Chronic obstructive pulmonary disease (COPD) is a major global health burden. However, it remains widely under-recognized despite its substantial impact on morbidity and mortality rates. Most cases remain undiagnosed bec...Chronic obstructive pulmonary disease (COPD) is a major global health burden. However, it remains widely under-recognized despite its substantial impact on morbidity and mortality rates. Most cases remain undiagnosed because the early symptoms are often subtle, thus hindering timely intervention. Globally, the World Health Organization (WHO), within its noncommunicable disease framework, advocates a multifaceted approach to COPD, including prevention, early diagnosis, and long-term management. Several countries have established national COPD strategies that emphasize early diagnosis, rehabilitation, and population-based interventions. In Japan, the Japanese Respiratory Society launched "COMORE-By2032" (Project for COPD Mortality Reduction By 2032), which phonetically corresponds to the Japanese word "Komorebi," pronounced "koh-moh-reh-bee." It employs a two-step approach. Step 1 promotes public awareness and early consultation for high-risk individuals, whereas Step 2 supports healthcare professionals in improving diagnosis and treatment. This initiative emphasizes collaboration to enhance awareness, improve the diagnostic rates, prevent exacerbations, and ultimately extend the healthy life expectancy.
Ulcerative colitis (UC) and Crohn's disease (CD) are well-known representative forms of inflammatory bowel disease (IBD) and they have long been regarded as intractable diseases of unknown etiology. Recent advances in ge...Ulcerative colitis (UC) and Crohn's disease (CD) are well-known representative forms of inflammatory bowel disease (IBD) and they have long been regarded as intractable diseases of unknown etiology. Recent advances in genomic analyses, immunology, studies of the intestinal microbiota, elucidation of environmental factors, and long-term human cohort studies have greatly improved our understanding of the disease pathogenesis and accelerated the development of preventive approaches. Historically, the incidence of IBD was the highest in Western countries; however, in recent years, the number of patients in newly industrialized countries has increased rapidly. Therefore, the establishment of active strategies aimed at preventing disease onset has become extremely important, in addition to the development of new therapeutic agents. This review summarizes the most recent findings regarding the etiology of IBD obtained mainly from human cohort studies and discusses the current efforts directed toward prevention and early intervention, with particular emphasis on the importance of dietary and nutritional factors.
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis characterized by asthma, chronic rhinosinusitis with nasal polyps, eosinophil-driven tissue inflammation, and necrotizing small- to mediu...Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis characterized by asthma, chronic rhinosinusitis with nasal polyps, eosinophil-driven tissue inflammation, and necrotizing small- to medium-sized vessel vasculitis. Myeloperoxidase - Anti-Neutrophil Cytoplasmic Antibody (MPO-ANCA) is detectable in approximately 30%-40% of patients, and ANCA-positive and ANCA-negative diseases exhibit distinct yet overlapping clinical patterns. Type 2 immune responses are predominant, with interleukin-5 (IL-5) driving eosinophil differentiation and survival, and IL-4 and IL-13 promoting eosinophil recruitment and IgE-associated pathways. Activated eosinophils contribute to tissue injury through degranulation and eosinophil extracellular trap formation (EETosis). Glucocorticoids remain the foundation of therapy, but they are often insufficient to achieve a sustained remission as monotherapy. Conventional immunosuppressants are used for severe disease, and B-cell-targeted therapy may be considered for selected vasculitic presentations. Biological agents targeting the IL-5/IL-5 receptor axis have been shown to prolong remission, reduced relapse risk, and enabled glucocorticoid sparing. However, some patients remain symptomatic, and reliable biomarkers to guide individualized therapy are lacking. Ongoing research focuses on biomarker panels and cell-free DNA to clarify the role of EETosis and define molecular endotypes to support precision-medicine approaches.
