Nevin Manimala

JMA J. 2026 Jan 15;9(1):309-320. doi: 10.31662/jmaj.2025-0395. Epub 2025 Dec 19.

ABSTRACT

INTRODUCTION: There is no standard geriatric assessment (GA) for patients aged ≥65 years with lung cancer (hereafter referred to as patients). This retrospective study evaluated whether GA could be achieved by combining Geriatric-8 (G8) score (G8s), body weight loss (BWL) of more than 5% (5%BWL), and bioelectrical impedance analysis (BIA).

METHODS: This study included patients who underwent G8 screening, BIA (measuring skeletal muscle mass index [SMI] and extracellular water-to-total body water ratio [ECW/TBW]), and physical function tests before treatment at our hospital between March 1, 2023, and December 31, 2024. Patient clinical records were reviewed to collect baseline data. Statistical analyses were conducted using R (version 4.1.1).

RESULTS: A total of 120 patients were analyzed. We found the following significant associations: G8s ≤14.0 and 5%BWL were associated with advanced-stage disease; G8s >14.0 and SMI ≥cut-off value (CV) with higher body mass index; ECW/TBW ≥0.4 (0.4 ECW/TBW) with aging and poor performance status; 5%BWL with lower maximum lower leg calf circumference (MLLCC); SMI ≥CV with higher maximum handgrip strength (MHGS) and MLLCC; 0.4 ECW/TBW with lower MHGS, gait speed, and five-time sit-to-stand performance. The multivariate analysis confirmed significant associations: G8s ≤14.0 was associated with cancer cachexia; SMI < CV and 0.4 ECW/TBW were associated with sarcopenia, and 0.4 ECW/TBW was associated with physical function decrease, as indicated by a Short Physical Performance Battery score of ≤9. Patients with G8s ≤14.0, 5%BWL, or 0.4 ECW/TBW had shorter survival durations than their respective counterparts. Patients were classified into three frailty categories (none, mild combined with moderate, severe) based on a combination of four factors (G8, BWL, SMI, and ECW/TBW) and had distinct survival curves.

CONCLUSIONS: The combination of these four factors offers a simple and objective approach for GA in patients.

PMID:41676841 | PMC:PMC12889063 | DOI:10.31662/jmaj.2025-0395

JMA J. 2026 Jan 15;9(1):180-188. doi: 10.31662/jmaj.2025-0174. Epub 2025 Nov 21.

ABSTRACT

INTRODUCTION: Near-infrared photoimmunotherapy (NIR-PIT) has emerged as a promising treatment for unresectable locally advanced or recurrent head and neck cancer. This study aimed to identify potential predictors of NIR-PIT efficacy before treatment by focusing on blood biomarkers in addition to pathological findings, including epidermal growth factor receptor (EGFR) expression in tumors.

METHODS: A retrospective analysis of the medical records of 10 patients with head and neck cancer, who exhibited confirmed EGFR expression and underwent NIR-PIT treatment at Akita University Hospital from December 2021 to April 2024, was conducted (13 cycles of NIR-PIT). EGFR expression, cluster of differentiation (CD)4/CD8 ratio, regulatory T cell (Treg) frequency, serum albumin, neutrophil-to-lymphocyte ratio (NLR), and neutrophil-to-eosinophil ratio (NER) were calculated from the tumor tissue and blood collected immediately before treatment. Correlations of these factors with tumor response to NIR-PIT were determined.

RESULTS: The objective response rate (ORR) was 61.5% and the disease control rate (DCR) was 100%. A statistically significant association was observed between the EGFR index and tumor response. No statistically significant correlation was found between other biomarkers (CD4/CD8 ratio, Treg frequency, serum albumin, NLR, NER) and tumor response.

CONCLUSIONS: These findings underscore the important role of EGFR expression in predicting the efficacy of NIR-PIT in the management of head and neck cancer, and highlight the significance of incorporating EGFR assessment in patient selection and optimized treatment strategies. Further studies are needed to elucidate the role that these other potential predictors, including tumor immune response markers, play in NIR-PIT outcomes.

