Medicine In Japan Research Articles

Impact of the ARCH Project on National Capacity Development on Disaster Health Management among the ASEAN Member States and Japan.

This report tries to capture the impact of the Project for Strengthening the ASEAN Regional Capacity on Disaster Health Management (ARCH Project) in each ASEAN Member State (AMS) and Japan as a result of the ARCH Project implementation since July 2016. Impact on AMS: The analysis of the impact on AMS was based on a comparison of the impact of the project on management and coordination of Emergency Medical Teams (EMTs), and application of the project outcome in actual emergency operations compared to the previous status in each AMS.Impact on Japan: The history of the development of disaster medicine in Japan was reviewed, with an aim to analyze the impact of supporting AMS through the ARCH Project on Japan, and the possibility of bi-directional cooperation in the future. Impact on AMS: Since the initiation of the ARCH Project, AMS has made significant progress in WHO EMT accreditation, strengthening EMTCC capacity for receiving international assistance, as well as the development of legislation or strategic plans related to DHM, and application of the Project products such as standard operating procedures or regional tools in actual disasters/emergencies.Impact on Japan: Disaster medicine in Japan originated from the Cambodian refugees' relief mission in 1979. Since then, the management system has been strengthened including the foundation of the Japan Disaster Relief (JDR) Team, a structure with a legal foundation. The experience gained through international operations has contributed to the development of Japan's domestic disaster response system. Japan learned the operational effectiveness of the post-disaster health surveillance system through the disaster response operation in 2013 Typhoon Yolanda Disaster in Philippines and introduced a modified system in Japan for domestic disaster response, which was later refined and proposed for an international standard. ARCH Project is highly appreciated by AMS as the opportunity to share knowledge and experience among countries and thereby contributing to achieving the "One ASEAN, One Response" concept, as well as the driving force for each AMS to develop its capacity in DHM. While the ARCH Project started to support AMS to strengthen its regional capacity in disaster health management, it is important to build a bi-directional relationship between ASEAN and Japan in terms of mutual learning and support to tackle future disasters.

Adaptive challenges of curriculum implementation for enhancing medical student resilience at Showa University in Japan

It has been consistently reported that medical students experience a high rate of psychological morbidity, depersonalization, and low personal accomplishment around the world. Under the circumstances, resilience-enhancing programs have been gathering attention and partially implemented even in Japan. However, most of the programs just imitate resiliency programs in North America even though studies have indicated that there are cultural differences between East Asia and North America in the capacity to cope with a stressful situation. The presenters investigated what factors might affect the similarities or differences in the perception of resilience among experienced palliative care physicians in Canada and Japan in 2017-2018. This study showed that Japanese physicians are more likely to rely on “Relationships” with other persons such as family members, friends, mentors or colleagues; in contrast, Canadian physicians tended to be more focused on individual factors such as “Autonomy” and “Confidence”. As a result, the presenters at Showa University School of Medicine in Japan have implemented a progressively advancing resiliency program in a passed manner for the 1st through 6th year medical students as part of a new curriculum. This represents one of the most drastic revisions of curriculum in the school’s history. This presentation will introduce a course for resiliency programs as part of a new curriculum, including course description, course content, educational objectives, instructional strategies and the tips for the classroom teaching and learning.

Japan Society of Clinical Oncology Clinical Practice Guidelines 2017 for fertility preservation in childhood, adolescent, and young adult cancer patients: part 2

The Japan Society of Clinical Oncology (JSCO) published the “JSCO Clinical Practice Guidelines 2017 for Fertility Preservation in Childhood, Adolescent, and Young Adult Cancer Patients” in 2017. This was the first guideline in cancer reproductive medicine in Japan. In the field of cancer reproductive medicine, close cooperation between an oncologist and a physician for reproductive medicine is important from before treatment initiation until long after treatment. The guideline takes into consideration disease specificity and provides opinions from the perspective of oncologists and specialists in reproductive medicine that are in line with the current state of the Japanese medical system. It is intended to serve as a reference for medical staff in both fields regarding the availability of fertility preservation therapy before the start of cancer treatment. Appropriate use of this guideline makes it easier to determine whether fertility preservation therapy is feasible and, ultimately, to improve survivorship in childhood, adolescent, and young adult cancer patients. In this article (Part 2), we describe details by organ/system and also for pediatric cancer.

