Influence of Biomedical Factors on the Five Viscera Score (FVS) on Middle-Aged and Elderly Individuals: Application of Structural Equation Modeling

The five viscera score (FVS) is a diagnostic scale for traditional Chinese medicine (TCM). The purposes of current study are to elucidate the characteristics of FVS obtained from middle-aged to elderly individuals and to investigate the validity of FVS using biological medical data of middle-aged and elderly individuals. Structural equation modeling (SEM) was used to conduct assessments between FVS and medical data. Eighty men and 99 women participated in this study, whose mean ages (SD) were 58 ± 7 years in both genders showing no significant difference. FVS of women was significantly higher than that of men in the spleen of the 50s (P=0.019) and liver of the 60s age group (P=0.030). By SEM, the following biomedical factors were found to influence viscera: gender, diastolic blood pressure, and HDL-C for the liver; GLU, GOT, and γ-GTP for the spleen; age, BMI, and HCRP for the lungs; and HbA1c and creatinine clearance for the kidneys. These results provide objective evidence that FVS can be used for TCM diagnosis in middle-aged and elderly individuals

A comparison of hand-arm vibration syndrome between Malaysian and Japanese workers

A Comparison of Hand-arm Vibration Syndrome between Malaysian and Japanese Workers: Anselm Ting SU, et al. Centre for Occupational and Environmental Health, Department of Social and Preventive Medicine, University of Malaya, Malaysia-The evidence on hand-arm vibration syndrome (HAVS) in tropical environments is limited. The legislation for the control of occupational vibration exposure has yet to be established in Malaysia. Objectives: The aim of this study was to investigate the clinical characteristics of HAVS in a tropical environment in comparison with a temperate environment. Methods: We conducted a series medical examinations among the forestry, construction and automobile industry workers in Malaysia adopting the compulsory medical examination procedure used by Wakayama Medical University for Japanese vibratory tools workers. We matched the duration of vibration exposure and compared our results against the Japanese workers. We also compared the results of the Malaysian tree fellers against a group of symptomatic Japanese tree fellers diagnosed with HAVS. Results: Malaysian subjects reported a similar prevalence of finger tingling, numbness and dullness (Malaysian=25.0%, Japanese=21.5%, p=0.444) but had a lower finger skin temperature (FST) and higher vibrotactile perception threshold (VPT) values as compared with the Japanese workers. No white finger was reported in Malaysiansubjects. The FST and VPT of the Malaysian tree fellers were at least as bad as the Japanese tree fellers despite a shorter duration (mean difference=20.12 years, 95%CI=14.50, 25.40) of vibration exposure. Conclusions: Although the vascular disorder does not manifest clinically in the tropical environment, the severity of HAVS can be as bad as in the temperate environment with predominantly neurological disorder. Hence, it is essential to formulate national legislation for the control of the occupational vibration exposure

A Multicenter Phase 2 Trial Evaluating the Efficacy and Safety of Preoperative Lenvatinib Therapy for Patients with Advanced Hepatocellular Carcinoma (LENS-HCC Trial)

Introduction: The phase III REFLECT trial demonstrated that lenvatinib was superior to sorafenib in terms of progression-free survival (PFS), time to progression, and objective response rate (ORR) for patients with unresectable hepatocellular carcinoma (HCC). This study assessed the efficacy and safety of preoperative lenvatinib therapy for patients with oncologically or technically unresectable HCC. Methods: In this multicenter single-arm phase II trial, patients with advanced HCC and factors suggestive of a poor prognosis (macroscopic vascular invasion, extrahepatic metastasis, or multinodular tumors) were enrolled. Patients with these factors, even with technically resectable HCC, were defined as oncologically unresectable because of the expected poor prognosis after surgery. After 8 weeks of lenvatinib therapy, the patients were assessed for resectability, and tumor resection was performed if the tumor was considered technically resectable. The primary endpoint was the surgical resection rate. The secondary endpoints were the macroscopic curative resection rate, overall survival (OS), ORR, PFS, and the change in the indocyanine green retention rate at 15 min as measured before and after lenvatinib therapy. The trial was registered with the Japan Registry of Clinical Trials (s031190057). Results: Between July 2019 and January 2021, 49 patients (42 oncologically unresectable patients and 7 technically unresectable patients) from 11 centers were enrolled. The ORR was 37.5% based on mRECIST and 12.5% based on RECIST version 1.1. Thirty-three patients underwent surgery (surgical resection rate: 67.3%) without perioperative mortality. The surgical resection rate was 76.2% for oncologically unresectable patients and 14.3% for technically unresectable patients. The 1-year OS rate and median PFS were 75.9% and 7.2 months, respectively, with a median follow-up period of 9.3 months. Conclusions: The relatively high surgical resection rate seen in this study suggests the safety and feasibility of lenvatinib therapy followed by surgical resection for patients with oncologically or technically unresectable HCC

