研究者詳細 - 辻　喜久

論文 - 辻　喜久

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Three Molecular Developmental Pathways of Remnant Pancreatic Cancer After Resection: A Nationwide Project Study of Japan Pancreas Society.

Shuji Suzuki, Yuko Omori, Yusuke Ono, Katsuya Hirose, Taito Itoh, Hidenori Karasaki, Mitsugi Shimoda, Yuichi Nagakawa, Ryota Higuchi, Itaru Endo, Toshiki Rikiyama, Michiaki Unno, Tsutomu Fujii, Yuki Sunagawa, Hidetoshi Eguchi, Hideki Sasanuma, Takahiro Akahori, Keiichi Okano, Masaji Tani, Satoshi Hirano, Yasuhiro Shimizu, Minoru Kitago, Shugo Mizuno, Tomohisa Yamamoto, Masayuki Furukawa, Masayuki Ohtsuka, Motokazu Sugimoto, Akira Matsushita, Kenichi Hakamada, Hisato Igarashi, Tamotsu Kuroki, Satoshi Tanno, Yoshihisa Tsuji, Atsushi Masamune, Kazuhiro Mizumoto, Yoshiki Hirooka, Hiroki Yamaue, Kazuichi Okazaki, Sohei Satoi, Yoshifumi Takeyama, Yusuke Mizukami, Toru Furukawa

Annals of surgery 281 ( 6 ) 1015 - 1025 2025年06月 [査読有り] [国際誌]

OBJECTIVE: To clarify the molecular mechanism of remnant pancreatic cancer (PC) development after primary PC resection. BACKGROUND: Molecular mechanisms of the development of remnant PCs after primary PC resection are largely unknown. METHODS: Forty-three patients undergoing remnant PC resection after primary PC resection between 2001 and 2017 at 26 institutes were retrospectively analyzed. Clinicopathologic features and molecular alterations detected by targeted amplicon sequencing of 36 PC-associated genes were evaluated. RESULTS: These patients showed significantly lower body mass indices and higher hemoglobin A1c values at remnant PC resection than at primary PC resection. A comparison of the molecular features between primary and remnant PCs indicated that remnant PCs were likely to develop through 3 different molecular pathways: successional, showing identical and accumulated alterations (n = 14); phylogenic, showing identical and distinct alterations (n = 26); and distinct, showing independent distinctive alterations (n = 3). The similarity of gene alterations was associated with time to the remnant PC development ( r = 0.384, P = 0.0173). Phylogenic pathways were significantly associated with the intraductal spread of carcinoma ( P = 0.007). Patient survival did not differ significantly depending on these molecular pathways. CONCLUSIONS: Molecular profiling uncovered 3 pathways for the development of remnant PCs, namely, successional, phylogenic, and distinct pathways. The vast majority of remnant PCs are likely to be molecularly associated with primary PCs either in the successional or phylogenic way. This information could impact the design of a strategy for monitoring and treating remnant PCs.

DOI PubMed

Participation-based clinical clerkships contribute to increased medical student confidence in community emergency care: a cohort study.

Hiroshi Mihara, Atsushi Jinno, Kenta Sato, Kazuhito Nomura, Takao Wakabayashi, Yoshihisa Tsuji

BMC medical education 25 ( 1 ) 734 - 734 2025年05月 [査読有り] [国際誌]

