ACP Japan Chapter communication server

June 18, 2020

Public Relations Committee 2019

PRC releases blog articles as Governor’s Newsletter and updates Facebook page of the ACP Japan Chapter.

Chair; Yasuo Oshima, Vice-chair: Masami Hara, Yuka Kitano

The Governor’s Newsletter

Since February 2018, the Newsletter has been now published as blog issues. (https://plaza.umin.ac.jp/~ACP/) We have issued 52 articles from May 2, 2019 to May 1, 2020. Total of 17,706 users visited the site and recorded 37,938 views of the articles in 2019 (calendar year). First quarter of 2020 (calendar year), we have lost site visits most likely due to the cancellation of planned chapter meeting.

The Facebook page

The Facebook page of the ACP Japan Chapter is designed to inform the latest articles from Annals of Internal Medicine, Internist Weekly, and other information from ACP and ACP Japan Chapter. PRC members posted 111 articles on ACP Japan Chapter Facebook page from May 2, 2019 to May 1, 2020.

In the clinic project

PRC and collaborating members translate “In the clinic” articles. Total of six Japanese-translated articles have been released in 1^st season. This year, we are going to release another set of translation.

June 18, 2020

Health and Public Policy Committee 2019

Chair: Yuhta Oyama, Vice-Chair: Hiroshi Ono

Our mission is to seek the best possible solutions to professionalism and ethical issues in healthcare and to share these information with the members of the ACP Japan Chapter.

Report: What We Have done

We planned “The Road to FACP – Why do we aim for it?” and held at the 2019 ACP Japan Chapter Annual Meeting.

Plan: Where we are going to go

1) Planned and going to have a workshop at the 2020 chapter meeting titled “The road to an FACP – Why do we aim for it? -“

2) Continue to develop a model to resolve common challenges on medical professionalism

3) Preparation of criteria for COI disclosure of roles at ACP Japan Chapter (ACP-JC) and COI disclosure at annual meeting of ACP-JC

4) Attempt to update the page of professionalism on the homepage of ACP-JC

5) Attempt to publish Choosing Wisely lists as the ACP-JC based on questionnaire of ACP-JC members

6) Examine and discuss “End of life care” that would more suitable for Japanese medical circumstances

7) Analyze the attitude of ACP headquarters towards COI and report it to the ACP-JC members

June 18, 2020

Scientific Program Committee 2019

Chair: Sugihiro Hamaguchi Vice-Chair: Shunpei Yoshino

1. REPORT（What we have done）

It is terribly regrettable to report that two major annual events, The ACP Japan Chapter Annual Meeting 2020 and The Joint session with Japanese society of Internal Medicine, were cancelled because of the enormous impact of corona virus disease 2019 pandemic not merely on our preparation procedures for the events but also all participants’ health and lifestyles changes.

The annual meeting 2020 was planned to be held on June 6 and 7, 2020 at Kyoto university and The Joint session with Japanese society of Internal Medicine was on April 11, 2020.

2. PLAN（What we are going to do）

We will prepare for the next annual meeting held in June 2021. Given the unclear situation of Covid-19 in 2021, we have to come up with a new and feasible style of academic meetings for the “post-corona” era. A meeting style should avoid 3 Cs (Closed spaces, Crowded places, Close-contact setting). A hybrid type of meeting using real and online meetings will be a promising candidate. The venue must be large enough for social distancing. Decontamination procedure is necessary in front of every room or venue. We would like to expect any ideas from all ACP Japan Chapter members what is the best meeting style for the post-corona era.

We are planning on the Primary Care Research connect (PCR connect) annual meeting 2020, integrated research network among ACP Japan Chapter, Japan Primary Care Association, and Society for Clinical Epidemiology for the enforcement of primary care related research outputs from Japan. It is planned to be held on December 12 and 13, 2020.

June 18, 2020

Local Nominations Committee 2019

Chair: Masao Nagayama Vice-Chairs: Toshihiko Hata, Takeshi Yanagawa

Report: What we have done

We selected the following ACP members to receive each award;

Volunteerism Award

Takaaki Ishiyama, MD, FACP (ACP Number 01307662)

Sakura Award of Excellence

There was not an applicable person this year.

