Objective Early defibrillation is crucial for improving the survival rates of patients with shockable cardiac arrest (OHCA). Automated external defibrillators (AEDs) are essential in basic life support (BLS), yet their usage in out-of-hospital cardiac arrests remains around 10%. There are two types of AEDs: semi-automatic (s-AED) and fully automatic (f-AED), with the latter automatically delivering a shock if indicated. Although f-AEDs were introduced in Japan in 2021, they have not yet been widely adopted. The present study investigated whether or not the ease of use and preferences for these AED types differ between healthcare professionals and laypersons.

Methods BLS courses, including training on both AED types, were conducted between 2021 and 2022 at our institution. The participants were divided into medical and non-medical professional groups, and a survey was administered.

Results A total of 443 participants were included, with 47 medical professionals and 396 non-medical professionals. Notably, 401 participants were new to f-AED lectures. The medical professional group had more prior experience with AED training courses than non-medical professionals and showed a preference for s-AEDs, whereas the non-medical professional group showed no significant preference. Although a subset of participants expressed hesitation in pressing the shock button on the s-AEDs, no statistically significant difference was observed between the groups.

Conclusion This study suggests that preferences for AED types may vary between medical and non-medical professional groups, with some reluctance in using s-AEDs. Although no significant differences in hesitation were found between the groups, f-AEDs may reduce hesitation and potentially improve AED effectiveness during cardiopulmonary resuscitation.

Objective Despite the controversy regarding its clinical utility, the arterial oxygen partial pressure (PaO₂) to the fraction of inspired oxygen (FIO₂) ratio has been used to define the severity of acute respiratory distress syndrome (ARDS). This systematic review and meta-analysis (SRMA) details summary estimates of the predictive performance of PaO₂/FIO₂ ratio in predicting mortality in patients with ARDS.

Methods To clarify the integrated diagnostic accuracy, we included studies in which the study population comprised patients with ARDS in any clinical setting, included adult patients (≥18 years old), and evaluated mortality. The MEDLINE and Cochrane Central Registry of Controlled Trials databases were searched for articles in English. We performed SRMA on the accuracy of the diagnostic prognostic tests using the Quality Assessment of Diagnostic Accuracy Studies-2 tool to evaluate the risk of bias. We obtained summary point estimates of sensitivity and specificity and calculated the area under the receiver operating characteristic (AUROC) curve of the summary receiver operating characteristic curve with 95% confidence intervals (CIs).

Results Twenty-eight trials with 38,270 patients were included in the quality assessment. Most of the studies were conducted in intensive-care units. Overall, the risk of bias is high. For PaO₂/FIO₂ of 100 and 200 the pooled sensitivity, specificity, and AUROC were 44.8% (95% CI, 38.1-51.7%), 70.6% (95% CI, 65.9-74.9%), 0.60 (0.58-0.64) and 83.9% (95% CI, 78.9-87.8%), 26.1% (95% CI, 20.8-32.1%), 0.64 (0.60-0.69), respectively.

Conclusion The PaO₂/FIO₂ ratio alone did not have impressive prediction accuracy for mortality in patients with ARDS and might not be able to be used solely as a clinical prognostic tool.

Objective Constipation is an important symptom in older adults. Sarcopenia is associated with constipation, but its directionality remains unclear. The present study assessed the association between sarcopenia and new-onset constipation.

Methods This prospective cohort study assessed sarcopenia at baseline in 2019 using the the Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls (SARC-F) questionnaire. Sarcopenia was defined as a SARC-F score of ≥4. Constipation was measured in 2019 and 2020 based on self-reported constipation or laxative use, using a self-administered questionnaire. Logistic regression was used to estimate the association between new-onset constipation in 2020 and sarcopenia status at the baseline.

Patients Independent community-dwelling adults ≥75 years old in Sukagawa City, Fukushima, Japan.

Results The analysis included 2,388 participants without constipation at baseline (mean age: 80.0±4.3 years old; 44.9% men), of whom 310 (13.0%) had sarcopenia at baseline. Overall, 262 participants (11.0%) developed constipation, including 57 of 310 (18.4%) with sarcopenia and 205 of 2,078 (9.9%) without sarcopenia. Participants with sarcopenia had a significantly higher risk of developing constipation than those without sarcopenia after adjusting for age, sex, lifestyle factors, and comorbidities (adjusted odds ratio, 1.98; 95% confidence interval, 1.40-2.81; p<0.001). The association between sarcopenia and new-onset constipation remained statistically significant at higher and lower SARC-F cutoff values.