BACKGROUND: The Community-based assessment for Clinical and Emergency Practice (C-CEP) scale is a validated tool comprising 15 items across four components: "Attitude and Communication in Emergency Medicine," "Basic Clinical Skills," "Knowledge about Community Medicine," and "Knowledge in Evidence-Based Medicine." The C-CEP scale enables medical students' self-assessment of their confidence in clinical and emergency care. This study aimed to evaluate whether a two-week comprehensive general practice clerkship would improve C-CEP scores and to identify the specific training elements contributing to increased confidence in primary care, particularly in emergency responses. METHODS: After obtaining ethical approval and written informed consent, fifth-year medical students at Sapporo Medical University who participated in two-week off-campus clerkships at external healthcare facilities (hospitals) during the 2023 academic year were included. Pre- and post-clerkship C-CEP scores were collected. Changes in the baseline and average scores were analyzed across facilities accepting more than four trainees. Text mining was conducted on students' reflective portfolios from the facilities with significant findings to identify frequent and co-occurring words related to confidence-building activities. RESULTS: Out of 115 eligible participants, 97 students were included in the analysis (84.3% participation rate). The data from seven facilities accepting more than four trainees, representing 74 students in total, were analyzed. These facilities averaged 243 beds, were located 147 km from the medical school, and had an emergency admission rate of 84.6%. C-CEP scores showed significant improvement across all components post-clerkship (p < 0.05). Although pre-clerkship scores did not differ significantly across facilities, post-clerkship score increases varied. Multivariate analysis identified Facilities D and F as exhibiting significant differences in confidence improvement compared with the other facilities (R² = 0.20, p = 0.0379). Text mining highlighted that Facility F emphasized active learning activities such as "interviews," "examinations," and "conferences," whereas Facility D focused on passive activities such as "observation", which were associated with limited impact on trainee confidence. CONCLUSION: The C-CEP effectively measured confidence improvements in primary care and emergency responses among fifth-year medical students following their clinical clerkships. The C-CEP scale's ability to detect inter-facility differences highlights its potential to inform and refine clinical education programs, ensuring more targeted and effective training.

DOI PubMed

Diagnostic accuracy of endoscopic ultrasonographic shear wave elastography for assessing early chronic pancreatitis using the Japanese diagnostic criteria 2019.

Shuhei Shintani, Osamu Inatomi, Takuya Okamoto, Kosuke Hiroe, Takaaki Eguchi, Yuki Tomozawa, Akitoshi Inoue, Hidenori Kimura, Atsushi Nishida, Yoshihisa Tsuji, Yoshiyuki Watanabe, Akira Andoh

DEN open 5 ( 1 ) e387 2025年04月 [査読有り] [国際誌]

BACKGROUND AND AIM: Endoscopic ultrasound shear wave elastography (EUS-SWE) can facilitate an objective evaluation of pancreatic fibrosis. Although it is primarily applied in evaluating chronic pancreatitis, its efficacy in assessing early chronic pancreatitis (ECP) remains underinvestigated. This study evaluated the diagnostic accuracy of EUS-SWE for assessing ECP diagnosed using the Japanese diagnostic criteria 2019. METHODS: In total, 657 patients underwent EUS-SWE. Propensity score matching was used, and the participants were classified into the ECP and normal groups. ECP was diagnosed using the Japanese diagnostic criteria 2019. Pancreatic stiffness was assessed based on velocity (Vs) on EUS-SWE, and the optimal Vs cutoff value for ECP diagnosis was determined. A practical shear wave Vs value of ≥50% was considered significant. RESULTS: Each group included 22 patients. The ECP group had higher pancreatic stiffness than the normal group (2.31 ± 0.67 m/s vs. 1.59 ± 0.40 m/s, p < 0.001). The Vs cutoff value for the diagnostic accuracy of ECP, as determined using the receiver operating characteristic curve, was 2.24m/s, with an area under the curve of 0.82 (95% confidence interval: 0.69-0.94). A high Vs was strongly correlated with the number of EUS findings (rs = 0.626, p < 0.001). Multiple regression analysis revealed that a history of acute pancreatitis and ≥2 EUS findings were independent predictors of a high Vs. CONCLUSIONS: There is a strong correlation between EUS-SWE findings and the Japanese diagnostic criteria 2019 for ECP. Hence, EUS-SWE can be an objective and invaluable diagnostic tool for ECP diagnosis.