J-TEC's efforts to industrialize regenerative medicine in Japan

J-TEC was launched in 1999 to industrialize regenerative medicine in Japan. We developed the first regenerative medicine product, JACE (autologous cultured epidermis), which received PMDA approval for treating serious burns in 2007. Then, JACC (autologous cultured cartilage), the second product, was approved in 2012 for efficacy on traumatic cartilage defects. In 2014, the Pharmaceutical Affairs Law was revised to the Pharmaceutical and Medical Device Act, and regenerative medicine products, including gene therapies, were newly classified to accelerate productization. Subsequently, Nepic (autologous cultured corneal epithelium) and Ocural (autologous cultured oral mucosal epithelium) for epithelialization of limbal stem cell deficiencies in ophthalmology were approved in 2020 and 2021, respectively. To develop regenerative medicine products, it is necessary to ensure the safety of raw materials, standardize the cultivation process, examine cell characteristics on GLP tests, construct transportation methods, build facilities, and conduct clinical trials.

Large-Scale Observational Study on the Current Status and Challenges of General Medicine in Japan: Job Description and Required Skills.

PurposeTo identify the current ambiguous status of general medicine (GM) and assess current problems and weaknesses for further development of GM.Patients and MethodsThis study adopted an observational design. GM practitioners were selected from the mailing lists of two primary professional associations for Japanese GM doctors. We included physicians currently working in a GM department, those self-described as GM doctors, and those board-certified in family medicine or general internal medicine. Respondents replied to survey questions about their sociodemographic data, job descriptions, and the requisite skills for practice. GM doctors’ job description and required skills were categorized into “clinical,” “management,” “education,” and “research.” Participants (n = 971) were compared based on job descriptions and important skills in each category by facility type, size, and position.Results“Clinical” was indicated as the most important category for both job description and important skills, followed by “management,” “education,” and “research.” For job description details, “follow-up outpatient” (35.6%) ranked first for “clinical,” and “resident education” (57.3%) ranked first for “education.” By facility type and size, job description and important skills decreased for clinical and management categories as facility sizes increased; the opposite was true for “education.” “Research” was generally rated low. By position, no significant difference was found in effort or importance given to research.ConclusionThis study is the first survey on GM physicians across Japan. The results show that while Japanese GM physicians focus on and place importance on clinical practice, they are less involved in research and do not consider research skills to be important. The challenge for the future development of GM lies in research.

E-labeling system in prescription medicines in Japan: measures and perspectives in pharmaceutical industry

E-labeling system in prescription medicines in Japan: measures and perspectives in pharmaceutical industry

Clinical outcomes of corticosteroids for COVID-19 patients at the National Center for Global Health and Medicine during the first wave of infections.

BackgroundCoronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2, has been a significant concern worldwide since its outbreak in December 2019. Various treatments are being researched and developed, and there are reports that dexamethasone has reduced the mortality rate and improved the clinical course of critically ill patients with COVID-19. In this study, we examined the clinical efficacy of corticosteroid therapy for patients with COVID-19 in our hospital during the first wave of infections.MethodsWe retrospectively reviewed the medical records of patients with COVID-19 who were treated with or without corticosteroid therapy at the National Center for Global Health and Medicine in Japan between February and April 2020. The primary outcome was improvement in the patients’ clinical course using a seven-category ordinal scale. We collected data on patient characteristics, treatment, and clinical course, and compared them between two groups: the steroid-using group and the non-steroid-using group.ResultsBetween February and April 2020, 110 patients were diagnosed with COVID-19. Despite poor conditions during admission into the steroid group, there were no statistical differences in clinical course between both groups, as measured using the scale. There were no statistical differences between the two groups in the number of days to fever resolution or negative polymerase chain reaction results.ConclusionsThere was no difference in the clinical course between both groups. Because of the difference in background, corticosteroids may potentially make the clinical course of severely ill patients similar to that of mildly ill patients.

