Tokyo Women's Medical University Journal
Online ISSN : 2432-6186
Advance online publication
Displaying 1-13 of 13 articles from this issue
  • Takako Iwasaki, Ayako Kou, Nozomi Harasawa, Miki Morishita-Kawahara, C ...
    Article ID: 2022004
    Published: 2022
    Advance online publication: July 13, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Background: This study explores the working generation's attitudes and needs regarding advance care planning and the factors associated with its practice.

    Methods: This cross-sectional study was conducted through a questionnaire survey with adults working in Kakegawa City, Japan. Logistic regression was used to assess the relationships between advance care planning practices and potential related factors.

    Results: Of the 182 participants whose data were analyzed, 49.5%, 17.6%, and 2.7% reported having considered, discussed, and documented advance care planning, respectively. The logistic regression analysis showed that advance care planning consideration was associated with three factors: experience of serious accidents/diseases, presence of agencies/persons to consult about medical treatment and care, and willingness to learn about it. Discussion about advance care planning was significantly associated with the following factors: female, experience of serious accidents/diseases, and willingness to learn about it. Due to limited completion rates, documented advance care planning was excluded from the relevant statistics.

    Conclusions: Incidence of advance care planning among the working generation is low. It might be necessary to create a foundation of related knowledge as well as opportunities for consideration or discussion by which people can understand the need for advance care planning.

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  • Shota Mochizuki, Junko Oya, Megumi Sato, Tomomi Mori, Yu Horiba, Satos ...
    Article ID: 2022002
    Published: 2022
    Advance online publication: July 08, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 57-year-old Japanese man with type 2 diabetes presented with bilateral pitting edema and pain of the hands and feet two months after being initiated on a dipeptidyl peptidase-4 (DPP-4) inhibitor, alogliptin. Laboratory tests showed elevated levels of C-reactive protein, matrix metalloproteinase-3 and vascular endothelial growth factor, and a negative rheumatoid factor. The computed tomography scan showed swelling in the dominant right wrist joint, and joint ultrasonography showed synovial swelling. He was diagnosed with remitting seronegative symmetrical synovitis and pitting edema (RS3PE) syndrome. Alogliptin was discontinued and prednisolone was initiated, thereafter, his symptoms quickly improved. As for his glycemic control, his hemoglobin A1c (HbA1c) went from an initial 9.1% to 8.3% once alogliptin was initiated. However, after being diagnosed with RS3PE syndrome, his treatment was changed from alogliptin to metformin, and his HbA1c remained between 6% and 7%. The diagnosis of RS3PE syndrome should be considered if pitting edema and arthralgia in the extremities are observed after initiating patients with type 2 diabetes on DPP-4 inhibitors.

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  • Eiko Ozasa, Asuka Sakuraya, Yasuto Sato, Sachiko Takehara, Noriko Koji ...
    Article ID: 2022003
    Published: 2022
    Advance online publication: July 08, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Background: The objective of this study was to investigate the association of the recognition of the importance and the effectiveness of clinical practice guidelines with the use of them among doctors in charge of medical education.

    Methods: A cross-sectional questionnaire survey was conducted on doctors in charge of medical education at Tokyo Women's Medical University. Multiple logistic regression adjusted for sex, age, and position was used to assess the association between the recognition and use of clinical practice guidelines for education among the participants.

    Results: Data from 89 respondents (response rate: 72.4%) were analyzed. The odds ratios (ORs) for using the guidelines in lectures (OR = 4.19, p < 0.05) and clinical clerkships (OR = 4.26, p < 0.05) were significantly greater among doctors who thought that "clinical practice guidelines are important in medical education" compared with those who did not. The OR for using the guidelines in clinical clerkships was also significantly greater among doctors who thought that "clinical practice guidelines are effective in medical education" compared with those who did not (OR = 6.46, p < 0.05).

    Conclusion: The results of this study suggest that doctors who recognize the importance and effectiveness of clinical practice guidelines tend to use them more frequently in medical education.

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  • Takuya Yoshida, Masayuki Ozaki, Akihiro Kozuka, Masafumi Idei, Yusuke ...
    Article ID: 2022006
    Published: 2022
    Advance online publication: July 05, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Background: Although early enteral nutrition (EN) plays a key role in managing patients after cardiac surgery, only a few studies have evaluated the effects of multidisciplinary team rounds (MDTR) in an intensive care unit (ICU) on the outcomes of cardiac surgery. We launched the MDTR in June 2020 and investigated its effect on clinical outcomes and nutritional management after cardiac surgery.