PMID:41676833 | PMC:PMC12888994 | DOI:10.31662/jmaj.2025-0174

JMA J. 2026 Jan 15;9(1):1-9. doi: 10.31662/jmaj.2025-0167. Epub 2025 Nov 14.

ABSTRACT

Systemic sclerosis (SSc) is one of the systemic autoimmune diseases characterized by disease-specific autoantibodies and generalized fibrosis in connective tissues and internal organs, resulting from microvascular and immune dysfunctions, which lead to premature death in affected individuals. The etiology of SSc is complex and poorly understood; however, as with most autoimmune conditions, it is widely accepted that both environmental and genetic factors interact and contribute to disease development. Over the last decade, genome-wide association studies (GWAS) have identified multiple genetic markers associated with SSc, and a number of causal variants have also been fine-mapped using state-of-the-art statistical techniques. Furthermore, the latest East Asian GWAS identified novel risk variants that were not as strongly represented in Europeans as in East Asians, and also provided additional novel risk variants, highlighting the importance of enrolling a diverse population for the analysis of complex traits. The association of human leukocyte antigen regions has been clarified mainly in individuals of European descent, with the identification of clinical subtype-specific associations of certain alleles. The associations in East Asian SSc are currently being analyzed by our team. Recent advances in single-cell ribonucleic acid (RNA) sequence technology have enabled the identification of transcriptomic changes at the single-cell level in a cell type or tissue-specific manner, allowing for the identification of disease-relevant cells or transcriptomes. To date, multiple single-cell RNA sequence studies have been conducted, primarily focusing on cells and transcriptomes in peripheral blood, skin, or lung. Despite the remarkable advances in state-of-the-art technology for both genetics and transcriptomics, gene expression regulations, especially by enhancers, enriched for disease heritability and thus critical for SSc development, remain unresolved. Integrative analysis using multi-omics approaches, combined with deep phenotyping of study cohorts, is imperative to fully characterize the genetic component of this disease and to identify causal variants, which may lead to more targeted and effective treatment of SSc.

PMID:41676820 | PMC:PMC12889322 | DOI:10.31662/jmaj.2025-0167

JMA J. 2026 Jan 15;9(1):355-359. doi: 10.31662/jmaj.2024-0313. Epub 2025 Dec 26.

ABSTRACT

There is increasing awareness of the need to incorporate social determinants of health (SDH) into medical practice. However, the extent to which the reimbursement system addresses SDH remains unclear. This narrative policy review aimed to evaluate the Japanese medical reimbursement system to determine whether and to what degree it incorporates assessments and actions related to SDH, with a special focus on primary care settings. We also explored the potential impacts and challenges of these programs in addressing patients’ SDH issues. A team consisting of physicians experienced in clinics, hospitals, home care, social epidemiological research, and a community care nurse reviewed the current reimbursement system. They identified eight medical reimbursement programs for evaluation. Two programs directly included SDH elements (“Hospitalization and Discharge Support Fee” and “Guidance in Cooperation with Mental Health Care Fee”). The two programs were introduced in 2022. It was found that SDH assessments are often optional and need more clarity in their items; few programs offer SDH assessments in outpatient and home care settings, and there is no mandate for collaboration with community supporters. We found the Japanese reimbursement system has provisions for some programs involving SDH. However, significant challenges remain that require revision. This study offers insights and recommendations for addressing health disparities related to SDH in the future.

PMID:41676803 | PMC:PMC12889345 | DOI:10.31662/jmaj.2024-0313

JMA J. 2026 Jan 15;9(1):340-349. doi: 10.31662/jmaj.2025-0343. Epub 2026 Jan 14.

