Type 1 diabetes mellitus is an autoimmune disease characterized by the immune-mediated destruction of pancreatic β cells, requiring lifelong insulin replacement therapy. Advances in diabetes management devices, particularly automated insulin delivery systems that integrate continuous glucose monitoring with insulin pumps, have markedly improved glycemic outcomes. Hybrid and advanced closed-loop systems have reduced hypoglycemia and glucose variability, but they continue to depend on user input for meal announcements and exercise adjustments. Efforts to reduce user burden include bihormonal pump systems and simplified carbohydrate-counting strategies; however adaptation to rapid physiological changes, such as those during physical activity, remains challenging. In addition to technological advancements, β-cell replacement therapies have progressed. Whole-organ pancreas and islet transplantation can restore endogenous insulin secretion but is limited by donor shortages and the requirement for lifelong immunosuppression. Stem cell-derived islet therapies, including allogeneic and autologous products in clinical trials, demonstrate promising metabolic efficacy. However, challenges such as immune rejection, immunosuppressive therapy, and long-term safety concerns hinder widespread adoption, especially in pediatric patients. Alternative strategies such as encapsulation and gene editing for immune evasion are being explored but have not yet achieved durable insulin independence without immunosuppression. This review outlines evolving therapeutic approaches for type 1 diabetes mellitus, focusing on automated insulin delivery systems and β-cell replacement therapies. It highlights pediatric considerations and Japan-specific challenges, such as limited device availability and scarce clinical transplantation data in children.

Interpretation of laboratory test results is fundamental to clinical decision-making, yet is often oversimplified into intuitive labels such as "high," "low," or "normal." This review argues that appropriate interpretation of laboratory values requires a three-layered framework: (i) reference intervals as statistical descriptors of population-based distributions, (ii) clinical decision limits as thresholds for diagnostic, therapeutic, or preventive actions, and (iii) measurement comparability ensured through assay standardization, harmonization, and external quality assessment.

Reference intervals indicate where an individual's result lies within a healthy population and do not define clinical normality or abnormality. In contrast, clinical decision limits are action-oriented thresholds based on disease risk or expected benefit of intervention and may be set within or outside reference intervals depending on purpose. Confusion arises when these distinct concepts are conflated, as illustrated by examples from anemia diagnosis and LDL cholesterol assessment in health screening.

Crucially, neither reference intervals nor clinical decision limits can function as intended unless laboratory results are comparable across assays and institutions. Using TSH testing as a representative case, we demonstrate how assay harmonization improves comparability and enhances the clinical utility of shared reference intervals and decision limits. This three-layered perspective provides a coherent framework for clinical practice, screening, and medical education.

Transthyretin amyloid cardiomyopathy (ATTR-CM) is an infiltrative cardiomyopathy characterized by extracellular deposition of misfolded transthyretin (TTR) fibrils within the myocardium. Once considered rare, ATTR-CM is increasingly recognized in aging populations and in selected high-yield clinical settings such as heart failure with preserved ejection fraction (HFpEF), aortic stenosis, and unexplained conduction disease. Disease pathogenesis is initiated by tetramer destabilization and monomer misfolding, followed by fibril formation and extracellular accumulation. Both hereditary (ATTRv) and wild-type (ATTRwt) forms converge on a restrictive cardiomyopathy phenotype, although genotype influences penetrance and extracardiac manifestations.

Diagnostic practice has been transformed by structured nonbiopsy algorithms integrating bone-avid scintigraphy with hematologic testing. Risk stratification using biomarkers and imaging-derived extracellular volume has refined staging and therapeutic timing. Randomized trials have established disease-modifying therapy as standard care. Tafamidis demonstrated survival benefit in ATTR-ACT. Acoramidis improved hierarchical clinical outcomes in ATTRibute-CM. Vutrisiran reduced mortality and cardiovascular events in HELIOS-B. Emerging approaches include gene editing and antibody-mediated amyloid clearance.

