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Abstract Objectives This study aimed to investigate the characteristics of patients with recurrent or advanced non‐small cell lung cancer (NSCLC) treated with tyrosine kinase inhibitors (TKIs) or immune‐checkpoint inhibitors (ICIs) who developed secondary malignancies, as well as evaluate the impact of these secondary malignancies on the course of lung cancer. Materials and Methods This study included 112 patients with postoperative recurrent or advanced NSCLC, who received TKIs, ICIs, or immune combination therapy as the primary treatment modality between April 1, 2013, and March 31, 2020, and achieved long‐term survival (≥2 years). Secondary malignancies were defined as newly diagnosed cancers in other organs occurring after NSCLC treatment initiation. Results Among the 112 patients, 10 (8.9%) developed 12 carcinomas, including third primary malignancies. Univariate analysis, considering secondary malignancies as the outcome, revealed a non‐significant trend towards a higher incidence of secondary malignancies in smokers compared to non‐smokers. Conclusion This study found that 8.9% of patients with advanced NSCLC who received TKIs, ICIs, or immune combination therapy and survived ≥2 years developed secondary malignancies. This underscores the importance of early diagnosis and treatment, even during lung cancer treatment, to identify suspicious lesions in other organs either via imaging or physical examinations.

Introduction There are often opportunities to consider treatment strategies for synchronous or metachronous prostate cancer with colorectal cancer. Performing robot‐assisted radical prostatectomy for prostate cancer following previous rectal cancer surgery in cases involving anal‐preserving surgeries such as low anterior resection or intersphincteric resection can be challenging because of the possibility of adhesions. Case presentation A 74‐year‐old man who had undergone laparoscopic intersphincteric resection for rectal cancer was diagnosed with prostate cancer. The patient desired to undergo robot‐assisted radical prostatectomy. During surgery, we observed the absence of Denonvillier's fascia on the dorsal surface of the prostate, the intestinal anastomosis was distal to the vesicourethral anastomosis, and the rectum was replaced with a peristaltic sigmoid colon with minimal adhesions. Conclusion Periprostatic conditions vary depending on previous rectal surgical approaches. It is crucial to confirm the previous surgical approach for rectal cancer when performing robot‐assisted radical prostatectomy following rectal cancer surgery.

Abstract Background Mentorship is a dynamic reciprocal relationship, wherein a novice (mentee) grows with the encouragement of an advanced careerist (mentor). It is widely implemented in medical training programs. However, there are few reports on mentorship's educational effects in the Japanese context. This study investigated the association between mentorship and in‐training examination scores during a clinical residency program in Japan. Methods A cross‐sectional study was conducted in Japan, involving first and second year postgraduate (PGY‐1 and PGY‐2) residents set to take the General Medicine In‐Training Examination (GM‐ITE) at the end of the academic year of 2021. The GM‐ITE, developed by a non‐profit organization in 2012, assesses the overall clinical knowledge of PGY‐1 and PGY‐2 residents. Data on mentorship were obtained through an electronic survey, conducted immediately after the GM‐ITE. The association between a resident's self‐reported identification of at least one mentor and GM‐ITE score was analyzed at multiple levels. Results Of the total 4929 residents, 3266 (66.3%) reported having mentors. However, there was no association between mentorship and GM‐ITE scores (adjusted score difference [aSD] = −0.22; 95% confidence interval [95% CI]: −0.64 to 0.19). Conclusions Among Japanese residents, in‐training examination scores were not associated with mentorship.

Abstract Background Physical activity inequalities are an important global concern; nonetheless, few studies have comprehensively examined the association between physical activity inequalities and related factors. We aimed to explore factors associated with regional inequalities in physical activity in Japan. Methods We investigated the relationship of individual, psychological/behavioral, social, and built‐environmental factors with the proportion of individuals with exercise habits across Japanese prefectures. We sourced data from open databases, including the Japanese National Health Insurance Claims and Nationwide Screening Program Database. We defined exercise habits as engaging in at least 30 min of moderate exercise at least twice a week. We employed multiple regression analysis to identify factors associated with prefectural level physical activity. Results The median proportion of individuals with exercise habits was 27% (interquartile range, 25–29). Higher frequency of exercise habits was associated with higher frequency of history of exercise (coefficients, 0.60; 95% confidence interval, 0.41–0.80) and lower proportion of female gender (coefficients, −1.74; 95% confidence interval, −2.80 to −0.69). Conclusions Exercise history and female gender may be related to prefectural level physical activity in Japan. Physical activity interventions should be promoted among women without exercise history.

Abstract Aims Remote dielectric sensing (ReDS) represents a contemporary non‐invasive technique reliant on electromagnetic energy to quantify pulmonary congestion. Its prognostic significance within the context of heart failure (HF) patients remains elusive. This study aimed to assess the prognostic implications of residual pulmonary congestion, as gauged by the ReDS system, among patients admitted due to congestive HF. Methods and results We enrolled hospitalized HF patients who underwent ReDS assessments upon admission and discharge in a blinded manner, independent of attending physicians. We evaluated the prognostic impact of the ReDS ratio between admission and discharge on the primary outcome, which encompassed all‐cause mortality and HF‐related re‐hospitalizations. A cohort of 133 patients (median age 78 [72, 84] years, 78 male [59%]) was included. Over a median observation period of 363 days post‐index discharge, an escalated ReDS group (ReDS ratio > 100%), determined through statistical calculation, emerged as an independent predictor of the primary outcome, exhibiting an adjusted hazard ratio of 4.37 (95% confidence interval 1.13–16.81, P = 0.032). The cumulative incidence of the primary outcome was notably higher in the increased ReDS group compared with the decreased ReDS group (50.1% vs. 8.5%, P = 0.034). Conclusions Elevated ReDS ratios detected during the index hospitalization could serve as a promising prognostic indicator in HF patients admitted for treatment. The clinical ramifications of ReDS‐guided HF management warrant validation in subsequent studies.

