This study aimed to explore the effect of intraoperative glucose load on metabolism in patients with type 2 diabetes anesthetized with remifentanil. A total of 30 patients were enrolled and randomly allocated to one of two groups:no glucose or low-dose glucose (0.1 g/kg/h for 1 hour followed by 0.05 g/kg/h for 1 hour). Glucose, adrenocorticotropic hormone, 3-methylhistidine, insulin, cortisol, free fatty acid, ketone bodies, and creatinine were measured at several points before, during, and after general anesthesia. Glucose levels in the low-dose glucose group increased significantly at 1 and 2 hours after glucose infusion compared to their preanesthetic levels and to those in the no glucose group. Two patients in the low-dose glucose group had blood glucose levels exceeding 11.1 mmol/L. Free fatty acids, ketone bodies, and 3-methylhistidine/creatinine did not differ significantly between groups. Ketone body levels were significantly higher at 1 hour than preanesthetic levels in both groups;after 1 hour, however, they did not change in the no glucose group but significantly decreased in the low-dose glucose group. Intraoperative low-dose glucose load may suppress ketogenesis, but clinicians must consider the risk of causing hyperglycemia in patients with type 2 diabetes undergoing remifentanil-induced anesthesia. J. Med. Invest. 73 : 222-228, February, 2026.
BACKGROUND:Transforaminal full-endoscopic spine surgery (TF-FESS) under local anesthesia is a minimally invasive approach for treating lumbar radiculopathy and is increasingly being used worldwide. METHODS:This case series reports the preliminary results for 6 patients with lumbar radiculopathy who underwent TF-FESS under local anesthesia between November 2023 and November 2024. RESULTS:The patient cohort consisted of 3 men and 3 women with a mean age of 49±13 years. The mean operation time was 80.7±15.9 min, and the mean anesthesia time was 149.2±16.3 min. Significant improvements were observed in visual analog scale scores for back and leg pain after surgery, with respective mean decreases of 2.7±2.0 and 6.3±2.3 points. Oswestry Disability Index scores showed a mean recovery of 55%±10%. Patients could return very quickly to their daily activities within a mean of 1.5 days and to work within a mean of 2.7 weeks postoperatively. No complications or recurrences were reported during follow-up. The results were good or excellent in all patients according to MacNab's criteria. CONCLUSION:The results in this preliminary case series suggest that TF-FESS under local anesthesia is a feasible and effective treatment for lumbar radiculopathy. J. Med. Invest. 73 : 129-134, February, 2026.
Vitamin D nutritional status was assessed in very elderly people living in a nursing home to determine its association with nutritional status, and a supplement intervention was provided to those with vitamin D deficiency. In 36 (3 male and 33 female) nursing homes residents aged 91 (IQR 85-94) years, their serum 25-hydroxyvitamin D (25(OH)D) levels were 17.3 (IQR 12.9-23.4) ng / ml distributing 8.3% (3/36) of <10 ng / ml, 47.2% (17 / 36) of 10-<20 ng / ml and 44.4% (16/36) of 20-<30 ng / ml, respectively. Serum 25(OH)D levels were significantly associated with parathyroid hormone (PTH) level, Barthel Index, diaper wearing rate, nursing care level and swallowing function, but not with nutritional intake. By daily 1000 IU vitamin D supplementation for 6 months in 7 residents (male 2 / female 5), serum 25(OH)D levels increased from 14.1 (13.0-21.8) ng / ml to 35.9 (34.0-47.1) ng / ml but physical functions did not improve. These data suggest that other factors such as insufficient protein and energy intake, chronic comorbidities and limited physical activity in addition of vitamin D status might be involved in the manifestations of nursing homes residents. J. Med. Invest. 73 : 21-25, February, 2026.
