Fumio Otsuka

Background: The clinical features and recovery of patients with obesity and Long COVID remain incompletely understood. Methods: We retrospectively analyzed 903 patients attending a COVID-19 aftercare clinic during the Omicron period. Biomarkers were compared across body mass index (BMI) categories. Recovery was defined as physician-determined conclusion of outpatient follow-up following sufficient symptom improvement, not necessarily complete resolution. Recovery analyses were exploratory; 572 patients comprised a sensitivity cohort clinically compatible with the World Health Organization (WHO) post-COVID-19 condition definition. Results: Serum ferritin levels were higher in overweight and obese men than in normal-weight men. Cortisol/adrenocorticotropic hormone (ACTH) ratios in women and free thyroxine (FT4) levels in men differed across BMI categories. Recovery analysis from symptom onset included 565 participants and 186 events. Men with obesity had a lower recovery hazard than normal-weight men, with consistent direction across sensitivity analyses (age-adjusted pooled model, n = 565; hazard ratio: 0.390; 95% CI: 0.170–0.894), based on six recovery events among men with obesity. The main sex-by-obesity interaction was nonsignificant; additional interaction results varied by model. The WHO-compatible recovery analysis was limited by sparse events. Conclusions: Obesity was associated with a longer time to clinically defined recovery among men, alongside BMI-related endocrine–metabolic differences. These exploratory findings warrant confirmation; sparse events and residual confounding preclude causal or definitive sex-specific conclusions.

Background: Citrate‐related reactions remain the most common adverse events during peripheral blood stem cell (PBSC) collection despite routine prophylactic intravenous calcium administration. We evaluated whether prophylactic oral calcium–vitamin D3–magnesium supplementation reduces citrate‐related reactions in healthy PBSC donors. Study Design and Methods: In this prospective open‐label randomized controlled trial, 52 healthy allogeneic PBSC donors were randomly assigned to receive prophylactic oral calcium–vitamin D3–magnesium supplementation before PBSC collection ( n = 26) or no oral supplementation ( n = 26). The primary endpoint was Grade ≥1 citrate‐related reactions. Secondary endpoints included Grade ≥2 reactions, electrolyte‐related outcomes, and safety. Results: All randomized donors completed the study and were included in the final analysis. Grade ≥1 citrate‐related reactions occurred in 8 of 26 donors (30.8%) in the control group and in none of the intervention group (RR, 0.000; 95% CI, 0.000–0.000; p < .001). Grade ≥2 reactions occurred in two donors (7.7%) in the control group and in none of the intervention group. One donor in the control group developed Grade 4 tetany near the end of PBSC collection, after which the procedure was terminated. No Grade 4 reactions occurred in the intervention group. No statistically significant between‐group differences were observed in electrolyte‐related outcomes. Conclusion: Prophylactic oral calcium–vitamin D3–magnesium supplementation markedly reduced citrate‐related reactions during PBSC collection in healthy donors and may represent a practical approach to improving donor safety.

Fatigue, loss of energy, low sexual desire and erectile dysfunction are common in primary care, and late-onset hypogonadism (LOH), defined according to symptoms and low testosterone levels, is one possible explanation. Its symptoms are non-specific, and terminology and diagnostic thresholds vary between guidelines. Testosterone prescribing has risen in the UK, yet men requiring treatment may remain unidentified. Evidence has primarily been derived from specialist settings and intervention trials, and primary care evidence has not been systematically mapped. The aim of this scoping review is to map evidence on the frequency and clinical presentation of LOH in primary care; its recognition, assessment and management; and associated barriers and facilitators, and to identify evidence gaps relevant to primary care practice to inform future research. This review will follow JBI principles, and the outcomes will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). This review will cover primary care and general practice settings internationally. PubMed, CINAHL and Web of Science Core Collection will be searched for peer-reviewed, original research published in English from 2000 onwards. Two reviewers will independently screen titles/abstracts and full texts, with disagreements resolved by discussion or a third reviewer. Data will be extracted by one reviewer and verified by another. Descriptive and basic qualitative content analyses will be conducted. This review will clarify evidence and identify knowledge gaps concerning LOH in primary care, informing future research and guidance.