Abstract Aim This pilot examined the effect of online peer support on mental health problems among individuals with post‐acute sequelae of COVID‐2019 (PASC). Methods A single‐arm pre‐post design of online peer‐support design consisting of eight sessions of 1 h per week with three to six participants and two facilitators per group was performed. Participants were recruited from online communities, social media, and medical clinics for the PASC between May and August 2023. The degrees of depression, anxiety, loneliness, social withdrawal, and self‐esteem were measured pre‐ and post‐intervention. Participants' statements during the sessions were analyzed using thematic analyses. Results Of the 18 participants, three dropped out of the interventions, and 17 (including two participants who dropped out) completed the pre‐ and post‐intervention questionnaires. Depression severity significantly decreased in the paired t‐test and linear mixed model. The following interactions were extracted: conveying the same feelings, dealing with difficulties, showing empathy, enhancing the atmosphere, and adapting to suit health conditions. Impressions extracted from participating in the interventions included feelings of emotional support, a sense of bonding, changes in perspective, changes in behaviors or new actions through participation, inadequacy during sessions, and adverse effects associated with participation. Conclusion Online peer support may be helpful in treating depression in individuals with PASC.

Introduction CHARGE syndrome is a rare disorder that causes congenital abnormalities in multiple organs, including secondary hypogonadism. We report, herein, a unique case of CHARGE syndrome with both primary and secondary hypogonadism and discuss the possible causes and pathogenesis in this patient. Case presentation A 15‐year‐old boy with delayed secondary sexual characteristics and non‐palpable testes was referred to our hospital. Physical examination and detection of a chromodomain‐helicase‐deoxyribonucleic acid‐binding protein 7 gene mutation confirmed CHARGE syndrome. Hormone stimulation tests suggested both primary and secondary hypogonadism. Laparoscopic bilateral orchiectomy was performed because of decreased testosterone production and atrophy in both testes. Pathological examination of the testes revealed maturation arrest, germ cell neoplasm in situ, and decreased expression of steroid synthase. Conclusion This appears to be the first report of CHARGE syndrome with both primary and secondary hypogonadism demonstrated in endocrinological and histological examinations.

Background The atherogenic characteristics of heterozygous familial hypercholesterolemia (HeFH) increase the risk of premature atherosclerotic cardiovascular disease including not only coronary artery disease but ischemic stroke. Asymptomatic intracranial artery stenosis/occlusion (IASO) is a major cause of ischemic stroke, but it has not yet been fully characterized in patients with HeFH. Methods and Results This study analyzed 147 clinically diagnosed subjects with HeFH who underwent magnetic resonance imaging/magnetic resonance angiography imaging for evaluation of IASO (≥50% diameter stenosis). Major adverse cerebrovascular and cardiovascular events (cardiac death, ischemic stroke, and acute coronary syndrome) were compared in patients with HeFH with and without asymptomatic IASO. Asymptomatic IASO was observed in 13.6% of patients with HeFH. The untreated low‐density lipoprotein cholesterol level (240±95 versus 244±75 mg/dL; P=0.67) did not differ between the 2 groups. Despite the use of lipid‐lowering therapies (statin, P=0.71; high‐intensity statin, P=0.81; ezetimibe, P=0.33; proprotein convertase subxilisin/kexin type 9 inhibitor, P=0.39; low‐density lipoprotein apheresis, P=0.14), on‐treatment low‐density lipoprotein cholesterol level in patients with both HeFH and IASO was still suboptimally controlled (97±62 versus 105±50 mg/dL; P=0.17), accompanied by a higher triglyceride level (median, 109 versus 79 mg/dL; P=0.001). During the 12.4‐year observational period (interquartile range, 6.2–24.6 years), asymptomatic IASO exhibited a 4.04‐fold greater likelihood of experiencing a major adverse cardiovascular event (95% CI, 1.71–9.55; P=0.001) in patients with HeFH. This increased risk of a major adverse cardiovascular event was consistently observed in a multivariate Cox proportional hazards model adjusting clinical characteristics (hazard ratio, 4.32 [95% CI, 1.71–10.9]; P=0.002). Conclusions A total of 13.6% of Japanese subjects with HeFH presented with asymptomatic IASO. Despite lipid‐lowering therapies, patients with both HeFH and IASO more likely had elevated risk of cerebrovascular and cardiovascular events. Our findings highlight asymptomatic IASO as a phenotypic feature of HeFH‐related atherosclerosis, which ultimately affects future outcomes.

Abstract Immunoglobulin G4 (IgG4)‐related disease is a chronic inflammatory condition often characterized by exudative pleural effusions. However, transudative pleural effusions, like in the presented case of an 80‐year‐old man with multiple comorbidities, are less common but possible. Despite initial treatment with diuretics, the effusion persisted, prompting further investigation. Medical thoracoscopy revealed lymphatic follicle hyperplasia and an abundance of IgG4‐positive plasmacytoid cells, confirming IgG4‐related pleuritis. This case underscores the importance of considering inflammatory etiologies, such as IgG4‐related disease, when faced with unresponsive transudative pleural effusions. Thoracoscopy serves as a valuable diagnostic tool in such scenarios, allowing for precise diagnosis and appropriate management.

