I graduated from Osaka University in 1982 and joined the Department of Traumatology, Osaka University Medical School. Patients with severe injuries and illnesses were brought in every day. Staff brushed up their skills on site, taught each other, and engaged in friendly competition for research. We had many frustrating moments when we could not save lives. Since then, the needs of emergency medicine have changed, and the scope of practice of emergency physicians has expanded to include pre-hospital emergency care, primary health care, intensive care, and disaster medicine. I was transferred to Juntendo University Urayasu Hospital in September 2007. Soon after my assignment, Urayasu Hospital was in the spotlight due to the emergency hospitalization of the All-Japan soccer coach and the Chinese frozen dumpling incident. It is said that emergency medicine is a mirror of society. I myself have experienced many disasters and incidents. It has been 15 years since I was assigned to this hospital, and I have 62 colleagues at Urayasu Hospital. They have all acquired various medical specialties, and some are emergency medicine specialists. In 2019, we hosted the 47th Annual Meeting of the Japanese Association for Acute Medicine. The theme of the conference is “Fudan Zenshin, Kyumeikyukyu (constant advancement, emergency medical services)”. Emergency medical care is the starting point of “medicine” and is the ultimate source of life preservation for all citizens. We emergency physicians will continue to provide lifesaving medical care to patients without giving up until the very end, to keep the light of life from going out.

In the present review, I provide an overview of the development of radiation therapy and short history of the Department of Radiation Oncology, Juntendo University. I also emphasize the importance of radiation therapy as a major treatment modality for cancers.

Radiation therapy is a standard treatment for malignant tumors. It aims to deliver a sufficient radiation dose to a target volume to eradicate tumor cells or relieve symptoms of disease. Therapy can achieve good results in many types of cancers. Although radiation therapy sometimes causes undesirable adverse events, it is generally less invasive than other treatment modalities and does not alter the shape and function of healthy organs. When the author joined this field in 1981, radiation therapy techniques were highly primitive; however, during the past 42 years, treatment has advanced rapidly with the development of computer science, mechanical techniques and instrumentation. Currently, patients can be treated with precise radiation techniques, including intensity-modulated radiation therapy, image-guided radiation therapy, stereotactic irradiation, and brachytherapy. We also introduced a new treatment planning system that uses not only anatomical but also metabolic imaging, which permits correct delineation of the target volume. Therefore, it is crucial to stay up to date with advances and developments in rapidly emerging technologies to maintain high-quality treatment. The Department of Radiation Oncology at Juntendo University (Tokyo, Japan) is still small; however, it is gradually expanding and conducting research in both clinical and basic fields. It is the author’s hope that many young investigators will join this field in the future.

Purpose The purpose of this study was to determine what proteins are present in the ciliary body (CB). To accomplish this, we conducted a proteomic analysis of the CB of cynomolgus monkeys. We also determined the location of the proteins in CB by immunohistology.

Methods The eyes of euthanized cynomolgus monkeys were enucleated, and the CB, were isolated from the eyes. Proteins were extracted from the CB and determined by liquid chromatography-mass spectrometry. Separated CB epithelial cells were cultured, and the proteins expressed in the CB were determined by Western blotting. The location of these proteins in the CB was determined by immunohistochemical staining. We also investigated whether adding dexamethasone to the culture medium changed protein expression by the epithelial cells.

Results Proteomic analysis of the CBs showed that 813 proteins were expressed in the epithelium and stroma. These proteins included the small guanosine triphosphate-binding protein Rab8 and the ezrin/radixin/moesin (ERM) family. Tissue and immunohistological staining confirmed the colocalization of these proteins in non-pigmented CB epithelium. Western blotting of cultured CB epithelial cell lysates showed a tendency that adding dexamethasone changed Rab8 protein expression levels.

Conclusions Proteomic analysis of CBs identified several proteins involved in the transport and secretion of proteins. These proteins may be involved in the production of aqueous humor and protein secretion by the CB.

Objectives To evaluate the difference in action between the iliopsoas and rectus femoris muscles in hip flexion by estimating the relative contribution to the maximal hip flexion torque and relative rotation speed.

Materials We examined 22 lower limbs of 10 male and 12 female formaldehyde-fixed adult Japanese cadavers.

