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Background: Migraine is a highly prevalent neurological disorder and a leading cause of disability worldwide. Although triptans and non-steroidal anti-inflammatory drugs are widely used, a substantial proportion of patients show inadequate responses. Lasmiditan, a selective 5-HT1F receptor agonist introduced in Japan in January 2022, represents a novel acute treatment option that lacks vasoconstrictive activity and can be prescribed even in patients with cardiovascular risk. However, little is known about the trend of its long-term real-world use. Objectives: To characterize 2-year lasmiditan prescription patterns using time-series clustering. Design: A retrospective observational study using nationwide health insurance claims data in Japan. Methods: Data were extracted from the REZULT database for patients aged ⩾15 years diagnosed with migraine (ICD-10 code G43) between January 2022 and December 2024. Prescription claims were analyzed in 90-day intervals for up to 24 months after the initial lasmiditan prescription. Time-series clustering was applied to identify subgroups with distinct trajectories of lasmiditan use. Results: Lasmiditan was prescribed to 21,199 of 167,461 (12.7%) migraine patients (mean age 33.8 ± 10.3 years; 76.6% female). In the first 3 months, 86.2% received 50 mg, 12.8% received 100 mg, and 1.0% received both doses. About half were also prescribed analgesics, 66.7% triptans, and 33.9% prophylactic drugs. Lasmiditan prescriptions were gradually tapered over 2 years, with the most common long-term pattern being combination therapy with analgesics and triptans. Clustering identified three groups: Cluster 1 (massively continuous use), Cluster 2 (gradual tapering), and Cluster 3 (early discontinuation). Conclusion: This nationwide claims-based study provides the first real-world evidence of long-term lasmiditan prescribing patterns. The identification of three distinct trajectories highlights the heterogeneity of clinical practice. It underscores the need for further research on lasmiditan’s optimal use, particularly regarding combination therapy and potential medication overuse.

Emicizumab reduces bleeding episodes in patients with severe hemophilia A (PwHA). Little information is available on hemostatic management of severe traumatic hemorrhages in emicizumab-treated pediatric PwHA. We assessed therapeutic efficacy and global coagulation potentials in two pediatric cases of emicizumab-treated pediatric PwHA with intracranial or retroperitoneal/iliopsoas hemorrhage. A modified clot waveform analysis (CWA) triggered by mixtures of tissue factor and ellagic acid was used to assess coagulant potentials, and maximum coagulant velocity (Ad|min1|) was calculated. One patient with intracranial hemorrhage was treated with continuous infusions of recombinant factor VIII (rFVIII) at a dose of 4–4.6 IU/kg/hr for 9 days, followed by bolus infusion at 66 IU/kg/day for 2 days and 33 IU/kg/day for an additional 2 days. The Ad|min1| was increased from 5.5 (at baseline) to 7.0–8.1 under concomitant treatment and maintained within or near normal range (IQR; 6.9–7.7). The other patient with retroperitoneal/iliopsoas hemorrhage received bolus infusions of rFVIII at 50 IU/kg/day for 20 days and every-other-day infusion of rFVIII for 8 days. The Ad|min1| was increased from 5.2 (at baseline) to 5.8–6.8 under concomitant treatment and maintained within the normal range. We successfully managed a treatment plan for severe traumatic bleeding in emicizumab-treated pediatric PwHA using modified CWA.

In 2008, the Japanese government implemented a National Intervention Program for metabolic syndrome. Low-risk individuals were not direct targets of this intervention. Nevertheless, they were indirectly enlightened by this massive campaign. Documentation of the metabolic shifts in low-risk individuals following the program launch may inform public health policy regarding approaches to metabolic risks in the general population. We conducted a cross-sectional analysis of data from non-diabetic participants who underwent general health check-ups at the Physical Check-up Center of Sumitomo Hospital. Participants during 2007-2008 were pair-matched with those during 2015-2016 with respect to sex, age, smoking status, hemoglobin level, and red blood cell (RBC) count. Each participant was included only once in the study. Totals of 3,140 men and 2,048 women were pair-matched. The non-diabetic participants showed lower waist circumference, blood pressure, heart rate, and serum lipid concentrations during the second study period. In contrast, the entire distributions of fasting plasma glucose (FPG) concentration in both sexes and glycated hemoglobin (HbA.sub.1c) in women were shifted upwards. In men, [DELTA] FPG was +1.6 mg/dL (P < 0.001) and [DELTA] HbA.sub.1c was ±0% (P = 0.6). In women, [DELTA] FPG was +3.0 mg/dL (P < 0.001), and [DELTA] HbA.sub.1c was +0.1% (P < 0.001). [DELTA] Homeostasis model assessment of [beta]-cell function was -6.6 in men (P < 0.001) and -10.3 in women (P < 0.001). The homeostasis model assessment of insulin resistance did not change significantly. The \"glycemic set point\" has increased in non-diabetic people in Japan during recent years. Lifestyle or environmental changes may have caused this metabolic shift through obesity-independent pathways, possibly through effects on pancreatic [beta]-cell function. The underlying mechanism awaits further investigation.