Buddhism and Medicine in Japan: A Topical Survey (500–1600 CE) of a Complex Relationship, written by Katja Triplett

Buddhism and Medicine in Japan: A Topical Survey (500–1600 CE) of a Complex Relationship, written by Katja Triplett

Inactivation of human norovirus by chlorous acid water, a novel chlorine-based disinfectant

IntroductionHuman norovirus (HuNoV) is a leading cause of infectious gastroenteritis. Since HuNoV shows resistance to alcohol, chlorine-based sanitizers are applied to decontaminate the virus on environmental surfaces. Chlorous acid water (CA) has been recently approved as a novel chlorine-based disinfectant categorized as a Type 2 OTC medicine in Japan. In this study, we aimed to evaluate the capability of CA to inactivate HuNoV. MethodsHuNoV (genogroups GII.2 and GII.4) was exposed to the test disinfectants including CA and sodium hypochlorite (NaClO), and the residual RNA copy was measured by reverse transcription quantitative PCR (RT-qPCR) after pretreatment with RNase. In addition, the log10 reduction of HuNoV RNA copy number by CA and NaClO was compared in the presence of bovine serum albumin (BSA), sheep red blood cells (SRBC), polypeptone, meat extract or amino acids to evaluate the stability of these disinfectants under organic-matter-rich conditions. ResultsIn the absence of organic substances, CA with 200 ppm free available chlorine provided >3.0 log10 reduction in the HuNoV RNA copy number within 5 min. Even under high organic matter load (0.3% each of BSA and SRBC or 0.5% polypeptone), 200 ppm CA achieved >3.0 log10 reduction in HuNoV RNA copy number while less than 1.0 log10 reduction was observed with 1,000 ppm sodium hypochlorite (NaClO) in the presence of 0.5% polypeptone. CA reacted with only cysteine, histidine and glutathione while NaClO reacted with all of the amino acids tested. ConclusionsCA is an effective disinfectant to inactivate HuNoV under organic-matter-rich conditions.

The Birth of Sports Medicine in Prewar Japan: A Perspective on Its Ideological and Organizational Origins

The relationship between sports and medicine in Japan has remained largely unexplored by historians. This paper aims to clarify the historical context in which the relationship became closer and the professional practice called ‘sports medicine’ grew in relation to the social and political situation surrounding sports around 1930 in prewar Japan. From the late-1920s to the early 1930s, the view on sports of sports medical scientists, who had come to occupy a position as experts on sportspeople’s bodies, was different from that of physical education and exercise advocates, and they rejected the framing of sports as physical education. Also, the mechanism for realizing sports medicine research and the application of the findings were not established by the state-led movement, but by private sports medicine organizations. It can thus be said that sports medicine was the product of a movement by the sports world to define sports and the ‘sportsman’, and to autonomously prevent the physical harm of sports and at the same time contribute to the improvement of athletic performance.

Physicians' perceptions of the factors influencing disclosure of secondary findings in tumour genomic profiling in Japan: a qualitative study.

Tumour genomic profiling (TGP), conducted in search of therapeutics, sometimes reveals potentially pathogenic germline variants as secondary findings (SFs). Physicians involved in TGP are often specialised in oncology and not in clinical genetics. To better utilise SFs, we explored issues physicians have during disclosure and the potential for collaborations with clinical genetics professionals. Semi-structured interviews were conducted with 14 physicians who had experience in handling outpatient TGP at designated core hospitals for cancer genomic medicine in Japan. The data were analysed thematically. The difficulties physicians experienced during informed consent (IC) included educating patients about SFs, providing detailed information on SFs, and explaining the impact of SFs on patients' family members. When SFs were detected, physicians had reservations regarding the relevance of the disclosure criteria. Confirmatory germline tests were performed using peripheral blood when tumour-only tests detected suspected SFs. Some physicians had reservations about the necessity of confirmatory tests when they did not affect the patients' treatment options. To encourage patients to receive confirmatory tests, improvements are necessary in the healthcare system, such as insurance reimbursements, education for physicians so that they can provide a better explanation to their patients, and genetic literacy of physicians and patients. The physicians offered insights into the challenges they experienced related to IC, disclosure of SFs, and expectations for active collaborations with clinical genetics professionals. Wider healthcare insurance coverage and better genetic literacy of the population may lead to more patients taking confirmatory tests when SFs are suspected.