Methods Using morphometric data from cadaver dissections, we calculated the moment arm length and physiological cross-sectional area for each muscle. We considered moment arm length and physiological cross-sectional area as indices of the maximal torque and compared them among the muscles at various hip joint angles. To evaluate the relative rotation speed, we calculated the increase of the hip joint angle for a 1% reduction of the muscle fiber length in each muscle.

Results The rectus femoris contributed approximately 2/3 to the flexion torque in mild flexion up to 60°, whereas the iliopsoas contribution increased sharply beyond 60°. The relative iliopsoas rotation speed was 2.5- to 3-times higher than that of the rectus femoris in mild flexion up to 60° under the specific condition that each muscle had the same muscle contraction speed.

Conclusions We found that the iliopsoas served as a rapid flexor, while the rectus femoris was a powerful flexor.

Objectives The goal of the study was to examine the relationships among micrometastasis, pathological degree of differentiation and survival in patients with esophageal squamous cell carcinoma (SCC).

Design A single-center retrospective study of patients diagnosed with thoracic esophageal SCC.

Methods Immunostaining using CK13 was carried out for all lymph nodes resected by radical esophagectomy with three-field lymphadenectomy. The relationships among micrometastasis to lymph nodes, degree of differentiation and survival were investigated.

Results The 25 patients included 14 (56.0%) well-differentiated and 11 (44.0%) moderately differentiated cases. In multivariate analysis, well-differentiated cases were not related to micrometastasis (odds ratio (OR): 1.5, confidence interval (CI): 0.2-12, p=0.7). In multivariate analysis of survival, cases in pStage III or higher were likely to have shorter survival (hazard ratio (HR): 2.8, CI: 0.7-12, p=0.16), and those with micrometastasis also tended to have shorter survival (HR: 2.7, CI: 0.8-9, p=0.11)); however, well-differentiated cases were not significantly related to survival (HR: 1.5, CI: 0.4-5.5, p=0.5).

Conclusion Micrometastasis to lymph nodes may be a prognostic factor even in advanced esophageal cancer. The degree of differentiation was not related to micrometastasis or survival.

Objective In recent years, circulating tumor cells (CTCs) have attracted attention for prediction of metastasis in breast, prostate, and colon cancers. This study aimed to investigate whether detection of CTCs could be prognostic factor in esophageal cancer.

Methods This study involved 38 patients treated at Juntendo University from May 2010 to April 2013 who provided consent. CTCs were measured using CellSearch^® system in preoperative peripheral blood. Clinicopathological parameters and prognostic factors were retrieved from our medical records.

Results CTCs were detected in 6 of 38 patients (15.8%). Among patients’ characteristics and clinicopathological features, CTC-positive group had higher serum SCC levels and tended to have more advanced cStages than the CTC-negative group. The CTC-negative group showed better survival curves than CTCs positive-group in both overall survival (OS) and disease-free survival (DFS) although the differences were not statistically significant. CTCs positivity has a possibility to be prognostic marker according to multivariable analysis of OS and DFS.

Conclusion Although this study has some limitations, our results suggest that CTCs in preoperative peripheral blood has potential to be a prognostic marker for esophageal cancer.

Objectives In radiation therapy, the field-in-field (FIF) technique is used to prevent the administration of unnecessarily high doses to reduce toxicity. Recently, the FIF technique has been used for whole brain irradiation (WBI). Using the FIF technique, the volume that receives a higher than prescribed dose (hotspot) can be largely reduced; however, the treatment planning requires time. Therefore, to reduce the burden on the treatment planners, we propose a semiautomatic treatment planning method for the FIF technique.

Methods In the semiautomatic FIF technique, hotspot regions in a treatment plan without the FIF technique are identified three-dimensionally, and beams with blocks that cover the hotspot regions using a multileaf collimator (sub-beams) are automatically created. The sub-beams are added to the original plan, and weights are assigned based on the maximum dose of the original plan to decrease the doses in the hotspot regions. This method was applied to 22 patients previously treated with WBI, wherein treatment plans were originally created without the FIF technique.

Results In the semiautomatic FIF plans, the hotspots almost disappeared. The dose to 95% of the volume and the volume receiving at least 95% of the prescribed dose in the planning target volume decreased by only 0.3% ± 0.2% and 0.0% ± 0.1%, respectively, on average compared with those in the original plan. The average semiautomatic FIF processing time was 28 ± 4 s.

Conclusions The proposed method reduced the hotspot regions with a slight change in the target coverage.

