This study aimed to clarify the current state of research on the effects of stretching exercises on the health of patients with type 2 diabetes mellitus (T2DM). A scoping review of the literature was conducted in December 2024, using four databases. Experimental and clinical studies were included if they compared stretching exercises with non-stretching exercises for T2DM-related health outcomes. The primary search terms used were "diabetes mellitus, type 2," "muscle stretching exercises," and "range of motion, articular." Eleven studies met our inclusion criteria. Eight studies focused on blood glucose levels, one of which assessed the functional capacity. The remaining studies investigated plantar pressure, shoulder joint mobility/pain/disability, and fatigue, with one study addressing each outcome. This review indicates that stretching exercises may affect a variety of health parameters, including blood glucose regulation, in patients with T2DM but emphasizes the need for further high-quality research to determine their effectiveness.

Objective Lusutrombopag is recommended for severe thrombocytopenia (<5.0×10⁴/μL) in patients with chronic liver disease who are scheduled to undergo invasive procedures. However, reports on the efficacy of repeated lusutrombopag dosing are scarce. It is also not known whether lusutrombopag causes the platelet count to exceed 5.0×10⁴/μL. We evaluated the efficacy of repeated lusutrombopag dosing and the efficacy of the platelet prediction simulation software program.

Methods We evaluated the number of platelet elevations according to the number of lusutrombopag administrations. We also evaluated the correlation between the highest software-predicted platelet count and the platelet count measured in actual clinical practice.

Patients This retrospective study included 236 patients treated with lusutrombopag at 11 medical institutions in Japan.

Results The platelet count increased with the number of lusutrombopag administrations (1, 2, 3, 4, >4) in all groups, and no significant difference was found among the groups (p=0.169). In all groups, the platelet counts reached their highest levels at 8-14 days after treatment with lusutrombopag (p=0.243). There was a correlation between the highest software-predicted platelet count and the platelet count measured in actual clinical practice in all dose frequency groups; however, the correlation was the strongest in the one-dose group (r=0.74, p<0.0001).

Conclusion Frequent lusutrombopag administration is therefore both effective and safe, and a platelet prediction simulation software program is thus considered to be useful in practice.

Objective Immediate primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction is closely associated with better clinical outcomes. However, the optimal timing of PCI for the culprit lesion in non-ST-elevation myocardial infarction (NSTEMI) is not fully understood. The aim of this study was to compare clinical outcomes between patients with early and delayed PCI and to investigate whether early PCI within 24 hours of admission can improve long-term clinical outcomes in patients with NSTEMI.

Methods This was a single-center, retrospective study. The primary endpoint was major adverse cardiovascular events (MACE), which was defined as the composite of all-cause death, non-fatal MI, and re-admission for heart failure.

Results We included 816 patients with NSTEMI and divided them into an early PCI group (n=446) and a delayed PCI group (n=370). The median follow-up period was 856 days. The median age was lower in the early PCI group [73 (65-79) years] than in the delayed PCI group [76 (69-81)] (p<0.001). Shock at admission was more frequently observed in the early PCI group (11.9%) than in the delayed PCI group (3.2%) (p=0.001). The incidence of MACE in the delayed PCI group (40.8%) was higher than that in the early PCI group (28.5%) (p<0.001). However, a multivariate Cox hazard analysis revealed that early PCI was not associated with MACE after controlling for multiple confounding factors (hazard ratio 1.005, 95% confidence interval 0.763-1.322, p=0.973).

Conclusion The timing of PCI may not be important in hemodynamically stable patients with NSTEMI, as long as primary PCI is performed.

Objective The respiratory rate (RR) can be monitored continuously using a HiSanso^®i, a stationary oxygen concentrator with a built-in respiratory sensor. To examine the efficacy of this device, we compared its performance with that of polysomnography in inpatient settings and the home sleep apnea test (HSAT) in residential settings for patients with interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD).

Methods The oxygen flow rate was set at 1, 3, and 5 L/min in inpatient settings and 1-3 L/min (conditions similar to the home surroundings) in residential settings. Intraclass correlation coefficients (ICCs) (2,1) were calculated to determine the agreement between the RR measured with the HiSanso^®i and that measured with polysomnography or the HSAT. The minimum acceptable reliability level is 0.7.