Scapular models were created based on preoperative computed tomography images obtained for 8 cases of cuff tear arthropathy that underwent reverse shoulder arthroplasty (RSA). Four surgeons performed baseplate implantation:A, a shoulder surgeon with experience of more than 200 RSA cases;B, an arthroscopic shoulder surgeon with experience of fewer than 10 RSA cases;C, an orthopedic fellow;and D, an orthopedic resident. Implantation was performed using the conventional method and using patient-specific instrumentation (PSI). Overall, the mean ΔInc was 9.1° using the conventional method and 3.7° using PSI;the respective mean ΔVer were 3.7° and 3.2°. Using the conventional method, there were statistically significant inter-surgeon differences in ΔInc (p=0.038) but not in ΔVer (p=0.77). Using the PSI method, there was no significant inter-surgeon difference in ΔInc (p=0.89) or ΔVer (p=0.23). There was a statistically significant intra-surgeon difference in ΔInc for surgeons B and C (B, p<0.001;C, p=.007) but not in ΔVer for any of the surgeons. PSI ensured the accuracy of baseplate implantation in RSA regardless of a certain amount of surgeon's experience. Implantation accuracy was more impacted when the surgeon was less experienced. J. Med. Invest. 73 : 217-221, February, 2026.
Full-endoscopic trans-Kambin's lumbar interbody fusion (FE-KLIF) is a type of minimally invasive fusion surgery that requires only a 14-mm skin incision for cage insertion. The only surgery-related complication of concern with FE-KLIF is exiting nerve root injury (ENRI). We investigated the incidence of ENRI in 131 cases that underwent FE-KLIF at 10 hospitals. After encountering 5 cases of ENRI, all of which occurred during insertion of an open cannula, we devised a novel type of open cannula, which we call a rescue cannula, to avoid ENRI. There were 5 cases of ENRI (5.7%) in the 88 patients who underwent FE-KLIF before use of the rescue cannula. We have put the rescue cannula in the FE-KLIF system, and one can use the rescue cannula when electromyography alarms. Under such strategy to avoid the ENRI for using the rescue cannula, none of these 43 cases developed ENRI. FE-KLIF is a minimally invasive fusion surgery in which ENRI is the only worrisome complication. Use of a rescue cannula could be the solution to avoiding ENRI. J. Med. Invest. 73 : 26-31, February, 2026.
The HIV-1 envelope glycoprotein (Env)-gp120 plays a critical role in viral entry by binding to the receptor CD4 and coreceptors CCR5/CXCR4. The V3 loop in CCR5-tropic HIV-1 Env-gp120 is a key domain responsible for interacting with CCR5. Based on virus mutation and adaptation studies, our structural modeling predicted that the IXI triplet residues within the V3 loop of Env-gp120 interact with hydrophobic cores in CCR5, potentially modulating viral infectivity. In this study, we investigated the functional significance of the IXI triplet in HIV-1 replication. Substitutions at the central "X" position of the IXI triplet significantly affected viral replication in both macaque and human cell lines without altering Env expression. Combinatorial mutations with the V3 tip residue G310R showed either enhancing or suppressive effects on replication in macaque cells, highlighting a complex interplay between the IXI triplet and V3 tip. Furthermore, the impact of these mutations varied between different HIV-1 strains, suggesting that some strain-specific sequence/structural context(s) is critical for the observed biological effect. Taken together, these findings indicate that the IXI triplet can be a novel motif influencing HIV-1 replication and underscore the importance of V3 loop variability in coreceptor interaction and viral growth potential. J. Med. Invest. 73 : 80-87, February, 2026.
Low back pain in athletes can arise from asymptomatic dysfunctional/non-painful (DN) joints, which cause compensatory stress on adjacent regions. This report highlights the clinical importance of identifying and correcting these underlying 'DN joints,' integrating concepts from the Selective Functional Movement Assessment and the joint-by-joint approach to prevent recurrence. A 25-year-old female professional volleyball player underwent surgery for L5 radiculopathy due to disc herniation. Postoperatively, a functional assessment revealed DN joints:restricted mobility in her right glenohumeral joint and thoracic spine. This dysfunction led to compensatory lumbar lateral flexion during spiking motions and unilateral landing on the left foot after spiking, increasing mechanical stress on her lower back. A rehabilitation program successfully corrected these DN joints. Consequently, the compensatory movement pattern resolved. The patient returned to competition six months post-surgery and remained pain-free at a two-year follow-up, competing at her pre-injury level. This case demonstrates that addressing asymptomatic DN joints as the root cause of symptomatic lumbar disorders is crucial for athletes. This comprehensive approach, which looks beyond the site of pain, is essential for a durable recovery and the prevention of injury recurrence. J. Med. Invest. 73 : 274-280, February, 2026.
