Gastrin has garnered attention in recent years as a tumor growth factor in gastric cancer, but the discovery of its similar role in colon cancer has prompted further research in this field. We investigated the relationship between serum gastrin and liver metastasis in 53 patients with colorectal cancer who visited the Usa Gastrointestinal Hospital during the twenty-year period between 1992 and 2011 for whom serum gastrin was measured before and after surgery. The items investigated included cancer stage, cancer site, gastrin levels, and the relationships between gastrin levels and tumor markers as well as pathological factors. The results showed that the rate of metastasis and gastrin levels increased with advancing cancer stage. However, gastrin levels conversely decreased in stage IV patients. The rate of liver metastasis was elevated in patients with gastrin levels ≥150 pg/mL, and the results suggested that gastrin may be an indicator in the diagnosis of metachronous liver metastasis. Moreover, histopathologically, the rate of liver metstasis was higher among patients with venous invasion, suggesting that venous invasion findings and gastrin measurement are useful for predicting liver metastasis.

　　Background & Aims: Nuclear lamin and emerin play roles in nuclear morphological maintenance. Methods: In the present study, we examined the expression patterns of lamins A, B1, B2 and emerin in 17 patients with invasive lobular carcinoma (ILC) of the breast. Using computer-assisted image analysis of immunohistochemical specimens, we determined the interrogated proteins’ positive rate relative to the total number of tumor cells. Results: We found that the percentage of lamin B2-positive nuclei was negatively correlated with mean nuclear area and nuclear perimeter. Additionally, the percentage of emerin-positive nuclei was negatively correlated with mean nuclear roundness. We also found moderate positive correlations between lamin A and lamin B1and between lamin A and emerin and a strong positive correlation between lamin B1 and emerin. The percentages of emerin- and lamin B1-positive tumor cells were significantly lower in patients with triple-negative ILC than in those with luminal ILC, including luminal A, luminal B, and luminal HER2-like ILC. Conclusions: This is the first study to evaluate the association of nuclear lamins and emerin with nuclear morphology in ILC. Our analyses suggest that lamin B2 and emerin, and not lamin A and B1, are involved in altered nuclear morphologic maintenance in ILC.

Background & Aims: COVID-19 incidence has persisted since December 2019, with emerging variants affecting infection rates in children. Limited studies exist on the effectiveness of non-pharmaceutical interventions for children. To investigate the relationship between hygiene habits and infection rates among elementary school students during the COVID-19 pandemic.

Methods: A prospective observational study was conducted with 498 students in Gunma Prefecture. Hygiene habits were surveyed, and handwashing frequency and daily physical condition were recorded from January to February 2022. Incidence of acute upper respiratory tract infections (AURI) and influenza-like illness (ILI) was calculated based on self-reports, while COVID-19 and influenza cases were confirmed via medical tests.

Results: Data was available for 431 students; 35 reported episodes of AURI, ILI, or COVID-19. Handwashing 16 or more times a day significantly reduced infection risk (OR, 0.43; 95% CI, 0.20-0.92). Cloth masks were associated with a higher infection risk compared to non-woven masks (OR, 3.02; 95% CI, 1.05-2.73).

Conclusions: Regular handwashing and the use of non-woven masks are effective non-pharmaceutical interventions to prevent infectious diseases, including COVID-19, in elementary school students.

　　The Gunma-gun Medical Association created a regional antibiogram. Data on 470 samples from six clinics were collected from 2022–2024. We collected 198 samples of gram-negative bacilli, Escherichia coli, and generated an annual antibiogram. Gram-negative bacilli, Klebsiella pneumoniae, gram-positive cocci, Enterococcus faecalis, and Streptococcus agalactiae created an antibiogram using the data collected. The sensitivity rates of Escherichia coli to antibiotics were 84.2–90.3％ for cefaclor （CCL） and 86.7–94.2％ for cefotiam （CTM）. The sensitivity rate of levofloxacin （LVFX） was 71.9–86.7％, and that of fluoroquinolone-resistant bacteria was 13.3–28.1％. The sensitivity rates of CCL, CTM, and LVFX for Klebsiella pneumoniae were 89％, 92％, and 100％, respectively. The susceptibility rate of the two gram-positive cocci was 98–100％ for ampicillin. The number of drug-resistant bacteria may be reduced by continuing the selection of appropriate antimicrobials based on regional antibiograms.