Results In total, 14 (10 with ILD and 4 with COPD) and 5 (all with ILD) patients were assessed in inpatient and residential settings, respectively. In inpatient settings, the detection rate of patients' respiration measured with the HiSanso^®i was 77.0% and 73.3% in patients with ILD and COPD, respectively. At oxygen flow rates of 1, 3, and 5 L/min, the ICCs (2,1) were 0.91, 0.85, and 0.91, respectively, for patients with ILD and 0.96, 0.90, and 0.74, respectively, for patients with COPD. In residential settings, the detection rate of patients' respiration measured with the HiSanso^®i was 86.6%, and the ICC (2,1) was 0.97.

Conclusion The HiSanso^®i accurately monitored the RR without any additional devices, independent of oxygen flow rates or disease status.

Objective High-dose methotrexate (HD-MTX) is widely used as central nervous system (CNS) prophylaxis in patients with diffuse large B-cell lymphoma (DLBCL) who are at a high risk of CNS relapse. Ensuring safe prophylactic administration with minimal adverse events is a key concern; however, few studies have detailed the safety profile of HD-MTX prophylaxis in patients with high-risk DLBCL. We analyzed the adverse events associated with HD-MTX in this population, focusing on delayed MTX elimination.

Methods This multicenter retrospective study included 98 patients with DLBCL at high risk of CNS relapse who received HD-MTX as part of frontline therapy between 2014 and 2020. CNS prophylaxis involved 2 cycles of HD-MTX (3.0 g/m²) at 2-week intervals.

Results The median age at the diagnosis was 63 (34-84) years old, and 34 patients received a reduced methotrexate (MTX) dose. The overall incidence of delayed MTX elimination was 18.4%. No cases of delayed MTX elimination were observed in the group that received a 3-h MTX infusion (n=50). Toxicities were more frequent in patients with delayed MTX elimination than in those without (77.8% vs. 26.2%, p≤0.05), including higher incidences of grade ≥3 adverse events and grade ≤2 renal dysfunction.

Conclusion Delayed MTX elimination is associated with increased complications. Shorter MTX infusion rates, particularly at 3 h, may reduce the risk of delayed MTX elimination.

Endoscopic ultrasound-guided pelvic abscess drainage (EUS-PAD) has emerged as a viable alternative to percutaneous drainage. However, reports of this method are limited to procedures associated with transrectal access. We herein present the first case of successful transvaginal EUS-PAD in a 22-year-old female who developed a pelvic abscess after undergoing a cesarean section. An ultrasound endoscope was inserted transvaginally to visualize the abscess. Puncture and dilation were performed and a 7 Fr endoscopic nasobiliary drainage tube was put in place. The patient showed a rapid improvement after the procedure and was discharged without any complications. This case report highlights the efficacy and safety of transvaginal EUS-PAD as a viable option for performing pelvic abscess drainage.

We herein report a 46-year-old woman with autonomously functioning thyroid nodules (AFTNs) who developed Graves' disease (GD) approximately one year after AFTN resection. Before surgery, the patient was positive for anti-thyroglobulin antibodies (TgAb) and anti-thyroid peroxidase antibodies (TPOAb), and negative for TSH-receptor antibodies (TRAb). An AFTN is a follicular adenoma surrounded by chronic thyroiditis. At the onset of GD, her TgAb and TPOAb titers increased, and TRAb became positive. This case suggests that surgery releases a large amount of thyroid tissue that contains thyroid-stimulating hormone receptors, leading to GD in susceptible individuals. Preoperative chronic thyroiditis can predict the postoperative development of GD.

Excess iodine can influence the pathophysiology of the thyroid gland and results of various thyroid-related examinations. We herein report a 60-year-old Japanese man with thyrotoxicosis and excess iodine due to habitual use of polyvinylpyrrolidone iodine (PVP-I) to gargle for 20 years. Initial laboratory and imaging findings were suggestive of painless thyroiditis. However, after cessation of PVP-I use for gargling, these results changed to findings suggestive of Graves' disease, with worsening thyrotoxicosis. A detailed questionnaire regarding excess iodine is important for the accurate diagnosis of thyrotoxicosis, even in patients living in iodine-sufficient areas where iodine-induced thyrotoxicosis is rare.

