Juntendo Medical Journal
Online ISSN : 2188-2126
Print ISSN : 2187-9737
ISSN-L : 2187-9737
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Showing 1-13 articles out of 13 articles from the selected issue
Research of the 3rd Alumni Scientific Award for Medical Student, Juntendo University School of Medicine [2]
Special Reviews: Triannual Meeting of the Juntendo Medical Society “Forefronts of Rehabilitation Medicine”
    2021 Volume 67 Issue 1 Pages 10-16
    Published: 2021
    Released: February 28, 2021

     Cardiac rehabilitation refers to a long-term, multifaceted, comprehensive program designed to optimize a patient’s physical, psychological, social, and vocational status. Early mobilization and rehabilitation in intensive care units have become an established position in the Japanese medical insurance system since “early rehabilitation addition (5,000 yen/patient/day, 14-day upper limit)” was newly established in the revision of medical treatment fees in FY2018.

     The number of older patients with heart failure continues to increase in Japan. For older patients, in addition to increasing the walking distance and confirming the safety of expanding the range of life during hospitalization, it is important to have a rehabilitation program to improve daily life functions such as being able to stand up safely and maintain good balance and stability.

     Although older patients with heart failure who need to improve their ability to perform activities of daily living need continuous rehabilitation after discharge from acute care hospitals, cardiac rehabilitation in rehabilitation hospitals is rarely performed due to various medical insurance systemic restrictions. In addition, only 7% of patients underwent in-patient and outpatient cardiac rehabilitation. Therefore, there are growing expectations for tele-rehabilitation using digital information and communication technology.

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    2021 Volume 67 Issue 1 Pages 17-23
    Published: 2021
    Released: February 28, 2021

     Cancer rehabilitation is classified into the following four categories: (a) Preventive rehabilitation performed in early-stage cancer. (b) Restorative rehabilitation performed for the management of cancer- and cancer treatment-induced impairments and disabilities. (c) Supportive rehabilitation performed for the management of impairments and disabilities secondary to progressive and recurrent cancer. (d) Palliative rehabilitation performed to maintain quality of life (QOL) in patients at the end-of-life stage. Therefore, cancer rehabilitation can be performed for all patients with cancer.

     Usually, it is possible to predict postoperative impairments and establish perioperative rehabilitation goals for patients with cancer. Compared with patients who undergo surgery, patients who receive chemotherapy or radiotherapy tend to have advanced cancer, lower motor function, and a poorer general health condition. Therefore, establishing rehabilitation goals and planning rehabilitation programs is often challenging for such patients.

     The Japanese Association of Rehabilitation Medicine cancer rehabilitation clinical guidelines show the effectiveness of rehabilitation during and after chemotherapy and radiotherapy. However, high-intensity and high-frequency exercises performed by participants in the reports were used as evidence. These exercises are often inappropriate for patients with advanced cancer, and exercises suitable for these patients are being developed.

     The importance of exercise in cancer survivors is being recognized in recent times; it is known that colon and breast cancer survivors with high physical activity levels show better prognosis.

     Reportedly, one out of two Japanese individuals has cancer. Innovations in cancer therapy have improved the prognosis of patients with cancer. Currently, it is being acknowledged that patients should learn to live with cancer; cancer tends to affect even young adults and reintegration into society is important. Rehabilitation plays an important role in supporting social reintegration.

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    2021 Volume 67 Issue 1 Pages 24-31
    Published: 2021
    Released: February 28, 2021

     Stroke is a disease that leads to long-term disability, with about 80% of stroke patients having upper extremity paresis just after stroke and more than 40% in the chronic phase. The functional prognosis of the paretic upper extremity is dependent on its severity, and for severe paresis, it is difficult to obtain the function for practical use of daily living. Therefore, symptomatic approaches such as effective utilization of residual functions and compensation by the unaffected side, including dominant hand exchange training, self-help devices, and environment setting after accepting the state of paresis, are adopted in the conventional rehabilitation adjuvant approaches for paretic upper extremity. Neurorehabilitation techniques have been developed to modulate cortical excitability and improve paretic upper extremity function. The main concept of the newly developed neurorehabilitation techniques is task-oriented training and dose dependent plasticity. Constraint-induced movement therapy is an intensive training of the paretic upper extremity in which patients use their paretic upper extremity with their unaffected hand constrained and overcome learned non-use. Neuromuscular electrical stimulation is usually performed along with other rehabilitation approaches. Stimulation of the target nerve assists the movement of the paretic upper extremity and reduces the difficulty of the task. Non-invasive brain stimulation, such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation, could temporarily modulate cortical excitability by preconditioning before rehabilitation and is usually performed before conventional rehabilitation. Robotics is used to assist the patient’s performance like a neuromuscular electrical stimulation. These new rehabilitation techniques are combined and used as a hybrid rehabilitation therapy. The tailor-made neurorehabilitation approaches adjusted to the paresis and needs of individual patients are needed for functional recovery.

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Original Articles
    2021 Volume 67 Issue 1 Pages 32-38
    Published: 2021
    Released: February 28, 2021
    [Advance publication] Released: October 09, 2020

    Objective: To identify a high-risk group with poor computer-based testing (CBT) results, we hypothesized that CBT scores are higher in students who selected biology than in those who selected physics as a science subject for the university entrance examination.

    Materials: We examined 727 students (477 males and 250 females) studying medicine at Juntendo University who took the CBT and the graduation examination between 2012 and 2019. We divided them into a Physics group and Biology group for the medical school entrance examination and investigated the relationship between the subjects selected and the examination results.

