Objective This study explored the conditions for applying telemedicine to patients with inflammatory bowel disease (IBD), attempting to demonstrate that the application of telemedicine to patients with IBD does not adversely affect their condition and clarifying the form of telemedicine that meets the needs of patients with IBD.

Methods Study 1 retrospectively investigated the application of telemedicine and its impact on IBD treatment, whereas Study 2 investigated the perceptions of telemedicine in patients with IBD.

Patients Study 1 was conducted using the medical records of 267 patients with IBD who had been treated at our department throughout the financial years (FY) 2019 and 2020. In Study 2, a questionnaire survey was presented to 113 patients from Study 1, who agreed to complete the questionnaire.

Results No patient background factors significantly influenced telemedicine implementation in FY 2020. A shorter disease duration, relapse in the previous FY, and lower Hb levels were significantly related to relapse in FY 2020, whereas the use of telemedicine was not related to relapse. The survey revealed that most patients with IBD preferred a conventional face-to-face treatment system; however, patients who had difficulty finding the time to visit the hospital tended to prefer telemedicine.

Conclusion Telemedicine can be implemented in patients with IBD without adverse effects on their medical conditions; however, the appropriate conditions for applying telemedicine need to be clarified in the future. It is necessary to establish an IBD treatment system that satisfies patients' needs, considering the characteristics of those who wish to receive telemedicine.

Objective Understanding the prevalence of screening targets is essential for optimizing cancer-screening strategies. However, the precise clinicoepidemiological characteristics of Helicobacter pylori-naïve gastric cancer (H. pylori-naïve GC), especially the undifferentiated type, remain unknown. We herein aimed to confirm the clinicopathological characteristics of H. pylori-naïve patients with undifferentiated GC in Japan.

Methods This retrospective cross-sectional study used a database of esophagogastroduodenoscopies (EGDs) from 12 Japanese institutions (2016-2022). Patients who underwent EGD as part of their health monitoring were analyzed for the prevalence and clinical characteristics of H. pylori-naïve undifferentiated GC, including pure signet ring cell carcinoma (PSRCC) and por/sig lesions. The previous EGD images were reviewed to estimate the rate of missed lesions.

Results Among 222,656 individuals, 35 PSRCC and 7 por/sig lesions were identified (prevalence: 0.020% and 0.003%, respectively). Por/sig lesions were more frequently located in the upper half of the stomach than were PSRCC lesions (71.4% vs. 40.0%, p=0.040). All PSRCC lesions were classified as pT1a, whereas 71.4% of por/sig lesions were pT1b or deeper, and 57.1% required surgery. Furthermore, 44.4% of PSRCC lesions were missed during previous EGDs, whereas none of the por/sig lesions were overlooked.

Conclusion The prevalence of undifferentiated H. pylori-naïve GC was low. Compared with PSRCC, por/sig lesions were diagnosed at a more advanced stage and were not identified during previous examinations, highlighting their difficulty in detection during routine EGD screening. These findings underscore the need to revise EGD screening strategies, particularly in populations with a low prevalence of H. pylori infection.

Objective Reflux esophagitis (RE) is caused by gastroesophageal acid reflux, whereas the heterotopic gastric mucosa (HGM) of the cervical esophagus often shows acid secretion. This study investigated whether an intra-esophageal acidic condition in patients with RE or HGM prevents the occurrence of esophageal candidiasis.

Materials We enrolled 5,221 adults (males/females: 3,260/1,961, mean age 54.8±9.8 years) who underwent an esophagogastroduodenoscopy (EGD) examination as part of a medical checkup. The presence of esophageal candidiasis, RE, and/or HGM in the cervical esophagus was endoscopically determined, and the risk factors for esophageal candidiasis were investigated.

Results The EGD findings revealed esophageal candidiasis, RE, and HGM of the cervical esophagus in 176 (3.4%), 1,119 (21.4%), and 367 (7.0%) patients, respectively. A multiple logistic regression analysis showed that an older age, habitual alcohol consumption, and comorbidities (poorly controlled diabetes mellitus, bronchial asthma with steroid therapy, autoimmune disease with immunosuppressive treatment, and/or malignant disease with chemotherapy) were significant risk factors, whereas RE was negatively correlated with esophageal candidiasis. HGM of the cervical esophagus was not significantly related to its occurrence.

