In the process of repair from tissue injury, 'regeneration' naturally occurs in-vivo. Also in the vessels, mechanical stress induces injury, but then the injured sites are repaired by tissue regeneration. Our research has long focused on stem cell biology in vascular injury and repair. In the process of repair from vascular injury, bone marrow-derived stem cells including endothelial progenitor cells (EPCs) are recruited, and the EPCs differentiate into endothelial cells, leading to endothelial regeneration. On the other hand, also in the cardiovascular scene, regenerative medicine has been clinically applied as vascular and myocardial regeneration. We have been promoting vascular regeneration therapy (angiogenesis therapy) for critical limb ischemia, using adipose-derived regenerative (stem) cells (ADRCs). Now, we are planning a new project for research and clinical application of regenerative medicine, using the multi-lineage differentiating stress enduring (Muse) cell as a novel cell source.

Although several guidelines have been proposed for the physical management of patients with mental disorders, there are many differences among these guidelines, and it is necessary to review the literature for clinical implementation in Japan. The purpose of this study was to conduct a literature review using PubMed and Web of Science to examine the following serious physical risks that may affect the prognosis of patients with mental disorders: 1) abnormal glucose and lipid metabolism, 2) electrocardiographic abnormalities, 3) lithium poisoning, 4) severe drug eruption, and 5) malignant syndrome. There were some similarities in the monitoring plans for abnormal glucose and lipid metabolism, electrocardiographic abnormalities, and lithium poisoning. It was therefore assumed that a plan suitable for the actual situation in Japan could be formulated from these similarities. For severe drug eruptions, it is highly useful to provide information on these side effects as part of psychological education in addition to complying with the description in the package insert. For malignant syndromes, we suggest that it is important to consider the direction of basic interventions such as discontinuation of antipsychotics, systemic monitoring and management, infusion of fluids, and additional treatments as necessary.

Background: In coronary angiography (CAG), fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are widely measured for evaluating physiological ischemia and indication for percutaneous coronary intervention (PCI). On the other hand, the progress of ultrasonic devices and techniques have enabled the evaluation of coronary blood flow by non-invasive transthoracic echocardiography. Although, its application is limited to left anterior descending coronary artery (LAD).

Objective: To investigate the correlation between the evaluation of physiological ischemia by catheterization and the evaluation of flow velocities by transthoracic echocardiography.

Methods: In patients who underwent CAG for diagnosing angina, physiological evaluation of coronary blood flow was performed using pressure wire in LAD lesions. Transthoracic coronary echocardiography was also performed to evaluate the coronary blood flow velocity in the same lesions.

Results: The peak diastolic flow velocity of the stenotic portion (V-stn) and the ratio of peak diastolic flow velocities of the stenotic and the reference portions (V-stn/V-ref) showed higher correlation efficient (r) values with FFR (r=0.561, p<0.001 and r=0.612, p<0.001, respectively) than with % diameter stenosis by quantitative CAG (r=0.481, p<0.001). On the other hand, iFR was also correlated with V-stn (r=0.411, p<0.001) but the correlation with V-stn/V-ref was not significant. According to the Receiver operating characteristic curve analysis, the V-stn and the V-stn/V-ref values corresponding to FFR=0.80 were 0.56 m/s (sensitivity 0.90, specificity 0.69) and 2.05 (sensitivity 0.85, specificity 0.69), respectively. Especially, almost all the patients with V-stn>1m/s or V-stn/V-ref >3 had FFR<0.80 and were sent for revascularization therapy.

Conclusion: In LAD region of coronary artery, transthoracic coronary echocardiography is considered to be a practically useful method for evaluating physiological ischemia and indication for PCI.

Background: The coronavirus disease 2019 (COVID-19) pandemic has caused many people mental distress. Negative changes have been reported in physical activity, sleep, alcohol consumption, and smoking. Many patients with alcoholic liver disease (ALD) have a tendency for alcohol dependence, but there are no reports on how the COVID-19 pandemic has affected ALD patients.

Aims: The purpose of this study was to clarify the effects of the COVID-19 pandemic on ALD patients.

Methods: The study consisted of two parts. In the first part, changes in the alcohol consumption and blood biochemistry of ALD patients who continued to visit our hospital as outpatients before and during the COVID-19 pandemic were compared. In the second part, the clinical backgrounds at the time of the initial examination of ALD patients who were first examined in the year before the COVID-19 pandemic (before outbreak group) and ALD patients who were first examined in the six months after the start of the COVID-19 pandemic (after outbreak group) were compared. Patients in the after outbreak group were asked whether their motivation to drink was related to the COVID-19 pandemic.

