Fukushima Medical University Research Articles

Countermeasures and follow-up actions in response to information on thyroid cancer, which possibly provoked misunderstanding and unfounded rumour, issued by five former Japanese prime ministers.

This study summarises the responses to information on thyroid cancer, which possibly provoked misunderstanding and unfounded rumour, described in a letter issued by five former Japanese Prime Ministers on 27 January, 2022. Fukushima Medical University (FMU) implemented countermeasures and follow-up in three phases in response to the letter. In Phase 1, FMU shared scientific facts on the relationship between radiation exposure and thyroid cancer, as well as the response of FMU towards those who read the letter and were concerned about the description. Furthermore, FMU organised lectures and workshops to facilitate peer support among medical and non-medical staff, which were publicised through a newspaper article. In Phase 2, the peer support programme targeting patients with thyroid cancer was launched. In Phase 3, FMU participated in a TV programme to explain the medical aspects of thyroid cancer and the importance of providing peer support to patients with cancer, featuring individuals with experiences as medical staff and survivors.

Nucleolar casein kinase 2 alpha as a prognostic factor in patients with surgically resected early‑stage lung adenocarcinoma.

Lung cancer remains a leading cause of global cancer‑related deaths, therefore the identification of prognostic factors for lung cancer is critical. Casein kinase 2 alpha (CK2α) is one of the driver kinases in various cancers, and it was previously demonstrated that CK2α localization was associated with a poor prognosis in invasive breast cancer. In the present study, the importance of CK2α in the nucleolus was explored as a potential prognostic marker for surgically resected early‑stage lung adenocarcinoma. The present study included 118 patients who underwent pulmonary lobectomy between 2014 and 2018 in Fukushima Medical University Hospital (Fukushima, Japan), and in whom CK2α localization in tumor samples was assessed by immunohistochemistry. Patient and tumor characteristics, including pathological stage, histological type and histological grade, were analyzed. Recurrence‑free survival (RFS) and overall survival were evaluated in relation to nucleolar CK2α staining. CK2α staining in the nucleoli was observed in 50.8% of lung adenocarcinoma tumors. Positive nucleolar CK2α staining was independent of pathological stage, histological type and histological grade. Patients with positive nucleolar CK2α staining exhibited significantly worse RFS compared with patients with negative staining. Multivariate analysis identified nucleolar CK2α staining and lymph node metastasis as independent poor prognostic factors. The results of the present study suggested that nucleolar CK2α staining is a novel and independent prognostic factor in surgically resected early‑stage lung adenocarcinoma. These findings indicated the potential of nucleolar CK2α as a predictive biomarker for future recurrence, and a guide to treatment decisions. Further research is required, particularly in understanding the molecular mechanisms linking nucleolar CK2α to recurrence.

Clinicopathological Findings of 220 Pediatric, Adolescent, and Young Adult Patients with Thyroid Cancer in Fukushima Medical University Hospital.

Background: Thyroid ultrasound examinations (TUEs), conducted as part of the Fukushima Health Management Survey (FHMS), were initiated to monitor the health status of residents after the Fukushima Daiichi Nuclear Power Plant accident owing to concerns regarding the increased incidence of thyroid cancer among children, as observed after the Chernobyl Nuclear Power Plant accident. This study reported the clinicopathological characteristics of patients with thyroid cancer diagnosed through the FHMS and treated at the Fukushima Medical University Hospital. Methods: Data regarding the clinicopathological characteristics of patients with thyroid cancer were collected and evaluated in this descriptive study. Results: Among the 263 patients diagnosed with thyroid cancer as of September 2021, 220 patients with cytologically diagnosed thyroid cancer were treated as referrals from the FHMS. The median (interquartile range) age at the time of diagnosis was 18.6 (16.2-20.3) years. The median maximum tumor diameter was 13.0 (10.4-18.0) mm. To reduce surgical invasiveness, 199 patients (90.1%) underwent unilateral lobectomy. Pathological findings were suggestive of papillary thyroid carcinomas (PTC) in 216 (98.2%) patients; among them, 205 patients had PTC of the classical type. In addition, 216 (98.2%) patients had stage I disease. Cancer cell extension in the sternothyroid muscle or perithyroidal soft tissues and microscopic lymphovascular invasion were observed in 112 (50.9%) and 123 (55.9%) patients, respectively. No differences were observed between the two age groups (<18.6 years and ≥18.6 years) in terms of the clinical or pathological characteristics of thyroid cancer: risk classification (p = 0.69) and American Thyroid Association pediatric risk level (p = 0.24). Compared with those from previous reports, few surgical complications were observed. Conclusions: Patients with thyroid cancer diagnosed with TUEs underwent safe and minimally invasive operations, and careful postoperative follow-up was provided. The pathological findings of the detected thyroid cancers indicated that the majority were classical papillary carcinomas, and approximately half of the patients had extrathyroidal or lymphovascular invasion. No differences were observed between the two age groups in terms of the clinical or pathological characteristics of thyroid cancer.