Optimization of injection dose in 18F-FDG PET/CT based on the 2020 national diagnostic reference levels for nuclear medicine in Japan

ObjectiveRecently, the national diagnostic reference levels (DRLs) in Japan were revised as the DRLs 2020, wherein the body weight-based injection dose optimization in positron emission tomography/computed tomography using 18F-fluoro-2-deoxy-D-glucose (18F-FDG PET/CT) was first proposed. We retrospectively investigated the usefulness of this optimization method in improving image quality and reducing radiation dose.MethodsA total of 1,231 patients were enrolled in this study. A fixed injection dose of 240 MBq was administered to 624 patients, and a dose adjusted to 3.7 MBq/kg body weight was given to 607 patients. The patients with body weight-based injection doses were further divided according to body weight: group 1 (≤ 49 kg), group 2 (50–59 kg), group 3 (60–69 kg), and group 4 (≥ 70 kg). The effective radiation dose of FDG PET was calculated using the conversion factor of 0.019 mSv/MBq, per the International Commission on Radiological Protection publication 106. Image quality was assessed using noise equivalent count density (NECdensity), which was calculated by excluding the counts of the brain and bladder. The usefulness of the injection dose optimization in terms of radiation dose and image quality was analyzed.ResultsThe body weight-based injection dose optimization significantly decreased the effective dose by 11%, from 4.54 ± 0.1 mSv to 4.05 ± 0.8 mSv (p < 0.001). Image quality evaluated by NECdensity was also significantly improved by 10%, from 0.39 ± 0.1 to 0.43 ± 0.2 (p < 0.001). In no case did NECdensity deteriorate when the effective dose was decreased. In group 1, the dose decreased by 32%, while there was no significant deterioration in NECdensity (p = 0.054). In group 2, the dose decreased by 17%, and the NECdensity increased significantly (p < 0.01). In group 3, the dose decreased by 3%, and the NECdensity increased significantly (p < 0.01). In group 4, the dose increased by 14%, but there was no significant change in the NECdensity (p = 0.766).ConclusionBody weight-based FDG injection dose optimization contributed to not only the reduction of effective dose but also the improvement of image quality in patients weighing between 50 and 69 kg.

MO37-3 Is bronchoscopic cytology pellets useful for oncomine comprehensive assay? – from the samples submitted to LC-SCRUM

Gene mutation screening in lung cancer is performed on formalin-fixed paraffin-embedded (FFPE), but there are some cases that cannot be analyzed. Lung cancer genomic screening project for individualized medicine in Japan (LC-SCRUM) is nationwide cancer genome screening project as academic industrial collaboration for individualized medicine in Japan. In LC-SCRUM, fresh frozen tissues or bronchoscopic pellet samples are analyzed by Oncomine Comprehensive Assay version 3 (OCA v3) Thermo Fisher SCIENTIFIC, and the measurement principle is the same as that of Oncomine Dx Target Test. We investigated the amount of extracted DNA/RNA and the feasibility of gene mutation analysis in fresh frozen tissues and pellet samples prepared from lavage of bronchoscopic device. We compared the background factors of frozen tissues or pellet samples submitted to LC-SCRUM after being diagnosed with lung cancer from May 2016 to March 2020 at our hospital. DNA/RNA concentration and the success rate of gene mutation analysis by OCA v3 were examined. There were 67 enrolled cases, 26 frozen tissues and 41 pellets. The DNA analysis rate was 100%, the RNA analysis rate was 81%, and the overall analysis success rate for both was 78%. The median DNA /RNA extraction amount was 0.065/0.01 (μg/μL) in the tissues and 0.07/0.01 (μg/μL) in the pallets with no significant differences. The analysis success rate was 76.9% in the tissues and 78% in the pellets. In the pellets group, the samples from EBUS-TBNA was 34%, which was higher than that in the tissue group (8%). The amount of DNA extracted from the EBUS-TBNA samples was significantly larger than that from transbronchial biopsy (0.16 vs 0.03 (μg/μL), P<0.001). In OCA, gene mutation analysis using bronchial pellets may be as useful as that in frozen tissues, especially in the EBUS-TBNA samples.