　　Cytomegalovirus reactivation (CMVR) frequently complicates treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). In the POLARIX clinical trial, polatuzumab vedotin (Pola) is the standard treatment for diffuse large B-cell lymphoma (DLBCL), but Pola with R-CHP (Pola-R-CHP) is associated with a higher incidence of febrile neutropenia than R-CHOP. However, real-world evidence is lacking. We retrospectively analyzed 72 patients with DLBCL with International Prognostic Index risk score ≥2 who received R-CHOP (n＝60) or Pola-R-CHP (n＝12) at our institution and examined the frequency of CMVR and lymphopenia in these patients. Patient characteristics were similar between the groups. None of the patients in the R-CHOP group had CMVR complications, whereas 2 patients in the Pola-R-CHP group developed CMVR. However, there was no significant difference between the two groups (p＝0.476). Although no significant difference in the frequency of lymphopenia was observed between the two groups (p＝0.446) , the 2 patients in the Pola-R-CHP group who developed CMVR had prolonged lymphopenia. This study showed that the frequency of CMVR and lymphopenia did not significantly differ between R-CHOP and Pola-R-CHOP. However, we report two unusual cases of CMVR and prolonged lymphopenia after Pola-R-CHP. Special attention should be paid to patients with multiple risk factors for CMVR.

Object: In Japan, widespread adoption of preventive long-term care activities is an urgent priority; hence, this study aims to evaluate a brain activity program called the Brain Activity Jyuku (Academy) Program in City A for its older adult residents.

Methods: A citywide recruitment conducted through City A’s public newsletter led to the selection of 40 participants. The Brain Activity Jyuku Program included 10 sessions conducted at two locations, one a mountainous area and the other an urban region. The program, led by healthcare professionals, comprised lectures on exercise, nutrition, and oral health, combined with physical activities designed to enhance brain and motor functions, as well as orientation and reflection.

Results: The results showed that scores on the RDST-J, hand grip strength and SPPB-com significant improvement in all participants when pre- and post-intervention scores were compared. Notably, participants in the mountainous area exhibited greater improvement compared to those in the urban area. Additionally, 13 participants recorded goal attainment scores on the weekly Brain Activity Challenge Sheet, and a comparison between Week 1 and Week 9 showed significant score improvement.

Conclusion: These findings suggest that the Brain Activity Jyuku Program may contribute to preventive long-term care and enhance older adults’ motivation to achieve their goals.

Objective: To examine gender differences in university students’ perceptions regarding the feasibility of measures to reduce the risk of suicide due to overwork.

Methods: 126 university students (78 males, 48 females) were presented with fictional cases of both male and female individuals who died by suicide due to overwork. Their perceptions regarding the feasibility of four preventive measures were surveyed: consulting with others, consulting with professionals, quitting work, and spouse noticing the problem.

Results: The analysis showed significantly higher percentage of male respondents perceived that consulting with others, consulting with professionals, and quitting work would be “more difficult in male cases.” In contrast, significantly higher percentage of female respondents perceived “no difference in difficulty” regarding quitting work and spouse noticing the problem.

Conclusion: The differences in perception based on gender could be partially explained by the psychosocial characteristics of men and women, including traditional gender role views. Furthermore, the results suggested a possible discrepancy between “men’s perception of women’s difficulties” and “women’s perception of men’s difficulties.” Respecting the perspectives and experiences of each gender and promoting dialogue based on these differences may contribute to the development of effective support measures for preventing suicide due to overwork.

Purpose: Fostering social capital (SC) is important for addressing the rapidly declining birthrate and aging population. The purpose of this study is to identify trends in SC research contributing to the health of the elderly in Japan.

Method: Using three literature databases, a search was conducted with the keywords “elderly” and “SC”. After removing duplicate articles and those that met exclusion criteria, 79 articles were included in the analysis. The articles were organized by publication year, type of study, main research themes, characteristics of the target regions and elderly populations, and SC indicators, including questionnaires and scales.

Results: Over 90％ of the studies were quantitative. The most common research themes were daily living functions and social participation (40 studies). The studies covered diverse regions, and more than 40％ of the studies had ADL conditions for the subjects. While 69 articles were cited as sources for SC indicators, some studies were not clear about the SC indicators they cited.