Abstract Relativistic electron precipitation (REP) refers to the release of high‐energy electrons initially trapped in the outer radiation belt, which then precipitate into Earth's upper atmosphere, contributing significantly to the rapid depletion of radiation belt electron flux. This study presents a statistical analysis of REP observations collected by the Calorimetric Electron Telescope (CALET) experiment aboard the International Space Station from 2015 to the present day. Specifically, the analysis utilizes count rates acquired from the two top scintillators constituting the top charge detector, each sensitive to electrons with energies above 1.5 and 3.4 MeV, respectively. Analysis of CALET data reveals a previously unreported semi‐annual variation in the occurrence of REP events. REP periodicities resemble those observed for trapped electron fluxes in the outer belt. Furthermore, their amplitude follows the overall trend of solar wind high‐speed streams and the solar activity.

Abstract We report a citizen science‐motivated study on the cause of an unusually bright red aurora as witnessed from Hokkaido, Japan during a magnetic storm on 1 December 2023. The auroral brightness of 5 kR is unusual for the Dst index peak of only −107 nT. In spite of the moderate storm amplitude, the extremely high solar wind density of >50/cc and dynamic pressure of >25 nPa caused the aurora oval extension to 53 magnetic latitudes (L = 2.8). We discuss that the drift loss of the ring current particles across the small‐size magnetopause is important, and Hokkaido was at the right position to see the direct effect of the large particle injection of the storm‐time substorm.

Abstract Background Mentorship is a dynamic, reciprocal relationship in which an advanced careerist (mentor) encourages the growth of a novice (mentee). Mentorship may protect the mental health of residents at risk for depression and burnout, yet despite its frequent use and known benefits, limited reports exist regarding the prevalence and mental effects of mentorship on residents in Japan. Methods We conducted a cross‐sectional study involving postgraduate year 1 and 2 (PGY‐1 and PGY‐2) residents in Japan who took the General Medicine In‐Training Examination (GM‐ITE) at the end of the 2021 academic year. Data on mentorship were collected using surveys administered immediately following GM‐ITE completion. The primary outcome was the Patient Health Questionaire‐2 (PHQ‐2), which consisted depressed mood and loss of interest. A positive response for either item indicated PHQ‐2 positive. We examined associations between self‐reported mentorship and PHQ‐2 by multi‐level analysis. Results Of 4929 residents, 3266 (66.3%) residents reported having at least one mentor. Compared to residents without any mentor, those with a mentor were associated with a lower likelihood of a positive PHQ‐2 response (adjusted odds ratio [aOR] 0.75; 95% confidence interval [95% CI] 0.65–0.86). Mentor characteristic significantly associated with negative PHQ‐2 response was a formal mentor (aOR; 0.68; 95% CI 0.55–0.84). Conclusions A mentor‐based support system was positively associated with residents' mental health. Further research is needed to determine the quality of mentorship during clinical residency in Japan.

Introduction Intensive treatment is typically considered for very high‐risk patients with locally advanced prostate cancer and an expected survival time of 5 years or longer. Herein, we report a case of locally advanced prostate cancer with rectal infiltration treated with laparoscopic total pelvic exenteration combined with transanal total mesorectal excision. Case presentation A 73‐year‐old man presented with a ring‐shaped mass around the rectum. He was diagnosed with prostate cancer with rectal infiltration and underwent laparoscopic total pelvic exenteration combined with transanal total mesorectal excision following neoadjuvant androgen deprivation therapy. Twenty‐two months postoperatively during ongoing androgen deprivation therapy, no biochemical recurrence was observed. Conclusion To our knowledge, this is the first report of a laparoscopic total pelvic exenteration combined with transanal total mesorectal excision for prostate cancer with rectal infiltration. We believe this surgery may be considered a new option for high‐risk prostate cancer patients with rectal infiltration.

Abstract Background Immune checkpoint inhibitors (ICIs) can cause severe immune‐related adverse events (irAEs). However, biomarkers for irAEs common to different types of ICIs and cancers have not been reported. This study examined whether eosinophils can be used as a predictor of irAEs. Methods Six hundred fourteen patients with cancer (esophageal, gastric, head and neck, lung, melanoma, renal cell, urothelial, and other cancer) received anti‐PD‐1, anti‐PD‐L1, or anti‐CTLA‐4 plus anti‐PD‐1 therapy. The patients were divided into two groups depending on whether they experienced irAEs (irAE group) or not (non‐irAE group). Eosinophils were examined before the two‐course treatment. Results Patients in the irAE group who received anti‐PD‐1 or anti‐CTLA‐4 plus anti‐PD‐1 therapy had higher eosinophils before the two‐course treatment than those in the non‐irAE group (p

Abstract During endoscopic ultrasound‐guided biliary drainage (EUS‐BD), there is a risk for bile leakage until stent deployment, which can result in severe peritonitis, particularly when passing a drainage stent becomes challenging despite tract dilation. There is no established method or dedicated device to optimize EUS‐BD. Therefore, we have developed a novel stent deployment technique using the tapered sheath dilator. To address the safety and technical aspects of the EUS‐BD technique, we retrospectively analyzed 11 consecutive patients who underwent EUS‐BD using the tapered sheath dilator. The procedure involved the insertion of a guidewire, followed by mechanical dilation using the tapered sheath dilator. Subsequently, the inner catheter was removed and drainage stents (up to 6 Fr in diameter) were deployed through the outer sheath. We found a 100% technical success rate for tract dilation and stent deployment; moreover, all patients achieved clinical success. The median time for dilation was 40 s (range, 8–198), whereas the median time from dilation to stent deployment was 10 min (range, 6–19). Notably, no cases of bile leakage or peritonitis were observed. In conclusion, the use of the integrated device for tract dilation and stent delivery system might provide a safe and straightforward technique for drainage stenting during EUS‐BD.

