Objective: To clarify the characteristics of medical students' motives for choosing their profession.Methods: A nationwide, cross-sectional, quantitative web survey was conducted using the Profession Choice Motivation Scale for Education Students. Results: Valid responses were obtained from 1,804 medical students, and the applicability of this scale was demonstrated. Medical students considered "contribution to others," "fulfillment in the profession and studying medicine," "financial aspects," and "evaluation by others" to be important, while "mental and physical comfort" was deemed less important. Mean scores for "contribution to others" were significantly higher among female students, public medical school students, students attending their first- or second-choice medical schools, regional quota students, public high school graduates, and first-generation college students. Conversely, students with very low scores for "contribution to others" showed opposite demographic backgrounds. Discussion: The Profession Choice Motivation Scale for Education Students was applicable to the analysis of medical students, and a correlation was observed between demographic backgrounds and profession choice motives.

BACKGROUND: Among the more than 300 mycotoxins that are known to have toxic effects on animals and humans, Fusarium toxins deoxynivalenol (DON), T-2 and HT-2 toxins (T2/HT2), and zearalenone (ZEN) are frequently detected in domestic agricultural products. This study aimed to assess DON, T2/HT2, and ZEN exposure in Japanese adults by measuring urinary mycotoxins, observing their distributions, and making comparisons with data from other countries. METHODS: A total of 201 individuals participated in the study. Twenty-four-hour urine samples were collected from young adults (34 men and 35 women) in the Tokai region (urban area) and spot urine samples were collected from middle-aged and elderly adults (64 men and 68 women) in the Donan area of Hokkaido Prefecture (rural area). Urinary DON, T2/HT2, and ZEN levels were measured using a validated liquid chromatography-tandem mass spectrometry method. RESULTS: For DON, T2/HT2, and ZEN, the detection frequencies above the limit of detection (LOD) level (0.15, 0.13, and 0.01 µg/L, respectively) in all the samples were 53%, 26%, and 71%, respectively. The median concentrations (95^th percentile) of urinary DON, HT2, and ZEN were 0.19 (3.93), CONCLUSIONS This study represents the first comprehensive exposure assessment for DON, T2/HT2, and ZEN in Japanese adults using human biomonitoring methods. These data provide valuable information for a better understanding of mycotoxin exposure in Japan.
Humans ; Zearalenone/urine* ; Japan ; Male ; Female ; Trichothecenes/urine* ; T-2 Toxin/urine* ; Biological Monitoring ; Adult ; Middle Aged ; Aged ; Cross-Sectional Studies ; Young Adult ; Mycotoxins/urine* ; Environmental Exposure/analysis* ; East Asian People

BACKGROUND: Mitochondria, which harbor their own genome (mtDNA), have attracted attention due to the potential of mtDNA copy number (mtDNA-CN) as an indicator of mitochondrial dysfunction. Although mtDNA-CN has been proposed as a simple and accessible biomarker for metabolic disorders such as metabolic dysfunction-associated steatotic liver disease, the underlying mechanisms and the causal relationship remain insufficiently elucidated. In this investigation, we combined longitudinal epidemiological data, animal studies, and in vitro assays to elucidate the potential causal relationship between reduced mtDNA-CN and the development of steatotic liver disease (SLD). METHODS: We conducted a longitudinal study using data from a health examination cohort initiated in 1981 in Yakumo, Hokkaido, Japan. Data from examinations performed in 2015 and 2022 were analyzed, focusing on 76 subjects without SLD at baseline (2015) to assess the association between baseline mtDNA-CN and subsequent risk of SLD development. In addition, 28-day-old SD rats were fed ad libitum on a 45% high-fat diet and dissected at 2 and 8 weeks of age. Blood and liver mtDNA-CN were measured and compared at each feeding period. Additionally, in vitro experiments were performed using HepG2 cells treated with mitochondrial function inhibitors to induce mtDNA-CN depletion and to examine its impact on intracellular lipid accumulation. RESULTS: Epidemiological analysis showed that the subjects with low mtDNA-CN had a significantly higher odds ratio for developing SLD compared to high (odds ratio [95% confidence interval]: 4.93 [1.08-22.50]). Analysis of the animal model showed that 8 weeks of high-fat diet led to the development of fatty liver and a significant decrease in mtDNA-CN. A further 2 weeks of high-fat diet consumption resulted in a significant decrease in hepatic mtDNA-CN, despite the absence of fatty liver development, and a similar trend was observed for blood. Complementary in vitro experiments revealed that pharmacologically induced mitochondrial dysfunction led to a significant reduction in mtDNA-CN and was associated with increases in intracellular lipid accumulation in HepG2 cells. CONCLUSIONS Our findings suggest that reduced mtDNA-CN may contribute causally to SLD development and could serve as a convenient, noninvasive biomarker for early detection and risk assessment.
Animals ; DNA, Mitochondrial/genetics* ; Humans ; Male ; DNA Copy Number Variations ; Female ; Fatty Liver/blood* ; Rats ; Middle Aged ; Longitudinal Studies ; Rats, Sprague-Dawley ; Adult ; Japan/epidemiology* ; Aged ; Biomarkers/blood* ; Hep G2 Cells ; Diet, High-Fat/adverse effects*

