Polydoctoring and health outcomes among the very old population with multimorbidity: a retrospective cohort study in Japan.

To assess the relationship between polydoctoring and patient outcomes, we conducted a retrospective cohort study using a Japanese population-based dataset from April 2014 to December 2022. Overall, 2,338,965 patients aged 75-89 years with at least two chronic conditions were included. Polydoctoring was assessed by the number of regularly visited facilities (RVFs).

Ramucirumab-containing chemotherapy for patients with gastrointestinal neuroendocrine carcinoma refractory/intolerant to platinum-based chemotherapy: A multicenter observational retrospective study (WJOG13420G).

No standard second-line chemotherapy has been established for gastrointestinal neuroendocrine carcinoma (NEC). This study aimed to determine whether ramucirumab (RAM) is a treatment candidate in this setting. We retrospectively collected data from patients with gastric and colorectal NEC who received second-line chemotherapy following platinum-based chemotherapy.

Home-based collaborative management of bullous pemphigoid with delayed seropositive conversion of anti-BP180-NC16a antibody.

We report the case of an 82-year-old male with a history of multiple cerebral infarctions who developed bullous pemphigoid while receiving home-based care. Anti-BP180-NC16a antibody was initially negative, but later became positive as the disease severity worsened. The patient was successfully managed at home through a collaborative effort between a home-visiting physician (general practitioner), dermatologist, nursing staff, and pharmacists.

A multicenter Phase II study of mFOLFOX6 plus nivolumab for gastric cancer with severe peritoneal metastases: WJOG16322G.

Advanced gastric cancer (AGC) patients with severe peritoneal metastases (SPM), characterized by massive ascites and/or inadequate oral intake, have a poor prognosis with the median overall survival of around 7 months, even when treated with fluorouracil/l-leucovorin plus oxaliplatin (mFOLFOX6), despite being a treatment options for these patients demonstrated in the WJOG10517G study. However, these patients were excluded from pivotal Phase III trials, including the CheckMate 649 study, which demonstrated the benefit of adding nivolumab to mFOLFOX6, due to tumor-related complications. Given the lack of data on the efficacy and safety of combining nivolumab with mFOLFOX6 for AGC patients with SPM, we initiated a Phase II study to evaluate this combination.

How often does a mixed type intraductal papillary mucinous neoplasm on imaging indicate pathological involvement of the main pancreatic duct?

Objectives: A pancreatic cyst >5 mm in diameter that communicates with the dilated main pancreatic duct (MPD) ≥5 mm on imaging is defined as mixed type intraductal papillary mucinous neoplasm (MX-IPMN). However, the frequency of tumor involvement of the MPD in MX-IPMN remains unknown. This study investigated how often MX-IPMNs involve the MPD and whether MPD involvement can be diagnosed by peroral pancreatoscopy (POPS).

Development and psychometric properties of the Japanese version of the capacity for wonder scale.

Objectives: To develop a Japanese version of the capacity for wonder Scale (J-CfWS) and to examine its psychometric properties.

Methods: An anonymous online self-administered questionnaire was distributed to medical undergraduates in three universities in Japan. We assessed the structural (factor analysis and model fitness test (comparative fit index, root mean square error of approximation, and standardized root mean square residual)) and convergent validity and internal consistency reliability of the scale.

Translating and Validating the Japanese Version of the Tolerance for Ambiguity Scale.

Background: Ambiguity is inherent in medicine, and tolerance for ambiguity (TFA) has recently been of substantial interest. Effective medical education for TFA requires a validated inventory; one validated measure in wide use is the seven-item TFA scale. In Japan, however, a tool for measuring TFA in undergraduate medical education has not been available.

A multicenter, prospective, observational study of nivolumab readministration for advanced gastric cancer (NIVO RETURNS).

Combination treatment with an anti-programmed cell death-1 (PD-1) antibody, an immune checkpoint inhibitor (ICI), and chemotherapy is the standard treatment for patients with HER2-negative advanced gastric/esophagogastric cancer (AGC). ICI re-administration has been reported to have a clinical benefit for patients with lung cancer or melanoma. However, data on patients with AGC have not yet been collected.

Investigation of Recognition Areas by Explainable Artificial Intelligence for Colonoscopy Images of Irritable Bowel Syndrome.

Introduction: Irritable bowel syndrome (IBS) is a condition in which gastroenterological endoscopists cannot detect anomalies using colonoscopy, yet an artificial intelligence (AI) developed for IBS colonoscopy images has been able to distinguish between IBS and healthy individuals with high accuracy. However, it was unclear which areas the AI identified as abnormal. The aim of this study was to elucidate how AI identifies regions typical of IBS by constructing an additional explainable AI (XAI).

Do family physicians develop ambiguity tolerance as they gain experience? A multicenter cross-sectional study.

Background: Ambiguity tolerance is important because it contributes to both better patient care and physician well-being. Although a recent study showed that family physicians have greater ambiguity tolerance than non-family physicians, the question of when family physicians develop tolerance remains unanswered. Thus, the aim of this study was to examine the associations between the number of postgraduate years (PGYs) and ambiguity tolerance.

Precision risk stratification of primary gastric cancer after eradication of by a DNA methylation marker: a multicentre prospective study.

Background: Precision cancer risk stratification for gastric cancer is urgently needed for the growing number of healthy people after eradication. The epimutation burden in non-malignant tissues has been associated with cancer risk in multiple cross-sectional studies.

Objective: To confirm the clinical usefulness of a DNA methylation marker for epimutation burden, and to identify a cut-off methylation level for a super-high-risk population.