Background: Nasal and sinonasal findings have been reported in patients with Behçet’s syndrome, but their frequency, clinical significance, and relationship to underlying disease remain unclear. We performed a scoping review to map the published literature on epidemiology, clinical characteristics, and management. Methods: Following PRISMA-ScR guidance, we systematically searched MEDLINE, EMBASE, and Web of Science from inception through June 2026 for peer-reviewed primary studies reporting nasal or sinonasal findings in patients with Behçet’s syndrome. Two reviewers independently screened studies and extracted data. Results: Fifteen eligible studies, including seven case reports and eight observational studies, were identified. Reported frequencies of nasal or sinonasal findings varied substantially across studies. A spectrum of nasal and sinonasal symptoms was noted among the literature, including direct mucosal lesions, sinonasal symptoms and functional abnormalities such as olfactory impairment or delayed mucociliary clearance, and secondary nasal conditions occurring in patients with Behçet’s syndrome. Oral ulcers were consistently reported in the limited studies describing associated systemic features. Treatment data were sparse, and no evidence-based management approach specific to nasal disease was identified. Conclusions: The published literature suggests that a range of nasal and sinonasal findings may occur in patients with Behçet’s syndrome. However, the available evidence is sparse, heterogeneous, and insufficient to determine true prevalence, attribution, or optimal management. Future studies should distinguish direct Behçet-related nasal lesions from secondary or nonspecific findings and use standardized clinical assessment.

Background and Objectives: Persistent COVID-19 sequelae, often referred to as “long COVID”, still constitute a major global medical challenge. In particular, general fatigue is the most widely reported, serious symptom. In the framework of Japanese traditional (Kampo) medicine (JTM), post-infection fatigue is frequently considered a “Qi deficiency”, a significant loss of vital energy. In JTM, accurately diagnosing Qi deficiency is essential for determining the appropriate treatment. However, one challenge in JTM diagnosis is that mastering traditional diagnostic techniques takes time. We sought to validate the “Qi deficiency score”, a quantitative patient-reported outcome measure designed to assess Qi deficiency in patients suffering from long COVID. Materials and Methods: This was a methodological study. We conducted a cross-sectional study of 237 patients who sought treatment at the post-COVID-19 clinic (COVID-19 Aftercare Clinic) at Okayama University Hospital. The patient population was randomly split into two cohorts: one for Exploratory Factor Analysis (EFA, n = 122) and another for Confirmatory Factor Analysis (CFA, n = 115). The simple Qi-deficiency score comprises eight items derived from Terasawa’s diagnostic criteria, with a total range of 0–56. We evaluated internal consistency using Cronbach’s α/McDonald’s ω and examined structural validity. Convergent validity was established by examining correlations between the simple Qi deficiency score and the Fatigue Assessment Scale (FAS), the Self-rating Depression Scale (SDS), and Quality of Life (QOL) metric. Results: The score’s internal consistency (α = 0.64 and ω = 0.63) was considered modest for screening traditional clinical syndromes. EFA showed major factors representing Qi deficiency symptoms. CFA supported a one-factor model with modest fit indices (CFI = 0.87; RMSEA = 0.079; SRMR = 0.077; TLI = 0.82). Factor loadings revealed that “Body feels tired (now)” (0.98) and “Tires easily (tendency)” (0.73) were the most significant symptoms. Convergent validity showed a strong positive correlation with the FAS (r = 0.61, ρ = 0.60) and a moderate correlation with the SDS (r = 0.55, ρ = 0.55). A significant negative correlation was found with QOL scores (r = −0.42, ρ = −0.43). Conclusions: The simple Qi deficiency score may be useful for evaluating Qi deficiency in patients with post-COVID-19 condition.

Calcium pyrophosphate deposition disease may mimic an iliopsoas abscess on imaging. The combined use of polarized light microscopy and 16S rRNA gene analysis can help distinguish crystal‐induced inflammation from infection, thereby preventing unnecessary antimicrobial therapy.