    Methods: A retrospective observational study was conducted in a single ICU. This study included 160 patients admitted to the ICU. The patients were divided into the Conventional and MDTR groups according to their MDTR status. The postoperative hospital stay (PoHS) and EN initiation process were compared between the two groups.

    Results: No significant difference was observed in the PoHS between the two groups (median: 15 days in the Conventional group and 14 days in the MDTR group). Multiple regression analysis indicated that MDTR was associated with shortened PoHS (regression coefficient: −4.65 days). The time to EN initiation was significantly shorter without increasing EN-related complications in the MDTR group (28.2 vs. 22.5 hours).

    Conclusion: MDTR could be associated with the shortening of PoHS; it allows the early and safe provision of EN for patients after cardiac surgery.

    The study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000044240).

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  • Kozue Takano, Toshitaka Uchiyama, Noriko Otsuki, Hisahide Nishio, Yuji ...
    Article ID: 2021020
    Published: 2022
    Advance online publication: May 20, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Background: Spinal muscular atrophy (SMA) is a lower motor neuron disease caused by SMN1. Several clinical trials have indicated that valproic acid (VPA) benefits a limited number of SMA patients. To clarify the difference in VPA responsiveness and elucidate the mechanism, we analyzed gene expression changes by VPA treatment in Japanese pediatric patients using data from clinical trials.

    Methods: To identify VPA responders, we correlated the changes in motor function and survival motor neuron (SMN) protein levels. To determine the effects of VPA on gene expression profiles, a microarray analysis was performed. The Gene Ontology (GO) analysis evaluated statistically overexpressed GO terms within a group of genes.

    Results: The group with significant improvement showed elevated SMN protein levels following VPA administration, whereas that with the highest SMN levels at baseline did not improve immediately. GO analysis suggested that specific factors contributed to the correlation between changes in motor function and the SMN protein levels, including splicing factors HNRNPC and SNRNP70.

    Conclusions: This is the first study to indicate that the time for VPA effectiveness varies among individuals and is associated with SMN protein levels at baseline and expression changes in splicing factor genes.

    Clinical Trials Registry of the Center for Clinical Trials, Japan Medical Association, a registry of the Japan Primary Registries Network certified by the World Health Organization as a primary registry (registration numbers: SMART01 trial, JMA-II A00190; SMART02 trial, JMA-II A00231; SMART03 trial, JMA-II A00259).

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  • Ayumi Inoue, Kyoko Hirasawa, Satoru Nagata
    Article ID: 2021022
    Published: 2022
    Advance online publication: May 17, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Background: While the prevalence of very low birth weight children (VLBWC) experiencing difficulties as a result of developmental coordination disorder (DCD) is increasing, the diagnostic criteria for DCD have remained unclear.

    The objective of this study is to elucidate the current situation and characteristics of DCD in VLBWC.

    Method: The VLBWC group (n = 14) comprised subjects with a mean birth weight of 986±355 g and a mean gestational age of 26±2.74 weeks. The fine motor skill characteristics of VLBWC were compared to those of the control group using the Movement Assessment Battery for Children-Second Edition (MABC-2). Moreover, the association between the MABC-2 results and the parent-completed child behavior checklists (CBCL) was determined.

    Result: There was a relatively high percentage of VLBWC with DCD/DCD risk. A significantly low MABC-2 index reported in VLBWC was attributed primarily to manual dexterity. Moreover, VLBWC with DCD frequently experienced daily difficulties as a result of their incompetence.

    Conclusion: The six-year-old VLBWC were more frequently associated with DCD and had more difficulties with clumsiness in their daily lives compared to the control group.

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  • Susumu Yoshida, Kiyoyuki W Miyasaka, Nobuko Fujita, Hiroyuki Kojima, N ...
    Article ID: 2021017
    Published: 2022
    Advance online publication: March 28, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Background: Spinal anesthesia with intrathecal morphine is widely used for cesarean section (CS), and is associated with nocturnal desaturation. No studies have correlated respiratory depression (RD) in this population with the Mallampati (MMP) classification. We examine the value of MMP for preoperative risk stratification.

    Method: MMP was assessed preoperatively in patients scheduled for elective CS under spinal anesthesia.