Objective Neurobehavioral symptoms of dementia substantially impair the quality of life (QOL) of caregivers. However, most caregiver burden instruments are ordinal and lack empirically derived symptom-specific weighting,...Objective Neurobehavioral symptoms of dementia substantially impair the quality of life (QOL) of caregivers. However, most caregiver burden instruments are ordinal and lack empirically derived symptom-specific weighting, limiting quantitative interpretation. This study aimed to develop a utility-weighted scale to quantitatively assess caregiver QOL impairment across the dementia severity levels. Methods Eleven dementia-related neurobehavioral symptoms were identified through a literature review and interviews with 115 dementia care professionals. Utility weights were estimated using a conjoint analysis based on the rankings of 27 hypothetical dementia profiles. The resulting Caregiver Quality of Life (CgQOL) scale was evaluated for reliability and validated in individuals with Alzheimer's disease using the Zarit Burden Interview (ZBI), Functional Assessment Staging Tool (FAST), and Mini-Mental State Examination (MMSE). Results A conjoint analysis revealed a clear hierarchy of symptom importance, with agitation having the highest relative importance (15.5%), followed by difficulties with toileting (12.1%) and sleep disturbances (11.7%). The total CgQOL scores ranged from 0 to 36.3. The scale demonstrated excellent inter-rater reliability (weighted κ=0.86) and internal consistency (Cronbach's α=0.998). CgQOL scores increased monotonically with advancing FAST stage and were negatively correlated with the MMSE scores. Moderate convergent validity was observed with the ZBI scores, thus indicating that the two instruments captured related but distinct aspects of the caregiver burden. Conclusion The CgQOL scale is a novel parametric utility-weighted instrument that quantitatively captures caregiver QOL impairment associated with dementia-related neurobehavioral symptoms and complements existing caregiver burden measures. This framework enables a more nuanced and quantitative evaluation of caregiver burden and may serve as a complementary tool to conventional scales in both clinical and research settings.
Tani Y, Sugita T, Ikumi A
… +19 more, Rai A, Shibasaki F, Sugita N, Kikuchi R, Tokunaga K, Kawashima F, Nishiyama T, Ohyama A, Kitada A, Shimizu M, Miki H, Asashima H, Kondo Y, Tsuboi H, Watanabe M, Ohkusu K, Kiyasu Y, Suzuki H, Matsumoto I
A 77-year-old man receiving a seven-week course of systemic glucocorticoids for organizing pneumonia was referred to our hospital with persistent fever and generalized edema. During hospitalization, swelling of the left...A 77-year-old man receiving a seven-week course of systemic glucocorticoids for organizing pneumonia was referred to our hospital with persistent fever and generalized edema. During hospitalization, swelling of the left wrist became apparent and it progressively worsened. Repeated blood culture examinations were initially negative, and Corynebacterium striatum was subsequently isolated from the synovial fluid and from a single set of blood cultures obtained on the sixth attempt. However, these findings were initially regarded as contamination. A subsequent synovial biopsy identified C. striatum, thus leading to a final diagnosis of native wrist septic arthritis. The patient's symptoms improved after initiating intravenous vancomycin therapy.
Objective Nationwide population-based epidemiological data on intussusception in Japan are limited. This study aimed to preliminarily investigate the temporal trends, demographic characteristics, and seasonal patterns of...Objective Nationwide population-based epidemiological data on intussusception in Japan are limited. This study aimed to preliminarily investigate the temporal trends, demographic characteristics, and seasonal patterns of intussusception reduction procedures using a comprehensive administrative database. Methods We analyzed data from the National Database of Health Insurance Claims and Specific Health Checkups (NDB) Open Data (2014-2023). The procedures were categorized as nonoperative or operative. The crude and age-adjusted procedure rates were calculated per 100,000 person-years. Temporal trends were assessed using linear and Poisson regressions. Seasonal variations (April 2019-March 2024) were evaluated using a one-way analysis of variance with post-hoc comparisons, and correlations with pediatric infectious diseases and meteorological variables were examined using Pearson's correlation coefficients. Results Over the decade, 42,173 procedures were performed, with an average annual rate of 3.4 per 100,000 person-years and an overall male-to-female ratio of 2.1:1. The age distribution was bimodal, with a major peak among children aged 0-4 years and a minor peak among adults aged ≥90 years. The annual procedure counts declined from 5,836 in 2014 to 3,735 in 2023. The age-adjusted nonoperative procedure rates decreased significantly, particularly among older adults (p <0.001). In 2023, nonoperative reductions accounted for 94.7% of all procedures, whereas operative procedures accounted for 5.3%. Nonoperative procedures demonstrated significant seasonal variation (p <0.05), particularly between spring and summer, and showed moderate positive correlations with pharyngoconjunctival fever and hand, foot, and mouth disease, as well as weak positive correlations with temperature. Conclusion This preliminary nationwide study provides contemporary epidemiological insights into the management of intussusception in Japan.
