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Introduction Retrocaval ureter is a rare congenital anomaly that causes ureteral obstruction. Because of the rarity of retrocaval ureter, only a few cases of open, laparoscopic, or robot‐assisted surgery have been reported. We herein report a case of retrocaval ureter that was successfully reconstructed with robot‐assisted surgery. Case presentation A 24‐year‐old woman was incidentally diagnosed with right hydronephrosis on ultrasonography. Computed tomography revealed retrocaval ureter, and the right hydronephrosis was attributed to the retrocaval ureter. The patient underwent robot‐assisted right ureteral reconstruction in the left lateral decubitus position. No intraoperative or postoperative complications occurred, and no right hydronephrosis was observed 6 months after the operation. Conclusion The present case demonstrated the feasibility and efficacy of robot‐assisted ureteral reconstruction for retrocaval ureter.

Metabolic dysfunction-associated steatohepatitis (MASH) is a progressive liver disease linked to fibrosis and hepatocellular carcinoma (HCC). Gut-derived lipopolysaccharide (LPS) promotes hepatic inflammation, fibrosis, and angiogenesis through toll-like receptor 4 (TLR4) signaling. This study examined the effects of rifaximin, a non-absorbable, gut-targeted antibiotic, on MASH-related liver fibrosis and early hepatocarcinogenesis, with a focus on the LPS–epiregulin–IL-8–angiogenesis axis.MASH was induced in Fischer 344 rats using a choline-deficient, L-amino acid-defined high-fat diet (CDAHFD). Rifaximin (30 mg/kg/day) was orally administered for 12 weeks. Liver histology, gene expression, intestinal permeability, LPS levels, and angiogenic markers were evaluated. Rifaximin reduced hepatic inflammation, fibrosis, hydroxyproline content, and fibrogenic gene expression. The number and size of GST-P-positive preneoplastic lesions and proliferation-related genes were decreased. Portal LPS levels and Kupffer cell activation declined, with downregulation of Lbp, Cd14, Tlr4, and inflammatory cytokines. Rifaximin decreased hepatic epiregulin and IL-8 expression, attenuated CD34-positive neovascularization, and suppressed proangiogenic gene expression, accompanied by improved intestinal barrier function and reduced gut permeability. Rifaximin mitigates MASH progression by restoring gut barrier integrity, limiting LPS translocation, and inhibiting fibrogenic and angiogenic pathways. These results suggest its potential as a chemopreventive agent in MASH-related hepatocarcinogenesis.

This paper examines the relationship between user pageview (PV) histories and their itemchoice behavior on an e-commerce website. We focus on PV sequences, which represent time series of the number of PVs for each user–item pair. We propose a shape-restricted optimization model that accurately estimates item-choice probabilities for all possible PV sequences. This model imposes monotonicity constraints on item-choice probabilities by exploiting partial orders for PV sequences, according to the recency and frequency of a user’s previous PVs. To improve the computational efficiency of our optimization model, we devise efficient algorithms for eliminating all redundant constraints according to the transitivity of the partial orders. Experimental results using real-world clickstream data demonstrate that our method achieves higher prediction performance than that of a state-of-the-art optimization model and common machine learning methods.

Background Asthma patients with comorbid chronic rhinosinusitis or nasal polyps (CRS/NP) often experience poor asthma control. However, the comparative efficacies of biological therapies in this subgroup remain unclear. Methods A comprehensive search of multiple databases was conducted to identify randomized controlled trials (RCTs) on biological therapies targeting uncontrolled asthma that included CRS/NP data. The outcomes of interest were annual asthma exacerbation rate (AER), pre-bronchodilator forced expiratory volume in one second (pre-BD FEV1), asthma control questionnaire (ACQ) scores, and sinonasal outcome test (SNOT-22) scores. Pairwise meta-analyses were performed based on the presence or absence of CRS/NPs. Subsequently, random-effects network meta-analyses were conducted to perform indirect comparisons of the individual biological therapies. Results Eleven eligible RCTs evaluating tezepelumab, dupilumab, mepolizumab, and benralizumab were identified. Omalizumab and reslizumab were excluded because subgroup data were not available. Pairwise meta-analyses demonstrated significantly greater improvement effects of biological therapies on all outcomes in patients with CRS/NP than in those without CRS/NP ( p  < 0.01). In the network meta-analyses, for CRS/NP patients, tezepelumab showed the most pronounced reduction in AER (rate ratio 0.17; 95% confidence interval [CI] 0.09, 0.29), while benralizumab (mean difference [MD] 0.30 L; 95% CI 0.19, 0.40) exhibited the greatest improvement in pre-BD FEV1. Tezepelumab demonstrated the most substantial improvement in the ACQ scores (MD -0.80; 95% CI -1.25, -0.35), whereas mepolizumab (MD -11.80; 95% CI -19.75, -3.85) was associated with the greatest improvement in the SNOT-22 scores. Conclusions In the management of asthma with CRS/NP, it is crucial to select biological therapies that consider specific improvements in individual outcomes.