Kinetic vision acuity (KVA) is an index developed in Japan that refers to the capacity to recognize a moving object that moves back and forth against the observer. This review outlines the history of KVA and studies on KVA conducted at the Faculty of Health and Sports Science of Juntendo University, i.e. characteristics of KVA in athletes, factors associated with KVA, sports and age-dependent decline of KVA, and effects of docosahexaenoic acid (DHA) and astaxanthin on KVA. KVA was defined in the early 1960s, and the measurement device was invented in 1968. Studies at the Faculty of Health and Sports Science began in the 1990s. In track-and-field athletics and skeleton, a winter downhill event, higher-ranked athletes had higher KVA than lower-ranked athletes. Although KVA cannot be predicted from static visual acuity or reaction time, a significant correlation was found between KVA and the peak latency of visual-evoked potentials. KVA could not be improved by training and did not change between age of 8 and 17 years. In contrast, habitual practice in kendo may inhibit the age-dependent decline in KVA. DHA may also improve KVA in subjects with low KVA; however, astaxanthin did not improve KVA.

In this article, we report the case of a patient with unresectable stage III squamous cell lung carcinoma who developed immune-related adverse events in the gastrointestinal tract following the administration of immune checkpoint inhibitors. The patient developed severe acute respiratory syndrome coronavirus 2 pneumonia and cytomegalovirus gastritis during immunosuppressive therapy for an immune-related adverse event. Cytomegalovirus infection was managed with the administration of ganciclovir.

Azygos vein injury seems to be an uncommon cause of hemothorax and hemomediastinum; however, this injury is potentially fatal. We report a fatal case of blunt azygos injury and a PubMed search was undertaken to identify English articles from 1989 to 2022 using the key words “azygos”, “injury” and “blunt”. We found 28 articles about blunt azygos injury and 39 patients including the present case (average 41.2 years [range: 18-81 years]; male, n=20; female, n=19). The other variables were as follows: right hemothorax (n=32); unstable circulation on arrival (n=32); and survival (n=19; unknown, n=2). These cases were divided into two groups based on the outcome: the survival group and the fatal group. There were no significant differences with regard to the year of the report, age, sex, rate of right rib fracture, rate of preoperative computed tomography (CT) examination, rate of associated injury, and rate of operation. The rate of shock on arrival in the survival group was significantly lower than that in the fatal group. The rate of azygos arch injury in the survival group was significantly greater than that in the fatal group. The emergency physician must consider azygos vein injury as a possible cause of right hemothorax when a patient with blunt chest trauma presents persistent hypotension.

We herein present the case of a 33-year-old woman with no family history of metachronous bilateral breast cancer and osteosarcoma, diagnosed with Li-Fraumeni syndrome (LFS), which is a rare autosomal dominant hereditary cancer syndrome associated with a germline TP53 variant. She was diagnosed with left distal femoral osteosarcoma at the age of 16, and metachronous bilateral breast cancer at the ages of 29 and 33. When the third cancer was diagnosed, a hereditary tumor syndrome was suspected and the patient was referred to our genetic outpatient clinic. There was no family history of the ‘core’ cancers for LFS, but since the patient met Chompret’s criteria, germline TP53 genetic testing was performed with the patient’s will. A pathogenic variant, TP53:c.216dupC (p.Val73ArgfsX76) was found in exon 4 of the gene. This case is didactic because radiotherapy was performed on the first breast cancer before the diagnosis of LFS was made; radiation should be avoided if there are other options in LFS because of the inability to repair DNA damage. As a lesson learned, oncologists reaffirmed the importance of being aware of hereditary tumors from the keywords “multiple,” “young,” “familial,” and “rare,” and consulting the genetic department. In addition, surveillance using whole-body magnetic resonance imaging is recommended in LFS. However, this system is not yet provided nationwide, but we have newly settled it in our hospital.

We evaluated the current status of supporting activities in core clinical research hospitals across Japan using the Japan Registry of Clinical Trials (jRCT) data given the lack of previous research objectively investigated supporting activities for clinical trials in core clinical research hospitals throughout Japan. Briefly, our findings showed that despite the officially supposed cooperation scheme, core clinical research hospitals have not been the primarily selected contractor for clinical research supporters. Considering that core clinical research hospitals are designated spearhead physician-led clinical trials and are responsible for ensuring the quality of such trials, there is a need to determine why the officially supposed cooperative scheme between core and non-core hospitals are still not established in Japan in order to increase the development and quality of Japanese clinical research with maximum efficiency moving forward.