De-stigmatizing Mental Illness through Graphic Medicine

Graphic medicine - or the communication of health-related narratives through images and texts, such as comics - has been increasingly recognized as a powerful educational tool. My project investigates the value of integrating graphic medicine to medical education, specifically to improve mental health literacy and de-stigmatize mental illness. As a medical student, I have encountered several instances where fellow medical students and even doctors casually throw around diagnostic terminology, especially those used to describe mental health disorders, in a colloquial and insensitive manner that seem to indicate that they do not take mental illness seriously, or even ignorant of what a particular mental illness clinically entails due to lack of exposure and influences from media portrayal (e.g. “I have PTSD from that test,” “The weather is bipolar,” and “I am having an ADD/OCD/Alzheimer moment”). This demonstrates a concerning lack of professionalism and sensitivity in the medical community that may be contributing to a social environment where shame and embarrassment prevent people from seeking care. As healthcare providers, it is imperative that we actively reflect on our language to avoid perpetuating mental health stigma in clinical practice. Graphic medicine provides an opportunity to expose medical students to the day-to-day experiences of people living with illness. Comics and other graphic illustrations may be suitable and cost-effective vehicles for disseminating information to medical students, and this increased understanding could play a role in improving patient satisfaction and clinical outcomes. For my deliverable, I will share a series of graphic medicine illustrations that I created as a first- and second-year medical student and I plan to summarize my experience in a case report

Combined effects of body mass index and unhealthy behaviors on disability in older Japanese adults: the Okayama study

Background: Body mass index (BMI) is a significant predictor of functional disability in older adults. However, when evaluated, the association between BMI and incident functional disability, considering behaviors only as covariates or not, may not be appropriate. The primary purpose of the study was to investigate the combined effects of BMI and unhealthy behaviors on the risk of incident functional disability. Methods: This was a retrospective cohort study that took place in Okayama City, Japan. Data on BMI and unhealthy behaviors were obtained using the health check-up questionnaire. The certification of Long-Term Care Insurance was used to measure functional disability. Cox proportional hazard models were used; adjusted hazard ratios (HRs) with 95% confidence interval (CI) were calculated for incidence of functional disability across categories of BMI and number of unhealthy behaviors. Results: The relationship between BMI and incident functional disability was U-shaped (HR = 1.18, 95% CI [1.11-1.25], among the underweight range; and 1.26 [1.19-1.34] among the obesity range), and its risk was significantly higher within the normal-to-overweight range of BMI values with co-occurring unhealthy behaviors (with normal weight range and one, 1.17 [1.01-1.21]; two, 1.29 [1.18-1.41]; and three or four unhealthy behaviors 1.38 [1.24-1.54]; as well as among overweight range and one, 1.16 [1.05-1.27]; two, 1.26 [1.15-1.38]; and three or four unhealthy behaviors, 1.47 [1.31-1.64]). In each BMI category, the risk of incident functional disability increased with increasing number of unhealthy behaviors (p = 27.5, for both sexes (2.20 [1.64-2.92] in men and 1.66 [1.35-2.04] in women). Conclusion: It is necessary to consider the combined effects of BMI and behaviors on incident functional disability. Furthermore, interventions targeting multiple behaviors should be considered as such interventions may offer greater benefits than simple interventions

Significant response of sunitinib for RCC

Introduction: A case of multiple liver metastases of clear cell RCC with a significant response to sunitinib as the fifth line after nivolumab is reported. Case presentation: The patient was a 65-year-old man who underwent open nephrectomy for RCC. After the nephrectomy, he had recurrences several times, and metastasectomy had been performed for each recurrence. At 13 years after the nephrectomy, multiple liver, and lung metastases appeared. The treatment was switched to axitinib, followed by cabozantinib, then nivolumab. The best response was PR, SD, and PD for these three drugs, and treatment duration was 14, 3, and 3 months, respectively. As the fifth line, sunitinib was administered, with significant shrinkage of the multiple liver metastases, and PR has been maintained for 34 months. Conclusion: Sunitinib after an IO-drug showed a significant effect in spite of only slight efficacy with other VEGFR-TKIs, which may have occurred through the alteration of the immunological microenvironment

Ureteral stent replacement in women

Purpose : To evaluate the efficacy of the direct grasping technique using pean forceps under fluoroscopic guidance for ureteral stent replacement in women. Methods : Between April 2018 and September 2020, 28 female patients underwent ureteral stent replacements at our facility, and 184 stent replacement procedures were performed. A total of 127 stents were replaced using pean forceps under fluoroscopic guidance (pean forceps group), and 57 stents were replaced using the cystoscope (cystoscopy group). Clinical characteristics and surgical outcomes were compared between the groups. Results : All stents were successfully replaced. There was a statistically significant difference in the procedure time between the two groups (median [interquartile range], pean forceps group : 10.8 [8.2–13.9] minutes vs. cystoscopy group : 15.8 [11.1–20.9] minutes, P < 0.001). There were no intraoperative complications in either group and no difference in the incidence of postoperative complications (pean forceps group : 1.6% vs. cystoscopy group : 1.8%, P = 1.000). Fluoroscopy time was longer in the pean forceps group, although this difference was not statistically significant (pean forceps group : 38.9 [22.6–60.1] seconds vs. cystoscopy group : 33.0 [20.0–48.9] seconds, P = 0.0558). Conclusion : The direct grasping technique using pean forceps under fluoroscopy may be a beneficial alternative to cystoscopy for ureteral stent replacement in women