Conclusion Esophageal candidiasis was found in 3.4% of the subjects who underwent EGD for a medical checkup. RE was negatively correlated with esophageal candidiasis, whereas HGM of the cervical esophagus did not show such an association.

Objective The intracoronary acetylcholine (ACh) provocation test is an invasive standard for diagnosing coronary spastic angina (CSA)/vasospastic angina. Although the guidelines recommend incremental doses of ACh, the clinical relevance of the significant response to lower ACh doses is unclear.

Methods From April 2012 to June 2024, 636 patients with no significant epicardial coronary disease undergoing intracoronary ACh provocation testing for the diagnosis of CSA were included. Patients with positive ACh test results were divided into two groups: the low-dose positive group, defined as those who tested positive at the initial dose of ACh in the left and/or right coronary arteries without further dose escalation, and the high-dose positive group, including those who required higher doses for a positive result. The occurrence of intraprocedural adverse events and long-term outcomes was also evaluated.

Results Of the 636 patients, 306 (48.1%) were classified as negative, 304 (47.8%) as high-dose positive, and 26 (4.1%) as low-dose positive based on the ACh provocation tests. The baseline characteristics did not differ significantly between the high- and low-dose positive groups. ST-segment elevation on electrocardiography during ACh tests and unstable angina during the follow-up period were more frequent in the low-dose positive group than in the high-dose positive group, while the overall clinical outcomes were similar among the groups.

Conclusion Among patients with CSA diagnosed using ACh provocation testing, nearly 10% had a positive diagnosis at a low dose. There may be distinct underlying mechanisms and clinical outcomes depending on the ACh dose required for a positive test result.

Objective Although nintedanib is commonly used to treat interstitial lung disease (ILD), its clinical utility is often limited by adverse gastrointestinal events. Ramosetron, a selective 5-HT₃ receptor antagonist, has shown efficacy in managing irritable bowel syndrome; however, its effects on nintedanib-associated abdominal symptoms remain unclear. This study evaluated the effect of ramosetron on continuation of nintedanib therapy.

Methods This retrospective analysis enrolled patients with ILD who received nintedanib at our institute between August 2018 and October 2024, and the clinical courses of those receiving nintedanib with or without ramosetron were compared. The duration of nintedanib administration was evaluated using the log-rank test, and a multivariate Cox proportional hazards regression analysis was performed to identify the factors associated with the duration of nintedanib treatment.

Results Among the 142 patients included in the analysis, 55 were administered ramosetron and 87 were not. The duration of nintedanib therapy was significantly longer in the ramosetron group than in the non-ramosetron group (1,269 vs. 497 days; p=0.005). Ramosetron administration was an independent factor associated with prolonged nintedanib treatment even after adjusting for clinical variables. Notably, ramosetron treatment initiated after nintedanib therapy was more effective than its prophylactic use.

Conclusion Ramosetron administration significantly correlated with prolonged duration of nintedanib therapy. The selective use of ramosetron may improve adherence to nintedanib treatment. However, prospective studies are required to validate these findings.

Objective The homocysteine levels are risk factors for vascular events and dementia. However, whether their predictive validity is similar remains unknown. We compared the utility of the homocysteine levels for predicting vascular events and Alzheimer's disease (AD) and dementia in the same population.

Methods This study was a Japanese hospital-based cohort study. A total of 426 patients with vascular risk factors were followed for a median of 4.65 years. Based on the homocysteine levels, patients were divided into three groups: 1st tertile (≤8.2 nmol/L, n=141), 2nd tertile (8.3-10.9 nmol/L, n=141), and 3rd tertile (≥11.0 nmol/L, n=144). They were also divided with the cut-off value of 15.0 nmol/L into high (n=55) and low (n=371) groups. The outcomes were stroke, major cardiovascular events (MACE), and AD dementia.