ACP Japan Chapter Contribution Award (ACPJCCA)

Hiroshi Yoshida, MD, FACP (ACP Number 01283876)

Yuhta Oyama, MD, FACP (ACP Number 01288145)

Laureate Award

Keijiro Saku, MD, FACP (ACP Number 01075550)

Masaya Kino, MD, FACP (ACP Number 01166385)

We nominated an ACP member for the mastership;

MACP (Master of the ACP)

We nominated a candidate but undisclosed until officially

approved by the ACP

ACP Japan Chapter Academic Award (ACPJCAA)（new award）

Will be awarded to those ACP members or non-members who contributed to the ACP Japan Chapter through clinical medicine (every aspect of clinical research and practice) or basic medicine.

PLAN: Where we are going to go

– Started preparation of the nominating and supporting letters for the Mastership nominee.

– Started preparation to launch the new Awards by the ACP Japan Chapter based on the encouragement by the ACP which may include the following awards;

ACP Japan Chapter Young Leadership Award (ACPJCYLA)

ACP Japan Chapter Women Leadership Award (ACPJCWLA)

ACP Japan Chapter Senior Contribution Award (ACPJCSCA)

June 18, 2020

ACP Japan Chapter Student Committee 2019

Chair: Rika Terashima, Vice-Chair: Masahiro Kato

Our mission is to facilitate interest and interaction amongst ACP student members and, provide an educational experience, and contribute to the further success of ACP Japan Chapter (ACPJC).

1. REPORT- what we have done

We had originally planned a student session during the ACPJC Annual Meeting in Kyoto. However, due to the spread of COVID-19, the ACPJC Annual Meeting was cancelled and we did not present our student session. Here, we describe what we originally had planned.

Our session was titled “Clinical skills in English”, and we would act out a case, with a student posing as the patient, the doctor, and the rest as presenters. We would do history-taking and physical examination in English, and discuss differential diagnosis. The reason we chose this topic is because many students wanted to learn how to apply the clinical skills they learned in Japanese to English. We believed this would be educational to students who wish to study abroad in the future, and to students who wish to feel more confident communicating with patients from foreign countries. The session would be interactive involving both us, student committee presenters, and the audience. We invited several physicians who had experience practicing medicine in the U.S. to our session, so we may receive professional feedback. It is very disappointing that we were not able to present our final work, but the process of planning for this session, finding a case, and translating it to English/Japanese, proved to be educational. Through this preparation we, the student committee members, were able to get to know one another.

In an effort to present our work to the public, and recruit more people for the student committee, we have created an ACPJC student committee Facebook page. The ACPJC student committee is unfortunately not well-known amongst medical students and we wanted more people to recognize the student committee and what we do. Our Facebook page was modelled after the ACPJC Resident Fellow Committee Facebook page. In under 3 weeks, our Facebook page reached over 95 likes/follows.

ACPJC Student Committee Facebook page link: https://tinyurl.com/ya9lxkr9

2. PLAN- what we are going to do

We have just closed receiving applications for members for the next year (starting July), and we are currently in the selection process.

Hideta Teshirogi, 5^th year medical student, will be the new chair for the student committee next year.

Over the next year, we plan to prepare a student session for the next ACPJC Annual Meeting and continue promoting the student committee’s activities on our Facebook page.

May 23, 2020

Governor’s Message

Dear ACP members and friends,

I hope you and your families are safe and well.

As covid-19 spreads around the world including this country, I believe all of you, more or less, have involved in the fight against the virus. Thank you for everything for you’re doing on a daily basis to support one another and your patients.

Normally, in this timing of newsletter, I would tell about the success of the recent ACP meeting, the Internal Medicine Meeting 2020, but as you may have already known, it was unfortunately cancelled.

We too had to cancel all the schedule concerning our chapter meeting in June due to this crisis, although now it seems that the first wave of the awful pandemic is passing…

As for the information concerning the pandemic, ACP is compiling first-hand accounts and relevant resources from the internal medicine community during these challenging times, helping you stay informed with the latest articles. You can find the resources on the ACP website. “COVID-19: An ACP Physician’s Guide” is available at the top page. (If it’s not available, access the Clinical Information bar at the top.) It is a great resource provided by ACP!

I look forward to reuniting as a chapter. Until then, stay safe and well.

