Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
最新号
選択された号の論文の24件中1~24を表示しています
REVIEW ARTICLE
  • Kenya Kusunose
    2025 年 64 巻 3 号 p. 331-336
    発行日: 2025/02/01
    公開日: 2025/02/01
    [早期公開] 公開日: 2024/07/25
    ジャーナル オープンアクセス

    Artificial intelligence (AI) has shown transformative potential in various medical fields, including diagnostic imaging. Recent advances in AI-driven technologies have opened new avenues for improving echocardiographic practices. AI algorithms enhance the image quality, automate measurements, and assist in the diagnosis of cardiovascular diseases. These technologies reduce manual errors, increase consistency, and match the diagnostic performances of experienced echocardiographers. AI in tele-echocardiography offers significant benefits, particularly in rural and remote regions in Japan, where healthcare provider shortages and geographic isolation hinder access to advanced medical care. AI enhances accessibility, provides real-time remote analyses, supports continuous monitoring, and improves the quality and efficiency of remotely delivered cardiac care. However, addressing challenges related to data security, transparency, integration into clinical workflows, and ethical considerations is essential for the successful implementation of AI in echocardiography. On overcoming these challenges, AI will be able to revolutionize echocardiography and ensure timely and effective cardiac care for all patients in the future.

ORIGINAL ARTICLES
  • Atsushi Takahashi, Hiromasa Ohira, Kazumichi Abe, Mikio Zeniya, Masano ...
    2025 年 64 巻 3 号 p. 337-342
    発行日: 2025/02/01
    公開日: 2025/02/01
    [早期公開] 公開日: 2024/07/04
    ジャーナル オープンアクセス
    電子付録

    Objective Metabolic-associated fatty liver disease (MAFLD) has only recently been proposed; therefore, the characteristics of patients with autoimmune hepatitis (AIH) and MAFLD remain unclear. This study evaluated the effect of MAFLD on AIH patients with AIH.

    Methods We reevaluated the Japanese Nationwide Survey of AIH in 2018, which involved a survey of patients diagnosed with AIH between 2014 and 2017. We categorized patients with AIH according to the presence or absence of MAFLD and compared the clinical characteristics between the two groups.

    Results A total of 427 patients (77 men and 350 women) were included in this study. The overall prevalence of MAFLD was 10.5%. Compared to AIH patients without MAFLD, AIH patients with MAFLD had the following characteristics at the time of the AIH diagnosis: (1) a higher body mass index, (2) a higher prevalence of hypertension, (3) mild elevation of hepatobiliary enzymes and total bilirubin, and (4) histologically progressive fibrosis. However, the levels of hepatobiliary enzymes and total bilirubin after treatment were significantly higher in AIH patients with MAFLD than in those without MAFLD.

    Conclusion AIH patients with MAFLD had characteristics different from those of AIH patients without MAFLD. These findings could help increase our understanding of patients with AIH with MAFLD.

  • Sakiko Kuraoka, Seiji Kawano, Shoko Ino, Takuya Satomi, Kenta Hamada, ...
    2025 年 64 巻 3 号 p. 343-350
    発行日: 2025/02/01
    公開日: 2025/02/01
    [早期公開] 公開日: 2024/07/04
    ジャーナル オープンアクセス

    Objective The characteristics of gastric cancer in patients with atrophic mucosa and no apparent history of Helicobacter pylori eradication have not been thoroughly investigated. Therefore, this study examined the clinicopathological characteristics of gastric cancer in these patients.

    Methods We retrospectively examined the endoscopic and pathological characteristics of gastric cancer in patients who underwent endoscopic submucosal dissection.

    Patients We divided the patients into 2 groups: those with gastric atrophy and no history of eradication (group A; n=102) and those with a history of eradication (group B; n=161). In group A, patients were further divided into mild atrophy (group C) and severe atrophy (group D) groups, while group B was further divided into those who underwent eradication treatment >5 years ago (group E) and those who underwent eradication 1-5 years ago (group F).

    Results Group A comprised significantly older individuals (75±8.0 vs. 71±7.5 years old, p<0.001) with a higher frequency of elevated gastric cancer than group B (32.4% vs. 17.4%, p=0.006). Compared with group E, group A was older and had a greater incidence of elevated gastric cancer. The incidence of gastric cancer in the U or M region was lower in group C than in group D.

    Conclusion Gastric cancer in patients with gastric atrophy and no history of eradication was associated with an older age and higher frequency of elevated-type morphology than in those with a history of eradication.

  • Tsuyoshi Takeda, Takashi Sasaki, Takeshi Okamoto, Koshiro Fukuda, Tats ...
    2025 年 64 巻 3 号 p. 351-358
    発行日: 2025/02/01
    公開日: 2025/02/01
    [早期公開] 公開日: 2024/06/20
    ジャーナル オープンアクセス
    電子付録

    Objective The efficacy of anamorelin in pancreatic cancer (PC) patients with a poor performance status (PS) is uncertain, as previous trials have excluded such patients. This study evaluated the efficacy of anamorelin in PC patients with a poor PS (2) compared with those with a good PS (0-1).

