The indications for endoscopic resection (ER) and the criteria for the curability of early gastric cancer (EGC) have been expanding. Among Korea, Japan, and Europe, Korea has the most strictly defined indication for ER, followed by Europe and Japan, whereas the curability criteria are relatively similar. Additional surgery is the standard treatment after noncurative resection; however, it is not frequently performed in older patients in clinical practice. Several risk-scoring systems have been developed to further stratify the risk of lymph node metastasis after noncurative resection, and they may help refine the indications for ER and curability assessment in older patients. Nevertheless, the current evidence remains insufficient to establish recommendations specific to this population. In older patients, most deaths are attributable to non-gastric cancer-related causes, regardless of the post-resection treatment strategy. Therefore, in addition to gastric cancer-specific mortality, non-gastric cancer-related mortality and quality of life should be considered.Endoscopic submucosal dissection (ESD) techniques continue to evolve. Traction methods and multibending endoscopes are useful for achieving safe and reliable ESD in selected cases.Although no intervention has been proven effective in reducing delayed bleeding after gastric ESD in randomized controlled trials, several closure methods have shown promising results in retrospective or phase II studies. Furthermore, novel image-enhanced endoscopies may help improve the technical success of gastric ESD. This review provides an evidence-based perspective that may guide optimal management of patients with EGC.

Methods: Lateral radiographs were obtained from 100 healthy adults in standing and seated postures at 25°, 35°, and 45° recline angles. Spinal parameters (cervical lordosis, thoracic kyphosis, thoracolumbar kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and T1 spinopelvic inclination) and seat belt metrics (X-value, Z-value, and lap belt angle) were measured. Multivariate regression was used to assess associations with sex, age, height, and body mass index (BMI). Results: Reclining reduced cervical/lumbar lordosis and sacral slope, while thoracic kyphosis and pelvic tilt increased. Higher BMI was associated with a cranially shifted and more horizontal lap belt. Taller individuals showed greater T1 spinopelvic inclination and pelvic parameters. Females exhibited more pronounced thoracic kyphosis and pelvic retroversion across reclining angles. Conclusions Car seat recline significantly alters spinal alignment and seat belt positioning, with changes influenced by age, height, and BMI. These findings support ergonomic improvements in seat design and may inform surgical planning for ASD.

Methods: This study included 62 patients with Lenke type 2 AIS who underwent posterior correction and fusion surgeries. The patients were categorized into the PSI and non-PSI groups based on their radiographic shoulder height 2 years after surgery. Radiographic parameters, lower end vertebra (LEV), lower instrumented vertebra (LIV), sagittal stable vertebra (SSV), postoperative DA and DJK, and Scoliosis Research Society 22 scores were compared between the two groups using unpaired t -tests or Pearson’s chi-square tests. Results: Twenty-eight patients in the PSI group and 34 in the non-PSI group were evaluated. Three patients had DA in the PSI group and 10 with DA and four with DJK in the non-PSI group. LIV–LEV was higher in the PSI group than in the non-PSI group. Although the LIV–SSV was not significantly different between the two groups, among the three patients with DJK, two had LIV–SSV of −3, one had −1, and one had 0. No significant differences in other examinations were noted between the two groups. Conclusions Although more proximal LIV selection might lead to stable DA and DJK, the LIV selection should not be extended distally to prevent DA and DJK because favorable shoulder balance and clinical outcome can still be achieved.

Methods: This single-center study included 130 patients with osteoporotic vertebral fractures who underwent BKP and preoperative computed tomography and magnetic resonance imaging. After propensity score matching for age; sex; body mass index; fracture level; use of steroids, teriparatide, or osteoporosis medication; and previous AVF, patients were classified into the AVF (−) and AVF (+) groups, each of which included 34 patients. Bone strength was assessed using the L1 HU, L1–4 HU (mean HU of L1–L4), L1 VBQ, and L1–4 VBQ. Group differences were analyzed, and the predictive accuracy for AVF was evaluated using area under the receiver operating characteristic curve (AUC). Results: L1 HU was significantly lower in the AVF (+) group than in the AVF (−) group (92.1±29.4 vs. 71.6±21.4, p =0.013). No significant differences between the groups were observed for L1–4 HU, L1 VBQ, and L1–4 VBQ. L1 HU had the highest AUC (0.657), compared with those for L1–4 HU (0.625), L1 VBQ (0.524), and L1–4 VBQ (0.523). The predictive accuracy of L1 was superior to that of L1–4 for both HU and VBQ scores. Conclusions HU was superior to VBQ in predicting AVF risk after BKP, with L1 HU being the most effective indicator of bone strength and AVF risk.