ABSTRACT

INTRODUCTION: Malnutrition is common and often goes unrecognized among hospitalized patients, particularly older adults. Early identification and individualized nutritional interventions are essential for improving outcomes. The Nutritional Risk Screening 2002 (NRS-2002) is a validated tool widely used in acute care settings, but its utility in dental and oral surgery remains underexplored. This study aimed to evaluate the clinical utility of NRS-2002 in patients admitted to the Department of Oral and Maxillofacial Surgery (OMFS) at a university-affiliated dental hospital in Japan, and to examine the relationship between nutritional risk and clinical factors such as age, body mass index (BMI), diagnosis, and length of hospital stay.

METHODS: A retrospective observational study was conducted on 548 patients (224 men, 324 women) hospitalized between August 2024 and March 2025. Nutritional screening was performed at admission using NRS-2002. Patients scoring ≥3 were classified as at nutritional risk and further assessed according to the Global Leadership Initiative on Malnutrition criteria.

RESULTS: The overall prevalence of nutritional risk, defined as NRS-2002 ≥3, was 1.6% (n = 9), which was insufficient for robust statistical analysis. Most patients identified as at nutritional risk were elderly women with low BMI and severe conditions, including medication-related osteonecrosis of the jaw and osteomyelitis. These patients experienced prolonged hospital stays and were more likely to require oral nutritional supplements. In contrast, the majority of inpatients were younger adults, accounting for the overall low prevalence of nutritional risk.

CONCLUSIONS: The NRS-2002 effectively identified older, underweight patients who underwent OMFS with severe conditions and longer hospital stays, despite the overall low prevalence of nutritional risk. Early nutritional screening with standardized tools such as NRS-2002 may help optimize perioperative management.

PMID:41676799 | PMC:PMC12889139 | DOI:10.31662/jmaj.2025-0343

JMA J. 2026 Jan 15;9(1):124-133. doi: 10.31662/jmaj.2025-0399. Epub 2025 Nov 21.

ABSTRACT

INTRODUCTION: Japan’s aging population and declining birthrate have intensified the need for foreign workers, with Vietnamese workers now forming the largest group among over 2 million foreign laborers. While statistical studies on their work situations and mental health are increasing, they offer limited direct insight into these workers’ lived experiences. This study aimed to capture their firsthand voices, focusing on differences by residency status.

METHODS: Open-ended responses from 100 Vietnamese workers in Japan, collected through a 2022 survey, were analyzed. Content analysis was used to categorize experiences into positive and negative aspects.

RESULTS: Positive experiences included job satisfaction, adequate salaries, safe environments, supportive colleagues, and personal growth, with workers particularly valuing learning opportunities and workplace relationships that fostered development. Negative experiences, which were more prevalent, encompassed demanding workloads, unfair treatment, inadequate pay, long hours, and insufficient rest. Cultural and language barriers also hindered workplace relationships. Technical Intern Trainees (TIT) more frequently reported dissatisfaction with wages and conditions, while Engineer/Specialist in Humanities/International Services (ESI) workers more often cited interpersonal challenges linked to cultural adaptation.

CONCLUSIONS: Vietnamese workers gain certain benefits from employment in Japan but frequently report dissatisfaction. TIT workers tend to face systemic issues, whereas ESI workers more often experience interpersonal challenges rooted in cultural differences. Addressing both types of challenges with consideration for the distinct situations of foreign workers may improve their mental health and well-being.

PMID:41676797 | PMC:PMC12889150 | DOI:10.31662/jmaj.2025-0399

JMA J. 2026 Jan 15;9(1):160-170. doi: 10.31662/jmaj.2025-0157. Epub 2025 Nov 21.

ABSTRACT

INTRODUCTION: The demand for genetic counseling is increasing in Japan owing to rapid advancements in genetic medicine and increased utilization of genetic testing. However, access to genetic counseling remains limited, particularly in rural areas, owing to a shortage of certified professionals. Online genetic counseling (OGC), a form of telemedicine, offers a potential solution to address these disparities. Although OGC is widely practiced in Western countries, its implementation and systemic evaluation in Japan remain limited. To our knowledge, this study represents the first attempt in Japan to systematically assess the effectiveness, challenges, and user satisfaction of OGC compared with in-person genetic counseling (IPGC) in the context of the Japanese health care system.