Occupational radiation exposure among medical personnel in university and general hospitals in Japan.

This study aimed to compare the occupational radiation exposure of medical workers between general hospitals and university hospitals. Radiation exposure data from three hospitals in Hiroshima city, including one university hospital and two general hospitals, were collected using personal dosimeters. Monthly radiation doses were analyzed, and the annual sum of radiation exposure dose was calculated for 538 subjects in general hospitals and 1224 subjects in the university hospital. To assess the impact of locality, additional data from Nagasaki University Hospital and Fukushima Medical University Hospital were included for comparative analysis. Professional affiliations, such as doctors, nurses, and radiological technologists, were considered in the evaluation. The study revealed slight but significant differences in radiation doses between general and university hospitals. In general hospitals, except for radiological technologists, a slightly higher radiation dose was observed compared to university hospitals. Despite the annual increase in the use of medical radiation, the majority of hospital workers in both settings adhered to safety guidelines, with occupational radiation exposure remaining below the limit of detection (LOD). Workers who involved in fluoroscopic procedure, whether at university or general hospitals, had higher radiation doses than those who did not. The study's primary conclusion is that workers in general hospitals experience a slight but significantly higher radiation dose and a lower percentage below the LOD compared to university hospitals. The observed difference is attributed to the greater workload at general hospitals than at university hospitals, and also may be due to the different nature of university hospital and general hospital. University hospitals, characterized by greater academic orientation, tend to benefit from comprehensive support systems, specialized expertise, and advanced technology, leading to more structured and regulated radiation control. These findings provide a basis for targeted interventions, improved safety protocols.

Long-term outcomes in patients with primary biliary cholangitis complicated with CREST syndrome

Primary biliary cholangitis (PBC) is frequently associated with autoimmune disease. Although PBC complicated with CREST syndrome (PBC-CREST) has been reported, the long-term outcomes of the affected patients have not been fully investigated. Herein, the long-term outcomes of PBC-CREST were evaluated. Next, the GLOBE and UK-PBC scores were validated and compared between the PBC alone and PBC-CREST groups. A total of 302 patients who were diagnosed with PBC between December 1990 and August 2021 at Fukushima Medical University Hospital were included. The liver transplantation (LT)-free survival rates were compared between patients with PBC alone (n = 245) and those with PBC-CREST (n = 57). Moreover, 173 patients, excluding those with liver-related death/LT within 1 year after ursodeoxycholic acid administration, were divided into two subgroups (PBC alone (n = 147) and PBC-CREST (n = 26)), and the GLOBE and UK-PBC scores were compared between the subgroups. The survival rates without LT (3/5/10 years) were 92/87/80% for the PBC-alone group and 98/96/96% for the PBC-CREST group, with a significantly better prognosis in the PBC-CREST group (log-rank P = 0.0172). Multivariate analysis revealed that the presence of CREST syndrome is an independent protective factor for the presence of cirrhosis. The predicted 5/10/15-year risks of liver-related death or LT based on the UK-PBC score were significantly lower in the PBC-CREST group (2.4/7.6/13.2%) than in the PBC-alone group (4.8/11.8/18.8%) (P < 0.05). The predicted 3/5-year LT-free survival rates based on the GLOBE score were significantly higher in the PBC-CREST group (93/88%) than in the PBC-alone group (88/81%) (P < 0.05). Patients with PBC-CREST may have better long-term outcomes than those with PBC alone.