Abstract Plexiform fibromyxoma is a rare mesenchymal tumor identified in recent years and presents as a gastrointestinal submucosal tumor that is typically located in the gastric antrum. We report a case of gastric plexiform fibromyxoma in which the diagnosis was difficult despite repeated tissue sampling. Before visiting our hospital, the patient had been followed up for 3 years without a definitive diagnosis despite serial examinations, including computed tomography, endoscopy, endoscopic ultrasound, and endoscopic ultrasound‐guided fine‐needle aspiration. Endoscopic ultrasound‐guided fine‐needle aspiration was reperformed, and endoscopic submucosal dissection for deep biopsy was conducted for differential diagnosis of the tumor. However, histological analysis with immunostaining of tumor samples obtained using these techniques cannot provide a reliable diagnosis. Finally, the tumor was resected surgically because of its increasing size, and subsequent microscopic analysis revealed a multinodular plexiform growth pattern of spindle‐like cells with myxoid stroma. Immunohistochemically, the tumor cells were positive for smooth muscle actin but negative for c‐kit, CD34, and S100. Based on these findings, the patient was diagnosed with plexiform fibromyxoma. No evidence of residual or recurrent tumors was observed at 24 months postoperatively.

Abstract Sarcoidosis is a multisystemic granulomatous disease that is frequently localized in the lungs and lymph nodes. We herein report a case of pulmonary sarcoidosis secondary to shin'iseihaito administration. During remission with 5 mg prednisolone/day of maintenance treatment, chest computed tomography revealed a mass in the left lower lobe with re‐enlarged bilateral hilar/mediastinal lymph nodes. Transbronchial lung biopsy of the mass and endobronchial ultrasound‐guided transbronchial needle aspiration of mediastinal lymph nodes revealed adenocarcinoma and noncaseating granulomas, respectively. Based on these findings, the patient was diagnosed with sarcoidosis recurrence associated with lung cancer without cancer metastasis. We present the case of sarcoidosis recurrence associated with lung cancer after drug‐induced pulmonary sarcoidosis with lung injury. To our knowledge, this is the first report of sarcoidosis triggered by drug administration and lung cancer. Histological diagnosis of mediastinal lymphadenopathy with lung cancer is essential for differentiating metastasis from sarcoidosis.

Abstract Electromagnetic ion cyclotron (EMIC) waves have been shown to be able to drive strong electron precipitation, particularly at MeV energies. However, the spatio‐temporal evolution of both the waves and the resulting precipitation is still not well understood. Here we investigate the evolution of relativistic electron precipitation driven by EMIC waves through combined observations from the Van Allen Probes and the CALorimetric Electron Telescope experiment onboard the International Space Station. Two case studies are examined where EMIC waves near the magnetic equator and precipitation at low altitude were detected in close magnetic conjunction, both of which were confined to narrow radial regions but persisted multiple hours. These observations, combined with quasilinear calculations, confirm that long‐lived EMIC waves can drive hours‐long MeV electron precipitation loss. However, the magnitude of the precipitation varied significantly during one of the events, as resonance conditions, particularly plasma density, evolved.

Abstract Severe asthma affects approximately 5%–10% of patients with asthma. Herein, we describe a case of non‐type 2 asthma that progressively worsened over the years. An 80‐year‐old woman was diagnosed with asthma 11 years back. She experienced repeated exacerbations requiring treatment with systemic corticosteroid despite therapy with medications including high‐dose inhaled corticosteroids/long‐acting beta‐agonists plus long‐acting muscarinic antagonist. The patient presented with non‐eosinophilic asthma. Therefore, the patient was initially treated with bronchial thermoplasty, which was effective for 1 year only. Treatment with bronchial thermoplasty, benralizumab, dupilumab, and mepolizumab was ineffective. The fourth treatment, which included tezepelumab, was initiated. The patient's symptoms and quality of life improved significantly. This is the first case of a patient who did not respond to sequential bronchial thermoplasty, benralizumab, dupilumab, and mepolizumab but who presented with good clinical response to tezepelumab. Therefore, tezepelumab may be useful for patients with non‐type 2 asthma.

Abstract Aim The Mental Health Supporter Training Program is a national project conducted in Japan. This study aimed to determine the effects on mental health‐related stigma, mental health literacy, and knowledge about mental health difficulties and support techniques among program participants. Methods The target population was local residents of a wide range of generations in Japan. Outcomes were assessed at baseline (T1), immediately postintervention (T2), and at the 6‐month follow‐up (T3). A mixed model for repeated‐measures conditional growth model analyses were employed to examine the effects of the intervention over time (T1, T2, T3). We also calculated effect sizes using Cohen's d. Results The program had a significantly favorable pooled effect on the Japanese version of the Reported and Intended Behaviour Scale score after adjusting for covariates (reported behavior [t = 3.20, p = 0.001]; intended behavior [t = 8.04, p

Abstract Background Photodynamic therapy (PDT) using photosensitisers is a minimally invasive treatment for malignant tumours. However, ideal photosensitisers are not yet established. Recently, we developed a new photosensitiser, glucose‐conjugated chlorin e6 (G‐Ce6). Objectives To evaluate the clinical efficacy of vascular‐targeted PDT (VTP), a type of PDT utilising a short drug‐light interval, using G‐Ce6 to treat spontaneously occurring tumours in dogs. Methods Five dogs with spontaneously occurring tumours (malignant melanoma: three; haemangiopericytoma: two; and squamous cell carcinoma: one) were subjected to VTP. These dogs were intravenously injected with G‐Ce6 at doses of 1–3 mg/kg 5 min before laser irradiation. Tumours were superficially or interstitially irradiated using a 677‐nm diode laser. Results Repeated VTP decreased tumour size, yielding complete remission in three dogs. Complications such as oedema surrounding normal tissues and fistulae were observed, and the oedema was self‐limiting. The fistula was cured by debriding the necrotic tissues formed after VTP. Conclusions Our findings demonstrate that VTP using G‐Ce6 had antitumour effects in dogs with spontaneously occurring tumours.

