[Hokkaido igaku zasshi] The Hokkaido journal of medical science

The Hokkaido Medical Society is a group of doctors and medical researchers in Hokkaido. Its purpose is to contribute to medicine and to the improvement of medical treatment. This symposium was carried out in order to inform citizens about the condition known as sudden death. We hypothesize that the incidence of sudden death tends to increase in line with the incidence of metabolic syndrome. Approximately four hundred patients were transported to our hospital by ambulance in a state of cardiopulmonary arrest (CPA) last year. The number of CPA patients who are treated in our hospital has increased in comparison to the previous decade. The theme of this year is "The clinical condition and treatment of diseases associated with sudden death" in view of the above mentioned situation. In 2015, it was reported that sudden death occurred in an American pilot and that the co-pilot was forced to make an emergency landing. Interestingly, sudden death can ever sometimes occur in pilots who undergo regular physical examinations. Numerous diseases and conditions are associated with sudden death, including: acute myocardial infarction, irregular pulse, cardiac insufficiency, cerebrovascular disease, aortic dissection and choking. We are of the opinion that the frequency of sudden death is very high in the fields of emergency medicine, cardiovascular medicine, cardiovascular surgery and neurosurgery. In this symposium, we presented and explained the condition that is known as sudden death and the current state of treatment of sudden death in emergency medicine, cardiovascular medicine, cardiovascular surgery and neurosurgery departments of the Hokkaido University Graduate School of Medicine in October, 2015. We hope that the symposium will help the citizen audience to understand the condition and treatment of sudden death, and also to help prevent sudden death.

INTRODUCTION Neovascularization consists of angiogenesis and vasculogenesis during which bone marrow-derived endothelial progenitor cells (EPCs) are mobilized for blood vessel formation. Pigment epithelium-derived factor (PEDF) is known to be a potent inhibitor of angiogenesis in some solid carcinomas. However, the effects of PEDF on human esophageal squamous cell carcinoma (ESCC) and vasculogenesis are still unknown. The purpose of this research was to investigate the effect of PEDF on angiogenesis, tumor growth, and vasculogenesis in ESCC. MATERIALS AND METHODS The PEDF gene was transduced to the TE8 ESCC cell line not secreting endogenous PEDF and the HEC 46 cell line originally secreting endogenous PEDF by lentivirus-based vectors expressing PEDF. In vitro endothelial cell proliferation and migration assays were performed using the supernatant derived from PEDF-overexpressing cells. In in vivo experiments, the effects of PEDF on chronological tumor growth, intratumoral microvessel density (MVD), tumor cell apoptosis, and the frequency of EPCs in peripheral blood and tumor tissues were examined in murine subcutaneous tumor models. RESULTS PEDF inhibited endothelial cell proliferation and migration in vitro and showed potent in vivo antitumor properties by inhibiting MVD in the human ESCC cell line that did not secrete endogenous PEDF. However, in the cell line secreting endogenous PEDF, additional PEDF gene transfer showed no inhibition of angiogenesis and no subsequent antitumor properties. With respect to vasculogenesis, PEDF was found to have potential to suppress vasculogenesis; the frequency of EPCs both in peripheral blood and tumor tissue was decreased in mice implanted with PEDF-overexpressing TE8 and HEC46 cells. CONCLUSION PEDF may have potent antiangiogenic and antitumor effects in ESCC cells naturally not secreting endogenous PEDF and can be expected to be applied as gene therapy in the future.

The introduction of robotic surgical system is one of the most exciting topic in the field of the surgery. In this symposium, we presented and explained the present condition of robotic-assisted laparoscopic surgeries performed in the department of Urology, Gastroenterology and Gynecology of the Hokkaido University Hospital. By using this surgical system, laparoscopic surgery, which is generally considered to be difficult, can be safely performed by surgeons. Especially in radical prostatectomy against localized prostate cancer, this surgical approach brought the decrease in peri- and postoperative problems including blood loss and postoperative urinary incontinence in comparison with open or laparoscopic radical prostatectomy. We wish that this symposium would help the audience to understand the present condition and new vista of the future in robotic-assisted laparoscopic surgeries.

