Cardiovascular disease is the leading cause of death and has been the major health care issue worldwide ^1)-3). Tremendous effort has been continuously made against cardiovascular disease from the bench, bed side and population science. In the clinical cardiology field, new development of technology continuously improved the patient outcome resulting marked improvement of prognosis during recent several decades ⁴⁾. In this period, the Department of Cardiovascular Medicine (Department of Cardiology), Juntendo University has been actively working in the clinical practice, research and education especially in the field of coronary artery disease and atherosclerosis. In this article, I will review the twenty-years progress of this department especially in the field of catheter intervention, clinical trials and porcine model research as well as cardiac rehabilitation.

　The treatment of severe dysplasia of the hip remains controversial. The rationale for the use of the rotational acetabular osteotomy (RAO) is that it increases the weight-bearing area by shifting the osteotomized acetabulum to cover the femoral head. We have used the technique of Ninomiya and Tagawa in more than 540 patients with acetabular dysplasia. This can improve joint function as well as achieve relief of pain. In this report, we describe the technique of RAO and the results of this procedure in patients with severely dysplastic hips.

　The mean JOA clinical score changed from 65.4±11.8 points (29-90) preoperatively to 68.6±21.0 points (21-68.6) at final follow-up (before revision surgery) after mean of 17.1 years. The mean pain score improved from 18.3±6.3 points (0-30) to 25.6±9.6 points (0-40). 19 hips had required THA (Total Hip Arthroplasty), which were performed in 10 patients within 10 years after RAO.

　The results of RAO for correction of severely dysplastic hips in adults were satisfactory after mean of 17.1 years.

　Articular ultrasonography (US) is an essential examination tool for medical treatment of rheumatic diseases. By supplementing the physical examination findings and the blood test results with articular US, it is possible to accurately judge the diagnosis and disease state. Immediate point-of-care ultrasonography (POCUS) contributes to earlier problem solving, and the picture-based explanation is also effective for deep understanding of the patient and relief of anxiety (picture superiority effect). It is thought that the further development of articular US devices and the spread of utilization skills will contribute to the improvement of patients’ outcomes.

Rheumatoid arthritis (RA) is a chronic inflammatory disease that causes persistent inflammation, primarily in the synovial membrane of the joints. It may cause joint pain, swelling, and even deformation. Due to the strong involvement of abnormal immune function in its pathogenesis, RA is classified as a connective tissue disease. Most RA patients initially develop articular symptoms such as finger stiffness, pain, and swelling. They often visit medical institutions primarily complaining of these symptoms. However, it is known that manifestations of RA are found not only in the joints but also in a variety of organs in the entire body, including the lungs, skin, eyes, and blood vessels. These manifestations are called extra-articular manifestations, and they pose a problem as they significantly affect the patient’s activities of daily living (ADL), quality of life (QOL), and life expectancy. The pathology of RA has been elucidated in detail thanks to recent advances in molecular biology, and treatment strategies have undergone marked changes with the advent of biological drugs. Previously, the primary treatment goal was pain relief. Now, complete remission is becoming a reality with the prevention of bone destruction by completely inhibiting disease activity. However, extra-articular symptoms such as those involving the lungs pose major obstacles in drug selection for RA in many cases. When diagnosing and treating RA, it is important to not only evaluate articular manifestations but also accurately identify extra-articular manifestations and act appropriately.

　Methotrexate (MTX) and biological agents have revolutionized the rheumatoid arthritis (RA) treatment by shifting the focus from alleviating pain to preventing joint degeneration, improving the quality of life and remission of the disease. Many guidelines list MTX as a first line and an anchor drug and recommend use of biologic agents or Janus kinase (JAK) inhibitors when responses to MTX treatment are not adequate. However, in clinical practice we encounter patients for whom this strategy is not feasible for various reasons, and others in whom good outcomes can be achieved with conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) other than MTX; thus, csDMARDs continue to be used for RA today. Thorough understanding of the characteristics of other csDMARDs and their appropriate usage are important in RA care, rather than exclusive reliance on MTX and biologic agents.

With the advent of biological disease modifying anti-rheumatic drugs (DMARDs) and Janus kinase (JAK) inhibitors as a new treatment for rheumatoid arthritis (RA), the treatment of RA has made a dramatic progress. The new treatment not only suppresses the joint swelling and tenderness but also it can maintain the function of daily life, further suppress joint destruction and aim for remission. Biological DMARDs and JAK inhibitor have the advantage that their effect is prompt and high efficacy is sustained over a long period of time, while disadvantages such as high risk of infection and high cost of treatment. Especially infection is serious side effect, but patients themselves should seek medical institutions promptly without missing a change in their physical condition, regularly conduct inspections even when there is no symptoms prevent infectious diseases in advance. It is important to have correct knowledge and share direction of treatment with their doctor.

Objectives: To examine the clinical efficacy and factors predictive of the therapeutic effect of golimumab in patients with rheumatoid arthritis (RA).

Methods: This single-center, prospective observational study enrolled in 2011 to 2015 all 71 (male 7 cases / female 64 cases) patients with RA treated with golimumab. Disease activity at 52 weeks was assessed by the disease activity score in 28 joints (DAS28) and the simplified disease activity index (SDAI). The variables at baseline, including patient demographics, clinical characteristics were analyzed for their association with clinical remission at 52 weeks.

