Risk factors and timing of postoperative hypothyroidism onset following hemithyroidectomy.

Objective: This study aimed to identify prognostic factors for postoperative hypothyroidism and assess the timing of its onset in patients who underwent hemithyroidectomy for thyroid tumors. Despite normal preoperative thyroid function, some patients develop postoperative hypothyroidism, necessitating lifelong thyroid hormone replacement therapy. Identifying risk factors and establishing appropriate follow-up guidelines are essential for optimizing patient management.

Risk prediction model for relapse of anti-synthetase syndrome- associated interstitial lung disease in Japanese multicentre MYKO cohort study.

Objectives: This study aimed to establish a risk prediction model for the relapse of anti-synthetase syndrome-associated interstitial lung disease (ASyS-ILD).

Methods: Patients diagnosed with ASyS-ILD and treated with prednisolone and calcineurin inhibitors as remission induction therapy were enrolled in the Japanese multicentre MYKO cohort. We followed up on patients who experienced relapse of ASyS-ILD after remission induction therapy, and examined the risk factors for predicting relapse by comparing initial clinical and laboratory findings.

Deep learning model for screening causes of activated partial thromboplastin time prolongation using clot waveform analysis at multiple wavelengths.

Activated partial thromboplastin time (APTT) prolongation occurs due to coagulation factor deficiencies/inhibitors, lupus anticoagulant (LA), and anticoagulant-taking, necessitating discrimination through further testing. Clot waveform analysis (CWA) can discriminate causes while measuring APTT, but conventional CWA exhibits moderate accuracy due to visual judgement and limited parameter use. We applied deep learning (DL) techniques to huge numerical data constituting clot waveforms and their first- and second-derivative curves (CWA curves) to leverage hidden features for developing an accurate classification model.

Evaluation of the Glucocorticoid-Sparing Effect of Adding Methotrexate in Polymyalgia Rheumatica: A Single-Center Retrospective Study.

Objective This study assessed whether the addition of methotrexate (MTX) to glucocorticoid therapy reduces overall glucocorticoid usage in patients with polymyalgia rheumatica (PMR), focusing particularly on those exhibiting glucocorticoid-resistant disease.  Methods This retrospective study included 82 patients with PMR treated with glucocorticoids. After applying matching weights, outcomes were compared between weighted populations of 18 patients receiving MTX and 18 receiving glucocorticoid monotherapy.

Fluoroless coronary sinus cannulation using a BeeAT catheter and the CARTO mapping system.

Fluoroscopy-free ablation techniques have gained popularity in recent years. However, coronary sinus (CS) cannulation via the femoral approach remains technically challenging, particularly when using specialized catheters like the BeeAT™. To demonstrate a reproducible technique for fluoroscopy-free CS cannulation using the BeeAT catheter guided by CARTO® electroanatomical mapping and intracardiac echocardiography (ICE).

Robotic Laparoscopic Pelvic Lymphadenectomy for Endometrial Cancer Under the Japanese Public Health Insurance System.

Background/aim: Surgery is the preferred treatment modality for endometrial cancer. In recent years, minimally invasive surgery (MIS) has become increasingly popular, and in Japan, robotic surgery has been covered by national insurance in addition to laparoscopic surgery for apparent stage IA cases since 2018. We conducted a comparative analysis of laparoscopic and robotic surgeries, including pelvic lymphadenectomy for stage IA endometrial cancer, with the aim of evaluating the efficacy of robotic surgery.

Cardiac Damage Stages and Clinical Outcomes in Patients With Severe Aortic Stenosis.

Background: The prognostic impact of cardiac damage staging in severe aortic stenosis (AS) based on gradient patterns, symptoms, and initial treatment strategies is not well understood.

Objectives: This study aimed to assess the differences in characteristics and clinical outcomes of AS patients according to cardiac damage stage, stratified by gradient patterns, symptoms, and treatment strategies.

Methods: A total of 3,369 consecutive patients with severe AS (high-gradient [HG] AS, n = 1986; low-gradient [LG] AS, n = 1,383) from the CURRENT AS registry-2 were included.

