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Whether hyperuricemia (HU) independently predicts cardiovascular disease (CVD) remains debated, whereas chronic kidney disease (CKD) is a well-established risk factor. This study assessed the independent and mediated association of HU in CKD on long-term CVD mortality in a 30-year nationwide Japanese cohort. Data from NIPPON DATA90 participants aged ≥ 30 years enrolled in 1990 and followed for up to 30 years were used. HU was defined as serum uric acid ≥ 416.4 µmol/L, and CKD as an estimated glomerular filtration rate < 60 mL/min/1.73 m² or positive proteinuria. Four baseline categories were created (neither, HU-only, CKD-only, both conditions), and analyzed via Cox models to estimate hazard ratios (HR) for CVD mortality, adjusted for age, sex, hypertension, diabetes mellitus, dyslipidemia, BMI, and history of smoking/alcohol. Among 7,336 participants (58.5
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare and often fatal pulmonary complication of malignancy, characterized by rapidly progressive pulmonary hypertension and difficulty in ante-mortem diagnosis. We report a case of PTTM associated with previously untreated metastatic prostate cancer in a 62-year-old man with an initial serum prostate-specific antigen level of 3,835 ng/mL and clinical stage cT3N0M1. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) performed during the diagnostic workup revealed findings suggestive of pulmonary hypertension and right heart strain before the onset of overt respiratory failure. Shortly after prostate biopsy, the patient developed acute hypoxemic respiratory failure. Based on the clinical suspicion of PTTM, hormonal therapy was initiated promptly before pathological confirmation, resulting in rapid improvement of respiratory status. A definitive diagnosis of PTTM was subsequently established by pulmonary artery aspiration cytology obtained via right heart catheterization. The patient has remained alive for more than 10 years without recurrence of PTTM. This appears to represent the longest survival reported for PTTM to date. This case highlights the importance of early clinical suspicion and prompt cancer-directed therapy in patients with suspected PTTM.
This study assessed the impact of an institutional certification system that was newly introduced by the Japanese Gastric Cancer Association on short-term surgical outcomes in patients with gastric cancer using data from the National Clinical Database. A retrospective cohort study of distal gastrectomy and total gastrectomy procedures performed between January 2020 and December 2022 was conducted. The institutions were classified into three categories: type A, type B, and non-certified institutions, in decreasing order of certification stringency. The primary outcome was the incidence of grade ≥ IIIa postoperative complications based on the Clavien–Dindo classification system. The secondary outcome was surgery-related mortality. Logistic regression with risk adjustment, estimated using generalized estimating equations, was used to account for intra-cluster correlation. There was no significant difference in the risks of distal gastrectomy-related complications across the three institution types. However, type A- (odds ratio (OR) 0.39, 95
The nature of doctor-patient relationships (DPRs) and decision-making style (DMS) is related to patient satisfaction, clinical outcomes, and the occurrence of disputes. Given the importance of understanding the current state of DPRs, we conducted an exploratory analysis of the current state of DPRs and DMS in clinical settings in China and Japan. We explored similarities and differences between the two countries, as well as influential factors in DPRs and DMS. Twenty doctors in China and 20 doctors in Japan were recruited through the authors’ personal networks as well as snowball sampling, and semi-structured interviews were conducted. Doctors were asked about mainstream DPR models and DMS in current medical practice, and their responses were analyzed using qualitative descriptive methods. Results of the analysis suggest that, in both China and Japan, a diverse mosaic of DPRs and DMS coexists. In both countries, there are paternalistic relationships between doctors and patients, as well as teacher-and-student relationships, but there are also cases in which patients make final decisions and those which adopt shared decision-making. Some doctors referred to DPRs as a friendship. Furthermore, attitudes of individual doctors and patients, the medical environment, trust between the two parties, and national and cultural characteristics strongly impact the formation of DPRs. Our findings highlight the importance of carefully monitoring the current state and various influencing factors of DPRs in order to realize effective human relationships in clinical settings.
Frustration is the negative emotional state that arises from the unexpected omission, reduction, delay, or inaccessibility of an appetitive reinforcer. Building upon a century of discoveries since Edward C. Tolman’s pioneering 1925 work on expectancy, this review explores the multifaceted phenomenon of Frustrative Nonreward (FNR), a specific type of frustration. We synthesize psychological and biological perspectives to illustrate how FNR shapes motivation, aggression, conflict resolution, and partial reinforcement phenomena, as well as broader learning processes. By linking foundational animal studies with cutting-edge human research, we underscore the relevance of FNR to clinical conditions such as substance abuse, anxiety, and mood disorders. This integrative overview aims to deepen our understanding of how frustration dynamics operate across species and contexts, while highlighting its translational applications for future scientific and therapeutic advances.
