関西医科大学

The surgical care infrastructure faces a critical dual crisis: acute access shortages in low- and middle-income countries and systemic instability in high-income countries. This dysfunction stems from a global surgical workforce crisis defined by dual failures: failure in workforce development in low- and middle-income countries and failure in workforce retention in high-income countries. At the individual level, these failures are driven by distinct “vicious triads” centered on surgeon burnout. In low- and middle-income countries, the triad of burnout, professional isolation, and rational exodus arises from systemic fragility. Conversely, in high-income countries, the convergence of burnout, diminishing aspiration for surgery, and aging of surgeons destabilizes retention. Beyond work-hour limits, durable retention requires improved working conditions and incentives aligned with clinical responsibility. Relying on migration to mitigate shortages is self-defeating; instead, essential countermeasures demand bilateral international partnerships and a fundamental cultural transformation, moving away from reliance on individual self-sacrifice toward a sustainable model. This requires developing surgical educators, empowering female surgeons, and enhancing working environments. Integrating these human-centric reforms with technological innovations to alleviate administrative burdens allows surgeons to focus primarily on specialized care—the art of surgery. Ultimately, protecting workforce well-being is vital for securing the future of the surgical care infrastructure.

Understanding the relationship between viral proteins and host factors is essential for developing strategies to control virus infections. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects host cells using angiotensin converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2) as viral receptor and priming protease during the viral entry phase. Here, we report that TMPRSS2 reduces the infectivity of SARS-CoV-2 and HIV-1 during the viral production phase. Treatment of virus-producing cells with a TMPRSS2 inhibitor increases the production of infectious virions. TMPRSS2 enzymatic activity specifically disrupts the trans-Golgi by phosphorylating Golgi stacking proteins through ERK activation, which disturbs virion spike incorporation and structural maturation of the viral envelope glycoproteins, causing lower viral infectivity. We find that SARS-CoV-2 envelope protein (E protein) counteracts this TMPRSS2 activity to rescue SARS-CoV-2-S incorporation. These results demonstrate negative regulation of viral envelope glycoprotein incorporation by TMPRSS2 and reveal that SARS-CoV-2 regulates the Golgi system to create an optimal viral replication environment.

The COVID-19 pandemic necessitated the transition of Mindfulness-Based Stress Reduction (MBSR) from in-person to online delivery. However, the impact of this transition on participants’ characteristics, adherence, and outcomes in community-based MBSR programs has not been adequately examined. The present study retrospectively compared the effects on psychological well-being outcome measures of in-person delivery and online delivery without and with added individual interviews. A total of 506 Japanese participants completed validated questionnaires before and after participating in an 8-week community-based MBSR program delivered either in person (IP; n = 156) or online. Online participants attended the program either without brief individual interviews (OL-NoInt; n = 147) or in later cohorts with such interviews added to the protocol (OL-Int; n = 203). The questionnaires assessed three outcomes related to psychological well-being (PWB)—mood states, health-related quality of life, and perceived stress—and two presumed mediators of MBSR’s effects on PWB: mindfulness and self-compassion. Significant pre–post improvements were observed across all outcome measures in all three groups. Compared with IP, OL-NoInt demonstrated 32.3–62.0

With recent advances in chemotherapy for unresectable pancreatic ductal adenocarcinoma (PDAC) with liver metastasis (LM), attempts have been made to resect the primary tumor in patients showing favorable responses to anti-cancer treatment (so-called “conversion surgery”; CS). This study aimed to clarify the outcomes of CS for PDAC with LM in a nationwide multicenter study. This retrospective, multicenter study was conducted as a project study of the Japan Pancreas Society and included patients with PDAC with LM at initial diagnosis, diagnosed radiologically or intraoperatively (occult LM), who underwent CS after at least 4 months of chemotherapy between 2010 and 2022. Survival outcomes and prognostic factors were analyzed. 90 patients were enrolled from 31 Japanese institutions. Median duration of preoperative chemotherapy was 10.4 (range, 4.2–58.5) months, and gemcitabine plus nab-paclitaxel was the most common first-line regimen, followed by folinic acid, 5-fluorouracil, irinotecan, and oxaliplatin. Liver metastasectomy was performed in 27 patients (30

Robot-assisted minimally invasive esophagectomy (RAMIE) has become increasingly prevalent due to its ability to provide a magnified, three-dimensional operative field and articulate instrumentation. However, the narrow and fixed field of view creates peripheral blind zones. Assistant maneuvers and instrument movements frequently occur outside the console view, potentially affecting intraoperative situational awareness and workflow. These factors can lead to inadvertent injuries to adjacent organs such as the aorta, pulmonary vein, trachea, or lungs. This dynamic manuscript illustrates a practical visualization strategy using a 5-mm flexible sub-scope to address blind zones during robot-assisted esophagectomy. This manuscript presents synchronized intraoperative footage from the main robotic camera and a 5-mm flexible sub-scope used during the thoracic phase of RAMIE. Representative operative scenes were selected to demonstrate how the sub-scope provides complementary visualization of areas outside the console field of view. Quantitative assessment of visual coverage was performed in a representative case to illustrate the proportion of assistant activity occurring within and outside the robotic camera view. Additional illustrative scenarios highlight sub-scope utilization during port insertion, instrument exchange, vascular division, and assistant-led background tasks. Video analysis demonstrated that a substantial proportion of assistant forceps activity occurred outside the robotic camera’s field of view during the thoracic phase. The sub-scope enabled continuous visualization of these blind zones, allowing assistants to monitor instrument trajectories, surrounding structures, and spatial relationships without requiring repositioning of the main camera. Dynamic intraoperative examples illustrate how this complementary visualization supports safe confirmation during critical steps, facilitates autonomous assistant actions, and enables parallel task execution while preserving uninterrupted console workflow. This video-based report demonstrates a practical technique for dynamic visualization of peripheral blind zones during robot-assisted esophagectomy. A 5-mm flexible sub-scope may support intraoperative awareness and coordinated workflow while preserving the stability of the primary console view.