DOI PubMed

地方の中規模病院における内科医リカレント教育の試み

三原弘, 神野敦, 永幡研, 宮西秀二, 服部哲夫, 辻喜久

医学教育 ( 日本医学教育学会 ) 56 ( 1 ) 46 - 47 2025年02月 [査読有り]

DOI

IR情報の自動的な可視化への挑戦

篠崎淳, 高塚伸太朗, 三原弘, 山本武志, 鵜飼渉, 小山雅之, 小川宰司, 木村心南, 佐藤直, 深川周平, 横山和樹, 根木亨, 辻喜久

大学情報・機関調査研究集会論文集 ( 日本インスティテューショナル・リサーチ協会 ) 13 80 - 84 2024年11月 [査読有り]

札幌医科大学では、教学IRのみを行う目的で、2019年4月に統合IR部門が設置された。毎年の出版物として教学データを掲載する「データブック」の作成、および、「教員の業績評価」の実行が求められていた。本学においてデータを自動的に可視化するツールはなく、限られた予算内でこれらを達成するため、RとPythonを用いて０からシステム構築を行った。ここではその報告と課題を述べる。

DOI

Efficacy and safety of elobixibat in combination with or switched from conventional treatments of chronic constipation: A retrospective observational study.

Takaaki Eguchi, Osamu Inatomi, Shuhei Shintani, Kenji Momose, Tomoya Sako, Megumi Takagi, Daiki Fumihara, Kazuki Inoue, Norio Katayama, Toshiyuki Morisawa, Takumi Ota, Yoshihisa Tsuji

JGH open : an open access journal of gastroenterology and hepatology 8 ( 8 ) e70019 2024年08月 [査読有り] [国際誌]

BACKGROUND AND AIM: Elobixibat is a triple mode of action laxative that increases water secretion into the colon, promotes colonic motility, and reestablishes the defecation desire. This study aims to evaluate the effectivity and safety of elobixibat in chronic constipation (CC) patients refractory to conventional laxatives. METHODS: A single-center retrospective observational study was conducted in refractory CC patients diagnosed according to the Rome IV criteria and received elobixibat between April 2018 and June 2022 at Osaka Saiseikai Nakatsu Hospital. Data were collected for spontaneous bowel movement (SBM), Bristol stool form scale (BSFS) scores, abdominal symptoms, and adverse events. RESULTS: Eligible 311 patients were selected for the analysis. Two-week Elobixibat treatment significantly increased SBM (times/week) from 2.9 ± 1.9 to 4.3 ± 1.9 (P < 0.0001). The BSFS score improved significantly from 3.2 ± 1.7 to 4.4 ± 1.4 (P < 0.0001). The percentages of patients with hard stool were decrease and that with normal stools were increase. Improvements in abdominal symptoms (sensation of incomplete bowel evacuation, straining, abdominal pain and distention, and difficulty defecating) were also significant (P < 0.05). These constipation symptoms were improved irrespective of patient characteristics or previous laxatives. The 43.9% of previous laxatives were discontinued at the start of or after starting elobixibat treatment. A few adverse events were observed, elobixibat was well tolerated. CONCLUSION: Elobixibat was effective in patients who were refractory to other laxatives, irrespective of previous therapy or patient characteristics. Elobixibat may contribute to resolving polypharmacy with single mode of action laxatives.

DOI PubMed

在宅終末期ケアにおける訪問診療同行看護師の役割検討同行看護師および多職種、患者家族を対象としたインタビュー

奥岡由美, 本田日奈子, 古山悦子, 神野敦, 市来智子, 日下勝博, 辻喜久, 辻喜久

Palliative Care Research ( (NPO)日本緩和医療学会 ) 19 ( Suppl. ) S.555 - S.555 2024年06月 [査読有り]

J-GLOBAL

Gut microbiota and metabolites in patients with COVID-19 are altered by the type of SARS-CoV-2 variant.