Clinical features of flare in Japanese patients with new-onset SLE and risk factors for SLE flare in daily clinical practice: a single-center cohort study

This study aimed to elucidate the clinical features, outcomes and risk factors of flares in patients with systemic lupus erythematosus (SLE). Data were collected from patients with newly diagnosed SLE at the Fukushima Medical University Hospital between 2011 and 2022. Patients who experienced a flare during the study period constituted the flare group, and their clinical features were compared with those of the no-flare group. The cumulative flare-free survival regarding several clinical items was compared between the two groups using Kaplan–Meier’s curves. Among 387 patients with SLE, 83 patients with newly diagnosed SLE were included. Their mean age was 37.9 years, and 29 patients experienced flares during the study period. The general characteristics were similar between the two groups, with the exception of the observation period and anti-SS-A antibody positivity. Regarding therapy, a significantly increased frequency of hydroxychloroquine intake and combination with immunosuppressive agents were observed in the no-flare group. The Kaplan–Meier analysis revealed a significantly higher cumulative flare-free survival in the anti-SS-A negative group and combination immunosuppressive therapy group. In conclusion, anti-SS-A positivity may be a risk factor for SLE flare. In turn, combination immunosuppressive therapy may be beneficial for SLE treatment in daily clinical practice.

Detection of atmospheric radon concentration anomalies and their potential for earthquake prediction using Random Forest analysis

Various anomalies occurring before earthquakes are currently being studied to predict seismic events, with one of them being the radioactive element radon (222Rn). Radon concentrations in the soil, water, and atmosphere fluctuate in response to crustal movement. Recent research has statistically detected anomalies by analyzing the fluctuations in radon concentrations before earthquakes and conducting quantitative evaluations of radon. However, the method used to determine the parameters in the analysis was problematic. Therefore, in this study, we compared observed atmospheric radon concentration data with predicted values based on typical annual patterns using Random Forest analysis. We conducted a more objective analysis by employing this method and statistically determining anomalies using thresholds. This analysis was conducted using atmospheric radon concentration observation data obtained at Kobe Pharmaceutical University (KPU) before the 1995 Kobe Earthquake, and ionization currents emitted when radon decays were obtained at Fukushima Medical University (FMU) before the 2011 Tohoku-oki Earthquake. Consequently, before the major earthquakes occurred at both locations, the difference between the predicted and observed values exceeded the standard deviation by a factor of three. These results indicate the potential of Random Forest analysis to identify anomalies in atmospheric radon concentrations before earthquakes occur.

Renal Pathological Image Classification Based on Contrastive and Transfer Learning

Following recent advancements in medical laboratory technology, the analysis of high-resolution renal pathological images has become increasingly important in the diagnosis and prognosis prediction of chronic nephritis. In particular, deep learning has been widely applied to computer-aided diagnosis, with an increasing number of models being used for the analysis of renal pathological images. The diversity of renal pathological images and the imbalance between data acquisition and annotation have placed a significant burden on pathologists trying to perform reliable and timely analysis. Transfer learning based on contrastive pretraining is emerging as a viable solution to this dilemma. By incorporating unlabeled positive pretraining images and a small number of labeled target images, a transfer learning model is proposed for high-accuracy renal pathological image classification tasks. The pretraining dataset used in this study includes 5000 mouse kidney pathological images from the Open TG-GATEs pathological image dataset (produced by the Toxicogenomics Informatics Project of the National Institutes of Biomedical Innovation, Health, and Nutrition in Japan). The transfer training dataset comprises 313 human immunoglobulin A (IgA) chronic nephritis images collected at Fukushima Medical University Hospital. The self-supervised contrastive learning algorithm “Bootstrap Your Own Latent” was adopted for pretraining a residual-network (ResNet)-50 backbone network to extract glomerulus feature expressions from the mouse kidney pathological images. The self-supervised pretrained weights were then used for transfer training on the labeled images of human IgA chronic nephritis pathology, culminating in a binary classification model for supervised learning. In four cross-validation experiments, the proposed model achieved an average classification accuracy of 92.2%, surpassing the 86.8% accuracy of the original RenNet-50 model. In conclusion, this approach successfully applied transfer learning through mouse renal pathological images to achieve high classification performance with human IgA renal pathological images.

Radiation Exposure Characteristics among Healthcare Workers: Before and After Japan's Ordinance Revision.

Radioactive materials and ionizing radiation have both medical value and disease risks, necessitating radiation dose measurement and risk reduction strategies. The International Commission on Radiological Protection (ICRP) lowered the lens of the eye exposure limit, leading to Japan's revised "Ionizing Radiation Ordinance." However, the effects on radiation exposure in medical settings and compliance feasibility remain unclear. To examine the impact of the revision to the "Ionizing Radiation Ordinance" and use it for measures to reduce exposure to radiation, a comprehensive analysis was conducted on data collected from Nagasaki University Hospital, Hiroshima University Hospital, and Fukushima Medical University Hospital in 2018, 2020, and April to September 2021. This included information on age, sex, occupation, department, and monthly radiation doses of workers, aiming to assess the impact of the revision to the "Ionizing Radiation Ordinance" on radiation exposure before and after its enforcement. Out of 9,076 cases studied, 7,963 (87.7%) had radiation doses below the measurable limit throughout the year. Only 292 cases (3.2%) exceeded 1 mSv y -1 , with 9 doctors and 2 radiological technologists surpassing 5 mSv y -1 . Radiological technologists showed significantly higher doses compared to doctors, dentists, and nurses (p < 0.01), while male subjects had significantly higher exposure doses than females (p < 0.01). No significant changes in radiation exposure were observed before and after the revision of the Ionizing Radiation Ordinance; however, variations in radiation exposure control were noted, particularly among nurses and radiological technologists, suggesting the impact of the revision and the need for tailored countermeasures to reduce radiation dose in each group.

