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Objectives Methods Results Conclusions To evaluate the safety, efficacy, and patient‐reported outcomes of Aquablation therapy using the AQUABEAM Robotic System for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) in a Japanese population.This post‐market use‐results survey included 103 Japanese men with BPH who underwent Aquablation across five centers with previously Aquablation naïve physicians. Data were collected at baseline, during the procedure, at discharge, and at 3 and 6 months post‐procedure. Key outcomes included International Prostate Symptom Score (IPSS), quality of life (QoL), uroflowmetry parameters, and adverse events.The mean age of patients was 71.1 years, and the average prostate size was 82.3 mL. At 6 months, the mean IPSS significantly improved from 18.1 ± 9.0 to 6.1 ± 5.0 (p < 0.0001), and QoL scores improved from 4.9 ± 1.3 to 1.8 ± 1.3 (p < 0.0001). Uroflowmetry showed a significant increase in Qmax from 8.3 ± 4.4 to 15.5 ± 7.8 mL/s (p < 0.0001) and a decrease in post‐void residual volume (PVR) from 85.6 ± 107.2 to 43.3 ± 60.0 mL (p = 0.0006). At the 30‐day primary safety endpoint, there were no reported adverse events of pad‐use incontinence, erectile dysfunction, or ejaculatory dysfunction reported, and no device‐related serious adverse events were reported. One subject (0.97%) experienced a Clavien–Dindo grade 3 adverse event.Aquablation therapy using the AQUABEAM Robotic System is a reproducible, safe, and effective treatment for Japanese men with BPH, providing significant improvements in LUTS and QoL with a favorable safety profile. [ABSTRACT FROM AUTHOR]

Cyclic adenosine monophosphate‐response element‐binding protein‐1‐regulated transcription coactivator‐1 (CRTC1), a cytoplasmic coactivator that translocates to the nucleus in response to cAMP, is associated with obesity. We previously reported that CRTC1 deficiency in melanocortin‐4 receptor (MC4R)‐expressing neurons, which regulate appetite and energy metabolism in the brain, causes hyperphagia and obesity under a high‐fat diet (HFD). HFD is preferred for mice, and the dietary fat in HFD is the main factor contributing to its palatability. These findings, along with our previous results, suggest that CRTC1 regulates the appetite for dietary fat. Therefore, in this study, we aimed to investigate the dietary fat intake behavior and energy metabolism of MC4R neuron‐specific CRTC1 knockout mice fed soybean oil or lard. CRTC1 deficiency increased the intake of soybean oil and significantly increased body weight gain. Furthermore, obesity induced by soybean oil intake was partially due to leptin resistance. No significant changes in soybean oil intake were observed between young CRTC1‐deficient and wild‐type mice; however, soybean oil intake increased with age. Moreover, lard intake did not significantly affect the body weight. Overall, our findings highlighted the crucial role of CRTC1 in the regulation of spontaneous dietary fat intake. Furthermore, the role of CRTC1 becomes increasingly significant with age. [ABSTRACT FROM AUTHOR]

Background: We aimed to examine the effectiveness of a nurse‐led, screening‐triggered early specialized palliative care intervention program for patients with advanced lung cancer. Methods: Patients with advanced lung cancer who underwent initial chemotherapy were randomized to intervention and usual care groups between January 2017 and September 2019. The intervention comprised comprehensive needs assessments, counseling, and service coordination by advanced‐level nurses. Patients in the usual care group received the usual oncological care. The primary end point was a change in the trial outcome index (TOI) scores from baseline to 12 weeks. The secondary end‐points were TOI scores at week 20, depression, anxiety, and survival. Results: In total, 102 patients were assigned to each group. Compared with the usual care group, no significant improvement in TOI scores was observed at 12 weeks in the intervention group (mean group difference: 2.13; 90% confidence interval: −0.70, 4.95; p = 0.107, one‐sided), whereas significant improvement was observed at 20 weeks (3.58; 90% confidence interval: 0.15, 7.00; p = 0.043). There were no significant differences in the change from baseline depression and anxiety between the groups from baseline at week 12 and 20 weeks (depression: p = 0.60 and 0.10, anxiety: p = 0.78 and 0.067). Survival did not significantly differ between the groups (median survival time: 12.1 vs. 11.1 months; p = 0.302). Conclusions: Nurse‐led, screening‐triggered, early specialized palliative care did not show significant superiority over usual care during the 12‐week study period. However, it may have yielded delayed clinical benefits, such as improved quality of life and this feasible model can be acceptable in clinical practice. Trial Registration: The University Hospital Medical Information Network Clinical Trials Registry: UMIN000025491 [ABSTRACT FROM AUTHOR]