Yoshihiro Yokoyama, Tomoko Ichiki, Tsukasa Yamakawa, Yoshihisa Tsuji, Koji Kuronuma, Satoshi Takahashi, Eichi Narimatsu, Akio Katanuma, Hiroshi Nakase

Frontiers in microbiology 15 1358530 - 1358530 2024年 [査読有り] [国際誌]

INTRODUCTION: Patients with COVID-19 have dysbiosis of the intestinal microbiota with altered metabolites in the stool. However, it remains unclear whether the differences among SARS-CoV-2 variants lead to differences in intestinal microbiota and metabolites. Thus, we compared the microbiome and metabolome changes for each SARS-CoV-2 variant in patients with COVID-19. MATERIALS AND METHODS: We conducted a multicenter observational study of patients with COVID-19 and performed fecal microbiome, metabolome, and calprotectin analyses and compared the results among the different SARS-CoV-2 variants. RESULTS: Twenty-one patients with COVID-19 were enrolled and stratified according to the SARS-CoV-2 strain: six with the Alpha, 10 with the Delta, and five with the Omicron variant. Fecal microbiome analysis showed that α-diversity was reduced in the order of the Omicron, Delta, and Alpha variants (p = 0.07). Linear discriminant analysis revealed differences in the abundance of short-chain fatty acid-producing gut microbiota for each SARS-CoV-2 variant. Fecal metabolome analysis showed that the Omicron and Delta variants had markedly reduced propionic and lactic acid levels compared to the Alpha strain (p < 0.05). CONCLUSION: The intestinal microbiota of patients with COVID-19 varies depending on the SARS-CoV-2 variant. Dysbiosis of the intestinal microbiota due to differences in SARS-CoV-2 variants causes a decrease in intestinal short-chain fatty acids.

DOI PubMed

急性膵炎患者における遺伝子組換えヒト可溶性トロンボモジュリン(rTM)投与の臨床的意義

江口考明, 江口考明, 辻喜久, 辻喜久, 稲富理

胆膵の病態生理 ( 金沢 : 日本胆膵病態・生理研究会 ) 40 ( 1 ) 7 - 11 2024年 [査読有り]

J-GLOBAL

化学療法開始後に脳梗塞を発症した膵癌患者の臨床的特徴

羽田綾子, 上野真行, 上野真行, 辻喜久

胆膵の病態生理 ( 金沢 : 日本胆膵病態・生理研究会 ) 40 ( 1 ) 107 - 112 2024年 [査読有り]

J-GLOBAL

便秘症治療難治抵抗例に対するエロビキシバット併用・切替え治療における治療有効な背景因子の検討

江口考明, 江口考明, 迫智也, 稲富理, 辻喜久

日本消化器病学会雑誌(Web) 121 2024年 [査読有り]

J-GLOBAL

IR情報の自動的な可視化への挑戦

篠崎淳, 高塚伸太朗, 三原弘, 山本武志, 鵜飼渉, 小山雅之, 小川宰司, 木村心南, 佐藤直, 深川周平, 横山和樹, 根木亨, 辻喜久

大学情報・機関調査研究集会論文集(Web) 13 2024年 [査読有り]

J-GLOBAL

在宅終末期ケアを担う訪問診療同行看護師の役割

奥岡由美, 本田日奈子, 古山悦子, 神野敦, 市来智子, 日下勝博, 辻喜久, 辻喜久

木村看護教育振興財団看護研究集録 ( 東京 : 木村看護教育振興財団 ) 31 ( 31 ) 1 - 24 2024年 [査読有り]

J-GLOBAL

Trauma-related thyroid storm in adolescents: A case report.

Atsushi Jinno, Naofumi Bunya, Junya Hagiwara, Kai Takao, Keigo Sawamoto, Akira Ishii, Takeshi Tsugawa, Eichi Narimatsu, Yoshihisa Tsuji

Acute medicine & surgery 11 ( 1 ) e70004 2024年 [査読有り] [国際誌]

BACKGROUND: Because of a scant report, it is little known that thyroid storms can occur after trauma, even in adolescence. Significantly, this increases the risk of delaying diagnosis resulting in life-threatening. CASE PRESENTATION: A 13-year-old girl was admitted to the emergency department after a traffic accident. Despite receiving comprehensive trauma care, the patient developed hyperthermia and tachycardia that did not respond to temperature management therapy. On the 10th day of her admission, she was diagnosed with a thyroid storm. Treatment for thyroid storm was initiated; thereby, her condition was totally improved. CONCLUSION: We experienced a case of an adolescent girl, who developed a thyroid storm during the treatment of trauma and could save her life. Clinicians should consider thyroid storm in post-traumatic hyperthermia and tachycardia patients, even in children.