Prolonged impact of the Fukushima Nuclear Power Plant Accident on health and society

Prolonged impact of the Fukushima Nuclear Power Plant Accident on health and society Naomi Ito, Research Assistant at the Fukushima Medical University, tells us how the 2011 Fukushima Daiichi Nuclear Power Plant Accident impacted and continues to impact local residents. The health effects on local residents following a nuclear power plant accident are diverse, not only because of radiation exposure but also because of changes in lifestyle and social environment. It has also been indicated that various environmental changes that could emerge during the restoration process may affect residents in various ways over a long time. On March 11, 2011, the Great East Japan Earthquake struck Japan with a magnitude of 9.0. Within an hour, a tsunami hit the shore. Three reactors at the Fukushima Daiichi Nuclear Power Plant (FDNPP, operated by Tokyo Electric Power Company) lost power. The reactors could not be cooled, and core meltdowns occurred, which resulted in an explosion due to hydrogen being generated at high temperatures. As a result, radioactive materials were released and scattered northwest from the power plant.

2023 Fukushima Medical University International Symposium on the Fukushima Health Management Survey, "Thinking Together about Health, Life, and our Future in Fukushima".

In response to the release of radioactive materials and evacuation of residents after the Tokyo Electric Power Company's Fukushima Daiichi Nuclear Power Plant accident, caused by the Great East Japan Earthquake, the Fukushima Health Management Survey (FHMS) began in June of 2011. This survey aims to provide long-term follow-up of the physical and mental health of Fukushima residents and to maintain and improve their health for the future. Every year since 2019, Fukushima Medical University (FMU) has organized the FHMS International Symposium to share survey results with people in Fukushima Prefecture and beyond. The fifth annual symposium convened at FMU's Ekimae Campus on Saturday, 4 March 2023, with the theme, "Thinking Together about Health, Life and our Future in Fukushima."

2022 Fukushima Medical University International Symposium on the Fukushima Health Management Survey Build Back Better, Together. "Science for Society: Advancing Fukushima's Well-Being".

The Fukushima Medical University (FMU) International Symposium on the Fukushima Health Management Survey (FHMS) convened for the fourth time in March 2022 to share FHMS findings within Fukushima and beyond. Dr. TAKENOSHITA Seiichi, FMU President, underscored Fukushima's restoration journey, while Governor UCHIBORI Masao committed to partnering with FMU for residents' welfare.The Introduction by Dr. KAMIYA Kenji highlighted FHMS results for more than 460,000 participants, of whom 99.8% were exposed to radiation doses below 5 mSv post-accident. Thyroid examinations detected tumors, but no dose-response relationship was found. The Comprehensive Health Check showed increased lifestyle-related diseases among evacuees, with improvements in some health markers. Mental health issues initially prevalent after the accident decreased over time, and perinatal outcomes were consistent with national data.Session 1 focused on radiation effects in Fukushima. The UNSCEAR 2020 Report indicated significantly reduced radiation exposure estimates and negligible cancer risks. Studies from Hiroshima, Nagasaki, and Chernobyl found no radiation-induced genetic effects.Session 2 explored post-disaster well-being, emphasizing the evolution of psychological responses. Practices like Psychological First Aid (PFA) and emotional resilience promotion were highlighted. Katsurao Village's post-evacuation health measures addressed lifestyle diseases, but faced challenges. The WHO framework for mental health and psychosocial support in nuclear emergencies emphasized the importance of mental health care throughout all disaster phases.The symposium facilitated valuable insights, underlining comprehensive health strategies and the significance of long-term studies for Fukushima's recovery and health management.