Hepatic enzyme induction, an inherent defense system against xenobiotics, is known to simultaneously affect endocrine system functions in mammals under specific conditions, particularly thyroid hormone (TH) regulation. While this phenomenon has been studied extensively, the pathway leading to this indirect thyroid effect in mammals has unclear applicability to amphibians, despite the importance of amphibian species in assessing thyroid‐disruptive chemicals. Here, we investigated the effects of three well‐known mammalian enzyme inducers—β‐naphthoflavone (BNF), pregnenolone carbonitrile (PCN), and sodium phenobarbital (NaPB)—on the gene expression of phase‐I and phase‐II metabolizing enzymes in Xenopus laevis tadpoles. Waterborne exposure to BNF and PCN significantly induced the expression of both phase‐I (cytochrome P450, CYP) and phase‐II enzymes (UDP‐glucuronosyltransferase, UGT and sulfotransferase, SULT), but in different patterns, while NaPB exposure induced CYP2B expression without affecting phase‐II enzymes in tadpoles, in contrast to mammals. Furthermore, an ex vivo hepatic enzyme activity assay confirmed that BNF treatment significantly increased phase‐II metabolic activity (glucuronidation and sulfation) toward TH. These results suggest the potential for certain mammalian enzyme inducers to influence TH clearance in X. laevis tadpoles. Our findings provide insights into the profiles of xenosensing activity and enzyme induction in amphibians, which can facilitate a better understanding of the mechanisms of indirect effects on the thyroid system via hepatic enzyme induction in nonmammalian species. This study examined the effects of waterborne exposure to typical mammalian hepatic enzyme inducers—β‐naphthoflavone (BNF), pregnenolone carbonitrile (PCN), and sodium phenobarbital (NaPB)—on Xenopus laevis tadpoles. BNF and PCN significantly upregulated the gene expression of both phase‐I and phase‐II metabolizing enzymes in different patterns, while NaPB only induced CYP2B expression without affecting phase‐II enzymes, unlike in mammals. BNF also enhanced ex vivo phase‐II metabolic activity toward thyroid hormone (TH), suggesting hepatic enzyme induction may influence TH clearance in tadpoles. [ABSTRACT FROM AUTHOR]

Pharyngocutaneous fistula is a critical complication of head and neck cancer reconstruction and it is often difficult to manage. We herein report two cases of pharyngocutaneous fistulas that developed after oropharyngeal reconstruction and were successfully treated with negative pressure wound therapy with instillation and dwell time (NPWTi‐d), an advanced form of traditional NPWT. NPWTi‐d may be a useful nonsurgical treatment for pharyngocutaneous fistula. Laryngoscope, 134:4573–4576, 2024 [ABSTRACT FROM AUTHOR]

The consensus‐based TOKYO criteria were proposed as a standardized reporting system for endoscopic transpapillary biliary drainage. The primary objective was to address issues arising from the inconsistent reporting of stent outcomes across studies, which has complicated the comparability and interpretation of study results. However, the original TOKYO criteria were not readily applicable to recent modalities of endoscopic biliary drainage such as biliary drainage based on endoscopic ultrasound or device‐assisted endoscopy. There are increasing opportunities for managing hilar biliary obstruction and benign biliary strictures through endoscopic drainage. Biliary ablation has been introduced to manage benign and malignant biliary strictures. In addition, the prolonged survival times of cancer patients have increased the importance of evaluating overall outcomes during the period requiring endoscopic biliary drainage rather than solely focusing on the patency of the initial stent. Recognizing these unmet needs, a committee has been established within the Japan Gastroenterological Endoscopy Society to revise the TOKYO criteria for current clinical practice. The revised criteria propose not only common reporting items for endoscopic biliary drainage overall, but also items specific to various conditions and interventions. The term "stent‐demanding time" has been defined to encompass the entire duration of endoscopic biliary drainage, during which the overall stent‐related outcomes are evaluated. The revised TOKYO criteria 2024 are expected to facilitate the design and reporting of clinical studies, providing a goal‐oriented approach to the evaluation of endoscopic biliary drainage. [ABSTRACT FROM AUTHOR]

