Yonago Acta Medica
Online ISSN : 1346-8049
ISSN-L : 0513-5710
Advance online publication
Displaying 1-12 of 12 articles from this issue
  • Yoshiyuki Hasegawa, Keiichi Hanaki
    Article type: Original Article
    Article ID: 2023.02.008
    Published: 2023
    Advance online publication: February 04, 2023
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    Background The administration of basic life support (BLS) by bystanders is essential to improve the survival rates of patients who have experienced out-of-hospital cardiac arrest (OHCA). Although providing BLS to individuals who experience OHCA greatly improves their chances of survival, the actual implementation rate is low. Therefore, we investigated the association between bystanders’ willingness to perform BLS and facilitative/obstructive factors with the objective of identifying educational methods that would improve the likelihood of bystanders performing BLS should they encounter a patient with OHCA.

    Methods The study participants included 502 male and 498 female Japanese residents (total, 1000 participants) with no experience in performing BLS and 42 male and 59 female Japanese residents (total 101 participants) with experience in performing BLS. The participants were aged 15–65 years. Both groups graded the strength of their willingness to perform BLS in the future on a 4-point scale, as well as their level of agreement with factors facilitating or obstructing their willingness to perform BLS. These factors were established based on the theory of helping behavior, which defines psychological states when helping others in social psychology.We then analyzed the associations between willingness to perform BLS in the future and their level of agreement with factors facilitating or obstructing their willingness to perform BLS.

    Results The willingness to perform BLS decreased in accordance with the increase in the level of intervention required for patients who experienced OHCA , and was significantly associated with four facilitating factors: sufficient ability and experience to perform BLS, personal advantage, high personal norms, and psychological closeness to the patient.

    Conclusion Our results suggested that workshops and other educational activities focused on these facilitative factors may be helpful in increasing the rate at which bystanders perform BLS.

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  • Mikihiro Izuta, Satoshi Kuwamoto, Tetsutaro Kamiya, Keiko Nagata, Mich ...
    Article type: Original Article
    Article ID: 2023.02.009
    Published: 2023
    Advance online publication: February 04, 2023
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    Background Low-vacuum scanning electron microscopy (LVSEM) enables the detailed three-dimensional imaging of archival tissues without special pretreatments. The clinical utility of LVSEM in the assessment of liver diseases has not yet been defined. So, we investigated the utility of LVSEM imaging in morphological assessments of normal and diseased liver tissues, with a focus on reticulin structures.

    Methods Formalin-fixed tissue samples of two normal livers and two hepatocellular carcinomas with background regenerative nodules/areas were stained with platinum blue stain or silver-impregnated using Watanabe’s method and then comparatively observed under LVSEM. We also evaluated the applicability of LVSEM imaging of liver tissues to a quantitative analysis using a digital image analysis technique.

    Results Optimal high-resolution images of reticulin structures were obtained using 10-μm-thick silver-impregnated sections. Reticulin fibers were clearly observed to run dendritically around sinusoids in normal livers, and markedly increased in regenerative nodules/areas. Normal reticulin frameworks were lost in hepatocellular carcinoma, leaving a few fragments of reticulin fibers within tumors. Moreover, when a quantitative analysis was applied to these images, we successfully demonstrated a significantly higher reticulin fiber density in regenerative nodules/areas than in the normal liver (P < 0.05).

    Conclusion We not only obtained detailed three-dimensional images of reticulin structures in various liver tissues by LVSEM combined with silver impregnation but also showed their applicability to a quantitative analysis. The method presented herein may be applied to future studies for the more accurate diagnosis and better classification/risk stratification of various liver diseases.

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  • Naomi Sunami
    Article type: Short Communication
    Article ID: 2023.02.019
    Published: 2023
    Advance online publication: February 04, 2023
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    The School of Medicine offers study counseling. In particular, the School of Medicine has many required courses, and it is important to respond to students with learning difficulties. It is necessary to discuss a new approach to learning counseling for such students, considering the prevention of COVID-19 infection, but online learning counseling has not been discussed so far. In the future, flexible selection and response based on an understanding of the advantages and disadvantages of online learning counseling will be required. To overcome this challenge, this paper examines the practice of online learning counseling at the University’s School of Medicine in the Corona Disaster. The practice could be characterized by seven advantages [behavioral understanding, physical condition consideration, continuity, confidentiality, sharing, immediacy, and convenience] and two challenges [grasping reactions and interruptions]. Subsequently, it was presented new possibilities for online learning counseling by examining the content related to learning.

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  • Kazuma Otsuki, Isamu Kodani, Dawa Zangpo, Masato Nakatome, Morio Iino
    Article type: Original Article
    Article ID: 2023.02.017
    Published: 2023
    Advance online publication: February 01, 2023
    JOURNAL FREE ACCESS ADVANCE PUBLICATION
    Supplementary material

    Background The morphology of the maxillary sinus varies between individuals which could be used in the forensic personal identification process.