Results During follow-up, stroke, MACE, and AD dementia occurred in 23, 31, and 15 patients, respectively. Patients in the 3rd tertile and high groups were more likely to have incident stroke and MACE than those in the other tertiles or low group. Patients with high homocysteine levels had a higher risk of stroke (hazard ratio 3.59; 95% confidence interval 1.09-11.83) and MACE (hazard ratio 5.19; 95% confidence interval 1.90-14.15) than those with low homocysteine levels after adjustment for confounding factors. However, no association was observed between the homocysteine levels and AD.

Conclusion High serum homocysteine levels, especially more than 15.0 nmol/L, were significantly associated with vascular events but not with AD dementia in the same population during a 4.65-year follow-up period.

Objective Iguratimod (IGU) is a synthetic disease-modifying anti-rheumatic drug that is mainly used in East Asia. Kidney impairment related to IGU may be under-recognized, and its proportion, severity, and risk factors remain unclear. To assess the influence of IGU on the kidney function among rheumatoid arthritis (RA) and to clarify the risk factors associated with kidney impairment.

Methods We retrospectively assessed the influence of IGU on the kidney function in patients with RA and identified the risk factors associated with kidney impairment. We enrolled patients with RA who had been treated with IGU. The clinical characteristics, including the estimated glomerular filtration rate (eGFR), were assessed. The difference in eGFR between baseline and after 3 months of treatment (ΔeGFR) was calculated, and kidney impairment was defined as Δ an eGFR ≥15% from baseline. ΔeGFR was defined as the magnitude of decline in eGFR from baseline to the observation time point. A positive ΔeGFR value indicates a reduction in the kidney function.

Results Among 108 patients, Δ an eGFR ≥15% was observed in 32 patients (30%). Concomitant use of salazosulfapyridine (SASP) was more frequent in patients with ΔeGFR ≥15% than in those with ΔeGFR <15%. The median ΔeGFR was higher in patients with IGU and concomitant SASP than in those without. SASP use was identified as the only significant risk factor for Δ an eGFR ≥15% in a binomial logistic regression analysis. The same analysis, after propensity score matching, also yielded similar results.

Conclusion IGU combined with SASP reduced eGFR more than IGU alone, and SASP was an independent risk factor for ΔeGFR ≥15% among RA patients treated with IGU.

We present the case of a woman with heterozygous familial hypercholesterolemia with a history of myocardial infarction at 53 years of age. Her initial low-density lipoprotein (LDL) cholesterol level was 312 mg/dL, which was reduced to ~50 mg/dL using statins, ezetimibe, and evolocumab. However, the patient also had diabetes, and its management gradually worsened. We introduced oral semaglutide, which contributed not only to the good management of diabetes, but also to the further reduction of LDL cholesterol in addition to intensive LDL-lowering therapies, including statins, ezetimibe, and evolocumab.

Constrictive pericarditis (CP) is often underdiagnosed, partly because of the lack of established diagnostic criteria. Exaggerated ventricular interdependence during inspiration is a hallmark physiological feature of CP. We herein report the case of a 55-year-old patient with CP who demonstrated a hemodynamic improvement following pericardiectomy. This case is characterized by two features: (1) delayed-onset CP 36 years after undergoin thoracic radiotherapy, which developed without pericardial calcification in contrast to severe aortic calcification, and (2) a postoperative improvement of inspiratory-exaggerated ventricular interdependence, documented by intracardiac pressure tracings. This case provides meaningful insight into the diagnosis and management of radiation-induced CP.

Staphylococcus saprophyticus primarily colonizes the lower gastrointestinal tract; however, infections from this site are rarely reported. A 77-year-old man developed an ischemic stroke and fever. Blood cultures showed S. saprophyticus, but repeated transthoracic echocardiography showed no vegetation. The patient was discharged after two weeks of antibiotic treatment. Four months later, the patient was readmitted with recurrent fever and stroke, and transesophageal echocardiography confirmed infective endocarditis (IE). No urinary or catheter-related entry was identified; however, a rectal ulcer was detected. This case highlights the potential of S. saprophyticus, a low-virulence bacterium, to cause IE with significant morbidity, and suggests gastrointestinal mucosal disruption as an entry site.