Cerebral aneurysms can present with warning headaches before rupture or during minor leaks. Internal carotid artery-posterior communicating artery (IC-PC) aneurysms are among the few aneurysms for which the clinical observation of growth and associated symptoms is possible. Enlargement or morphological changes may worsen oculomotor nerve (ON) palsy, intensified headache, or orbital pain, indicating an impending rupture that requires urgent intervention. Notably, blurred vision with eye discomfort preceding ON palsy during impending rupture is rarely reported. Herein, we present a case highlighting this phenomenon. A 74-year-old woman with hypertension and migraines with aura presented with a 14-day history of gradual-onset left frontal headache. Despite the initial normal neurological findings and no evidence of subarachnoid hemorrhage on computed tomography, she later developed blurred vision and left eye discomfort without objective ON palsy. Her symptoms were initially attributed to migraines. Two days later, the patient developed ptosis and was diagnosed with complete ON palsy. Magnetic resonance angiography revealed a left IC-PC aneurysm, and urgent direct clipping confirmed rupture of the aneurysm. The patient recovered without complications. Blurred vision with eye discomfort during a warning headache may indicate early ON dysfunction and impending aneurysm rupture. Early recognition and vascular evaluation are crucial to prevent catastrophic outcomes. J. Med. Invest. 73 : 257-259, February, 2026.
BACKGROUND:Inhaled nitric oxide (iNO) is approved in Japan for perioperative pulmonary hypertension and persistent pulmonary hypertension in newborns;however, its role in non-cardiac respiratory failure is unclear. CASE PRESENTATION:A 47-year-old woman with Sjögren's syndrome developed severe acute type I respiratory failure due to collagen vascular disease. Despite high-FIO2 ventilation, her PaO2/FIO2 ratio remained <80, and extracorporeal membrane oxygenation (ECMO) was considered. Administration of iNO at 10 ppm improved oxygenation, with a rapid increase in PaO2/FIO2 ratio. This response allowed time for steroid pulse therapy, rituximab, plasma exchange, and pleural drainage, which stabilized the patient's condition without ECMO. Notably, the temporal association between iNO initiation and rapid oxygenation improvement suggests that pulmonary vascular dysfunction was a major contributor to hypoxemia. Subsequent stabilization with immunosuppressive therapy highlights the role of iNO as a bridging therapy rather than a definitive treatment. CONCLUSION:In this case, iNO may have served as a bridging therapy, improving oxygenation until immunosuppressive treatment was effective. iNO may serve as a useful interim measure for avoiding ECMO in collagen vascular disease-associated respiratory failure, particularly when pulmonary hypertension is suspected. J. Med. Invest. 73 : 270-273, February, 2026.
PURPOSE:This study aimed to clarify the association between subjective emotions and food choice behavior in Japanese adults aged 18 years or older. METHODS:Five hundred Japanese adults completed an online questionnaire. We collected data on the participants' characteristics, lifestyle, and changes in food group selection under normal conditions and six emotional states (anger, disgust, fear, happiness, sadness, and surprise). We calculated the dietary balance score (DBS) based on the frequency of intake for 10 food groups. Estimated mean DBS and intake frequency of its components during each emotional state were assessed using generalized estimating equations. RESULTS:More than half of participants (59.6%) reported that their food selection usually changed according to their emotional state. The DBS score was lower in all six emotional states than in the normal state in both sexes. Sadness decreased intake frequency of the DBS components in both sexes. Additionally, the frequency of confectionery and beverage intake during happiness increased compared to the normal state in both sexes. Conversely, the frequency of confectionery intake during sadness decreased compared to the normal state in both sexes. CONCLUSION:Emotions, especially sadness and happiness, may affect the frequency of food group intake and dietary balance in Japanese adults. J. Med. Invest. 73 : 241-250, February, 2026.