PSY1-1 The framework of cancer precision medicine in Japan

The year 2019 was considered to be the first year of cancer precision medicine in Japan because three NGS gene-panel tests (Oncomine DxTT, FoundationOne CDx, and the NCC OncoPanel) were approved by the government and have been introduced in clinical practice. Ahead of this approval, the Japanese government organized a framework to promote precision medicine using CGP testing. Currently, 12 'core' institutes, 33 base hospitals, and 161 cooperative hospitals were designated as implementing cancer genomic medicine. Although the cost of Oncomine DxTT can be reimbursed in any patients with advanced lung cancer, the two CGP tests, F1CDx and the NCC OncoPanel can be implemented only within the hospitals under this framework, and the only core and base hospitals can order a CGP test. Another characteristic of this framework is the collection of all genome data with clinical information to the Center for Cancer Genomics and Advanced Therapeutics (C-CAT). This center functions as a hub for aggregating and managing nationwide efforts in precision cancer medicine, as well as utilizing these data to enhance the quality of treatment and develop new therapies in collaboration with research facilities and industrial partners. A primary aim of this program is to enable access to selected unapproved drugs based on the genome profile, so the target of this program is limited to the patients who completed or are expected to complete standard therapy, to whom treatments with unapproved drugs are allowed according to the advice of the institutional multidisciplinary expert panel. In addition to the current restriction of precision cancer medicine to the limited patients, a host-spot panel test (Oncomine DxTT) is not widely used, and multiple single-gene testing was still dominated in 2019. This situation might be associated with the consideration that EGFR mutations cannot be missed because of the high frequency in Japanese.

Difference in the Care of Patients with Amyotrophic Lateral Sclerosis With and Without Intervention from the Palliative Care Team: Observations from a Center in Japan

Background: Despite the significant palliative care needs for people living with amyotrophic lateral sclerosis (ALS), palliative medicine in Japan is mainly focused on oncologic disease.Objective: To compare the care provided to patients with ALS with and without intervention from the palliative care team (PCT and non-PCT groups, respectively).Design: This is a retrospective case–control study.Setting: One ALS center in Japan.Participants: Sixty patients with clinically definite ALS treated until death from January 2012 to December 2019.Measurements: We compared the two groups based on the presence of advance directives, patient age, use of noninvasive and invasive ventilation, maximum opioid dosage, and use of nonopioid palliative medications such as antidepressants and anxiolytics. We also compared the prescribing practices of the attending physicians.Results: There was no difference in the rate of advance directive completion between the PCT and non-PCT groups. Although all but one patient in the PCT group used opioids, only half of the patients in the non-PCT group used opioids (p < 0.001). The mean maximum opioid dosage was higher in the PCT group than in the non-PCT group (p = 0.003). Moreover, 79.2% and 41.7% of the PCT and non-PCT groups, respectively, received antidepressants or antianxiety agents (p = 0.004). Maximum opioid dosages were not different on the basis of attending physician's experience level.Conclusions: Opioid and nonopioid medications intended for symptom management were more likely to be prescribed to patients with ALS who received intervention from a PCT.

Reflection on the enactment and impact of safety laws for regenerative medicine in Japan.

Japan's Act on the Safety of Regenerative Medicine (ASRM) created an innovative regulatory framework intended to safely promote the clinical development of stem cell-based interventions (SCBIs) while subjecting commercialized unproven SCBIs to greater scrutiny and accountability. This article reviews ASRM’s origins, explains its unprecedented scope, and assesses how it envisions the regulation of SCBIs. This analysis is used to highlight three key insights that are pertinent to the current revision of the ASRM: clarifying how the concept of safety should be defined and assessed in research and clinical care settings; revisiting risk criteria for review of SCBIs; and taking stronger measures to support the transition from unproven interventions to evidence-based therapies. Finally, the article reflects on lessons drawn from Japanese experiences in dealing with unproven SCBIs for international endeavors to regulate SCBIs.