Radiation Measurements at Fukushima Medical University over a Period of 12 Years Following the Nuclear Power Plant Accident

Background: Fukushima Medical University (FMU) is located 57 km northwest of the Fukushima Daiichi Nuclear Power Plant. Our laboratory has been conducting environmental radiation measurements continuously before and after the nuclear accident. We aimed to report the observed behavior of radiation originating from the released radioactive materials due to the accident, predict future trends, and disseminate the results to the local residents.Materials and Methods: Measurements of the counting rate by a diameter of 76 mm and a length of 76 mm thallium-doped sodium iodide (NaI[Tl]) scintillation detector (S-1211-T; Teledyne Brown Engineering Environmental Services) in the central part of the laboratory, and the dose rate outward at the window by NaI(Tl) scintillation detector and digital processor (EMF211; EMF Japan Co. Ltd.) were conducted.Results and Discussion: Measurements by Teledyne S-1211-T showed that in the early stages, radiation from radioactive isotopes with short half-lives was dominant, while radiation from radioactive isotopes with longer half-lives became dominant as the measurement period became longer. Through nonlinear least squares regression, both short and long half-lives were successfully determined. It was also possible to predict how the radiation dose would decrease. The environmental radiation trends around FMU were measured by the EMF211. Both measurements were affected by rainfall and snow accumulation. Decontamination work on the FMU campus impacted measurements by the EMF211 especially.Conclusion: The results of two types of measurements, one at the center and the other at the window side of the laboratory, were presented. By applying a simplified model, radiation from radioactive isotopes with short and long half-lives was identified. Based on these results, future trends were predicted, and the information was used for public communication with the local residents.

Immunological Responses Associated With Neoadjuvant Therapy in the Tumor Microenvironment of Esophageal Squamous Cell Carcinoma.

Development of multidisciplinary therapies including immune checkpoint inhibitors for esophageal squamous cell carcinoma (ESCC) requires a clear understanding of immunological responses induced by chemotherapy with/without radiotherapy in the tumor microenvironment. This is a retrospective analysis of paired pretreatment biopsy samples and surgically resected tumor samples of 49 patients who underwent radical surgery for ESCC with/without neoadjuvant therapy at Fukushima Medical University Hospital. The cohort included 30 patients treated with neoadjuvant chemotherapy (NAC), 11 treated with neoadjuvant chemoradiotherapy (NACRT), and eight who underwent surgery alone and did not receive neoadjuvant antitumor therapy. Chemotherapy included fluoropyrimidine- and platinum-based agents in all treated patients, and radiotherapy included 40 or 42 Gy administered in 20 or 21 fractions. Expression of CD8, human leukocyte antigen (HLA) class I-ABC, PD-L1, PD-L2, CEACAM-1, LSECtin, and p-STAT1, were determined using immunohistochemistry. The frequency of tumor-infiltrating CD8+ T cells was significantly increased by NAC (p<0.05), and the expression of HLA class I-ABC on tumor cells was significantly increased by NAC and NACRT (p<0.05). Furthermore, the ESCC cells expressed PD-L1, PD-L2, and CEACAM-1, whereas the expression of PD-L1 on ESCC cells was significantly correlated with the expression of p-STAT1 in ESCC cells (p<0.05). NAC and NACRT induced both positive and negative immunological responses in patients with ESCC. These results may be a part of basis for multidisciplinary therapy including immune checkpoint inhibitors for patients with advanced ESCC.

Development and evaluation of a nursing care profile for the promotion of preventive care measures in post-disaster evacuation areas

Japan is the first country to adopt a return policy after the all-village evacuation due to the Fukushima disaster and reporting on whatâ–™s happening in such areas is important. This is the premise of the work of Naomi Ito, a Public Health Nurse with a Masters of Public Health (MPH) degree and a research assistant in the Department of Radiation Health Management at Fukushima Medical University, Japan. Her research focuses on health issues, including both the direct impacts and secondary health effects in communities where people are encouraged to return following an evacuation order. Important issues are nursing care for the elderly and the concept of â–˜ageing in placeâ–™. In her current study, Ito is investigating a number of cases of Fukushima nuclear accident evacuees following the 2011 nuclear accident in Fukushima and how ageing in place was impacted by relocation, including the cases of three individuals evacuated from Katsurao village who did not return to their original homes following evacuation orders. By looking at their respective health conditions, Ito gained insight into the current situation and key challenges. This research is highlighting issues associated with the provision of medical and welfare services in areas affected by the nuclear accident, with hospitals closed and the evacuation of younger people changing the social structure and impacting the future of this community. The researchers believe that a comprehensive community care system is crucial and that it is important to consider the health challenges facing evacuated residents and a required improvement to medical, welfare and transportation systems.

