Minoru Hattori

Nursing students with attention-deficit/hyperactivity disorder (ADHD) traits may struggle with demanding academic and clinical training, potentially increasing the risk of insomnia and depressive symptoms. This study examined whether insomnia statistically mediates the association between ADHD traits and depressive symptoms in this population. A cross-sectional survey was conducted with 131 nursing students (96.9% female; mean age = 20.4 ± 2.3 years) at two Japanese universities in late October–November 2018, prior to the COVID-19 pandemic. Participants completed measures of ADHD traits (ASRS v1.1 Part A), depressive symptoms (PHQ-9), and insomnia (Athens Insomnia Scale). A bootstrapped mediation analysis (5,000 resamples), adjusted for age, sex, and sleep/circadian factors (sleep duration, chronotype, social jetlag), was performed. ADHD traits showed a weak positive correlation with insomnia (r = 0.29, p < 0.001) and a moderate positive correlation with depressive symptoms (r = 0.44, p < 0.001); insomnia and depressive symptoms were moderately correlated (r = 0.54, p < 0.001). Insomnia partially mediated the association between ADHD traits and depressive symptoms: the indirect effect was significant (β = 0.105, 95% bootstrap CI [0.024, 0.194]; Sobel z = 2.49, p = 0.013), accounting for approximately 26% of the total effect, while the direct effect remained significant (β = 0.293, p < 0.001). A Monte Carlo post-hoc power analysis indicated that statistical power for the indirect effect was 0.82. These findings, interpreted within the constraints of a cross-sectional design, identify insomnia as a candidate mechanism linking ADHD traits to depressive symptoms and suggest that integrating sleep health screening and targeted sleep-focused interventions into nursing education may offer a feasible and scalable preventive approach to supporting student mental health within higher-education support systems.

Introduction: Hiroshima University, in collaboration with BeRISE Corp, developed a virtual reality-based objective structured clinical examination (VR OSCE ^TM ) practice software, as an educational tool to enhance clinical skills. This study aimed to assess the effectiveness of training with VR OSCE ^TM for medical students. Methods: Twenty medical students participated in this prospective, pre- and post-intervention study. They conducted medical interviews and physical examinations of simulated patients using VR OSCE ^TM and presented their findings. Two instructing doctors assessed and scored their performance based on predefined criteria before and after training. A paired t-test was used to analyze the pre- and post-training scores of five parameters: (a) safety checks, (b) patient care, (c) medical interviews and physical examinations, (d) presentation skills, and (e) overall performance. A questionnaire survey was also administered to assess participants’ perceptions of VR OSCE ^TM . Results: Post-training scores significantly improved across all parameters compared with pre-training scores ( p < 0.01). Scores for (a) safety checks (Pre: 6.0 ± 1.9, Post: 8.6 ± 1.8) and (b) patient care (Pre: 4.6 ± 1.8, Post: 7.8 ± 1.1) were close to the OSCE passing threshold prior to training. Notably, there were remarkable improvements in scores for (c) medical interviews and physical examinations (Pre: 4.1 ± 1.7, Post: 7.3 ± 1.2) and (d) presentation skills (Pre: 3.5 ± 1.3, Post: 7.0 ± 1.6). Scores for (e) overall performance (Pre: 3.8 ± 1.3, Post: 7.2 ± 1.5) mirrored these improvements. The survey indicated that all participants recognized the effectiveness of training with VR OSCE ^TM as a component of OSCE certification preparation. Conclusion: This study is the first to evaluate the educational impact of VR OSCE™ training in medical students. VR-based training appears to be effective, likely due to its immersive nature. These findings suggest that VR-based digital simulation has substantial potential to enhance medical education.

A publicly shared digital phenotyping dataset was recently used to train models predicting day-before-panic (DBP) events, reporting a cross-validated receiver operating characteristic area under the curve (ROC-AUC) of around 0.90. Because the stratified five-fold cross-validation (CV) allowed the same participant's days in both training and test folds, it was unclear whether this reflects between-person generalization or information leakage. We reanalyzed the public dataset to quantify this distinction. We reanalyzed the public dataset (3,969 person-days; 254 DBP events, 6.4%, across 19 of 43 participants) with the same XGBoost classifier and 71 features, comparing stratified five-fold cross-validation with leave-one-subject-out (LOSO) cross-validation. A retrospective diagnostic decomposition was applied within-subject z-scoring to dynamic features before LOSO. We reproduced the original ROC-AUC at 0.895 ± 0.011. Under LOSO, pooled ROC-AUC dropped to 0.489 (bootstrap 95% CI: 0.325–0.643, including 0.50). The SHapley Additive exPlanations (SHAP) ranking under stratified CV was dominated by static traits (CTQ subscales, BRIAN, SPAQ). The diagnostic decomposition yielded LOSO ROC-AUC 0.516 (precision–recall area under the curve [PR-AUC] 0.114), suggesting a weak residual within-person signal, though this should not be interpreted as prospective performance. Robust between-person generalization was not confirmed under subject-held-out evaluation. The feature ranking was trait-dominated, though the data cannot definitively distinguish identity discrimination from other between-person variance sources. Digital phenotyping studies should report subject-level cross-validation alongside standard metrics, per the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) and Prediction model Risk of Bias Assessment Tool (PROBAST) guidelines.

