Objective:This study aimed to compare the clinical outcomes of total laparoscopic hysterectomy (TLH) and robot-assisted laparoscopic hysterectomy (RALH) for treating symptomatic uterine fibroids at a single institution in Japan. Additionally, we identified factors associated with operative time in each surgical approach.

Methods:This retrospective cohort study included 163 premenopausal women with symptomatic uterine fibroids who underwent TLH (n = 119) or RALH (n = 44) between October 2021 and March 2025. Clinical characteristics, magnetic resonance imaging findings, and surgical outcomes were reviewed. Operative time was defined as the time from skin incision to closure. Multivariate linear regression analyses stratified by surgical method were performed to identify factors influencing operative time.

Results:Operative time was significantly longer in the RALH than in the TLH group (median:208 vs. 176 min, p < 0.001). Multivariate analysis revealed that uterine length (LU) was associated with longer operative time in both groups, whereas parity was associated with reduced operative time in the RALH group.

Conclusion:Both UL and parity were independent factors influencing operative time and highlighted the clinical implications of longer operative time in early-phase RALH compared with TLH.

This paper reports a rare case of coexisting systemic sarcoidosis and eosinophilic gastroenteritis. Multiple inflammatory lesions were detected by computed tomography and (18)F-fluorodeoxyglucose positron emission tomography, and a diagnosis of systemic sarcoidosis was established by biopsies from the hilar lymph node and palpable purpura. The patient exhibited peripheral blood eosinophilia. Upper endoscopy revealed duodenitis, and histological examination confirmed marked eosinophilic infiltration of the duodenal mucosa, consistent with eosinophilic gastroenteritis (EGE). The patient also had hypopituitary adrenal insufficiency, thought to be caused by neurosarcoidosis, based on medical history and evidence of systemic sarcoidosis. Early administration of corticosteroids resulted in improvement without sequelae. Our case suggests that hypereosinophilia and EGE may manifest as a lethal disease phenotype, such as adrenal insufficiency or neurosarcoidosis.

Abstract

Rectal neuroendocrine tumor (NET) G1 is a docile-looking tumor. We herein report a 77-year-old male whose rectal NET G1 measuring 10 mm recurred eight years after endoscopic mucosal resection. Tumor recurrence was detected by his mild general fatigue. Abdominal computed tomography revealed widespread metastasis, including the liver, lymph nodes around the rectum, and cervical spines. Subsequent somatostatin receptor scintigraphy, as well as histological reassessment of previously resected specimen, proved that these metastatic diseases originated from the rectal NET G1 with vascular invasion and possible positive vertical margin. First, octreotide long-acting repeatable 30 mg i.m. was administered every four weeks. Second, transcatheter arterial chemoembolization (TACE) for multiple liver metastases and irradiation therapy for spinal metastasis were carried out. One year after these treatments started, everolimus (mTOR inhibitor) 10 mg p.o. was administered every day. For the last five years, he received two rounds of TACE treatments and one round of irradiation. Although recurrent diseases were temporally controlled by these multidisciplinary treatments for the last month, he died of multiple metastases six years later, after tumor recurrence was detected. This case underscores the potential for late recurrence even in rectal NET G1 with unfavorable histological features, highlighting the importance of long-term surveillance.

Patients with schizophrenia often experience deficits in timing and rhythm-processing abilities, yet the impact of group-based expressive rhythm training on these functions remains unclear. In this study, we examined the effects of short, daily rhythm training sessions on rhythm perception and production in patients with schizophrenia. Participants (N = 15) in an acute care ward received an average of 18.6 training sessions (15 minutes each). Rhythm abilities were assessed before and after the intervention using the Harvard Beat Assessment Test (H-BAT). Group-level analyses showed no significant changes in the mean values of H-BAT measures. However, correlation analysis revealed that the association between the two rhythm production subtests strengthened considerably post-training (from ρ = −0.539 to ρ = −0.896), indicating greater consistency in rhythm production performance. These findings suggest that expressive rhythm training may help stabilize rhythm output in patients with schizophrenia, even when average performance levels do not significantly change. This improvement in internal consistency provides new insights into the potential mechanisms linking schizophrenia pathology to impaired rhythmic processing and may contribute to the development of novel rehabilitation strategies for this population.