Salvage surgery for advanced non-small cell lung cancer following previous immunotherapy: a retrospective study

BackgroundThe development of systemic chemotherapy including immune checkpoint inhibitors (ICIs) has provided patients with unresectable advanced non-small cell lung cancer (NSCLC) an opportunity to undergo surgical intervention after initial treatment. However, no consensus regarding the indication for salvage surgery in these patients has been reached.MethodsWe conducted a retrospective study of patients who underwent salvage surgery for advanced NSCLC (cStage IIIA–IVB) after treatment with ICIs from January 2018 to December 2022 at Aizu Medical Center and Fukushima Medical University Hospital. We evaluated the patients’ clinical data, calculated disease-free survival (DFS) and overall survival (OS), and assessed the survival benefit using the Kaplan–Meier method.ResultsThirteen patients underwent salvage surgery after immunotherapy. All patients achieved downstaging after initial chemotherapy. Eleven patients underwent lobectomy, and one patient underwent extirpation of intra-abdominal lymph nodes. The mean surgery time and intraoperative blood loss were 242.2 min and 415.1 g, respectively. The mean drainage period was 4.2 days (range, 2–9 days). Grade ≥ 3 postoperative complications were confirmed in three patients. The 2-year DFS rate was 71.2%, and the 2-year OS rate was 76.2%. A pathological complete response compatible with ypStage 0 was achieved in four (30.8%) patients. Patients with ypStage 0 and I achieved significantly better OS than those with ypStage ≥ II (p = 0.044), and patients without severe complications achieved significantly better DFS and OS than those with severe complications (p = 0.001 and p < 0.001, respectively).ConclusionsSalvage surgery after chemotherapy including ICIs is a feasible and effective treatment option for patients with advanced NSCLC, especially those who acquire downstaging to pathological stage 0 or I. However, severe perioperative complications might affect patient survival. A prospective study is urgently needed to evaluate the efficacy of salvage surgery.

Development of the “Conductor Type Human Resources Development” program for Disaster Medicine and Health Care by Tohoku University and Fukushima Medical University

Introduction:On March 11, 2011, the Great East Japan Earthquake with a 9.0 magnitude struck the northeastern coast of Japan. The death toll reached 15,892 and 2,576 people were reported missing. Tohoku University and Fukushima Medical University, both of which are located in the affected prefectures, responded massively to the disaster.Method:To deal with the next disaster, both universities established the “Conductor type Human Resources Development” (CHRD) program for Disaster Medicine and Health Care in 2019, not only for doctors, but also other medical professionals (such as dentists, nurses, pharmacists, etc.) supported by the Japanese government. The main course of CHRD program, “Disaster Management course,” which is also a certification program at Tohoku University, comprises 14 practical educational contents (seven practical trainings and seven lectures) based on the work experience of both universities in collaboration with various organizations.Results:To date, 59 students have enrolled in the Disaster Management course, two students are enrolled in the board-certified physician in public health and social medicine acquisition course, three students are enrolled in the master's course, a Tohoku University Graduate School of Medicine course, and two students are enrolled in the doctoral course. Until October 2022, a total of 17 people were certified to have completed the "Disaster Management course," and one person completed the board-certified physician in public health and social medicine acquisition course. A total of 68 practical trainings and lectures were held until 2021, the total number of times this program was attended by students until 2021 was 916. Average comprehension rate and satisfaction rate with practical trainings and lectures by students are 97.2% and 98.3%, respectively.Conclusion:All the students who complete the CHRD program are believed to acquire comprehensive skills related to disaster health and medical care and will be able to respond effectively in all phases.

“I’d like to let people know what we did:” values of Fukushima medical students following the Great East Japan Earthquake