A Simulated Interprofessional Team Conference Using Cross-Training for Junior Healthcare Students in Interprofessional Education: a Qualitative Content Analysis.

Purpose: In 2021, we introduced a new simulation-based learning program focusing on a roleplay conference before patient discharge. This study aimed to evaluate the program's effectiveness and highlight the significance of cross-training in interprofessional education (IPE).

Methods: In September 2023, the program included 346 students (98 medical, 110 nursing, and 138 pharmacy students).

Early-onset Colorectal Cancer in a Patient with Li-Fraumeni Syndrome: A Case Series and Literature Review.

Screening for colorectal cancer (CRC) in individuals with Li-Fraumeni syndrome (LFS) typically recommends initiating colonoscopy at 25 years old. We herein report a case of LFS with dual CRC and liver metastasis diagnosed before the recommended screening age. A 17-year-old boy with a history of sarcoma underwent colonoscopy, revealing 2 advanced CRCs: neuroendocrine carcinoma in the descending colon and adenocarcinoma in the rectum, each displaying distinct histological features.

Overlooked Carbamazepine Toxicity: A Diagnostic Pitfall in an Elderly Patient With Dizziness.

Dizziness is a common chief complaint that often poses a diagnostic challenge. A 79-year-old man was initially misdiagnosed with peripheral vertigo based on normal neuroimaging but later developed altered consciousness and involuntary limb movements, ultimately revealing carbamazepine (CBZ) toxicity. This case highlights a critical diagnostic pitfall: prematurely attributing dizziness to peripheral vertigo without considering drug-induced syndromes.

Family physicians have greater ambiguity tolerance in the clinical context: A nationwide cross-sectional study.

Background: Ambiguity tolerance in the clinical context is increasingly recognized as essential for physicians to work as professionals. However, the relationship between specialty and ambiguity tolerance in the clinical context has been understudied. Here, we investigated the association between specialty and ambiguity tolerance in the clinical context, focusing on differences between family physicians (FPs) and non-FPs.

Antitumor Activity of the PD-1/PD-L1 Inhibitor SCL-1 in Various Mouse Tumor Models.

Background/aim: Immune checkpoint blockade has achieved great success as a targeted immunotherapy for solid cancers. However, small molecules that inhibit programmed death 1/programmed death ligand 1 (PD-1/PD-L1) binding are still being developed and have several advantages, such as high bioavailability. Previously, we reported a novel PD-1/PD-L1-inhibiting small compound, SCL-1, which showed potent antitumor effects on PD-L1 tumors.

Determinants of polydoctoring among multimorbid older adults; a cross-sectional study in an urban area of Japan.

Background: Multimorbidity increases with age, leading to various adverse outcomes, including higher mortality, care dependency, hospitalizations, and healthcare costs. Polydoctoring, managing a patient with multimorbidity by multiple healthcare providers, can be a risk of fragmented care and increased healthcare expenditures. This study aims to identify patient-related factors contributing to polydoctoring in older adults with multimorbidity.

Competencies related to generalism for Japanese medical undergraduates: Essential skills for comprehensive care.

Objective: To identify generalism-related competencies that medical students in Japan should acquire in order to provide comprehensive care for patients.

Methods: The team responsible for developing the new 'Generalism' section of the 2022 revision of the Model Core Curriculum for Medical Education in Japan (MCC) consisted of nine members from diverse medical backgrounds across Japan. We adopted pragmatism paradigm and analyzed to identify decision-making processes using a qualitative document analysis.

A case of successful conversion surgery for unresectable gallbladder cancer treated with durvalumab in combination with gemcitabine plus cisplatin.

We report a rare case of a patient with initially unresectable gallbladder cancer who underwent conversion surgery with durvalumab in combination with gemcitabine plus cisplatin and achieved an R0 resection. A 68 year-old woman was found to have gallbladder cancer and multiple enlarged lymph nodes around the suprapancreatic rim and hepatic hilum invading the proper hepatic artery on computed tomography. The diagnosis was cT3cN2cM0, cStage IVB.

Prolonged Peritoneal Attack: A Rare but Crucial Clinical Presentation of Familial Mediterranean Fever.

Familial Mediterranean fever (FMF) presents with various symptoms. Episodic abdominal pain is one of the most prevalent clinical characteristics of FMF and usually improves within 24-48 hours. We encountered a 50-year-old male patient from Japan who experienced recurrent episodes (several episodes occurring per year) of abdominal pain with fever since his late 20s.

Identification of membrane proteins targeted by small-molecule compounds using nanomagnetic beads.

In drug discovery research, it is important to identify target proteins of bioactive small-molecule compounds and analyse their functions. In this study, we examined whether target membrane proteins could be captured by compounds that bind to membrane proteins on the cell surface. For this purpose, we performed affinity purification using the compound-immobilized nanomagnetic beads.

Naldemedine for Opioid-Induced Constipation in Patients With Cancer: A Multicenter, Double-Blind, Randomized, Placebo-Controlled Trial.

Purpose: Opioid-induced constipation is the most frequent and non-self-limiting adverse effect of opioid analgesia, reducing adherence and interfering with pain relief. This clinical trial aimed to clarify the preventive effect of naldemedine versus placebo for constipation in patients with cancer starting regularly dosed strong opioids therapy.

Methods: This multicenter, double-blinded, randomized, placebo-controlled, confirmatory trial was conducted between July 2021 and May 2023 at four academic hospitals in Japan (Japan Registry of Clinical Trials identifier: jRCTs031200397).