DOI PubMed

都市と僻地の差異から学ぶ地域医療教育について

辻喜久

医学教育 ( (一社)日本医学教育学会 ) 54 ( 5 ) 467 - 473 2023年10月 [査読有り]

我々は,北海道南部の南檜山地域(2次医療圏)をリソースとした地域医療教育に取り組んでいる.南檜山地域は(1万4千km2,人口2万3,000人,高齢化率41.6%)と僻地である.一方,近年,"地域"に求められる医師像が多様化し,高度にデザインされた医師養成プログラムが必要となった.そこで,我々は,"差異"の概念に基づき地域医療教育のデザインを試みている."差異"は都市-地方間だけではなく,異なった文化間に常に生じうる.ここでは南檜山と札幌を遠隔診療/教育のシステムでつなぐことで"差異"が生じ,差異を経験した学修者において,より地域医療への理解が深まることを期待した.(著者抄録)

DOI J-GLOBAL

Sex-based differences in metabolic protection by the ANP genetic variant rs5068 in the general population.

Tomoko Ichiki, Valentina Cannone, Christopher G Scott, Seethalakshmi R Iyer, S Jeson Sangaralingham, Kent R Bailey, Jens P Goetze, Yoshihisa Tsuji, Richard J Rodeheffer, John C Burnett Jr

American journal of physiology. Heart and circulatory physiology 325 ( 3 ) H545-H552 2023年09月 [査読有り] [国際誌]

Atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) are produced in the heart and secreted into the circulation. As hormones, both peptides activate the guanylyl cyclase receptor A (GC-A), playing a role in blood pressure (BP) regulation. A significant role for ANP and BNP includes favorable actions in metabolic homeostasis. Sex-based high prevalence of risk factors for cardiovascular disease in males compared with females is well established, but sex-based differences on cardiometabolic protection have not been investigated in relation to ANP (NPPA) and BNP (NPPB) gene variants. We included 1,146 subjects in the general population from Olmsted County, Minnesota. Subjects were genotyped for the ANP gene variant rs5068 and BNP gene variant rs198389. Cardiometabolic parameters and medical records were reviewed. In the presence of the minor allele of rs5068, diastolic BP, creatinine, body mass index (BMI), waist measurement, insulin, and prevalence of obesity and metabolic syndrome were lower, whereas HDL was higher in males with only trends observed in females. We observed no associations of the minor allele with echocardiographic parameters in either males or females. Regarding rs198389 genotype, the minor allele was not associated with any BP, metabolic, renal, or echocardiographic parameters in either sex. In the general community, the minor allele of the ANP gene variant rs5068 is associated with a favorable metabolic phenotype in males. No associations were observed with the BNP gene variant rs198389. These studies support a protective role of the ANP pathway on metabolic function and underscore the importance of sex in relationship to natriuretic peptide responses.NEW & NOTEWORTHY Males are characterized by lower ANP and BNP with greater prevalence of cardiometabolic disease. The ANP genetic variant rs5068 was associated with less metabolic dysfunction in males, whereas no metabolic profile was related to the BNP genetic variant rs198389 in the general population. ANP may play a more biological role in metabolic homeostasis compared with BNP in the general population with greater physiological metabolic actions in males compared with females.