    Methods In the current study, the CBCT images of the maxillary sinus in 453 patients (217 males, 236 females) aged 14 to 95 years were analyzed. In particular, each left, and right maxillary sinus of the subjects was measured for its maximum height, width, and breadth in 2-D, and volume in 3-D perspectives, and their usefulness for age and sex estimation was examined. Regarding age estimation, because the size of the maxillary sinus increases up to 20s and then decreases over time, two separate age estimation formulas were created, one for subjects in their 14–21 years and the other for those over 22 years old. For each age group, multiple regression formulas were generated using the diameters and volume as explanatory variables and the chronological age as a response variable. This study used 150 cases not included in the study as a validation set for age estimation.

    Results Generally, all the diameters and volumes in both sinuses tended to increase till the mid-20s, and then gradually decreased over time. The derived formulas were tested for their accuracy on additional 150 subjects. Plausibly, the model could estimate the age between 14–21 years old with an average accuracy of ± 1.8 years for men and ± 3.2 years for women. Whereas for those over 22 years old, it was possible to estimate the age with an accuracy of ± 11.8 years for males and ± 10.3 years for females, respectively. A comparison of estimated age and chronological age did not show a statistically significant difference(P > 0.05). It was found that the left maxillary sinus had more age groups showing the most significant difference than other measurements between sexes(P < 0.05). The maxillary sinus height may be significantly affected by gender differences.

    Conclusion Overall, this study showed the effectiveness of age and sex estimation using the maxillary sinus morphometric analyses.

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  • Masahiko Inoue, Naho Inoue, Keita Nakatani, Yoko Shikibu
    Article type: Original Article
    Article ID: 2023.02.012
    Published: 2023
    Advance online publication: January 28, 2023
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    Background Parent training (PT) is a promising support for improving parents’ mental health, and behavior in children with autism spectrum disorders (ASD). In recent years, there has been an increase in online PT studies. We developed a prototype for the on-demand PT. In this study, we examined changes in the program implementation, accomplishment of homework, parents’ mental health, and behavior of children among parents of children with ASD.

    Methods This study participated two mothers of children with ASD. The first was the mother of a child aged three years and eight months with ASD and intellectual disability; the second was the mother of a child aged four years and 5 months who had a diagnosis of ASD. An on-demand PT consisting of six sessions was provided online. The program was structured so that the participants watched lecture videos for each session, answered a confirmation test, and submitted homework to advance to the next session. Feedback for the submitted homework and questions was provided via email by the researchers.

    Results Both participants watched the program on a schedule for all sessions and submitted all tests and homework assignments. The percentage of correct responses to the tests per session was 100% for both participants. Two of the four target behaviors of the children changed significantly. Pre- and post-questionnaires also showed improvements in the scores of parental depression and parenting stress, as well as overall behavior of the child.

    Conclusion The program in this study was developed as a prototype for on-demand PT, and two case studies showed positive results. Although this program was on-demand, changes in parent and child behaviors were confirmed by the scale and actual behavior records. Further demonstration is needed to increase the number of cases and to compare the results between the groups.

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  • Masayoshi Oguri, Tetsuya Okazaki, Tohru Okanishi, Masashi Nishiyama, S ...
    Article type: Original Article
    Article ID: 2023.02.006
    Published: 2023
    Advance online publication: January 25, 2023
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    Background Childhood epilepsy with centrotemporal spikes (CECTS) is the most common epilepsy syndrome in school-aged children. However, predictors for seizure frequency are yet to be clarified using the phase lag index (PLI) analyses. We investigated PLI of scalp electroencephalography data at onset to identify potential predictive markers for seizure times.

    Methods We compared the PLIs of 13 patients with CECTS and 13 age- and sex-matched healthy controls. For the PLI analysis, we used resting-state electroencephalography data (excluding paroxysmal discharges), and analyzed the mean PLIs among all electrodes and between interest electrodes (C3, C4, P3, P4, T3, and T4) and other electrodes. Furthermore, we compared PLIs between CECTS and control data and analyzed the associations between PLIs and total seizure times in CECTS patients.

    Results No differences were detected in clinical profiles or visual electroencephalography examinations between patients with CECTS and control participants. In patients with CECTS, the mean PLIs among all electrodes and toward interest electrodes were higher at the theta and alpha bands and lower at the delta and gamma bands than those in control participants. Additionally, the mean PLIs toward interest electrodes in the beta frequency band were negatively associated with seizure times (P = 0.02).

    Conclusion The resting-state delta, theta, alpha, and gamma band PLIs might reflect an aberrant brain network in patients with CECTS. The resting-state PLI among the selected electrodes of interest in the beta frequency band may be a predictive marker of seizure times in patients with CECTS.

