Nagoya Journal of Medical Science

The frozen elephant trunk (FET) technique, which was an advanced version of the elephant trunk technique, is now the gold standard for distal aortic arch repair. The major advantage is that the distal anastomosis is fixed by the stent; therefore, anastomosis that has been used to be performed in the descending aorta can be performed on the more proximal side of the aortic arch. The FET technique has become widely used, causing the increased risk of spinal cord injury (SCI) to become a major concern. As the FET fixes the distal side, the risk of SCI increases depending on its landing zone and depth. To avoid SCI, stent length should be limited to about 10 cm, and the use stents of 15 cm in length or landing beyond Th8 should be avoided. Another problem after the FET technique is the distal site new entry (d-SINE) in the mid- and long-term stages. d-SINE can also occur after thoracic endovascular aortic repair (TEVAR), mainly due to its oversizing. The spring-back-force, which is also related to the stent strength, is also said to be a cause of d-SINE after the FET technique. I herein review the FET technique, its surgical outcomes, and complications.

Neuroendocrine tumors (NETs) are a heterogenous group of neoplasms originating from neuroendocrine cells, most frequently found in the gastrointestinal tract and pancreas. A defining feature of NETs is the overexpression of somatostatin receptors (SSTRs), particularly subtype 2 (SSTR2), which is the primary target for both diagnostic imaging and therapeutic interventions. Peptide receptor radionuclide therapy (PRRT) using ¹⁷⁷Lu-DOTATATE, a radiolabeled somatostatin analog, has emerged as a transformative alternative for patients with advanced or progressive well-differentiated NETs. Considering that SSTR expression is also present in various other tumors—including pheochromocytomas, paragangliomas, meningiomas, and medullary thyroid carcinomas—there is increasing interest in expanding the use of PRRT to other SSTR-positive malignancies. This review aimed to present evidence, explore ongoing clinical research, and highlight emerging directions for ¹⁷⁷Lu-DOTATATE therapy beyond gastroenteropancreatic NETs.

Lymphedema is the swelling of tissues caused by lymphatic stasis. Intermittent pneumatic compression (IPC), a treatment device for lymphedema, improves lymphatic flow using multiple donut-shaped air chambers with graduated compression from the distal. However, the lymphatic pathway has complicated three-dimensional networks; thus, a simple donut-shaped air chamber cannot adapt to the anatomy. A new pneumatic lymphatic drainage (PLD) device consisting of multiple round air chambers located according to the lymphatic pathways was collaboratively developed with a company. The device’s air chambers simulate a therapist’s manual lymphatic drainage (MLD) movements; however, the efficacy of this novel PLD is unknown. This feasibility study evaluated the lymphatic flow change by lymphoscintigraphy under PLD in 18 lower limbs with lymphedema and showed that the PLD enhanced lymphatic flow, especially in limbs with mild lymphedema. Previous reports have shown that in patients with lymphedema, improving lymphatic flow requires IPC with a high pressure (~100 mmHg). Although the PLD in this study only utilized mild pressure (50 mmHg) for 10 min, the tracer injected into the distal leg moved stably to the inguinal region. MLD promotes flexible lymphatic flow in response to anatomical variations; however, technical heterogeneity, labor costs, and other problems exist. PLD that can imitate MLD would solve these problems derived from human power.

Acupuncture (AP) has been widely used in the treatment of knee osteoarthritis (KOA); however, its underlying molecular mechanisms remain elusive. This study aimed to identify whether acupuncture can relieve KOA progress via inhibiting X-inactive specific transcript (XIST)-mediated Piezo1 activation. The OA cells treated by interleukin (IL)-1β, and rat OA models induced by monosodium iodoacetate were established respectively. The expression of XIST, Piezo1, and extracellular matrix (ECM)-degeneration proteins were evaluated. Cell proliferation was detected by Cell Counting Kit-8 assay. The binding interaction between XIST and Piezo1 was performed using RNA binding protein immunoprecipitation assay (RIP). When XIST is knocked down, apoptosis is significantly reduced, and CHON-001 cell proliferation is increased in comparison to control and IL-1β-induced chondrocytes. Function tests revealed that both in vitro and in vivo, siRNA targeting XIST (si-XIST) increased cell proliferation while preventing apoptosis, ECM degradation, and the production of inflammatory factors. Additionally, we demonstrated that XIST and Piezo1 were bound together via insulin-like growth factor 2 messenger RNA (mRNA) binding proteins 2 (IGF2BP2), with Piezo1 serving as XIST’s target. The effects of XIST downregulation were reversed by Piezo1 activation via rescue tests conducted both in vitro and in vivo. Piezo1’s expression was reversed after XIST knockdown by IGF2BP2 overexpression. Our findings highlight the therapeutic potential of acupuncture in mitigating the progression of KOA by targeting the XIST-mediated activation of the Piezo1 pathway. By inhibiting this pathway, acupuncture may offer a promising approach to ameliorate the symptoms and slow the progression of KOA.

