Ryuichi Ohta

Rural communities often face structural and psychological barriers to healthcare access, particularly among older and socially isolated populations. Conventional clinic-based services may not adequately address early, ambiguous health concerns or facilitate low-threshold help-seeking. This technical report describes the implementation of a hybrid digital-physical health dialogue model designed to enhance accessibility, trust, and sustained engagement in a rural Japanese community. The intervention integrated an anonymous, free health consultation service delivered via the LINE messaging platform (LINE Corporation, Tokyo, Japan) with face-to-face dialogue sessions conducted at local community centers. Healthcare professionals and a community-based organization collaboratively facilitated both components. Rather than evaluating effectiveness, this report focuses on the implementation process and on observational insights from routine operations, including staff field notes, informal debriefings, and participant feedback. The digital consultation service served as a low-threshold entry point, enabling residents to raise health-related concerns early. Over time, some participants transitioned from online consultations to in-person dialogues, which may indicate gradual trust-building and increased confidence in engagement. Face-to-face sessions appeared to foster mutual recognition, peer support, and a shared understanding of community health concerns. Healthcare professionals reported enhanced contextual awareness of residents’ lived experiences. Key challenges included digital exclusion among some older adults, reliance on voluntary human resources, and the absence of formal outcome evaluation. The hybrid digital-physical health dialogue model demonstrates practical feasibility as an implementation approach to support accessible and relational health dialogue in a rural setting. While not an effectiveness study, the findings provide transferable insights for designing community-based, low-threshold health dialogue initiatives that balance accessibility, trust, and sustainability in resource-limited contexts.

Streptococcus dysgalactiae subsp. equisimilis (SDSE) has been increasingly recognized as a causative pathogen of skin and soft tissue infections and bacteremia, particularly in elderly individuals or those with underlying comorbidities. It typically presents with fever and localized pain associated with cellulitis; however, it may occasionally manifest with nonspecific symptoms, leading to diagnostic delay.We report the case of an 87-year-old man who presented with abdominal and lower back pain, initially suspected to have intestinal ischemia based on contrast-enhanced computed tomography findings and elevated serum lactate levels, but was later diagnosed with SDSE bacteremia following positive blood cultures and subsequent identification of cellulitis between the right third and fourth toes.After initiation of antimicrobial therapy with ampicillin/sulbactam and intravenous fluids, his fever and inflammatory response improved. Based on the clinical course, it was suggested that bacteremia-related circulatory disturbances and transient intestinal ischemia might have contributed to the nonspecific abdominal and back pain.This case highlights the importance of recognizing SDSE bacteremia as a potential etiology of atypical initial symptoms - such as abdominal or back pain - even before the development of overt skin lesions.

Trousseau syndrome is a well-recognized manifestation of cancer-associated hypercoagulability, characterized by recurrent or migratory thrombotic events. Although thrombotic complications have been reported in various malignancies, the clinical characteristics of Trousseau syndrome associated with prostate cancer remain poorly described. This study aimed to systematically review reported cases of prostate cancer-associated Trousseau syndrome and summarize their clinical features. A systematic literature search was conducted in PubMed, Embase, and Web of Science to identify relevant reports describing thrombotic events associated with prostate cancer. Full-text case reports and case series providing sufficient clinical details were included. Six cases met the inclusion criteria. The patients’ ages ranged from 55 to 87 years. Hypertension and dyslipidemia were the most commonly reported comorbidities. In half of the cases, thrombotic events preceded the diagnosis of prostate cancer. All cases with available staging information had stage IV disease, and reported Gleason scores ranged from 7 to 9. Thrombotic events occurred in diverse vascular territories and involved both the arterial and venous systems, including the carotid arteries, deep veins of the lower extremities, the thoracic aorta, retinal veins, and the internal jugular vein. Anticoagulation therapy, particularly intravenous heparin, was the most commonly reported treatment, although clinical outcomes varied among cases. These findings suggest that Trousseau syndrome associated with prostate cancer tends to occur in advanced disease and may occasionally represent the initial manifestation of malignancy; however, interpretation is limited by the small sample size and heterogeneity of reporting inherent to case-report-based evidence. Clinicians should consider underlying prostate cancer in patients presenting with unexplained thrombotic events, particularly in older men. Further studies are required to clarify the optimal management and prognostic implications of cancer-associated thrombosis in prostate cancer.