Abstract Endobronchial metastasis (EBM) of hepatocellular carcinoma (HCC) is rare though HCC often metastasizes to the lungs. In this case report, a 74‐year‐old man with a history of HCC with chronic hepatitis C experienced hemoptysis and a dry cough. During immunotherapy for postoperative recurrent HCC, chest computed tomography (CT) revealed soft tissue shadows in the right upper and lower lobe bronchi, and we pathologically diagnosed as EBM of HCC using bronchoscopy. Although the prognosis of HCC with EBM is poor, lenvatinib, a tyrosine kinase inhibitor, was administered and resulted in improved symptoms, decreased tumour markers, and reduced EBM shadows on chest CT scans. To the best of our knowledge, this is the first case of lenvatinib monotherapy for EBM of HCC. It is important to perform a bronchoscopy for early diagnosis of EBM, followed by lenvatinib treatment.

Abstract Background We aimed to clarify the genomic characteristics of HER2‐positive and negative gastric cancer cases that potentially affect tumor progression and treatment response in a prospective trial. Methods We collected 80 formalin‐fixed paraffin‐embedded (FFPE) samples (49 HER2+ and 31 HER2‐) from gastric cancer patients who participated in the TROX‐A1 trial (UMIN000036865). We queried a 435‐gene panel (CANCERPLEX‐JP) to generate comprehensive genomic profiling data, including the tumor mutation burden, somatic mutations, and copy number variations. In addition, the genomic differences between HER2+ and HER2‐ gastric cancer patients were analyzed. Results Mutational analyses showed that TP53 was the most frequently mutated gene regardless of HER2 status. ARID1A mutation was significantly enriched in HER2‐negative patients. The number of total mutations in HER2‐negative patients with ARID1A mutation was remarkably higher than that in HER2‐positive patients. Next, copy number variation analyses showed that the number of amplified genes (such as CCNE1, PGAP3, and CDK12) in HER2‐positive cases was significantly higher than that in HER2‐negative cases. Moreover, PTEN deletion was more common in HER2‐positive cases. Finally, we found that, compared with HER2‐positive patients, HER2‐negative patients tended to have a higher tumor mutation burden, particularly in patients with ARID1A mutation. Pathway analyses of the gene alterations showed an enrichment of several immune‐related pathways in HER2‐negative patients. Conclusions According to the genomic profiling of HER2‐positive and negative gastric cancer, several gene alterations in the HER2 pathway may be the potential mechanism underlying trastuzumab resistance. Relative to HER2‐positive gastric cancer, HER2‐negative gastric tumors with ARID1A mutation may be sensitive to immune checkpoint inhibitors.

Introduction Basal cell carcinoma of the prostate is rare, with no established treatment for its recurrence or metastasis. We report a case involving basal cell carcinoma of the prostate controlled using radiotherapy. Case presentation A 57‐year‐old man complained of perineal pain. Although his prostate‐specific antigen was 0.657 ng/mL, a digital rectal examination revealed his prostate was stone hard. Prostate needle biopsy showed basal cell carcinoma of the prostate. The patient then underwent radical prostatectomy. Local recurrence and sacral bone metastasis appeared 2 months after surgery. OncoGuide™ NCC Oncopanel System showed deletion of SMARCB1; however no recommended treatment was identified. Thus, we decided to perform radiotherapy, which reduced all lesions. Conclusion Basal cell carcinoma of the prostate may have a poor prognosis with recurrence or metastasis, hence evaluation of prognostic factors is important. In this case, the genomic profiling test suggested that SMARCB1 deletion may be a prognostic factor associated with disease progression.

Abstract Background The long‐term relationship between fracture‐prone implantable cardioverter‐defibrillator (ICD) leads and poor prognosis remains unclear in Japanese patients. Methods We conducted a retrospective review of the records of 445 patients who underwent implantation of advisory/Linox leads (Sprint Fidelis, 118; Riata, nine; Isoline, 10; Linox S/SD, 45) and non‐advisory leads (Endotak Reliance, 33; Durata, 199; Sprint non‐Fidelis, 31) between January 2005 and June 2012 at our hospital. The primary outcomes were all‐cause mortality and ICD lead failure. The secondary outcomes were cardiovascular mortality, heart failure (HF) hospitalization, and the composite outcome of cardiovascular mortality and HF hospitalization. Results During the follow‐up period (median, 8.6 [4.1–12.0] years), there were 152 deaths: 61 (34%) in patients with advisory/Linox leads and 91 (35%) in those with non‐advisory leads. There were 32 ICD lead failures: 27 (15%) in patients with advisory/Linox leads and five (2%) in those with non‐advisory leads. Multivariate analysis for ICD lead failure demonstrated that the advisory/Linox leads had a 6.65‐fold significantly greater risk of ICD lead failure than non‐advisory leads. Congenital heart disease (hazard ratio 2.51; 95% confidence interval 1.08–5.83; p = .03) could also independently predict ICD lead failure. Multivariate analysis for all‐cause mortality demonstrated no significant association between advisory/Linox leads and all‐cause mortality. Conclusions Patients who have implanted fracture‐prone ICD leads should be carefully followed up for ICD lead failure. However, these patients have a long‐term survival rate comparable with that of patients with non‐advisory ICD leads in Japanese patients.

