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.

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.

Non-invasive prenatal genetic testing (NIPT) began in Japan in 2013 as clinical research. Fukushima Medical University Hospital (FMU) was the only accredited facility for NIPT in Fukushima Prefecture from 2016 until 2022, when two additional collaborative facilities were accredited. This study aimed to describe the current status of NIPT at FMU through a retrospective analysis of the medical records of 1,123 individuals who sought NIPT and received genetic counseling at FMU between January 2016 and December 2023. Of these individuals, 1,078 underwent NIPT, while 45 did not. The total NIPT uptake corresponded to 1.2% of all births in Fukushima during this period. Although the number of patients undergoing NIPT at FMU has been continuously decreasing since 2022, overall uptake in the prefecture increased in 2023. All three accredited facilities are located in highly populated, easily accessible parts of Fukushima Prefecture, leading to higher uptake among those living in these and surrounding areas. After genetic counseling, some opted against NIPT, while others chose to undergo other tests, which indicates the importance of informed decision- making. In large regions like Fukushima, increasing the number of accredited facilities and improving access to appropriate genetic counseling are crucial for ensuring informed decision-making about NIPT.

Background : The aim of this questionnaire-based study is to characterize serum uric acid (UA) levels in a cohort of young adults and to assess associations of serum uric acid levels with epidemiological factors.

Methods : Cohort data from 15,574 new university enrollees aged 18 to 20 years, including their serum UA levels, were collected. The prevalence of hyperuricemia and the relationship between serum UA and epidemiological factors, including blood pressure, sex, and obesity, were examined.

Results : The mean serum UA (mg/dL) was 5.2 (4.2 in women and 5.8 in men) and the prevalence of hyperuricemia (UA>7.0 mg/dL) was 6.6%. Serum UA levels were positively correlated with systolic blood pressure (SBP) levels. No statistically significant interactions were detected between serum UA and sex or obesity in relation to SBP.

Conclusion : Hyperuricemia is common among young adults. A higher UA level is related to increased blood pressure, irrespective of sex and obesity.

Objective : To investigate the relationship between physical activity levels and atypical femoral fractures (AFF) in bisphosphonate (BP) users.

Methods : In the Assessing Daily-Activity-Level for Decisions on Bisphosphonate Prescription (ADD-BP) study, we retrospectively analyzed 27 women with AFF from five hospitals (2019-2023), categorized into BP (n = 18) and no-BP (n = 9) groups. Pre-injury physical activity was assessed via mobility aid usage, Long-Term Care Insurance System status, and independence in daily living.

Results : Median ages were 77 years (BP) and 86 years (no-BP). In the BP vs. no-BP groups, 83.3% vs. 33.3% used no mobility aids, 11.1% vs. 22.2% used canes, and 5.6% vs. 33.3% used walkers. No BP users (0%) vs. 33.0% of no-BP users were housebound ; others were independent.

Conclusion : BP users with AFF exhibited higher physical activity levels than non-users, suggesting low activity may not elevate AFF risk in long-term BP use. These findings support the safety of extended BP therapy for fragility fracture prevention in less active patients. Future case-control studies are needed to confirm these results. This study was approved by the Fukushima Medical University Ethics Committee (REC2023-176).

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.

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.

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.

Leukocytoclastic vasculitis (LCV) is a disease secondary to infections, malignancies, or drug exposure, although its pathogenesis remains unclear. Secondary LCV from different causes in the same patient has been rarely reported. We present a case of LCV secondary to pancreatic cancer that remained in remission for one year post-surgery, after which the patient suffered from a subdiaphragmatic abscess caused by Escherichia coli, followed by recurrence of LCV. This case suggests that patients with acquired hyposplenism may be susceptible to developing LCV as a manifestation of underlying disease. Careful evaluation of the underlying disease is important to avoid inappropriate immunosuppressive treatment.

Infectious mononucleosis (IM), caused by Epstein–Barr virus, often mimics group A streptococcal (GAS) pharyngitis and may result in an ampicillin rash when aminopenicillins are administered. We report a 22-year-old woman with fever, sore throat, lymphadenopathy, and a generalized erythematous rash after a 7-day course of amoxicillin-clavulanate. Although a rapid streptococcal antigen test was positive, non-tender lymphadenopathy and absence of left shift in the white blood cell count suggested viral infection, and the result was considered consistent with a carrier state rather than true GAS infection. No additional antibiotics were given ; corticosteroid and antihistamine treatment led to improvement. Serology confirmed acute Epstein-Barr virus infection, and throat culture revealed only alpha-hemolytic streptococci. This case underscores the diagnostic overlap between IM and streptococcal pharyngitis, the need for caution in interpreting rapid antigen tests, and the importance of avoiding unnecessary antibiotics in suspected viral illness.

Background : Lymphangiomas are rare benign tumors typically occurring in children’s head and neck regions. Pelvic lymphangiomas in adults are extremely uncommon and often mimic ovarian tumors, making preoperative diagnosis challenging in peri- and postmenopausal women.

Case Presentation : A 53-year-old Japanese woman with a duodenal ulcer history developed a multicystic right adnexal mass during follow-up for uterine fibroid (initially diagnosed at age 43). The uterine fibroid measured 11 cm on imaging at the start of follow-up, with no abnormalities detected in the adnexa. Magnetic resonance imaging (MRI) performed at age 52 revealed a 58×37 mm multicystic mass in the right adnexa, which enlarged to 80 mm over the following year. MRI revealed a multicystic mass near the right ovarian vessels ; the left adnexa appeared normal. Surgery included right adnexectomy, total hysterectomy, and left salpingo-oophorectomy. Intraoperatively, a well-defined multicystic lesion was identified along the infundibulopelvic ligament with normal right ovary appearance. Histopathological examination confirmed lymphangioma, with positive immunostaining for D2-40 and CD31. The postoperative course was uneventful, with no recurrence at the 3-year follow-up.

Conclusion : Pelvic lymphangioma should be considered in the differential diagnosis of multilocular pelvic masses. Comprehensive imaging and histopathological analysis are crucial for accurate diagnosis and management.