Background: A closed‐loop bedside‐type artificial pancreas for perioperative glucose control has previously been introduced. However, artificial pancreas therapy was often interrupted due to continuous blood sampling failure. We developed an interprofessional work manual to reduce the interruption time of artificial pancreatic therapy for perioperative blood glucose control due to continuous blood sampling failure. This study aimed to investigate the usefulness of this manual. Methods: The manual consisted of the following sections: (1) the roles of the professionals in the preparation and management of the artificial pancreas, (2) how to address continuous blood sampling failure, and (3) checkpoints for interprofessional transfer of the artificial pancreas. We compared the results before the introduction of the manual and 2 years after the introduction of the manual. Results: There were 35 and 37 patients in the Before and After groups, respectively. There were no significant differences in patient backgrounds between the two groups, although there was significantly less blood loss in the After group (1164 vs. 366 mL; p < 0.001). The mean artificial pancreas therapy and artificial pancreas therapy interruption times were 847 min and 20 min, respectively. Artificial pancreas therapy interruption time (34 vs. 8 min; p = 0.078) and time per interruption (24 vs. 4 min; p < 0.001) were significantly shorter in the After group than in the Before group. Conclusions: The interprofessional working manual was useful in reducing the artificial pancreatic therapy interruption time for perioperative glucose control. [ABSTRACT FROM AUTHOR]

Carbonate‐electrolyte‐based lithium–sulfur (Li–S) batteries with solid‐phase conversion offer promising safety and scalability, but their reversible capacities are limited. In addition, large‐format pouch cells are paving the way for large‐scale production. This study demonstrates the in situ formation of a solid‐electrolyte interphase (SEI) as a protective layer using vinylene carbonate (VC), highlighting its industrial adaptability. A high reversible capacity is achieved by the lithiated poly‐VC SEI formed inside the cathode particles as a nanoscale ionic conduction path, along with the traditional surface protective layer. Furthermore, the severe dissolution of poly‐VC is mitigated by LiF derived from fluorine ethylene carbonate as a co‐solvent, enabling high rate performance and a long cycle life. A large 8 Ah pouch cell is successfully developed, which shows a high energy density of 400 Wh kg−1 based on the cell weight. This work demonstrates the high performance of large‐scale Li–S batteries with the in situ formation of a protective layer as a scalable technique for future applications. [ABSTRACT FROM AUTHOR]

Background and Aim: Sodium picosulfate plus magnesium citrate (SP + MC) is a well‐tolerated bowel preparation agent. However, Japan currently approves only two methods of taking SP + MC: the day‐before and split‐dose preparation, without approval of same‐day preparations. This study aimed to evaluate the efficacy and safety of same‐day SP + MC preparations. Methods: This was a multicenter, single‐arm, nonrandomized, open‐label study. We enrolled 145 Japanese patients between June and December 2023. The patients received two sachets of SP + MC dissolved in 300 ml of water and 1200 mL or more of clear liquid on the day of colonoscopy. Bowel cleansing efficacy, adverse events (AEs), and patient satisfaction were evaluated. Results: Of the enrolled patients, 137 underwent colonoscopy according to our protocol. Bowel preparation was adequate in 133 patients (97.1%). The mean total Boston Bowel Preparation Score was 8.3 ± 1.2. Five patients experienced AEs (3.6%): two (1.5%), abdominal pain; one (0.73%), ischemic enteritis; one (0.73%), vomiting or nausea; and one (0.73%), headache. All AEs were treated conservatively. None of the patients exhibited abnormal blood test results or clinical symptoms after receiving SP + MC. Regarding patient satisfaction, all patients were able to take SP + MC as directed; 136 (99.2%) expressed a preference for this bowel preparation for future colonoscopies. Conclusion: The same‐day SP + MC preparation showed high bowel‐cleansing efficacy and satisfaction in Japanese patients without serious AEs. [ABSTRACT FROM AUTHOR]

