Tsurugi Hospital

<title>Abstract</title> <bold>Objectives:</bold> To develop a revised version of the Professional Identity Scale for Physiotherapists and clarify core elements of professional identity among Japanese physiotherapists. <bold>Design:</bold> A nationwide cross-sectional web-based survey. <bold>Setting:</bold> The survey was conducted across 499 institutions employing physiotherapists in Japan. <bold>Participants:</bold> A total of 1 <bold/> 037 physiotherapists participated in the study (mean age = 32.3 years; 68.5% male, 31.0% female, and 0.5% unspecified gender). <bold>Main outcome measures:</bold> Primary outcome measures were the factor structure and internal consistency of the newly developed Professional Identity Scale for Physiotherapists. Secondary outcome measure included correlations between this scale and the Burnout Scale to assess criterion-related validity. <bold>Results:</bold> Exploratory factor analysis yielded a five-factor structure (“Development of and Contribution to the Professional Group,” “Practical Skills,” “Client-Centered Support,” “Sense of Adaptability,” and “Orientation Toward Contributing to Interprofessional Collaboration”) comprising 28 items, after excluding 9 items from the original 37-item version. Cronbach’s α coefficient ranged from 0.85 to 0.92 for the five factors, with an overall value of 0.96. Criterion-related validity was evidenced by significant correlations with the Burnout Scale: the total identity score was negatively correlated with emotional exhaustion ( <italic>r</italic> = -0.322, <italic>p</italic> &lt; 0.001) and depersonalization ( <italic>r</italic> = -0.281, <italic>p</italic> &lt; 0.001) and positively correlated with personal accomplishment ( <italic>r</italic> = 0.498, <italic>p</italic> &lt; 0.001). <bold>Conclusions:</bold> The revised Professional Identity Scale for Physiotherapists is a reliable and valid instrument for assessing professional identity among physiotherapists. It provides a practical framework for research and educational initiatives aimed at fostering professional identity and mitigating burnout. In addition, the scale may contribute to curriculum development, competency-based training, and international comparative studies focused on professional identity within the health professions.

Background/Objectives: This study aimed to describe the population pharmacokinetics of cefazolin (CFZ) using unbound serum and periprostatic adipose tissue concentrations and to optimize dosing regimens for patients undergoing robotic-assisted radical prostatectomy (RARP). Methods: We investigated the population pharmacokinetics of CFZ using 295 unbound serum and 67 periprostatic adipose tissue samples from 67 individuals. CFZ concentrations were determined in all samples. A nonlinear mixed-effects model was developed. The pharmacodynamic target was defined as maintaining unbound trough and periprostatic adipose tissue concentrations exceeding the minimum inhibitory concentration (MIC) against methicillin-susceptible Staphylococcus aureus (MSSA) for over 90% of the dosing interval (MIC90; 0.5 mg/L). Results: Systemic clearance of unbound CFZ was significantly associated with creatinine clearance (CLcr). In patients with normal renal function, simulations showed that a 1 g CFZ infusion over 15 min maintained unbound concentrations exceeding the MSSA MIC90 for >90% of the 3 h interval after the initial dose. Notably, in patients with mild renal impairment (CLcr ≤ 80 mL/min), a 5 h dosing interval also achieved a >90% probability of maintaining the target CFZ concentration. Conclusions: The simulations demonstrated that the probability of target attainment of >90% was maintained for up to 5 h in patients with mild renal impairment (CLcr ≤ 80 mL/min). These findings provide a pharmacokinetic rationale suggesting that the standard additional dose may not be necessary for this subgroup; however, future clinical studies are needed to validate safety and efficacy.