Recently, customer harassment has attracted considerable attention in various professional fields. Home visits are the basis of public health nurses’ activities, but there are few reports on customer harassment during home visits. This study clarified the current situation and factors related to verbal abuse and physical violence experienced from residents during public health nurses’ home visits. Data were collected from 80 individuals through a mailed survey of 154 public health nurses employed at 17 health centers in Gifu Prefecture. The survey utilized anonymous and self-administered questionnaires (response rate, 51.9%). The analysis showed that 80.0% of the participants had experienced the verbal abuse by residents during home visits, and 16.3% had experienced the physical violence. Result of logistic analysis, those who had experienced verbal abuse were approximately 10 times more likely to experience physical violence (adjusted odds ratio [AOR]=9.95; 95% confidence interval [CI]=2.49–39.79). Additionally, it was suggested that a factor associated with verbal abuse was “the number of months from starting work until visiting alone.” In contrast, factors associated with physical violence included “total years of experience as a public health nurse,” “highest level of education,” “qualifications,” “type of work,” and “experience outside of public health center or health center.”

The quality of care in care facilities for older adults varies according to the employees’satisfaction level. This study aimed to clarify the relationship between the level of support from supervisors and colleagues and job satisfaction among nurses working in care facilities for older persons. Using a cross-sectional design, we analyzed the responses of 295 nurses in long-term care facilities in Japan to a questionnaire survey. The surveyed items included the nurses’ satisfaction with their current job (the dependent variable), and the degree of support from supervisors and colleagues. Of the 295 nurses, 166 (56.3%) were satisfied with their nursing jobs. Additionally, 125 (42.4%) nurses had low support from both supervisors and colleagues, 110 (37.3%) had high support from either supervisors or colleagues, and 60 (20.3%) had high support from both. There was a positive association between support from supervisors and nurses’ satisfaction. Furthermore, based on the criterion of low support from supervisors and colleagues, high support from either or both was significantly associated with nurses’ satisfaction (an odds ratio of 2.04 in the case of support from either and 4.02 in the case of support from both). These results suggest that there should be strategic hiring and training of managers who can support staff, as well as the strengthening of teamwork.

As Vietnam’s population has been aging, dementia is becoming more prevalent. This study aims to identify the prevalence of dementia and its related factors among older adults in Thaibinh Province, Vietnam. A cross-sectional study was conducted among 762 older adults living in two communes of Thaibinh Province, Vietnam. The Revised Hasegawa’s Dementia Scale (HDS-R) Vietnamese version was used as a screening instrument for dementia. Participants were interviewed using face-to-face method. Descriptive statistics and multivariable logistic regression analyses were calculated in this study. The overall rate of dementia among older adults was 22.7%. Female were more likely to develop dementia than male participants (adjusted odds ratio [AOR] = 6.5; 95% confidence interval (95% CI), 2.71–15.64). Participants aged 70 or older, who had personal income of 3 million Vietnam Dong and higher (AOR = 5.7; 95% CI, 3.01–10.77), who smoke or used to smoke, who had poor vision ability (AOR = 8.9; 95% CI, 1.77–44.77), who had hypertension (unadjusted odds ratio [UOR] = 2.0; 95% CI, 1.24–3.38), and who with less ability of self-eating (UOR = 10.6; 95% CI, 3.31–33.73) were more likely to have dementia. Participants who had education levels of primary school and higher and who self-rated health as healthy (AOR = 0.5; 95% CI, 0.23–0.95) were less likely to have dementia. The prevalence of dementia among older adults was quite high in Vietnam. Associated factors including education level and smoking should be considered in future studies to prevent dementia among aging population.