    Methods We retrospectively reviewed consecutive PC patients with cachexia who received anamorelin at our institution. The primary outcome was the proportion of responders, defined as those who maintained or gained body weight and appetite over 12 weeks. The secondary outcomes included anamorelin treatment duration, proportion of patients who discontinued anamorelin within 4 weeks (early discontinuation), and the overall survival.

    Results Forty-five patients (35/10) were included in this study. The proportion of responders was significantly lower in patients with a poor PS than in those with a good PS (0% vs. 37%, p=0.042). Moderate weight loss (5-10%) and administration of pancreatic enzyme replacement therapy were associated with a response to anamorelin. A poor PS was significantly associated with a shorter treatment duration of anamorelin (14 vs. 93 days, p<0.001), a higher proportion of patients who discontinued anamorelin within 4 weeks (70% vs. 17%, p=0.003), and a reduced survival (62 vs. 188 days, p<0.001). A poor PS was associated with early discontinuation of anamorelin.

    Conclusion The efficacy of anamorelin is extremely limited in PC patients with a poor PS. Patients with PC with a poor PS may not be good candidates for anamorelin compared to those with a good PS.

  • Kimika Arakawa, Rina Imazu, Yuki Morinaga, Mitsuhiro Tominaga, Takuya ...
    2025 年 64 巻 3 号 p. 359-366
    発行日: 2025/02/01
    公開日: 2025/02/01
    [早期公開] 公開日: 2024/06/13
    ジャーナル オープンアクセス

    Objective This study aimed to investigate the antihypertensive goal achievement rate for office blood pressure (OBP) and the rate of clinical inertia (inertia) as factors for non-achievement in hypertensive patients in 2020. After documenting these results in the medical records, we observed changes in the achievement rate of the OBP goals in 2020 and 2022.

    Methods In Study 1, the participants were 517 outpatients (mean age 68.6±13.2 years, 54% women) who visited the Division of Hypertension regularly between March and September 2020. We investigated the achievement rate of OBP goals during that period and confirmed the prevalence of inertia as a possible factor for failure to achieve OBP goals. In Study 2, the participants were 308 who visited the division, and who had at least one condition for which an OBP of <130/80 should be targeted in both 2020 and 2022 (mean age 66.6±12.4 years, 50% of women in 2020). We investigated the trends in the achievement of OBP for the same period in both years.

    Results The rate of achievement of the OBP goals in 2020 was 48%. Inertia accounted for 14% of the non-achievement factors. The OBP significantly decreased in 2022 in comparison to 2020. The achievement rate of OBP goals showed an increasing trend from 45% in 2020 to 52% in 2022.

    Conclusion Attending physicians' awareness of unmet antihypertensive goals can help them overcome inertia and improve blood pressure control in patients.

  • Taisuke Isono, Ayaka Kojima, Takashi Nishida, Yoichi Kobayashi, Takash ...
    2025 年 64 巻 3 号 p. 367-374
    発行日: 2025/02/01
    公開日: 2025/02/01
    [早期公開] 公開日: 2024/11/21
    ジャーナル オープンアクセス

    Objective Thymus and activation-regulated chemokine (TARC) can predict severe disease in patients with coronavirus disease 2019 (COVID-19). However, no reports have addressed the predictive value of TARC with the widespread use of vaccines and medications for COVID-19 during the Omicron variant period of the pandemic.

    Methods This single-center prospective cohort study enrolled COVID-19 patients admitted to our institution between December 1, 2021, and August 15, 2022. Patients with respiratory failure due to diseases other than COVID-19 were also excluded. We measured the serum TARC levels of patients at admission.

    Results We enrolled 157 patients, with 89 in the severe group and 68 in the non-severe group. The severe group was more likely than the non-severe group to include older patients, those with no or one dose of vaccine, and those with interstitial lung disease. The cutoff level of TARC derived from a receiver operator characteristic curve analysis to predict severe disease was 174.0 pg/mL. The sensitivity, specificity, positive predictive value, and negative predictive value were 72.1%, 69.7%, 64.5%, and 76.5%, respectively. The area under the curve was 0.722 (95% confidence interval: 0.635-0.809). A multivariate analysis showed that 2 vaccination doses were associated with non-severe disease, and TARC ≤174 pg/mL was associated with severe disease.

    Conclusion TARC was a predictive factor for severe disease, but its cutoff value was higher and its predictive accuracy lower than those in previous reports. We surmised that during the Omicron variant period of the pandemic, the widespread use of vaccines and medications for COVID-19 decreased the predictive accuracy of TARC.

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