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  • Sayaka Suzuki, Satoshi Kuwamoto, Koji Kawamura, Michiko Matsushita, To ...
    Article type: Original Article
    Article ID: 2023.02.007
    Published: 2023
    Advance online publication: January 25, 2023
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    Background Diffuse large B-cell lymphoma, not otherwise specified (DLBCL-NOS), is the most frequent type of lymphoid neoplasm.

    Methods We investigated the relationships between clinical factors of DLBCL-NOS and MYC immunohistochemistry (IHC) staining.

    Results A total of 110 patients diagnosed with DLBCL-NOS from 2012 to 2020 at Tottori University Hospital and treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) chemotherapy were included. IHC staining of MYC in formalin-fixed, paraffin-embedded tumor specimens was performed, and ROC-curve analysis revealed the cut-off value of the MYC positive rate as 55%. The 2-year overall survival (OS) rates of the MYC-negative and -positive groups were 84.7% vs 57.7% (P = 0.0091), and the progression-free survival rates were 77.8% vs 54.7% (P = 0.016), respectively. Multivariate analysis for OS showed prognostic significance of MYC positivity [hazards ratio (HR): 2.496; P = 0.032], and serum levels of soluble interleukin-2 receptor (sIL-2R) > 2000 U/mL (HR: 3.950; P = 0.0019), as well as age > 75 (HR: 2.356; P = 0.068). The original scoring system was developed based on these findings. By assigning one point to each item, age (> 75), MYC positivity, and sIL-2R level (> 2000), all patients were classified into three risk categories: group 1 (0 points), group 2 (1 point), and group 3 (2–3 points). The 2-year survival rates were 100%, 83.0%, and 47.1% for the groups 1, 2, and 3, respectively (P < 0.0001).

    Conclusion We suggest that a prognostic scoring system using MYC expression and soluble interleukin receptor -2 level is useful for the prediction of prognosis, contributing to further stratification in DLBCL-NOS.

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  • Wataru Miyauchi, Tomoyuki Matsunaga, Yu Sakano, Masahiro Makinoya, Sho ...
    Article type: Original Article
    Article ID: 2023.02.001
    Published: 2023
    Advance online publication: January 17, 2023
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    Background Esophagectomy is an invasive and complication-prone surgical procedure. Therefore, a tool that can predict the occurrence of postoperative complications may be useful for perioperative management. In this study, we investigated whether the modified frailty index (mFI) could be a useful tool for predicting the postoperative complications of esophagectomy.

    Methods In this study, 162 patients who underwent curative esophagectomy for esophageal squamous cell carcinoma from 2004 to 2019 at our institution were included. The patients were divided into the high mFI (≥ 0.27) and low mFI (< 0.27) groups, and the short-term postoperative outcomes of each group were examined retrospectively.

    Results Regarding background factors, age and the American Society of Anesthesiologists physical status classification were significantly higher in the high mFI group (P = 0.049 and P = 0.002, respectively); however, the other items were not significantly different between the two groups. Regarding surgical outcomes, no significant differences in operative time, blood loss, and hospital stay were observed between the two groups. Regarding postoperative complications, pneumonia was significantly more common in the high mFI group (P = 0.035). In multivariate analysis, high mFI (P = 0.034) was an independent predictor of pneumonia, along with operative time ≥ 613 min (P = 0.03) and preoperative BMI < 20.48 (P = 0.006).

    Conclusion The mFI is useful for predicting pneumonia after esophagectomy.

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  • Makoto Wakahara, Keiko Hosoya, Hiroshi Ishii, Yoshihisa Umekita
    Article type: Original Article
    Article ID: 2023.02.003
    Published: 2023
    Advance online publication: January 16, 2023
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    Background Maspin is known to be a tumor suppressor protein: however, its prognostic value in patients with breast cancer remains controversial. The key influential factors contributing to this complexity may be the differences in antibodies used, as well as the positive criteria and sample size. To date, no study has investigated the prognostic significance of maspin expression by using two different antibodies in the same cohort. We aimed to clarify whether differences in antibodies could influence on the prognostic value of maspin in breast cancer patients.

    Methods Immunohistochemical analyses using an anti-maspin antibody (clone G167-70) were performed on 164 resected specimens of invasive carcinoma of no special type (NOS). The correlation with clinicopathological factors was compared to previous results using clone EAW24, with longer follow-up duration.

    Results The subcellular localization of maspin expression was as follows: cytoplasmic-only staining, 3 cases (1.8%), pancellular staining, 43 cases (26.2%); and no staining, 118 cases (72.0%). No nuclear-only staining was observed. There was no significant correlation between clinicopathological characteristics and the pancellualr expression of maspin. The pancellular expression group showed a significantly longer disease-free survival (DFS) than the other groups (P = 0.046). When clone EAW24 was used, the cytoplasmic-only staining group showed significantly shorter DFS than the pancellular staining group (P = 0.003).