Results: In part 1, of the 95 ALD patients surveyed, alcohol consumption increased after the start of the pandemic in 20 (21.1%) patients, and 13 (65%) of these 20 patients blamed the increase on the COVID-19 pandemic. Gamma-glutamyltransferase levels increased and prothrombin activity (PT%) decreased markedly after the start of the pandemic in the 20 patients in this increased alcohol consumption group. Although 32 patients reported that their alcohol consumption remained unchanged, liver function appeared to deteriorate after the start of the pandemic, which suggests that ALD patients' self-reports of alcohol consumption were inaccurate. In part 2, the clinical backgrounds of 28 ALD patients first examined in our hospital in the year before the COVID-19 pandemic and 12 ALD patients first examined in the six months after the start of the pandemic were compared. Liver damage was more severe in the after outbreak group, and 8 of these 12 patients (66.7%) blamed their drinking on the COVID-19 pandemic. Although the difference was not significant, there tended to be more employed people among the ALD patients who were first examined after the start of the COVID-19 pandemic.

Conclusion: Liver function in ALD worsened due to the COVID-19 pandemic. In some ALD patients who were first examined for ALD after the start of the pandemic, the motive for drinking was associated with the COVID-19 pandemic.

Background: There are pros and cons regarding the benefit of extended pelvic lymph node dissection (PLND) during surgery for prostate cancer (PCa). A randomized controlled trial failed to demonstrate any survival benefits, and the therapeutic role of PLND remains unclear. We evaluated early survival outcome using a propensity score (PS)-matched analysis.

Methods: Three hundred ninety-nine patients with intermediate- to high-risk PCa were enrolled. They were determined to have a lymph node (LN) invasion probability of greater than 7% on the established nomogram. The National Comprehensive Cancer Network classification was used as risk stratification. Biochemical recurrence (BCR)-free survival was compared between the two groups divided by the threshold of the LN yield set at 15.

Results: The mean LN yield was 23.7 and 3.4 in the sufficient (n = 217) and insufficient (n = 182) LN yield groups, respectively. In the unmatched cohort, the advantage of the 3-year BCR-free survival for sufficient LN yield remained at 10.0% (hazard ratio [HR] 0.68, 95% confidence interval [CI] 0.43-1.07; p = 0.098). In the PS-matched cohort with 133 patients in each group, the difference in the 3-year BCR-free survival rate widened to 15.8% (HR 0.54, 95% CI 0.31-0.93; p = 0.027). A Cox regression multivariate analysis performed on the model with postoperative pathological factors showed an independent predictive value of LN yield.

Conclusions: The results demonstrate the therapeutic role of PLND in intermediate- to high-risk PCa. The benefit of PLND depends on the surgeon adhering to the template and removing a sufficient number of LNs in patients with an optimal risk-range.

In Japan, a regional quota system was introduced to ensure that a sufficient number of medical students enroll in regional quota programs throughout the country. The number has increased since 2010, reaching 9,330 students at 71 Japanese universities, comprising 18.0% of all new medical students in 2020. Since this system started, some students with scholarships requiring them to work in designated areas for 9 years opted to repay their scholarship fund and withdrew from the program. Thus, this study examined attitudes and motivation toward community medicine among students enrolled in a regional quota program.

Participants were 82 first- to fourth-year students enrolled in comprehensive community medicine practicums at Dokkyo Medical University in 2018. The survey was completed by 63 students (76.8%) who provided voluntary and anonymous answers to a questionnaire using a learning management system. Most had positive attitudes toward community medicine and practicums. Students in lower years tended to be more motivated to pursue community medicine in the future than students in higher years. Students without scholarships were significantly more motivated to pursue community medicine in the future than students with scholarships. The top lessons learned from practicums were the role of physicians in community medicine, the state of medical care in communities, and multidisciplinary and team health care.

All students stated that the community medicine program is important. In order to enhance motivation and to maintain positive attitudes toward community medicine among medical students, lectures and practicums need to be improved and adapted to each year of medical training.

Introduction: Comprehensive genomic profiling (CGP) was widely adopted in Japan after its coverage by national healthcare insurance began in June 2019. We investigated the clinical utility of CGP in pediatric and adolescent young adults (AYA) solid tumor patients.

Materials and Methods: Between November 2017 and December 2019, 13 patients who progressed with or who were likely to progress with standard therapies were recruited to the PROFILE-F study to undergo CGP using either FoundationOne^® CDx or FoundationOne^® Heme.

