Atypical Adult-Onset IgA Vasculitis With Extremely Rare Complications Including Diffuse Alveolar Hemorrhage, Heart Failure, and Stroke.

IgA vasculitis (IgAV) generally occurs in young people and presents with a tetrad of symptoms: purpura, abdominal pain, arthralgia, and nephritis. However, it may have an atypical course without the typical tetrad. Diffuse alveolar hemorrhage (DAH), heart failure, and stroke are known complications of IgAV but are all very rare.

Treatment of Crohn's Disease With Infliximab and Subsequent Development of Takayasu's Arteritis.

A 23-year-old man was diagnosed with Crohn's disease (CD) of the large intestine after colonoscopy revealed longitudinal ulcers, and pathology revealed non-caseating epithelioid cell granulomas and anal fistulas. The CD relapsed, and therefore prednisolone (PSL) and infliximab (IFX) treatment was initiated. The PSL was gradually tapered.

Microwave ablation single-needle radiofrequency ablation for the treatment of HCC up to 4 cm: A randomized-controlled trial.

Background & Aims: Radiofrequency ablation (RFA) is the standard treatment for small hepatocellular carcinoma (HCC), specifically for tumors <3 cm in size and numbering fewer than three, excluding surgical candidates. Microwave ablation (MWA) is an innovative approach believed to have theoretical benefits over RFA; however, these advantages are yet to be empirically verified. Therefore, we evaluated and compared the effectiveness of MWA and RFA in managing HCC tumors up to 4 cm in size.

Corticosteroid therapy and long-term outcomes in patients with cardiac sarcoidosis stratified by left ventricular ejection fraction.

Aims: This study aimed to investigate the relationship between corticosteroid therapy and long-term outcomes in patients with cardiac sarcoidosis, stratified by left ventricular ejection fraction (LVEF) at diagnosis.

Methods And Results: This study conducted a analysis of the ILLUstration of the Management and prognosIs of JapaNese PATiEnts with Cardiac Sarcoidosis, a retrospective multicentre registry. Cardiac sarcoidosis was diagnosed based on the 2016 Japanese Circulation Society and 2014 Heart Rhythm Society criteria.

Surgical and patient-reported outcomes of staged urethroplasty for anterior urethral strictures: A comprehensive analysis.

Objectives: To evaluate the efficacy of staged urethroplasty for complex anterior urethral strictures from both surgical and patient-reported outcome perspectives.

Methods: This retrospective study included 100 patients who underwent staged urethroplasty for anterior urethral strictures between May 2011 and June 2023. Anatomical success was defined as the ability to pass cystourethroscopy without resistance and the patient's ability to void without additional interventions.

Surgical outcomes of artificial urinary sphincter implantation in patients with a history of urethroplasty: A retrospective analysis.

Objectives: Limited data exist on surgical outcomes following artificial urinary sphincter (AUS) implantation in patients with a history of urethroplasty for urethral stricture. This study aimed to evaluate the surgical outcomes of AUS implantation in such patients, focusing on the risk of urethral erosion.

Methods: We retrospectively reviewed 14 male patients who developed severe urinary incontinence following urethroplasty for urethral stricture and subsequently underwent AUS implantation at our center between March 2012 and January 2024.

The association between dual sensory impairment and dementia: A systematic review and meta-analysis.

Background: Sensory impairments have been linked to dementia. However, the impact of dual sensory impairment (DSI), combining both vision impairment and hearing impairment, on dementia has shown inconsistent results.

Objective: To systematically review the evidence on the association DSI and dementia.

Effectiveness of Y-V-plasty for refractory bladder neck stenosis after transurethral prostate surgery.

Objectives: To evaluate the surgical and patient-reported outcomes of YV-plasty in patients with refractory bladder neck stenosis (BNS) following transurethral prostate surgery.

Methods: This retrospective study reviewed five patients who underwent YV-plasty for BNS between January 2021 and October 2023. The surgical procedure involved a midline lower abdominal incision to expose the bladder neck.

Optimal outpatient training for resident physicians' general medicine in-training examination score: a cross-sectional study.

Background: Outpatient training for resident physicians has been attracting attention in recent years. However, to our knowledge, there have only been a few surveys on outpatient training, particularly in Japan. This study evaluates outpatient care among Japanese resident physicians by determining how the volume of outpatient encounters and length of outpatient training correlate with residents' clinical competence.

A Native LH1-RC-HiPIP Supercomplex from an Extremophilic Phototroph.

Halorhodospira (Hlr.) halophila strain BN9622 is an extremely halophilic and alkaliphilic purple phototrophic bacterium and has been widely used as a model for exploring the osmoadaptive and photosynthetic strategies employed by phototrophic extreme halophiles that enable them to thrive in hypersaline environments. Here we present the cryo-EM structures of (1) a unique native Hlr.

Anatomical Characterization of the Motor Branch to the Fourth Lumbrical: A Cadaver Study.

Purpose: The branching pattern of the deep motor branch of the ulnar nerve (DBUN) in the hand is complex. The anatomy of the motor branch innervating the fourth lumbrical (4L), where paralysis results in a claw hand deformity after ulnar nerve injury, is not well defined. This cadaver study focused on mapping and defining anatomical landmarks in relation to the motor branch to the 4L.

Effectiveness for remission maintenance rate and safety of different rituximab regimens for treating anti-neutrophil cytoplasmic antibody-associated vasculitis in Japan: a J-CANVAS study.

Rituximab (RTX) has been reported to effectively maintain remission in anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). In this multicenter study involving 57 patients who achieved remission after 24 weeks, we evaluated the effectiveness of RTX in maintaining remission in patients with AAV. Patients were divided into three groups based on RTX administration: continuous, induction phase-only, and maintenance phase-only groups.