BACKGROUND: Although serum carotene may contribute to dementia prevention, there is a lack of longitudinal evidence for early cognitive decline before dementia symptoms. The aim of this study was to examine whether serum carotene levels were associated with annually evaluated cognitive trajectories among the Japanese general population. METHODS: Among 581 baseline participants, 199 individuals (83 males; mean age [min, max], 62.7 [39, 90] years) who underwent cognitive assessments more than twice after baseline were analyzed. "Attention" levels were assessed using one- and three-target Digit Cancellation Tests (D-CAT1 and D-CAT3). "General cognitive ability" was assessed by the short version of Mini-Mental State Examination (SMMSE). Serum carotenes (α-carotene, β-carotene and lycopene) were measured by high-performance liquid chromatography. After the measurements, we calculated total carotene levels by summing up the levels of all measured carotene. Carotene levels were categorized into three groups for analysis (low: 0%-25%, middle: 25%-75%, and high: 75%-100%). A linear mixed model was used to estimate the slope of the D-CAT score trajectory and to compare it between three categories. RESULTS: Compared with the middle carotene group, decline of attention was faster in the D-CAT1 for low β-carotene (β = -3.48, p = 0.035), lycopene (β = -3.10, p = 0.062), and total carotene (β = -4.75, p = 0.003), but not for α-carotene (β = -2.60, p = 0.111). For the D-CAT3, decline of attention was faster in the group of low lycopene (β = -3.17, p = 0.002) and total carotene (β = -2.17, p = 0.037) compared with the middle carotene group, while no clear association for α-carotene (β = -0.67, p = 0.521) and β-carotene (β = -0.64, p = 0.639). There were no clear associations between serum carotene and the SMMSE score. CONCLUSIONS These findings suggest low levels of serum lycopene are associated with a decline of attention in the setting of the general population.
Humans ; Male ; Carotenoids/blood* ; Female ; Longitudinal Studies ; Middle Aged ; Japan ; Aged ; Adult ; Aged, 80 and over ; Attention ; Lycopene ; East Asian People

Objective: To determine the socio-economic and educational backgrounds of first-generation college students (FGCs) among Japanese medical students, with the aim of contributing to the improvement of medical school admissions.　Methods: A nationwide cross-sectional online questionnaire survey was conducted. A total of 1,849 medical students and 295 nursing students participated.　Results: The proportion of FGCs among medical students was 12.1%, lower than that among nursing students (39.4%). The backgrounds of FGCs were compared with those of non-FGCs (students whose parents were university graduates). FGCs were more likely to come from small cities and from outside the Kanto/Kansai regions. They reported lower annual family incomes and had fewer doctors or dentists among their relatives. FGCs attended cram schools less frequently, were more likely to have graduated from national or public high schools, and had higher academic grades. They applied exclusively to national or public medical schools, were more likely to take regional quota or recommended AO entrance examinations, passed these exams immediately after high school graduation, and were more often enrolled in their first-choice and national or public medical schools. FGCs also expressed a stronger intention to work in less-populated areas in the future.　Discussion: The backgrounds of FGCs differ significantly from those of non-FGCs. Further investigation into the challenges and potential of FGCs in medicine is warranted.

