We are under pressure to reform the social security system and work styles. To realize these reforms and basic principles, we need to understand the current environment surrounding the hospital and consider future measures. We report on the problems identified as a result of our investigation of the medical environment in the South West Mikawa West Medical Region and our hospital, and propose the use of emergency medical technicians (EMTs) as a solution to these problems. We examined data from the National Census, the Japan Medical Association Research Institute for General Policy Studies, the Fire and Disaster Management Agency of the Ministry of Internal Affairs and Communications, and our hospital’s management meeting. In this medical area the population aged 65 years or older and the demand for medical care are projected to increase toward the year 2045. On the other hand, the number of physicians and nurses per 100,000 population in this medical region is below the national average. Almost no change was seen in the number of patients coming to the hospital by ambulance or the number of emergency admissions by ambulance, and their admission rates did not change significantly over the past 5-year period. However, the rate of unfilled ambulance demand increased, due to the impact of full beds. Of the total number of emergency ambulance admissions, the rate of moderately ill patients averaged 74% over the 5-year period. The number of inpatient transfers in 2022 decreased by 25.5% (176) compared to that in 2019 due to the lack of personnel to transport patients. As the demand for medical care increases toward 2045, we need to reduce the rate of unfilled ambulance demand while at the same time reforming work styles to create a more comfortable workplace for healthcare workers. To achieve these goals, key tasks may be to review the transfer transport system for moderately ill patients and to expand the role of EMTs.

Objective: Checkpoint inhibitor-associated autoimmune diabetes mellitus (CIADM), a variant of type 1 diabetes, is a rare immune-related adverse events (irAEs) caused by antibody-based immune checkpoint inhibitors. CIADM typically manifests as fulminant or acute-onset type 1 diabetes in the insulin-depleted state. However, we encountered a patient with slow-onset CIADM who initially presented with hyperglycemia without decreased insulin secretion after treatment with durvalumab (an anti-PD-L1 antibody).Patient: A 60-year-old man diagnosed with small-cell lung cancer on durvalumab combined with dexamethasone treatment experienced an increase in glycated hemoglobin (HbA1c) from 6.4% to 7.8% after three cycles.Results: Despite preserved endogenous insulin secretion (C-peptide, 2.47 ng/mL with a casual plasma glucose level of 287 mg/dL), basal insulin therapy was initiated considering CIADM. HbA1c levels remained stable (8.5–9.2%) for 3 months but increased to 13.4% at 18 weeks, indicative of CIADM. Declining endogenous insulin secretion resulted in ketosis; however, hyperglycemic crisis was prevented through basal insulin therapy.Conclusion: We emphasize that CIADM develops gradually and does not always occur in the course of fulminant or acute-onset type 1 diabetes; therefore, early initiation of insulin in the presence of hyperglycemia is crucial to prevent hyperglycemic crises.

Following the Japan-Korea Symposium at the 37th ICMART World Congress in Jeju, Korea, September 27-29, 2024, another international symposium was held in Daegu on November 17, 2024, by three countries, including not only Japan and Korea but also the Chinese Medical Association of Acupuncture in Taiwan. In addition, a Korean domestic symposium was held by three societies under the Society of Korean Medicine.　Korea has been actively inviting such international symposiums in recent years, and international exchanges in the field of acupuncture and moxibustion has been progressing further than ever before. Academia of traditional medicine in Japan needs to respond actively to this trend, including human resource development.

Case reports are an indispensable research format in the advancement of medicine. They play a significant role in accumulating medical knowledge on new or rare diseases and evaluating the efficacy and safety of therapeutic interventions. Furthermore, case reports provide a critical opportunity for generating new research hypotheses and are widely recognized for their value as essential educational tools for healthcare professionals. However, some case reports fail to include sufficient essential information, and their incompleteness or lack of transparency may lead to misinterpretation by readers. To address these issues, the CARE (CAse REport) guidelines were established in 2013, providing standards to improve the completeness and transparency of case reports. The CARE guidelines comprehensively cover essential reporting items for case reports in various fields. By adhering to these guidelines, authors can ensure the completeness of information and achieve transparent reporting. However, there still does not seem to be sufficient recognition and dissemination of the CARE guidelines in Japan. Therefore, this article introduces the key components of the CARE guidelines and discusses their application, particularly in the field of acupuncture practice. It is hoped that the wider use of the CARE guidelines in case reports related to acupuncture will enhance reporting quality and facilitate the provision of more reliable and credible information.