METHODS: This cross-sectional, single-center study involved 49 participants (15 OGC, 34 IPGC) who received genetic counseling at the NHO Tokyo Medical Center between July 2020 and January 2025. Participants completed anonymous questionnaires assessing demographic characteristics, satisfaction with counseling, and perceived advantages and disadvantages. Statistical analyses included Mann-Whitney U tests, chi-square tests, and Fisher’s exact tests. Free-text responses were analyzed using conventional content analysis and word cloud visualization.

RESULTS: Overall satisfaction was high in both groups, with all participants selecting “Strongly agree” or “Agree” regarding satisfaction. However, the IPGC group scored significantly higher in counselor introduction, responsiveness, and overall satisfaction. OGC participants had significantly longer travel times and were more likely to be in their 20s-30s. Key advantages of OGC included convenience and accessibility, whereas disadvantages included concerns about privacy and technical issues.

CONCLUSIONS: OGC has high potential to improve access to genetic services in Japan, particularly for individuals in remote areas. Despite high satisfaction, challenges such as communication limitations, privacy concerns, and lack of insurance coverage must be addressed. Policy reforms, improved infrastructure, and further large-scale studies are needed to support the widespread implementation of OGC in Japan.

PMID:41676789 | PMC:PMC12889013 | DOI:10.31662/jmaj.2025-0157

Hepatobiliary Surg Nutr. 2026 Feb 1;15(1):7. doi: 10.21037/hbsn-24-417. Epub 2025 Feb 11.

ABSTRACT

BACKGROUND: In the past decade, diabetes prevalence in China increased significantly, with many cases undiagnosed, particularly in rural areas. Despite the limitations of body mass index (BMI) in assessing visceral fat, obesity indices like waist circumference (WC) and waist-to-height ratio (WHtR) have shown stronger associations with the risk of type 2 diabetes mellitus (T2DM). Few cohort studies, especially in rural China, have examined the predictive power of these obesity indices and their changes on T2DM risk. We aimed to assess sex and age difference in the association between obesity, long-term waist circumference and weight changes with the risk of T2DM among rural Chinese adults.

METHODS: Population-based cohort study of 15,076 adult participants was conducted from 2006.08.11 to 2014.07.19 in rural Deqing, China. Participants were annually followed up for the occurrence of major chronic diseases and vital status through the Deqing electronic health records system from enrollment to December 31st, 2021. Cox proportional hazards model was used to estimate adjusted HR (aHR) and 95% confidence intervals (CIs) for the association of obesity indices and their long-term changes with incident T2DM.

RESULTS: A total of 1,888 cases of incident T2DM were found (incidence: 12.35/1,000 person-years) during the mean follow-up of 10.14±3.64 years. Baseline WC (aHR =1.37, 95% CI: 1.31, 1.43), WHtR (aHR =1.38, 95% CI: 1.32, 1.44), BMI (aHR =1.27, 95% CI: 1.21, 1.32), WHtHR (aHR =1.34, 95% CI: 1.25, 1.43) exhibited statistically significant associations with increased risk of T2DM. Per SD increment of WC and weight changes were associated with a 15% and 13% higher risk of incident T2DM, respectively. Stratification analysis revealed that abdominal obesity indices presented stronger associations among males and those under 60 years, while general obesity markers among females and the elderly.

CONCLUSIONS: Obesity, long-term WC and weight changes increase the risk of incident T2DM among rural adults of eastern China, with modification by sex and age.

PMID:41676777 | PMC:PMC12887344 | DOI:10.21037/hbsn-24-417

Hepatobiliary Surg Nutr. 2026 Feb 1;15(1):3. doi: 10.21037/hbsn-24-300. Epub 2024 Dec 17.