BACKGROUND:The gut microbiota plays an important role in inflammatory bowel disease (IBD). However, its relationship with inflammatory markers remains unclear, especially in Asian populations. METHODS:This prospective observational study examined the gut microbiota composition and its association with systemic inflammatory markers in Japanese patients with ulcerative colitis (UC) and Crohn's disease (CD) compared to healthy controls. Bacterial diversity, short-chain fatty acid-producing bacteria, and key genera were analyzed via 16S rRNA gene sequencing. RESULTS:Patients with CD exhibited reduced bacterial diversity. Clostridium cluster IV was decreased in CD and showed a negative correlation with fecal calprotectin levels in UC. Clostridium cluster XIVa was negatively correlated with fecal calprotectin levels in both UC and CD, and with C-reactive protein (CRP) levels in CD. Oscillibacter positively correlated with CRP levels in CD. These findings suggest that a reduction in butyrate-producing bacteria is associated with increased inflammation in patients with IBD. CONCLUSION:To our knowledge, this is the first study to demonstrate a significant association between specific bacterial taxa and inflammatory markers in Japanese patients with IBD. Clostridium clusters IV and XIVa may serve as biomarkers, although potential confounders such as age, sex, and concurrent medication use should be recognized as study limitations. J. Med. Invest. 73 : 92-100, February, 2026.
This study examined the effect of positive end-expiratory pressure (PEEP) on sevoflurane washout from anesthesia workstations using a test lung model. Two workstations (Perseus A500 and Carestation 650) were tested with fresh gas flows (FGF) of 2-8 L / min at PEEP levels of 0 and 8 cmH2O. Washout time was the interval for sevoflurane concentration to fall from 8% to 0%. In the Perseus A500, PEEP prolonged washout at 2 L / min (2562 [92] s vs. 2266 [17] s, p = 0.027), 4 L / min (1397 [36] s vs. 1275 [32] s, p = 0.012), and 6 L / min (756 [8] s vs. 533 [34] s, p = 0.006), but not at 8 L / min (115 [2] s vs. 113 [2] s, p = 0.23). In the Carestation 650, washout was prolonged at 2 L / min (5254 [229] s vs. 4447 [113] s, p = 0.013), 4 L / min (3597 [101] s vs. 2911 [230] s, p = 0.022), and 6 L / min (1816 [94] s vs. 1492 [115] s, p = 0.021), but not at 8 L / min (252 [3] s vs. 212 [35] s, p = 0.187). Our findings indicated that PEEP delayed anesthetic washout most at lower FGFs, which warrants caution in low-flow anesthesia. J. Med. Invest. 73 : 111-115, February, 2026.
BACKGROUND:Individualized nursing care is essential for patient-centered practice, yet few validated instruments exist in Japan for assessment from the nurse's perspective. PURPOSE:This study aimed to develop and validate the Japanese version of the Individualized Care Scale-Nurse (JICS-Nurse) in acute care hospitals. METHODS:A cross-sectional survey was conducted with nurses and midwives in Japan. Item analysis, exploratory and confirmatory factor analyses were performed. Internal consistency was assessed with Cronbach's alpha, test-retest reliability with Pearson's correlations and intraclass correlation coefficients (ICC), and concurrent validity with correlations to the Self-assessment Scale for Nursing Practice for Person-Centered Care (SSNP-PCC). RESULTS:Valid responses from 536 of 705 invited participants were analyzed. A three-factor structure consistent with the original version was supported. CFA showed good fit for JICS-A and an overall acceptable fit for JICS-B, Internal consistency was high (α=.94), while test-retest reliability was moderate (ICC=.54 for JICS-A, .51 for JICS-B). Strong correlations with SSNP-PCC supported concurrent validity (r=.78 and r=.72;p<.001). CONCLUSIONS:The JICS-Nurse demonstrated reliability and validity and may be a useful tool for assessing individualized nursing care in Japanese acute care hospitals. J. Med. Invest. 73 : 121-128, February, 2026.