    Results: The Item Response Theory (IRT) score for the CBT was 491.6±85.4 in the Physics group and 516.8±81.2 in the Biology group (p<0.001). The Biology group also achieved a significantly higher score in the CBT (IRT≧400) than the Physics group (85.1% versus 95.2%, p<0.0001). This was confirmed by the multivariate-adjusted odds ratio in all students, i.e., 0.31 and male students i.e., 0.18, but not in female students in the Biology group. In comparisons of correct answer rates for the graduation examination, no significant difference was noted between the 2 groups.

    Conclusions: Students who selected biology for the university entrance examination achieved higher CBT scores than those who selected physics. Some of male students who selected physics as a science subject for the university entrance examination showed greater difficulty with covering biology knowledge and, thus, need to be instructed to study seriously on a regular basis and prepare early for the CBT.

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    2021 Volume 67 Issue 1 Pages 39-45
    Published: 2021
    Released: February 28, 2021
    [Advance publication] Released: December 17, 2020

    Objective: Stroke is associated with high risks for mortality. The bidirectional communication between ischemic brain and other organ dysfunctions is widely recognized. However, the mechanisms underlying cerebrorenal crosstalk remains unclear. Herein, we investigated the effect of ischemic stroke on the kidney using a middle cerebral artery occlusion (MCAO) model. Moreover, we explored the effects of overexpression of liver-type fatty acid binding protein (L-FABP), as antioxidant role in this disease.

    Methods: MCAO was performed in wild-type (WT) and L-FABP transgenic (Tg) mice. At 24 h after this procedure, renal hypoxia, oxidative stress, and lipid metabolism were examined. Hypoxia was examined by pimonidazole staining and oxidative stress was examined by heme oxygenase-1 staining in MCAO WT mice. The biomarkers such as urinary 8-OHdG for oxidative stress and silent information regulator 2 mammalian homolog 1, peroxisome proliferator-activated receptor α, and 3-hydroxy-3-methylglutaryl-CoA reductase for renal lipid metabolism were compared between MCAO WT and Tg mice.

    Results: MCAO enhanced renal hypoxia and oxidative stress, and the biomarkers for oxidative stress tended to increase in the MCAO WT mice than in the sham-operated control mice, and these were diminished by L-FABP overexpression. The expression levels of renal lipid metabolism-related genes markedly changed. These alterations were blocked in the L-FABP Tg mice.

    Conclusions: Ischemic stroke-mediated renal oxidative stress and the resulting alteration of lipid metabolism could partly account for cerebrorenal connection and the induction of renal L-FABP activity and could be a novel therapeutic target for the prevention of renal diseases in patients with stroke.

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    2021 Volume 67 Issue 1 Pages 46-59
    Published: 2021
    Released: February 28, 2021
    [Advance publication] Released: December 11, 2020

    Objective: This study aimed to: (a) develop scales for measuring the causes of and coping behaviors with loneliness in Japanese and Chinese university students and (b) compare the interrelationships between the causes of loneliness, sense of loneliness, and coping behaviors with loneliness among Japanese and Chinese student samples.

    Participants: In the preliminary survey, participants were 111 Japanese (M=20.06, SD=1.34) and 83 Chinese university students (M=18.90, SD=1.20). In the main survey, 864 Japanese (M=18.95, SD=0.967) and 414 Chinese university students (M=19.94, SD=1.27) participated.

    Methods: In the preliminary survey, items from the Loneliness Cause Scale and Coping Behaviors with Loneliness Scale were extracted during the open-ended interviews with Japanese and Chinese university students. The main survey was conducted with Japanese and Chinese university students, using a questionnaire which included three parts: UCLA Loneliness Scale, Loneliness Cause Scale, and Coping Behaviors with Loneliness Scale.

    Results and Conclusion: The researchers developed a Loneliness Cause Scale and Coping behaviors with Loneliness Scale. The causes of loneliness consisted of 3 factors, while coping behaviors included 4 factors. Chinese university students felt a strong sense of loneliness and were more aware of the cause of their loneliness compared to Japanese university student samples. Regarding coping behaviors with loneliness, Japanese university students tended to choose “interpersonal contacts” and “diversions and pastimes,” while their Chinese counterparts engaged in the “use of social media.”

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Mini Reviews
    2021 Volume 67 Issue 1 Pages 60-65
    Published: 2021
    Released: February 28, 2021

     The epidermis, a rapidly regenerating tissue, acts as a barrier against environmental factors. The dermis, composed of connective tissue, imparts strength and flexibility to the skin. Full-thickness skin defects are healed by the migration of epidermal stem cells from regions surrounding the ulcer, and by wound contraction induced by the myofibroblasts in the dermis. Stem cells are expected to play a central role in treating skin diseases as well as in the diseases of other organs. Among stem cells, adipose-derived stem cells (ADSCs) can be easily harvested in large quantities, have less immunogenicity, and a powerful immunosuppressive potential. Therefore, they are suitable for clinical use, including allogeneic cell transplantation. ADSCs promote wound healing and can differentiate into keratinocyte-like cells. Recessive dystrophic epidermolysis bullosa (RDEB) is a severe form of epidermolysis bullosa. The pathogenesis of RDEB involves mutations in the COL7A1 gene, which encodes type VII collagen, the main constituent of anchoring fibrils that attach the epidermis to the dermis. Persistent skin erosion frequently results in intractable ulcers, which result in severe scarring. Therefore, skin ulcers in RDEB patients should be treated at an early stage. Keratinocyte-like cells transdifferentiated from ADSCs (KC-ADSCs) express more type VII collagen than undifferentiated ADSCs do, thereby facilitating skin wound healing with less contracture. Therefore, KC-ADSCs may be useful for the treatment of skin ulcers in RDEB and other skin diseases.

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