Juntendo Medical Journal
Online ISSN : 2188-2126
Print ISSN : 2187-9737
ISSN-L : 2187-9737
Volume 66 , Issue 2
Showing 1-15 articles out of 15 articles from the selected issue
What's New from Juntendo University, Tokyo
    2020 Volume 66 Issue 2 Pages 102-107
    Published: 2020
    Released: April 30, 2020

     On June 22nd 2019 we successfully finished the “Japan-China International Nursing Symposium ~ Japan-China Nursing Interaction for the Future ~”. This included a commemoration ceremony, poster sessions and the symposium at the auditorium and the foyer of Building A, which was newly completed in December 2018, to celebrate the 180 years anniversary of Juntendo University and the 120 years anniversary of its Nursing Education.

     There were 21 participants from China, including 4 guest speakers and 17 teachers and nurses from China’s leading universities such as Peking University, China Medical University, the Fourth Military Medical University, Sichuan University, China-Japan Friendship Hospital. And also from Japan, as many as 448 participants including nurses from 6 Juntendo University affiliated hospitals, teachers and students from Juntendo University Faculty of Health Care and Nursing, Juntendo University Faculty of Health Science and Nursing, and Juntendo University Graduate School of Health Care and Nursing attended the ceremony and the symposium.

     In the commemorative ceremony held in the morning, Hideoki Ogawa, CEO of Japan-China Medical Association and CEO of Juntendo University, delivered a ceremonial speech as an honorary chairman of the ceremony. In the speech he referred to the history of Juntendo and interactions with China. Currently, Juntendo University has expanded its horizon of exchange in the field of medical nursing with China’s leading universities. There are now active exchanges and interactions between both sides in the field of nurse training.

     In the symposium, top leaders of the hospital nurses and the professors who teach at universities in China gave their presentations. This symposium consisted of 2 sessions. The themes of 2 sessions were on “History and Management of Nursing Education” and “Opening up the future of Japan-China nursing education”. In first session, all of lecturers focused on the historical transition in nursing styles and activities at each university and hospital. And in second session, several efforts which have been done from the perspective of how to develop nursing in the future were introduced. In both sessions, they had time for questions and answers until the last minute.

     In the poster sessions, there were 24 submissions altogether, 9 of them from China. Those presentations were performed in English, and the themes covered 6 areas which are “Nursing Education, Cancer Nursing, Nursing Management, Clinical Education, Maternity / Pediatric Nursing, and Home / Psychiatric Nursing” with many questions and answers.

     We are convinced that Japan-China exchanges on the levels of nurses, teachers and students are leading to the fruitful results to understand each other and advance interactions with Japan and China.

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Research of the 2nd Alumni Scientific Award for Medical Student, Juntendo University School of Medicine
    2020 Volume 66 Issue 2 Pages 108-119
    Published: 2020
    Released: April 30, 2020

     Volume scanning electron microscopy (SEM) is a powerful approach for the 3D analysis of biological ultrastructure. It can obtain an enormous number of serial sectional images, which are quite similar to transmission electron microscopic images in quality, from sections on a substrate or sectional surface of resin-embedded biological samples. The individual cells and organelles can be reconstructed from the serial sectional images using an image-analysis software. The reconstructed cells and organelles can be viewed from all angles with sectional information. Here, we review the methodology, advantages, and limitations of volume SEM for 3D ultrastructural analysis of biological samples. Using volume SEM, our research group studies the 3D ultrastructure of podocytes, which form a part of an ultrafiltration apparatus for producing primary urine in metazoans. As successful examples of volume SEM analysis, we also show recent data on podocyte 3D ultrastructure in healthy and diseased conditions.

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    2020 Volume 66 Issue 2 Pages 120-124
    Published: 2020
    Released: April 30, 2020

    Carboxylesterases (CESs) play important roles in the metabolism of prodrugs containing ester bonds, which are often introduced to improve bioavailability and drug efficacy. CES1 and CES2 are major isozymes encoded by genes in the CES multigene family in humans, and their characteristics such as tissue distribution and substrate specificity have been extensively studied over the past few decades. This mini review briefly summarizes the current knowledge on CES2 focusing on its roles in the metabolism of anticancer prodrugs. We also discuss the regulatory mechanism of CES2 expression, which is often dysregulated in cancer cells. The development of CES2 inhibitors and methods to evaluate CES2 activity in biological samples are also discussed.

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    2020 Volume 66 Issue 2 Pages 125-126
    Published: 2020
    Released: April 30, 2020
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    2020 Volume 66 Issue 2 Pages 127-128
    Published: 2020
    Released: April 30, 2020

     In Japan, until 2007 the number of medical school enrollment had decreased from 8,280 to 7,625 due to the prediction of future surplus of medical doctors. However, the decision was reversed and now 9,419 students enter medical school. In order to improve the geographical disparities, a special quota was allocated for applicants who are willing to stay in the prefecture where the school is located; it is called community-quota (chiiki-waku). Chiiki-Waku was started in 2008 and 2,293 students of the quota graduated by 2018 1).

