Coordinates: 35°37′52.52″N 139°43′32.75″E / 35.6312556°N 139.7257639°E / 35.6312556; 139.7257639NTT Medical Center Tokyo (NTT東日本関東病院) is a general hospital located in the Gotanda district of Shinagawa, Tokyo, Japan. It was founded as Kanto Teishin Hospital for employees of NTT Public Corporation in 1952, and was opened to general public in 1986. The present hospital building was renovated in 2000. It was accredited by Joint Commission International in 2011..
BACKGROUND:"Sacred moments" refer to times when people experience deep mutual connection, accompanied by spiritual emotions. Previous North American studies reveal that such moments can predict overall well-being for patients and clinicians. However, sacred moments have not been studied in Japanese healthcare, where the cultural background differs substantially from previous studies. OBJECTIVE:To examine sacred moments among patients and clinicians in Japan. DESIGN:An exploratory qualitative study featuring two facilities: a Tokyo community hospital and a national university hospital in Western Honshu. PARTICIPANTS:Hospital-based clinicians and patients. APPROACH:Semi-structured interviews with 30 participants from January to March 2024. Interviews were audio recorded and transcribed verbatim, and thematic analysis was performed. KEY RESULTS:Most participants-22 of 26 clinicians (84.6%) and 3 of 4 patients (75.0%)-reported having experienced sacred moments during healthcare visits once the concept had been explained, as most initially expressed unfamiliarity with the term "sacred moments" in either Japanese or English. Twenty of 26 clinicians (76.9%) and 2 of 4 patients (50.0%) highlighted the importance of taking time to build rapport and trust for sacred moments to occur. Twenty-three of 26 clinicians (88.5%) and all 4 patients (100.0%) believed that fostering the mind and spirit was beneficial, while 4 of 26 clinicians (15.4%) and 1 of 4 patients (25.0%) expressed negative views toward religion and spirituality. Qualitative findings were divided into three domains: (1) common elements that characterize sacred moments; (2) discomfort or resistance to religion; (3) elements necessary to foster sacred moments. CONCLUSIONS:Our exploratory study highlights the important concept of sacred moments in Japan. The high prevalence of reported sacred moments after the concept had been explained underscores the need for a conceptual translation into the Japanese cultural space. Alternative terms may resonate more naturally within non-Western cultural contexts, such as emphases on deep connection and fate.
Objective Endovascular coiling (EC) for unruptured intracranial aneurysms (UIAs) aims to safely prevent rupture while preserving cortical functions. However, newly developed silent embolic lesions are frequently captured on postprocedural diffusion-weighted imaging (DWI). This study evaluated how these subclinical lesions influence subsequent longitudinal neurocognitive trajectories using comprehensive psychometric batteries. Methods We retrospectively analyzed 26 consecutive patients who underwent EC for UIAs and completed detailed neurocognitive assessments both preoperatively and 6 months postoperatively. Neuroimaging was conducted using a 3-Tesla system, with DWI strictly obtained both on the immediate preprocedural day and on postoperative day 1 to count newly developed microlesions. Neuropsychological trajectories were evaluated via the WAIS-III and WMS-R batteries. Patients were stratified into the Low-Load (0 to 9 lesions, n = 16) and the High-Load (10 or more lesions, n = 10) groups. Results Cross-sectional inter-group comparisons revealed no statistically significant differences between the two cohorts. However, a critical disparity was unveiled during longitudinal intra-group analyses from baseline to 6 months. The Low-Load group demonstrated significant improvements across multiple cognitive domains, capturing score elevations in the PIQ ( p = 0.0004), composite memory ( p = 0.046), and average scores ( p = 0.013). In contrast, these longitudinal improvements were abolished in the High-Load group (PIQ, p = 0.477; memory, p = 0.315; average, p = 0.131). Conclusion While EC achieves excellent overall safety, a postprocedural DWI lesion count ≥ 10 is significantly associated with suboptimal neurocognitive recovery, counteracting the expected longitudinal practice effect. Neurointerventionalists should maintain strict embolic protection to ensure subclinical cognitive safety.
Abstract Background Whether asymptomatic hyperuricemia should trigger pharmacologic intervention in maintenance hemodialysis remains unresolved. This question differs fundamentally from hyperuricemia management in the general population or in nondialysis chronic kidney disease because hemodialysis itself substantially alters urate kinetics, lowers serum urate during each session, and may contract the effective urate burden. In routine dialysis practice, predialysis serum urate values are frequently available and may prompt therapeutic uncertainty even when gout symptoms are absent. We reviewed the recent literature to clarify whether serum urate alone should prompt urate-lowering therapy in hemodialysis patients and to identify which patients may require individualized reassessment because of persistent gout burden. Main body Current evidence does not support a dialysis-specific serum urate threshold that justifies routine pharmacologic treatment of asymptomatic hyperuricemia. Hemodialysis markedly reduces circulating urate, and emerging work suggests that urate burden in hemodialysis may be better interpreted in the context of urate pool and extra-renal urate handling rather than serum urate concentration alone. In parallel, observational studies in hemodialysis have repeatedly shown that lower as well as higher serum urate levels are associated with worse survival, with low urate often linked to malnutrition, frailty, and inflammatory burden. These observations do not prove that low urate itself is harmful, but they caution against assuming that pharmacologic urate lowering is automatically beneficial in patients undergoing hemodialysis. Although cohort studies suggest possible associations between xanthine oxidoreductase inhibitor use and improved mortality or cardiovascular outcomes, these findings remain observational and do not establish a causal benefit in asymptomatic patients. Furthermore, urate-lowering therapy is not harmless: treatment initiation can precipitate gout flares, and flare prophylaxis is particularly challenging in dialysis because colchicine requires conservative use and close toxicity monitoring in severe kidney failure, particularly in the setting of interacting drugs. Drug-specific risks also remain relevant for allopurinol and febuxostat. Conclusions In maintenance hemodialysis, asymptomatic hyperuricemia should not automatically trigger pharmacologic intervention. In the absence of persistent gout burden, a cautious approach is more appropriate than routine serum urate-driven treatment. Treatment decisions should therefore be guided by persistent gout burden rather than by serum urate elevation alone.
