A 73-year-old man, who underwent total esophagectomy and gastric tube reconstruction via the retrosternal route for esophageal cancer 10 years eariler, was referred to our hospital with chest pain. He was suspected of acute coronary syndrome, and coronary artery angiography was performed, showing in-stent restenosis of the proximal site of the right coronary artery, diagnosed as the culprit lesion, and drug-coated ballooning was performed. His symptoms improved, however, the poor expansion of the stent and in-stent stenosis remained, and he was referred to our department for coronary artery bypass surgery. Because the gastric tube was reconstructed just below the sternum and performing sternotomy seemed to be difficult, a left mini-thoracotomy approach using great saphenous vein was planned. Under general anesthesia, an approximately 10-cm skin incision was made on the left fifth rib from the anterior axillary to the midclavicular line, and the chest wall was opened at the fifth and third intercostal spaces from the same skin incision, to secure views of the AV node branch and ascending aorta. First, the great saphenous vein was anastomosed to the ascending aorta from the third intercostal space, using 3.8 mm puncher and Heartstring III (Getinge, Lindholmspiren, Sweden). After that, the graft was guided extrapericardially via the left intrathoracic cavity, and was anastomosed to the AV nodal branch from the fifth intercostal space. The graft blood flow was 48 ml/min. The postoperative course was uneventful and contrast-enhanced CT confirmed the patency of the graft.

The role of academic journals evolves with the times. Academic publishing is diversifying, shifting from traditional paper-based formats to broader dissemination through open access. In response to these developments-and to contribute to ongoing progress in medical education-Medical Education (Japan) has undertaken a comprehensive revision of its submission guidelines. As of January 17, 2025, all submissions, peer reviews, and editorial processes are being conducted in accordance with the updated guidelines.　The Editorial Board convened a round-table discussion to explore recent developments, beginning with the revision of the submission guidelines. This discussion elaborates on the journal's role and its relevance to the academic community, including society members, authors, and readers. It features statements from participating editorial committee members and highlights the key issues discussed, including the criteria each member uses to evaluate manuscripts. The aim is to offer insight into the journal's editorial stance and decision-making process.

Objective: To implement early rehabilitation interventions by physical therapists is recommended. However, the effectiveness of early rehabilitation for severe coronavirus disease 2019 (COVID-19) patients in the prevention of post-intensive care syndrome (PICS) is unclear. We analyzed a multicenter prospective observational study (Post-Intensive Care outcomeS in patients with COronaVIrus Disease 2019) to examine the association between early rehabilitation interventions and PICS physical impairment. Methods: An analysis was performed on COVID-19 patients who were admitted to intensive care units (ICUs) between March 2020 and March 2021, and required mechanical ventilation. The primary outcome was the incidence of PICS physical impairment (Barthel Index≤90) after one year. Multivariate logistic regression analysis was used to estimate the association between early rehabilitation interventions and PICS physical impairment by adjusting ICU mobility scale (IMS) during seven-day following ICU admission, and clinically relevant risk factors. Results: The analysis included 259 patients, 54 of whom developed PICS physical impairment one year later. In 81 patients, physical therapists intervened within seven days of ICU admission. There was no significant difference in mean IMS by day seven of admission between the early and non-early rehabilitation patients (0.70 and 0.61, respectively). Multivariate logistic regression analysis showed that early rehabilitation interventions were significantly associated with a low incidence of PICS physical impairment (odds ratio, 0.294; 95% confidence interval, 0.123–0.706; p=0.006). Conclusion Early rehabilitation interventions by physical therapists were an independent factor associated with the decreased development of PICS physical impairment at one year, even though early rehabilitation had no significant effect on IMS.

Methods: This study included a total of 85 patients between 2016 and 2021. Nonsurgical treatments were provided by the respiratory medicine department. HU values for metastatic spinal lesions were evaluated upon diagnosis of spinal metastasis (baseline) and at 3, 6, and 12 months thereafter. Patients were then divided into two groups based on the median HU increase from baseline to 3 months. Overall survival was assessed using the Kaplan-Meier method. Results: Based on the median change in HU value (124), 42 and 43 patients were categorized into the HU responder and non-responder groups, respectively. The median overall survival was significantly longer in the HU responder group than in the HU non-responder group (13.7 months vs. 6.4 months, p <0.001). Multiple linear regression analysis revealed that the use of antiresorptive agents and molecularly targeted therapies were factors significantly associated with an increase in HU. Conclusions An increase in HU values for metastatic spinal lesions after 3 months of treatment was correlated with a significantly longer overall survival in patients with NSCLC. Thus, HU measurements may not only serve as an easy and quantitative approach for evaluating treatment response in metastatic spinal lesions but also predict overall survival.

