BACKGROUND:The Japanese version of the high bleeding risk (J-HBR) criteria was proposed to identify Japanese patients at HBR after percutaneous coronary intervention. However, the diagnostic ability of the J-HBR in patients with lower extremity peripheral arterial disease (LEAD) remains unclear. METHODS AND RESULTS:This multicenter registry included 818 LEAD patients undergoing endovascular treatment (EVT). Based on J-HBR major (1 point) and minor (0.5 points) criteria, patients were grouped into LEAD with (≥2.0 points) and without (1.0-1.5 points) additional J-HBR. LEAD itself is a major criterion. The primary endpoint was major bleeding events and major adverse cardiovascular and limb events (MACLE), a composite of cardiovascular death, myocardial infarction, ischemic stroke, acute limb ischemia, and major amputation. Of the 818 patients in the study, 683 (83.5%) had LEAD with additional J-HBR. During the median follow-up period of 729 days, the risk of major bleeding events did not differ significantly between the 2 groups, although the risk of MACLE was higher in the LEAD with than without additional J-HBR group (12.4% vs. 5.9%; P=0.03). The probability of major bleeding and MACLE increased progressively with an increase in the number of J-HBR major and minor criteria. CONCLUSIONS:Among patients with LEAD undergoing EVT, the J-HBR criteria successfully stratified ischemic and bleeding risks. This risk-predicting model may be useful in patients with LEAD.
The risk of platinum exposure in infants breastfed by mothers receiving chemotherapy with a platinum-containing agent remains unclear. From the perspective of toxicity, both quantification and speciation of platinum in breast milk are needed. We collected breast milk samples from a cervical cancer patient who underwent six cycles of cisplatin-based chemotherapy after childbirth. Samples were collected during the fifth and sixth cycles, and platinum concentrations were measured by inductively coupled plasma mass spectrometry (ICP-MS). Platinum speciation was investigated by liquid chromatography hyphenated with ICP-MS. Platinum concentration in breast milk increased immediately after cisplatin administration and then declined rapidly, reflecting the distribution and excretion of the majority of cisplatin in the body. However, platinum concentration in breast milk remained above 5 µg/L for up to three weeks, suggesting that the secretion of platinum into breast milk continues over a prolonged period. Speciation analysis revealed that at trough levels before cisplatin administration, platinum was primarily bound to serum albumin. Immediately after administration, lactalbumin-bound platinum increased but disappeared within 6 h. After the protein fraction was digested with simulated gastrointestinal fluid, part of the protein-bound platinum was converted into low-molecular-weight compounds. However, no free cisplatin was released from the proteins. We revealed the concentration and speciation changes of platinum in breast milk during cisplatin-based chemotherapy. However, the toxicity of low-molecular-weight platinum compounds after digestion remains unclear. Further investigation is needed to assess the safety of lactation during cisplatin-based chemotherapy.
It is important to understand post-mortem changes in post-mortem computed tomography (PMCT) image interpretation. Only a few studies have focused on the eyeballs. This study aimed to clarify the changes in eyeball findings on PMCT and examine whether it is possible to estimate the post-mortem interval (PMI) based on this findings. During a 13-year period, data from 29 consecutive patients who underwent CT scans twice (the first CT taken at the time of death in our hospital: time from confirmation of death from − 4 h 15 min to 2 h 17 min, and the second CT taken prior to autopsy in our forensic facility: from 15 h 27 min to 196 h 32 min) were analyzed after excluding performing first CT scans during the return of spontaneous circulation, under 2 years of age and periorbital damage due to trauma. The maximum longitudinal diameter, lens position, and vitreous radiodensities were measured. The Wilcoxon signed-rank test was used for statistical analysis. The correlation between the changes in each measurement value and the elapsed time of the two scans was examined using regression analysis. In the second scan, the maximum longitudinal diameter was significantly reduced (p < 0.0001), and the vitreous radiodensities significantly increased (p < 0.0001). There was no significant change in the distance from the cornea to the lens. However, no correlation was found between any of the findings and the elapsed time. With early post-mortem changes, the maximum longitudinal diameter decreased, whereas the vitreous radiodensities increased. It was nevertheless not possible to estimate PMI based on these findings.
The rapid advancement of generative artificial intelligence (GAI) necessitates reconceptualizing medical educators’ professional roles. While Harden’s Six Roles of the Teacher have long defined educator identity, GAI integration may require expansion beyond this established framework. This study explored how medical educators perceive role evolution in the GAI era and identified emerging educator functions. A qualitative descriptive study was conducted during a faculty development program at a Japanese medical school in August 2025. Fifty-two faculty members discussed improving education using GAI. From 137 analyzed statements, content analysis applied Harden’s framework deductively, while the SAMR model assessed transformation levels. Statements showing high transformation (Modification/Redefinition) underwent inductive analysis to identify new roles. Traditional roles dominated: resource developer (n = 34), assessor (n = 29), facilitator (n = 29), information provider (n = 23), planner (n = 17), and role model (n = 5). Most statements reflected enhancement of existing practices (Substitution n = 51; Augmentation n = 67). Critically, 19 statements demonstrated transformative potential (Modification n = 15; Redefinition n = 4), revealing five emergent educator roles: analyst (evaluating GAI outputs), coordinator (orchestrating human-AI collaboration), content generator (co-creating with AI), fact checker (verifying AI accuracy), and lifelong learner (continuously adapting to AI evolution). This study demonstrates that GAI is expanding medical educators’ professional identity beyond traditional frameworks. While GAI enhances conventional roles, it simultaneously creates new responsibilities requiring critical judgment, ethical oversight, and adaptive expertise. These findings challenge the notion of AI as mere replacement, instead positioning educators as essential mediators in human-AI educational ecosystems. Faculty development must incorporate AI literacy and reflective practice to support this expanded professional identity.
While heart failure (HF) duration before left ventricular assist device (LVAD) implantation may influence postoperative outcomes, data evaluating this relationship remains limited. This study investigated the association between HF duration and outcomes following LVAD implantation. This international retrospective multicenter study included 1,071 patients who underwent LVAD implantation between 2006—2019. Patients were stratified into quartiles by HF duration before implantation: Q1 ≤ 3.9 months, Q2 > 3.9 months-4 years, Q3 > 4—10.7 years, and Q4 ≥ 10.7 years. Primary outcome was 3-year all-cause mortality. Secondary outcomes included cardiac death, early (≤ 30 days) and late ventricular arrhythmias (VAs), and left ventricular ejection fraction (LVEF) recovery. Multivariable Cox regression and restricted cubic spline analyses were performed. After 3-year follow-up, 426 patients died (31.1