Conclusion: Going forward, applied research that aligns with the characteristics of regions and groups is expected, to enable analyses that take into account geographic context and other factors.

　　Multisystem inflammatory syndrome in children (MIS-C) can occur after coronavirus disease 2019 (COVID-19) infection. Moreover, although various viral infections have been associated with the onset of systemic lupus erythematosus (SLE）, there have been reports of its development following COVID-19 infection. Here we report the case of a 10-year-old girl diagnosed with SLE after COVID-19 who presented with an MIS-C-like course of persistent fever, bulbar conjunctival hyperemia, strawberry tongue, erythema of the anterior chest, edema of the lower extremities, lymphocytopenia, and coagulopathy. She was initially diagnosed with MIS-C and treated with oral aspirin and high-dose intravenous immunoglobulin; however, her condition did not improve. She exhibited malar rash, developed hypocomplementemia, and tested positive for anti-double-stranded DNA and anti-single-stranded DNA antibodies. The patient was subsequently diagnosed with SLE. After the initiation of oral prednisolone therapy, her symptoms improved quickly. Including the present case, 11 pediatric cases of SLE diagnosed post-COVID-19 have been reported to date. Among them, MIS-C was suspected during the clinical course in four cases. These cases demonstrate that it is crucial to distinguish between MIS-C and SLE. In cases in which fever and lymphocytopenia persist after COVID-19, SLE should be considered a differential diagnosis in addition to MIS-C.

The patient is a 64-year-old man. He was admitted to the hospital with a complaint of abdominal pain and vomiting, due to intrahepatic bile duct dilation on CT scan. After admission, ERCP revealed a common bile duct stone, and during EST, bleeding was observed from the duodenal papilla. CT revealed air in the retroperitoneal space, and a diagnosis of retroperitoneal perforation. Conservative treatment with antibiotics was started. An attempt was made to decompress the bile duct using ENBD, but was abandoned due to difficulty in cannulation. During the treatment, biliary stasis due to papillary edema was suspected, and surgery was performed to decompress the bile duct. The surgical findings showed biliary ascites in Morrison’s fossa and a sub-serosal hemorrhage in the hepatoduodenal mesentery. Laparoscopic cholecystectomy was performed, and a C-tube was placed in the bile duct from the cystic duct. Cholangiography showed no obvious leakage of contrast medium outside the bile duct. Postoperative bile excretion from the C-tube was good, and cholangiography showed no problem. The C-tube was clamped on the 6 th postoperative day. The patient was discharged on postoperative day 14. We report a case of retroperitoneal perforation treated by laparoscopic surgery.

　　A 34-year-old woman visited a nearby dental clinic with complaints of missing and loose teeth. Suspecting a bone dysplasia, she was referred to our department. She had been diagnosed with hypophosphatemic vitamin D-resistant rickets and received oral treatment until junior high school but discontinued follow-up visits on her own. Based on her symptoms and test results, she was re-diagnosed with X-linked hypophosphatemic rickets (XLH) , and we started to treat with burosumab (anti-FGF23 antibody) injections. Her occasional knee joint pain improved. In XLH, some patients discontinue treatment in childhood and revisit other departments in adulthood. For bone disorders such as XLH, it is important to educate patients from childhood about the need for continued treatment into adulthood and to raise awareness of such conditions among various medical departments.

　　A man in his 60s was diagnosed with pancreatic head cancer in month Y of year X, and began chemotherapy treatment with pain control at our outpatient pain clinic. He had been experiencing symptoms of visual and auditory hallucinations, such as “seeing figures” and “hearing commands” since month Y＋5 of year X. Since he distinguished his visual and auditory hallucinations from reality and they did not interfere with his daily life, we decided to monitor his symptoms on the advice of a psychiatrist. After being hospitalized in month Y＋11, he began receiving supportive pain control and mental care from the palliative care team. Palliative care team psychiatrists ruled out the possibility of delirium, schizophrenia, and other disorders of consciousness, determining that he was suffering from psychological dissociation caused by high self-esteem due to his previous work history and pride that prevented him from complaining. In this case, appropriate supportive care that took into consideration this background not only contributed to the disappearance of the visual and auditory hallucinations, but also achieved pain control.