In this report, we present a case of nonsmall-cell lung cancer with anaphylaxis after 41 courses of pembrolizumab along with adrenal insufficiency as an immune-related adverse event (irAE). A 73-year-old man with no allergic disease started pembrolizumab for postoperative recurrence of lung cancer. After four courses, tumor shrinkage was observed and maintained thereafter. After the 39th course, his serum sodium level and random serum cortisol level decreased. Adrenal insufficiency was considered; however, the patient was asymptomatic. Furthermore, his serum sodium level improved spontaneously; therefore, he was followed up. At the end of the 40th course, rhinorrhea and pharyngeal discomfort were noted; however, they were mild and resolved spontaneously. Immediately after administration of the 41st course, he developed pembrolizumab-induced anaphylaxis with percutaneous oxygen saturation decreased. The symptoms quickly improved after intramuscular adrenaline were administered and did not recur. Three months after discharge, the patient was urgently examined for vomiting and anorexia. His serum sodium levels decreased to 119 mEq/L, and an adrenocorticotropic hormone stimulation test was performed. It showed a low response, and the patient was diagnosed with secondary adrenal insufficiency as an irAE of pembrolizumab and treated with hydrocortisone, which quickly improved his serum sodium levels and symptoms. When adrenal insufficiency develops due to irAEs, patients may be susceptible to allergic reactions.

Although the global emergency phase of the coronavirus disease 2019 (COVID-19) pandemic has ended, antiviral therapy remains crucial for patients at high risk of severe illness. In Japan, the out-of-pocket costs for antiviral drugs shifted from full public coverage to partial patient payment in April 2024. However, the impact of physicians’ background characteristics on antiviral cost perceptions and prescribing behavior remains underexplored. This study involved a secondary analysis of a nationwide, web-based interventional survey of 1,500 physicians treating COVID-19. Participants reported whether they avoided prescribing antivirals owing to drug costs and identified what they considered an appropriate cost per treatment course. Associations between physicians’ characteristics and their cost perceptions were analyzed. Among 1,500 physicians surveyed, 1,193 (79.5%) reported avoiding antiviral prescriptions owing to drug costs. The most commonly selected appropriate cost was ≤ 33 USD (65.0%). Generalists, pulmonologists, ear, nose, and throat specialists, and clinic-based physicians were more likely to refrain from prescribing antivirals and favor lower treatment costs compared with physicians in other specialties or hospital settings. A multivariate analysis revealed workplace setting as the only factor independently associated with cost-related prescribing behavior. High antiviral drug costs in Japan may contribute to underprescription, particularly among clinic-based physicians, and this underprescription could hypothetically lead to delays in treatment, which might increase the risk of severe outcomes in high-risk patients. As high-risk patients with mild COVID-19 often first seek care in clinics, promoting appropriate antiviral use in these settings is essential. Strengthening communication and sharing clinical experiences between hospitals and clinics may help reduce prescribing disparities driven by drug costs.

Introduction Testicular mucinous borderline tumor is a rare primary testicular neoplasm with a generally favorable prognosis. Herein, we report a case diagnosed after high orchiectomy, with a brief literature review. Case Presentation A 77‐year‐old man presented with discomfort in the left scrotum. Computed tomography revealed enlargement and calcification of the left testis and indicated a testicular tumor. High orchiectomy was performed, and pathological examination revealed a mucinous borderline tumor. Postoperative upper and lower gastrointestinal endoscopy showed no abnormal findings, leading to the diagnosis of primary testicular mucinous borderline tumor. Twelve months postoperatively, no evidence of postoperative recurrence or metastasis was observed. Conclusion We presented a rare case of testicular mucinous borderline tumor. Considering the existence of a case with metastasis, long‐term imaging follow‐up is advised. Keynote Message Testicular mucinous borderline tumor is extremely rare, and the initial treatment is high orchiectomy. In the diagnostic process, unlike typical germ cell tumors, such as seminoma, gastrointestinal endoscopy must be performed in addition to chest and abdominal computed tomography to exclude metastatic testicular tumors. Although many reported cases indicate a favorable prognosis, a case with metastasis has been reported. Therefore, postoperative imaging is necessary to rule out recurrence or metastasis.

