Internal medicine
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Non-bacterial thrombotic endocarditis (NBTE) causes myocardial and cerebral infarctions and is associated with advanced stages of malignancy. However, only a few cases of myocardial and cerebral infarctions have been reported in the same patient. We herein report a 47-year-old woman with advanced uterine and ovarian cancer who experienced acute myocardial infarction (MI) after receiving chemotherapeutic intervention for the cancer and hemorrhagic cerebral infarction 1 month after admission for acute MI, attributable to NBTE of the aortic valve. NBTE should be considered in patients with malignancies and life-threatening thromboembolism of important organs.
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There are no clear strategies for non-insulin-dependent slowly progressive type 1 diabetes mellitus (SPIDDM). We herein report a 25-year-old man with SPIDDM in whom appropriate diet therapy and exercise improved the initial insulin secretion without medication. ⋯ These improvements were maintained over five years with continuous lifestyle interventions. Patients with non-insulin-dependent SPIDDM may recover and retain their insulin secretion through lifestyle interventions.
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Traditionally, leptomeningitis (LM) has been considered untreatable and terminal, but the development of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) has significantly improved the prognosis of patients with EGFR mutations. However, non-LM lesions occasionally progress or recur, even when the LM is successfully controlled with EGFR-TKIs, and treatment of such cases remains unclear. We herein report a patient with advanced non-small-cell lung cancer (NSCLC) who was treated with an EGFR-TKI for LM and cytotoxic chemotherapy for EGFR-TKI-resistant pulmonary lesions. The patient survived for almost four years after the diagnosis of LM, suggesting that this treatment may be beneficial in advanced NSCLC with EGFR-TKI-sensitive LM and EGFR-TKI-resistant extracranial lesions.
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Introduction Evidence-based medicine (EBM) competency is crucial for healthcare professionals; however, validated tools to assess EBM skills in Japanese are scarce. This study aimed to develop and validate a Japanese version of the Assessing Competency in EBM (ACE) tool. Methods We translated the ACE tool into Japanese, following international standards, and distributed it online to 99 healthcare professionals and students. ⋯ The median completion time was 847 s (IQR, 577-1,249 s). Conclusion Although the Japanese version of the ACE tool showed some promising aspects, including a quick administration and partial validity, its low internal consistency suggests that refinement is needed before it can be confidently used in Japanese medical education settings. Future studies should focus on improving the tool's reliability, potentially through in-person administration, to develop a robust EBM assessment tool in the Japanese healthcare context.
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Mesalazine-induced pericarditis is rare, and most cases occur at the time of treatment initiation. A 30-year-old man with ulcerative colitis who had experienced remission for 2 years with mesalazine 2,000 mg/day subsequently experienced relapse. ⋯ Chest radiography revealed marked cardiac dilation (cardiothoracic ratio, 63%) and echocardiography revealed pericardial effusion. Adverse events associated with mesalazine should be carefully monitored, not only at the time of treatment initiation but also after dose escalation.