Aims: The adverse effects of low daily protein intake (DPI) on clinical outcomes in patients with heart failure (HF) are known; however, an optimal DPI to predict event adverse outcomes remains undetermined. Moreover, whether protein restriction therapy for chronic kidney disease is applicable in patients with HF and renal dysfunction remains unclear. Methods and results: In this single‐centre, ambispective cohort study, we included 405 patients with HF aged ≥65 years (mean age, 78.6 ± 7.5 years; 50% women). DPI was estimated from consumption over three consecutive days before discharge and normalized relative to the ideal body weight [IBW, 22 kg/m2 × height (m)2]. The primary outcome was a composite of all‐cause mortality and HF‐related readmission within the 2 year post‐discharge period. Results: During an average follow‐up period of 1.49 ± 0.74 years, 100 patients experienced composite events. Kaplan–Meier survival curves revealed a significantly lower composite event‐free rate in patients within the lowest quartile of DPI than in the upper quartiles (log‐rank test, P = 0.02). A multivariate Cox proportional hazards analysis after adjusting for established prognostic markers and non‐proteogenic energy intake revealed that patients in the lowest DPI quartile faced a two‐fold higher risk of composite events than those in the highest quartile [hazard ratio (HR), 2.03; 95% confidence interval (CI), 1.08–3.82; P = 0.03]. The composite event risk linearly increased as DPI decreased (P for nonlinearity = 0.90), with each standard deviation (0.26 g/kg IBW/day) decrease in DPI associated with a 32% increase in composite event risk (HR, 1.32; 95% CI, 1.10–1.71; P = 0.04). There was significant heterogeneity in the effect of DPI, with the possible disadvantage of lower DPI in patients with HF with cystatin C‐based estimated glomerular filtration rate <30 mL/min/1.73 m2. The cutoff value of DPI for predicting the occurrence of composite events calculated from the Youden index was 1.12 g/kg IBW/day. Incorporating a DPI < 1.12 g/kg IBW/day into the baseline model significantly improved the prediction of post‐discharge composite events (continuous net reclassification improvement, 0.294; 95% CI, 0.072–0.516; P = 0.01). Conclusions: Lower DPI during hospitalization is associated with an increased risk of mortality and HF readmission independent of non‐proteogenic energy intake, and the possible optimal DPI for predicting adverse clinical outcomes is >1.12 g/kg IBW/day in older patients with HF. Caution is warranted when protein restriction therapy is administered to older patients with HF and renal dysfunction. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the outcomes and complications of secondary hepatolithiasis following choledochoenterostomy to guide suitable management. Methods: The study analyzed 127 patients from a 2017 national survey conducted by the Ministry of Health, Labor, and Welfare. The 2023 cohort study assessed residual stones, recurrences, cholangitis, cholangiocarcinoma, and prognosis. Results: The median follow‐up duration was 48 months. Balloon endoscopy‐assisted endoscopic retrograde cholangiography (BE‐ERC) was the most common treatment, achieving complete stone clearance in 84.4% of patients. Anatomical hepatectomy was the most common surgery. Predictors of residual stones were stone number ≥10 (odds ratio [OR], 7.480; p =.028) and stone diameter ≥10 mm (OR, 5.280; p =.020). Predictors of stone recurrence during follow‐up were biliary strictures (hazard ratio [HR], 3.580; p =.005) and cholangitis (HR, 2.700; p =.037). Predictors of cholangitis during follow‐up were biliary stricture (HR, 5.016; p =.006) and dilatation (HR, 3.560; p =.029). Any treatment for hepatolithiasis reduced cholangitis occurrence (HR, 0.168; p =.042). Balloon dilation combined with stenting for ≥3 months improved biliary strictures in 57.1% of patients. Conclusion: This study recommends BE‐ERC as the first‐choice treatment for secondary hepatolithiasis. Stone removal and relief of biliary strictures and dilatation are crucial to prevent stone recurrence and cholangitis after treatment. [ABSTRACT FROM AUTHOR]