The influence of leg dominance on lumbar intervertebral joint deformity and osteoarthritis remains poorly understood, particularly across different age groups. A clearer understanding of this relationship could improve rehabilitation strategies and patient outcomes. This study investigated 109 patients with spinal disorders who had not undergone spinal surgery and underwent computed tomography after myelography between May 2023 and January 2024 at our hospital. Lateral lumbar radiographs in a neutral standing position were used to evaluate lumbar lordosis (L1–S), lower lumbar lordosis (L4–S), pelvic incidence, and sacral slope. Hand and leg dominance were self-reported before admission, and observed leg dominance (determined by the leg used to climb onto a platform) was recorded. Lumbar facet joint osteoarthritis at each disk level was assessed using computed tomography imaging. Most participants reported right-side dominance for both the hand (101 participants, 92.7%) and leg (98 participants, 90%). Concordance between hand and leg dominance was observed in 102 (93.6%) participants. The most pronounced difference in osteoarthritis prevalence between the dominant and nondominant-leg sides at L5–S occurred among participants aged 45–64 years. Osteoarthritis on the dominant-leg side developed earlier (after age 40) than on the nondominant-leg side, where it emerged approximately a decade later. These findings suggest that leg dominance plays a role in lumbar facet joint degeneration, underscoring the need for further research and clinical consideration.

Distraction osteogenesis can induce substantial skeletal tissue regeneration; however, the treatment duration is long, making the procedure suboptimal for clinical care. Rho-associated coiled-coil-containing protein kinase inhibitors might promote bone generation in distraction osteogenesis and shorten treatment durations. However, the relationship between Rho-associated coiled-coil-containing protein kinase inhibitors and distraction osteogenesis levels has not been described. In this study, we focused on osteoblasts and osteoclasts, which are essential for bone remodeling and regeneration. Proliferation assay, boyden chamber, and wound healing assay were performed on MC3T3-E1 and RAW264 cells. Osteogenic differentiation assay was performed on MC3T3-E1 cells, and osteoclast differentiation assay was performed on RAW264 cells. Samples collected from distraction osteogenesis model mice were subjected to micro-computed tomography analysis and tissue staining. We found that Y-27632, a Rho-associated coiled-coil-containing protein kinase inhibitor, promoted cell motility and affected cell differentiation and bone differentiation in MC3T3-E1 preosteoblast cells. We also found that Y-27632 promoted cell motility and osteoclast differentiation in the osteoclast precursor RAW264 cells. In vivo experiments showed that the local administration of Y-27632 in a mouse distraction osteogenesis model promoted bone formation and increased the number of osteoblasts and osteoclasts in the distraction osteogenesis gap. These findings demonstrate that Y-27632 promotes bone formation in a mouse distraction osteogenesis model. Collectively, the study findings suggest that Y-27632 can be used as a therapeutic agent to promote distraction osteogenesis healing.

This study evaluated the effects of a cycling intervention on glucose homeostasis, lipid profile, and body composition in individuals with insulin resistance and excess body weight. Seven women participants completed a 12-week supervised cycling program (20–30 min/day, 3 days/wk). Body composition assessments and biochemical analyses, including oral glucose tolerance tests, triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and non-high-density lipoproteins, were conducted pre- and post-intervention. Paired t-tests and Hedge's g assessed changes in body composition, lipid profile, and homeostatic model assessment for insulin resistance (HOMA-IR), while a 2×4 repeated-measures analyses of variance (ANOVA) analyzed exercise- and time-related effects on glucose and insulin. Post-intervention, significant moderate reductions were observed in body fat mass (p = 0.020, g = −0.52), body fat percentage (p = 0.006, g = −0.55), visceral fat area (p = 0.005, g = −0.64), and waist-to-hip ratio (p < 0.001, g = −0.87). A significant, small reduction in non-high-density lipoproteins was also noted (p = 0.016, g = −0.34). A 2×4 repeated-measures ANOVA revealed a significant effect of exercise on glucose concentration (p = 0.031; η²_p = 0.640, moderate), with lower post-exercise levels. Additionally, a significant time×exercise interaction was observed for insulin concentration (p = 0.009; η²_p = 0.30, moderate). Follow-up tests comparing pre to post-exercise changes revealed significant decreases in insulin levels at 30-min (p < 0.001), 60-min (p = 0.008), and 120-min (p = 0.011) postload. These findings suggest a 12-week cycling intervention improves glucose homeostasis, lipid profile, and body composition in overweight women with insulin resistance.

Traumatic wound dehiscence is one of the most serious postoperative complications that can be seen after penetrating keratoplasty (PK). Depending on the damage caused by the trauma to the anterior and posterior segments of the eye, the level of vision can be most severely affected. Data from 17 eyes of 17 patients treated for traumatic wound dehiscence after PK between 2013 and 2024 were retrospectively reviewed. Patient records were reviewed for type and time of injury, corrected distance visual acuity (CDVA), surgical method, and final results. The incidence of graft dehiscence was 2.46% (17 eyes) in 690 PK eyes. The interval between PK and trauma ranged from 2 months to 60 months, with a median of 10 months. The median age at trauma was 36.7 years (range, 12–78 years). Wound dehiscence occurred at the donor-recipient interface in all patients, and 75.2% of graft dehiscence occurred at 16 months postoperatively. In all patients, the wound was closed by primary repair under general anesthesia. The mean follow-up period was 16.4±12.3 months (4–66 months). Median CDVA was 4 mps (range, 2 mps– 0.2, Snellen chart) at final visit. Graft failure was the most common complication after wound repair (29.42%). This study aimed to demonstrate the postoperative outcomes due to traumatic wound dehiscence after PK.