BackgroundThe Great East Japan Earthquake and the resulting tsunami and nuclear disaster on March 11, 2011 have had a profound and lasting effect on residents of Japan’s Fukushima Prefecture, particularly among evacuees. While there continues to be extensive news coverage and academic study of Fukushima Prefecture’s recovery, there has been little exploration of individual narratives. This study aims to illuminate some individual stories of medical students at Fukushima Medical University (FMU) who lived in the Prefecture at the time of the Earthquake.MethodsA qualitative approach was taken in order to investigate individuals’ experiences with the goal of adding a personal dimension to quantitative studies on the subject. 10 open-ended ethnographic interviews were conducted with medical students at FMU in years 1–5 who lived in Fukushima Prefecture at the time of the Great East Japan Earthquake. All interviews were audio recorded and transcribed. Transcriptions were reviewed using inductive thematic analysis under the lens of ethnographic anthropology.ResultsThree major themes emerged from these interviews: first, that the events following the Earthquake influenced not only these students’ decisions to pursue careers in medicine, but the ways in which they hope to practice medicine in the future. Second, that these students were motivated to share their experiences by a want to change Fukushima Prefecture’s public image. And lastly, that the students viewed the opportunity to discuss their experiences through these interviews as healing, both for themselves and for the future.ConclusionsWhile multiple factors undoubtably contributed these students’ medical education, they cite the Earthquake as essential to their approach to their medical careers. Additionally, opportunities for the participants to discuss their experiences following the Earthquake appear to be rare but valued, as the students view their stories as their “legacies.” The enduring, burdening effects of the Earthquake appear to have galvanized the participating students to act on behalf of their communities and their Prefecture. Further qualitative studies in more generalizable populations are needed to improve and deepen our understanding of the societal, cultural, and personal impacts of the Great East Japan Earthquake.

PD02-10 THE HUMORAL IMMUNITY ACTIVATION CAUSES THE BLADDER OUTLET OBSTRUCTION RELATED WITH PROSTATE THROUGH THE DIFFERENT MECHANISM FROM THE PROSTATE VOLUME

You have accessJournal of UrologyCME1 Apr 2023PD02-10 THE HUMORAL IMMUNITY ACTIVATION CAUSES THE BLADDER OUTLET OBSTRUCTION RELATED WITH PROSTATE THROUGH THE DIFFERENT MECHANISM FROM THE PROSTATE VOLUME Hidenori Akaihata, Yuki Harigane, Kei Yaginuma, Yu Endo, Yuki Yoshida, Hitomi Imai, Yuta Matsuoka, Akifumi Onagi, Kanako Matsuoka, Seiji Hoshi, Tomoyuki Koguchi, Junya Hata, Yuichi Sato, Masao Kataoka, Motohide Uemura, and Yoshiyuki Kojima Hidenori AkaihataHidenori Akaihata More articles by this author , Yuki HariganeYuki Harigane More articles by this author , Kei YaginumaKei Yaginuma More articles by this author , Yu EndoYu Endo More articles by this author , Yuki YoshidaYuki Yoshida More articles by this author , Hitomi ImaiHitomi Imai More articles by this author , Yuta MatsuokaYuta Matsuoka More articles by this author , Akifumi OnagiAkifumi Onagi More articles by this author , Kanako MatsuokaKanako Matsuoka More articles by this author , Seiji HoshiSeiji Hoshi More articles by this author , Tomoyuki KoguchiTomoyuki Koguchi More articles by this author , Junya HataJunya Hata More articles by this author , Yuichi SatoYuichi Sato More articles by this author , Masao KataokaMasao Kataoka More articles by this author , Motohide UemuraMotohide Uemura More articles by this author , and Yoshiyuki KojimaYoshiyuki Kojima More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003219.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The prostate volume and morphological features of the prostate are well known to be associated with bladder outlet obstruction (BOO) in the male patients. However, the causative agents and factors of BOO are multifactorial and incompletely understood. This study aims to find out the novel mechanism underlying bladder outlet obstruction (BOO) except for prostate volume and morphological features by comprehensive gene expression analysis (CGEA). METHODS: A total of 31 patients who had a diagnosis of benign by the random prostate biopsy were enrolled in this study. CGEA was performed with prostate specimens obtained by the biopsy. The patients were divided into control group (prostate volume <30 mL) and benign prostatic enlargement (BPE) group (prostate volume ≥30 mL). Hierarchical clustering was performed to identify the clusters with similar gene expression by the genes indicated significantly different between two groups by t-test. The uroflowmetry parameters were compared among each cluster. The protocol was approved by the ethics committee of Fukushima Medical University. RESULTS: CGEA selected 12 genes with significant difference in mean converted value between control and BPE (p<0.01) from 11,907 genes. Hierarchical clustering analysis using these 12 genes categorized three different clusters: the control (n=8), the BPE (n=11) and BPE with inflammatory (n=12) clusters. As compared BPE cluster, the BPE with inflammatory cluster have activation of humoral immunity (increased VSIG2 gene), more suppression of estrogen receptor signaling (reduced ELK4 gene) and more decreased angiogenesis (reduced MME gene). The maximum flow rate was significantly lower in the BPE with inflammatory cluster than in the control cluster (p=0.03). There was no significant difference about the maximum flow rate between control cluster and BPE cluster. CONCLUSIONS: Our results suggested that humoral immunity activation, estrogen receptor signaling suppression and decreased angiogenesis reduced maximal urinary flow rate in the patients with large prostate volume. The activation of humoral immunity in addition to the change of estrogen receptor signaling and angiogenesis causes BOO related with prostate through the different mechanism from the prostate volume. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e72 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hidenori Akaihata More articles by this author Yuki Harigane More articles by this author Kei Yaginuma More articles by this author Yu Endo More articles by this author Yuki Yoshida More articles by this author Hitomi Imai More articles by this author Yuta Matsuoka More articles by this author Akifumi Onagi More articles by this author Kanako Matsuoka More articles by this author Seiji Hoshi More articles by this author Tomoyuki Koguchi More articles by this author Junya Hata More articles by this author Yuichi Sato More articles by this author Masao Kataoka More articles by this author Motohide Uemura More articles by this author Yoshiyuki Kojima More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract P2-16-06: Protein expression and subcellular localization of a clathrin adaptor AP-1 associate with tumor growth activity in breast cancer