    We defined RD events as follows within 24 hours postoperatively, measured by mainstream capnometry waveform analysis:

    1. Bradypnea (RR ≤ 9 bpm for ≥ 120 seconds);

    2. Apnea (PETCO2 < 5 mmHg for ≥ 15 seconds up to 120 seconds);

    3. Temporary hypopnea (5 mmHg ≤ PETCO2 < 15 mmHg for ≥ 15 seconds up to 120 seconds);

    4. Sustained hypopnea (PETCO2 > 45 mmHg for ≥ 120 seconds).

    Results: There were 100 patients with MMP 1-2, and 90 patients with MMP 3-4. Bradypnea was observed in 55 patients (MMP 1-2, 55%) vs. 55 patients (MMP 3-4, 61%), p = 0.394. Apnea was observed in 77 patients (MMP 1-2, 77%) vs. 75 patients (MMP 3-4, 83%), p = 0.276. Temporary hypopnea was observed in 68 patients (MMP 1-2, 68%) vs. 76 patients (MMP 3-4, 84%), p = 0.008. No sustained hypopnea events were noted in any patients.

    Conclusions: Temporary hypopnea was more frequent in patients with MMP 3-4 vs. 1-2, following 0.15 mg intrathecal morphine for CS.

    The study was registered at the University Hospital Medical Information Network Clinical Trials Registry (UMIN000031410).

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  • Kei Sugimoto, Yukihide Chiba, Satoru Nagata
    Article ID: 2021021
    Published: 2022
    Advance online publication: March 28, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Background: Molecular biological analysis of the in vitro response of peripheral blood mononuclear cells (PBMCs) from children allergic to ovalbumin could help to elucidate the mechanism of IgE-mediated egg allergy in humans.

    Methods: PBMCs obtained from children with egg allergy who visited our clinic (December 2019 to September 2020) were subjected to in vitro stimulation by ovalbumin for 48 hours. The signal transducer and activator of transcription (STAT) signal and nuclear transcription factor expression were examined using real-time PCR-targeted mRNA of those parameters.

    Results: We co-cultured PBMCs with ovalbumin from persistent (n = 24), tolerant (n = 12), and control (n = 22) groups, and observed the following. (1) STAT1, STAT4, Foxp3, and STAT3 mRNA expressions fell significantly in the persistence group compared with the control group. (2) STAT4, T-bet, STAT6, GATA3, STAT5, Foxp3, STAT3, and RORγt mRNA expressions increased significantly in the tolerant group compared with the persistent group. (3) T-bet, GATA3, Foxp3, and STAT3 mRNA expressions increased significantly in the tolerant group compared with the control group. (4) PBMCs in the persistent, tolerant, and control groups did not differ significantly in CXCR5 or CD25 mRNA expression.

    Conclusions: Functional peripheral blood T cells changes may occur at the onset and remission of egg allergy.

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  • Naoyuki Arai, Taku Yoneyama, Yasunori Sato, Hidenori Ohbuchi, Shinji H ...
    Article ID: 2021018
    Published: 2022
    Advance online publication: March 16, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Background: We sought to evaluate the clinical outcomes and association of therapeutic intervention with activities of daily living (ADL) in patients with unruptured intracranial aneurysms (UIAs) during follow-up.

    Methods: Study cohort comprised 346 patients (mean age: 65.9 years, median follow-up length: 63.5 months) with UIA ≥ 2 mm, and was retrospectively analyzed. ADL decline was defined as deterioration of the modified Rankin Scale.

    Results: ADL decline occurred in 46 patients (13.3%, annual incidence rate [AI]: 2.5%, excluding deaths: 22 patients, 6.4%). Twenty-four deaths (6.9%, annual mortality rate: 1.3%) and eight UIA ruptures (2.3%, AI: 0.43%) were observed. The propensity score-matched cohort analysis revealed that intervention corresponded to a lower hazard ratio (HR) for ADL decline in patients with UIA ≥ 5 mm (HR, 0.24; P = 0.028) and eliminated the risk of aneurysm rupture (P < 0.0001). A significantly higher HR (HR, 4.73; P = 0.005) for ADL decline in patients aged ≥ 70 years was also demonstrated.

    Conclusions: Therapeutic intervention could prevent UIA rupture and might not contribute to reducing ADL in patients with UIA ≥ 5 mm. In elderly patients, ADL declined; however, therapeutic intervention might not be a major cause.

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  • Takeshi Ishita, Hidekazu Kuramochi, Takeshi Yamada, Sho Kuriyama, Hiro ...
    Article ID: 2021019
    Published: 2022
    Advance online publication: March 11, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Background: Amphiregulin (AREG) and epiregulin (EREG), which are ligands of epidermal growth factor receptor (EGFR), are associated with the prognosis of patients with unresectable colorectal cancer (CRC). The objective of this study was to determine whether the expressions of these genes are useful as prognostic markers for stage III CRC patients who received curative surgery.