[...]muscle weakness and decreased deep tendon reflexes were only first observed on POD 30. Medical Research Council (MRC) scores were as follows (right/left): shoulder abduction 1/3, elbow flexion 1/3, hip flexion 0/2, knee extension 0/2. Table 1 Nerve conduction studies Motor nerves Latency (ms) CMAP Amplitude (distal / proximal) (mV) MCV (m/s) Median nerve 3.7 (<2.6) 2.8/2.1 (>8.8) 53.8 (>57.2) Tibial nerve 4.9 (<3.6) 0.51/0.34 (>15.8) 45.4 (>48.2) Sensory nerves Latency (ms) SNAP Amplitude (mV) SCV (m/s) Median nerve 2.4 (<2.1) 7.4 (>20.5) 60.1 (>43.7) Sural nerve NE CMAP, compound muscle action potential; MCV, motor conduction velocity; NE, not evoked; SNAP, sensory nerve action potential. ( ) indicates normal range.

Introduction We present a rare case of long‐term survival following metastasectomy for lumbar metastasis with growing teratoma syndrome. Case presentation An 18‐year‐old man presented with left scrotal mass and lumbago. Alpha‐fetoprotein was elevated to 648.8 ng/mL, while human chorionic gonadotropin and lactate hydrogenase were normal. Pathology of left inguinal orchiectomy revealed immature teratoma, and computed tomography confirmed a single metastasis in the second lumbar vertebra. After two courses of bleomycin, etoposide, cisplatin chemotherapy, alpha‐fetoprotein decreased, but computed tomography confirmed an enlarged lumbar metastasis. A vertebral biopsy demonstrated teratoma with a dominant mature component, and growing teratoma syndrome was suspected. Following additional etoposide, cisplatin chemotherapy, and normalization of alfa‐fetoprotein, total spondylectomy was performed. Vertebral pathology proved mature teratoma. After adjuvant chemotherapy, he has been recurrence‐free for 17 years. Conclusion Spondylectomy of a single metastatic vertebra contributed to long‐term survival in a testicular teratoma case.

Introduction Fournier's gangrene refers to a necrotizing fasciitis that mainly affects the perineal region and a condition that requires immediate debridement. This case involved elective debridement of Fournier's gangrene after the general condition was improved through antibiotic treatment instead of requesting an emergency debridement. Case presentation The patient was an 85‐year‐old man with a performance status of 4 admitted to a nursing home. He was transferred by ambulance with a fever. Blood tests showed a markedly elevated inflammatory response, and computed tomography revealed widespread aerodermectasia around the right testis to the lower abdomen. The patient was diagnosed with Fournier's gangrene. However, his family declined emergency surgical debridement. The patient's general condition was improved with antibiotics, and debridement was eventually performed. After 52 days of hospitalization, the patient was transferred to another hospital. Conclusion This study describes the successful treatment of Fournier's gangrene through conservative treatment followed by elective debridement.

IntroductionIatrogenic ureteral injury is a rare but often encountered complication of abdominal and gynecological surgery. This is a case of iatrogenic ureteral injury with infected urinoma treated with one-stage laparoscopic drainage and ureterocystoneostomy.Case presentationAn 80-year-old man with rectal cancer had robot-assisted low anterior rectum resection and left lateral lymph node dissection after colostomy and preoperative chemoradiotherapy. On the 14th postoperative day, he had a fever, and a noncontrast-enhanced computed tomography scan revealed a low-density polycystic area in the left pelvic cavity. Retrograde pyelography revealed contrast medium leaking from the left lower ureter, preventing ureteral stent placement. We identified it as a delayed ureteral injury with infected urinoma and performed laparoscopic one-stage drainage and ureterocystoneostomy.ConclusionThis study reported a case of one-stage laparoscopic drainage and ureterocystoneostomy for iatrogenic ureteral injury with infected urinoma.