Aging is a phenomenon in which cells, tissues and organs undergo systemic pathological changes. We examined the effects of soy isoflavone on immune function in aged mice. Although aged mice showed lower T cell response against anti-CD3 monoclonal antibody stimulation than did young mice, aged mice have treated with soy isoflavone reversed the low responses. The percentage of CD4+ cells was higher in aged mouse splenocytes treated with soy isoflavone than in untreated mouse splenocytes. Unexpectantly, aged mice treated with soy isoflavone showed higher programmed cell death-1 expression on T cells than did aged control mice. These results showed that soy isoflavone improve low T cell proliferation response in aged mice. J. Med. Invest. 73 : 212-216, February, 2026.
Unilateral leg edema in elderly patients is often attributed to deep vein thrombosis (DVT), particularly when D-dimer levels are elevated. We report an unusual case of an elderly woman with subacute unilateral leg edema caused by compression of the external iliac vein by a traumatic hematoma following a minor fall. Contrast-enhanced computed tomography excluded DVT and revealed venous obstruction due to the hematoma. Percutaneous aspiration led to prompt resolution of the edema without the need for anticoagulation. This case underscores the importance of appropriate imaging to identify alternative etiologies of unilateral leg edema and avoid potentially harmful empiric anticoagulant therapy. J. Med. Invest. 73 : 291-293, February, 2026.
BACKGROUND:Japan's aging population presents significant healthcare challenges, particularly in colorectal cancer care, where nutritional assessment is vital for improving outcomes. This study evaluated the prognostic value of the geriatric nutritional risk index (GNRI) in patients undergoing curative colorectal cancer surgery. METHODS:We retrospectively analyzed 113 patients with stage II / III colorectal cancer who underwent curative surgery. Patients were categorized into GNRI Low (≤ 92) and High (> 92) groups. Clinicopathological characteristics, immunonutritional indicators, postoperative complications, and survival outcomes were compared. RESULTS:The GNRI Low group (24.8%) had significantly older age, lower BMI, poorer ASA classification, frailty, and larger tumor size compared with the GNRI High group. Immunonutritional indicators, including albumin, CRP, NLR, and PNI, were also worse in the GNRI Low group. However, no significant difference in perioperative complications was observed between the groups. Five-year OS was 76.0% in GNRI Low versus 89.2% in GNRI High (p = 0.05), and 5-year DFS was 53.8% versus 74.2% (p = 0.04). CONCLUSION:Low GNRI was associated with poor prognosis in colorectal cancer patients, despite no increase in surgical complications. Preoperative nutritional assessment using GNRI may help identify high-risk patients and support targeted interventions. J. Med. Invest. 73 : 101-105, February, 2026.
This study focused on bedside bowel movement-related information obtained during days 0 to 14 after the onset of subarachnoid hemorrhage (SAH) due to cerebral aneurysmal rupture, with the aim of examining its potential as a monitoring index for predicting vasospasm onset. This retrospective study covered April 2013 to December 2022. Data collected included age, sex, Hunt and Hess grade, and whether and how radical aneurysm treatment was performed, and patient characteristics were compared between those with and without vasospasm. Among 170 participants, no significant differences were observed in factors related to the gut-brain axis according to the presence of vasospasm. Subsequent descriptive analysis of vasospasm cases during post-SAH days 0 to 14 revealed that patients generally experienced constipation postoperatively while bedridden and received laxatives or bowel-stimulating medications. These findings suggest impaired bowel motility and possible involvement of the gut-brain axis in vasospasm onset. Although no numerically significant differences were demonstrated, the present results indicate a potential relationship between vasospasm and the gut-brain axis, warranting further investigation. J. Med. Invest. 73 : 135-142, February, 2026.