ObjectivesTo evaluate the efficacy and safety of bilateral vas deferens sutures in preventing postoperative inguinal hernia after prostatectomy for clinically localized prostate cancer.Materials and MethodsThis retrospective study included 282 patients with localized prostate cancer who underwent open or laparoscopic radical prostatectomy between July 2012 and July 2023. The inguinal hernia incidence rates were compared between the vas deferens suture group (141 patients, May 2017 to July 2023) and the control group (141 patients, July 2012 to April 2017). We further determined the risk factors for inguinal hernia after prostatectomy using a multivariate regression analysis.ResultsAmong the 282 patients analysed, postoperative inguinal hernia was observed in 10 (7.1%) and 37 (26.2%) patients in the vas deferens suture and control groups, respectively. The incidence differed significantly between patients who did and did not undergo radical prostatectomy with a prophylactic procedure (P = 0.006). The 2‐year inguinal hernia‐free rates were 93.4% and 85.1% in the vas deferens suture and control groups, respectively. The median duration for inguinal hernia development was 15 months. Multivariate analysis identified the vas deferens suture procedure as a single factor associated with protection against inguinal hernia development after radical prostatectomy (hazard ratio, 0.36; 95% confidence interval, 0.177–0.734; P = 0.005).ConclusionsThe vas deferens suture is a simple and safe prophylactic procedure to decrease the risk of inguinal hernia after radical prostatectomy.

This study aimed to evaluate published population pharmacokinetic models of unbound cefazolin to assess their predictive performance using an independent dataset. A systematic literature search was conducted on PubMed to identify studies evaluating the population pharmacokinetics of unbound cefazolin in patients. Subsequently, the selected models were used for external validation. Predictive bias was visually assessed by plotting the prediction errors (PEs) and relative PEs. Predictive precision was evaluated by calculating the mean absolute error (MAE), root mean square error (RMSE), and mean relative error (MRE). The predictive performance of the 4 unbound population pharmacokinetic models was evaluated using clinical data from 64 patients and 218 unbound concentration samples. The PEs for unbound cefazolin concentrations in the Komatsu model indicated a positive bias, while the RPEs demonstrated similar predictive distributions along the y = 0 line, regardless of the predicted values. In contrast, the other 3 models showed a negative bias for both PE and RPE at unbound cefazolin concentrations. The best MAE, RMSE, and MRE (%) values were 4.71, 9.02, and 30.2 in Komatsu et al.'s model, while the next best values were 11.5, 16.1, and 107.2 in Chung et al.'s model. Both models, which performed best regarding bias and accuracy, were also utilized in studies on unbound concentrations and the correlation between total concentrations and protein-binding sites. This study identified these models as the most suitable for predicting unbound cefazolin concentration profiles in surgical patients.

Cognitive dysfunction is a major symptom in schizophrenia associated with social skills. It has been reported that cognitive rehabilitation can improve cognitive dysfunction. The Brief Assessment of Cognition in Schizophrenia-Japanese version (BACS-J) is often used as an outcome measure to assess the effectiveness of cognitive rehabilitation. However, the minimal clinically important difference (MCID) in the BACS-J composite score has not been reported. Therefore, we conducted this study to calculate a preliminary MCID in the BACS-J composite score and confirm the feasibility of retrospective data collection and analysis for future large-scale studies. The medical records of patients with schizophrenia who underwent cognitive rehabilitation were retrospectively surveyed. BACS-J data were collected at the beginning and end of the cognitive rehabilitation, and Clinical Global Impression-Improvement (CGI-I) data obtained at the end of the cognitive rehabilitation were evaluated retrospectively. To calculate the MCID in the BACS-J composite score using distribution-based methods, the standard error of measurement was calculated as a characteristic of the scale itself. To calculate the MCID using anchor-based methods, the mean change in BACS-J score corresponding to "minimally improved" on the CGI-I was determined. Twenty-eight patients were included in this study, and BACS-J data were collected from all patients. The CGI-I was completed by 11 patients, 3 of whom showed "minimally improved" according to their CGI scores. Distribution-based methods applied to the data of 28 patients revealed an MCID of 0.735 for the BACS-J composite score. Anchor-based methods were ultimately not applied because the sample size was insufficient. This study confirmed that CGI and BACS-J data can be collected and analyzed retrospectively. According to distribution-based methods, an increase of approximately 0.7 in the BACS-J composite score can be considered clinically meaningful. Future studies with larger sample sizes using both calculation methods could provide more accurate MCID.

