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Syphilitic aortitis is usually associated with thoracic aortic saccular aneurysm, aortic regurgitation and coronary ostial stenosis. However, syphilitic aneurysms have rarely been reported today. Here, we report a patient with ascending aortic aneurysm with aorta-superior vena cava (SVC) fistula with positive syphilitic test. A 52-year-old man was admitted to our institution with a giant ascending aortic aneurysm complicated with SVC syndrome. Computed tomography revealed a giant ascending aneurysm 79 mm in diameter. The result of serodiagnostic tests for syphilis had not been judged yet preoperatively. Total arch replacement concomitant with elephant trunk was performed. Intraoperatively, we detected the ascending aorta to SVC fistula. Postoperatively, we suspected the syphilitic aneurysm strongly, because preoperative serodiagnostic test was concluded to be positive. However, histological examination did not show typical syphilitic features. The patient remains asymptomatic 1 year later. Although extremely rarely today, syphilitic aneurysm should be still considered in the differential diagnosis of ascending aortic aneurysm.

We present a case of a 61-year-old female who underwent excision of the mass within left atrial appendage. She underwent cardiac surgery due to cardiac tumor. The tumor was measured 6 cm, and it was completely resected. After surgery, pathological examination diagnosed endocardiac-based cardiac hemangioma. The post operative course was uneventful and the patient discharged on the 18th postoperative day.

This study aimed to assess the discriminatory ability and calibration performance of the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II, a widely used risk prediction tool, in predicting postoperative mortality among patients undergoing cardiac surgery at Prince of Wales Hospital (PWH) in Hong Kong. Complete data from 4180 patients who underwent cardiac surgery at PWH between 2013 and 2023 were available for validation of EuroSCORE II and comparison of its discriminatory ability with the logistic EuroSCORE. Discriminatory performance was primarily assessed using the area under the receiver operating characteristic curve (AUROC). Calibration was evaluated using the Hosmer-Lemeshow test, coefficient of determination (R2), and normalised root mean square error (NRMSE). EuroSCORE II demonstrated strong discrimination and good calibration for predicting 30-day mortality in the overall cohort (AUROC=0.829; Hosmer-Lemeshow P=0.155) and key subgroups: isolated coronary artery bypass grafting (CABG) [AUROC=0.847; P=0.113], isolated valve surgery (AUROC=0.810; P=0.162), and aortic surgery (AUROC=0.735; P=0.549). More than 85% of the variation in 30-day mortality (R ) was explained across these groups. Compared with the logistic EuroSCORE, EuroSCORE II showed improved discrimination and calibration, with higher AUROC values and lower NRMSE. EuroSCORE II demonstrates strong discriminatory ability and good calibration for predicting 30-day mortality among patients undergoing cardiac surgery and within key subgroups-isolated CABG, isolated valve surgery, and aortic surgery-in this cohort.

Background Workplace social capital (WSC), a social resource available within work or occupational environments, has been identified as an important factor for employees’ health in fields other than medical education. However, little is known about whether WSC is associated with well-being and work engagement among medical residents. The aim of this study was to examine the relationships between WSC, well-being, and work engagement specifically among medical residents. Methods This cross-sectional study was conducted at 32 hospitals in Japan, assessing WSC with the Japanese medical resident version of the Workplace Social Capital (JMR-WSC) scale. Well-being and work engagement were measured as the primary and secondary outcomes using the Subjective Well-Being Scale and the Japanese version of the Utrecht Work Engagement Scale. Results We analyzed data from 276 residents. Adjusting for possible confounders, the JMR-WSC Scale scores were associated with well-being in a dose-dependent manner (adjusted mean difference 6.55, 95% CI 4.96–8.15 for the WSC highest score quartile, compared with the lowest score quartile). The WSC Scale scores demonstrated a dose-dependent association with work engagement (adjusted mean difference 15.12, 95% CI 11.66–18.57 for the WSC highest score quartile, compared with the lowest score quartile). Conclusions This study showed that WSC was linked to enhanced well-being and work engagement among residents. Our findings offer insights for developing interventions to prevent resident burnout and create an environment conducive to residents’ well-being and engagement.

Purpose Ambiguity tolerance specific to the clinical context – in contrast to ambiguity tolerance as a personality trait – may vary with experience and has received considerable attention. Although this tolerance appears to be related to burnout and work engagement, few studies have examined this association among physicians. Thus, we aimed to examine the relationships between clinical context-specific ambiguity tolerance, burnout, and work engagement among physicians in Japan. Methods We conducted a nationwide cross-sectional study in Japan. We invited family physicians from 14 family medicine residency programs and physicians with specialties other than family medicine from monitors of an Internet survey company to participate in the study. We measured ambiguity tolerance in the clinical context using the Japanese version of the Tolerance of Ambiguity in Medical Students and Doctors (J-TAMSAD) scale, burnout using the Japanese version of the Burnout Assessment Scale (BAT-J), and work engagement using the Utrecht Work Engagement Scale (UWES). We performed a multivariable linear regression analysis to determine whether the J-TAMSAD scale score was associated with the BAT-J and UWES scores. Results 383 respondents were included in the analysis. After adjustment for possible confounders, clinical context-specific ambiguity tolerance showed a dose-dependent negative association with burnout (adjusted mean difference  -0.39, 95% confidence interval (CI) -0.56 to -0.22 for the highest J-TAMSAD score quartile compared with the lowest). Ambiguity tolerance in the clinical context also showed a dose-dependent positive association with work engagement (adjusted mean difference 0.83, 95% CI 0.49 to 1.16 for the highest J-TAMSAD score quartile compared with the lowest). Conclusions Our study showed that tolerance for ambiguity in the clinical context was negatively associated with burnout, and positively associated with work engagement. These findings will be useful in developing interventions aimed at preventing burnout and promoting work engagement among physicians.