BACKGROUND:Genitourinary Syndrome of Menopause (GSM) is a chronic condition in postmenopausal women characterized by vulvovaginal and urinary symptoms due to estrogen deficiency. PURPOSE:We aimed to investigate the prevalence of GSM in Japanese women based on symptoms and vulvar findings. METHODS:We enrolled 71 women aged 50-75 years who visited the gynecology outpatient clinics of Tokushima University Hospital and Tsurugi Municipal Handa Hospital in 2023. GSM symptoms were assessed using the Vulvovaginal Symptoms Questionnaire and Core Lower Urinary Tract Symptom Score. Gynecologists evaluated the vulvar findings and measured vaginal pH. GSM was diagnosed when symptoms and objective findings were present. RESULTS:Among the 62 postmenopausal women, 17 met the symptom and objective criteria for GSM. The prevalence was 35%, 36.4%, and 10% among those in their 50s, 60s, and 70s, respectively. GSM prevalence was significantly higher in postmenopausal women than in premenopausal women and in sexually active women than in inactive women. CONCLUSION:Among postmenopausal Japanese women, GSM prevalence was lower than that reported internationally;however, it was higher in sexually active women and increased with time since menopause. Early diagnosis and management are essential to preserve the quality of life of women. J. Med. Invest. 73 : 229-233, February, 2026.
INTRODUCTION:While venous thrombosis is often associated with malignancy, arterial thromboembolisms are rare. We report a case of unresectable rectal cancer complicated by superior mesenteric artery (SMA) embolism, resulting in short bowel syndrome (SBS), but was successfully treated with chemotherapy. CASE PRESENTATION:A 60-year-old woman with unresectable rectal cancer presented to our hospital with abdominal pain. Computed tomography revealed contrast defects originating from the SMA. In addition, CT demonstrated small intestinal wall disruption and free air. She was diagnosed with small intestinal ischemia and gastrointestinal perforation due to SMA embolism. Emergency small intestinal resection and jejunostomy were performed (operative time, 77 min; blood loss, 80 mL). The stoma was created 60 cm from the ligament of Treitz, resulting in the development of SBS. After stabilization with fluid management, a central venous port was placed. Chemotherapy was initiated, and the patient was discharged on postoperative day 29. The tumor shrank after completing four courses of chemotherapy. The patient received home parenteral nutrition and had nine courses of chemotherapy. CONCLUSIONS:This case suggests that the introduction of chemotherapy may be feasible and effective even in patients with SBS secondary to SMA embolism. SBS should not preclude chemotherapy in patients with malignant tumors. J. Med. Invest. 73 : 260-264, February, 2026.
INTRODUCTION:The presence of renal artery pseudoaneurysms, a complication after robot-assisted partial nephrectomy, was evaluated by abdominal ultrasonography. The incidence of renal artery pseudoaneurysms detected by abdominal ultrasonography and the usefulness of abdominal ultrasonography for evaluation after partial nephrectomy were also examined. METHODS:A total of 73 patients who underwent robot-assisted partial nephrectomy between September 2020 and June 2023 and who underwent abdominal ultrasonography on postoperative day 7 to screen for renal pseudoaneurysms were retrospectively reviewed. RESULTS:Ultrasonography after partial nephrectomy showed the presence of renal artery pseudoaneurysms in 3 of 73 patients (4.1%). One of the patients with a renal artery pseudoaneurysm was diagnosed with a large, 15-mm renal artery pseudoaneurysm on postoperative day 7, followed by hematuria with blood clot on postoperative day 10, but the bleeding was stopped by vascular embolization, and the patient had a good course. Two other patients were diagnosed with 20-mm and 16-mm renal artery pseudoaneurysms on postoperative day 7;they were carefully monitored, and the pseudoaneurysms disappeared and regressed by CT or ultrasonography. One of the 73 patients in this study had an intravesical hemorrhage on the 8th postoperative day and underwent emergency embolization. The results of this study showed that renal artery pseudoaneurysms as small as 15 mm in diameter can be identified. CONCLUSION:The present results suggest that screening ultrasonography is useful in identifying renal pseudoaneurysms in the early postoperative period after partial nephrectomy. J. Med. Invest. 73 : 106-110, February, 2026.