Impact of the Balloon Pulmonary Angioplasty on the Diagnosis of Chronic Thromboembolic Pulmonary Hypertension: From the COMMAND VTE Registry-2.

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is the most serious long-term complication of acute pulmonary embolism (PE). Balloon pulmonary angioplasty (BPA) has been an effective treatment for improving the prognosis of CTEPH patients.

Aims: This study aimed to evaluate the impact of BPA at each institution on the rate of CTEPH diagnosis based on the observations suggesting that the emergence of effective treatments could draw attention to targeted diseases.

The Clock and the Scalpel: Does delayed Robot-assisted radical prostatectomy affect pathological progression and upgrading in prostate cancer?

Introduction: We investigated whether surgical delay may be associated with histological progression in patients treated with robotic-assisted radical prostatectomy (RARP) for prostate cancer (PCa).

Materials And Methods: Patients diagnosed with localized (cT1-2cN0cM0) PCa who underwent RARP between 2011 and 2022 were retrospectively reviewed. Surgical delay was categorized into four groups based on the time from biopsy to RARP: 0-3, 4-6, 7-12, and >12 months.

Echocardiographic measurement of inferior vena cava diameter for estimating central venous pressure in adult Fontan patients.

Aims: In adult Fontan patients, a higher central venous pressure (CVP) is associated with worse clinical outcomes. Assessing CVP is helpful to guide therapeutic strategies; however, it remains unclear whether CVP can be accurately estimated from the inferior vena cava (IVC) diameter by echocardiography.

Methods And Results: This single-centre, retrospective study enrolled 21 adult Fontan patients (median age: 21.

Challenges in the Diagnosis and Management of Culture-Negative Infective Endocarditis in a 64-Year-Old Hemodialysis Patient.

We report a case of culture-negative infective endocarditis in a 64-year-old hemodialysis patient who presented with fever and dyspnea. Despite empirical antibiotic therapy and negative blood cultures, transesophageal echocardiography later revealed aortic valve vegetation and destruction. The patient developed cardiogenic shock and died before surgery.

Airtight compartmentalization of the anterior skull base reconstructed using a pedicled pericranial periosteal flap: illustrative case.

Background: Anterior skull base surgery to address tumor, trauma, or infection causing extensive bony destruction is associated with rhinorrhea and infection as potentially life-threatening complications. When performing anterior skull base reconstruction, watertight dural closure and airtight closure of the nasal cavity mucosa are essential for preventing these complications.

Observations: The authors describe the case of a patient with a mixed olfactory neuroblastoma and adenocarcinoma who underwent resection.

Clarification of fibrin generation and degradation reaction processes of clot-fibrinolysis waveform in hemorrhagic disorders.

Clot-fibrinolysis waveform analysis (CFWA) is an assay used to simultaneously evaluate coagulation and fibrinolysis reactions. Although the assay detected the reaction via transmittance changes, there was no evidence that the transmittance changes indicated reactions. This study aimed to demonstrate that transmittance changes indicate coagulation and fibrinolysis reactions by detecting relative markers.

A case of giant Brunner's gland hyperplasia of the duodenum diagnosed by endoscopic ultrasonography-guided fine needle biopsy.

A 60-year-old man was referred to our hospital due to upper abdominal pain and distension for 1 month. His past medical history was dilated cardiomyopathy. He had no significant abnormality on physical examination and blood tests were within normal range.

Differences in risk factors between all-cause and pulmonary embolism-related death in acute pulmonary embolism: insights from the COMMAND VTE registry-2.

Background: Accurate risk prediction of early mortality, particularly pulmonary embolism (PE)-related death, in patients with acute PE has become more important for selecting optimal management strategies.

Objectives: To evaluate the cumulative 30-day incidence of and risk factors for all-cause and PE-related death within 30 days.

Methods: In the COMMAND VTE Registry-2, which enrolled symptomatic patients with venous thromboembolism at 31 centers in Japan, we analyzed 2035 patients with acute PE.

Techniques for dividing incomplete pulmonary interlobar fissure using bipolar soft coagulation forceps in robot-assisted thoracoscopic surgery.