This is a study of 4 patients implemented to Advance Care Planning (ACP) reflecting on the health care professionals' role and the outcomes. ACP has been defined as a process of formal decision making that aims to help patients establish their decision about future care that take effect when they lose capacity. For about two years, we tried to engage all patients who were referred to our palliative care team and their families to ACP since their first consultation. We informed their conditions at that time, how their health might change and how treatment might impact on their life goals. We also attempted to help patients' decision making and then fulfill their wishes in cooperation with patients' families and healthcare professionals. We learned three important elements: understanding patients' values and wishes, explaining prediction of the clinical course of the patients and establishing a collaborative healthcare team in order to fulfill the patients' hopes. ACP improved quality of life (QOL) not only for the patients involved, but also for the family members. ACP can play a crucial role in ensuring that patients receive the care they want throughout various stages of their lives.

In the past, we made several efforts making curriculum changes to Medical English Practice, however, these changes did not improve motivation effectively. We have completely modified the curriculum in 2012, and performed a questionnaire survey to 112 sophomore medical students. In the final exam, students answered a questionnaire assessing all classes of the course by scoring 3 points (no change required), 2 points (minor change required), and 1 point (major change required or discontinue). In addition, students could write free comments about potential contents they would like to add to the curriculum. Each class was assessed as more than or equal to 2.5 points on average (range: 2.50-2.96). Potential contents students want to add are: 1. Speaking (45 students [55%]), 2. Listening (30 students [37%]), 3. Reading (6 students [7%]), 4. Writing (1 student [1%]). The most frequent suggestion was to include group discussions in speaking (27 students [33%]), followed by listening on topics of healthcare systems (11 students [13%]). Many students suggested to include conversation classes in small groups, or classes in which international students introduce the structure of healthcare systems of their home countries to the curriculum. Increasing the participation of international faculty, staff and students in the Medical English Practice might contribute to the improvement of medical students' motivation.

Cancer is the most major cause of death in Japan recently. In this symposium, we explained advanced treatment technology for cancer treatment, now used and that will be used in near future at the Hokkaido University Hospital. Intensity Moderated Radiation Therapy (IMRT) and Proton Beam Therapy (PBT) are considered to be the most promising and advanced technologies for cancer treatment. Various kinds of radiation treatment equipment and methods have been developed and constructed at the Hokkaido University. One of the most worlds wide famous one is the real time tumor tracking radiotherapy system. The FIRST (Funding for World-Leading Innovative R&D on Science and Technology) Program has been supporting us to produce cutting-edge technology. We hope that this symposium would help the audience to understand the latest technology for cancer treatment especially in the field of radiation therapy and also we wish the audience would recognize the importance of the research aspect that have been performed at Hokkaido University and its Hospital.

INTRODUCTION:Nephron-sparing surgery (NSS) has become the standard treatment for small renal cell carcinoma because of its comparable oncological outcome and superior patient survival compared to total nephrectomy. However, the precise chronological course of recovery from initial kidney damage and the factors responsible for it remain unknown.MATERIALS AND METHODS:Seventy-one patients who underwent NSS were enrolled. To elucidate the chronological changes in kidney function that occur after NSS, the estimated glomerular filtration rate (eGFR) was calculated at different two points, the early (7 days after surgery) and late time points (more than 12 months after surgery), and compared with the preoperative eGFR. Perioperative factors were applied to a multivariate regression model to investigate the factors that most affect patient recovery from nephron damage.RESULTS:eGFR was decreased at the early time point but had partially recovered at the late time point. Male gender, ischemic time, and tumor size were found to be significant predictors of the initial drop in eGFR. The only significant factor that prevented later functional recovery was the presence of DM.CONCLUSION:Several perioperative factors significantly influence early kidney damage; however, the presence of DM is the only factor affecting the risk of long-term chronic kidney damage.