Abstract

Chronic pain patients can achieve substantial improvement within six months, but some require prolonged care. This study aimed to explore differences in baseline characteristics and questionnaire responses between patients who showed significant improvement within six months (completion group) and those requiring treatment beyond six months (continuation group). A cross-sectional study was conducted among 131 patients. Patients were classified into completion group (n = 97) or continuation group (n = 34). Baseline data included demographic information (sex, age), ICD-11J classification, average pain intensity using the numeric rating scale (NRS) and scores from the Brief Pain Inventory (BPI), Pain Catastrophizing Scale (PCS), Pain Disability Assessment Scale (PDAS), Hospital Anxiety and Depression Scale (HADS), Pain Self-Efficacy Questionnaire (PSEQ), EuroQol Five Dimensions Questionnaire (EQ-5D), and Athens Insomnia Scale (AIS). There were no significant differences in age, sex, or ICD-11J classification between the groups. However, the continuation group exhibited significantly higher baseline scores for average pain intensity, PDAS, and HADS depression than the completion group. Patients with higher baseline pain intensity, greater functional impairment, and more severe depressive symptoms were more likely to require extended multidisciplinary treatment. Early identification of these risk factors is critical for optimizing treatment planning and improving outcomes in chronic pain management.

Background: This questionnaire-based study aimed to evaluate whether health information conveyed by high school students can encourage their guardians to undergo annual health checks, regardless of their guardians’ health literacy (HL) level.

Methods: After a lecture to students by an internist on lifestyle-related diseases and chronic kidney disease (CKD), we asked their guardians (n = 1,027) if the students had shared information about the lecture with them and their willingness to participate in an annual health check. We also measured guardian HL using a self-administered questionnaire from which an HL score (minimum=1;maximum=5) could be derived.

Results: The median HL score (with interquartile range) of guardians was 3.8 (3.2-4.0). Guardians whose children informed them about CKD were more likely than those who were not informed to plan health checks in the year ahead, regardless of their HL level.

Conclusion: Our study demonstrated that the transmission of CKD information from high school students significantly encourages their guardians to schedule health checks, regardless of their HL level.

This retrospective single-center study evaluated and compared the short-term outcomes of robot-assisted thoracic surgery (RATS) segmentectomy with those of conventional segmentectomy performed via thoracotomy or video-assisted thoracic surgery (VATS). The primary objective was to assess the safety of RATS segmentectomy. Our findings demonstrated that RATS segmentectomy was found to be as safe as conventional segmentectomy, with shorter operation times and hospital stays. No significant differences were observed in intraoperative blood loss and rates of surgical complications. However, prolonged postoperative air leaks are a potential concern. Among simple segmentectomy cases, RATS still showed shorter operation time and hospital stay. The longer experience of the surgeons in the RATS group may be a reason for the shorter operation time in this group. Additionally, the use of preoperative transbronchial marking with indocyanine green dye and barium, and intraoperative identification of intersegmental boundaries using intravenously administered indocyanine green dye may contribute to shorter operation time. Further studies are warranted to clarify the long-term oncological outcomes.

The HSV-1 UL50 gene encodes dUTPase (DUT), which dephosphorylates dUTP into dUMP, and its mutant strain is known to reduce neurovirulence in mice over 3 weeks old. Therefore, the UL50-deficient strain may be a candidate as a vaccine strain or viral vector. In this study, the UL50-deficient strain demonstrated reduced levels of replication in brain and neurovirulence compared to the wild strain in 4-week-old mice, but not in newborn mice. Furthermore, the expression level of cellular DUT in the mouse brain was not detectable in 4-week-old mice, but was detectable in newborn mice. In vitro experiments showed replication of the UL50-deficient strain was reduced due to the knockdown of cellular DUT. These results suggest that in actively dividing cells, such as the brain neurons of newborn mice, efficient cellular DUT expression helps with the sufficient replication of the UL50 mutant, resulting in the same level of neurovirulence as that in the wild type. However, in the brains of 4-week-old mice, DUT expression is insufficient, resulting in reduced neurovirulence of the UL50 mutant. These results suggest that when using the UL50 mutant strain as a vaccine or virus vector, it is necessary to pay attention to the timing of inoculation.