A 46-year-old Japanese man with nonobstructive hypertrophic cardiomyopathy harboring a heterozygous PSEN1 c.367G>A (p.Glu123Lys) variant experienced sudden cardiac arrest due to ventricular fibrillation at 56 years of ag...A 46-year-old Japanese man with nonobstructive hypertrophic cardiomyopathy harboring a heterozygous PSEN1 c.367G>A (p.Glu123Lys) variant experienced sudden cardiac arrest due to ventricular fibrillation at 56 years of age. Although PSEN1 variants are primarily associated with early onset Alzheimer's disease, emerging evidence suggests a role in cardiomyopathy that is independent of the amyloid pathology. This case demonstrates a novel cardiac manifestation of presenilin 1 dysfunction. At the time of genetic diagnosis, the patient exhibited normal cognition, suggesting that cardiovascular manifestations may precede neurodegeneration. This report suggests an expansion of the phenotypic spectrum associated with PSEN1 variants and highlights the need for further investigation of potential cardiac manifestations in PSEN1 variant carriers.
Objective The COVID-19 pandemic has significantly impacted the lifestyle patterns in Japan. During behavioral restrictions, reduced physical activity may have increased the prevalence of reflux esophagitis (RE). We compa...Objective The COVID-19 pandemic has significantly impacted the lifestyle patterns in Japan. During behavioral restrictions, reduced physical activity may have increased the prevalence of reflux esophagitis (RE). We compared the prevalence of RE regardless of the presence or absence of reflux symptoms before and during the pandemic and evaluated its relationship with clinical factors. Methods We conducted a retrospective analysis of individuals who underwent esophagogastroduodenoscopy during an annual health checkup. The study period was divided into pre-pandemic (April 2017-March 2020; 15,039 cases) and pandemic (April 2020-March 2023; 14,338 cases) phases. We compared the acid-suppressive agent use, the prevalence and severity of RE, BMI, waist circumference, and diaphragmatic hiatus size between the phases. Results The use of acid-suppressive agents increased from 4.6% before the pandemic to 6.3% during the pandemic (p <0.001). After excluding participants who used acid-suppressive agents, the prevalence of RE increased significantly from 14.3% before the pandemic to 18.9% during the pandemic (p <0.001), and the prevalence of severe RE cases increased from 0.6% to 1.4%. The diaphragmatic hiatus size increased significantly during the pandemic. The COVID-19 pandemic period was positively associated with RE, with an odds ratio (95% confidence interval) of 1.22 (1.14-1.31) in the multiple logistic regression analysis. Among the 4,440 individuals who underwent endoscopy in both phases without acid-suppressive agents, the RE prevalence, mean BMI, proportion with BMI ≥25 kg/m, and waist circumference increased significantly. Conclusion During the COVID-19 pandemic, the use of acid-suppressive agents and the prevalence of endoscopically diagnosed RE increased, which may be associated with an increased BMI, waist circumference, and diaphragmatic hiatus size, thus indicating the contribution of lifestyle-related factors.