Introduction: Serum thyroglobulin (Tg) and thyroid hormones are essential biomarkers in the diagnosis and management of thyroid diseases. Although Tg is routinely measured as a marker for thyroid neoplasia and an adjunct in the diagnosis of thyrotoxicosis due to destructive thyroiditis, its clinical significance under conditions of abnormal thyroid function remains unclear. Methods: We investigated the association between serum Tg levels and thyroid function in 292 patients who underwent simultaneous evaluation of serum Tg, free thyroxine (FT4), and free triiodothyronine (FT3) levels in routine clinical practice. Based on thyroid-stimulating hormone (TSH) levels, participants were classified into three groups: high-TSH (> 4.23 μIU/mL; n = 38), normal-TSH (0.61–4.23 μIU/mL; n = 191), and low-TSH (< 0.61 μIU/mL; n = 63). Results: The low-TSH group exhibited significantly higher serum Tg levels (118.66 ± 32.13 ng/mL) than the normal-TSH (70.20 ± 23.48 ng/mL) and high-TSH (34.70 ± 13.62 ng/mL) groups. Among patients positive for TSH-receptor antibodies (TRAb) or thyroid-stimulating antibodies (TSAb), elevated Tg levels were observed exclusively in the low-TSH group. Correlation analyses revealed that Tg levels were positively correlated with the FT3/FT4 ratio in the low-TSH group ( rho = 0.62, p < 0.01), and this association was more evident in patients positive for both TRAb and TSAb ( rho = 0.71, p < 0.01). These associations remained significant after multivariable adjustment and were supported by correlations between Tg and SPINA-GD, a model-based index of thyroid function reflecting deiodinase activity, with similar findings observed in patients with autoimmune hyperthyroidism. Conclusion: These findings suggest that serum Tg levels may reflect biochemical features consistent with T3 predominance in autoimmune hyperthyroidism and have potential clinical utility in characterizing disease pathophysiology.

Background: Although several risk factors have been reported for long COVID (LC), reliable biomarkers for this illness remain lacking. Insulin-like growth factor (IGF)-I, a major mediator of growth hormones, plays an important role in metabolism, neuroprotection, and systemic homeostasis, and therefore may be useful in predicting the severity and prognosis of LC. Methods: This study included patients who visited a specialized clinic for long COVID between 2022 and 2025 during the Omicron period and had serum IGF-I measurements taken. IGF-I levels were expressed as age- and sex-adjusted standard deviation scores (IGF-I SD), and patients were classified into low (SD < −1.0), normal (−1.0 ≤ SD < 1.0), and high (SD ≥ 1.0) groups. Clinical characteristics, patient-reported outcomes, laboratory data, and follow-up duration were analyzed. Results: A total of 811 patients were included (median 42 years; 52.5% female). Compared with the normal group, the low-IGF-I group exhibited higher fatigue (FAS: 37.0 vs. 34.0; p < 0.05) and depressive (SDS: 50.0 vs. 49.0; p < 0.05) status. Multivariable linear regression analyses identified lower IGF-I SD as independently associated with higher scores of both FAS and SDS. IGF-I SD values showed negative correlations with ferritin (ρ = −0.125, p < 0.05) and TSH (ρ = −0.202, p < 0.01) and positive correlations with albumin (ρ = 0.227, p < 0.01) and FT4 (ρ = 0.165, p < 0.01). Among the 237 patients who completed follow-up, the median duration from the initial visit to recovery tended to be longer in the low-IGF-I group (221 days) compared with the normal (191 days) and high (109 days) groups, although these differences were not statistically significant overall. In patients aged < 50 years, the low-IGF-I group showed a relatively longer follow-up duration (p < 0.05). Furthermore, the low-IGF-I group had a longer time to recovery compared to the high-IGF-I group (p < 0.05), and this difference was more pronounced in patients under 50 years of age, with significant differences observed among the three IGF-I groups. Conclusions: Lower IGF-I levels in LC may be associated with greater fatigue and depressive symptoms and longer recovery time, particularly in younger patients. Further studies are needed to clarify the clinical significance of these findings.