The patient was a 40-year-old woman who initially presented with ascites in September 2016. She was observed for suspected fatty liver disease and IgA nephropathy. In April 2023, she was admitted to the hospital after sustaining a self-inflicted injury. She presented with ascites and impaired liver and kidney function. A liver biopsy revealed no significant fibrosis, and she was diagnosed with idiopathic portal hypertension (IPH). The ascites did not improve with diuretics or paracentesis. A colonoscopy revealed multiple hyperplastic polyps, and a protein leakage scintigraphy identified protein leakage from the sigmoid colon. This led to a diagnosis of Cronkhite-Canada syndrome (CCS). She presented with characteristic skin symptoms of CCS, including nail atrophy and taste disturbances. Prior to the onset of symptoms, she reported experiencing psychological stress. Steroid therapy improved the ascites and pleural effusion, and the liver dysfunction gradually improved. This case suggests that an autoimmune background may have triggered or exacerbated the IPH and that CCS should be considered in the differential diagnosis of refractory ascites.

Purpose:Neoadjuvant pancreatic ductal adenocarcinoma (PDAC) treatment is evolving, and chemoradiotherapy (CRT) is emerging as a promising strategy for neoadjuvant therapy. Given the variability in radiotherapy protocols, this study aimed to evaluate the feasibility and safety of gemcitabine-based neoadjuvant chemoradiotherapy.

Methods:In this single-arm, phase 1 clinical trial, 31 patients with PDAC were enrolled between April 2016 and August 2019. All patients received preoperative gemcitabine-based chemoradiotherapy with adverse events as the primary endpoint. Multichannel radiation was administered at a total dose of 54 Gy in daily fractions of 1.8 Gy (five fractions per week), which represents a novel aspect of this study.

Results:Neoadjuvant therapy was completed in 24 patients, while seven were discontinued due to disease progression. The common adverse events included leukopenia (48.3%), thrombocytopenia (12.9%), and anemia (3.2%). Among the patients who underwent pancreatectomy, the R0 resection rate was 95.8%. Intention-to-treat analysis indicated a 2-year overall survival rate of 49.8% and a 2-year recurrence-free survival rate of 42.4%. High pretreatment CA19-9 levels were identified as predictive factors for overall survival (HR = 28.7, 95% CI:5.00-164.3).

Conclusions:Gemcitabine-based neoadjuvant chemoradiotherapy is a feasible and effective approach for achieving high R0 resection rates in resectable and borderline PDAC.

Abstract

We clarified the differences between the two pre-set protocols for iodine-digital subtraction angiography (ICM-DSA) and carbon dioxide (CO₂)-DSA in terms of radiation exposure to patients and physicians when patients diagnosed with lower extremity artery disease (LEAD) undergo ICM-DSA or CO₂-DSA, and identified factors that affect radiation exposure when patients undergo ICM-DSA or CO₂-DSA. CO₂-and ICM-DSA yielded 149 and 272 vessels in 21 and 49 patients, respectively. Multiple regression analyses revealed strong positive linear correlations between total air kerma (kinetic energy released per unit mass) at the patient entrance reference point (K_a,r), the total kerma area product (KAP), and the total number of acquisitions for ICM-DSA and CO₂-DSA, respectively. Compared to K_a,r, there were significant differences in the tube potentials, KAP, and spectral shaping filters in both DSA procedures. The linear correlations between K_a,r and the number of ICM-DSA and CO₂-DSA images varied among dose types, with strong linear correlations observed when K_a,r was classified into the above three groups. The X-ray conditions for each DSA image differed, with CO₂-DSA using a significantly higher tube potential and different spectral shaping filters compared to ICM-DSA. When performing DSA for LEAD, an optimized protocol for each type of ontrast agent should be used.

This study aimed to investigate the factors influencing pupil diameter in individuals of a community in Japan, contributing to a broader understanding of the potential of pupillometry as a non-invasive and reliable health indicator. We used a pupillometry device, “AiLive,” developed by Mecara Inc. The participants were recruited during a sports festival (SPORTEC 2023), where Mecara Inc. hosted a booth event. The primary outcomes were pupillometry parameters, including the size of pupil parameters and velocity parameters. We analyzed the association between the primary outcome and participant characteristics, including age, sex, the presence of disease, and medication usage. Significant differences were observed between pupillometry parameters and age, sex, and having cataracts, notably pupil size parameters, while velocity parameters remained consistent across groups. These results highlight that the size of pupil parameters could be under-adjusted for age, sex, and the presence of cataracts;in contrast, velocity parameters might have potential as a diagnostic support tool without any adjustment of participants’ characteristics.