Early urinary catheter removal in stroke

Objective : The aim of the present study was to identify factors related to the success of trial without catheter (TWOC) in patients with stroke and to examine the effect of the timing of urinary catheter removal on the course of stroke. Methods : Patients who were admitted to the Stroke Care Unit of our institution between March 2018 and October 2021 were included. To identify factors related to success of TWOC, a multivariate analysis was performed on the patient’s condition at admission and catheter indwelling time. The patients were divided into two groups by the timing of catheter removal, and we assessed the relationship between the timing of catheter removal successful TWOC and recovery of physical function. Results : A total of 118 patients were included. The presence of comorbidities and scores of severity and function at admission were not predictors of successful voiding. The time to achieve voiding sussess was significantly shorter in the early catheter removal group than in the later group (p < 0.005). Interestingly, the early group also showed better improvements in physical function. Conclusion : Early removal of catheters may lead to early recovery of bladder function, improvement of physical function, and lower risk of complications in patients with stroke

Virtual imaging-guided RAPN

Objectives : To evaluate whether virtual partial nephrectomy images could help surgeons identify vascular and collecting system around tumors during actual surgery. Materials & methods : We retrospectively analyzed 36 patients who underwent robot-assisted partial nephrectomy (RAPN) between 2016 and 2017. Virtual partial nephrectomy images were created from preoperative CT images using computer software, and then analyzed. For analysis, blood vessels and collecting system portions within a 5-mm-thick safety margin around the tumor were examined. During analysis, we predicted whether targeted vasculature around the tumor would require clipping or suturing during surgery, and also whether the collecting system would require opening during resection. Surgical outcomes for virtual partial nephrectomy analyses and actual RAPNs were compared and analyzed for sensitivity and specificity. Results : In 36 cases, 119 arteries and 100 veins were targeted on virtual partial nephrectomy images. Arterial suturing or clipping for hemostasis showed a sensitivity and specificity of 83.3% and 84.5%, respectively. For veins, the sensitivity and specificity were 39.1% and 92.2%, respectively. Collecting system opening prediction sensitivity was 85.7%, and specificity was 65.2%. Conclusion : Virtual partial nephrectomy imaging is useful for RAPN planning, particularly regarding arteries and the collecting system. It is hoped that techniques for visualizing veins will improve

フィリピンにおける公衆衛生に関する留学記

As a second-year resident at the University of Tokushima Hospital, I report on my experience of overseas training in the Philippines under the training program of the National Institute of Health Sciences. The National Institute of Health Sciences is an institution that conducts education, investigation, and research related to health, medical care, and welfare, and I trained for two months in the Department of Clinical Training in Community Health, Specialty Course III. In addition to the out-of-hospital training at the Ministry of Health, Labour and Welfare, Chiba Prefectural Government, and National Institute of Infectious Diseases, the one week overseas training in the Philippines（Manila） consisted mainly of lectures and training on mosquito-borne infectious diseases, zoonosis, and parasites at the University of the Philippines, Philippine General Hospital, Suburban Health Center, and WHO Western Pacific Office. Infectious diseases are very different from those in Japan. The actual observation made us understand that rabies and parasitic infections are raging in the Philippines due to the sanitary conditions of the living environment, which is very different from that of Japan. By learning about the medical system at overseas medical facilities, we were able to rethink deeply about the merits of the Japanese medical system and the direction it should take in the future from various perspectives

Impact of body composition on mRCC Prognosis

Purpose : This study aimed to analyze the impact of patients’ nutritional status and changes in body composition on the prognosis of metastatic renal cell carcinoma (mRCC) patients who received systemic therapy with tyrosine kinase inhibitors (TKIs). Methods : A total of 57 mRCC patients who received systemic therapy with TKIs as first-line therapy at our facility between November 2004 and October 2018 were included. The Prognostic Nutritional Index (PNI) was used to evaluate their nutritional status. The volumes of skeletal muscle mass and fat tissue were calculated using the SYNAPSE VINCENT system. The effects of nutritional status and body composition of mRCC patients on progression-free survival (PFS) and overall survival (OS) were analyzed using Cox regression methods. Results : Low PNI at the start of systemic therapy was a significant prognostic predictor for OS (HR 3.807 [95% CI 1.205-12.027], P = 0.046), and it was related to loss of muscle mass three months after systemic therapy. Although the loss of muscle mass at the start of systemic therapy was not associated with OS, loss of muscle mass during treatment predicted worse OS. Conclusions : Nutritional status of mRCC patients may predict changes in body composition and be associated with their prognosis

Stress relaxation arrested the mainshock rupture of the 2016 Central Tottori earthquake

地震の破壊はなぜ止まるのか? --2016年鳥取県中部地震の断層サイズを決めたもの--. 京都大学プレスリリース. 2021-08-12.After a large earthquake, many small earthquakes, called aftershocks, ensue. Additional large earthquakes typically do not occur, despite the fact that the large static stress near the edges of the fault is expected to trigger further large earthquakes at these locations. Here we analyse ~10, 000 highly accurate focal mechanism solutions of aftershocks of the 2016 Mw 6.2 Central Tottori earthquake in Japan. We determine the location of the horizontal edges of the mainshock fault relative to the aftershock hypocentres, with an accuracy of approximately 200 m. We find that aftershocks rarely occur near the horizontal edges and extensions of the fault. We propose that the mainshock rupture was arrested within areas characterised by substantial stress relaxation prior to the main earthquake. This stress relaxation along fault edges could explain why mainshocks are rarely followed by further large earthquakes