Aim: Although quantitative acceptability/feasibility results on Multiple Mini-Interviews (MMIs) have been favorable, qualitative data-focused reports, especially from non-western countries are scarce. We investigated acceptability/feasibility analyses of a competency-based, applicant-centered, situational question (SQ)/past-behavior question (PBQ) -based MMI with fewer station numbers and with longer interview time for selection for Japan's basic postgraduate clinical training program (JBPGCTP) at a local teaching hospital, Okinawa Prefectural Nanbu Medical Center/Children's Medical Center (OPNMC/CMC), with emphasis on qualitative data.

Methods: First, identification of OPNMC/CMC physicians' competencies and their selection-oriented ranking were made. Based on this, a three-station MMI, with each lasting eight to twelve minutes per question was developed. This MMI was administered in an applicant-centered manner, an on-demand, first-come-first-serve style over six months annually. Interview questions were prepared in two formats, SQs and PBQs. Immediately after the MMI, both applicants and examiners were asked to complete a post-MMI survey. Qualitative analyses used the "selection procedural justice theory" for coding. Analyses periods were classified into three phases: 2013—2014 (Phase I), 2015 (Phase II), and 2016—2019 (Phase III) with the question types per station being "one PBQ then one SQ fixed in order"," PBQs/SQs alternated in order", and" only one PBQ", respectively.

Results: Quantitative analyses revealed statistically significant improvement in both applicant and examiners' perceptions: phase III than Phase I and II (P<0.05). Both stakeholders perceived PBQs to be preferable to SQs. Both felt three or four station numbers to be the most acceptable and feasible. In qualitative analyses, both acknowledged the importance of ensuring station structuredness and interview time.

Conclusion: The results showed favorable acceptability and feasibility of competency-based, applicant-centered, PBQ (rather than SQ)-based, postgraduate MMI with fewer station numbers and longer interview time per question.

Aim: Despite the established reliability of multiple mini-interviews (MMIs), some studies have questioned the practicability of setting approximately seven or more stations and of administering them “all-at-once”. Besides, limited evidence exists of MMIs' reliability related to (a) interview time and (b) two interview question types: situational questions (SQs) and past-behavioral questions (PBQs). This study investigated reliability of a competency-based, applicant-centered, SQ/PBQ-based postgraduate MMI with fewer stations and longer interview time.

Methods: To recruit trainees into Japan's Basic Postgraduate Clinical Training at a local teaching hospital, 16 physician competencies were identified, and of those, six were selected using social science techniques. With these, a “three-station, two examiners per station” MMI was developed. The MMI was administered on a “first come, first serve” (“on-demand”) basis over six months annually. Analysis periods comprised 2013-2014 (Phase I), 2015 (Phase II), and 2016-2019 (Phase III), which represented the per-station question formats of “one PBQ then one SQ fixed order, each lasting eight minutes”, “one PBQ/one SQ alternated, each lasting eight minutes”, and “only one PBQ, lasting 12 minutes”, respectively. Generalizability studies were performed to determine reliability of the MMIs.

Results: The MMIs in Phase I and II exhibited a generalizability coefficient (G. Coef.) of 0.844 and 0.735, respectively. The PBQ and SQ formats in Phase I exhibited a G. Coef. of 0.870 and 0.868, respectively. The PBQ and SQ formats in Phase II exhibited a G. Coef. of 0.742 and 0.754, respectively, and the PBQ format in Phase III exhibited a G. Coef. of 0.889.

Conclusion: The present study demonstrated favorable reliability of a competency-based, applicant-centered, SQ/PBQ-based postgraduate MMI with fewer stations and longer interview time. Both SQ- and PBQ-based stations showed equal reliability. However, the highest reliability was found with the station format of single PBQ and longer interview time.

Objectives: The aim of this study was to evaluate the effects of minimum incision endoscopic radical prostatectomy with intentional wide resection on urinary and sexual QOL in patients with prostate cancer.

Methods: We enrolled 101 patients, 72 in the minimum incision endoscopic radical prostatectomy group and 29 in the laparoscopic radical prostatectomy group as control. QOL was assessed using the Expanded Prostate Cancer Index Composite questionnaire. The evaluation items consisted of: urinary function, urinary bother, sexual function, sexual bother, pad-free rate, and satisfaction. Questionnaires were administered once preoperatively and six times postoperatively. In addition, we analyzed factors other than surgical technique that affected QOL.

Results: There was no significant difference in urinary domain scores between the two groups. pad-free rate was higher in the minimum incision endoscopic radical prostatectomy group. Sexual function scores showed a significant decrease at 4 weeks postoperatively in both groups and did not improve thereafter; however, no significant difference was finally found between the groups. There was no significant decrease in sexual bother score and satisfaction postoperatively, and there was no significant difference between the groups. Age influenced the preoperatively sexual function score. Although there was no significant difference between the groups at any time point, the younger group consistently had a lower sexual bother score.