Literature by Other Mediums: Revisiting Lu Xun's Preface to Outcry

AbstractBy recounting how Lu Xun 鲁迅 went from studying medicine in Japan to writing for the magazine Xin qingnian 新青年 (New Youth), the preface to Nahan 呐喊 (Outcry, 1923), Lu Xun's first collection of short stories, not only presents an origin story of an important author but also contains important clues for understanding modern Chinese literature. This article offers a new reading of that canonical text by focusing on the problem of medium. Synthesizing author biography, media history, and textual analysis, it examines three intermedial references in the preface—the famous lantern slide, the modern periodical, and the recurring notion of outcry. As an autobiographical account, the preface contains narrated events that call for more media-centered analysis, including the “slide incident” (renamed “screen incident”) and Lu Xun's failed experiment with the periodical medium. Reading the preface as an act of narration, this article scrutinizes textual choices such as the confusing word dianying 电影 (film) and the outcry metaphor. The emergence of both modern vernacular literature and Lu Xun as a major literary figure, it is argued, should be historicized in a broader transnational media environment, in which diverse media practices intersected.

Changes in Test Methods for Internationalization in the Japanese Pharmacopoeia (Part 1): Establishment of a Quantitative Test Method for Clonidine Hydrochloride Using HPLC Analysis

The Japanese Pharmacopoeia (JP) is an official normative guide for maintaining the authenticity of properties and qualities of medicine in Japan. The JP is revised every 5 years, and partial amendments are made from time to time to keep abreast with progress in science and technology and international harmonization. We are conducting a related study on the elimination of toxic reagents from the JP. The elimination of toxic reagents is an important study in relation to the five pillars of the revision of the 18th JP, "Improvement in quality by proactively introducing the latest knowledge and technological advances". In addition, "Internationalization of the JP" is an important issue to be addressed during revision of the JP. Considering international harmonization of the JP, it is important to incorporate the test methods that have been used in other pharmacopoeia, such as the United States Pharmacopeia (USP) and the European Pharmacopoeia (EP) in the JP. To achieve the above, herein, we selected clonidine hydrochloride, which is listed in the 17th JP. A potentiometric titration method is used as a quantitative method for clonidine hydrochloride in the 17th JP; in contrast, a HPLC method is utilized in the USP and the EP. In this study, we synthesized impurities of clonidine hydrochloride and determined their purities using quantitative NMR. In addition, the complete separation conditions of these compounds by HPLC were examined, and simultaneous analysis was performed.

日本の近代獣医学史 － エルシニア研究の第一人者 坪倉 操 －

日本の近代獣医学史 － エルシニア研究の第一人者 坪倉 操 －

Establishment and implementation of Cancer Genomic Medicine in Japan.

Approximately 1 in 2 Japanese people are estimated to be diagnosed with cancer during their lifetime. Cancer still remains the leading cause of death in Japan, therefore the government of Japan has decided to develop a better cancer control policy and launched the Cancer Genomic Medicine (CGM) program. The Ministry of Health, Labour, and Welfare (MHLW) held a consortium at their headquarters with leading academic authorities and the representatives of related organizations to discuss ways to advance CGM in Japan. Based on the report of the consortium, the CGM system under the national health insurance system has gradually been realized. Eleven hospitals were designated in February 2018 as core hospitals for CGM; subsequently, the MHLW built the Center for Cancer Genomics and Advanced Therapeutics (C‐CAT) as an institution to aggregate and manage genomic and clinical information on cancer patients, and support appropriate secondary use of the aggregated information to develop research aimed at medical innovation. As the first step in Japan's CGM in routine practice, in June 2019 the MHLW started reimbursement of 2 types of tumor profiling tests for advanced solid cancer patients using the national insurance system. Japan's CGM has swiftly been spreading nationwide with the collaboration of 167 hospitals and patients. The health and research authorities are expected to embody personalized cancer medicine and promote CGM utilizing state‐of‐the‐art technologies.