ABSTRACT

BACKGROUND: Highly urgent living donor liver transplantation (HU-LDLT) is vital for treating acute liver failure (ALF), acute-on-chronic liver failure (ACLF), and critically ill cirrhotic patients in life-threatening scenarios. The purpose of our study was to identify the characteristics of HU-LDLT patients, compare the outcomes of HU-LDLT patients with those of elective LDLT patients, and determine the risk factors that can influence the outcomes of HU-LDLT.

METHODS: We retrospectively analyzed Korean Network for Organ Sharing (KONOS) data for consecutive HU-LDLT patients between 2017 and 2021. For comparison with the HU-LDLT group, patients who received elective LDLT except HU-LDLT at Samsung Medical Center during the same period were analyzed as the control group.

RESULTS: The most common reasons for HU-LDLT were hepatic encephalopathy, a model for end-stage liver disease (MELD) score ≥35, and uncontrolled varix bleeding. Among the 419 HU-LDLT patients, 53 (12.6%) were pediatric. The cumulative 1-, 3-, and 5-year overall survival rates were 82.4%, 78.3%, and 74.8%, respectively, in the adult HU-LDLT group. The 1-year overall survival rate was 86.1% in the pediatric HU-LDLT group. The presence of chronic kidney disease, pre-transplant ventilator care, high pre-transplant MELD score, and re-transplantation were closely related to mortality in the adult group. Only hepatorenal syndrome (HRS) was a strong risk factor for graft failure in the adult group. The graft and overall survival in the adult HU-LDLT group were significantly lower than those in the control group.

CONCLUSIONS: High MELD scores, hepatic encephalopathy, and bleeding are the main reasons for HU-LDLT applications in Korea. Graft and overall survival curves in the HU-LDLT group are lower than in the elective LDLT group, but the HU-LDLT outcomes are considered acceptable.

PMID:41676776 | PMC:PMC12887345 | DOI:10.21037/hbsn-24-300

Hepatobiliary Surg Nutr. 2026 Feb 1;15(1):2. doi: 10.21037/hbsn-24-276. Epub 2024 Nov 19.

ABSTRACT

BACKGROUND: Postoperative pulmonary complications (PPCs) can impact patient recovery and long-term oncological outcomes after hepatectomy. This study aimed to define whether laparoscopic approach was associated with a reduced incidence of PPCs compared with open approach for patients undergoing hepatectomy for hepatocellular carcinoma (HCC).

METHODS: A multicenter, retrospective cohort study was conducted at 12 Chinese centers between January 2010 and December 2021. Patients underwent either laparoscopic hepatectomy (LH) or open hepatectomy (OH) for HCC. The primary outcome was the incidence of PPCs including symptomatic pleural effusion, respiratory insufficiency, acute respiratory distress syndrome (ARDS), pulmonary infection, and pulmonary embolism. Statistical analysis was performed using propensity score analysis with inverse probability of treatment-weighing (IPTW), multivariable logistic regression, and subgroup analysis to adjust for potential confounders and explore the robustness of the findings.

RESULTS: Among 4,694 patients, 766 (16.3%) patients underwent LH while 3,928 (83.7%) underwent OH for HCC. The overall incidence of PPCs was 10.9%. Among the entire cohort, the incidence of PPCs among patients who underwent LH was significantly lower than individuals who underwent OH (7.3% vs. 11.6%, P=0.001); IPTW analysis demonstrated similar findings (7.4% vs. 11.6%, P=0.01). On multivariable analysis, laparoscopic approach remained independently associated with a lower risk of PPCs [adjusted odds ratio (OR) 0.63, 95% confidence interval (CI): 0.42-0.92, P=0.02]. Subgroup analyses demonstrated similar results relative to different patient and tumor characteristics.

CONCLUSIONS: Laparoscopic approach was associated with improved postoperative pulmonary outcomes and a lower incidence of PPCs than open approach the following hepatectomy for HCC. These findings have potentially important implications in selecting optimal surgical management for HCC.

PMID:41676768 | PMC:PMC12887286 | DOI:10.21037/hbsn-24-276