初年次導入教育における「多職種連携学習（IPE）」の評価：PBL/ ポスターツアーの実践から

　現代医療の高度化と複雑化の中で，多職種協働の教育は必須となっている。本研究は，保健学類5 専攻の初年次生を対象とした，多職種連携学習（Interprofessional Education:IPE）を評価するものである。教材に＜社会問題を焦点化した６ 課題＞を準備し，PBL（Problem/Project-Based Learning）およびポスターツアー（ジグソー法）を行ったが，この方法が目的達成に適したものであったかを，学生の反応から評価する。　分析対象は，授業後に提出された187 名のレポート，成果物（ポスター），事後アンケートである。レポートは内容分析の計量テキスト分析（KH Coder (ver.3.) 使用）を行い，アンケートは記述統計を行った。　レポートの内容分析では，総文数は4,508，総段落数は2,913，抽出語数67,510，異なる語数3,302 であった。抽出された高い出現単語は，「専攻：1,104」「医療：813」「自分：478」「意見：407」「考える：405」等だった。さらに，共起ネットワーク（サブグラフ検出modularity）では，＜自分－他専攻－違う－視点＞がネットとなり，また＜異なる－学生－保健－意義－考える＞と＜職種－理解－連携―思う＞，＜様々－意見－聞く＞がつながっていた。KWIC コンコーダンスでの文脈分析からは，IPE の「交わる」や「つながる」，互いの考えを「取り入れる」，「広がる」などで，その連携や知の交流の意味は多面的にとらえられていた。一方で，PBL/ ポスターツアーに関連する，「討論する」「難しい」「面白い」などの，問いを立て，討議を通して深めていく知的探求の語の出現数は少なかった。　グループワークの成果物であるポスターの評価は，30 グループで，優：10，良：11，可：9 であり，課題の明確化，論旨の一貫性および自分たちの主張の面で不足があり，知識の寄せ集め的ポスターとなっていると評価したグループが3 割あった。　事後アンケートでは，＜課題の発見＞＜レジュメ作成＞＜レジュメの説明＞で，身についたが7 割強に留まり，＜ポスターの発表力＞は６ 割だった。　全体として，IPE の理念の理解や態度形成は達成できた。一方PBL/ ポスターツアーの社会的課題を明確にしてプロジェクトとして課題解決をはかっていく，は課題が残り，授業設計の改善が示唆された

ポスターツアー，ワールドカフェによる高大接続プログラム「将来の医療と医療人について考える」：定量テキスト分析による教育実践の効果検証

The purpose of this study was to summarize a program that connects high schools and universities (involving a “Poster Tour” and “World Café”), which was carried out through the cooperation of five health science departments in the School of Health Sciences and to discuss whether it was a success with regard to achieving its objectives, based on responses from participating university and high school students. 　About ２00 first-year students in five departments and ３１ high school students participated in the program. The first-year students prepared posters in advance that summarized their opinions related to social problems in the medical field based on the methodology of problem/project-based learning. They gave their presentations in the “Poster Tour” and attended the “World Café” with the high school students. We analyzed the contents of the statements, which were written on 60 pieces of round paper put on round cardboard desks during the World Café session, as well as the results of ex-post questionnaires from the participants. We performed quantitative text analysis of the contents of description using KH Coder ver. ３ and totalized the results of the ex-post questionnaires. 　The quantitative text analysis involved a total of ２３,２７8 extracted words and １,98７ types of words. Some of the extracted high-frequency words were artificial intelligence (AI) (４１２ times), medicine (iryo, ２４１ times) and technology (gijutsu, 89 times). Some extracted words such as hungry (onakasuita, ２9 times) suggest that the participants were able to discuss frankly and freely with others. 80%, 50%, and ７0% of the high school students rated the atmosphere of the sessions as “excellent”, and stated that they were able to give their opinions “very well”, and that they were able to learn “very much”, respectively. There was a tendency for the participants to discuss a lot about “medical care provided by AI”, “AI changes job requirements”, and “induced pluripotent stem (iPS) cells and robots”, topics that have been prominent in the media. 　Based on these results, the program connecting high schools and universities seemed to be effective as an opportunity for conversations among students in five departments and between university and high school students. However, it did not lead them to deepen their conversations by analyzing future medical care multilaterally and thinking of the issues as concerns of their own

The dilemma of the disappeared colorectal liver metastasis: systematic review of reviews and evidence gap map.

Peer reviewedPublisher PD

Field Effect of Alcohol, Cigarette Smoking, and Their Cessation on the Development of Multiple Dysplastic Lesions and Squamous Cell Carcinoma: A Long-term Multicenter Cohort Study

