Teru Kumagi

Gastric lesions may be incidentally detected during pancreatobiliary endoscopic ultrasonography (PB-EUS). We aimed to clarify the detection rate of gastric lesions and the impact of awareness on the detection of gastric lesions during PB-EUS. We retrospectively analyzed consecutive patients who underwent PB-EUS (1932 procedures, 1220 patients). We compared the detection rate of incidental gastric lesions and documentation of gastric findings between the groups without and with gastric screening during PB-EUS: former group (2009-2014: 505 procedures, 409 patients) and latter group (2015-2020: 1427 procedures, 918 patients), respectively. Thirteen gastric lesions were incidentally detected during PB-EUS, all in the latter group, including gastric cancer (n = 1), malignant lymphoma (n = 1), gastric adenoma (n = 1), gastric submucosal tumor (n = 2), and gastric ulcer (n = 8). The detection rate of gastric lesions was significantly higher in the latter group than in the former group per procedure (0.91% vs. 0%, P = 0.027) and per patient (1.41% vs. 0%, P = 0.015), and gastric findings were significantly more commonly described in patients' medical records (39.8% vs. 2.97%, P < 0.001). Gastric lesions may be encountered during PB-EUS. A quick screening during PB-EUS improved the detection rate of gastric lesions, presumably due to increased awareness of gastric lesions during the procedure.

An unusual pancreatic tumor with prominent calcification in a middle-aged man: what is the diagnosis?

A high body mass index (BMI) is associated with the onset of diabetes mellitus (DM). However, evidence regarding the association between changes in BMI and DM onset is limited, and the effect of annual BMI (kg/m2/year) change on DM onset is unknown. Therefore, we assessed the effects of changes in BMI and annual BMI on DM onset. We enrolled 13,949 participants aged 21–81 years who underwent an annual health checkup at least twice between April 2003 and March 2021 and examined the effect of BMI change and annual BMI change on DM onset. In total, 462 individuals newly developed DM. Compared with a BMI change of –0.25–<0.25, univariate and multivariate analyses—adjusted for age, sex, BMI, systolic blood pressure, creatinine, total cholesterol, triglycerides, alanine aminotransferase, hemoglobin A1c, and family history of DM—showed that a BMI change <–2 was associated with a lower risk, while 2 ≤ BMI change < 4 and 4 ≤ BMI change were associated with a higher risk of DM onset. In contrast, compared with –0.05 ≤ BMI change per year < 0.05, univariate and multivariate analyses showed a significant association between DM onset and 0.3 ≤ BMI change per year. In the age-stratified analysis, these associations were significant among younger and middle-aged participants but not in older adults. In conclusion, changes in BMI affect DM onset. Therefore, clinicians can prevent DM onset by providing guidance based on BMI and focusing on a ≥2 increase in BMI and a ≥0.3 increase per year of BMI in young and middle-aged individuals.

Aims: Higher levels of remnant cholesterol (Rem‐C) are associated with diabetic conditions, serving as a treatment target and surrogate marker for identifying high‐risk groups for diabetes mellitus (DM) onset. However, the effect of Rem‐C on DM onset based on sex and age remains unclear. We aimed to examine the association between Rem‐C levels and DM onset, stratified by sex and age. Methods: In this health checkup‐based retrospective cohort study, we analyzed data from 13,952 participants who underwent medical checkups two or more times at the Ehime General Health Care Association between April 2003 and March 2021, a non‐hospital facility where health care services are provided to company employees and local residents. The mean follow‐up period was 4.66 years. Cox proportional hazard models were used to assess the association between Rem‐C and DM onset. Results: In the multivariate analysis, higher Rem‐C levels were associated with DM onset in individuals aged <50 years (men: adjusted hazard ratio [aHR] = 1.81, 95% CI: 1.46–2.20; women: aHR = 2.13, 95% CI: 1.18–3.37). However, this association was not observed in those aged ≥50 years. Triglycerides (TG) were also significantly associated with DM onset in younger adults, with slightly higher predictive ability (AUC) than Rem‐C, particularly among younger women. Sensitivity analyses using continuous age as a variable showed similar trends. Conclusions: Rem‐C and TG may be useful predictors of DM onset in younger adults, with TG showing slightly better performance. Age‐specific strategies may improve early DM prevention.