We herein report a case of IgG4-related kidney disease (IgG4-RKD) with an atypical cystic renal mass in a 73-year-old man. Computed tomography revealed diffuse renal enlargement and a cystic mass in the left kidney. Blood tests revealed elevated IgG and IgG4 levels. A renal biopsy led to the IgG4-RKD diagnosis. The cystic mass was deemed to be benign based on the clinical, imaging, and ultrasonography findings. No malignancy or abscess formation was noted. Both the renal function and IgG4 levels improved after steroid treatment; moreover, the mass shrunk, suggesting an IgG4-RKD etiology. Cystic renal masses with capsule formation should be considered in patients presenting with IgG4-RKD.

Idiopathic multicentric Castleman disease (iMCD), systemic lupus erythematosus (SLE), and IgG4-related disease (IgG4-RD) can cause lymphadenopathy with renal involvement. As no gold standards have been set for diagnosing these conditions, diagnoses can be made by excluding other conditions. However, some cases are difficult to identify. A 60-year-old man presented with lymphadenopathy, renal dysfunction, and hypocomplementemia. Autoimmune pancreatitis and iMCD had been suspected. A renal biopsy revealed immune complex-mediated glomerulonephritis superimposed on endothelial injury and plasma cell-rich tubulointerstitial nephritis with storiform-like fibrosis. While the features of iMCD, SLE, and IgG4-RD were present, a clear classification could not be achieved.

Yellow nail syndrome (YNS), a rare condition characterized by thickened yellow nails, lymphedema, and respiratory manifestations, is rarely caused by bucillamine, an anti-rheumatic agent. Respiratory manifestations of YNS include chylothorax in 18.8-22% of patients with pleural effusion. We herein report the first case of bucillamine-induced YNS with chylothorax. Lymphangiography revealed narrowing of the lymphatic vessels and stagnation of the lymphatic fluid, suggesting impaired lymphatic drainage. The chylothorax persisted despite the discontinuation of bucillamine. The present case illustrates that bucillamine can cause irreversible lymphatic impairment and chylothorax.

Advancements in immunotherapy, the phenomenon of hyperprogression in cancer patients, have garnered increasing attention. We herein report a case of acute adult T-cell leukemia/lymphoma (ATL) that developed after administration of the programmed death-ligand1 inhibitor durvalumab in a patient with lung cancer. Although the patient was a carrier of human T-cell leukemia virus type 1 (HTLV-1), this was unknown prior to durvalumab treatment. HTLV-1 bZIP factor was detected in formalin-fixed lymph node tissue, confirming the diagnosis of ATL. Our findings suggest a potential association between immune checkpoint inhibition and ATL development in HTLV-1 carriers.

Birt-Hogg-Dubé syndrome (BHDS) is an autosomal dominant disease caused by germline folliculin (FLCN) mutations and it is characterized by skin folliculomas, pulmonary cysts, and renal cell carcinomas (RCC). We herein report the first case of a female patient with BHDS who was diagnosed with multiple myeloma. Daratumumab-based treatment was effective, and the patient remained responsive for over three years. Whole-exome sequencing confirmed an FLCN germline mutation and nine somatic mutations, including an MPDZ mutation, which is a component of the tumor-suppressive Hippo-YAP pathway. Considering the reported association between the Hippo-YAP pathway and RCC with BHDS, an MPDZ mutation may contribute to carcinogenesis in patients with BHDS.

A 47-year-old man with a family history of juvenile dementia in his mother presented with memory loss and cognitive decline. Neuropsychological tests revealed impaired orientation, working memory, and apraxia. Magnetic resonance imaging revealed diffuse brain atrophy, and fluorodeoxyglucose positron emission tomography (PET) showed hypometabolism in the bilateral parietal lobes, posterior cingulate gyri, and precuneus, suggestive of Alzheimer's disease. However, amyloid-beta and tau PET scans were negative. Genetic testing revealed an abnormal repeat insertion in the prion protein gene, confirming inherited prion disease. This case highlights the need to consider inherited prion disease in the differential diagnosis of early-onset familial dementia.

We herein report an autopsy case of multiple cerebral infarctions caused by varicella-zoster virus (VZV) vasculopathy. A 60-year-old man, previously diagnosed with VZV uveitis, subsequently developed cerebral infarction with multiple cerebral vessel stenoses. Based on the results of a polymerase chain reaction test of cerebrospinal fluid, the patient was diagnosed with VZV vasculopathy. Despite treatment with acyclovir and prednisolone, the vascular stenosis progressed and became complicated by extensive cerebral infarctions. Upon autopsy, inflammatory cell infiltration was pathologically observed in the vessel walls of the anterior and middle cerebral arteries, consistent with the magnetic resonance imaging findings.