Abstract The water chestnut Trapa bispinosa Roxb. has been domesticated in China and has been reported as the only domesticated species of this genus. To understand the origin of T. bispinosa and its evolution pathway, we compared the genetic similarity and seed morphology of domesticated water chestnut T. bispinosa with three wild species T. natans, T. incisa, and T. japonica along with archeological seed samples from the Tianluoshan site (approximately 7000–6300 cal BP) in China. The largest seed size was observed only in the domesticated species, whereas other wild species showed smaller size including T. natans L. genetically close to the domesticated type, and T. incisa was the smallest in size. The volumes of the seed capsule and endosperm were measured using X ray CT scans, showing the ratios of total volumes between T. bispinosa and wild species ranged from 4.2 to 4.5. The ratios of endosperm volume ranged from 3.3 to 3.7. Both measurements showed domesticated species have larger seed volume. Genome size was indirectly estimated by flow cytometry. Domesticated species with larger seed size was estimated as diploid, as were the wild species except for tetraploid species T. japonica. Domesticated species clearly showed the largest edible organs, but it was not a result of ploidy level changes. Maternal lineages traced using complete whole chloroplast sequences, suggested that T. natans is the closest to T. bispinosa, both of which are close to T. japonica. The result was confirmed by PCR genotyping with chloroplast insertion/deletion (cpINDEL) markers developed in the study. T. incisa showed distinct plastid types within the species, and T. japonica showed a unique plastid genotype. Our study concludes the largest volumes for the edible endosperm have been accomplished through nearly 6000 years of artificial selection, but the domestication did not involve ploidy level changes.

Abstract Background & Aims Relationships of serum C‐C motif chemokine ligand 5 (CCL5) and C‐X‐C motif chemokine ligand 10 (CXCL10) levels with hot immune features have been reported in patients with hepatocellular carcinoma (HCC). Therefore, we examined the utility of their levels for predicting the efficacy of atezolizumab plus bevacizumab (Atez/Bev) in patients with HCC. Design In total, 98 patients with HCC treated with Atez/Bev were enrolled, and their initial responses were evaluated at least once via dynamic computed tomography or magnetic resonance imaging. Serum CCL5 and CXCL10 levels were assessed by enzyme‐linked immunosorbent assay before treatment and at the start of the second course of Atez/Bev therapy, and their relationships with treatment efficacy were determined. Results No analyzed factor was associated with the initial therapeutic response. Among the 56 patients with Barcelona Clinic Liver Cancer (BCLC) stage C, serum CXCL10 levels at the beginning of course two (CXCL10‐2c) tended to be higher in responders than in non‐responders in the initial evaluation, and its optimal cutoff level of 690 pg/mL could be used to stratify patients regarding overall survival (OS; high vs. low: not reached vs. 17.6 months, p = 0.034) and progression‐free survival (high vs. low: 13.6 vs. 5.1 months, p = 0.014). In multivariate analysis, high CXCL10 levels and neutrophil‐to‐lymphocyte ratios at the start of course two and Child–Pugh stage A at baseline were independent predictive factors of improved OS. Conclusions Serum CXCL10‐2c levels were predictive of Atez/Bev efficacy in patients with BCLC stage C HCC.

Abstract Chronic eosinophilic pneumonia (CEP) is an eosinophilic lung disease. Treatment for CEP includes corticosteroids; however, CEP often recurs. A 53‐year‐old woman was referred to our hospital because of poorly controlled asthma. She was treated with combination of moderate‐dose inhaled corticosteroid (ICS), a long‐acting β2‐agonist (LABA), and betamethasone/dexchlorpheniramine. She was switched to single‐inhaler triple therapy, after which her asthma control improved; thus, betamethasone/dexchlorpheniramine was discontinued. Ten weeks later, she was diagnosed with CEP due to marked eosinophilia and pulmonary eosinophilic infiltrates. Oral corticosteroid treatment was initiated, symptoms improved, and peripheral blood eosinophilia decreased with improved infiltrative shadows. Remission induction therapy was initiated with benralizumab combined with corticosteroid therapy. Eosinophilia and inflammatory responses decreased. After 7 months, corticosteroid was discontinued, and she was treated with benralizumab alone. She remained in remission for 4 months. This case suggests that benralizumab may be useful as a remission induction therapy in patients with CEP.

Background The utility of screening for the degree of common carotid artery (CCA) stenosis as a predictor of cardiovascular disease (CVD) in a general population remains unclear. Methods and Results We studied 4775 Japanese men and women whose CCA was measured using bilateral carotid ultrasonography at baseline (April 1994–August 2001). We calculated the degree of stenosis as a percentage of the stenotic area of the lumen in the cross‐section perpendicular to the long axis. The Cox proportional hazards model was used to calculate multivariable‐adjusted hazard ratios (HRs) with 95% CIs for incident CVD and its subtypes according to the degree of CCA stenosis. During the median 14.2 years of follow‐up, 385 incident CVD events (159 coronary heart disease and 226 stroke) were documented. The degree of CCA stenosis was associated with increased risks of incident CVD, coronary heart disease, and stroke, with multivariable‐adjusted HRs (95% CIs) for

Abstract This paper proposes and experimentally evaluates, a reconfigurable intelligent surface (RIS) control system for multiple users using stereo camera images. The aim is to enable fast and fair received signal strength (RSS) beamforming for multiple users. In the proposed system, a stereo camera is mounted on top of the RIS. Human bodies are recognized from the obtained images. Subsequently, the beam directions and the phase of the RIS are calculated for the estimated positions. The stereo camera‐based scheme enables fast beamforming because channel state information estimation is omitted. Moreover, identical RSS beamforming is enabled by calculating the weighted sums of the RIS phases for multiple users utilizing distance and angle information of users from the RIS obtained using the stereo camera. Experiments are conducted in an anechoic chamber using RIS operating at 28 GHz. The efficacy of the RIS control system using stereo camera images and its ability to increase the RSS fairly for multiple users is validated via simulations and experiments.

