In recent years, hospital-based geriatricians and general practitioners in Japan who frequently manage older people with multimorbidity in an acute setting have often found treating these patients difficult. In this study, we surveyed geriatricians and general practitioners who treat older people with multimorbidity in hospitals to identify patient characteristics that make treatment provision difficult in these patients. In June 2022, we mailed an anonymous questionnaire to 3,300 family medicine specialists, primary care-certified physicians, and geriatric specialists in Japan. We used a four-point Likert-type scale to score items specific to diseases, patient backgrounds, clinical factors, and important clinical strategies that make treatment provision difficult. We used logistic regression analysis to identify factors that hospital-based geriatricians and general practitioners associate with difficulty in treating older adults with multimorbidity. In total, 490 cases were included in the analysis. The factors that were associated with difficulty in treating older people with multimorbidity were experience as a physician (adjusted odds ratio [AOR]: 0.935; 95% confidence interval [95% CI]: 0.905-0.965), the overall scores for difficult disease (AOR: 1.028; 95% CI: 1.004-1.053) and difficult background (AOR: 1.065; 95% CI: 1.005-1.129), and the lack of emphasis on general practice guidelines (AOR: 2.91; 95% CI: 1.305-6.491). To facilitate the treatment of older people with multimorbidity, it is desirable to enhance education and training and strengthen support systems within Japan’s healthcare system based on the characteristics of hospital physicians who find treating these patients difficult.

Most pediatric intravenous anesthesia in Japan is performed outside the operating theatre by non-anesthetists. The 2020 revision increased reimbursement for long-term intravenous anesthesia (Category 3) by anesthesiologists, but its impact on practice behavior is unknown. We analyzed the annual number of calculations for each category of intravenous anesthesia and their age distribution from the national reimbursement data for the three-year period fiscal years (FY) 2018-20 to elucidate trends in the pediatric age group. Regional disparities of calculation rate of pediatric addition per capita were examined. According to FY 2019 statistics, 5,774 outpatient intravenous anesthesia and 50,686 inpatient intravenous anesthesia procedures were performed annually in patients under 15 years of age. Of these, no case was complex anesthesia (Category 3) performed by a specialist anesthesiologist in outpatient settings and 1,162(3.9%) in inpatient settings. Category 3 occupancy was slightly higher in infants and decreased with age. (P < 0.01) In FY 2020 data, 41(0.7%) new Category 3 procedure were calculated in outpatient cases. The share of Category 3 in inpatient cases decreased to 2.0%. There was no decrease in the number of overall venous anesthesia due to COVID-19 pandemic. Regional disparities in calculations were up to 20 times greater. Long-term total intravenous anesthesia by anesthesiologists is rarely performed in Japan. Improvements in reimbursement are not sufficient to enable total intravenous anesthesia by a specialized anesthesiologist. A system for safe intravenous anesthesia by non-anesthesiologists is needed.

The pathological process of atherosclerosis begins in childhood and increases the risk of myocardial infarction, other cardiac diseases, and subsequent stroke. To investigate the relationship between maternal low-density lipoprotein cholesterol (LDL-C) level during pregnancy and LDL-C level in offspring at 8 years old. The Japan Environment and Children’s Study (JECS) is an ongoing birth cohort study to elucidate the effects of environmental factors on health from the fetal period to early childhood. A total of 1,226 mother–child pairs were enrolled in the present study, which was conducted as an adjunct study to the JECS at the Kochi Unit Center (Kochi, Japan). Peripheral blood samples and anthropometric measurements of the children were collected at age 8. In addition, 540 of the enrolled children’s fathers whose peripheral blood samples were collected at the time of JECS enrollment were also analyzed. The exposures of interest were maternal serum LDL-C level during pregnancy and paternal LDL-C level. The outcome of interest was serum LDL-C level of offspring at 8 years old. Mean (SD) serum LDL-C levels were 107.0 (25.6) mg/dL for mothers, 116.5 (27.4) mg/dL for fathers, and 89.9 (21.4) mg/dL for offspring. LDL-C level in mothers whose offspring had above-normal LDL-C levels (≥ 110 mg/dL) was significantly higher than that in mothers whose offspring had normal LDL-C levels (< 110 mg/dL). If a mother has a high LDL-C level during pregnancy, her offspring might also have a high LDL-C at age 8.