Objective: To implement early rehabilitation interventions by physical therapists is recommended. However, the effectiveness of early rehabilitation for severe coronavirus disease 2019 (COVID-19) patients in the prevention of post-intensive care syndrome (PICS) is unclear. We analyzed a multicenter prospective observational study (Post-Intensive Care outcomeS in patients with COronaVIrus Disease 2019) to examine the association between early rehabilitation interventions and PICS physical impairment. Methods: An analysis was performed on COVID-19 patients who were admitted to intensive care units (ICUs) between March 2020 and March 2021, and required mechanical ventilation. The primary outcome was the incidence of PICS physical impairment (Barthel Index≤90) after one year. Multivariate logistic regression analysis was used to estimate the association between early rehabilitation interventions and PICS physical impairment by adjusting ICU mobility scale (IMS) during seven-day following ICU admission, and clinically relevant risk factors. Results: The analysis included 259 patients, 54 of whom developed PICS physical impairment one year later. In 81 patients, physical therapists intervened within seven days of ICU admission. There was no significant difference in mean IMS by day seven of admission between the early and non-early rehabilitation patients (0.70 and 0.61, respectively). Multivariate logistic regression analysis showed that early rehabilitation interventions were significantly associated with a low incidence of PICS physical impairment (odds ratio, 0.294; 95% confidence interval, 0.123–0.706; p=0.006). Conclusion Early rehabilitation interventions by physical therapists were an independent factor associated with the decreased development of PICS physical impairment at one year, even though early rehabilitation had no significant effect on IMS.

Methods: This study included a total of 85 patients between 2016 and 2021. Nonsurgical treatments were provided by the respiratory medicine department. HU values for metastatic spinal lesions were evaluated upon diagnosis of spinal metastasis (baseline) and at 3, 6, and 12 months thereafter. Patients were then divided into two groups based on the median HU increase from baseline to 3 months. Overall survival was assessed using the Kaplan-Meier method. Results: Based on the median change in HU value (124), 42 and 43 patients were categorized into the HU responder and non-responder groups, respectively. The median overall survival was significantly longer in the HU responder group than in the HU non-responder group (13.7 months vs. 6.4 months, p <0.001). Multiple linear regression analysis revealed that the use of antiresorptive agents and molecularly targeted therapies were factors significantly associated with an increase in HU. Conclusions An increase in HU values for metastatic spinal lesions after 3 months of treatment was correlated with a significantly longer overall survival in patients with NSCLC. Thus, HU measurements may not only serve as an easy and quantitative approach for evaluating treatment response in metastatic spinal lesions but also predict overall survival.

Objective: To implement early rehabilitation interventions by physical therapists is recommended. However, the effectiveness of early rehabilitation for severe coronavirus disease 2019 (COVID-19) patients in the prevention of post-intensive care syndrome (PICS) is unclear. We analyzed a multicenter prospective observational study (Post-Intensive Care outcomeS in patients with COronaVIrus Disease 2019) to examine the association between early rehabilitation interventions and PICS physical impairment. Methods: An analysis was performed on COVID-19 patients who were admitted to intensive care units (ICUs) between March 2020 and March 2021, and required mechanical ventilation. The primary outcome was the incidence of PICS physical impairment (Barthel Index≤90) after one year. Multivariate logistic regression analysis was used to estimate the association between early rehabilitation interventions and PICS physical impairment by adjusting ICU mobility scale (IMS) during seven-day following ICU admission, and clinically relevant risk factors. Results: The analysis included 259 patients, 54 of whom developed PICS physical impairment one year later. In 81 patients, physical therapists intervened within seven days of ICU admission. There was no significant difference in mean IMS by day seven of admission between the early and non-early rehabilitation patients (0.70 and 0.61, respectively). Multivariate logistic regression analysis showed that early rehabilitation interventions were significantly associated with a low incidence of PICS physical impairment (odds ratio, 0.294; 95% confidence interval, 0.123–0.706; p=0.006). Conclusion Early rehabilitation interventions by physical therapists were an independent factor associated with the decreased development of PICS physical impairment at one year, even though early rehabilitation had no significant effect on IMS.

Methods: This study included a total of 85 patients between 2016 and 2021. Nonsurgical treatments were provided by the respiratory medicine department. HU values for metastatic spinal lesions were evaluated upon diagnosis of spinal metastasis (baseline) and at 3, 6, and 12 months thereafter. Patients were then divided into two groups based on the median HU increase from baseline to 3 months. Overall survival was assessed using the Kaplan-Meier method. Results: Based on the median change in HU value (124), 42 and 43 patients were categorized into the HU responder and non-responder groups, respectively. The median overall survival was significantly longer in the HU responder group than in the HU non-responder group (13.7 months vs. 6.4 months, p <0.001). Multiple linear regression analysis revealed that the use of antiresorptive agents and molecularly targeted therapies were factors significantly associated with an increase in HU. Conclusions An increase in HU values for metastatic spinal lesions after 3 months of treatment was correlated with a significantly longer overall survival in patients with NSCLC. Thus, HU measurements may not only serve as an easy and quantitative approach for evaluating treatment response in metastatic spinal lesions but also predict overall survival.