Biomedical informatics increasingly reuses clinical artificial intelligence (AI) benchmarks, yet successor releases are often treated as independent external corpora. If the same participants reappear under new corpus names, features, or partition files, evaluation can become internal while reported as external. The objective of this study is to define successor-release participant leakage as a benchmark-integrity threat, operationalize a preevaluation audit and leak-free protocol, and demonstrate its impact using the Distress Analysis Interview Corpus, Wizard-of-Oz condition (DAIC-WOZ), and the Extended DAIC (E-DAIC) depression-screening benchmarks. We audited release lineage and participant identity using persistent identifiers, content hashing, Patient Health Questionnaire-8 (PHQ-8) label reconciliation, and fold-transition cross-tabulation. We compared leaky and participant-disjoint E-DAIC-to-DAIC-WOZ protocols on the same heldout participants using paired bootstrap inference and derived conservative leak-free reference baselines across standard pipelines. All 189 DAIC-WOZ participants reappeared in E-DAIC with byte-identical recordings and identical PHQ-8 totals. Across official partitions, 104 of 189 changed fold. Training on E-DAIC and evaluating on the DAIC-WOZ test set placed 47/47 test participants in the model-development pool; the reverse direction was clean. The leaky acoustic protocol yielded area under the receiver operating characteristic curve (AUROC) 0.797 versus 0.569 after deduplication, with paired Delta AUROC + 0.227 (95% confidence interval + 0.106 to + 0.372; two-sided p < 0.001). At matched training size, Delta AUROC was + 0.249. A generic visual classifier reached AUROC 0.887 on a blended external set but 0.562 on the unseen AI-only portion. Leak-free reference baselines were approximately AUROC of 0.60. Successor-release participant leakage is a preventable evaluation failure in clinical AI benchmark reuse. Before pooling, external validation, or model comparison, biomedical informatics studies should document release lineage, verify participant identity at the signal or record level, reconcile labels, deduplicate across releases, and enforce participant-disjoint evaluation.

Background/Objectives: Near-infrared photoimmunotherapy (NIR-PIT) represents a treatment approach for patients with locally advanced or recurrent head and neck cancers who are unsuitable for surgery post-standard therapy. Since its introduction in Japan in January 2021, NIR-PIT has been available exclusively under the national health insurance system, resulting in limited real-world clinical practice data. This study evaluated the association between NIR-PIT and overall survival (OS) in clinical practice. Methods: This single-center retrospective study included 45 patients with head and neck cancer who were not amenable to surgical resection owing to advanced local disease or regional recurrence without distant metastasis and who underwent NIR-PIT or systemic pharmacotherapy between January 2021 and April 2025. The primary endpoint was OS. Results: Twenty-two and 23 patients received NIR-PIT and pharmacotherapy, respectively. In the NIR-PIT group, irradiation was delivered to primary tumors in 20 patients, cervical lymph node lesions in one, and both primary and lymph node lesions in one. The median OS was 35 and 8 months, with median follow-up of 40 and 49 months in the NIR-PIT and pharmacotherapy groups, respectively. Among the NIR-PIT-eligible patients, 22 and 10 were treated with NIR-PIT and pharmacotherapy, respectively. The median OS was 35 and 8 months, with median follow-up of 40 and 24 months in the NIR-PIT and pharmacotherapy groups, respectively. Conclusions: NIR-PIT was independently associated with improved OS in patients with unresectable recurrent or metastatic head and neck cancer without distant metastasis. Prospective multicenter studies are warranted to validate these findings.