Introduction Bladder cancer is characterized by spatial and temporal recurrence in the urinary tract. We describe a case of recurrence at a uretero‐ileal anastomosis after radical cystectomy and nephroureterectomy. It was difficult to control bleeding from the tumor, but hemostasis was achieved. Case presentation A 73‐year‐old man with a history of radical cystectomy and reconstruction of the ileal conduit and right nephroureterectomy was diagnosed with recurrence at the uretero‐ileal anastomosis site. Bleeding from the tumor could not be controlled by flexible gastrointestinal endoscopy. The patient underwent coagulation via an ileal conduit approach using a rigid scope and bipolar electrocautery, which is usually a modality for transurethral resection. Conclusion This is the first report in which a modality normally used for transurethral resection was used to control bleeding in a patient with an ileal conduit. This application is useful in cases open surgery or additional irradiation might be difficult.

Introduction We report two cases where robotic‐assisted laparoscopic radical prostatectomy and inguinal hernia repair were performed simultaneously. Case presentation In case one, hernia repair was performed by implantation of 3D Max™ mesh and closure of the peritoneum. Total console time was 156 min, of which hernia repair took 21 min. In case two, hernia repair was performed using Ventralight™ ST mesh. Total console time was 181 min, of which hernia repair took 23 min. Pelvic lymph node dissection was performed in case two but not in case one. Both patients were discharged 7 days postoperatively without severe complications or mesh infection. Conclusion It may be possible to perform robotic‐assisted laparoscopic radical prostatectomy and inguinal hernia repair simultaneously.

Introduction Robot‐assisted surgery is spreading across surgical specialities as a less invasive alternative to conventional laparoscopic and open surgery. Case presentation In this report, robot‐assisted total laparoscopic hysterectomy and robot‐assisted nephroureterectomy were performed simultaneously for a 69‐year‐old Japanese female with giant cervical polyp and ureteral cancer. All specimens could be removed from the vagina. The operative time was 379 min, the estimated intraoperative blood loss was 29 mL, and the patient was discharged on the sixth postoperative day without complications. Conclusion We reported our experience with simultaneous robot‐assisted nephroureterectomy and robot‐assisted total laparoscopic hysterectomy. To our knowledge, this is the first report of simultaneous robot‐assisted nephroureterectomy and robot‐assisted total laparoscopic hysterectomy surgery.

Abstract Background Oxidative stress is associated with atrial fibrillation recurrence following catheter ablation. Urinary isoxanthopterin (U‐IXP) is one of the noninvasive markers which reflect the reactive oxygen species; however, its ability to predict atrial tachyarrhythmias (ATAs) occurrence following catheter ablation remains uncertain. Methods Among the patients who received scheduled catheter ablation for atrial fibrillation, baseline U‐IXP levels were measured just before the procedure. The prognostic impact of baseline U‐IXP upon postprocedural ATAs occurrence was investigated. Results Among 107 patients (71 years old, 68% men), baseline U‐IXP level was 0.33 nmol/gCr on the median. During a mean of 603 days of follow‐up, 32 patients had ATAs. Baseline higher U‐IXP was independently associated with the occurrence of ATAs following catheter ablation with a hazard ratio of 4.69 (95% confidence interval: 1.82–12.37, p = .001) adjusted for the left atrial diameter, a persistent type, and hypertension which were potential confounders, with a cutoff of 0.46 nmol/gCr, which stratified cumulative incidence of ATAs occurrence ( p

Adrenomedullin (AM) is a peptide with pleiotropic physiological functions that attenuates intestinal mucosal inflammation. However, the mechanism underpinning mucosal protection by AM is not fully understood, and its effect on intestinal epithelial cells remains unclear. Here, we investigated the effects of AM on junctional molecules in primary‐cultured murine intestinal epithelial cells and discovered that AM upregulates claudin‐4 expression. In a mouse model of dextran sulfate sodium‐induced colitis, AM administration also enhanced claudin‐4 expression and accelerated mucosal regeneration. Furthermore, AM reversed TNFα‐mediated downregulation of claudin‐4 and loss of cell–cell adhesion of the HCT116 human intestinal epithelial cell line in vitro. These results indicate that AM may enhance intestinal epithelial integrity by upregulating claudin‐4 expression.

Abstract Principal investigators (PIs) play a key role in clinical research, and must thus understand the role of clinical research support staff to conduct successful and appropriate clinical research. This study evaluates clinical research capabilities by examining the clinical research knowledge of PIs and clinical research support staff. The participants of this cross‐sectional study were academic researchers and clinical research support staff from Japanese universities and research institutions. The participants comprised of 54 respondents, among whom 36 were PIs (physicians) and 18 were clinical research support staff. A self‐administered electronic survey was created and evaluated by experts, with 50 knowledge items. Mann–Whitney U tests were used to determine the significance of the differences in knowledge between clinical research support staff and PIs. We compared the correct answer rate of clinical research support staff and PIs for each knowledge category and observed that the clinical research support staff scored significantly higher than the PIs in all aspects of clinical research knowledge sections, including total score. Our findings showed that PIs did not have the same amount of clinical research knowledge as the clinical research support staff. Clinical research knowledge is essential for investigators, especially PIs, to protect patients and promote medical breakthroughs. Thus, more accessible clinical research education and mandatory knowledge testing will allow PIs to lead successful clinical research and further the level of medical research in Japan.

