JMA Journal

Do Preys Prey on Their Predators? Confusion over Predatory “Hage-taka” Journals

2019-06-06T08:30:01+09:00

For the last several years, predatory journals have been a topic of discussion in top scientific journals, such as 　. Predatory journals are problematic because they create public mistrust of scientific publication as a whole by the mass production of non-credible publications with the sole aim of profit. Recently, articles in a Japanese newspaper and online articles exposed domestic institutions for the number of publications in predatory journals, saying that they “abused predatory journals to increase the number of their publications and falsely inflate their academic achievements.” We do not subscribe to this point of view because publications in predatory journals do not count as scholarly achievements, and we believe it is an information literacy problem. We feel strongly that it is both important and beneficial for the readers of 　　 to be aware of and understand this issue.

Importance of Neuropathological Diagnosis of Dementia Patients in Family Practice

2019-06-06T08:30:01+09:00

: Creutzfeldt–Jakob disease (CJD) is an important dementia disorder. However, clinical diagnosis can be difficult and delayed for many primary physicians caring for dementia patients. The aim of the present study was to describe clinical and neuropathological results of an individual with CJD who was seen by a community hospital. Our report may inform many primary physicians on understanding the significance of CJD.　: Clinical information was obtained from medical records. Neuropathological and biochemical analyses were performed using autopsied brain.　: A 58-year-old Japanese man who had worked as a carpenter developed memory and executive function impairments. He was initially diagnosed as having Alzheimer’s disease based on clinical and neuroradiological analyses. Myoclonus was observed in the later stage of clinical course. Hyperintense lesions on diffusion-weighted images were observed in the cerebral cortex in later stage. Analysis of cerebrospinal fluid showed increased levels of total tau and phospho-tau protein. However, 14-3-3 protein and amyloid β (1–42) were normal. Genetic analysis of the 　 gene showed methionine homozygosity at codon 129 and glutamate homozygosity at codon 219. The results of neuropathological analysis were consistent with sporadic CJD (MM2 cortical type with some type 1 pattern of 3F4 immunoreactivity). Western blot analysis of the frontal and cerebellar cortex revealed a type 2 and type 1 pattern of proteinase K (PK)-resistant prion protein, respectively. No Alzheimer’s pathology was present.　: Our experience may help primary physicians to assess dementia patients. Since atypical forms of prion disease are now well-established, we need to consider prion disease in dementia patients. Clinical examination alone is not enough for dementia workup; thus, we must understand the importance of neuropathological study and encourage autopsy to reach a definite diagnosis of dementia.

Multifaceted Evaluation of Ultra-high-field 9.4-T Magnetic Resonance Imaging after Inorganic Tattoos: An Animal Study

2019-06-06T08:30:01+09:00

: Tattooing techniques for reconstruction and rectification of the sequelae of cancer treatments, surgery, and scarring have received attention in the medical field. There is concern that tattooed skin is at risk of being burned by magnetic resonance imaging (MRI) examination. However, a detailed evaluation of the impact of MRI imaging on medically tattooed skin has not yet been performed. This study aimed to clarify the changes in common inorganic tattoo pigments during MRI examinations in an animal model.　: Tattooed hairless mice with eight typical pigments for tattoos were evaluated for changes in temperature, color tone, and histology of the tattoos during a 9.4-T MRI.　: None of specimens had signs of burns, such as redness or blisters. In terms of temperature changes, the black iron oxide and carbon black specimens had a maximum temperature increase of 0.4 degrees. In the Munsell color system, no specific color changes were observed before or after the MRI. Color changes, evaluated as the ΔE　 in the L　a　b　 color space, were all below 3.0 and were thus regarded as being indistinguishable and within the color unevenness of the tattoo. Histologic analysis of the specimens showed no significant changes before and after the MRIs.　: The observed temperature changes, color tone changes, and histological changes in the tattooed areas in this animal model were not of a magnitude considered likely to adversely affect the human body.

Development and Pilot Testing of Quality Indicators for Primary Care in Japan

2019-05-16T08:30:01+09:00

: To the best of our knowledge, no quality indicators (QIs) for primary care provided by local clinics have yet been developed in Japan. We aimed to develop valid and applicable QIs to evaluate primary care in Japan.　: Two focus group interviews were held to identify conceptual categories. Existing indicators for these categories were identified, and initial sets of potential QIs were developed. Using a modified Delphi appropriateness method, a multidisciplinary expert panel then developed and selected the QIs. Feasibility and applicability of these QIs were then confirmed in pilot testing at six local clinics in Hokkaido, Japan. To determine patient acceptance of these quality improvement activities, the survey asked two questions, “Do you think it is preferable that the patients of this clinic be periodically surveyed?” and “Do you think it is preferable that this clinic periodically undergo an external quality review by an independent body?”　: Seven categories emerged from the focus group discussions as key components of primary care in Japan. Thirty-nine QIs under five categories (Comprehensive care/Standardized care, Access, Communication, Co-ordination, and Understanding of patient background) were finally selected and named the QIs for Primary Care Practice in Japan. In pilot testing at six primary care clinics in 2015, 65.4% of patients answered favorably to the idea that clinics should conduct regular patient surveys, and 71.8% answered favorably to the idea that clinics should undergo periodic external quality review by an independent body.　: We developed QIs to assess primary care services provided by clinics in Japan, for the first time. Although further refinement is required, establishment of these QIs is the first step in quality improvement for primary care practices in Japan.