Aspiring to become a physician is a natural expectation for applicants to medical school. However, choosing a career in medicine is a critical decision, especially in countries where high school students can apply to medical school without an undergraduate degree. Students may select a medical career for various reasons, including parental pressure and academic performance. The question of whether there are students who enroll in medical school without clear intentions of becoming doctors has not been extensively investigated in the literature. We conducted a retrospective study at a national university in Japan. Given the scarcity of research examining medical students who did not have a clear intention to become doctors at the time of admission, we created a survey. The questionnaire asked students whether they had clear intentions to become doctors upon enrollment, and those who responded affirmatively were defined as students with clear intentions to become doctors at admission and assigned to the first group. The second group was composed of students who entered medical school without clear intentions to become doctors. We then compared the differences in sociodemographic characteristics and career determinants between these groups using statistical methods, including Chi-square tests and logistic regression. The collection rate of the questionnaire was 76.2%. We found that 28.8% of students at a national medical school in Japan entered medical school without clear intentions of becoming doctors. For these students, ‘parental expectations’ and ‘peer influence’ were identified as significant career determinants. No sociodemographic characteristics showed significant associations with the ambiguity of students’ intentions to pursue a medical career at admission. This study confirmed that some students enroll in medical school without clear intentions of becoming doctors. The background factors related to this type of student were parental expectations and the influence of peers on career choice.

Kawamoto R, et al. Clin Hypertens. 2025 Mar;31(1):e9. https://doi.org/10.5646/ch.2025.31.e9

Background/Aims: Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS) performed at the intrahepatic bile duct segment 3 (B3) is widely used for biliary drainage. Although performing post-puncture procedures is easier in the intrahepatic bile duct segment 2 (B2) when using a conventional oblique-viewing (OV) EUS scope, this method may cause transesophageal puncture and severe adverse events. We evaluated the safety and efficacy of B2 puncture using a novel OV-EUS scope.Methods: In this single-center retrospective study, we prospectively enrolled and collected data from 45 patients who consecutively underwent EUS-HGS procedures with a novel OV-EUS scope between September 2021 and December 2022 at our cancer center.Results: The technical success rates of B2-EUS-HGS and EUS-HGS were 93.3% (42/45) and 97.8% (44/45), respectively. The early adverse event rate was 8.9% (4/45) with no cases of scope changes or transesophageal punctures. The median procedure time was 13 minutes (range, 5–30).Conclusions: B2-EUS-HGS can be performed safely with the novel EG-740UT (Fujifilm) OV-scope without transesophageal puncture and with a high success rate. B2-EUS-HGS using this novel OV scope may be the preferred strategy for EUS-HGS.

Background Gastric lesions may be incidentally detected during endoscopic ultrasonography (EUS). We aimed to clarify the detection rate of gastric lesions and the impact of awareness on the detection of gastric lesions during EUS. Methods This retrospective study collected data on age, sex, primary pancreatobiliary disease, indication for EUS and detection of gastric lesions. The detection rate of incidental gastric lesions and documentation of gastric findings was compared between patients who underwent EUS (1,932 procedures, 1,220 patients). A quick gastric screening during EUS was introduced in 2015; therefore, EUS was classified into the former group (2009–2014: 505 procedures, 409 patients) and the latter group (2015–2020: 1,427 procedures, 918 patients). Results Thirteen gastric lesions were incidentally detected during EUS, all in the latter group, including gastric cancer (n = 1), malignant lymphoma (n = 1), gastric adenoma (n = 1), gastric submucosal tumor (n = 2), and gastric ulcer (n = 8). The detection rate of gastric lesions was significantly higher in the latter group than in the former group per procedure (0.91% vs. 0%, P = 0.027) and per patient (1.41% vs. 0%, P = 0.015), and gastric findings were significantly more commonly described in patients’ medical records (39.8% vs. 2.97%, P < 0.001). Conclusions Gastric lesions may be encountered during EUS. A quick screening during EUS improved the detection rate of gastric lesions, presumably due to increased awareness of gastric lesions during the procedure.

AimHepatitis C complicated by diabetes mellitus (DM) is considered a risk factor for the progression of fibrosis and development of hepatocellular carcinoma (HCC) and cardiovascular diseases. However, several studies may have lacked appropriate diagnosis of glucose intolerance. We aimed to examine the risk associated with abnormal glucose intolerance in the development of liver-related diseases, including HCC and complications of liver cirrhosis, such as ascites, esophageal and gastric varices, and hepatic encephalopathy, and cardiovascular diseases in patients with hepatitis C accurately diagnosed with impaired glucose tolerance. MethodsThis longitudinal retrospective study included 365 patients with chronic hepatitis C admitted to Ehime University Hospital for anti-hepatitis C therapy between September 1991 and January 2015. Patients were classified into normal glucose tolerance (NGT), prediabetes, and DM groups based on 75-g oral glucose tolerance test results. ResultsBoth univariate and multivariate (adjusted for potential confounders) analyses revealed a significantly higher risk of developing HCC and cardiovascular events in the DM group than in the NGT group. However, in multivariate analysis, liver-related events, particularly liver cirrhosis complications, revealed no significant association. In addition, the prediabetes group had no significant risk of any outcome. ConclusionsPatients with hepatitis C complicated by DM, compared with patients with hepatitis C with NGT or complicated with prediabetes, have a higher risk of HCC and cardiovascular disease events, but not liver-related events, particularly in not developing liver cirrhosis complications. Therefore, appropriate follow-up is required for patients with hepatitis C based on their glucose tolerance status.