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. Methods We performed a nationwide cross‐sectional study in Japan. We asked FPs from 14 family medicine residency programs across Japan and non‐FPs from monitors of an internet survey company in Japan to participate in the study. We assessed their tolerance for ambiguity using the Japanese version of the Tolerance for Ambiguity in Medical Students and Doctors (J‐TAMSAD) scale. Results In total, 388 physicians (178 FPs and 210 non‐FPs) completed our anonymous online survey and were included in the analysis. After adjustment for possible confounders (gender and postgraduate years), FPs had higher J‐TAMSAD scale scores than internists/pediatricians, surgeons, and physicians with other specialties, meaning that FPs had greater ambiguity tolerance. Conclusions This study reveals that FPs had greater tolerance for ambiguity in the clinical context than non‐FPs. Our findings suggest that there may be a need to increase non‐FP's tolerance for ambiguity specific to the clinical context through educational interventions, since ambiguity is inherent and growing in medicine today. FPs and non‐FPs should work together to complement each other's strengths, rather than simply improving the training of non‐FPs.

Background Patient care ownership (PCO) is crucial to enhancing accountability, clinical skills, and medical care quality among medical trainees. Despite its relevance, there is limited information on the association of personal or environmental factors with PCO, and thus, authors aimed to explore this association. Methods In 2021, the authors conducted a multicentered cross-sectional study in 25 hospitals across Japan. PCO was assessed by using the Japanese version of the PCO Scale (J-PCOS). To examine the association between personal (level of training, gender, and department) or environmental factors (hospital size, hospital type, medical care system, number of team members, number of patients receiving care, mean working hours per week, number of off-hour calls per month, and perceived level of the workplace as a learning environment) and PCO after adjusting for clustering within hospitals, the authors employed a linear mixed-effects model. Results The analysis included 401 trainees. After adjusting for clustering within hospitals, it was confirmed that the senior residents had significantly better J-PCOS total scores (adjusted mean difference: 8.64, 95% confidence interval [CI]: 6.18–11.09) than the junior residents and the perceived level of the workplace as a learning environment had a positive association with J-PCOS total scores (adjusted mean difference per point on a global rating of 0–10 points: 1.39, 95% CI: 0.88–1.90). Trainees who received calls after duty hours had significantly higher J-PCOS total scores than those who did not (adjusted mean difference: 2.51, 95% CI: 0.17–4.85). There was no clear trend in the association between working hours and PCO. Conclusions Seniority and the perceived level of the workplace as a learning environment are associated with PCO. An approach that establishes a supportive learning environment and offers trainees a reasonable amount of autonomy may be beneficial in fostering PCO among trainees. The study findings will serve as a useful reference for designing an effective postgraduate clinical training program for PCO development.

As the elderly population increases, independent living for the aged has become essential for extending a healthy life expectancy, and this requires the maintenance of mobility for daily activities, such as standing up and walking. Among these, standing up, a series of movements involved in getting out of a chair or bed, is the starting point of daily activities. Therefore, it is important to clarify the factors that contribute to accomplishing the transition from sitting to standing up. This study attempted to clarify the relationship between motor characteristics and the mechanism of muscle activity involved in the change from sitting to standing up. Specifically, we focused on the activity of the bi-articular muscles involved in the two joints simultaneously rather than joint torque that is the conventional standard for evaluating motion. We probed the mechanistic characteristics of bi-articular muscle activity as well as the main muscles that function during normal standing up motion, namely a natural standing up movement where the trunk is not vertically restricted, using electromyographic analysis, theoretical analysis using a link model based on the muscle arrangement of the lower limb, and experimental analysis using an actual model that reproduces the functions of these muscles to define the muscular activities of the thigh muscles.

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. Methods This was a nationwide cross‐sectional study involving family physicians in 14 residency programs throughout Japan. Ambiguity tolerance was assessed as the primary outcome using the Japanese version of the Tolerance for Ambiguity in Medical Students and Doctors scale. Secondary outcomes were burnout and work engagement, assessed using the Japanese version of the Burnout Assessment Tool and the ultra‐short version of the Utrecht Work Engagement Scale, respectively. Results 173 family physicians were included in the analysis. Physicians of PGY ≥7 had significantly greater ambiguity tolerance and lower burnout risk than those of PGY 3–6. Physicians of PGY 7–20 had significantly higher work engagement than those of PGY 3–6. Conclusions Family medicine resident physicians may be vulnerable for the duration of the residency program, although they may develop ambiguity tolerance and improve well‐being over the course of the program. Supervisors in family medicine residency programs should examine the learning environment of their program, considering the vulnerability of their trainees.

Landing is a frequently executed motion in athletic activities, and injuries have been reported to occur often during landing, suggesting that legs are subjected to large loads during landing. Many studies, based on posture and floor reaction, have been conducted on this subject; however, few have been conducted from the muscular-activity perspective. Moreover, we found no studies investigating the functions of biarticular muscles (muscles that cross two joints). Therefore, we studied landing motion in which feet make ground contact after falling from a suspended position. Our objective was to clarify activity patterns of biarticular thigh muscles in two different trunk postures. Our results showed that the activity patterns of the antagonistic biarticular muscle pair at the thigh anterior and posterior were affected by trunk posture.