Background: Identifying dysmorphic red blood cells (RBCs) is critical for diagnosing glomerular diseases, as distinguishing glomerular from non-glomerular hematuria may reduce reliance on invasive diagnostics such as kidney biopsy. We aimed to enhance urinary RBC morphological classification by employing machine learning (ML) to analyze UF-5000 scattergram data. Methods: RBCs in urine samples (N = 185) were classified as dysmorphic or isomorphic based on microscopic findings. UF-5000 scattergrams were quantified to generate 20 statistical features and used to train a ML model in DataRobot (v9.1) with an automated pipeline, five-fold cross-validation, and LogLoss-based selection. Performance was evaluated in an independent cohort (N = 1,093). Accuracy was defined as concordance with microscopy findings. Areas under ROC curves (AUROCs) and diagnostic metrics are reported with 95% confidence intervals (CIs). Results: Among conventional UF-5000 parameters, the small RBC/total RBC ratio was the strongest predictor (AUROC 0.97, 95% CI 0.94–0.99). Scattergram-derived features indicated that RBC size-related parameters were crucial for identifying dysmorphic RBCs. The ML model alone demonstrated superior accuracy over UF-5000 RBC-Info alone (concordance 95.2% vs. 92.1%; AUROC 0.95 [0.94–0.97] vs. 0.92 [0.91–0.94]). Logical (OR/ AND) combinations of the ML model with RBC-Info outperformed RBC-Info alone (OR: concordance 92.7%, AUROC 0.93 [0.92–0.95]; AND: concordance 94.6%, AUROC 0.94 [0.93–0.96]). Conclusions A scattergram-based ML model improves the accuracy and reliability of urinary RBC morphological classification based on UF-5000 scattergrams and may help reduce reliance on invasive diagnostics. Prospective, multicenter studies should validate generalizability and assess integration into routine workflows.

BACKGROUND: The long-term impact of symptom classification on quality of life (QOL) and economic outcomes among individuals with long coronavirus disease (COVID) remains poorly understood. This study aimed to clarify the situation of long COVID in Japan by analyzing patients using cluster classification. METHODS: This multicenter, retrospective cohort study enrolled 515 patients with COVID-19 and followed up for 36 months via standardized questionnaires. Patients were classified based on: 1) symptom trajectory over time and 2) symptom cluster profiles at 3 months. RESULTS: While the number of symptoms decreased, fatigue and dyspnea frequently persisted, whereas anosmia and dysgeusia declined. Cough and sputum decreased gradually. The proportion of patients with 5-9 symptoms increased. The mean (interquartile range) presenteeism scores were lower in the continuous (60 [50-80]) and relapse groups (65 [48-80]) than in the recovered group (70 [50-80]). The multiple symptoms cluster had the worst SF-36, presenteeism, and absenteeism scores (47.2 [44.7-49.8], 48.8 [27.5-72.5], and 10.9 [0.0-11.0], respectively). CONCLUSIONS Patients with continuous and multiple symptoms experienced persistently lower QOL and greater economic burden up to 36 months after COVID-19 diagnosis. The long-term effects of long COVID are not only physical but also mental and economical. Thus, further research is needed to clarify the economical and physiological impact of long COVID.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; COVID-19/complications* ; Japan/epidemiology* ; Post-Acute COVID-19 Syndrome/psychology* ; Quality of Life ; Retrospective Studies ; Surveys and Questionnaires ; East Asian People

The treatment strategy for acute type A aortic dissection consists of entry closure and maximal resection of the dissected aortic segment. In cases where the entry is located in the distal descending aorta, as in this case, entry closure is challenging, and surgery often involves only maximal resection of the dissected segment. The patient was a 53-year-old man who presented with sudden onset of chest pain. CT revealed a retrograde Stanford type A acute aortic dissection with a tear in the distal descending aorta. Preoperative measurements suggested that entry closure using frozen elephant trunk (FET) would be impossible. Surgery was performed with the goal of maximal resection of the dissected aortic segment in a hybrid operating room. The patient underwent total arch replacement (TAR) using FET. TEE revealed true lumen stenosis beyond the descending aorta, along with a decrease in lower limb blood pressure reducing blood flow to the abdominal branches. Therefore, emergency TEVAR was performed to achieve entry closure in the entire descending aorta. After TEVAR, the true lumen expanded, and perfusion to the lower limbs and abdominal branches improved. The postoperative course was uneventful, and the patient was discharged on postoperative day 10.