Conclusion Sarcopenia was associated with new-onset constipation. Sarcopenia is a risk factor for constipation in independent community-dwelling older adults ≥75 years old. Measures addressing sarcopenia may help prevent constipation in older adults.

We present the case of a 54-year-old woman who was diagnosed with intraductal papillary neoplasm of the bile duct (IPNB) in the remnant intrapancreatic bile duct, 37 years after surgery for congenital biliary dilatation. Endoscopic ultrasonography revealed a papillary, low-echoic mass in the intrapancreatic bile duct, and peroral cholangioscopy revealed a papillary mucosa. A pancreaticoduodenectomy was performed, and the patient was pathologically diagnosed with type 1 pancreatobiliary-type IPNB with associated invasive carcinoma. As a similar atypical epithelium was identified in the pancreatic duct, it was suggested that the IPNB extended longitudinally to the pancreatic duct through the common channel.

Granulomatous interstitial nephritis (GIN) has been reported in <0.5% of patients with inflammatory bowel disease, and most cases of GIN are drug-induced. A 13-year-old boy was referred for the evaluation of abdominal pain, diarrhea, and weight loss. The patient was diagnosed with non-drug-induced GIN and Crohn's disease based on total colonoscopy and a biopsy of the colon and kidney. Both tissues contained macrophages and increased epithelial expression of IκBζ, a protein involved in the nuclear factor kappa-light-chain-enhancer of activated B cells pathway. There may be more patients with GIN complicated by Crohn's disease than expected, and macrophages may be involved in the pathogenesis.

Gallbladder abscess is extremely rare. Aseptic abscesses are sometimes observed in patients with active ulcerative colitis (UC) with no history of colectomy; however, it is rare for an aseptic abscess in the gallbladder to develop after surgery for UC. We treated a 56-year-old man with UC and severe pouchitis who had undergone subtotal colorectal resection. A gallbladder lesion was noted during treatment for pouchitis, which increased in size. Therefore, the patient underwent cholecystectomy for suspected gallbladder cancer. A pathological examination revealed an aseptic abscess. This clinical report describes a rare case of an aseptic abscess in the gallbladder after surgery for UC.

A 74-year-old woman presented with sudden dyspnea 22 h after orthopedic surgery. Echocardiography revealed significant right ventricular dilatation, suggesting the development of acute pulmonary embolism. However, contrast computed tomography showed no signs of pulmonary thromboembolism, leading to suspicion of fat embolism syndrome (FES). Despite the administration of high-dose norepinephrine and dobutamine, her hemodynamic status did not improve, and high-dose methylprednisolone (250 mg) was administered. After administration, her hemodynamic status improved promptly, and she soon showed normotension. The current case suggests the possibility of high-dose methylprednisolone for hemodynamic improvement in FES.

A 54-year-old man presented with a significant fourth heart sound and increased intensity of the second heart sound, despite the absence of heart failure symptoms, in the second week of March 2024. Visualized phonocardiograms confirmed these findings, and further interviews revealed that he had suffered lifestyle changes, such as long commutes and sodium overload, while contributing to the response efforts in the 2024 Noto Peninsula Earthquake. Visualized phonocardiograms were also influential in determining the treatment strategy, persuading the patient to undergo a specific therapy, evaluating the therapeutic effects, and suggesting a new model for clinical practice.

Non-bacterial thrombotic endocarditis (NBTE) causes myocardial and cerebral infarctions and is associated with advanced stages of malignancy. However, only a few cases of myocardial and cerebral infarctions have been reported in the same patient. We herein report a 47-year-old woman with advanced uterine and ovarian cancer who experienced acute myocardial infarction (MI) after receiving chemotherapeutic intervention for the cancer and hemorrhagic cerebral infarction 1 month after admission for acute MI, attributable to NBTE of the aortic valve. NBTE should be considered in patients with malignancies and life-threatening thromboembolism of important organs.