Abstract La Niña persisted from 2020 to 2023, but its mechanisms are still unclear. In this study, atmosphere and ocean reanalysis and 100‐member initialized forecasts using a state‐of‐the‐art climate model were analyzed to identify factors contributing to the persistence of the first‐ to second‐year La Niña during 2020–2022. We found that North Pacific high pressure anomalies in the winter of 2020/2021 forced a negative phase of the Pacific meridional mode through the following spring, forming the broader structure of La Niña. The resultant broader La Niña pattern slowed down the recharge‐discharge process by Ekman transport, persisting La Niña. Ensemble forecast sensitivity analysis revealed that the meridional extent of La Niña explains its forecast spread, reaffirming the importance of La Niña spatial pattern. Advancing predictive understanding of 2020–2022 multi‐year La Niña can help to improve the extended seasonal forecast.

Introduction We aimed to evaluate the efficacy and safety of mechanical thrombectomy (MT) for medium vessel occlusion (MeVO) with the disabling deficit. Methods The study period was from January 2011 to December 2022. Inclusion criteria were 1) within 24 hours of stroke onset, 2) prestroke mRS score ≤1, 3) NIHSS score ≥4 or disabling deficit (complete hemianopia (≥2 on NIHSS), severe aphasia (≥2 on NIHSS), visual sensory extinction (≥1 on NIHSS), significant weakness with NIHSS subscore of paralysis ≥2), 4) MeVO (MCA distal M2, M3, ACA A1, A2, A3, PCA P1, P2, and P3). Outcomes were compared between the MT and standard medical treatment (SMT) groups. Outcome was defined as the favorable outcome (mRS score 0‐2 at 90 days), death within 90 days, and symptomatic intracranial hemorrhage (SICH). Results Of all, 192 patients (72 women, median age 78 years, median NIHSS score 11 points) were enrolled, and 76.6% (n=147) had distal M2 occlusion. Compared to the SMT group (n=153), the MT group (n=39) had a significantly larger median Tmax>10 sec volume (median 25 mL vs. 5 mL, P 6‐sec volume (61 mL vs. 44 mL, P

Key Clinical Message SMARCA4‐deficient thoracic carcinoma is a malignant tumor that may present as cancer of unknown primary. This tumor is refractory and requires a novel approach. In addition to identifying therapeutic targets, multigene panel testing can reveal novel genetic mutations, leading to more pathologically relevant diagnoses and appropriate tumor care. Abstract SMARCA4‐deficient undifferentiated tumors are characterized by SMARCA4 inactivation. We present a case of a 74‐year‐old man with an undifferentiated tumor and a novel SMARCA4 mutation detected using multigene panel testing. The tumor was multiagent and refractory to three chemotherapy lines. The test results helped guide appropriate medical management.

Key Clinical Message Portal venous gas (PVG) is rare. When PVG is seen, mesenteric ischemia should be differentiated. US is accurate in the diagnosis of mesenteric ischemia, but the value depends on various condition. Physicians should be familiar with findings of PVG and mesenteric ischemia to aid in appropriate management.

Abstract p16 has been used as a surrogate marker for human papillomavirus (HPV)‐related tumours. However, it remains unclear whether p16 is also a potential marker for pulmonary tumours. Herein, we report the case of an 80‐year‐old woman with a history of papillary squamous cell carcinoma of the uterine cervix, presenting with a left pulmonary tumour. A bronchoscopic biopsy revealed squamous cell carcinoma with a papillary pattern, which did not rule out pulmonary metastasis from the cervix. Immunohistochemical staining revealed that the cervical tumour was positive for p16, whereas the pulmonary tumour was negative and was effectively diagnosed as primary pulmonary carcinoma.

Introduction We present a case of simultaneous robot‐assisted radical nephroureterectomy (RANU) and robot‐assisted radical cystectomy (RARC) for muscle‐invasive bladder cancer with concomitant upper urinary tract urothelial carcinoma. Case presentation A 59‐year‐old Japanese man was diagnosed with right ureteral cancer and muscle‐invasive bladder cancer. We performed RANU and RARC simultaneously; three of the ports used for RANU were diverted to RARC. Console times for RANU and RARC were 66 and 207 minutes, respectively. Total operative time was 386 minutes. The intraoperative blood loss was estimated 255 ml. The patient was discharged on postoperative day 18 without complications. Conclusion We reported our experience with simultaneous RANU and RARC for muscle‐invasive bladder cancer with concomitant right ureteral cancer. To the best of our knowledge, this is the first report of its kind in Japan.

Abstract An 84‐year‐old woman who was admitted for protein‐losing gastroenteropathy associated with radiation enteritis 10 years after pelvic radiotherapy developed pyelonephritis. She became anuric despite having an indwelling bladder catheter. Imaging studies revealed bladder wall thickening, bilateral hydroureter formation, and hydronephrosis. Autopsy findings led to a diagnosis of gangrenous cystitis (GC). Our case indicates that radiation‐induced late effects may be an indirect cause of GC, not a direct cause as previously suggested, and that GC may induce bilateral vesicoureteral junction obstruction.

Introduction Patients with coronavirus disease, especially solid organ transplant recipients, are more susceptible to developing cytokine release syndrome than those with other viral infections. However, currently, treatment methods for such patients have not been established. Here, we describe two cases of successful immunomodulation in Japanese kidney transplant recipients with cytokine release syndrome following coronavirus disease. Case presentation Two patients who had been receiving long‐term immunosuppressant therapy developed coronavirus disease‐associated pneumonia caused by cytokine release syndrome, following immunosuppressant dosage reduction. However, they recovered immediately after administration of tocilizumab with or without dexamethasone. Conclusion The immunosuppressant dosage should be reduced to restore host immunity; however, immunomodulation should be considered in cases of suspected cytokine release syndrome.