Introduction: Comprehensive genome profiling (CGP) has revolutionized healthcare by offering personalized medicine opportunities. However, its real‐world utility and impact remain incompletely understood. This study examined the extent to which CGP leads to genomically matched therapy and its effectiveness. Methods: We analyzed data from advanced solid tumor patients who underwent CGP panel between December 2019 and May 2023 at the Osaka International Cancer Institute. Patient demographics, specimen details, and expert panel assessments were collected. Turnaround time (TAT) and genomically matched therapy outcomes were analyzed. Gene alterations and their co‐occurrence patterns were also assessed. Results: Among 1437 patients, 1096 results were available for analysis. The median TAT was 63 [28–182] days. There were 667 (60.9%) cases wherein recommended clinical trials were presented and there were 12 (1.1%) cases that could be enrolled in the trial and 25 (2.3%) cases that could lead to therapies under insurance reimbursement. The median progression free survival of the trial treatment was 1.58 months (95% CI: 0.66–4.37) in clinical trials and 3.66 months (95% CI: 2.14–7.13) in treatment under insurance. Pathologic germline variants were confirmed in 15 patients (1.3%). Co‐alteration of CDKN2A, CDKN2B, and MTAP was significantly observed in overall population. Conclusion: The effectiveness of the genomically matched therapy based on the CGP panel was unsatisfactory. Expansion of clinical trials and utilization of remote clinical trials are required to ensure that the results of the CGP panel can be fully returned to patients. [ABSTRACT FROM AUTHOR]

The article discusses a study comparing the HEART score's application in prehospital and in-hospital settings for patients with chest pain suspected to be myocardial infarction. Topics include the reliability of the HEART score in prehospital care, the agreement between prehospital and in-hospital assessments, and the study's findings on the accuracy and discrimination of the HEART score for major adverse cardiac events (MACE).

Background: Patients with isolated IgG4‐related sclerosing cholangitis (IgG4‐SC) often undergo unnecessary resection. The aim of this study was to validate the revised Japanese diagnostic criteria for isolated IgG‐4‐SC and to improve awareness about this condition in the population. Methods: This was a Japanese retrospective multicenter study. We focused on the data and diagnostic yield obtained using the Japanese diagnostic criteria published initially in 2012 and revised later in 2020 for the diagnosis of isolated IgG4‐SC. Results: Patients with isolated IgG4‐SC could be classified into two groups based on the primary location of the lesion: the hilar type (n = 40) and the extrahepatic type (n = 13). In total, 10 patients with the hilar type had undergone unnecessary resection. The revised 2020 criteria are useful for the diagnosis of extrahepatic lesions, which are not included in the 2012 criteria. The need for a steroid trial was reduced from 37.7% when the diagnosis was based on the 2012 criteria to 7.6% when the diagnosis was based on the revised 2020 criteria. The diagnostic specificity also improved from 58.5% for the 2012 criteria to 88.7% for the revised 2020 criteria. Conclusion: Our validation of the 2020 criteria for the diagnosis of IgG4‐SC could contribute to avoiding unnecessary resection in patients with isolated IgG4‐SC, which can be classified into the hilar and extrahepatic types. The 2020 criteria can enhance the diagnosis rate of isolated IgG4‐SC and uncover this tough‐to‐diagnose entity based on inclusion of the imaging findings and decrease the dependence on a steroid trial. [ABSTRACT FROM AUTHOR]