A hypothyroid mother, due to thyroid stimulation-blocking antibody (TSBAb), gave birth three times. Although her TSBAb levels remained almost 100%, her thyrotropin receptor antibody (TRAb) levels before delivery varied as follows: 315.0, 88.2 and 34.9 IU/L in the first, second, and third pregnancies, respectively. The first baby had a hypoplastic thyroid gland and developed severe hypothyroidism three days after birth. The second and third babies only showed latent hypothyroidism. Apparent neonatal hypothyroidism due to maternal TSBAb occurs when TRAb levels are very high, and extremely high TSBAb activity might impair not only the fetal thyroid function, but also its development.

An 81-year-old man was treated with prednisolone, avacopan, and rituximab for microscopic polyangiitis and sulfamethoxazole/trimethoprim (SMX/TMP) and vonoprazan for prophylaxis. The liver enzyme levels were elevated 42 days after avacopan administration. Avacopan, SMX/TMP, and vonoprazan treatment were discontinued. A liver biopsy revealed vanishing bile duct syndrome. The patient was subsequently treated with ursodeoxycholic acid and glucocorticoid. Although vasculitis remained in remission, the patient ultimately died. Autopsy revealed persistent bile ductopenia and progressive liver cell injury confirmed by cytokeratin 7 positivity, severe cholestasis, and portal fibrosis. Further studies are required to elucidate associated mechanisms and risk factors.

Copper deficiency is a rare but critical cause of anemia and neurological impairment. We herein report a hemodialysis patient who developed acute-onset copper deficiency after spinal surgery with zinc supplementation, despite no gastrointestinal surgery. The anemia was unresponsive to oral copper but improved with intravenous administration. We analyzed clinical data from copper-deficient patients at our institution and in the literature and compared them with matched dialysis controls. Our findings indicate the cumulative impact of multiple risk factors. Clinicians should consider functional copper deficiency in dialysis patients with unexplained anemia after surgery.

We report a rare case of small-cell lung cancer (SCLC) detected 14 months after the initial manifestation of brain metastases. A 71-year-old man presented with neurological symptoms that led to the resection of brain neuroendocrine carcinoma (NEC). Despite extensive imaging, no primary tumor was detected during the initial visit. Fourteen months later, a lung nodule appeared in the emphysematous bullae in the left upper lobe, which was confirmed as SCLC. Chemotherapy plus durvalumab was administered to control the tumor. This case highlights the diagnostic challenges of occult SCLC and emphasizes that brain NEC should be carefully followed-up, particularly in patients with emphysema.

We herein report a case of refractory pneumothorax in a patient with interstitial lung disease that was successfully treated using medical thoracoscopy-assisted thoracographic fibrin glue sealing (MTS-TGF). This novel hybrid technique enables accurate leak localization and safe delivery of fibrin glue under direct visualization and fluoroscopic guidance. The procedure achieved substantial leak reduction followed by complete resolution without surgical intervention. MTS-TGF may enhance the precision and safety of conventional TGF, particularly in anatomically complex or high-risk patients. This case supports MTS-TGF as a promising minimally invasive option for persistent air leaks when surgery is contraindicated.

Symptoms of bleeding caused by vitamin K-dependent coagulation factor deficiency (VKCFD) are rare in adults. We present two Japanese cases of adult-onset VKCFD, in which the cause of vitamin K deficiency remains unknown despite comprehensive evaluation. Both patients showed markedly decreased levels of coagulation factors (F) VII, FIX, FX, FII, protein C, and protein S, along with elevated levels of protein induced by vitamin K absence/antagonist II. The clinical course in both cases ruled out congenital VKCFD. Based on these findings and a similar case in the relevant literature, we propose a new disease entity, idiopathic acquired VKCFD.

Agranulocytosis is an extremely rare but potentially fatal immune-related adverse event (irAE) induced by immune checkpoint inhibitors (ICIs). Its management, particularly following combination therapies such as durvalumab/tremelimumab (Dur/Tre) for hepatocellular carcinoma (HCC), is challenging owing to limited data. We herein report a 79-year-old man with HCC who developed severe Dur/Tre-induced agranulocytosis that was refractory to granulocyte colony-stimulating factor, high-dose corticosteroids, and intravenous immunoglobulin. Subsequent treatment with oral cyclosporine (CsA), carefully dosed for liver cirrhosis, achieved complete hematologic recovery. This report details a successful management strategy for this rare, life-threatening irAE, suggesting the potential utility of CsA after initial therapies fail.