Conclusion: Minimum incision endoscopic radical prostatectomy did not significantly decrease QOL compared with laparoscopic radical prostatectomy. Age had a greater impact on QOL than surgical technique. Sexual dysfunction should be taken into consideration, especially when treating younger patients.

Background: Transcatheter aortic valve implantation (TAVI) is increasingly common in older adults with severe aortic stenosis. Changes in systemic blood pressure after TAVI have been reported, however, prognostic significance of low systolic blood pressure (sBP) at discharge remains unclear.

Methods: We retrospectively analyzed 946 patients who underwent TAVI at our institution between January 2016 and March 2023. Patients were categorized into two groups according to their discharge sBP: <90 mmHg and ≥90 mmHg. The primary endpoint was a composite of all-cause mortality and heart failure rehospitalization. Secondary endpoints included all-cause mortality and heart failure rehospitalization.

Results: 941 patients were included in the study. The sBP <90 mmHg group (n=27) had higher surgical risk and frailty than the sBP ≥90 mmHg group (STS 6.2 [4.1—11.6] vs. 4.8 [3.4—7.2]; Clinical Frailty Scale 5 [4—6] vs. 4 [3—5]). The 1-year composite endpoint did not differ between groups, and the secondary endpoints were similar. In multivariable analyses adjusting for history of hypertension, admission sBP, age, sex, and STS, discharge sBP<90 mmHg was not associated with the 1-year composite outcome (adjusted OR 1.22 [95% CI 0.41—3.64], p=0.725).

Conclusion: Among patients undergoing TAVI, discharge sBP <90 mmHg was not associated with worse 1-year outcomes despite higher baseline frailty and comorbidity burden, underscoring the value of individualized physiology-guided blood pressure management after TAVI.

Objective: To analyze the differences in age at death and cause of death between individuals with and without diabetes.

Materials and Methods: This study was a retrospective, single-center, observational study conducted at an acute-phase medical facility in urban Japan. We included adult patients who died at St. Marianna University Hospital between January 2011 and December 2020 (n=9,627). Data were extracted from electronic medical records, including sex, age at death, cause of death based on the International Classification of Diseases, 10th revision (ICD-10) codes, and the presence or absence of diabetes. The Chi-square test was employed to compare the distribution of causes of death between patients with and without diabetes.

Results: Of the 9,627 patients, 836 (8.7%) were diagnosed with diabetes. The median age at death [interquartile range] was 76.0 [65.0-84.0] years in patients without diabetes and 75.5 [68.0-81.0] years in those with diabetes (p=0.57). The peak age at death was in the 70s for patients with diabetes and in the 80s for those without. Malignant neoplasia (38.4%) was the leading cause of death in the diabetes group, followed by infection (12.4%), cerebrovascular disease (5.6%), and cardiovascular disease (5.1%). Malignant neoplasia, infection, and cerebrovascular disease were significantly more common in patients with diabetes, whereas cardiovascular mortality did not differ substantially between groups.

Conclusions: The difference in age at death between patients with and without diabetes has recently narrowed. Although the median age at death was similar, the age distribution was modestly shifted toward younger ages in patients with diabetes. These findings underscore the importance of early diagnosis, comprehensive risk factor management, and treatment of complications and comorbidities, including malignant neoplasms, infections, and cerebrovascular disease (particularly cerebral infarction), which are important for achieving diabetes treatment goals. The small difference in cardiovascular mortality underscores the need for risk control.

Objective: Severe airway stenosis caused by endobronchial tuberculosis (EBTB) often requires repeated interventional bronchoscopic procedures, complicating long-term airway management. This study aimed to evaluate the long-term efficacy of interventional bronchoscopy in the management of EBTB-related airway stenosis.

Methods: We retrospectively reviewed the medical records of 14 patients with EBTB who underwent interventional bronchoscopic procedures, including balloon dilation and airway stenting, between April 1, 2004, and October 16, 2021.

Results: Fourteen patients were followed up for a median duration of 10.5 years (range, 2—33 years). Thirteen patients underwent balloon dilation and 8 required stenting. One patient who did not undergo balloon dilation received airway stenting alone.

Silicone Y stents were placed in 4 cases of tracheobronchomalacia and silicone straight stents were placed in 2 cases of bronchomalacia and 2 cases of bronchial scar stenosis. Silicone straight stents were successfully removed 4 to 12 years after placement in a total of 3 cases: 1 case of bronchomalacia and 2 cases of bronchial scarring stenosis.

The silicone Y stents were replaced in seven patients because of complications, including granulation tissue formation, adherent secretions, or stent deterioration. Twelve patients remained clinically stable throughout the follow-up period; however, two patients died owing to complications from stent-related granulation tissue formation and infection.