Background Although antifibrotic agents (AFAs) are often discontinued due to side effects, their tolerability is crucial given the limited treatment options for interstitial lung disease associated with connective tissue disease (CTD-ILD). The possibility of intolerance due to organ damage caused by CTDs has also been considered; however, few detailed studies are available. We hypothesized that AFAs for CTD-ILD would be poorly tolerated or discontinued prematurely due to organ damage caused by collagen disease. Therefore, we conducted a retrospective investigation to explore this hypothesis. Methods We retrospectively reviewed the medical records of ILD patients treated with nintedanib or pirfenidone at St. Luke's International Hospital between December 2008 and November 2022, comparing the CTD-ILD group with the non-CTD-ILD group. Patient background, cumulative discontinuation rate due to adverse events (AEs), duration of prescription until discontinuation, AEs leading to discontinuation, and mortality rate were collected from medical records. Results We identified 42 and 129 patients in the CTD-ILD and non-CTD-ILD groups, respectively. The cumulative incidence of discontinuation due to AEs did not significantly differ between the CTD-ILD and non-CTD-ILD groups in the overall population or when restricted to nintedanib and pirfenidone (overall population, p = 0.402; nintedanib group, p = 0.510; pirfenidone group, p = 0.625). The duration of AFA use at discontinuation due to AEs was not significantly different between the overall group (CTD-ILD vs. non-CTD-ILD, median: 77 vs. 116 days, p = 0.496) and the pirfenidone group (CTD-ILD vs. non-CTD-ILD, median: 136 vs. 55 days, p = 0.127). However, for nintedanib, the duration in the CTD-ILD group was significantly shorter than that in the non-CTD-ILD group (median: 23 vs. 218 days, p = 0.016). Gastrointestinal symptoms were the most common reason for discontinuation. Of the seven cases of CTD-ILD patients who used nintedanib and discontinued due to AEs, six were female, four had systemic sclerosis (SSc), and three were using tacrolimus. Conclusions The cumulative incidence of discontinuations due to AEs did not significantly differ between the CTD-ILD and non-CTD-ILD groups. However, the duration of nintedanib use was significantly shorter in the CTD-ILD group when the discontinuation was due to AEs. Particularly, when administering nintedanib to patients with SSc and/or those using tacrolimus, measures to prevent AEs should be carefully implemented.

Introduction We report a rare case of multiple spermatic cord angiolipomas. Case Presentation An 85‐year‐old man with a history of laparoscopic right nephrectomy for renal cell carcinoma was referred for evaluation of a palpable right scrotal mass. Ultrasonography showed a single solid mass. Computed tomography and magnetic resonance imaging revealed a solid nodule in contact with the right spermatic cord and a fatty mass below the nodule. Right inguinal orchiectomy was performed. Histopathological examination of the surgical specimen was consistent with angiolipoma. He was discharged 4 days postoperatively, and no recurrence has been observed during the subsequent 8 months. Conclusion Angiolipomas are benign and rarely occur in paratesticular tissue. They should be distinguished from liposarcomas, given the differences in treatment and prognosis. Diagnosis requires surgical resection and histopathological examination. Once resected, angiolipomas rarely recur, and the prognosis is good.

Background Despite being minimally invasive, bronchoscopy does not always result in pathological specimens being obtained. Therefore, we investigated whether virtual bronchoscopic navigation (VBN) findings were associated with the rate of diagnosis of primary lung cancer by bronchoscopy in patients with peripheral lung lesions. Methods This study included patients with suspected malignant peripheral lung lesions who underwent bronchoscopy at St. Luke’s International Hospital between October 2013 and March 2020. Patients diagnosed with primary lung cancer were grouped according to whether their pathology could be diagnosed by bronchoscopy, and their clinical factors were compared. In addition, the distance between the edge of the lesion and the nearest branch (“distance by VBN”) was calculated. The distance by VBN and various clinical factors were compared with the diagnostic rates of primary lung cancer. Results The study included 523 patients with 578 lesions. After excluding 55 patients who underwent multiple bronchoscopies, 381 patients were diagnosed with primary lung cancer. The diagnostic rate by bronchoscopy was 71.1% (271/381). Multivariate analysis revealed that the lesion diameter (odds ratio [OR] 1.107), distance by VBN (OR 0.94) and lesion structure (solid lesion or ground-glass nodule; OR 2.988) influenced the risk of a lung cancer diagnosis. The area under the receiver operating characteristic curve for diagnosis based on lesion diameter and distance by VBN was 0.810. Conclusion The distance by VBN and lesion diameter were predictive of the diagnostic rates of primary lung cancer by bronchoscopy in patients with peripheral lung lesions.