Objective: Hospitals throughout Japan are being integrated and reorganized under the government's regional medical care plan. However, the effects on cardiovascular surgery practice remain unknown. In the year 2016, our institution employed hospital integration; we report its effects on patients with type A acute aortic dissection who underwent emergency surgery. Methods: This study included 89 patients who underwent emergency surgery for type A acute aortic dissection from May 2012 to December 2020. Evaluation items included preoperative patient factors, number of surgeries, surgical mortality, referral rate, patient transport time, transport distance, number of surgeries performed by young cardiovascular surgeons, and overtime work for surgery. Patients were categorized into pre-(group P: 29 patients) and post-integration (group A: 60 patients) groups, which were retrospectively compared. Results: Preoperative factors were not significantly different between the two groups. Operations accounted for 29 and 60 in groups P and A, respectively; they increased significantly after integration (p=0.005). Surgical mortality was 27.6 and 15% in groups P and A, respectively, with no significant difference (p=0.2). The referral rate was 17 (58.6%) and 21 (35%) patients in groups P and A, respectively; group A displayed a significantly lower referral rate (p=0.04). The interval from the onset of symptoms to arrival at the surgery cite was significantly reduced (p=0.01) in group A (112±140 min) compared to group P (206±201 min). There was no significant difference in the transfer distance between groups P (13.9±14.8 km) and A (13.5±16.2 km). The number of surgeries performed by young surgeons increased in 9 cases (31%) in group P and 34 cases (56.7%) in group A (p=0.02). Overtime work was substantially reduced:446±154 min in group P and 349±112 min in group A. Conclusion: Hospital integration resulted in increased number of acute aortic dissection surgeries and decreased interval time from the onset of symptoms to arrival at the surgery cite. The young surgeons performed more surgeries and reduced their overtime work.

A 74-year-old man, with a medical background of cryoglobulinemia, had been undergone nonbacterial thrombotic endocarditis with immunotherapy spanning three months. Following a year and three months, he has presented to our institution experiencing acute decompensated heart failure attributable to severe aortic regurgitation （AR），moderate mitral regurgitation （MR），and severe tricuspid regurgitation （TR）．Transesophageal echocardiography revealed aortic valve cusps destruction and anterior mitral valve leaflet vegetation. The potential complications of leukocytoclastic or necrotizing vasculitis due to hypothermic cardiopulmonary bypass in cryoglobulinemia patients were addressed preemptively through preoperative plasmapheresis. During the procedure, tepid core cooling cardiopulmonary bypass at 33℃ and tepid blood cardioplegia solution at 30℃ were employed to mitigate the risk of vasculitis. Urgent aortic valve replacement, mitral vegetation resection, and tricuspid annuloplasty were performed, and the patient was discharged on the 23rd postoperative day without any untoward events.

A 25-question “Nationwide Kampo Web Test” was conducted to evaluate the basic knowledge and diagnostic ability of Kampo among medical professionals nationwide. We analyzed the scores of all 608 examinees (241 doctors, 257 pharmacists, 77 others, 12 acupuncturists, 10 nurses, and 11 dentists) and evaluated the test quality. The performance of all examinees was 67.7 ± 16.9 points (mean score ± standard deviation). Among the doctors, the mean score of Kampo medicine specialists (83.8 ± 8.7 points) was significantly higher than that of non-specialists (65.3 ± 16.3 points) (p<0.0001). The performance of doctors who prescribed 20 or more Kampo medicines (78.4 ± 11.5 points) was significantly higher than that of other doctors (p<0.0001). Among the 25 questions, the difficulty levels of 13, 8, and 4 were easy, moderate, and hard (correct answer rates: 70% or more, 40-70%, and less than 40%), respectively. The ability of 13 questions (52%) to distinguish between good and poor performers was extremely high (discrimination index of 0.5 or higher). Collectively, these results supported the good performance of our test, suggesting that it is a highly practical learning achievement evaluation system that could utilize information and communication technology and is expected to be used in future lifelong learning in the field of Kampo medicine.

Following the revision of the structure and content of the Model Core Curriculum for Medical Education to be more outcome-based and the legal status of the medical practice performed by medical students in the clinical clerkship, we have revised the Guideline for Participatory Clinical Clerkship. The following items were revised or newly described : significance of enhancing the participatory clinical clerkship, scope of medical practice, confidentiality, patient consent, patient consultation and support service, objectives of the clinical clerkship, simulation education, departments where the clinical clerkship is conducted, assessment in the clinical practice setting, CC-EPOC, and entrustable professional activities. A foundation has been established to promote seamless undergraduate and postgraduate medical education. However, future work is needed to examine the specific level of performance expected at the end of the clinical clerkship and department-specific clinical practice goals and educational strategies.