Sincerely,

Kenji Maeda, MD, FACP

May 13, 2020

Annals of Internal Medicine のORIGINAL RESEARCH |31 DECEMBER 2019 からの紹介

Annals of Internal Medicine のORIGINAL RESEARCH |31 DECEMBER 2019　からの紹介です。

Disease-Modifying Effects of a Novel Cathepsin K Inhibitor in Osteoarthritis: A Randomized, Placebo-Controlled Study

https://annals.org/…/disease-modifying-effects-novel-cathep…

新規カテプシンK阻害薬の変形性関節症に対する疾患修飾効果：プラセボ対照ランダム化比較試験

背景：MIV-711は新規選択的カテプシンK阻害薬であり、変形性関節症モデルの前臨床試験において、骨と軟骨に有益な効果を示している。

目的：膝関節の症状およびレントゲン検査上所見を有する変形性関節症を罹患する被験者において、MIV-711の効果、安全性および忍容性を評価する事。

デザイン：26週間ランダム化二重盲検プラセボ対照試験のフェーズ2a試験とこれに引き続き26週間の安全性に対するオープンラベルサブ試験。

セッティング：ヨーロッパの6地域

被験者：Kellgren–Lawrence grade 2 あるいは 3　および　疼痛数値評価スケールで4から10スコアを有する初期の変形性膝関節症244人。

介入：MIV-711 100mg投与82人、200mg投与81人、対照プラセボ投与77人。200mg投与の46人とプラセボ投与の4人の被験者は、その後、拡大サブ試験（MIV-711：200mg毎日投与）に進んだ。

計測：主要評価項目は、疼痛数値評価スケールの変化であった。重要な二次評価項目は、MRI検査の骨域変化であった。その他の2次評価項目には、定量的MRIでの軟骨層厚とバイオマーカーのtype I および II collagen C-telopeptideが含まれていた。

結果：疼痛数値評価スケールは、統計学的に有意な変化が見られなかった。(placebo, −1.4; MIV-711, 100 mg/d, −1.7; MIV-711, 200 mg/d, −1.5)　MIV-711は、大腿骨の骨密度平均の低下を著明に抑制　(P = 0.002 for 100 mg/d and 0.004 for 200 mg/d)、大腿骨平均軟骨層の菲薄化を抑制　(P = 0.023 for 100 mg/d and 0.125 for 200 mg/d)、著明にバイオマーカー値も抑制した。6人の被験者に9件の重篤な副反応があった。1人はプラセボ群、3人は100mg投与群、2人は200mg投与群であったが、いずれも治療に関連しないものと考えられた。

限界：比較的短期間の試験であった。

結論：MIV-711は疼痛に対しては、プラセボに較べ有効ではなかった。しかし、高い安全性の側面を有しながら、骨と軟骨の病態進行を有意に抑制した。この治療は、変形性関節症の疾患修飾薬として、さらなる評価に値する可能性がある。

主たる資金源：Medivir社

＃変形性関節症＃カテプシンK阻害薬
PRC 平野昌也

May 13, 2020May 13, 2020

Annals of Internal Medicine5月5日号よりOriginal Researchを紹介

Annals of Internal Medicine5月5日号よりOriginal Researchを紹介します。

潜在性甲状腺機能低下症と甲状腺機能低下症状のある高齢者に対するL-チロキシン治療：無作為化試験の二次解析
L-Thyroxine Therapy for Older Adults With Subclinical Hypothyroidism and Hypothyroid Symptoms: Secondary Analysis of a Randomized Trial

https://annals.org/…/l-thyroxine-therapy-older-adults-subcl…

背景
L-チロキシン服用では潜在性甲状腺機能低下症（SCH）の成人患者の甲状腺機能低下症状は改善されない。しかし、治療前に症状による負担が大きい患者にはある程度有効だろう。

目的
SCHで症状による負担が大きい高齢者ではL-チロキシンによって甲状腺機能低下症状と疲労感が改善されるかを検討すること

研究デザイン
無作為化プラセボ比較試験TRUST（潜在性甲状腺機能低下症の未治療高齢患者での甲状腺ホルモン補充治療試験）の二次解析(ClinicalTrials.gov: NCT01660126)

セッティング
スイス、アイルランド、オランダ、スコットランド

被験者
持続性SCH(甲状腺刺激ホルモンTSH値4.60－19.9mIU/Lが3か月以上で持続し、遊離チロキシンFT4が正常値)で完全な転帰データのある65歳以上の患者638人

介入
L-チロキシンまたは偽装の用量調節でマッチングしたプラセボ服用

測定
症状による負担が大きい患者群（研究開始時での甲状腺機能低下症状スコア＞30または疲労感スコア＞40）と症状による負担が小さい患者群で、甲状腺関連QOL患者申告転帰問診票（Thyroid-Related Quality-of-Life Patient-Reported Outcome Questionnaire）の甲状腺機能低下症状スコアと倦怠感スコア（Hypothyroid Symptoms and Tiredness scores）（範囲、0－100；スコア高値であるほど症状が多いことが示唆される）の1年後の変化をL-チロキシン服用群とプラセボ服用群で比較した。