Medical statistics need to be properly understood and used in order to assess the significance of results obtained in clinical practice. To clarify whether the medical staff in our hospital appropriately understands medical statistics, this study conducted a questionnaire survey with an objective assessment of basic medical statistics. Of 1498 hospital staff, 464 responded to the questionnaire on medical statistics, which included the following items considered important for the evaluation and use of hypothesis testing: interpretation of p-values, reasons for using different tests (t-test and Mann-Whitney U-tests), presentation of test results for the Mann-Whitney's U-test, and selection of a statistical method to use as a measure of independence. The percentage of correct answers was 20.5%, 16.2%, 6.3%, and 15.1% for the interpretation of p-values, reasons for using different tests, presentation of test results, and choice of statistical method, respectively. The percentage of correct answers for each question was significantly higher for those with research and writing experience than for those without such experience. The number of correct answers was also significantly higher for those with research and writing experience than for those without such experience. Additionally, 20 of the 464 respondents were able to correctly answer all four questions. Multiple regression analysis showed that the number of correct answers was associated with experience in research, experience in writing papers, and job title (multiple regression analysis: R2=0.429758). Our medical staff’s understanding of medical statistics was low, and we were able to identify some of the factors that influence this understanding. These results suggest the importance of learning from clinical research and writing experience in order to improve understanding of medical statistics in the future.

The Endologix AFX is a bifurcated unibody endovascular aortic repair （EVAR） system used for the treatment of abdominal aortic aneurysms （AAA）. It consists of an inner metal endoskeleton with multiple metal struts covered by a polytetrafluoroethylene graft fabric, which is suitable for treating AAA with narrowed abdominal aortic bifurcations. However, the risk of type 3 endoleak （T3EL） has been alerted and it is recommended that a sufficient overlap length be considered when using a cuff device on the central side. We present the case of an 81-year-old man with a 45 mm AAA who underwent EVAR with an AFX2 main body device and AFX proximal cuff extension device, adhering to the recommended overlap length. However, postoperative aneurysm enlargement occurred gradually, and complete uncoupling of the main body and cuff was observed 4 years later. A retrospective review of 4 years of computed tomography （CT） scans revealed potential caudal migration of the main body device and cranial migration of the cuff device, potentially resulting in a type 3a endoleak （T3aEL）. An additional device was deployed to bridge both components, and the patient was discharged without complications. In cases where an AFX2 main body device and a cuff device are used on the central side, even with adequate overlap, careful follow-up is necessary because of the potential for sideways displacement or craniocaudal migration. The observation of device displacement using 3D reconstruction CT imaging is particularly useful.

The Japan Society of Gynecologic Oncology (JSGO) Guidelines 2022 for the Treatment of Uterine Cervical Cancer are revised from the 2017 guideline. This guideline aimed to provide standard care for cervical cancer, indicate appropriate current treatment methods for cervical cancer, minimize variances in treatment methods among institutions, improve disease prognosis and treatment safety, reduce the economic and psychosomatic burden of patients by promoting the performance of appropriate treatment, and enhance mutual understanding between patients and healthcare professionals. The guidelines were prepared through the consensus of the JSGO Guideline Committee, based on a careful review of evidence gathered through the literature searches and the medical health insurance system and actual clinical practice situations in Japan. The guidelines comprise seven chapters and 5 algorithms.The main features of the 2022 revision are as follows: 1) added discussed points at the final consensus meeting; 2) revised the treatment methods based on the International Federation of Gynecology and Obstetrics 2018 staging system; 3) examined minimally invasive surgery based on Laparoscopic Approach to Cervical Cancer trial; 4) added clinical question (CQ) for treatments of rare histological types, gastric type, and small-cell neuroendocrine carcinoma; 5) added CQ for intensity-modulated radiation therapy; 6) added CQ for cancer genomic profiling test; and 7) added CQ for cancer survivorship. Each recommendation is accompanied by a classification of recommendation categories based on the consensus reached by the Guideline Committee members. Here, we present the English version of the JSGO Guidelines 2022 for the Treatment of Uterine Cervical Cancer.

Objective: To determine the useful biomarker for predicting the effects of poly-(ADP ribose)-polymerase (PARP) inhibitors in Japanese patients with ovarian cancer. Methods: We collected clinical information and performed molecular biological analysis on 42 patients with ovarian, fallopian tube, and primary peritoneal carcinomas who received PARP inhibitors. Results: Among the analyzed patients with ovarian cancer, 23.8% had germline BRCAmutation (gBRCAm), 42.9% had homologous recombination repair-related gene mutation (HRRm), and 61.1% had a genomic instability score (GIS) of ≥42. Patients with HRRm had a significantly longer progression-free survival (PFS) than those without HRRm (median PFS 35.6 vs. 7.9 months; p=0.009), with a particularly marked increase in PFS in patients with gBRCAm (median PFS 42.3 months). Similarly, among patients with recurrent ovarian cancer, those with HRRm had a longer PFS than those without HRRm (median PFS 42.3 vs.7.7 months; p=0.040). Multivariate Cox proportional hazards regression analysis found that performance status and gBRCAm status were independent factors associated with prolonged PFS with PARP inhibitors. In recurrent ovarian cancer, multivariate regression analysis identified platinum-free interval (PFI) in addition to performance status as a significant predictor of PFS. On the contrary, no significant association was observed between PFS and a GIS of ≥42 used in clinical practice. Conclusion We found that HRRm can be a useful biomarker for predicting the effects of PARP inhibitors in treating ovarian cancer and that the PFI can also be useful in recurrent ovarian cancer.