Aims. The purpose of the present study was to investigate the influence of reborn soup on the perceptions of saltiness and palatability. Methods. Subjects comprised 103 staff working at Kokura Daiichi Hospital (22 males, 81 females, and mean age: 35 ± 12 years old). They tested soups (commercially available soup with 0.9% NaCl solutions (A), commercially available soup with 0.6% NaCl solutions (B), and reborn soup diluted to 0.6% NaCl solutions (C)). Evaluations of saltiness and palatability for each solution were conducted using a visual analog scale in a double‐blinded randomized manner. We estimated 24‐hour salt excretion using spot urine samples to estimate salt intake and also assessed blood pressure, the awareness of salt intake using a self‐description questionnaire score, and other confounding factors including lifestyle factors. Results. In all subjects, the average estimated salt intake was 9.0 ± 2.0 g/day, and the rates at which subjects met the established salt intake targets were 15.1% in 73 females without hypertension (<6.5 g/day), 23.5% in 17 males without hypertension (<7.5 g/day), and 0.0% in 13 subjects with hypertension (<6.0 g/day). In both saltiness and palatability, B scored significantly lower than A, but C scored significantly higher than B. Salt intake levels were categorized into tertiles (Q1, lowest; Q3, highest). C scored significantly higher for palatability in the Q1 group than in the Q3 group. Conclusions. Most participants exceeded the established targets of salt intake. The high‐salt‐intake group might be able to feel less palatable. Our results indicate that reborn soup may be effective in reducing salt intake without loss of palatability. [ABSTRACT FROM AUTHOR]

Angiogenesis is considered essential for tumor progression; however, whether histological counting of blood vessel numbers, expressed as microvessel density (MVD), can be a prognostic factor in breast cancer remains controversial. It has been suggested that the specific morphology of blood vessels such as glomeruloid microvascular proliferation (GMP) is associated with clinical parameters. Here, we aimed to clarify the significance of MVD with revised immunohistochemistry and to identify new blood vessel shapes that predict prognosis in breast cancer. Four hundred and eleven primary breast cancer specimens were collected, and the sections were immunohistochemically stained with CD31 (single staining) and CD31 and Collagen IV (double staining). The prognosis of patients was examined based on the MVD value, and the presence of GMP and other blood vessels with other specific shapes. As a result, high MVD value and the presence of GMP were not associated with worse prognosis. By contrast, patients with deep‐curved capillaries surrounding tumor cell nests (C‐shaped) or excessively branched capillaries near tumor cell nests showed a significantly poor prognosis. The presence of these capillaries was also correlated with clinicopathological parameters such as Ki‐67 index. Thus, the morphology of capillaries rather than MVD can be a better indicator of tumor aggressiveness. [ABSTRACT FROM AUTHOR]

Background and Aim: Changes in the number of surgeries for gastric cancer during the coronavirus disease 2019 (COVID‐19) pandemic have been reported, but data are insufficient to understand the impact at the national level. This study aimed to determine the impact of the COVID‐19 pandemic on gastric surgery in Japan. Methods: Insurance claims data registered from January 2015 to January 2021 were used. Changes in the number of endoscopic resections and gastrectomies for gastric cancer were estimated using an interrupted time‐series analysis. Results: The number of endoscopic resections significantly decreased in July 2020 (−1565; 95% confidence interval [CI]: −2022, −1108) and January 2021 (−539; 95% CI: −970, −109), and the number of laparoscopic surgeries significantly decreased in July 2020 (−795; 95% CI: −1097, −492), October 2020 (−313; 95% CI: −606, −19), and January 2021 (−507; 95% CI: −935, −78). Meanwhile, the number of open gastrectomies remained unchanged, and the number of robot‐assisted gastrectomies steadily increased since their coverage by public health insurance in April 2018. Conclusions: The decreased number of endoscopic resections and laparoscopic surgeries in Japan suggests a decline in early‐stage gastric cancer diagnosis, likely due to the suspension of gastric cancer screening and diagnostic testing during the pandemic. Meanwhile, the number of open and robot‐assisted gastrectomies remained unchanged and increased, respectively, indicating that these applications were not affected by the pandemic‐related medical crisis. These findings highlight that procedures for cancer diagnosis, including screening, should still be provided during pandemics. [ABSTRACT FROM AUTHOR]

