Hyogo Medical University

Abstract Students’ learning performance and its correlation with exam scores are examined using a unique factor: the day the online quiz was submitted. By collecting information on quizzes through an online learning management system for each subject in an introductory physics course for first-grade medical students, student learning performance is thoroughly analysed and compared with the final exam score. The results show a statistically significant negative correlation between the exam score and quiz submission day. Furthermore, by combining several parameters that are potentially related to the exam score, we are able to evaluate the student’s learning attitude in more detail. Based on the results, we discuss the negative effects of procrastinating behaviour and successful learning practices.

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is a common complication, and its prevention remains challenging. Although aggressive infusion of lactated Ringer's solution (hereafter Lactated Ringer's) has shown preventive effects, the efficacy of standard infusion rates remains unclear. To evaluate whether lactated Ringer's administered at a standard rate reduces the incidence or severity of post-ERCP pancreatitis compared with non-lactated Ringer's solutions. This single-center retrospective study compared patients who received non-lactated Ringer's solutions before January 2019 with those who received lactated Ringer's after January 2019, at a standard rate. The outcomes were post-ERCP pancreatitis incidence, severity, C-reactive protein (CRP) level, and systemic inflammatory response syndrome (SIRS). Of 1194 patients included (median age, 71years; 60% male), pancreatitis occurred in 5.6% (30/529) of the non-lactated Ringer's group and 5.3% (35/665) of the lactated Ringer's group (P = 0.76). Severe or moderately severe pancreatitis occurred in six patients each in both groups (approximately 1%). Mean CRP level at 24h was similar between the groups (1.26 vs. 1.44mg/dL, P = 0.75), and SIRS rates at 24/48h did not differ significantly (P = 0.61 and 1.00). Multivariate analysis identified pancreatic injection, naïve papilla, and female sex as independent risk factors; fluid type was not associated with outcome (OR 1.09, P = 0.76). Lactated Ringer's at a standard infusion rate did not reduce the incidence or severity of post-ERCP pancreatitis compared with a non-lactated Ringer's solution. Further research is required to optimize fluid therapy for preventing this complication.

The trigeminal nerve consists of three major branches or rami (r) in jawed vertebrates: the ophthalmic (rV1), maxillary (rV2), and mandibular (rV3), with rV2 and rV3 innervating the upper and lower jaws, respectively. This three-branch configuration is conserved in the lamprey, a representative of the cyclostomes, the sole survivor of jawless vertebrates. While the first branch is widely accepted to be homologous to that of jawed vertebrate rV1, the homology of the other two remains unclear, so they are called rV1, rV2/3A, and rV2/3B. In this study, we investigate evolutionary modifications of the trigeminal nerve by comparing its organization in lamprey and jawed vertebrate embryos. By detailed neuronal tracing analysis of rV2/3B, which innervates the velum, we demonstrate that it consists solely of motor components. Conversely, we identify both sensory and motor fibers in rV2/3A. These results make a striking contrast to the trigeminal nerve of the jawed vertebrates, as their rV2 is purely sensory, but rV3 is a mixed nerve. Furthermore, through comparative analyses of sensory projection inside the brain, we clarify that the principal sensory nucleus of the trigeminal nerve (PrV) of anamniotes (shark, catfish, and Xenopus) lacks a somatotopic organization, suggesting that somatotopy evolved in at least the last common ancestor of amniotes. Last, by gene expression analysis of Drg11, a marker for the PrV and the spinal trigeminal nucleus (SpV), we show that a PrV-equivalent region is not present in the lamprey. These findings indicate significant structural changes in the trigeminal nerve associated with jaw acquisition, including shifts in innervation territories, the disappearance of the branch innervating the velum, and the emergence of novel brain nuclei.

Primary Percutaneous Coronary Intervention (PCI) has significantly contributed to reducing the mortality of patients with ST segment elevation myocardial infarction (STEMI) even in cardiogenic shock and is now the standard of care in most of Japanese institutions. The Task Force on Primary PCI of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) proposed an expert consensus document for the management of acute myocardial infarction (AMI) focusing on procedural aspects of primary PCI in 2018 and updated in 2022 (Ozaki et al. in Cardiovasc Interv Ther 33:178-203, 2018), (Ozaki et al. in Cardiovasc Interv Ther 37:1-34, 2022). Following the publication of the 2023 European Society of Cardiology (ESC) Guidelines for the management of acute coronary syndromes, the CVIT Task Force released another revised version in 2024 (Ozaki et al. in Cardiovasc Interv Ther 39:335-375, 2024). In light of new clinical evidence and technological advances that have emerged since then, the Task Force now proposes an updated expert consensus document for the management of ACS focusing on procedural aspects of primary PCI in 2026 version.

This case series reports the first cases of para-aortic lymphadenectomy performed using the hinotori™ Surgical Robot System (Medicaroid Corporation, Kobe, Japan), Japan’s first domestically developed robotic surgical platform. Three patients with gynecologic malignancies (two endometrial and one ovarian cancer) underwent curative surgery, including total hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and para-aortic lymphadenectomy. All procedures were completed robotically without conversion or intraoperative complications. Operative time ranged from 461 to 512 minutes, and blood loss from 10 to 50 mL. A total of 9-38 para-aortic lymph nodes (median 26) were retrieved, comparable to yields from laparoscopic or da Vinci®-assisted procedures, confirming oncologic adequacy. Postoperative recovery was uneventful in all cases. These cases demonstrate that para-aortic lymphadenectomy using the hinotori™ system is technically feasible and safe. Expanding its use from well-established pelvic surgery to advanced oncologic procedures marks an important milestone for robotic surgery in Japan. Further studies are needed to refine protocols and assess outcomes.

The 3-dimensional (3D) volume of a pancreatic fluid collection (PFC) has not been fully investigated in EUS-guided treatment. In 372 patients, we examined the 3D volume in relation to the clinical outcomes. In walled-off necrosis, 3D volume was associated with time to clinical success and in-hospital mortality with a multivariable subdistribution hazard ratio of 0.43 (95% CI, 0.28-0.66; Ptrend = .010) and a multivariable odds ratio of 30.9 (95% CI, 4.31-222; Ptrend = .004), respectively (for ≥1000 cm3 vs < 250 cm3). In pseudocysts, 3D volume was associated with in-hospital mortality (Ptrend = .014) with a multivariable odds ratio of 12.5 (95% CI, 0.81-193; for ≥500 cm3 vs < 100 cm3). The maximum diameter represented a comparable model goodness-of-fit. PFC volume was associated with the outcomes of EUS-guided interventions, and the maximum diameter may be a reasonable surrogate.