This study aimed to evaluate the electrical characteristics of the da Vinci system's bipolar soft coagulation mode and to assess its feasibility for dividing incomplete pulmonary interlobar fissures during robot-assisted thoracoscopic surgery. The electrical properties of the bipolar soft coagulation mode were analyzed using an electrocautery analyzer. Additionally, safety was assessed through experiments on animal tissue with an infrared thermographic camera.

Serum cytokine profiling differentiates underlying diseases in cytokine storm syndrome.

Objective: Cytokine storm syndrome (CSS), commonly associated with hemophagocytic lymphohistiocytosis (HLH), is a fatal hyperinflammatory syndrome. Differentiating the underlying diseases responsible for CSS is essential for timely therapeutic decisions. This study explored the clinical usefulness of serum cytokine profiling in distinguishing underlying diseases in patients with CSS.

Association of dropout history and HbA1c levels with subsequent dropout risk in patients with diabetes: a secondary analysis of the Japan Diabetes Outcome Intervention Trial-2 Large-Scale Trial 008 (J-DOIT2-LT008).

Objectives: Adherence to treatment strategies is essential for preventing future complications during diabetes management. This study evaluated the association between dropout history, glycated haemoglobin (HbA1c) levels and subsequent risks of dropout (missed appointment)in patients with type 2 diabetes.

Design: This was a secondary analysis of a cluster-randomised trial (the Japan Diabetes Outcome Intervention Trial 2 Large-Scale Trial), focusing on the non-intervention group over the study period.

Efficacy of Simple Oral Nutritional Supplements versus Usual Care in Postoperative Patients with Gastric Cancer: A Multicenter, Open-label, Parallel, Randomized Controlled Trial.

Objective: To evaluate the efficacy of a simple oral nutritional supplement (ONS) without excess nutrients on body weight loss (BWL) after gastrectomy in patients with gastric cancer.

Summary Background Data: BWL is commonly observed in the early few months after gastrectomy for gastric cancer. It is uncertain if a simple ONS with usual diet improve postoperative BWL.

Analyzing Disparity in Geographical Accessibility to Home Medical Care Using a Claims Database and Geographical Information System: Simulation Study.

Background: The demand for home medical care services has increased in aging societies. Therefore, allocating health care resources optimally to meet the needs of each community is essential. Geographical accessibility is an important factor affecting access to home medical care services; however, little research has been conducted on regional disparities in geographical accessibility.

Development and Validation of the Diameter and Sinus Score, a Novel Model to Predict Trifecta Failure for Robot-Assisted Partial Nephrectomy: A Multicenter Retrospective Study.

To evaluate and restratify each component of the RENAL score and develop a novel model to predict the difficulty of robot-assisted partial nephrectomy. This retrospective multicenter study included 847 patients with localized renal-cell carcinoma, including 401 in the development cohort and 446 in the validation cohort. Multivariate logistic regression analysis was performed on the subdivided variable of the RENAL score to develop a novel model.

Mediastinoscopy-Assisted Esophagectomy as an Effective Treatment for IgG4-Related Esophageal Stenosis: A Case Report.

Introduction: Immunoglobulin G4-related disease (IgG4-RD) rarely involves the esophagus, typically causing stenosis that presents significant diagnostic and therapeutic challenges. Due to its rarity and its mimicry of other conditions, obtaining a definitive preoperative diagnosis can be difficult. This report details a case of IgG4-RD-induced esophageal stenosis with initial diagnostic ambiguity, which was successfully managed with mediastinoscopy-assisted esophagectomy (MAE), highlighting this minimally invasive approach in a patient with comorbidities.

Risk Stratification for the Prognosis of Patients With pT3aN0M0 Clear Cell Renal Cell Carcinoma.

Background: Predicting postoperative recurrence in patients with pathological T3aN0M0 clear cell renal cell carcinoma (pT3a ccRCC) is important to identify patients suitable for adjuvant immunotherapy. This study aimed to develop a novel predictive model for postoperative recurrence of pT3a ccRCC.

Materials And Methods: Patients diagnosed with pT3a ccRCC between 2010 and 2022 were retrospectively enrolled from 19 institutions.