結果
132人の被験者が甲状腺機能低下症状スコア＞30、133人が疲労感スコア＞40であった。症状による負担が大きいループでは1年後の甲状腺機能低下症状スコアの改善はL-チロキシン服用群患者群（平均群内変化、－12.3［95% CI, －16.6~－8.0］）とプラセボ服用者群(平均群内変化.－10.4［CI,－15.3~－5.4］)で同程度であった。；調整後群間差は－2.0（CI,－5.5~1.5；P=0.27）であった。倦怠感スコアの改善もL-チロキシン服用群（平均群内変化、－8.9［CI, －14.5~－3.3］）とプラセボ服用群（平均群内変化、－10.9［CI, －16.0~－5.8］）で同程度であった。；調整後群間差は0.0(CI,－4.1~4.0；P=0.99)であった。研究開始時での甲状腺機能低下症状スコアや倦怠感スコアにはL-チロキシンとプラセボの投与の比較で効果が確認できなかった（P for interaction は甲状腺機能低下症状スコアで0.20、倦怠感スコアで0.82）。

研究の限界
Post hoc 解析であること、サンプルサイズが小さいこと、1年間の転帰データの患者だけの検討であること

結論
研究開始時にSCHで症状による負担が大きい高齢者では、プラセボと比較してL-チロキシンによって甲状腺機能低下症状や倦怠感は改善されなかった。

主要資金提供
　ヨーロッパ連合FP7

PRC委員　川田秀一

May 13, 2020May 13, 2020

Internist Weekly 5月5日よりMKSAP Quizを紹介

Internist Weekly 5月5日よりMKSAP Quizを紹介します。

MKSAP Quiz: Prenatal evaluation and sickle cell disease

出産前評価と鎌状赤血球症

22歳の女性が出産前の定期診察のため受診している。；患者は妊娠10週である。今回が2回目の妊娠である。；1回目の妊娠では合併症はなかった。特記すべき病歴としては鎌状赤血球症があり、疼痛を伴う発作のために年間1－2回入院が必要である。患者は脳卒中や急性胸部症候群の病歴はない。唯一の服薬は葉酸サプリメントである。

診察所見ではバイタルサインは正常である。心臓診察では2/6度の収縮期雑音が聴取される。患者は子宮妊娠である。

血液検査ではヘモグロビン値6.4g/dL(64 g/L；妊娠前で5－7g/dL),白血球数11,500 /µL(11.5 ×109/L)、血小板数279,000/µL(279 ×109/L)であった。

最も適切な治療は次のうちのどれか？

A.クロピドグレル
B.妊娠中の交換輸血(exchange transfusion)
C.ヒドロキシウレア（本邦ではヒドロキシカルバミドとして承認）
D.妊娠中の単純輸血（simple tansfusion）
E.待機的（waiting）観察

正解と解説は下記をご覧ください。
http://acpinternist.org/weekly/archives/2020/05/05/3.htm

＃鎌状赤血球症

PRC委員　川田秀一

May 13, 2020May 13, 2020

4月28日付のInternist Weekly よりMKSAP Quizのご紹介

4月28日付のInternist Weekly よりMKSAP Quizのご紹介です。
ACP Internist Weekly / Test yourself / April 28, 2020
MKSAP Quiz / Validity of a study

MKSAP Quiz: 研究の妥当性　
　定期的な健康診断の際に、記憶喪失のリスクによりスタチン療法を避けることを推奨する記事について、患者から尋ねられています。調査結果は、十分に検証された国民健康調査の横断的データ分析に基づいており、居住地の郵便番号で患者を無作為に抽出し行われました。この分析では、記憶喪失を自己申告した患者は、スタチン薬の服用も報告する可能性が高かった（オッズ比1.8、95％CI 1.2〜2.7、P＝0.046）。

この研究の妥当性に対する最も可能性の高い脅威は、次のうちどれですか？
A. 交絡
B. 選択バイアス
C. 自己申告データ
D. 統計的有意性

正解と解説は，下記のリンクからご覧ください。
http://acpinternist.org/weekly/archives/2020/04/28/3.htm
＃ Cross-sectional study　
＃ Confounding

PRC委員　白石龍人