This study investigated incidence, clinical characteristics, and outcomes of post-radiation sarcoma, a rare but severe complication following radiotherapy. Post-radiation sarcoma is a malignant tumor arising within irradiated areas after a latency period, histologically different from the primary tumor. We retrospectively analyzed cases from January 2000 to January 2025 at three institutions in Japan, employing widely accepted diagnostic criteria. Patient characteristics, treatment details, oncologic outcomes, and prognostic factors were evaluated. Our study included 14 patients with various primary cancers, including three breast cancers, three prostate cancers, and one each of other cancer types. Among the cases, six had osteosarcoma, six had undifferentiated pleomorphic sarcoma, one had chondrosarcoma, and one had malignant peripheral nerve sheath tumor, predominantly occurring in the trunk. The median latency period from last irradiation to diagnosis was 9.9 years (range, 3.0–19.5 years). The median total radiation dose administered before post-radiation sarcoma diagnosis was 52.5 Gy (range, 12–74 Gy). The median overall survival and probability of 5-year overall survival were 2.6 years and 46.8%, respectively. The only factor that tended to correlate with prognosis was whether complete resection was achieved (P = 0.09). A literature review confirmed an increasing number of post-radiation sarcoma cases following radiotherapy for prostate cancer in recent years. The incidence of post-radiation sarcoma is expected to rise alongside the number of patients undergoing radiotherapy. Early detection and appropriate treatment are essential to improve prognosis, highlighting the need for careful long-term monitoring of patients receiving radiotherapy for post-radiation sarcoma.

According to the theory of force translation, the mechanical mechanism underlying posterior vaginal prolapse (PVP) can be speculated upon by measuring the displacement of the pelvic floor supporting structures with magnetic resonance imaging (MRI). Displacement of the posterior vaginal vault (Vp), the square root of the area under the curve between the sacrococcygeal inferior pubic point line (SCIPP) and the middle third of the posterior vaginal wall (PVW) (Sc′), the midperineal body (mid-PB), the H line, the M line, the estimated levator ani subtended volume (eLASV) and the levator hiatus width (LHW) were measured while participants performed during the Valsalva maneuver on MR images. These measurements were evaluated at different stages of PVP (n = 10, 12, 9, and 17 for stages 0, I, II, and ≥ III, respectively) with one-way analysis of variance (ANOVA), and the displacement difference ratio was used to describe the distribution process of force transfer. In Phase 1, the displacement difference ratios of Vp and Sc′ far exceeded those of mid-PB and eLASV; in Phase 2, the displacement difference ratio of eLASV increased significantly to more than ten times that of in Phase 1, whereas the displacement difference ratio of the mid-PB was unchanged; in Phase 3, the mid-PB displacement difference ratio increased by nearly 33 times that in Phase 2. Specific interactions between the pelvic floor muscles and connective tissues may occur during the course of PVW prolapse.

This study aimed to determine the mediating role of health literacy in self-care among female college students with menstrual symptoms. The participants were female students at Nagoya University who were aged ≥18 years, and 144 were included in the analysis. We used a questionnaire to investigate menstrual symptoms, self-care for menstruation, and their effect on daily life and health literacy. We defined high health literacy as scores equal to or above the median, and low health literacy as scores below the median, using the total score of the health literacy scale for female of reproductive age. In the high health literacy group, the intensity of menstrual pain and the Menstrual Distress Questionnaire score were significantly higher than those in the low health literacy group. The high health literacy group had significantly more regular menstrual cycles than the low health literacy group. The high health literacy group had a significantly higher rate of taking a contraceptive pill than the low health literacy group. The percentages of female students affected by menstrual symptoms during their academic studies and in non-physical leisure activities were significantly higher in the high health literacy group than in the low health literacy group. The high health literacy group also had significantly higher total self-care scores than the low health literacy group. Moreover, health literacy mediated the relationship between menstrual symptoms and self-care. These results suggest that health literacy is an important factor linking menstrual symptoms to self-care.

