Coffee consumption has been suggested to confer protective effects against major depressive disorder （MDD）; however, the underlying mechanisms remain unclear. This study examined whether coffee and caffeine intake are associated with gut microbiota composition in individuals with MDD. We analyzed the gut microbiota of 32 patients with MDD and 34 healthy controls using 16S rRNA gene sequencing. Dietary intake, including caffeine and coffee consumption, was estimated using the Brief-Type Self-Administered Diet History Questionnaire. Depression severity was assessed using the Hamilton Depression Rating Scale （HDRS） and the Montgomery-Åsberg Depression Rating Scale （MADRS）. In the MDD group, three bacterial taxa at the family level and 15 at the genus level were significantly correlated with depression severity scores. Among these taxa, a significant interaction was observed between depression status and caffeine intake on the relative abundance of Coriobacteriales Incertae Sedis （F ［1,62］＝10.322, uncorrected p＝0.002）. These findings suggest that caffeine consumption may be associated with specific gut microbiota in patients with MDD.

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In Japan, support systems for individuals with gender dysphoria （GD） remain underdeveloped, and access to appropriate diagnosis and treatment is limited. Furthermore, specialized clinics in this field are also scarce. The aim of this study was to examine the factors influencing sleep among individuals with GD to enhance their overall well-being. A total of 126 outpatients （69 females and 57 males, mean age＝28.0±11.7 years） who received treatment at Chiaki Clinic between April 23, 2024 and June 30, 2024, were included in the study. Data on demographics, core GD characteristics, sleep disturbances based on the Athens Insomnia Scale （AIS）, depressive symptoms checked by the Self-Rating Depression Scale （SDS）, and anxiety symptoms checked by the General Anxiety Disorder-7 （GAD-7）, were extracted from medical records. The prevalence of insomnia, as determined by AIS scores, was 53.2％ among individuals with GD. Multivariate analysis revealed several factors significantly associated with insomnia （AIS≥6）, including age, employment status, hormone therapy, and specific items from the SDS and GAD-7. Insomnia in individuals with GD was associated with similar factors as seen in general psychiatric populations, such as age and employment. Hormone therapy appeared to alleviate insomnia symptoms in patients with GD. Given the string relationship between insomnia, depression, and anxiety, careful assessment and management of psychiatric symptoms are essential in this population.

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Bimaxillary osteotomy is an invasive procedure with a serious risk of bleeding and airway complications. Lidocaine with adrenaline is preferentially used to prolong local analgesia and reduce bleeding. The local anesthetic dose for this procedure can be quite high. Sustained tachycardia, potentially caused by either the adrenaline or other factors, is sometimes observed perioperatively. The anesthesia records of patients undergoing bimaxillary osteotomy between January 2021 and December 2021 were reviewed. The records of non-osteotomy patients treated between March 2019 and March 2024 with a surgical time longer than four hours were used as a control group. Possible contributing factors, such as age, sex, and dose of administered local anesthetics, were used as objective variables in a binary logistic regression analysis. The dose of lidocaine was found to be a significant negative contributing factor for tachycardia at the end of anesthesia （odds ratio ［OR］, 0.958; 95％ confidence interval ［CI］, 0.921-0.997; p＝0.035）. Other significant factors were sex （OR, 9.674） and body weight （OR, 0.908）. The local anesthetic was thought to have contributed to pain control, rather than inducing tachycardia, due to the supplemental adrenaline, and men were more prone to developing tachycardia than women. Although we failed to clarify the etiological mechanism for tachycardia after bimaxillary osteotomy, supplemental adrenaline may not be a significant cause of tachycardia during emergence from anesthesia.

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As Japan continues to face the challenges of an aging population, a community-based integrated care system has been promoted to address evolving healthcare needs. Following the revision of The Model Core Curriculum for Medical Education in 2006, the Showa University School of Medicine implemented community healthcare practical training for third-year medical students. This study is the first to report the impact of enhanced preparatory learning on students’ knowledge and attitudes toward community healthcare prior to their 2024 training. In 2024, improvements to the pre-training curriculum included a new confirmation test to strengthen knowledge of community medicine, a regional diagnosis activity based on the ACCCA framework, and role-play exercises to improve communication skills. Student self-evaluation forms and supervisors’ evaluation forms were compared between 2023 and 2024 using the unpaired Student’s t-test. Additionally, students’ self-assessed communication skills before and after the 2024 training were analyzed using the paired Student’s t-test. In 2024, students reported significant improvements in self-evaluation items related to “active participation,” “goal achievement,” and “understanding of hospital-clinic and hospital-hospital cooperation.” Supervisors’ evaluations also reflected higher scores across all assessed areas, including “attitude,” “personal appearance,” “hospitality,” “adherence to rules,” and “training performance.” Furthermore, students’ self-evaluations of communication skills improved significantly across all categories after the training. Enhanced preparation and learning prior to community healthcare practical training significantly improved students’ knowledge, attitudes, and practical skills. These findings highlight the value of structured pre-training education and suggest that improvements may contribute to the development of future healthcare professionals who are well-equipped to serve in community medicine. Future research should determine the optimal content and duration of community healthcare education.

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Previous studies have indicated an association between low-birth-weight infants （LBWIs） and delayed mental development compared with normal-birth-weight infants （NBWIs）, which can be identified through the difference in intelligence quotient （IQ） scores. We here evaluated the efficacy of the Information and Communication Technology （ICT） program called the “Kids’ Brain Balancer” （KBB）, which could predict cognitive function similar to other established neuropsychological tests. Using this application, we examined 393 children with three tasks. Results of the three tasks did not indicate a significant difference between the LBWI （n＝33） and NBWI （n＝360） groups. Further investigation may highlight the usefulness of ICT tools, including the KBB.

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Abiraterone acetate is used to treat high-risk hormone-sensitive prostate cancer and metastatic castration-resistant prostate cancer. However, drug-induced liver injury is a complication of abiraterone acetate administration. Drug-induced liver injury can be categorized as hepatocellular, cholestatic, or mixed type based on the R ratio derived from the ratio of alanine aminotransferase to alkaline phosphatase. Case 1: An 87-year-old man experienced liver injury caused by abiraterone acetate treatment of metastatic hormone-sensitive prostate cancer. Grade 4 aspartate aminotransferase and alanine aminotransferase increasing were observed for 6 weeks after treatment. The R ratio was 27.5; therefore, the drug-induced liver injury was diagnosed as the hepatocellular type. Case 2: A 66-year-old man experienced liver injury caused by abiraterone acetate treatment of metastatic castration-resistant prostate cancer. Four weeks after treatment, Grade 3 aspartate aminotransferase, Grade 4 alanine aminotransferase, and Grade 3 γ-glutamyl transpeptidase increasing were observed. The R ratio was 7.0; therefore, the drug-induced liver injury was diagnosed as the hepatocellular type.Case 3: A 74-year-old man experienced liver injury caused by abiraterone acetate treatment of metastatic hormone-sensitive prostate cancer. Four weeks after treatment, Grade 3γ-glutamyl transpeptidase and Grade 3 alkaline phosphatase increasing were observed. The R ratio was 0.4; thus, the drug-induced liver injury was diagnosed as cholestatic type. Severe drug-induced liver injury is a potential complication of abiraterone acetate therapy. Monitoring of liver function is recommended at least every 2 weeks for the first 3 months of treatment.

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