Objective: Mucosal melanoma (MM) is an extremely aggressive malignant tumor in the head and neck region associated with a poor prognosis. In the present study, we conducted cell proliferation assay and western blotting using cell lines derived from MM and the immunohistochemical analysis of pathological MM tissues to identify novel therapeutic targets. Herein, we report on the potential of cyclin‐dependent kinase 4 (CDK4) inhibitors as molecular targeted therapies for MM. Study Design: Retrospective cohort study and laboratory analysis. Setting: A tertiary referral center. Methods: MTT assay and western blotting were performed on the HMV‐II (RCB0777) and GAK (JCRB0180) cell lines, treated with the CDK4 inhibitors abemaciclib (LY2835219) and palbociclib (PD‐0332991). This retrospective cohort study included patients with head and neck MM; immunohistochemistry was performed on clinical specimens. Results: Abemaciclib and palbociclib showed concentration‐dependent cytostatic effects on HMV‐II and GAK cells at 72 hours in the MTT assay. In western blotting, they exhibited concentration‐dependent inhibitory effects on phosphorylated RB1 in HMV‐II and GAK cells at 24 hours. Of 23 patients, 18 (78.3%) had positive results on CDK4 immunostaining. No clinicopathologic factors were significantly associated with CDK4 status. Conclusion: Abemaciclib and palbociclib may suppress MM cell proliferation. The CDK4 signaling pathway is a potential target for molecular‐targeted therapies in MM.

Background: Transoral robotic surgery (TORS) is a minimally invasive procedure that is performed with neck dissection (ND) and postoperative radiotherapy when necessary. This study aimed to review the methods of vascular ligation and ND in cases of TORS for oropharyngeal cancer in Japan. Methods: We enrolled 44 consecutive patients who underwent TORS for laryngopharyngeal cancer between December 2019 and December 2023. Of these, 35 patients who underwent TORS as a first-line treatment for oropharyngeal cancer were included in this study. We retrospectively collected patient data on age, sex, primary tumor location, clinical tumor–node classification, Eastern Cooperative Oncology Group performance status, history of irradiation to the neck, presence of anticoagulants, pathological results, tumor size, total operative duration, console time, length of skin incision operative result, estimated blood loss, late cervical lymph node metastasis, perioperative complications, postoperative hospital stay, postoperative bleeding, period until oral intake after surgery, and swallowing function. Intra- and postoperative outcomes of TORS, TORS + ND (IIa) + vascular ligation, and TORS + ND (II–IV) + vascular ligation. Results: Significant differences were found in operative duration, blood loss during ND, and skin incision length between TORS + ND (IIa) + vascular ligation and TORS + ND (II–IV) + vascular ligation. Console time and blood loss did not significantly differ between the two groups. Each group contained one case of postoperative bleeding. Conclusions: Safe and minimally invasive treatments can be established if vascular ligation and ND are implemented based on appropriate case selection.

Purpose: We developed an interventional radiology (IR) simulator using a virtual reality system (the VR–IR simulator) to teach IR procedures to medical students. In this study, we investigated the effectiveness of this teaching method. Materials and methods: All ninety-nine fifth-year medical students attended a conventional classroom lecture. To teach students the actual procedure, they were randomly divided into two groups: One received conventional verbal explanations and educator demonstrations (the conventional group [n = 44]), and the other received VR–IR simulator training (the VR–IR simulator group [n = 55]). Afterward, they underwent a test using an augmented reality- (AR-) IR simulator (the VIST^® G5 image-guided AR–IR simulator, Mentice, Gothenburg, Sweden). The total procedure time, amount of contrast media used, fluoroscopic time, and patient peak skin dose in the simulated patients were compared between groups. A board-certified radiologist evaluated ten aspects of the procedure technique using a 5-point Likert scale (total: 50 points). Results: Two students in the VR–IR simulator group were excluded due to VR sickness and simulator malfunction. There were no significant differences between the VR–IR simulator group and the conventional group regarding total procedure time (median [25–75% interquartile range]: 13.5 [11.8–14.5] vs. 14.3 [12.3–16.8] minutes, p = 0.11), fluoroscopic time (10.1 [8.5–13.0] vs. 11.0 [8.6–13.7] minutes, p = 0.31), and patient peak skin dose (276 [243–373] vs. 303 [239–395] mGy, p = 0.57), respectively. However, the amount of contrast media used was significantly lower (28.0 [21.0–36.2] vs. 40.0 [32.3–50.9] mL, p < 0.01) and the technical achievement scores by the radiologist (36 [34–44] vs. 31 [29–32], p < 0.01) were significantly higher in the VR–IR simulator group. Conclusion: The VR–IR simulator helped reduce the amount of contrast media in interventional procedures and improved technical achievement scores.