A 53-year-old man presented with recurrent, motor-predominant acute polyneuropathy that progressed to a loss of ambulation, accompanied by fever and arthralgia. Nerve conduction studies demonstrated demyelinating feature...A 53-year-old man presented with recurrent, motor-predominant acute polyneuropathy that progressed to a loss of ambulation, accompanied by fever and arthralgia. Nerve conduction studies demonstrated demyelinating features, a cerebrospinal fluid analysis revealed albuminocytological dissociation, and the presence of anti-GM1/GM2 IgM antibodies suggested acute inflammatory neuropathy. Further evaluation revealed markedly elevated interleukin-6 (IL-6) levels and diffuse lymphadenopathy on FDG-PET imaging, and a subsequent lymph node biopsy confirmed idiopathic multicentric Castleman disease (iMCD). While slowly progressive sensory neuropathy is the typical manifestation of iMCD, acute, severe, motor-predominant neuropathy is extremely rare. This case highlights the mechanisms of IL-6-mediated neuropathy.
Pulmonary infarction (PI) often mimics lobar pneumonia. A 23-year-old man with prostatitis presented with pleuritic pain and hemoptysis. Despite high inflammatory markers, consolidation was refractory to antibiotic treat...Pulmonary infarction (PI) often mimics lobar pneumonia. A 23-year-old man with prostatitis presented with pleuritic pain and hemoptysis. Despite high inflammatory markers, consolidation was refractory to antibiotic treatment. Retrospectively, the initial opacities represented the hyperacute hemorrhagic phase of PI. Thoracentesis revealed bloody effusion, and contrast-enhanced computed tomography (CECT) confirmed pulmonary thromboembolism with characteristic "central lucencies." Anticoagulation therapy led to his recovery. PI should be considered in young patients with refractory pneumonia. Bloody effusion and central lucencies are critical diagnostic clues. Combined localized infection and transient stressors (dehydration/immobility) can trigger venous thromboembolism, even in the absence of hereditary thrombophilia. Early CECT can prevent unnecessary invasive procedures.
A 51-year-old woman presented with severe headache and severe anemia. She was diagnosed with autoimmune hemolytic anemia (AIHA) and treated with prednisolone and red blood cell transfusion. During the clinical course, th...A 51-year-old woman presented with severe headache and severe anemia. She was diagnosed with autoimmune hemolytic anemia (AIHA) and treated with prednisolone and red blood cell transfusion. During the clinical course, the patient developed acute transient neurological symptoms. Magnetic resonance angiography revealed multifocal segmental narrowing of the cerebral arteries, which improved spontaneously on follow-up. The clinical and radiological findings were consistent with reversible cerebral vasoconstriction syndrome (RCVS). This case highlights that multiple factors, including active hemolysis, red blood cell transfusion, and corticosteroid therapy, may contribute to the development of RCVS.
Neisseria meningitidis is a Gram-negative diplococcus that rarely causes invasive diseases in Japan. We report a case of polyarticular meningococcal septic arthritis in an immunocompetent 62-year-old Japanese man. After...Neisseria meningitidis is a Gram-negative diplococcus that rarely causes invasive diseases in Japan. We report a case of polyarticular meningococcal septic arthritis in an immunocompetent 62-year-old Japanese man. After 3 days of fever, he developed pain in the dorsum of the right hand and right shoulder. Computed tomography revealed effusions in the right wrist and acromioclavicular joint. Blood cultures grew N. meningitidis serogroup Y, sequence type 1655. A PCR assay detected the 16S rRNA gene of N. meningitidis in culture-negative wrist synovial fluid. Treatment with ceftriaxone followed by oral amoxicillin led to a complete recovery.