     On the other hand, according to a report from Nagasaki 2), 54% of the community-quota students had returned their scholarship and withdrawn (34.6% was still at school). While 30% of the students enrolled as quota expressed their willingness of engaging community medicine but less than 10% of the graduates chose the primary care as their specialty 3). Among 67 colleges which have instituted Chiiki-Waku system, 30 colleges provide lectures about community medicine and 26 send students to community rotation 4).

     To explore what affect medical students’ willingness to practice in underserved areas, I conducted a cross-sectional survey involving Chiiki-Waku students from second to final year at Juntendo University. The questionnaire asked students their future career preference including a specialty, area of practice, and types of medical facilities. I analyzed the association with time spent in rural clinics as a student. Response rate was 92.4% (61 of the 66 Chiiki-Waku students). Analysis of covariance was used to test for the differences. The potential confounders (i.e. gender, year in medical school and the types of Chiiki-Waku) were adjusted in the analyses.

     This study demonstrated that the Chiiki-Waku students (years 2 to 6) who participated in electives at rural practice expressed more interest in working in a rural area and tended to choose specialties in primary care, such as pediatrics (p<0.05). Moreover, students who experienced rural practice had positive perceptions toward community medicine compared with their retrospective feelings upon first entering medical school.

     Further follow-up study is needed to elucidate the causal effects of clinical experience in rural areas on their perception of future career.

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    2020 Volume 66 Issue 2 Pages 129
    Published: 2020
    Released: April 30, 2020

     Ankylosing spondylitis (AS) is characterized by chronic inflammation of the axial and peripheral joints and ligamentous attachments. The major histocompatibility complex (MHC) haplotype HLA-B27 has the strongest genetic association with the disease. Among these subtypes of HLA-B27, B*2702, B*2703, B*2704, B*2705 and B*2710 are reported to significantly increase risk, whereas B*2706 and B*2709 are not associated with disease. To date, three major hypothesis have been raised. The first one is that the arthritogenic peptide presented by HLA-B27 activates CD8+ T cells to cause inflammatory arthritis. The second theory is that misfolding of HLA-B27 in the endoplasmic reticulum leads to endoplasmic reticulum stress resulting in the activation of unfolded protein responses (UPRs) and the upregulation of IL-23 in dendritic cells. The third theory is that the HLA-B27 has an ability to aberrantly fold to form homodimers and this homodimer can be recognized by killer-immunoglobulin-like receptors. Despite these theories have been studied, the pathogenic role of HLA-B27 still remains unclear.

     In the present study, in order to clarify the function of HLA-B27 at the cellular level, we established human-derived B cell line C1R stably expressing pathogenic HLA-B27 subtypes (B*2704 or B*2705) or non-pathogenic subtype (B*2706). We examined the localization of HLA-B27 using confocal microscopy. We also investigated their associated molecules using Liquid chromatography-tandem mass spectrometry (LC-MS/MS).

     Confocal microscopic analysis demonstrated that either B*2704 or B*2705 form smaller uneven multiple clusters on the cell surface compared to that of B*2706 which form a single large dense cluster on the cell surface. LC-MS/MS analysis showed that the molecules which bind to both B*2704 and B*2705 but not B*2706 were Target of Myb protein 1 (Tom1) and MHC class I molecules. Tom1 is an adaptor protein required for the maturation of autophagosomes and their fusion with lysosomes. Tom1 also participates in immune receptor recycling and Toll-like receptor signaling. Therefore, pathogenic HLA-B27 might have some effect on immune receptor or Toll- like receptor- mediated signals by the alteration of intracellular vesicle trafficking. The other associated molecule was MHC class I molecules heterodimer with other MHC class I molecules in addition to HLA-B27 or β2-microgloblin. Although the direct evidence of their association should be demonstrated in the future studies, a new type of heterodimer may have some effect on immune responses.

     To summarize these results, the AS-sensitive subtype and insensitive subtypes of HLA-B27 differed in quantitative, qualitative, and diversity. It was also speculated that they might lead to the pathogenesis of AS.

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    2020 Volume 66 Issue 2 Pages 130-131
    Published: 2020
    Released: April 30, 2020
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Original Articles
    2020 Volume 66 Issue 2 Pages 132-141
    Published: 2020
    Released: April 30, 2020
    [Advance publication] Released: February 15, 2020

    Herman Boerhaave and Albrecht von Haller were outstanding figures of medicine in the 18th century and published study guides for medical students. The aim of this study was to clarify the features of these study guides that have not been analyzed, and discuss their historical significance. Literature analysis shows that Boerhaave presented detailed information that was required for medical students, listed the books that students should read for each field of medicine and science, and included mechanics/physics that had not been introduced into medical education before. Subsequently, Haller modified Boerhaave’s study guide and increased the amount of bibliographical information. While Boerhaave only referred to a small number of the best books for each topic, Haller referred to comprehensive lists of books. By expanding the bibliographical references, Haller prevented the obsolescence of Boerhaave’s study guide and contributed toward sustaining Boerhaave’s educational framework. This analysis demonstrates the features of these study guides for medical students in the 18th century.