    Methods: From 2007 to 2014, consecutive CRC patients (stage III and IV who underwent primary tumor resection in our institute were analyzed. AREG and EREG mRNA expressions in surgically resected specimen were analyzed by real-time reverse transcription polymerase chain reaction (RT-PCR).

    Results: AREG and EREG expressions tended to be higher in stage IV patients than stage III patients. Among stage III patients, there were no significant differences in disease-free survival (DFS) or overall survival (OS) between patients with high AREG or EREG expression and low expression. In stage IV patients, those with high AREG or EREG expression tended to have better OS than those with low expression.

    Conclusion: We found no association between AREG and EREG expression and prognosis in stage III CRC. Our data may suggest that the role of the EGFR pathway in tumor cell growth is mainly in advanced phase but not in the early phase.

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  • Mai Miyaji, Atsushi Kawaguchi, Charlene Pringle, Torrey Baines, Ravi S ...
    Article ID: 2021016
    Published: 2022
    Advance online publication: March 02, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    High-frequency oscillatory ventilation (HFOV) use in the airway obstructive status can be relatively contraindicated by the risk of air trapping leading to hemodynamic compromise. We experienced three young patients, a 7-month preterm male with respiratory syncytial virus (RSV) bronchiolitis complicated by secondary Streptococcal pneumonia, an 11-month male with Moraxella catarrhalis pneumonia and a 2-month male with RSV bronchiolitis complicated by Moraxella catarrhalis pneumonia. Those three cases developed hypercarbia from suspected airway obstruction which was refractory to pharmacological therapy and conventional mechanical ventilation (CMV). We utilized HFOV and achieved improvement in respiratory acidosis. All three cases had lower PaCO2 level after 6 hours of HFOV initiation and successfully transitioned back to CMV. The CO2 clearance in HFOV may be achieved from the combination of airway stenting effect from the higher mean airway pressure of HFOV and the other gas exchange mechanisms that is unique to HFOV such as pendelluft. These three cases shows that HFOV may be considered as a rescue treatment in children who have hypercarbia with airway obstruction which is refractory to pharmacological therapy and CMV.

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  • Yukie Yamamura, Yukako Seo, Manabu Nonaka
    Article ID: 2021011
    Published: 2022
    Advance online publication: February 21, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Background: Impaired taste sensation not only diminishes the pleasures of life, but it can also lead to health problems. Therefore, we retrospectively analyzed the clinical characteristics of taste disorders in 419 patients.

    Methods: The subjects were 146 males and 273 females who visited our facility from 2008 through 2020. The patients ranged in age from 16 to 90 years, with 81.4% of the patients > 50 years.

    Results: The most frequent cause of taste disorders was zinc deficiency (n = 148, 35.3%), followed by drug-induced (n = 63, 15.0%), systemic disease (n = 51, 12.2%), idiopathic (n = 39, 9.3%), postcommon cold (n = 27, 6.4%), psychogenic (n = 19, 4.5%) and dry mouth (n = 18, 4.3%). Zinc replacement therapy was administered to 309 (73.9%) patients. In 174 (56.3%) of those patients, 34 mg/day of zinc was sufficient to achieve a normal serum zinc level within 2 months, but 128 (41.9%) patients needed a higher dose. Prognoses of good, better and unchanged were seen for 206 (49.0%) patients, 87 (20.8%) patients and 126 (30.1%) patients. Patients with a duration of symptoms of ≤ 6 months showed a significantly better prognosis. Patients with zinc deficiency also showed a better prognosis, whereas psychogenic taste disorders revealed a significantly poor prognosis.

    Conclusion: The patients with taste disorders should be starting to treat within months of onset.

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  • Tomomi Hashimoto, Akira Nakabayashi, Keiko Yanagisawa, Chihiro Toma, Y ...
    Article ID: 2021012
    Published: 2022
    Advance online publication: January 15, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Some patients with type 2 diabetes desire egg retrieval for future embryo transfer, and would prefer the procedure to be performed prior to exerting glycemic control, which is technically possible. We experienced a case of a 38-year-old woman suffering from type 2 diabetes mellitus, hypertension, and severe obesity (body mass index 43) desiring early oocyte retrieval due to suspected endometrial atypia. Only 3 transferable embryos were obtained through two oocyte retrieval procedures before glycemic control was applied, whilst 5 transferable embryos were obtained in one egg retrieval cycle post inpatient treatment for insulin adjustment. The transfer of an embryo post-treatment resulted in delivery of a healthy full term child.

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