DOI PubMed

超音波内視鏡下せん断波エラストグラフィによる慢性膵炎の定量的診断－膵の領域別計測とRosemont分類の対比－

新谷修平, 稲富理, 廣江光亮, 友澤裕樹, 井上明星, 木村英憲, 西田淳史, 辻喜久, 渡辺嘉之, 安藤朗

超音波医学 ( 公益社団法人日本超音波医学会 ) 50 ( 4 ) 485 - 492 2023年08月 [査読有り] [国内誌]

目的：超音波内視鏡（endoscopic ultrasound: EUS）は慢性膵炎（chronic pancreatitis: CP）の診断に広く用いられているが，Rosemont分類（Rosemont criteria: RC）による線維化の評価は概して主観的である．EUSを用いたせん断波エラストグラフィ（Shear wave elastography using EUS: EUS-SWE）は膵線維化の評価のための客観的アプローチであると提唱されている．しかし，どの膵領域を測定対象に選択するべきかは不明である．本研究の目的は膵の部位別にEUS-SWEを行い，CPの診断精度を比較することである．方法：EUS-SWEを受けたCPまたはCPを疑う50例の後ろ向き解析を実施した．RCに基づいて症例を2群（CP群と非CP群）に分類した．せん断波の速度（velocities of the shear wave: Vs）の測定によって膵硬度を評価し，Vsのカットオフ値を決定した．VsとRCとの相関および膵硬度に影響を及ぼすRC因子を評価した．結果：CP群では非CP群よりすべての領域でVsが有意に高値であった（P < 0.001）．VsによるCPの診断精度は膵体部で最も高かった［曲線下面積（area under the curve: AUC）：0.87］．すべての領域でRCの所見数とVsとの有意な相関が認められ，相関係数は膵体部で最も高かった（rs = 0.55）．多変量解析の結果から，蜂巣状分葉エコーがVsに関する独立因子であることが明らかになった（P = 0.02）．結論：膵体部はEUS-SWEによる膵硬度の評価に適した領域である．また，Vsの定量化はCPの診断に有用な客観的指標である．

DOI PubMed

Impact of S‐1 adjuvant chemotherapy longer than 6 months on survival in patients with resected pancreatic cancer: a nationwide survey by the Japan Pancreas Society based on real‐world data

Yoshito Tomimaru, Hidetoshi Eguchi, Yosuke Inoue, Yuichi Nagakawa, Akihiro Ohba, Hideki Takami, Michiaki Unno, Tomohisa Yamamoto, Shoji Kawakatsu, Tsuyoshi Hayashi, Ryota Higuchi, Hirohisa Kitagawa, Satoshi Hattori, Tsutomu Fujii, Yoshiki Hirooka, Hisato Igarashi, Masayuki Kitano, Tamotsu Kuroki, Atsushi Masamune, Yasuhiro Shimizu, Masaji Tani, Satoshi Tanno, Yoshihisa Tsuji, Hiroki Yamaue, Sohei Satoi, Yoshifumi Takeyama

Cancer ( Wiley ) 129 ( 5 ) 728 - 739 2022年12月 [査読有り] [国際誌]

BACKGROUND: Based on the Japan Adjuvant Study Group of Pancreatic Cancer 01 study, the standard duration of adjuvant chemotherapy with S-1 (an oral 5-fluorouracil prodrug consisting of tegafur, gimeracil, and oteracil) in patients with resected pancreatic ductal adenocarcinoma (PDAC) was considered to be 6 months, but the impact of increasing its duration on postoperative survival was unknown. Here, the authors investigated this question by reviewing real-world data from a large cohort of patients with PDAC. METHODS: In total, 3949 patients who underwent surgery for PDAC during the study period followed by S-1 adjuvant chemotherapy in board-certified institutions were included. Based on the duration of S-1 chemotherapy, two subgroups were defined: a standard-duration group that included patients who were treated for 180 ± 30 days and a longer duration group that included patients who received treatment for >210 days. RESULTS: The median duration of S-1 chemotherapy was 167 days, with a mean ± standard deviation of 200 ± 193 days. After excluding patients who had a recurrence within 210 days after the initiation of adjuvant chemotherapy, postoperative recurrence-free survival (RFS) and overall survival (OS) in the standard-duration group (n = 1473) and the longer duration group (n = 975) were compared. RFS and OS did not differ significantly between the standard-duration and longer duration groups (5-year RFS: 37.8% vs. 36.2% respectively; p = .6186; 5-year OS: 52.8% vs. 53.4%, respectively; p = .5850). The insignificant difference was verified by multivariate analysis and propensity-score matching analysis. CONCLUSIONS: The current findings suggest that extending S-1 adjuvant chemotherapy beyond 6 months has no significant additional effect on survival in patients with PDAC. This could be useful in determining whether to extend S-1 chemotherapy in patients who have completed the standard 6-month treatment.