Results: Seventy-one patients were registered. Reduction of disease activity was recognized as early as 4 weeks after the commencement of golimumab, and DAS28 remission at 52 weeks was observed in 43.3% of the patients. Golimumab was more effective in patients who were naïve for biological disease-modifying anti-rheumatic drugs (bDMARDs) than previously treated with bDMARDs, although bDMARDs naïve and switch both groups had similar rates of radiographic progression. When baseline variables were compared between remission and non-remission patients at 52 weeks, the remission group had shorter disease duration, less radiographic progression, higher concomitant methotrexate dose, and lower steroid dose. Multivariate analysis revealed that lower stages and classes in Steinbrocker’s classification, and higher dose of methotrexate at baseline, were independent factors for DAS28 remission at 52 weeks.

Conclusions: Rapid and sustained reduction of disease activity was observed in RA patients treated with golimumab. Clinical remission may be achieved more frequently when golimumab is started early in the disease course with an adequate dose of methotrexate, especially in patients who were naïve to bDMARDs.

Objective: We evaluated the efficacy of non-contrast magnetic resonance imaging (MRI)/transrectal ultrasound (TRUS) fusion-guided transperineal biopsy for the detection of prostatic carcinoma.

Methods: Between November 2013 and June 2015, eighty-three men, who presented to the Department of Urology with a clinically suspicious prostatic cancer, underwent non-contrast MRI/TRUS fusion biopsy (FB)(BioJet ^®: D&K Technologies, Kanalweg, Germany) and 16-core systematic biopsy (SB). All biopsies were taken through a transperineal template. In 27 patients, the Gleason scores of biopsy specimens were compared to those of radical prostatectomy specimens.

Results: The median patient age was 69 years (IQR 67-73) and the median Prostate Specific Antigen (PSA) level was 6.6 ng/ml (IQR 5.2-8.9). Fifty-three patients were diagnosed with prostate cancer (PCa)(64%) by biopsy. The per-core cancer detection rate (CDR) was found to be higher for FB than for SB (32.5 vs 13.3%; p<0.0001). Although not statistically significant, the CDR for clinically significant PCa was numerically higher for FB than for SB (65.1 vs 58.0%; p=0.309). The Gleason scores of prostatectomy specimens were assessed to be higher than those of biopsy specimens in 44% of the cases in the FB group and in 37% of those in the SB group.

Conclusion: Our study adds to the literature which supports the potential role of non-contrast MRI/TRUS fusion-guided transperineal biopsy in the detection of PCa, with a significantly higher per-core CDR compared with SB.

Objective: Hypothermia, metabolic acidosis, and coagulopathy are the components of the “lethal triad,” which contributes to high mortality of severe trauma. However, the important factors remain unclear. This study was performed to clarify whether these factors are correlated with the mortality of severe trauma at 24 h after the therapeutic intervention.

Materials: The retrospective study was performed from January 2012 to December 2012 in 15 Japanese hospitals.

Methods: 687 trauma patients, aged ≥18 years with an Injury Severity Score (ISS) of ≥16 were involved. Changes in the body temperature (BT), fibrinogen, prothrombin time-international normalized ratio, fibrin/fibrinogen degradation products, pH, base excess, lactate, and platelet count during 24 h after admission were analyzed, while providing adequate medical care including various therapeutic interventions such as fluid therapy, blood transfusion, and surgery. Extraneous factors such as age, sex, ISS, Revised Trauma Score, and probability of survival were also evaluated. The endpoint was 28-day survival, and all parameters were compared between the survivor (n=646) and non-survivor (n=41) groups.

Results: Age and ISS were significantly higher in the non-survivor group. The univariate analysis showed a BT increase of 1.0℃ in the survivor group relative to an increase of only 0.4℃ in the non-survivor group, indicating that BT variation contributes to survival after trauma (odds ratio, 4.07). Additionally, the increase in fibrinogen was significantly higher in the survivor than non-survivor group (54 vs. 17 mg/dl, respectively; odds ratio, 4.68). The multivariate logistic regression analysis revealed that increases in BT and fibrinogen were independent variables for 28-day survival.

Conclusion: BT and fibrinogen were independent variables for 28-day survival. In the study, these results may have suggested the importance of therapeutic interventions for the BT and coagulation in trauma patients.

Objective: The present study examined the relationship between Computer-based Testing (CBT) results and the status of taking a practice examination.

Materials: A total of 392 (275 males and 117 females) students, who had taken CBT during their fourth year at Juntendo University within a 3-year period between 2017 and 2019.

Methods: We divided into 2 groups: those who had (practice examination group) and those who had not (non-practice examination group) taken a practice examination prior to CBT, and their Item Response Theory (IRT) scores were compared. IRT scores lower than 400 were defined as poor CBT results, and were compared between the 2 groups.

Results: The numbers of practice and non-practice examination group members were 228 (58.2%) and 164 (41.8%), respectively. The mean IRT score was significantly higher in the practice examination group (515.9±88.6) than in the non-practice examination group (478.0±78.3)(p<0.0001). The proportion of students with IRT scores lower than 400 was significantly larger in the non-practice examination group (p=0.0004).

Conclusions: Students who had taken a practice examination achieved better CBT results than those who had not. However, the status of taking a practice examination is only an index of preparedness for CBT, and does not indicate improved CBT results. Since CBT requires early preparation, delays in initiating test studies may result in insufficient studies and a superficial understanding.