The Heart Failure “Pandemic” in Japan: Reconstruction of Health Care System in the Highly Aged Society

2019-05-16T08:30:01+09:00

An increase in the number of patients with heart failure is an international health-related problem. In advanced countries, the number of such patients has rapidly increased since the beginning of the 21　 century, raising an important issue regarding medical practice and public health. In 2010, the concept of “heart failure pandemic” was proposed, and it has been recognized as a global social/economic issue. In particular, the number of elderly patients with heart failure has increased with the rapid aging of society and a decrease in the number of children in Japan. A rapid increase in the number of heart failure patients increases stress and social disease-related/medical economic burdens on individuals and their families. The prognosis of patients with chronic heart failure is unfavorable, and the quality of life markedly reduces. To improve the prognosis of elderly patients with heart failure and reduce the readmission rate, the innovation of a medical-care-providing system for heart failure is required. In addition to the provision of medical practice based on a potent heart failure disease control program, manifold strategies, such as lifestyle improvements, self-care practice, cardiac rehabilitation, and environmental intervention, are essential. It is necessary to innovate hospital-based medical practice to a regional-care-system-based medical care system. In addition, to efficiently promote future heart failure strategies, an investigational study with disease registration must be conducted. Recently a new basic act on countermeasures to cardiovascular diseases has been established which may help the reform for this purpose.

Cerebral Microbleeds Detected Using 3.0T Magnetic Resonance Imaging in 2,003 Patients with Ischemic or Hemorrhagic Stroke

2019-05-16T08:30:01+09:00

: Compared with 1.5T magnetic resonance imaging (MRI), using 3.0T MRI makes it easier to detect cerebral microbleeds (CMBs). We used 3.0T MRI to investigate the backgrounds, risk factors, and number and location of CMBs in patients with ischemic or hemorrhagic stroke.　: We extracted data on clinical characteristics, risk factors, and number and location of CMBs in 2,003 patients treated between January 2010 and December 2014 within one week of stroke occurrence. We then carried out multivariate analysis of the data.　: CMBs were present in 1,025 patients. The numbers of CMBs in ischemic stroke and hemorrhagic stroke patients were 9,410 and 6,419, respectively. Patients with CMBs showed significantly higher rates of cognitive impairment (p < 0.001, odds ratio [OR] = 1.514), hypertension (p < 0.001, OR = 3.145), previous history of stroke (p < 0.001, OR = 1.782), and presence of hemorrhagic stroke (p < 0.001, OR = 2.066). The use of antithrombotic medication before the stroke did not affect the incidence of CMBs. In ischemic stroke patients, patients with small vessel occlusion had a significantly greater rate of previous history of hemorrhagic stroke (p = 0.046) and number of patients with CMBs (p < 0.001) than those with cardioembolism.　: CMBs were well observed in patients with small vessel disease, and hypertension was an important factor in ischemic and hemorrhagic stroke. Antithrombotic medication is not associated with the development of CMBs if adequate antihypertensive therapy is provided.

A Case Report of an Intrathoracic Mass Lesion Caused by 　 that Required Exclusion of a Malignant Tumor Diagnosis

2019-05-16T08:30:01+09:00

A 57-year-old man with untreated diabetes mellitus was admitted to our hospital due to an intrathoracic mass lesion infiltrating the vertebral body and mediastinum. The mass was suspected to be invasive lung cancer; however, percutaneous needle biopsy revealed that the mass was inflammatory granulation tissue caused by an 　 infection. To the best of our knowledge, this is the first report of an intrathoracic mass lesion caused by an 　 infection. When an intrathoracic mass lesion is suspected, clinicians should consider possible infections that cause granulation tissue, such as 　. This is particularly important in immunocompromized hosts such as patients with diabetes.

Vascular Complication after Collagenase Injection and Manipulation for Dupuytren’s Contracture: A Case Report

2019-05-16T08:30:01+09:00

A case of a vascular complication after collagenase injection and manipulation for Dupuytren’s contracture in a 57-year-old Japanese man is described. The patient presented with a 10-year history of worsening primary Dupuytren’s contracture. The metacarpophalangeal joint of his left little finger had a flexion contracture of 40° and was treated by collagenase injection. When the patient returned to our hospital for manipulation 24 hours later, however, his left little finger was almost completely improved because he hit his finger on the car’s gear lever. Then, 9 months after collagenase injection, in the first winter, he complained of a painful and pale left little finger occurring a few times a day, lasting for about 10 minutes. Now, two years after collagenase injection, the episodes of Raynaud’s phenomenon remain. Although Raynaud’s phenomenon after collagenase injection and manipulation for Dupuytren’s contracture is considered rare, it is a complication to be noted.

JMA Journal

Do Preys Prey on Their Predators? Confusion over Predatory “Hage-taka” Journals

Importance of Neuropathological Diagnosis of Dementia Patients in Family Practice

Multifaceted Evaluation of Ultra-high-field 9.4-T Magnetic Resonance Imaging after Inorganic Tattoos: An Animal Study

Development and Pilot Testing of Quality Indicators for Primary Care in Japan

The Heart Failure “Pandemic” in Japan: Reconstruction of Health Care System in the Highly Aged Society

Cerebral Microbleeds Detected Using 3.0T Magnetic Resonance Imaging in 2,003 Patients with Ischemic or Hemorrhagic Stroke

A Case Report of an Intrathoracic Mass Lesion Caused by that Required Exclusion of a Malignant Tumor Diagnosis

Vascular Complication after Collagenase Injection and Manipulation for Dupuytren’s Contracture: A Case Report

A Case Report of an Intrathoracic Mass Lesion Caused by 　 that Required Exclusion of a Malignant Tumor Diagnosis