ATTR-CM should be recognized as a prevalent and treatable cardiomyopathy in older adults. Early detection, stage-appropriate therapy selection, and comprehensive supportive management are essential to improving survival and quality of life.

Objectives: Speech-language-hearing therapy is an important issue in intensive care, facilitated by Japan's 2022 reimbursement revision. However, it is only weakly recommended. Furthermore, it is unclear when it should be initiated. This retrospective observational study examined the effect of early speech-language-hearing therapy within 48 hours after extubation from mechanical ventilation in elderly patients undergoing cardiovascular surgery.

Methods: This study included patients aged ≥65 years who underwent speech-language-hearing therapy for dysphagia following cardiovascular surgery. Age, sex, primary illness, Charlson Comorbidity Index, sequential organ failure assessment score, Geriatric Nutritional Risk Index, duration of ventilation, daily training time, training implementation rate, and early speech-language-hearing therapy were investigated as the patient background, Barthel index and Food intake LEVEL scale as the primary outcome, and postoperative pneumonia and disorientation as the secondary outcome. They were compared between the pre-revision group from April 2019 to March 2022 and the post-revision group from October 2022 to March 2024.

Results: Early speech-language-hearing therapy was performed in all 17 patients in the post-revision group and in 45 of 59 patients in the pre-revision group (P = 0.03). The post-revision group had a significantly higher Barthel index at discharge than the pre-revision group (median score 90 vs. 82.5, P = 0.049). The eating abilities were comparable. Pneumonia was observed in 8.5% of patients in the pre-revision group, but not in the post-revision group. Disorientation at rehabilitation initiation was significantly less in the post-revision group (11.8% vs. 47.5%, P = 0.01).

Conclusions: Preventing disorientation may improve activities of daily living.

Aims: This study was designed to investigate the effect of switching from glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1RAs) to weekly subcutaneous tirzepatide on glycemic control, as reflected by hemoglobin A1c (HbA1c), occasional plasma glucose (PG) and glycoalbumin (GA), in real-world clinical practice in our hospital.

Patients and Methods: A search of electronic medical records from June 2024 to July 2025 was performed for patients who had received GLP-1RAs for type 2 diabetes and were switched to tirzepatide mainly because of poor glycemic control. A total of 21 patients were enrolled and data for these patients were evaluated until the end of January 2026.

Results: Tirzepatide was not suspended in any cases during the observational period of 6 months after the switch. After the change to tirzepatide, HbA1c significantly decreased from baseline at 3 and 6 months. Occasional PG showed a significant decrease from baseline at 6 months, and GA significantly decreased from baseline at 3 and 6 months. There were no significant differences in low-density lipoprotein cholesterol, aspartate transaminase, alanine transaminase, gamma-glutamyl transpeptidase, uric acid, or estimated glomerular filtration rate at all time points. There was a significant decrease of body weight (BW) from baseline at 6 months, and a significant correlation of BW change with the change of HbA1c from baseline to 6 months. Baseline body mass index showed a significant positive correlation with the HbA1c change from baseline to 3 months.

Conclusion: The switch from GLP-1RAs to tirzepatide significantly improved glycemic control evaluated by HbA1c, occasional PG and GA over a 6-month observational period. Tirzepatide also significantly decreased BW.

Prosthetic upper limbs, particularly myoelectric prosthetic hands, are not commonly prescribed in Japan. Herein, we prescribed a myoelectric prosthetic hand to a woman in her 30s. The patient suffered a degloving injury to her left upper limb after being caught in agricultural machinery. Reattachment attempts proved difficult, leading to forearm amputation. Following amputation, the patient's deteriorating skin condition and elbow joint contracture indicated suitability for a cosmetic prosthetic hand. Based on the patient's deteriorating skin condition at the amputation site, desire for social reintegration, and aspiration to use a prosthetic hand with high-level functionality, a multidisciplinary conference decision was made to perform revision amputation from the upper-arm. Following reamputation and over a year of rehabilitation, the patient acquired the ability to use a myoelectric prosthetic hand, secured employment, and achieved social reintegration. Prescribing a myoelectric prosthetic hand following revision reamputation of the upper limb should be considered when the goal is social reintegration. We describe high-level revision amputation as functional reamputation when aimed at functional improvement, and report the outcomes of patients who underwent this functional reamputation method.

