In the United States, annual breast cancer surveillance using contrast-enhanced breast magnetic resonance imaging （MRI） is recommended for carriers of BRCA1/2 pathogenic variants. If lesions are detected, MRI-guided biopsies are recommended to confirm the pathological diagnoses. However, the utility of MRI surveillance for carriers of BRCA1/2 pathogenic variants in Japan remains unclear. Thus, the clinical utility of breast MRI in BRCA1/2 pathogenic variant carriers was examined in Japanese patients who developed secondary breast cancer during postoperative surveillance after their initial breast cancer diagnosis. This retrospective study included carriers of pathogenic BRCA1 or BRCA2 variants with breast cancer who were treated at Showa University Hospital between January 2010 and December 2020. Among the 81 patients with pathogenic BRCA mutations （48 BRCA1 and 33 BRCA2） who underwent breast cancer surgery, 8 （9.9％） patients developed secondary breast cancer （5 BRCA1, 6.2％ and 3 BRCA2, 3.7％）. The median follow-up period after the initial breast cancer surgery was 104.5 months （range: 46-112 months）. Four lesions were identified by MRI, three lesions were identified by breast ultrasonography, and one lesion was detected by the patient. Three of the four lesions detected by MRI could not be detected by mammography or breast ultrasonography but were confirmed by MRI-guided biopsies. One lesion was not detected by MRI due to bilateral background parenchymal enhancement but was identified by ultrasonography. The combined use of MRI and breast ultrasonography may enhance early cancer detection in BRCA1/2 pathogenic variant carriers. Larger-scale studies are needed to evaluate the role of MRI-guided biopsies and refine surveillance strategies for BRCA1/2 pathogenic variant carriers.

抄録全体を表示

As uniformly fortified human milk does not provide sufficient nutrition to ensure the optimal growth of preterm infants, individualized fortification （IF） is required. Two types of IF exist, including adjustable fortification （Adj F）, based on blood urea nitrogen levels, and targeted fortification （Targ F）, based on an analysis of the protein content in human milk. We aimed to clarify the effectiveness, ease, safety, and complications for very-low-birth-weight infants （VLBWIs） by comparing Adj F with Targ F in a neonatal intensive care unit. This is a randomized controlled study. VLBWIs were randomly divided into the Adj F （n＝23） and Targ F （n＝22） groups. The anthropometric data of corrected age, growth velocity, and plasma aminograms at 37 weeks were compared between the groups. The median gestational ages were 29.0 and 28.7 weeks in the Adj F and Targ F groups, respectively. In both groups, the first day of individualized human milk fortification was 7 days following full-strength fortification initiation. The anthropometric data, growth velocity, complications, and aminograms were not significantly different between the groups, nor were the plasma amino acid levels. The average nutritional protein and energy intake exhibited no difference between the groups. The Adj F and Targ F methods demonstrated comparable findings regarding anthropometric data, growth velocity, and plasma amino acids. Therefore, IF method may be selected on the basis of institutional protocols and feasibility.

抄録全体を表示

This study analyzed the progression of students’ practical pharmacotherapy skills from pre- to post-pharmacy practice experience to improve educational contents from the third to fifth years. It also explored the relationship between these skills at the end of the practice experience and rubric assessment subdomains. This study included 133 pharmacy students who completed their pharmacy practice experience. Self-assessments using a pharmacotherapy rubric were conducted before and after the experience, assessing progression in students achieving the target level. The rubric consists of three domains: “Evaluation of patient condition,” “Proposal of pharmacotherapy,” and “Plan for assessment of pharmacotherapy,” with 31 subdomains. At the end of the practice experience, students who reached the target level in all subdomains were categorized into the high practical pharmacotherapy skills groups, whereas those with unachieved subdomains were categorized into the low skills group. Significant subdomains differentiating these groups were extracted. Students’ practical pharmacotherapy skills improved steadily, with a significant increase in the percentage of those who achieved the target level each year. For the third, fourth, and fifth years, respectively, the results were: “Evaluation of patient condition” — 73％, 79％, and 89％, respectively; “Proposal of pharmacotherapy” — 66％, 72％, and 82％; and “Plan for assessment of pharmacotherapy” — 51％, 63％, and 78％. The high group comprised 46％, while the low group made up 54％. Large differences were observed between the two groups across 10 subdomains, which were classified into three patterns for educational improvement. Practical pharmacotherapy skills improved progressively. Furthermore, specific subdomains and optimal timing for educational improvement were identified.

