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.

This study investigated the physiological responses and effects of exercise training under hypoxic conditions at the skeletal muscle level induced by reducing muscle temperature in cold water environment. Participants were divided into two intervention groups, cooling and control conditions, according to the water temperature of 15°C and 33°C where the training were conducted in. Eight participants in each group performed submaximal cycling exercise in the water for 30 minutes at the lactate threshold (LT) intensity, three times a week for four weeks (12 sessions). LT intensity was assessed at pre- and post-intervention in a 33°C water temperature environment. A progressive load cycling test was performed on land to assess maximal oxygen uptake (VO2max) and Wingate test was conducted to measure anaerobic power. In the cooling group, working muscle deoxygenation increased during submaximal and maximal exercise, suggesting an improvement in the muscle oxygen extraction capacity. However, no effects on aerobic capacity such as VO2max or LT intensity were observed. The improvement in mean power and time to peak during the Wingate test in the cooling group indicated that LT intensity exercise training in a cold water environment would increase anaerobic power.

The Korean Acupuncture and Moxibustion Medicine Society (KAMMS) celebrated its 50th anniversary with a commemoration ceremony and a Japan-Korea Symposium held in Seoul in November 2023. This report outlines the participation and highlights from the commemoration ceremony celebrating the 50th anniversary of KAMMS on November 11 (Saturday), along with insights shared during the Japan-Korea Symposium held as a special session within KAMMS' Fall Academic Conference 2023 on November 12 (Sunday). The summary includes presentations delivered by four speakers during the symposium. The Korean session focused on "Collaborative-Based Integrated Healthcare," discussing endeavors in integrated medicine involving Western medicine and Korean medicine. Meanwhile, the Japanese session titled "Introduction of Acupuncture Clinics in Japanese University Hospital" highlighted efforts in acupuncture and moxibustion education within the Tohoku University Hospital in Japan.

A 71-year-old woman underwent repair of a ventricular septal perforation due to myocardial infarction by the extended sandwich patch technique 5 years ago. She was discharged from the hospital without complications. During the follow-up period, a ventricular apical aneurysm was found on contrast-enhanced computed tomography and transthoracic echocardiography. Since the aneurysm had enlarged gradually and a thrombus was found in it, repairing surgery was indicated. The patient was initiated on cardiopulmonary bypass after dissection of the adhesions of the previous surgery, and a longitudinal incision was made on the left side of the left anterior descending artery under cardiac arrest to remove the aneurysm. A large amount of thrombus was found inside the aneurysm. The thrombus was removed, Dor surgery was performed with a circular Hemashield patch. Reports of ventricular apical aneurysm after myocardial infarction in a remote period are rare. It is necessary to perform surgical intervention as soon as possible to prevent free wall rupture as well as cerebral infarction.

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.