C3 glomerulopathy (C3G) is a type of complement-associated glomerulopathy caused by a defect in the alternative complement pathway and is regarded as a rare disease. We report a 14-year-old boy with C3G and Sjögren’s syndrome (SS) whose school urinary screening revealed abnormalities, but the diagnosis was delayed because he refused to consult a medical institution. Histopathological examination revealed histologic features of membranoproliferative glomerulonephritis. He was diagnosed with C3G and Sjögren’s syndrome based on proteinuria, the histopathological findings, high levels of antibodies against SS-A, and lymphocytic infiltration around the salivary glands. He was treated with combination therapy, consisting of methylprednisolone pulse, prednisolone, and mycophenolate mofetil. At 3 months after treatment, urinary protein excretion was decreased and hematuria had disappeared, and improvement in hypocomplementemia and the levels of antibodies against SS-A were observed. The course of our case suggests that the management of patients with C3G should take into consideration the possibility of the coexistence of SS, and that those with positive findings on school urine screening should be encouraged to visit a medical institution.

A 50-year-old woman presented with a pancreatic tumor and multiple hepatic tumors identified via computed tomography (CT). The patient had undergone surgical resection for colon cancer 6 years earlier, followed by resection of a metastatic lung tumor 3 years ago. In the current presentation, primary pancreatic cancer with metastatic hepatic tumors was initially suspected. However, the possibility of previously resected colon cancer metastasizing to the pancreas also had to be considered. CT findings alone could not make this distinction. Therefore, endoscopic ultrasound-guided fine-needle aspiration was performed. Histopathological examination of the pancreatic tumor indicated adenocarcinoma, with features similar to those of the previously resected colon cancer. Immunohistochemical staining was negative for cytokeratin 7 but positive for cytokeratin 20, caudal-type homeobox 2, and special AT-rich sequence-binding protein 2. These findings indicated a pancreatic metastasis of colonic origin. In addition, a percutaneous ultrasound-guided biopsy of one of the hepatic tumors had histopathological findings that were similar to those of the pancreatic tumor. Hence, the patient was diagnosed with pancreatic and hepatic metastases from the previously resected colon cancer. Chemotherapy was initiated after this diagnosis.

Purpose: Recurrent respiratory papillomatosis (RRP) is associated with low-risk types of human papillomavirus (HPV). With HPV DNA testing, the oral rinse of RRP patients may be a useful liquid biopsy, as previously shown in patients with oropharyngeal cancer.

Methods: Oral rinse, along with palatine and pharyngeal tonsil swabs, were collected from seven patients with persistent RRP. HPV DNA detection was performed using polymerase chain reaction, followed by genotype identification.

Results: HPV DNA was detected in five of seven oral rinse samples, but not in any palatine or pharyngeal tonsil swabs. HPV6 was identified in four of the five HPV-positive oral rinses, which was consistent with the RRP tissues.

Conclusion: HPV DNA can be detected in oral rinses from patients with RRP, suggesting the utility of the oral rinse as a liquid biopsy. In contrast, neither the palatine nor the pharyngeal tonsils were reservoirs of HPV in study patients with RRP.

Aim:To clarify the frequency and characteristics of patients with attention deficit hyperactivity disorder (ADHD) born with low birth weight (LBW), very low birth weight (VLBW), small for gestational age (SGA), or preterm, we examined the clinical characteristics of ADHD patients. Methods:We collected data for 168 ADHD children, and the patients were retrospectively divided into each group according to birth weight, height, and gestational age. Results:1) Patients with ADHD born with LBW, VLBW, SGA, or preterm accounted for 10.1%, 3.0%, 3.6%, or 6.5% of all patients, respectively. 2) ADHD-RS scores for hyperactivity disorder and the frequency of patients requiring ADHD drugs in the LBW infant group were higher than those in the non-LBW infant group. 3) ADHD-RS scores for hyperactivity disorder and total in the VLBW infant group were higher than those in the non-VLBW infant (birth weight:1,500-2,500 g) group. 4) The ADHD scores for attention-deficit and trouble score at the most recent follow-up patients born with SGA were higher than for non-SGA patients. Conclusions:These results suggest that it is necessary to pay attention to the appearance of neurodevelopment disorders such as ADHD when monitoring the progress of patients born with LBW or VLBW, and it is important to provide more appropriate management and therapeutic guidance for patients born with VLBW or SGA.