Diagnosing sarcoid neuropathy (SN) can be difficult because of its nonspecific symptoms and requirement for histological confirmation. We herein report a 71-year-old woman who presented with distal muscle weakness and paresthesia. Nerve conduction studies support the existence of polyneuropathy. Nerve ultrasonography revealed enlargement of the sural nerve and loss of the normal "honeycomb" appearance. In addition, increased intraneural blood flow within the nerve and small saphenous vein wall thickening were observed. These ultrasound findings led to a successful nerve biopsy confirming SN. Steroid therapy has resulted in clinical and ultrasonographic improvements. These results suggest the potential utility of ultrasound for diagnosing and monitoring SN.

We herein report a rare case of a 78-year-old Japanese man who developed refractory status epilepticus due to tick-borne encephalitis (TBE). The patient initially presented with left-sided hemiplegia and loss of consciousness. Initial diagnostic tests could not identify the cause of the encephalomyelitis, leading to a preliminary diagnosis of autoimmune encephalomyelitis. Despite treatment with corticosteroids and plasma exchange, the patient experienced status epilepticus, which required multiple antiseizure medications. TBE viral antibodies were eventually detected, confirming the diagnosis. Despite the treatment, the patient remained critically ill. Clinicians should consider TBE in the differential diagnosis of encephalitis of unknown origin associated with status epilepticus.

Systemic lupus erythematosus (SLE) is a systemic disease that affects several organs. The diagnosis was performed using the international classification criteria updated in 2019. The significance of anti-nuclear antibodies (ANAs) with a centromere pattern has not been clearly documented in these criteria. We herein report a patient with ANAs with a centromere pattern and anti-centromere antibodies, without anti-Sm antibodies or anti-dsDNA antibodies, who developed severe lupus nephritis, neuropsychiatric SLE, and lupus pleuritis. The patient was successfully treated with prednisolone, hydroxychloroquine, mycophenolate mofetil, cyclophosphamide, and belimumab, despite several relapses. Anti-centromere antibodies are not regarded as characteristics of SLE but can be detected in SLE patients with severe organ involvement.

Cutaneous arteritis (CA) is a rare cutaneous manifestation of Crohn's disease. A 50-year-old woman with a 15-year history of CA was admitted to our hospital with a fever, abdominal pain, and hematochezia. Based on these symptoms and increased C-reactive protein levels, systemic vasculitis was considered. However, emergency colonoscopy revealed multiple longitudinal ulcers throughout the colon, thus suggesting Crohn's disease. Prednisolone (60 mg/day) was administered intravenously. A histopathological examination of the biopsied colonic mucosa revealed epithelioid granulomas, which confirmed the diagnosis of Crohn's disease. Because the systemic evolution of CA is rare, other comorbidities should be considered when patients with CA experience systemic manifestations.

Nocardiosis typically affects immunocompromised patients; however, the clinical characteristics of idiopathic CD4 lymphocytopenia (ICL) remain poorly understood. A 64-year-old patient was diagnosed with ICL following disseminated nocardiosis, including bacteremia, pneumonia, knee arthritis, and brain abscess. The patient underwent trimethoprim-sulfamethoxazole therapy with frequent dose adjustments based on the renal function, ranging from 2 to 12 single-strength tablets daily over 5 months of hospitalization. While he had a 1-year uneventful course of lifelong prophylaxis, he experienced prolonged recovery in physical activity. A literature review highlighted the life-threatening nature of nocardiosis in ICL, underscoring the importance of a timely diagnosis and tailored management strategies.

Hyponatremic-hypertensive syndrome (HHS) is a rare disorder, particularly in adults. A 76-year-old woman presented with vomiting and severe hyponatremia. The patient had been hospitalized four times over the past four years due to hyponatremia and recurrent vomiting. On admission, magnetic resonance angiography revealed left renal artery stenosis, which led to a diagnosis of HHS. Treatment with enalapril followed by tolvaptan improved the patient's condition, without the need for renal artery angioplasty. HHS should therefore be considered in patients with hyponatremia, hypertension, or recurrent vomiting. In addition to angiotensin-converting enzyme inhibitors and renal artery angioplasty, tolvaptan may also be a new effective treatment option for HHS.