抄録全体を表示

Despite growing interest in rehabilitation as a nonpharmacological intervention for delirium, the effective factors for improving delirium remain unexplored. Therefore, we aimed to investigate from various perspectives the rehabilitation factors contributing to the improvement of delirium and clarify early rehabilitation-related issues. This single-center retrospective observational study encompassed 382 patients who visited a critical care center and underwent rehabilitation from January 2018 to December 2019. Patients were included if they had delirium at the start of rehabilitation. The exclusion criteria were a ＜72-hstay, death, concomitant dementia, cerebrovascular disease, or psychiatric illness. Rehabilitation-related items were compared between patients who had delirium at discharge （n＝16） and those who did not （n＝44）. The impact of early rehabilitation was investigated using multiple logistic regression analysis. Sixty patients were included in the analyses. Multidisciplinary rehabilitation, number of days to start rehabilitation, delirium duration, and Intensive Care Unit Activity Scale as rehabilitation factors influencing delirium improvement showed significant differences. Logistic regression analysis revealed a significant association with multidisciplinary rehabilitation （odds ratio＝7.32, 95％ confidence interval＝1.59-33.72）. Although a multidisciplinary rehabilitation team is essential for rehabilitation factors to improve delirium in the intensive care unit, the lack of participation of occupational therapists and speech–language pathologists was a challenge.

抄録全体を表示

This study examined the proportion of oral medications used on an off-label basis in pediatric patients and evaluated a novel method for identifying pediatric drug development needs. Using medical big data from Japan Medical Data Center, we identified candidate drugs through criteria-based selection and expert review of prescription information. Among the analyzed medicines, 67.4％ （746/1,107） were not indicated for pediatric use according to their package inserts. Among the medicines used on-label, only 19.0％ explicitly provided pediatric indications in the package insert. Among the 1,107 ingredients, 608 were initially selected using criteria-based selection. Subsequent expert reviews further refined this selection, resulting in a final list of 138 ingredients. The status of the top 20 most prescribed ingredients as of November 2024 was checked. One similar medicinal product had already been developed as a pediatric formulation, whereas two others had been identified by academic societies as requiring drug development. This method, which combines quantitative analysis of medical big data with expert qualitative assessment of candidate pharmaceuticals for pediatric drug development, appears efficient for identifying actual medical needs.

抄録全体を表示

This study evaluated the diagnostic accuracy of a deep learning-based automated detection （DLAD） algorithm for coronavirus disease 2019 （COVID-19） pneumonia using chest X-ray images and the consistency of its performance across different variants of the severe acute respiratory syndrome coronavirus 2 （SARS-CoV-2）. A retrospective observational study was conducted at Showa Medical University Hospital. This study included 699 adult patients （aged ≥20 years） diagnosed with COVID-19 who underwent chest radiography and computed tomography （CT） scan between February 2020 and March 2022. Chest X-ray images were analyzed using the DLAD software developed by Fujifilm, which generated abnormality scores of 0％-100％. CT scan was used as the reference standard for diagnosing pneumonia. Diagnostic accuracy was evaluated via a receiver operating characteristic curve analysis. Subgroup analyses based on sex, age, body mass index, and SARS-CoV-2 variant were conducted. Of the 699 patients, （28.6％） had abnormal CT scan findings. The DLAD algorithm had a strong predictive performance, with an area under the curve of 0.85 （95％ confidence interval ［CI］: 0.82-0.88）, a sensitivity of 75.4％, and a specificity of 79.5％ at an optimal cutoff score of 28.5％. No significant differences were found in terms of the area under the receiver operating characteristic curve between the subgroups stratified according to sex, age, body mass index, or SARS-CoV-2 variant （p＞0.05）. The DLAD algorithm had a high diagnostic accuracy for COVID-19 pneumonia on chest radiography and a consistent performance across SARS-CoV-2 variants. These findings support the use of DLAD as a reliable tool for detecting COVID-19 pneumonia in clinical settings.

抄録全体を表示

A living will is a document in which the testator states in advance his or her wishes regarding the treatment desired by that person at time of death and the life-prolonging treatment the testator would like to receive. The existence of a living will is based on the right to self-determination. Generally, this right is interpreted as the right to freely dispose of matters concerning one’s interests without the involvement of public authority. This is based upon on the right to pursue happiness, under Article 13 of the Constitution. In the United States, California’s Natural Death Act recognizes the right of a person aged 18 years or older to prepare a written instruction in advance if they become terminally ill to instruct a doctor to discontinue life support or remove life support equipment. In Korea, living wills and other forms of advanced treatment planning are widely recognized in the legal system. On February 3, 2016, the Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End-of-Life, regarding the discontinuation of life-prolonging treatment, was promulgated. However, in Japan, patients are often in a state of mind that prevents them from expressing their wishes, or they may have lost consciousness before having done so; therefore, it is usually impossible for them to express their wishes appropriately. For this reason, it is desirable for them to institutionalize living wills.

抄録全体を表示