Introduction Bladder paraganglioma is exceedingly rare, accounting for <0.05% of bladder tumors. This is a case of paraganglioma with no symptom other than palpitations during urination, with atypical imaging, resulting in acute respiratory distress syndrome after transurethral resection of the bladder tumor. Case presentation A 46‐year‐old man underwent transurethral resection of the bladder tumor for a bladder tumor 61 × 52 mm in size on contrast‐enhanced computed tomography. The patient only had micturition attacks and was suspected to have urothelial carcinoma on magnetic resonance imaging. The patient had acute respiratory distress syndrome after the operation which improved conservatively. The 123Iodine metaiodobenzylguanidine scintigraphy, urinalysis, and pathological examination revealed bladder paraganglioma. Robot‐assisted radical cystectomy and ileal neobladder reconstruction were performed. Conclusion This study reported bladder paraganglioma with no symptoms other than micturition attacks in which acute respiratory distress syndrome occurred after transurethral resection of the bladder tumor.

Background Ectopic fat is fat that accumulates in or around specific organs or compartments of the body including myocardium. The clinical features of type 2 diabetes patients with high fat accumulation in the myocardium remain unknown. Moreover, little is known about the influence of myocardial fat accumulation in type 2 diabetes on coronary artery disease and cardiac dysfunction. We aimed to clarify the clinical features, including cardiac functions, of type 2 diabetes patients with myocardial fat accumulation. Methods We retrospectively enrolled type 2 diabetes patients who underwent ECG-gated coronary computed tomography angiography (CCTA) and abdominal computed tomography (CT) scan examinations within 1 year of CCTA from January 2000 to March 2021. High fat accumulation in the myocardium was defined as the low mean myocardial CT value of three regions of interest, and the associations between CT values and clinical characteristics or cardiac functions were assessed. Results In total, 124 patients were enrolled (72 males and 52 females). The mean age was 66.6 years, the mean BMI was 26.2 kg/m 2 , the mean ejection fraction (EF) was 67.6%, and the mean myocardial CT value was 47.7 Hounsfield unit. A significant positive correlation was found between myocardial CT value and EF (r = 0.3644, p = 0.0004). The multiple regression analyses also showed that myocardial CT value was independently associated with EF (estimate, 0.304; 95% confidence interval (CI) 0.092 to 0.517; p = 0.0056). Myocardial CT value showed significant negative correlations with BMI, visceral fat area and subcutaneous fat area (r = − 0.1923, − 0.2654, and -0.3569, respectively, p < 0.05). In patients who were ≥ 65 years or female, myocardial CT value showed significant positive correlations with not only EF (r = 0.3542 and 0.4085, respectively, p < 0.01) but also early lateral annular tissue Doppler velocity (Lat e’) (r = 0.5148 and 0.5361, respectively, p < 0.05). The multiple regression analyses showed that myocardial CT value was independently associated with EF and Lat e’ in these subgroups (p < 0.05). Conclusions Patients with type 2 diabetes, especially in elderly or female patients, who had more myocardial fat had more severe left ventricular systolic and diastolic dysfunctions. Reducing myocardial fat accumulation may be a therapeutic target for type 2 diabetes patients.

This study evaluated the effects of docetaxel and androgen receptor signaling inhibitors as second‐line treatments in patients with castration‐resistant prostate cancer after androgen receptor signaling inhibitors as first‐line treatment. This study retrospectively evaluated the clinical outcomes of second‐line treatment with docetaxel or androgen receptor signaling inhibitor in patients with castration‐resistant prostate cancer who received first‐line treatment with androgen receptor signaling inhibitors. Clinical backgrounds and outcomes were compared between docetaxel and androgen receptor signaling inhibitors as second‐line treatment. Of 59 patients, 21 (35.6%) and 38 (64.4%) received docetaxel and androgen receptor signaling inhibitors as second‐line treatment after first‐line treatment with androgen receptor signaling inhibitors, respectively. In the second‐line setting, the median progression‐free survival was longer with androgen receptor signaling inhibitor than with docetaxel (17 versus 6 months, P = 0.014). In the first‐line setting, the median progression‐free survival was longer with androgen receptor signaling inhibitors than with docetaxel (32 versus 25 months, P = 0.014); however, no significant difference was found in the overall survival. Multivariate analysis revealed that there was no significant association between second‐line treatment and survival, and first‐line treatment with abiraterone was identified as a prognostic factor for progression‐free survival. Subgroup analysis showed that the abiraterone–enzalutamide sequence was more effective than the other three sequences for progression‐free survival and overall survival. This study suggests that second‐line treatment with an androgen receptor signaling inhibitor for castration‐resistant prostate cancer after androgen receptor signaling inhibitors as first‐line treatment may be more beneficial, particularly with abiraterone as the upfront treatment.