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    2020 Volume 66 Issue 2 Pages 142-153
    Published: 2020
    Released: April 30, 2020
    [Advance publication] Released: February 17, 2020

    Objectives: This study was designed to achieve the following three objectives. The first objective was to ascertain the current status of sport and exercise engagement among nurses. The second objective was to examine factors affecting nurses’ sport and exercise activities, and the third objective was to examine the relationship between nurses’ sport and exercise activities and their job satisfaction and intention to continue working intention to stay.

    Design: Cross-sectional design was used.

    Methods: An anonymous self-administered questionnaire survey was conducted targeting 1,091 nurses at two university hospitals.

    Results: After excluding male nurses and missing data, the data of 891 female nurses were used in the final analyses. The findings can be summarized into the following three points; the first finding was that more than half of the nurses have not engaged in sport and exercise in the past year and running, jogging, and marathon training were the most popular among those who have engaged, the second finding was that the sport and exercise engagement rate of nurses with pre-primary children tends to be lower, and the third finding was that nurses who engaged in sport and exercise 1-2 times a week tended to have higher levels of job satisfaction and intention to continue working in terms of their relationship with their superiors, overtime and workload, approval, and sense of fulfillment compared to nurses who did not engage in sport and exercise at all.

    Conclusions: This research suggests the importance for medical institutions such as hospitals to try and promote engagement in sport and exercise among nurses from the viewpoint of job satisfaction and retention of nurses.

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    2020 Volume 66 Issue 2 Pages 154-161
    Published: 2020
    Released: April 30, 2020
    [Advance publication] Released: February 18, 2020

    Objective: Research has demonstrated the positive effects of physical activities on social cognition. The purpose of the present study was to find out whether coordination exercises have a beneficial effect on enhancing social functioning. We investigated the activation of the brain areas associated with doing one-person coordination exercises, as compared to doing two-person coordination exercises. We were interested in testing the hypothesis that two-person coordination exercises activate those brain areas underlying communication abilities, empathy in “theory of mind” (ToM), and working memory in social cognition.

    Materials: Thirty-four Japanese college students served as subjects.

    Methods: In the MRI system, the subjects carried out block-designed cognitive tasks containing affective visual stimuli (pleasant, unpleasant, and neutral stimuli). Then they got out of the MRI system and performed both one-person coordination and two-person coordination exercises. Just after the exercises, they were retested using the same types of the affective stimuli in the MRI system. We examined social abilities in terms of empathizing and memory span.

    Results: The present study provided evidence that coordination exercises activate language, working memory, and theory of mind functions. One of the fMRI results to be noted is that the right, but not the left, anterior cingulate correlated with the working memory function.

    Conclusions: We provided evidence for the effect of performing coordination exercises on the activation of the left frontal gyrus related to social functioning. We could also provide support for the hypothesis that two-person coordination exercises activate both the working memory function and the ToM function.

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Mini Reviews
    2020 Volume 66 Issue 2 Pages 162-171
    Published: 2020
    Released: April 30, 2020

     In our rapidly aging societies, the number of dementia patients is expected to reach 66 million worldwide by 2030. Currently, there are three types of acetylcholinesterase inhibitors used as anti-dementia drugs and an N-methyl-D-aspartate receptor antagonist that is prescribed to prevent the progression of Alzheimer’s disease (AD). However, adequate efficacy has not been demonstrated in clinical practice with these anti-dementia drugs. In addition, in 2019, several promising drugs failed at the phase III clinical trial stage. A beta-secretase inhibitor that could eliminate amyloid proteins, one of the pathophysiological features of AD was undergoing two clinical trials at our Juntendo University Hospital, both of which were canceled at phase III in September of 2019. One reason is that their first medical examinations were performed too late because some PET studies to detect accumulations of amyloid-beta proteins (Aβ), showed that in patients with mild cognitive impairment (MCI) levels, Aβ had already been accumulated. This paper discusses the current nutritional approaches and early clinical interventions available for AD. In particular, it discusses the first clinical trial conducted in Japan to investigate the adverse effects and benefits of using medical foods, especially, 1) medium-chain triglycerides as an energy source for brain, 2) milk-derived whey dipeptide and 3) ripening extract from hops, these two foods could act as anti-inflammation for the treatment of Japanese patients with AD.

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