DOI PubMed

Self-assessment scale for the community-based and emergency practice.

Takao Wakabayashi, Yoshihisa Tsuji, Takeshi Yamamoto, Hitoshi Sohma, Wari Yamamoto

BMC medical education 22 ( 1 ) 799 - 799 2022年11月 [査読有り] [国際誌]

BACKGROUND: For current medical education, community-based primary care for the elderly is an essential topic. This study aimed to establish a scale of community-based assessment for clinical and emergency practice (C-CEP). METHODS: A self-assessment scale for C-CEP was developed according to four steps. Initially, we reviewed publications from the societies of the United States, British, and Japan regarding educational goals. In addition, we searched MEDLINE for educational goals regarding attitude, skills, and knowledge. Getting together, we established 23 items as the educational goals of the C-CEP. Second, we collected responses for these 23 items from 5th-grade medical students (n = 195). Third, we conducted an exploratory factor analysis (EFA) using their responses to determine the fundamental structure of the self-assessment scale. Finally, a confirmatory factor analysis (CFA) was performed to assess the fitness of the self-assessment scale developing the EFA, resulting in modification of the items. RESULTS: In EFA and CFA results, C-CEP Scale consisted of four factors with 15 items: "Attitude and communication in emergency care," Basic clinical skills," "Knowledge of community healthcare," and "Knowledge of evidence-based medicine perseverance." The model fit indices were acceptable (Goodness of Fix Index = 0.928, Adjusted Goodness of Fit Index = 0.900, Comparative Fit Index = 0.979, and Root Mean Square Error of Approximation = 0.045). The values of McDonald's omega as an estimate of scale reliability were more than 0.7 in all four factors. As for test-retest reliability, the intraclass correlation coefficients were ≥ 0.58 for all factors. All four factors of the C-CEP Scale correlated positively with the Medical Professionalism Evaluation Scale subscales. CONCLUSIONS: We developed a valid and reliable self-assessment scale to assess student competence.

DOI PubMed

Natriuretic Peptide-Based Novel Therapeutics: Long Journeys of Drug Developments Optimized for Disease States.

Tomoko Ichiki, Atsushi Jinno, Yoshihisa Tsuji

Biology 11 ( 6 ) 2022年06月 [査読有り] [国際誌]

The field of natriuretic peptides (NPs) as an endocrine hormone has been developing since 1979. There are three peptides in humans: atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP), which bind to the guanylyl cyclase-A (GC-A) receptor (also called natriuretic peptide receptor-A (NPR-A)), and C-type natriuretic peptide (CNP), which binds to the GC-B receptor (also called the NPR-B) and then synthesizes intracellular cGMP. GC-A receptor stimulation has natriuretic, vasodilatory, cardiorenal protective and anti-renin-angiotensin-aldosterone system actions, and GC-B receptor stimulation can suppress myocardial fibrosis and can activate bone growth before epiphyseal plate closure. These physiological effects are useful as therapeutics for some disease states, such as heart failure, hypertension, and dwarfism. To optimize the therapeutics for each disease state, we must consider drug metabolism, delivery systems, and target receptor(s). We review the cardiac NP system; new designer NPs, such as modified/combined NPs and modified peptides that can bind to not only NP receptors but receptors for other systems; and oral drugs that enhance endogenous NP activity. Finally, we discuss prospective drug discoveries and the development of novel NP therapeutics.

DOI PubMed

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