The Three-Class Annotation Method Improves the AI Detection of Early-Stage Osteosarcoma on Plain Radiographs: A Novel Approach for Rare Cancer Diagnosis.

: Developing high-performance artificial intelligence (AI) models for rare diseases is challenging owing to limited data availability. This study aimed to evaluate whether a novel three-class annotation method for preparing training data could enhance AI model performance in detecting osteosarcoma on plain radiographs compared to conventional single-class annotation. : We developed two annotation methods for the same dataset of 468 osteosarcoma X-rays and 378 normal radiographs: a conventional single-class annotation (1C model) and a novel three-class annotation method (3C model) that separately labeled intramedullary, cortical, and extramedullary tumor components.

Association Between Gastrointestinal-Related Quality of Life and Frailty Using Baseline Data of the Prospective Cohort Study (JUSTICE-TOKYO Study).

To determine the prevalence of frailty and examine its association with gastrointestinal-related quality of life (QOL) among older outpatients in a geriatric hospital. This cross-sectional study involved 1042 outpatients (age: ≥65 years) diagnosed using the revised Japanese version of the cardiovascular health study criteria. Data collection was performed by a multidisciplinary team.

Alpha-synuclein inhibits the secretion of extracellular vesicles through disruptions in YKT6 lipidation.

Parkinson's disease is characterized by the presence of α-synuclein (α-syn) primarily containing Lewy bodies in neurons. Despite decades of extensive research on α-syn accumulation, its molecular mechanisms have remained largely unexplored. Recent studies by us and others have suggested that extracellular vesicles (EVs), especially exosomes, can mediate the release of α-syn from cells, and inhibiting this pathway could result in increased intracellular α-syn levels.

Quadrant, necrosis, and infection criteria for the risk stratification of walled-off necrosis: external validation using multi-institutional data.

Background And Aims: Endoscopic ultrasound-guided peripancreatic fluid drainage (EUS-PFD) with on-demand endoscopic necrosectomy, increasingly utilized to manage walled-off necrosis (WON), is associated with substantial morbidity and mortality. This multicenter study aimed to externally validate recently developed quadrant (an abdominal quadrant distribution), necrosis, and infection (QNI) criteria for risk stratification in this setting.

Methods: Of 423 patients with pancreatic fluid collections treated in a large multi-institutional cohort between 2010 and 2020, 212 with available preprocedural computed tomography images were included.

Clinical practice guidelines for management of disseminated intravascular coagulation in Japan 2024. Part 3: solid cancers and vascular abnormalities.

This study discusses disseminated intravascular coagulation (DIC) associated with solid cancers and various vascular abnormalities, both of which generally exhibit chronic DIC patterns. Solid cancers are among the most significant underlying diseases that induce DIC. However, the severity, bleeding tendency, and progression of DIC vary considerably depending on the type and stage of the cancer, making generalization difficult.

Autologous Rib Grafts for Sternal Reconstruction After Excision of a Chondrosarcoma.

Sternal chondrosarcoma is a rare malignant condition. Although surgical resection is crucial, the reconstruction of sternal defects is challenging. A 64-year-old male patient with a history of 2 separate sternal tumor resections received a diagnosis of sternal chondrosarcoma recurrence.

Robotic Portal Segmentectomy in the Right Middle Lobe After Right Upper Lobectomy.

Although segmentectomy is the standard surgical procedure for small-sized peripheral non-small cell lung cancer, reports on segmentectomy for right middle robe are rare because of the anatomical feature. We report a case of an 81-year-old woman with a history of left S4 segmentectomy, left basal segmentectomy, and right upper lobectomy for multiple primary lung cancer with a part solid nodule in S4a. Owing to the increased volume of the right middle lobe following a right upper lobectomy, a right S4 segmentectomy was performed.

Efficacy of Dynamic Chest Radiography for Evaluating Surgical Treatment of Diaphragmatic Paralysis.

Dynamic chest radiography (DCR) is a novel radiographic technique that evaluates the thoracic movement from inspiration to expiration. Here, we report the efficacy of DCR in the surgical treatment of diaphragmatic paralysis. A 60-year-old woman presented with phrenic nerve palsy after anterior mediastinal resection.

Efficacy of Surgical Treatment for Thymoma-Related Stiff Person Syndrome.

Stiff person syndrome (SPS) is a neurologic disorder, some cases of which are associated with malignant disease. Here, we report a case of thymoma-associated SPS that was successfully treated with surgical resection. A 57-year-old man with progressive muscle stiffness and weakness was diagnosed with thymoma-related SPS.

Pleomorphic Carcinoma Arising at Previous Resection Margins of Ground-Glass Opacities.

Pleomorphic carcinoma of the lung is highly malignant and occurs mostly in the upper lobes of smokers; however, no reports exist of new occurrences from the resection margins of the previous ground-glass opacities. In our case, a 73-year-old man underwent an initial partial resection of the left upper lung for ground-glass opacities, with progressive thickening of the resection margin during the following 10 months. Radical resection was performed, resulting in the diagnosis of a newly arising pleomorphic carcinoma from previously resected margins.

Emotional analysis of operating room nurses in acute care hospitals in Japan: insights using ChatGPT.

Aim: This study aimed to explore the emotions of operating room nurses in Japan towards perioperative nursing using generative AI and human analysis, and to identify factors contributing to burnout and turnover.

Methods: A single-center cross-sectional study was conducted from February 2023 to February 2024, involving semi-structured interviews with 10 operating room nurses from a national hospital in Japan. Interview transcripts were analyzed using generative AI (ChatGPT-4o) and human researchers for thematic, emotional, and subjectivity analysis.