Abstract [Introduction] Breast cancer is the fifth leading cause of cancer-related death among women, and its prevalence is the highest in all cancers of Japanese women. To improve the prognosis of breast cancer patients, new diagnostic and therapeutic tools need to be developed. Adaptor protein complex-1 (AP-1) is one of the clathrin adaptor molecules regulating intracellular transport of specific cargos between the trans-Golgi network (TGN) and endosomes. Although the detailed mechanisms have been poorly elucidated, previous reports suggest that AP-1 expression is related with cell proliferation and cancer metastasis. The purpose of this study is to investigate the association between AP-1 expression in tumor tissue measured with immunohistological analyses and surrogate markers of cancer aggressiveness, such as Ki-67 labeling index and/or breast cancer subtypes. [Materials and methods] The records of 207 primary breast cancer patients surgically treated at Fukushima Medical University Hospital from 2011 to 2014 were reviewed. Paraffin embedded sections of these patients were processed for immunohistochemistry examination using antibody against γ-adaptin, a subunit of AP-1, and then its immunoreactivity was quantified. The staining patterns were also graded into 4 grade: Negative (Neg) = 1, Perinuclear (PN) = 2, Scattered (Sc) = 3, and Diffuse (Dif) = 4. The association of the stain characteristics, such as intensity and patterns, and clinicopathological factors, including Ki-67 labelling index and tumor subtypes, were assessed. In addition, the detailed intracellular localization of AP-1 was examined with double immunofluorescence microscopy using markers for the TGN and endosome. [Results] AP-1 intensity was associated with Ki-67 index (p &amp;lt; 0.005) and subtypes (p &amp;lt; 0.0001). Patients with high Ki-67 index showed significantly higher AP-1 intensity than those with low Ki-67 index (p &amp;lt; 0.05). Regarding the tumor subtypes, HER2 type (p &amp;lt; 0.001) and TNBC (p &amp;lt; 0.05) showed significantly higher AP-1 intensity than Luminal A. HER2 type also showed significantly higher AP-1 intensity than Luminal B (p &amp;lt; 0.01). In terms of the staining pattern, AP-1 distribution was also significantly associated with Ki-67 index (p &amp;lt; 0.0001) and subtype (p &amp;lt; 0.0001). The staining pattern grade of high Ki-67 index patients was significantly higher (p &amp;lt; 0.0001) than that of low Ki-67 index patients. Regarding the association with subtypes, the grades in Luminal B (p &amp;lt; 0.0001), HER2 type (p &amp;lt; 0.0001), and TNBC (p &amp;lt; 0.005) were significantly higher than that of Luminal A, and HER2 type also showed higher score than Luminal B (p &amp;lt; 0.01). In tumor cells with Sc pattern, AP-1 was mainly localized in EEA1-positive endosomes, but the localization in TGN was not apparent. [Conclusion] Although further confirmative studies are needed, these results suggest that the protein expression and the endosomal localization of AP-1 are likely related to the cellular proliferation activity in breast cancer tissues. Aberrant AP-1 distribution could be a predictive marker of the tumor growth potential. Citation Format: Nobuhiro Hoshi, Kazunoshin Tachibana, Takefumi Uemura, Yuko Nishimagi, Masaru Noda, Maiko Okano, Sadahiko Abe, Tohru Otake, Satoshi Waguri. Protein expression and subcellular localization of a clathrin adaptor AP-1 associate with tumor growth activity in breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-16-06.