痙攣性発声障害（SD）に対する治療は，ボツリヌス治療が第一選択と位置づけられているが，患者ごとの重症度評価や治療効果を評価するためには，客観的な音声評価が必要である．本論文では，ボツリヌス治療後の音声評価の現状と，われわれの新たな取り組みについて述べた．自覚的評価にはVHIやV-RQOLなどが，他覚的評価にはGRBAS，CAPE-V，モーラ法，音響分析などがある．しかし，他覚的評価では必ずしもSDの病態を直接反映しないことや，評価が煩雑なことなどの課題がある．また，治療後の評価時期により，自覚的指標と他覚的指標は相関しないこともある．このため，自覚的評価と他覚的評価の両者を経時的に評価することが重要である．そこでわれわれはスマートフォンを活用して，医療機関を受診することなく音声解析を行うシステムの開発に取り組み，治療後の音声の改善と経時的な変化を確認した．

Abstract Background Oesophageal metastasis of breast cancer is relatively rare. In this report, we describe our experience of a case in which dysphagia was the main complaint, leading to the diagnosis of esophageal metastasis. Method A 63-year-old woman who had undergone partial mastectomy and sentinel lymph node removal in 20xx with a diagnosis of breast cancer presented 9 years after surgery with dysphagia. The postoperative pathological diagnosis of breast cancer was invasive ductal carcinoma, T2, N0, M0, ly1. She had previously received chemotherapy for recurrent bone metastases and mediastinal lymph node metastases 7 years post-operatively, and RT and chemotherapy for a diagnosis of SVC syndrome due to mediastinal lymph nodes 8 years post-operatively. In the present case, upper gastrointestinal endoscopy showed oesophageal stricture and biopsy showed ER+ and PgR- from oesophageal mucosa. Radiotherapy and chemotherapy were administered for the diagnosis of oesophageal metastasis of breast cancer, and the patient's symptoms improved. Conclusion In the case of oesophageal stricture with dysphagia after breast cancer surgery, it is essential to consider oesophageal metastases of breast cancer as a differential, although rare, in addition to benign and primary disease.

Although docetaxel and ARSI are picked up as treatment options against chemo-naïve metastatic CRPC in clinical guidelines for prostate cancer, there is no clear evidence which agent should be introduced as first line treatment. Therefore, we investigated our CRPC cohort treated with docetaxel or ARSI as first-line agent against chemo-naïve CRPC to solve these clinical questions. A total of 345 chemotherapy-naïve CRPC patients introduced to first-line docetaxel or ARSI (abiraterone or enzalutamide) between March 2006 and April 2017 at Jikei University Hospital and its affiliated institutions were included in this study. Propensity score matching method was used to minimize the patients' background. The outcome measures were PSA response rate, PSA decline ≥ 90%, cancer specific survival (CSS) and overall survival (OS). PSA decline correlated OS and CSS (p = 0.027, < 0.001, respectively) and median PSA decline rate was 60.4% in docetaxel group and 85.7% in ARSI group (p = 0.0311). Median OS was 33m (95%CI: 27-53) in docetaxel group and 61m (95%CI: 47-NA) in ARSI group (p = 0.0246). Median CSS was 34m (95%CI: 27-53) in docetaxel group and NR (not reached) (95%CI: 61-NA) in ARSI group (p = 0.000133) in propensity score matching cohort. In multivariate analysis, ARSI induction first showed significantly better for OS and CSS (p = 0.0033 and < 0.001, respectively). In this study, better survival outcome with ARSI induction first than docetaxel against chemo-naïve CRPC. And the candidates who had survival benefit by induction docetaxel first could not be found in this study.

部分肺静脈還流異常症（Partial Anomalous Pulmonary Venous Connection：PAPVC）は一部の肺静脈系が左心系に流入せず，右心房・上大静脈・下大静脈・奇静脈・左腕頭静脈などの右心系に流入する稀な先天奇形である．PAPVCに肺癌を合併すると切除肺葉と異常流入血管との位置関係が治療方針に重要となる事がある．症例は50歳男性，検診で胸部異常影を指摘され，精査の結果左肺腺癌と診断された．その際の術前胸部CTでPAPVCを指摘されたが，切除肺葉からの異常血管であった．肺癌に合併するPAPVCでは切除肺葉から還流する場合は特別な処置を必要としないが他肺葉に合併する場合には右心不全の懸念が生じ，慎重な手術戦略の検討を要する．今回我々は術前に診断し得たPAPVCに合併した肺癌を，術後合併症なく安全に肺葉切除を施行できた一例を経験したので文献的考察を加えて報告する．