The case report highlights the potential intracranial complications associated with otitis media, particularly cholesteatoma and mastoiditis, including meningitis, brain abscesses, epi- and subdural empyema, and sigmoid sinus thrombophlebitis. Pyogenic ventriculitis (PV), an inflammation of the ependymal lining of cerebral ventricles, is a rare but serious complication often secondary to factors such as meningitis, cerebral abscesses, or neurosurgery. The case presented involves a 52-year-old male with a history of head trauma who developed PV secondary to cholesteatoma. Despite initial challenges in diagnosis, timely antibiotic therapy and surgical intervention resulted in successful treatment. The study emphasizes the importance of considering ear diseases as potential sources of intracranial infection, particularly in cases of delayed symptom presentation or history of head trauma.

Voice abuse, chronic cough, laryngeal surgery, and tracheal intubation may lead to injury and subsequent repair/remodeling in the vocal fold mucosa. Periostin is known to be involved in airway remodeling and is also associated with various otolaryngological diseases. D-β-aspartic acid is the major isomer of D-aspartic acid found in tissues of elderly individuals. In ischemic heart disease, increased CD31 expression has been observed around cardiomyocytes during remodeling, and endothelial proliferation has been reported at these sites. In this study, we investigated the expression and role of CD31, CD34, D-β-aspartic acid, and periostin in the formation of laryngeal granulation tissue. This retrospective study involved five patients who underwent surgical treatment for laryngeal granulation tissue. The expressions of CD31, CD34, D-β-aspartic acid, and periostin in surgical samples were investigated by immunohistochemistry. Histologically, the specimens showed inflammatory cell infiltration, fibrin exudation, fibrosis, and neovascularization, but no tumor cells. No stratified squamous epithelial covering was observed. The expression of periostin and D-β-aspartic acid was also observed in the specimens. CD31-positive cells (endothelial cells) and CD34-positive cells (progenitors of endothelial cells) were observed in the specimens. Our results indicate that the overexpression of CD31, CD34, D-β-aspartic acid, and periostin may play a role in the pathogenesis of laryngeal granulation tissue, and we speculate that D-β-aspartic acid and periostin could serve as novel biomarkers and therapeutic targets for laryngeal granulation tissue.

Leucine-rich alpha-2-glycoprotein 1 (LRG1) promotes colorectal cancer (CRC) growth, migration, and invasion. This study intended to investigate the association of plasma LRG1 with clinical characteristics, disease-free survival (DFS), and overall survival (OS) in CRC patients who received tumor resection. This study retrospectively included 125 CRC patients who received tumor resection. LGR1 level was detected in their preoperative plasma samples via enzyme-linked immunosorbent assay. The median level of plasma LRG1 was 53.4 μg/mL (quartile 1: 34.0 μg/mL, quartile 3: 102.5 μg/mL). Plasma LRG1 was elevated in patients with high histological grade versus those with low grade (P = 0.005). Plasma LRG1 was varied among patients with different node (P = 0.004) and tumor-node-metastasis (P = 0.001) stages. Moreover, plasma LRG1 ≥ 50 μg/mL (at around the median level) was not related to DFS (P = 0.074) or OS (P = 0.077). While plasma LRG1 ≥ 100 μg/mL (at around the quartile 3 level) was linked with shortened DFS (P = 0.018) and OS (P = 0.016). The 3-year accumulating DFS and OS rates were 60.8% and 64.4% in patients with plasma LRG1 ≥ 100 μg/mL; they were 75.7% and 82.9% in patients with plasma LRG1 < 100μg/mL, respectively. Furthermore, plasma LRG1 ≥ 100 μg/mL (hazard ratio (HR): 2.728, P = 0.036) and age ≥ 60 years (HR: 2.815, P = 0.041) were independently associated with shortened DFS. Only node stage (HR: 3.150, P = 0.004) was independently linked with shortened OS. In conclusion, LRG1 is associated with elevated histological grade and worse DFS and OS, with its level ≥ 100 μg/mL as an independent factor for shortened DFS in CRC patients who receive tumor resection.