[Background and Aims] Multiple developments of squamous dysplasia and squamous cell carcinoma (SCC) in the upper aerodigestive tract have been explained by field cancerization phenomenon and were associated with alcohol and cigarette use. Second primary SCC development after curative treatment impairs patients’ quality of life and survival; however, how these consumption and cessation affect field cancerization is still unknown. [Methods] This is a multicenter cohort study including 331 patients with superficial esophageal SCC (ESCC) treated endoscopically and pooled data from 1022 healthy subjects for comparison. Physiological condition in the background esophageal mucosa was classified into 3 groups based on the number of Lugol-voiding lesions (LVLs) per endoscopic view: grade A, 0; grade B, 1–9; or grade C, ≥10 LVLs. Lifestyle surveys were conducted using a self-administered questionnaire. Patients were counseled on the need for alcohol and smoking cessation by physicians and were endoscopically surveyed every 6 months. [Results] LVL grades were positively associated with alcohol drinking intensity, flushing reactions, smoking, and high-temperature food and were negatively associated with eating green and yellow vegetables and fruit. Second primary ESCC and head/neck SCC were significantly more prevalent in the grade C LVL (cumulative 5-y incidences 47.1%, 95% confidence interval [CI] = 38.0–57.2 and 13.3%, 95% CI = 8.1–21.5, respectively). Alcohol and smoking cessation significantly reduced the development of second primary ESCC (adjusted hazard ratios 0.47, 95% = CI 0.26–0.85 and 0.49, 95% CI = 0.26–0.91, respectively). [Conclusion] Alcohol drinking, smoking, flushing reaction, and high-temperature food were closely associated with field cancerization, and cessation of alcohol and smoking significantly reduced the risk of development of second primary cancer. UMIN Clinical Trials Registry ID:UMIN000001676

Whole-genome analyses reveal genetic instability of Acetobacter pasteurianus

Acetobacter species have been used for brewing traditional vinegar and are known to have genetic instability. To clarify the mutability, Acetobacter pasteurianus NBRC 3283, which forms a multi-phenotype cell complex, was subjected to genome DNA sequencing. The genome analysis revealed that there are more than 280 transposons and five genes with hyper-mutable tandem repeats as common features in the genome consisting of a 2.9-Mb chromosome and six plasmids. There were three single nucleotide mutations and five transposon insertions in 32 isolates from the cell complex. The A. pasteurianus hyper-mutability was applied for breeding a temperature-resistant strain grown at an unviable high-temperature (42°C). The genomic DNA sequence of a heritable mutant showing temperature resistance was analyzed by mutation mapping, illustrating that a 92-kb deletion and three single nucleotide mutations occurred in the genome during the adaptation. Alpha-proteobacteria including A. pasteurianus consists of many intracellular symbionts and parasites, and their genomes show increased evolution rates and intensive genome reduction. However, A. pasteurianus is assumed to be a free-living bacterium, it may have the potentiality to evolve to fit in natural niches of seasonal fruits and flowers with other organisms, such as yeasts and lactic acid bacteria

フクマク ハシュ オ キタシタ アクセイド フメイナ シキュウ ヘイカツキン シュヨウ ノ 1レイ

悪性度不明な子宮平滑筋腫瘍は再発・転移をきたすことが知られているが、特に腹膜播種再発した症例の報告は乏しく、その治療方針は定まっていない。今回我々は初回の子宮全摘術から約13年、腹膜再発切除から約8年経過した後に腹膜へ再再発をきたした悪性度不明な子宮平滑筋腫瘍の1例を経験したため報告する。症例は68歳、女性。55歳時に両側付属器切除と子宮全摘術を受け、低異型度子宮肉腫と診断された。60歳時に骨盤内の10mm大の再発病巣を切除した。脾臓近傍に55mm×55mm×40mm大の境界明瞭で内部均一な増大傾向を示す腫瘤性病変を認めたことから子宮肉腫の再発を含めた診断かつ治療目的に手術の方針とした。開腹手術にて術前画像診断で指摘されなかった播種病変を認めたが、全ての病変を肉眼的に局所切除し得た。病理診断にて悪性度不明な子宮平滑筋腫瘍と診断された。術後1年経過して再発兆候を認めていない。悪性度不明な子宮平滑筋腫瘍は術後長期間を経て腹膜播種再発することがある。再発病変に対しては局所切除が可能であり、手術が勧められる。Smooth muscle tumor with uncertain malignant potential can recur and become metastatic; however, reports regarding its recurrence are scarce. Here we present a case of a 68-year-old woman with a smooth muscle tumor with uncertain malignant potential with peritoneal dissemination recurrence that occurred approximately 13 years after initial hysterectomy. The patient had a history of bilateral salpingo-oophorectomy and total hysterectomy for low-grade uterine sarcoma at the age of 55 years. The patient underwent open surgery for recurrence in the pelvis at the age of 60 years. At follow-up, abdominal computed tomography revealed a uniform tumor measuring approximately 55 mm × 55 mm × 40 mm near the spleen with a clear boundary. During laparotomy, peritoneal dissemination recurrence, which was not detected preoperatively, was revealed. All recurrent tumors were macroscopically removed. The patient was pathologically diagnosed with smooth muscle tumor of uncertain malignant potential. No recurrence was found at postoperative 1 year. Smooth muscle tumors with uncertain malignant potential may recur with peritoneal metastasis long after surgery. Based on our experience, we concluded that local resection is possible in such cases. Therefore, surgery is recommended for recurrent smooth muscle tumors with an uncertain malignant potential.departmental bulletin pape