated insulin delivery (AID) systems are innovative technologies for diabetes management. Accurate continuous glucose monitoring (CGM) is crucial for their safe and effective use; however, certain commonly used drugs can interfere with CGM accuracy. Although acetaminophen is known to cause falsely elevated CGM glucose values, previous CGM studies have primarily focused on its oral administration, with limited data on intravenous use. We report a case of a CGM reaction after the intravenous administration of acetaminophen in a boy with type 1 diabetes using SAP. The patient received repeated doses of intravenous acetaminophen (15 mg/kg for 15 min) for pain relief. After administration, we recorded a rapid increase in his CGM readings without a corresponding increase in blood glucose levels. The CGM glucose peaked at 29.2 ± 1.9 min (mean ± standard deviation) after administration and an estimated discrepancy of 55 to 114 mg/dL compared with capillary blood glucose measurements. Discrepancies between measured blood glucose and CGM readings were significantly greater at lower glucose levels. These falsely elevated CGM readings could potentially trigger an inappropriate autocorrection bolus in AID systems and increase the risk of hypoglycemia. Medical professionals should be fully aware of acetaminophen-induced CGM interference, particularly the potential risks in patients using AID systems.