Radiotherapy (RT) is an important standard treatment for head and neck cancer. On the other hand, osteoradionecrosis of the jaw (ORNJ), a side effect of RT, is intractable and has been a long-standing problem that needs to be overcome. Cellular senescence has been linked to the development of ORNJ; however, strategies for preventing and treating this disease have not been established. This study aimed to evaluate the effects of human dental pulp stem cell-derived small extracellular vesicles (hDPSC-sEV) on ORNJ. The effects of hDPSC-sEV treatment on rat bone marrow cells (rBMC) were examined in vitro. In addition, hDPSC-sEV were administered intravenously to a rat ORNJ model, and the extraction socket was examined radiologically and histologically. In vitro, rBMC treated with hDPSC-sEV immediately after irradiation showed downregulated expression of senescence-related genes. In vivo, the extraction sockets of the ORNJ models treated with hDPSC-sEV showed more new bone and greater coverage with gingiva relative to those observed in the comparison groups. This study suggests that hDPSC-sEV may inhibit ORNJ development. One possible mechanism is that hDPSC-sEV inhibit radiation-induced cellular senescence.

Fusion with a real-time virtual sonography system is an ultrasonography fusion technology with magnetic position navigation. We present a case of a left nephroblastoma successfully resected using real-time virtual sonography for tumor margin assessment and excision boundary determination. A 2-year-old girl presented with fever and abdominal distension. Contrast-enhanced computed tomography revealed a large heterogeneous mass (90 × 75 × 125 mm³) in the left kidney. Needle biopsy confirmed nephroblastoma. Chemotherapy with vincristine and actinomycin was initiated according to the International Society of Pediatric Oncology Wilms Tumor 2001 guidelines. Subsequent computed tomography revealed that the tumor size decreased to 45 × 25 × 63 mm³ ; however, margins with adjacent muscles remained unclear, indicating potential invasion beyond Gerota's fascia. Real-time virtual sonography evaluation revealed a single fat layer separating the tumor from the muscle groups, showing tumor regression to the medial side of Gerota’s fascia, with visible respiratory movements on ultrasonography. Left nephrectomy, including Gerota’s fascia, was performed, preserving the abdominal wall muscles. Pathology confirmed that the tumor had penetrated the renal capsule but was completely resected with clear margins. The postoperative diagnosis was high-risk stage II blastemal type nephroblastoma, prompting chemotherapy on postoperative day 12. During the 5-year follow-up, no recurrence was observed. Real-time virtual sonography is a valuable adjunct for detailed preoperative evaluation when computed tomography alone is inadequate, facilitating precise tumor margin assessment and successful surgical outcomes.

SMARCA4-deficient non-small-cell lung cancer (SD-NSCLC) is a rare and highly aggressive epithelial tumor that originates in the lungs. SD-NSCLCs are more prevalent among male smokers, lacks mutations of the mesenchymal-epithelial transition g (MET) gene, and does not have an established treatment plan. Herein, we present a unique case of an SD-NSCLC, an adenocarcinoma with a MET14 skipping mutation, in the left upper lung lobe which was classified as cT4N3M1a stage IVa. Next-generation sequencing revealed a D1010H skip mutation in exon 14 of MET, and immunohistochemistry indicated a programmed death ligand 1 expression level of 90%. Owing to financial constraints and concerns regarding chemotherapy, the patient declined MET inhibitor-targeted therapy and chemotherapy. Instead, the patient received sintilimab and anlotinib. Following two treatment cycles, a notable reduction in the lesions in the left upper lobe and a significant decrease in lung metastases were observed, and the patient has attained a progression free survival of >2 years. This case represents the initial documentation of SD-NSCLC featuring MET14 skipping mutations and its effective management with programmed death protein 1 inhibitors, in conjunction with anti-angiogenic agents. We believe that the combination of sintilimab and anlotinib can be a viable therapeutic approach for the treatment of SD-NSCLCs.

In medical education, psychological safety in teams and organizations facilitates problem solving in healthcare teams and learning opportunities for learners. Based on four types of organizational climate, this study examines the interventions needed for each type of team and organization to increase psychological safety and create an environment in which learners can learn independently and effectively. In considering interventions, the concept of three levels of personality organization, a framework for psychological assessment, seems to be valuable. Based on the overlap between the four types of organizational climate and the three levels of personality organization, the “Apathy Zone” requires educators and learners to reestablish autonomy rooted in reality. In the “Anxiety Zone,” the challenge is for educators to recognize their own limitations and be willing to understand learners. In the “Comfort Zone,” educators must respect learners’ autonomy while observing norms. Both educators and learners must distinguish between the realms of self and others, focusing on essential goals. The “Learning Zone” requires educators and learners to move without overthinking to achieve essential goals. The psychological perspective provides guidance for understanding the formation of organizational climate and considering specific interventions.