Conclusion: Balloon dilation and airway stenting are effective for managing unilateral main bronchial stenosis in patients with EBTB. However, tracheobronchomalacia presents significant challenges owing to frequent stent-related complications, emphasizing the need for careful long-term management.

[Introduction] At our Emergency and Critical Care Center, Emergency department physicians have traditionally activated a trauma code upon notification of a severely injured patient and initiated initial management in parallel with paging surgical services and radiology. On January 1, 2023, a hybrid emergency room system (HERS), co-locating Computed Tomography (CT) and an angiography suite, was introduced. We examined how this system changed our response, focusing on access to CT and angiography.

[Methods] We conducted a comparative study of trauma code activations during two one-year periods that excluded the COVID-19 peak: pre-HERS (January 1—December 31, 2019) and post-HERS (April 1, 2023—March 31, 2024). Severely injured patients for whom a trauma code was activated were analyzed.

[Results] Among 772 trauma patients, trauma code activations involved 35 patients in the pre-HERS group (PHEG) and 15 in the HERS group (HERG). Similar results were observed in regional Emergency Medical Service (EMS) trauma statistics. Patient severity did not markedly differ between the groups. The percentage of patients with pelvic fracture was higher in HERG. Arrival-to-CT time was significantly shorter, while the rate of transcatheter arterial embolization (TAE) was significantly higher in HERG. Although survival to hospital discharge did not significantly differ between the groups, social reintegration was significantly higher in HERG (P<0.05). In a multivariable analysis with social reintegration as the dependent variable, HERS implementation was identified as an independent predictor (P=0.01).

[Conclusion] The implementation of HERS in trauma code activations was associated with shorter arrival-to-CT times, increased pelvic fracture identification and TAE utilization, and a higher rate of social reintegration, suggesting system-level benefits beyond immediate survival.

Objective: This study aimed to identify human leukocyte antigen (HLA) alleles associated with arthritis and/or enthesitis in pediatric patients and compared their allele frequencies with those of healthy controls.

Methods: This retrospective cohort study included 23 patients aged under 18 years who had presented with arthritis or enthesitis and underwent HLA typing at our hospital from 2008 to 2023 (group 1). Among them, 19 seronegative patients without autoimmune diseases were classified as group 2. In group 1, we further analyzed 12 patients with enthesitis (group 3) and 11 without enthesitis (group 4), respectively. HLA allele frequencies were compared with those of healthy controls from the Japan Marrow Donor Program using Fisher's exact test.

Results: Groups 1, 2, and 3 demonstrated significantly higher HLA-B46 frequencies compared with the controls (odds ratio [OR]=3.81, p=0.004; OR=3.98, p=0.007; OR=5.59, p=0.004, respectively). Group 4 exhibited no significant difference in the HLA-B46 frequency.

Conclusion: In pediatric patients, HLA-B46 has been implicated as an HLA type associated with enthesitis. The result of this study may help elucidate the pathogenesis of pediatric enthesitis and assist in developing HLA-based classification and prediction strategies.

The Model Core Curriculum for Medical Education in Japan—2022 revision was designed to cultivate medical professionals capable of responding to future societal needs and healthcare challenges. This study evaluated the relationship between 125 items describing essential qualities and abilities in the revised curriculum and the syllabi of all courses offered at St. Marianna University School of Medicine in academic year 2023. Relationships were recognized only when explicitly stated in the syllabi or distributed materials and included in the scope of regular examinations. Of the 125 items, 35 (28.0%) showed no relationship to the curriculum. Most frequently unaddressed were “Clinical Skills,” “Problem Solving,” and “Medicine in Society.” Deficiencies were also noted in newly introduced domains of “Generalism” and “Information Technology,” suggesting that the current curriculum insufficiently covers essential competencies required to maintain healthcare quality and adapt to structural changes in society. A reconstructed curriculum was needed that emphasized horizontal and vertical integration and implemented practical education fostering “can-do” abilities. Rapidly advancing emerging technologies also urgently required new guidelines for educational use of generative artificial intelligence (AI). Accordingly, formal guidelines entitled “Guidelines on the Use of Generative AI in Medical Education” were established in 2025 to promote appropriate educational applications of AI. Relevant departments addressed insufficient items, and new courses such as “Application of AI in Medicine” were incorporated into the 2025 academic year curriculum alongside expanded instruction on healthcare professionals' workplace management and genetic analysis in the Department of Clinical Laboratory Medicine. Further, this survey revealed a lack of curricular content aligned with the constantly evolving medical environment, including domestic and international circumstances, relevance of regional and social structures, and quality of healthcare delivery. Continuous development of curriculum is needed that encompasses universal medical knowledge and also integrates adaptive elements responsive to changes in the medical field over time.