    Conclusion Clone EAW24 may be superior to clone G167-70 in selecting breast carcinoma with an aggressive phenotype, while clone G167-70 may be superior to clone EAW24 in selecting non-aggressive breast carcinoma.

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  • Shota Togai, Shusei Hamamichi, Yasuhiro Kazuki, Masaharu Hiratsuka
    Article type: Original Article
    Article ID: 2023.02.004
    Published: 2023
    Advance online publication: January 16, 2023
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    Background Cytoplasmic mislocalization of TAR-DNA binding protein of 43 kDa (TDP-43) is a major hallmark of amyotrophic lateral sclerosis (ALS). TDP-43 aggregation is detected in the cortical and spinal motor neurons in most ALS cases; however, pathological mechanism of this mislocalized TDP-43 remains unknown.

    Methods We generated a tetracycline-inducible TDP-43 A315T system on a mouse artificial chromosome (MAC) vector to avoid transgene-insertional mutagenesis, established a mouse embryonic stem (ES) cell line holding this MAC vector system, and investigated whether overexpressed exogenous TDP-43 A315T was mislocalized in the cytoplasm of the ES cell-derived neurons and triggered the neurotoxic effects on these cells.

    Results Inducible TDP-43 A315T system was successfully loaded onto the MAC and introduced into the mouse ES cells. These ES cells could differentiate into motor neurons and interneurons. Overexpression of TDP-43 A315T by addition of doxycycline in both neurons resulted in mislocalization to cytoplasm. Mislocalized TDP-43 caused cell death of motor neurons, but not interneurons.

    Conclusion Vulnerability to cytoplasmic mislocalized TDP-43 is selective on neuronal types, whereas mislocalization of overexpressed TDP-43 occurs in even insusceptible neurons. This inducible gene expression system using MAC remains useful for providing critical insights into appearance of TDP-43 pathology.

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  • Toshiki Fukuzaki, Sawako Ooba, Kenji Yamaguchi, Ryuko Matsuda, Noriyuk ...
    Article type: Original Article
    Article ID: 2023.02.005
    Published: 2023
    Advance online publication: January 16, 2023
    JOURNAL FREE ACCESS ADVANCE PUBLICATION

    Background Achieving an optimal work-life balance (WLB) is an important social issue not only for workers in general but also for doctors due to the shortage of women doctors. The present study aims to survey doctors’ WLB and their use of household chore support services (HCSS).

    Methods A questionnaire survey was conducted with doctors working in Tottori Prefecture and a total of 289 responses (212 men, 77 women) were obtained and analyzed. To examine the relationship between gender and satisfaction with working patterns or with life for WLB, as well as the use of HCSS, a chi-squared test was conducted. Furthermore, a chi-squared test was conducted including age, marital status, whether or not they have preschool-aged children, and type of institution the participant worked.

    Results A significant difference was found in type of institution the participant worked regarding satisfaction with work patterns and life. The proportion of those who have used HCSS was 12.5% of the total sample and was significantly higher for women than men (men: 8.5%; women: 23.4%). Regarding the reason to use HCSS, “to reduce the burden of household chores and childcare” and “to secure time for work” were most common with the same proportions, and amongst women, “to secure time for work” was the highest.

    Conclusion Doctors working at a university hospital could have different work patterns and satisfaction with life compared to those working at other types of medical institutions. Additionally, the demand for HCSS was particularly high among women doctors, which suggests that HCSS may be used to reduce the burden of household chores and childcare, as well as to create time for work.

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  • Yuki Hirayama, Miyako Takata, Akira Yamasaki, Masahiko Kato, Naoto Bur ...
    Article type: Short Communication
    Article ID: 2023.02.010
    Published: 2023
    Advance online publication: January 16, 2023
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    Heart rate variability (HRV) is measured to analyze autonomic nervous system function in humans, and pulse rate variability (PRV) assessed using the photoplethysmography method with a pulse oximeter has been proposed as a surrogate for HRV. To examine whether PRV is compatible with HRV in patients with chronic obstructive pulmonary disease (COPD), we simultaneously measured HRV with an electrocardiogram and PRV with a pulse oximeter in patients with COPD, and compared low-frequency and high-frequency components computed from HRV and PRV as indicators of autonomic nervous system function. In a Bland–Altman analysis, the low-frequency component computed from HRV exhibited good consistency with that computed from PRV. The high-frequency component showed a significant fixed error but relatively good consistency. Our results indicate that autonomic nervous system function may be estimated with the low-frequency component by measuring PRV with a pulse oximeter in patients with COPD.

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