We herein report two cases of tractopathy affecting the bilateral corticospinal tracts (CSTs) and the spinal cord following coronavirus disease 2019. Both patients developed progressive sensorimotor deficits with spasticity, a truncal sensory level with severely impaired deep sensation, and bowel/bladder dysfunction one to three months post-infection. Magnetic resonance imaging revealed bilateral CST and lateral column lesions. Somatosensory evoked potentials confirmed posterior column dysfunction. Initial treatment with intravenous methylprednisolone and immunoglobulin was ineffective; however, multiple courses of immunotherapy and prolonged corticosteroids led to marked improvement. These cases suggest a tract-specific, delayed, immune-mediated process triggered by severe acute respiratory syndrome coronavirus 2, underscoring the need for extended immunotherapy for optimal recovery.

We herein report a case of amyloid-related imaging abnormalities (ARIA)-E/H following lecanemab treatment in a 70-year-old man with mild cognitive impairment due to Alzheimer's disease. Generalized seizures occurred after the third infusion and were accompanied by fluid attenuated inversion recovery hyperintensity, microbleeds, and a minor acute infarct. Amyloid positron emission tomography revealed focal clearance of amyloid plaques in the ARIA-affected regions. CSF Aβ40 levels transiently decreased by about 30% during the ARIA episode, whereas Aβ42 remained stable, thereby increasing the Aβ42/40 ratio. These findings suggest that ARIA may facilitate focal amyloid clearance and that CSF Aβ40 reduction may serve as a potential biomarker for ARIA onset and resolution.

A 29-year-old woman with no medical history visited our hospital with a sudden onset of headache. Magnetic resonance imaging and angiography of the head and neck demonstrated an occlusion and intramural hematoma in the right vertebral artery. We diagnosed vertebral artery dissection and provided treatment to reduce her headache and control her blood pressure. The patient's symptoms and imaging findings gradually improved. Blood biochemistry was positive for anticardiolipin antibodies. Anticardiolipin antibodies are often associated with thromboembolism but rarely associated with the development of arterial dissection in the cerebral artery. We present a case of vertebral arterial dissection and anticardiolipin antibody positivity along with a discussion of the related literature.

Methotrexate (MTX) is an established anchor drug used for the treatment of rheumatoid arthritis. Patients receiving MTX are at an increased risk of developing MTX-associated lymphoproliferative disorders (MTX-LPDs). A diagnosis of MTX-LPD requires a pathological evaluation; however, biopsy samples are often unavailable because of the anatomical location of the lesions and their rapid regression following MTX withdrawal. In cases in which a biopsy is not feasible, biomarkers may aid in predicting the responsiveness to MTX cessation. This report describes a case of MTX-associated systemic lymphadenopathy characterized by a marked elevation in the serum IgG4 concentration. These findings suggest the potential role of serum IgG4 as a novel biomarker of MTX-LPD.

Behçet's disease (BD) is a multisystem inflammatory condition that rarely affects the nasal mucosa. We report the case of a 25-year-old man presenting with prolonged fever, bilateral rhinalgia, and nasal obstruction, who was subsequently diagnosed with nasal ulcers associated with BD. These ulcers resolved along with the systemic symptoms following treatment with colchicine, apremilast, and prednisolone. Although there is no specific treatment strategy for nasal mucosal lesions in BD, standard systemic therapies may be effective. This case highlights nasal mucosal involvement as a rare but important manifestation of BD, emphasizing the importance of thorough evaluation and consideration of nasal symptoms for the diagnosis and treatment.

Pneumomediastinum refers to the accumulation of air in the mediastinum, which may occur due to trauma, esophageal perforation, or spontaneously. Although rare, dental procedures, especially those involving air turbine drills, can cause mediastinal emphysema. Most reported cases are related to tooth extraction; however, nonextraction procedures may also be associated with this complication. We report the case of a 65-year-old woman who developed facial and neck swelling following a dental procedure using an air turbine drill, and provide a review of the relevant literature.