Results: The median age was 28 years old. Tumor types were as follows: neuroblastoma (n = 1), Wilms' tumor (n = 1), rhabdomyosarcoma (n = 2), Ewing sarcoma (n = 1), gastric cancer (n = 1), rectal cancer (n = 1), osteosarcoma (n = 1), neuroendocrine tumor (n = 2), salivary gland carcinoma (n = 1), tracheal adenoid cystic carcinoma (n = 1), and thymic cancer (n = 1). In 92% of cases, at least one genomic alteration was identified, including CDKN2A (four cases), TP53 (three cases), and MYC (two cases). Actionable aberrations were found in 10 cases (77%), and a clinical trial candidate was found in seven cases (54%). However, no patients were able to receive biomarker-matched therapy according to their genomic alterations.

Conclusions: Further efforts to increase basket trials and collection of clinical genomic data to predict response are necessary to advance precision cancer medicine and surgical management in pediatric and AYA populations.

Background: The current study investigated the relationship between maximum standardized uptake values (SUV_max) on Fluorine-18 Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and the plasma cell proliferation percentage in the bone marrow as well as hematological and biochemical test results of patients with multiple myeloma (MM). Moreover, we identified if differences exist in parameters across different types of paraproteins and stages.

Material and methods: Patients clinically and pathologically diagnosed with MM between 2012 and 2019 were selected from the database of the Dokkyo Medical University Hospital, Japan. Unsuitable patients were excluded from the current study to avoid false uptake. We examined 60 patients and hematological and biochemical tests were recorded and evaluated. The percentage of plasma cells in bone marrow aspiration samples was calculated. In PET/CT images, the SUV_max of the region of interest of the right posterior ilium (aspiration area) was measured. Relationships were examined using Spearman's correlation coefficient, and differences were identified using the Kruskal-Wallis test with SPSS.

Results: A positive correlation was observed between FDG uptake and the percentage of plasma cells (r = 0.672, P < 0.0001).

Conclusion: Increased FDG uptake by bone marrow correlated with the percentage of plasma cells. Some biochemical and hematological parameters were statistically different according to the stage and types of paraproteins. PET/CT is suitable for evaluating the condition of a patient and the activity of the MM lesion.

Rooibos tea is rich in a variety of polyphenols and is used for its anti-inflammatory and caffeine-free properties by women during pregnancy. However, a relationship between polyphenols and premature constriction of the ductus arteriosus (PCDA) has also been suggested. We experienced a case of PCDA in an infant whose mother began to drink Rooibos tea every day in the 26th week of pregnancy. The infant was a male with a birth weight of 3,099 g at gestational age of 36 weeks and 5 days. The infant was delivered by emergency Cesarean section due to placental dysfunction, and the Apgar score was 8/9. Respiratory distress was observed after birth and ductus arteriosus closure was confirmed by echocardiography; therefore, the infant was diagnosed with PCDA. His symptoms improved after oxygen supply and administration of furosemide and dobutamine, and he was discharged from hospital at age 26 days under home oxygen therapy. This case indicates the need to disseminate information on the possibility that PCDA may develop in newborn infants when their mothers drink Rooibos tea during pregnancy.

Polyethylene glycol is a safe agent for bowel cleansing in preparation for colonoscopy. However, it can cause considerable electrolyte abnormalities. We herein report two cases of hyponatremia because of bowel preparation using polyethylene glycol. Case 1: The patient, a man in his 70s, was admitted to our hospital for an endoscopic mucosal resection of an adenoma of the large intestine. After the preparation, the patient developed consciousness disturbance. His serum Na level was 122 mEq/L, indicating a marked degree of electrolyte abnormality. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) was inferred as the cause of hyponatremia. Case 2: A patient in his 70s, based on a positive fecal occult blood test result, was scheduled to undergo colonoscopy. A blood test on the day of the colonoscopy showed his serum sodium level as 107 mEq/L. The patient was found to have chronic hyponatremia, which prevented development of clinical symptoms. However, because of preservation of ADH secretion despite the hyponatremia, a diagnosis of SIADH was made. These cases suggest that clinicians should be aware of the risk of hyponatremia during bowel preparation for colonoscopy.

Introduction: We introduce a convincing method of placing and replacing ureteral stents in women using a pig-tail Straightener.

Materials and Methods: Eleven female patients with a median 78 years old (range 65 to 89) who underwent pre-stenting on urinary tract stones (4 kidney stones and 7 ureteral stones) with written informed consent were included. Prior to retrograde intrarenal surgery, pull the end of the stent out of the urethral meatus with Pean forceps under fluoroscopy. Very gently insert the guidewire into space outside the stent within the pig-tail Straightener until the tip is resistant, that is the state in which the pig-tail Straightener hits the ureteral orifice. Properly adjusting the position and angle of the pig-tail Straightener ensures that the guidewire is inserted into the ureter. Subsequently, the Double J stent is removed, and another insertion as a safety guidewire is possible by the same operation again.

Results: All procedures have been successful without adverse events.

Conclusions: The pig-tail Straightener may be useful for placement and replacement of a ureteral stent in a woman.