OBJECTIVE: To examine the socioeconomic backgrounds of medical students who intend to practice in less-populated areas.METHODS: A nationwide online questionnaire survey was conducted among 1,822 Japanese medical students (1,024 from public universities and 798 from private universities) across 40 medical schools.RESULTS: Regarding preferred future practice locations, 25.2% of students intended to work in areas with populations over 1,000,000; 36.8% in areas with 200,000-1,000,000; 17.2% in areas with 50,000-200,000; and 4.8% in areas with fewer than 50,000 residents. Students who intended to work in less-populated areas (population >200,000) were more likely to have grown up in such areas, come from families with lower annual incomes, have fewer physician parents, have graduated from public high schools, and be enrolled in regional quota programs. Logistic regression analysis identified having a family background in a less-populated area (OR 9.46) and enrollment in a regional quota program (OR 2.72) as significant predictors of the intention to work in less-populated areas.DISCUSSION: There is a correlation between medical students’ intentions to work in less-populated areas and their socioeconomic backgrounds, which are important factors to consider when addressing the uneven distribution of physicians in Japan.

Objective: Perceptions of citizens and health professions educators towards the socioeconomic backgrounds of medical students were investigated to elucidate the challenges of selecting medical students who will be responsible for the future of healthcare in Japan.Methods: Ten focus groups, comprising 14 citizens and 26 health professions educators, were conducted regarding the presented information on the socioeconomic backgrounds of Japanese medical students. Data were analyzed using an inductive thematic analysis approach.Results: Six themes related to family backgrounds, such as higher economic status, five themes related to social backgrounds, such as social and educational disparity, and four themes related to expectations for medical education, such as selection of medical students with diverse backgrounds were extracted.Discussion: Both citizens and health professions educators were aware of the problem of the skewed socioeconomic backgrounds of medical students and the need to expand diversity. This finding will contribute to the reconsideration of future medical school admission criteria.

Methods: This study included 46 patients who underwent spinal reconstruction surgery for thoracolumbar osteoporotic vertebral fractures and kyphosis and were followed up for 1 year postoperatively. DJK was defined as an advanced kyphosis angle >10° between the LIV and one lower vertebra. The patients were divided into groups with and without DJK. The risk factors of the two groups, such as patient background, surgery-related factors, radiographic parameters, and clinical outcomes, were analyzed. Results: The DJK and non-DJK groups included 14 and 32 patients, respectively, without significant differences in patient background. Those with instability in the distal adjacent LIV disc had a significantly higher risk of DJK occurrence (28.6% vs. 3.2%, p=0.027). DJK occurrence significantly increased in those with the sagittal stable vertebra not included in the fixation range (57.1% vs. 18.8%, p=0.020). Other preoperative radiographic parameters were not significantly different. Instability in the distal adjacent LIV disc (adjusted odds ratio, 14.50; p=0.029) and the exclusion of the sagittal stable vertebra from the fixation range (adjusted odds ratio, 5.29; p=0.020) were significant risk factors for DJK occurrence. Conclusions Regarding spinal reconstruction surgery in patients with osteoporotic vertebral fractures, instability in the distal adjacent LIV disc and the exclusion of the sagittal stable vertebra from the fixation range were risk factors for DJK occurrence in the short term.

Introduction: In patients receiving opioids, relief of cancer pain by palliative radiation therapy or other means can lead to opioid discontinuation and subsequent withdrawal symptoms, such as agitation, insomnia, and diarrhea, due to opioid-related physical dependence. Appropriate steps should be taken to prevent these symptoms. Case: A 72-year-old man underwent surgery for esophageal cancer. He developed low back pain and right lower limb pain, and was diagnosed with sacral and right iliac bone metastases. His pain was resistant to oxycodone (OXC), so he was simultaneously treated with methadone (MDN) and palliative radiotherapy. His pain gradually decreased, and MDN was tapered and switched to OXC, which was in turn discontinued at 20 mg/day at the patient's strong request. After OXC discontinuation, akathisia, anxiety, and diarrhea appeared as withdrawal symptoms. These were treated with immediate-release OXC, transdermal fentanyl, and suvorexant. Discussion: When discontinuing opioids, dose reduction below 10% per week is recommended, de-escalation to the lowest possible dose should be followed by cessation. In case of withdrawal symptoms, immediate-release opioids may be used, and opioid tapering should be attempted in parallel with symptom control.

Treatment for malignancy bowel obstruction (MBO) includes surgery, gastrointestinal stenting, nasogastric tube, percutaneous endoscopic gastrostomy, and drug therapy. Drug therapy such as octreotide acetate significantly reduces the quality of life of patients because oral intake is no longer possible and continuous intravenous infusion is required. After a multidisciplinary conference including the department of gastrointestinal surgery and the department of palliative medicine, we could perform staging laparoscopy on a nutritionally-depleted patient with MBO and laparoscopic jejunostomy as a palliative surgery. As a result, she could discontinue from administration of octreotide acetate and resume oral intake.