IntroductionParticipation is a central outcome in community-based rehabilitation, particularly in aging societies where social isolation among older adults is increasing. Community nurses have emerged as key facilitators of social participation in community settings. However, the mechanisms through which community nurses reconstruct participation in everyday practice remain insufficiently understood. This study aimed to clarify how community nurses reconstruct and facilitate participation in community-based rehabilitation.MethodsThis retrospective qualitative study analyzed activity logs and reflective practice records documented by three community nurses working in a rural Japanese community between January and December 2025. Thematic analysis following Braun and Clarke's framework was conducted. Participation episodes were identified and analyzed to examine how participation emerged and was facilitated in everyday community practice. Identified activities were also interpreted with reference to the participation concept of the International Classification of Functioning, Disability and Health (ICF).ResultsA total of 134 participation episodes were identified across multiple participation domains, including community life, recreation and leisure, interpersonal relationships, and digital communication. Four themes were identified: (1) creating participation-ready environments, (2) facilitating reciprocal roles and resident empowerment, (3) reconstructing participation through personal narratives and identity, and (4) bridging participation barriers through relational and structural support. Participation emerged as a relational and dynamic process embedded in everyday community interactions.ConclusionsCommunity nurses play a critical role in reconstructing participation in community-based rehabilitation by facilitating relational engagement, enabling meaningful social roles, and reducing participation barriers. These findings provide empirical insights into how participation can be operationalized in community practice and highlight the potential of participation-oriented approaches in aging societies.

Physical activity is recommended for breast cancer survivors to improve physical function, reduce treatment-related symptoms, and enhance quality of life. However, survivors living in rural areas often face barriers to participating in exercise programs due to geographic isolation, limited access to rehabilitation services, and fewer community resources. Although various exercise interventions have been developed for cancer survivors, evidence regarding their effectiveness and implementation in rural populations remains limited. This systematic review examined the effectiveness and feasibility of physical activity interventions for breast cancer survivors living in rural or non-urban settings. A systematic review was conducted in accordance with a predefined protocol. Electronic databases were searched to identify studies evaluating structured physical activity or rehabilitation programs for adult breast cancer survivors residing in rural areas. Eligible study designs included randomized controlled trials, quasi-experimental studies, and observational studies. Two reviewers independently screened studies, extracted data, and assessed methodological quality. Outcomes included physical function, physical activity levels, health-related quality of life, fatigue, adherence, and feasibility. Findings were synthesized narratively due to heterogeneity in study designs and outcome measures. Seven studies met the inclusion criteria. Interventions included telephone-based counseling, tele-exercise programs, lifestyle interventions, and community-based physical activity initiatives. Most studies reported improvements in physical activity participation, physical performance, lifestyle behaviors, or quality of life. Several interventions demonstrated measurable benefits, including increased physical activity levels and improvements in functional outcomes. Remote delivery approaches, such as telephone or telehealth programs, were frequently used to address geographic barriers. Risk-of-bias assessment indicated generally low to moderate methodological quality across the included studies. Physical activity interventions appear to be feasible and beneficial for breast cancer survivors living in rural areas. Remote and community-based delivery approaches may help overcome access barriers and support participation in exercise programs. Future research should explore sustainable, community-engaged models that promote long-term physical activity and improve quality of life among rural cancer survivors.

Rathke’s cleft cyst (RCC) is a benign pituitary lesion that is often asymptomatic but can cause hypopituitarism, including central adrenal insufficiency, which may become clinically apparent under physiological stress. However, RCC presenting with adrenal insufficiency unmasked by acute respiratory illness is rare, particularly in elderly patients. We report a case of RCC diagnosed after adrenal insufficiency became evident following pneumonia-associated asthma exacerbation. An 89-year-old woman presented with fever, productive cough, and generalized fatigue and was diagnosed with pneumonia-triggered asthma exacerbation. Initial laboratory evaluation revealed hyponatremia (serum sodium 126 mEq/L). She was treated with bronchodilators, systemic corticosteroids, and antibiotics, resulting in prompt improvement of respiratory symptoms and normalization of serum sodium levels. After discontinuation of corticosteroids and discharge, she developed persistent fatigue, anorexia, and right eyelid ptosis. Brain magnetic resonance imaging revealed a 22-mm cystic lesion in the pituitary gland consistent with RCC. Endocrine evaluation demonstrated markedly reduced adrenocorticotropic hormone and cortisol levels, along with central hypothyroidism, hypogonadism, and growth hormone deficiency, confirming panhypopituitarism with central adrenal insufficiency. Hydrocortisone replacement therapy was initiated, leading to clinical stabilization. Surgical intervention was deferred due to advanced age and absence of visual field defects, and the patient was managed conservatively with hormone replacement and follow-up imaging. This case highlights that acute respiratory illness may precipitate overt adrenal insufficiency in patients with previously unrecognized RCC. Transient improvement with corticosteroids during acute treatment may mask the underlying endocrine disorder, delaying diagnosis. Persistent fatigue, hyponatremia, or neurological findings after resolution of respiratory illness should prompt evaluation for central adrenal insufficiency and pituitary pathology, as early recognition and hormone replacement are essential to prevent life-threatening complications.