Purpose: Romosozumab reportedly increases bone density in patients with severe osteoporosis; however, data on its clinical effects are limited. We conducted a multicenter retrospective survey to study the bone density-increasing effects of romosozumab and blood test-based predictive factors in patients with severe osteoporosis, examining its effects in clinical practice. Materials and Methods: This was a multicenter retrospective observational study. The subjects were patients with severe osteoporosis who were treated with romosozumab at the participating facilities. The increase in bone density was assessed by comparing bone density changes (as a percentage) in the lumbar spine, femoral neck, and total femur before and 12 months after administration using dual-energy X-ray absorptiometry. The association between changes in bone density at each site and pre-treatment bone metabolism markers (Tracp 5b, P1NP), serum calcium levels, nutritional status [Conut score: albumin, total cholesterol (TCho), and total lymphocyte count], and kidney function (eGFR) was assessed. Results: In both naïve patients and those switching from bone resorption inhibitors, the bone density increased significantly. In naïve patients, eGFR were positively associated with bone density in the total femur. In cases of switching from bone resorption inhibitors, correlations were found between Tracp 5b and lumbar spine bone mineral density (BMD), as well as between Tracp 5b, Alb, T-Cho, and eGFR in the total femur BMD. Conclusion Romosozumab administration significantly increases bone density in osteoporosis, and assessing key predictive factors is necessary to ensure clinical effectiveness.

Objective: Recent treatment advancements have improved the survival rates of patients with hematological malignancies, making hematopoietic stem cell transplantation (HSCT) a key curative option. However, despite ongoing awareness efforts, the number of bone marrow donor registrations has not significantly increased over time, possibly because of the impact of recent infectious disease outbreaks. This may affect patients requiring allogeneic HSCT. This study explored the experiences of adolescent and young adult (AYA) bone marrow donors.Patient and Methods: Using a qualitative descriptive research design, we conducted semi-structured interviews with six AYA individuals who had experience as bone marrow donors. The study was approved by the institutional ethics committee (022-03), and no conflicts of interest were disclosed.Results: Seven categories and 23 subcategories were identified in this analysis. Participants reported a strong sense of duty as donors, but faced challenges such as family opposition, lack of understanding from employers, and concerns about the impact on work and family life. Despite these difficulties, donors often experienced personal growth and fulfillment through donation.Conclusion: Nurses should recognize AYA bone marrow donors as a population that requires support, and consider strategies to increase the understanding and registration among this crucial demographic group.

This study investigated the psychological impact of autopsy imaging (Ai) on bereaved families of patients with terminal cancer. These patients, one with pancreatic cancer of the body and tail and the other with intrahepatic cholangiocarcinoma, underwent Ai, and a mixed-methods survey was conducted with 7 bereaved family members using a self-administered questionnaire. Although the awareness of Ai was low (14.3%), all participants reported that Ai helped them understand the cause of death. Moreover, 71.4% felt that Ai was necessary. Qualitative analysis of free-text responses suggested that Ai contributed to a clearer understanding and acceptance of the cause of death and provided psychological reassurance. On the other hand, it became evident that the implementation of Ai could evoke emotional conflict and complex feelings in bereaved families. Therefore, confirming the patient’s wishes and providing psychological support to both the patient and their family are essential when conducting Ai. In the future, it will be essential for medical professionals to carefully explain the purpose and significance of Ai during advance care planning discussions, and to consider its implementation while respecting the wishes of both the patient and their family.

In recent years, expectations and demand for Japanese Kampo medicines have increased in Japan. However, the self-sufficiency rate of raw materials for crude drugs in Japan is approximately 10%, with most imported from China. Although discussions on the domestic production of raw materials are gaining momentum, achieving self-sufficiency of crude drugs for Kampo preparation poses several challenges, including production costs, sales channels, and distribution prices. However, it is well-known that a diverse array of crude drugs can be cultivated in the Japanese climate. Since 2013, Ibara City in Okayama Prefecture has been promoting a medicinal plant cultivation project to utilize fallow land effectively. Currently, we have achieved successful cultivation of ‘benishizuka,’ a medicinal peony known as Paeoniae radix, with sufficient quality. However, the present circumstances in Japan limit its sales channels for medical use. The project initiated by Ibara City has evolved from its inception, primarily involving farmers, the government, and national research institutes, to now encompass an unprecedented collaboration among medical professionals as well as local construction companies and a local university. This transformation has propelled Ibara City’s various new medicinal plant cultivation businesses into a new phase of development. In this report, we investigated the local history and climate from the perspective of a Kampo medicine practitioners and discuss the path to successful peony cultivation. Additionally, we delve into the innovations and outcomes pertaining to peony cultivation. Moreover, we report the challenges and prospects for the domestic production of crude drugs for Kampo preparation from the perspective of multiple professions.