This case report describes a 47-year-old woman with coronavirus disease 2019 (COVID-19)-related multisystem inflammatory syndrome in adults (MIS-A), who presented with fulminant myocarditis and severe rhabdomyolysis. Despite the absence of severe respiratory symptoms, the patient showed remarkable myocardial and leg edema with significant systemic inflammation and elevated creatine kinase levels after the COVID-19 infection. The patient required venoarterial extracorporeal membrane oxygenation (VA-ECMO) and Impella CP^® for hemodynamic stabilization; however, she was successfully treated. We also reviewed reported cases of concurrent myocarditis and muscular involvement in patients with COVID-19, as well as cases of fulminant myocarditis and MIS-A requiring VA-ECMO.

Alport syndrome is an inherited disorder characterized by progressive renal failure, sensorineural hearing loss, and ocular involvement due to pathogenic variants of genes encoding type IV collagen. A renal biopsy does not reveal specific findings in the early stages; thus, Alport syndrome may be diagnosed as another glomerular disease. We herein report two families that were previously diagnosed with other glomerular diseases based on renal biopsies and were then accurately diagnosed by genetic testing. An early diagnosis may lead to the avoidance of unnecessary biopsies and treatments, and appropriate management may improve the renal prognosis.

We herein report a 68-year-old man with advanced non-small-cell lung cancer treated with tepotinib who showed marked general edema, hypoalbuminemia, and an elevated serum creatinine level. Although tepotinib-induced kidney injury due to creatinine transporter inhibition has been reported, renal biopsy findings suggested tubulointerstitial injury due to decreased renal blood flow, likely secondary to refractory fluid retention. This case highlights the potential for true kidney injury during tepotinib therapy and underscores the importance of careful monitoring and management of adverse renal effects.

A patient with advanced colon cancer treated with ramucirumab, an anti-vascular endothelial growth factor receptor-2 agent developed nephrotic-range proteinuria and hypertension. A renal biopsy revealed hyaline occlusive glomerular microangiopathy with macrophage infiltration and focal podocyte swelling with hyperplasia. Furthermore, a circular fibrocellular crescent formation was observed. Anti-CD34 immunostaining indicated severe endothelial injury. Circulating syndecan-1, which is derived from the glycocalyx covering the endothelium, was moderately increased, similar to the plasma D-dimer level, but not as high as that in systemic endotheliopathy. This case suggests that severe kidney-specific endothelial injury may be responsible for the development of a unique extracapillary glomerulopathy as a side effect of ramucirumab.

We herein report a 69-year-old man with acute kidney injury who required dialysis after receiving a combination of three drug-induced lymphocyte stimulation test-positive drugs. A kidney biopsy showed tubulointerstitial nephritis with severe eosinophilic infiltration and numerous granuloma formations. Acute eosinophilic granulomatous tubulointerstitial nephritis was diagnosed. Eosinophilic granulomatosis with polyangiitis was ruled out because there was no evidence of vasculitis or serum antineutrophilic cytoplasmic antibody and no history of allergy. No clinical findings were suggestive of sarcoidosis. Based on the above findings, the disease was considered to be induced by these three drugs. The renal function was normalized with glucocorticoid treatment.

A 21-year-old male with hereditary hemorrhagic telangiectasia underwent coil embolization for three pulmonary arteriovenous malformations (right S⁶c, right S¹⁰a, and left S⁶b). Three years after coil embolization, coil migration was observed in the right S⁶c and S¹⁰a, and a cavitary lesion developed between the two coils. Four years after embolization, the two coil lesions were found to have merged within the cavity. Right lower lobectomy was performed for severe recurrent hemoptysis. A histological examination revealed a granuloma with caseous necrosis related to Mycobacterium avium complex (MAC) infection around the cavity. The patient did not exhibit hemoptysis or MAC recurrence after resection.

A 59-year-old woman presented with multiple mediastinal masses 6 months after post-thymectomy for type B2 thymoma. A diagnosis of small-cell carcinoma (SmCC) via a computed tomography-guided biopsy and fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography revealed no primary lesions outside the anterior mediastinum. The pathologically reevaluated post-thymectomy specimen showed no neuroendocrine differentiation. SmCC is presumed to arise either from malignant transformation of the thymoma or de novo formation. She was treated with carboplatin and paclitaxel to achieve complete response. This case highlights the importance of a re-biopsy to guide appropriate treatment in cases of rapid progression during the course of thymoma.