Liver abscess is a severe infection that can progress to septic shock. Although early fluid resuscitation is recommended in septic shock, patients with heart failure, particularly those with heart failure with preserved ejection fraction (HFpEF), are prone to fluid overload, making volume management challenging. In addition, hemodynamic instability may occur even after source control. We report the case of a 91-year-old man with a history of HFpEF who was transported to our hospital with fever and difficulty ambulating. He was diagnosed with septic shock secondary to a liver abscess caused by Escherichia coli. Initial resuscitation was performed with antibiotics, vasopressors, and approximately 6.5 L of intravenous fluid, followed by percutaneous drainage. Although his hemodynamic status temporarily improved, shock recurred after the drainage procedure. During hospitalization, he experienced multiple episodes of heart failure exacerbation associated with fluid shifts, requiring careful fluid management, including diuretics and respiratory support. His general condition subsequently improved, and he was successfully weaned from intensive care. This case suggests the importance of balancing adequate initial resuscitation with avoidance of fluid overload in septic shock complicated by HFpEF, and the potential for transient hemodynamic deterioration following source control. Individualized fluid management and close periprocedural monitoring are essential in such patients.

Iron deficiency anemia (IDA) is common in older adults, and gastrointestinal bleeding is an important cause that should be investigated. However, identifying the bleeding source can be challenging when upper and lower gastrointestinal endoscopy findings are negative. We report the case of a 90-year-old woman who presented with anorexia, general fatigue, and dizziness and was found to have severe IDA with a hemoglobin level of 3.9 g/dL. Upper and lower gastrointestinal endoscopy failed to identify the bleeding source. Although her anemia initially improved after blood transfusion and iron supplementation, it recurred, requiring readmission. Double-balloon enteroscopy (DBE) revealed a submucosal tumor with ulceration in the ileum, and surgical resection confirmed an ileal gastrointestinal stromal tumor (GIST). Retrospective review of contrast-enhanced computed tomography (CT) images also identified the corresponding small bowel lesion. This case highlights the importance of considering small bowel lesions in patients with recurrent IDA despite negative findings on upper and lower gastrointestinal endoscopy. It also highlights the value of retrospectively reviewing existing CT images, which may reveal overlooked lesions. Our findings suggest that additional evaluation of the small bowel should be considered in patients with recurrent IDA regardless of advanced age.

Acute exacerbation of interstitial lung disease (AE-ILD) is associated with high mortality and a poor prognosis. Particularly in the oldest-old population, comprehensive assessment, including factors contributing to delays in seeking medical care and decisions regarding treatment eligibility, is clinically important. A 92-year-old man, who had been independent in activities of daily living (ADLs), ambulated with a cane, and lived at home before admission, was treated for presumed pneumonia at a local clinic because of a cough. However, his symptoms did not improve, and he was referred to our hospital because of worsening dyspnea. Chest computed tomography (CT) revealed bilateral ground-glass opacities and pre-existing pulmonary fibrosis. He was clinically diagnosed with previously undiagnosed interstitial lung disease (ILD) complicated by bacterial pneumonia, and treatment with antibiotics and corticosteroids was initiated. His respiratory status initially improved; however, chest CT performed on hospital day 5 showed worsening bilateral ground-glass opacities. On hospital day 6, his respiratory status rapidly deteriorated, leading to a diagnosis of AE-ILD. Despite treatment with corticosteroid pulse therapy and cyclophosphamide, he ultimately died. In this case, the delay in seeking medical care may have been related not only to the patient’s awareness of his disease but also to healthcare system factors, including the timing of referral to our hospital and the availability of continuous follow-up. Although the patient was 92 years old, his pre-admission ADLs were preserved; therefore, aggressive treatment was selected based on his functional status rather than chronological age alone. Nevertheless, this case suggests that AE-ILD can follow a rapidly progressive and fatal course even in patients with preserved ADLs. In the management of AE-ILD in the oldest-old population, the factors underlying delays in seeking medical care should be assessed from both patient- and healthcare system-related perspectives. Furthermore, treatment eligibility should not be determined solely on the basis of chronological age; individualized care based on a comprehensive assessment of ADLs and the patient’s overall clinical background is essential.

Solid state electron spins have important practical advantages for quantum technologies, but fluctuations in their host material cause decoherence.