Traumatic testicular dislocation is a rare complication often associated with high-impact pelvic trauma. Its diagnosis can be challenging and is frequently delayed due to concomitant injuries. This report presents the case of a 17-year-old boy who sustained right-sided testicular dislocation following a motorcycle accident. Imaging confirmed the ectopic position of testes in the superficial inguinal region. Despite unsuccessful manual reduction under sedation and local anesthesia, delayed surgical orchidopexy performed 22 days after injury successfully preserved testicular function, as evidenced by the normal postoperative semen analysis results. This case emphasizes the importance of a thorough clinical evaluation in patients with trauma and highlights the potential for successful outcomes, even with delayed surgical intervention.

A 60-year-old woman with a right diaphragmatic mass shadow noted by a previous physician was referred. Twenty years prior, the patient underwent a right thoracoscopic thymoma resection for a thymoma (WHO classification type B2, Masaoka stage II). Thymoma recurrence was suspected, thus surgery with a single-port thoracoscopic approach through an incision 4 cm along the mid-to-posterior axillary line at the 7th intercostal space was conducted. A tumor was noted near the diaphragmatic tendon center and a partial diaphragmatic resection performed, ensuring a clear resection margin. The diaphragmatic defect was then repaired with use of a non-absorbable hernia repair mesh (ETHIBOND^®). Pathological examination findings were consistent with history of thymoma and confirmed complete resection. Postoperative examinations have found no new lesions and at the time of writing the patient was doing well.

Vitiligo is a common acquired depigmenting skin disorder caused by selective destruction of melanocytes, and is viewed as an autoimmune disease. Vitiligo is often associated with other autoimmune diseases, including autoimmune thyroid diseases such as chronic thyroiditis and Graves' disease, and alopecia areata. However, combined complication of vitiligo, Graves' disease and alopecia areata is very rare. Herein, we report a case of a male patient with Graves' disease who had acute onset of vitiligo after development of recurrent alopecia areata. A 34-year-old man had noted fatigue, finger tremor, palpitation, and reduced concentration 9 years ago, and had diagnosed as Graves' disease. Nine months ago, at age 33, the patient noted depigmented spots; i.e., vitiligo on skin in the neck region. Thereafter, the vitiligo gradually expanded with a mild itching sensation in the enlarged region. The patient also mentioned that he had experienced recurrent alopecia areata for about 25 years. Although simultaneous complication of these three diseases is very rare, physicians should pay attention to possible autoimmune diseases complications such as vitiligo or alopecia areata in patients with Graves' disease.

A 60-year-old man who had previously undergone surgery for a cleft lip and palate, an iliac cancellous bone graft on the alveolar cleft and a jaw deformity operation at another hospital, visited our hospital to improve his oral function. During his first visit, he was missing most of his maxillary teeth, and had the exposed titanium plates on the maxilla and oronasal fistula. Despite receiving prosthetic treatment at a local dental clinic, his oral function was severely impaired. Under general anesthesia, we closed the oronasal fistula, removed the exposed titanium plates on the maxilla, and extracted the impacted supernumerary teeth in our hospital. At the same time, we placed three dental implants in the maxilla. Six months after dental implant placement, we remove the cover screw and insert the locater abutment, and an implant-supported denture was fitted one month later. To evaluate masticatory function, gummy jelly test was performed, an implant-supported denture with locator abutments improves his masticatory function by about half the capacity of healthy individuals.