Traditionally, leptomeningitis (LM) has been considered untreatable and terminal, but the development of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) has significantly improved the prognosis of patients with EGFR mutations. However, non-LM lesions occasionally progress or recur, even when the LM is successfully controlled with EGFR-TKIs, and treatment of such cases remains unclear. We herein report a patient with advanced non-small-cell lung cancer (NSCLC) who was treated with an EGFR-TKI for LM and cytotoxic chemotherapy for EGFR-TKI-resistant pulmonary lesions. The patient survived for almost four years after the diagnosis of LM, suggesting that this treatment may be beneficial in advanced NSCLC with EGFR-TKI-sensitive LM and EGFR-TKI-resistant extracranial lesions.

A 66-year-old man who was receiving treatment for B-cell non-Hodgkin lymphoma presented with fever. He tested positive for severe acute respiratory syndrome coronavirus 2 antigen. Chest computed tomography (CT) revealed pneumonia. Therefore, remdesivir was administered to the patient. However, steroid pulse therapy was initiated owing to the lack of any symptom improvement and a worsening of the CT findings. The patient developed recurrent fever following a reduction in the steroid dose. His respiratory condition gradually worsened, and he eventually died. Autopsy revealed diffuse alveolar damage. In high-risk patients with hematologic malignancy, coronavirus disease 2019 (COVID-19) vaccination should be repeated at shorter intervals to avoid increasing the viral load during the COVID-19 infection.

An 82-year-old man presented with acute progressive disturbance of consciousness. We suspected autoimmune limbic encephalitis because of abnormal magnetic resonance imaging findings in the bilateral temporal lobes and cerebrospinal fluid pleocytosis. The patient tested positive for anti-Tr/Delta/Notch-like epidermal growth factor-related receptor (DNER) antibodies, and a tissue biopsy revealed complications of anaplastic large cell lymphoma. Typically, anti-Tr/DNER antibody-associated paraneoplastic neurological syndrome presents with cerebellar ataxia and is complicated by Hodgkin lymphoma (HL). However, there are rare cases that present only with limbic encephalitis (LE) and are complicated by tumors other than HL; therefore, aggressive antibody measurement and search for tumors are important.

A 63-year-old previously healthy man participated in a longitudinal epidemiologic study of dementia and aging. Although he initially showed no subjective symptoms and a normal motor function, verbal fluency test scores gradually declined, and progressive atrophy of the frontal lobes was observed on magnetic resonance imaging of the head. At 71 years old, progressive supranuclear palsy (PSP) was diagnosed after supranuclear gaze palsy, and gait disturbance developed. This longitudinal epidemiological study suggests that verbal symptoms and mild frontal lobe atrophy may be evident in the premotor phase of PSP.

A 69-year-old woman with left-sided breast cancer developed elevated creatine kinase levels and muscle weakness in her extremities after treatment with pembrolizumab. The patient was diagnosed with immune checkpoint inhibitor (ICI)-related myositis. Although the patient had no symptoms of dysphagia, we evaluated her swallowing function because esophageal dysfunction is a known complication of idiopathic inflammatory myopathy. A videofluoroscopic swallowing study detected barium residues in the lower esophagus. Furthermore, high-resolution manometry showed impaired upper esophageal sphincter opening and absence of esophageal peristalsis, which improved partially after immunotherapy. These findings suggest that esophageal dysfunction may be an unrecognized complication of ICI-related myositis.

We herein report a 52-year-old woman with anti-aquaporin 4 antibody-positive neuromyelitis optica spectrum disorder (NMOSD) and idiopathic multicentric Castleman disease (iMCD) who was successfully treated with tocilizumab, a humanized anti-human interleukin (IL)-6 receptor monoclonal antibody. This is the first report of a case of coexisting NMOSD and iMCD. IL-6 is involved in the pathogenesis of both NMOSD and iMCD, and tocilizumab is effective against both diseases. By treating the patient with tocilizumab, the lung lesions due to iMCD improved, and the neurological symptoms of NMOSD did not recur.