We report a case of intravascular large B-cell lymphoma (IVLBCL) characterized by three episodes of spontaneous remission before a definitive diagnosis. A 60-year-old man presented with headache and cognitive impairment,...We report a case of intravascular large B-cell lymphoma (IVLBCL) characterized by three episodes of spontaneous remission before a definitive diagnosis. A 60-year-old man presented with headache and cognitive impairment, with elevated serum lactate dehydrogenase (LDH) and soluble interleukin-2 receptor levels. Although IVLBCL was suspected, a random skin biopsy and bone marrow examination yielded nonspecific findings, and the symptoms resolved spontaneously. Similar self-limited relapses occurred twice in this patient. Ten months after onset, persistent fever, neurological deterioration, hypoxemia, and sustained LDH elevation developed, and IVLBCL was finally diagnosed by a random skin biopsy. This case illustrates the extremely rare phenomenon of the repeated spontaneous remission in IVLBCL.
A 73-year-old woman experienced sudden drowsiness and sleep attacks for 10 years, as well as a loss of strength in her legs when laughing. Polysomnography (PSG) showed an apnea-hypopnea index (AHI) of 87.0, indicating se...A 73-year-old woman experienced sudden drowsiness and sleep attacks for 10 years, as well as a loss of strength in her legs when laughing. Polysomnography (PSG) showed an apnea-hypopnea index (AHI) of 87.0, indicating severe obstructive sleep apnea (OSA). The Multiple Sleep Latency test showed three sleep-onset rapid eye movement periods, and symptoms of sleep attacks and cataplexy were observed, leading to a diagnosis of narcolepsy. After Continuous Positive Airway Pressure treatment, the AHI decreased to 21.0, and cataplexy occurred only once a month. Late-onset narcolepsy is a rare condition. We herein report a case of late-onset Type1 narcolepsy complicated by OSA.
A 34-year-old woman with common variable immunodeficiency (CVID) developed pulmonary abnormalities despite adequate subcutaneous immunoglobulin replacement and long-term low-dose erythromycin therapy. Her lung lesions an...A 34-year-old woman with common variable immunodeficiency (CVID) developed pulmonary abnormalities despite adequate subcutaneous immunoglobulin replacement and long-term low-dose erythromycin therapy. Her lung lesions and hypoxemia progressed, and a surgical biopsy confirmed granulomatous-lymphocytic interstitial lung disease (GLILD). Prednisolone and cyclosporine were administered. However, her condition worsened, and she died of infectious complications. Although patients with CVID-GLILD often respond to immunoglobulin replacement therapy or immunosuppression, this case was rapidly progressive and refractory to treatment.
Objective Physician burnout threatens healthcare quality, safety, and sustainability. Identifying individual (e.g., lifestyle) and organizational (e.g., work environment, leadership) factors is critical for developing ef...Objective Physician burnout threatens healthcare quality, safety, and sustainability. Identifying individual (e.g., lifestyle) and organizational (e.g., work environment, leadership) factors is critical for developing effective interventions. This study aimed to examine the factors associated with burnout among board-certified internists in Japan. Methods A nationwide cross-sectional survey was conducted from November 15 to December 31, 2024, among 3,320 internists on the Japanese Society of Internal Medicine mailing list; 353 responded (10.6%). Burnout was assessed using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), which covers emotional exhaustion, depersonalization, and reduced personal accomplishment. The survey also captured professional, community, and personal factors. Results Among 316 complete responses, 17.1% (n=54) met the criteria for extreme burnout (high-risk thresholds in all domains), and 64.6% (n=204) met high-risk thresholds for emotional exhaustion and/or depersonalization. The risk factors included a high workload (OR 2.16, 95% CI 1.36-3.41), electronic health record burden (OR 1.42, 95% CI 1.11-1.83), and preoccupation with the past or future (OR 2.43, 95% CI 1.84-3.21). Protective factors included in-person social interaction (OR 0.58, 95% CI 0.39-0.87), supportive/respectful leadership from supervisors (OR 0.52, 95% CI 0.38-0.69), and perceived support from senior leadership (OR 0.60, 95% CI 0.47-0.78) and co-workers (OR 0.63, 95% CI 0.49-0.81). Conclusion Workload, psychological stress, and leadership quality strongly influence burnout among Japanese internists. Structural interventions that promote a supportive culture and relational well-being may help mitigate burnout.