Stereotactic body radiation therapy (SBRT) for spinal metastases is a new treatment technique applied in combination with image-guided SBRT and intensity-modulated radiation therapy (IMRT), which delivers a higher dose to spinal metastases than the tolerance dose of the spinal cord. In Japan, public medical insurance for this treatment was approved in April 2020. The superiority of SBRT over conventional radiotherapy in terms of pain palliation for spinal metastases was proven by a multi-institutional randomized controlled trial (RCT). Thus, spine SBRT will be considered as state-of-the-art for painful spinal metastases. On the other hand, spine SBRT is technically complicated and treatments may lead to a high incidence of severe adverse effects. In addition, spine SBRT requires much more human or institutional resources. The problem of how to guarantee resources to deliver spine SBRT for many patients with painful spinal metastases is marked. Multiple phase 2 RCTs suggested the efficacy of metastases-directed treatment (MDT) for patients with oligometastases. Currently, several phase 3 RCTs are on-going to confirm the efficacy of MDT. SBRT has an important role in MDT, especially MDT for spinal metastases for which resection requires extensive invasion. The usefulness of SBRT has also been investigated in cases of reirradiation, spinal cord compression,and painful non-spinal metastases.
Cognitive decline and frailty exacerbated by chronic polypharmacy are caused by anticholinergic burden, possibly impairing psychosomatic functions of elderly people. However, elucidating the anticholinergic burden on dementia is difficult, as techniques that measure anticholinergic activity (AA) in the body have not yet been established. In 1980, Tune et al., established a serum AA (SAA) assay technique that inhibits the binding of [3H]-quinuclidinyl benzylate ([3H]-QNB) to the membrane fraction of a rat’s forebrain homogenate. However, the procedure resulted in varying IC50 values of specific compounds among the researchers due to the use of rat forebrain homogenate membrane fractions. Therefore, Nobrega et al., utilized M1 muscarinic receptor subtype expressing cells from the brain homogenate instead of membrane fractions. However, this procedure took longer and egested a large amount of radioactive waste materials. In this study, we used MeltiLex as a melt-on scintillator, instead of a liquid scintillator to perform cost-effective and rapid measurements. This modified procedure for measuring SAA is faster, reduces the time required to 1/20 of the initial time; is economical, lowers cost to 1/30 of the initial cost; and reduces the quantity of radioactive waste, reduces wasted liquid to 1/80 and solid materials to 1/60 of previous quantities. Using this procedure to measure SAA is efficient and useful in diagnosing dementia associated with prescribed medicines. It also ensures the proper use of drugs in patients.
In 2019, to train medical interview skills, presentation skills, and clinical reasoning skills required for bedside learning (BSL) in medical schools, we developed practical Problem-Based Learning (PBL) using ICT (Information and Communication Technology). In our ICT-based PBL (ePBL), all students divided into groups simultaneously used their own devices to edit Google slides and solve a task regarding a fictional clinical case. In addition to fill-in-the-blank questions about medical interviews and physical examinations, the students were also tasked with filming a role-play of an actual medical interview and examination technique. Some patient information (medical interview, neurological findings, heart murmurs, etc.) were presented in video and audio format to encourage students to analyze and verbalize the information. In 2020, due to the COVID-19 pandemic, all students were required to join ePBL courses from home using Google Meet for group communications. The situation made role-playing and video recording tasks more difficult, but the ePBL style of learning, including video viewing tasks using ICT and tutorless operations, received higher evaluations by students in 2020 than that in 2019. The ePBL educational method may therefore be able to solve some medical education problems in Japan.