Midinfrared photonic devices are used as lasers and photodetectors in optical gas sensors and fiber‐optic communications. Herein, the pair number dependence and strain compensation dependence of the InAsSb/InAsP superlattice structure to increase luminescence intensity and reduce crystal defects is investigated. InAs substrates are used to demonstrate various effects of strain compensation, including its role in increasing luminescence intensity and improving the surface flatness. Furthermore, the photoluminescence spectra of a grown superlattice between the InAs substrate and GaAs substrate with two‐temperature‐step growth are shown. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate perioperative complications and the details of postoperative ureteral stricture after ureteroscopy with laser lithotripsy (URS‐L) for upper urinary tract stones in Japan. Methods: Patient data on intra‐ and postoperative complications after ureteroscopy using URS‐L were retrospectively collected from multiple centers in Japan between April 2017 and March 2020 with the cooperation of the Japanese Society of Endourology and Robotics. Data included the number of patients undergoing URS‐L, number and type of intra‐ and postoperative complications, and detailed characteristics of postoperative ureteral stricture. Results: In total, 14 125 patients underwent URS‐L over 3 years at 82 institutions. Annual URS‐L numbers gradually increased from 4419 in 2017, to 4760 in 2018, and 4946 in 2019. The total complication rate was 10.5%, which was divided into intra‐operative complications in 1.40% and postoperative complications in 9.18%. The annual incidences of intra‐ and postoperative complications were not significantly different from year to year (p = 0.314 and p = 0.112). Ureteral perforation, ureteral avulsion, and the intra‐operative conversion rate were 1.35%, 0.03%, and 0.02%, respectively. Fever >38°C, septic shock, blood transfusion, and postoperative mortality were 7.44%, 0.81%, 0.07%, and 0.04%, respectively. Ureteral stricture occurred in 0.8% of cases. The median length of stricture site was 10.0 mm and the success rate of stricture treatment was 54.6%. Conclusion: Although URS‐L utilization has increased in Japan, the annual complication rate has remained steady. Although URS‐L is a useful and less invasive procedure, devastating complications can still occur. [ABSTRACT FROM AUTHOR]

Objectives: For preoperative biliary drainage (PBD) of malignant hilar biliary obstruction (MHBO), current guidelines recommend endoscopic nasobiliary drainage (ENBD) due to the higher risk of cholangitis after endoscopic biliary stenting (EBS) during the waiting period before surgery. However, few studies have supported this finding. Therefore, we aimed to compare the outcomes of preoperative ENBD and EBS in patients with MHBO. Methods: Patients with MHBO who underwent laparotomy for radical surgery after ENBD or EBS were included from retrospectively collected data from 13 centers (January 2014 to December 2018). We performed a 1:1 propensity score matching between the ENBD and EBS groups. These patients were compared for the following: cholangitis and all adverse events (AEs) after endoscopic biliary drainage (EBD) until surgery, time to cholangitis development after EBD, postsurgical AEs, and in‐hospital death after surgery. Results: Of the 414 patients identified, 355 were analyzed in this study (226 for ENBD and 129 for EBS). The matched cohort included 63 patients from each group. The proportion of cholangitis after EBD was similar between the two groups (20.6% vs. 25.4%, P = 0.67), and no significant difference was observed in the time to cholangitis development. The proportions of surgical site infections, bile leaks, and in‐hospital mortality rates were similar between the groups. Conclusion: For PBD of MHBO, the proportion of AEs, including cholangitis, after EBD until surgery was similar when either ENBD or EBS was used. [ABSTRACT FROM AUTHOR]

Immune checkpoint inhibitors (ICIs) bring prognostic benefits to patients with malignancies. However, there is a substantial number of patients whose lesions are not improved by ICIs. In addition, ICIs may cause immune‐related adverse events (irAEs), which could lead to an unfavorable prognosis with fatal consequences. Therefore, we conducted a retrospective study to evaluate the utility of circulating sPD‐L1 (soluble programmed cell death 1 ligand 1) as a biomarker in patients with advanced melanoma treated with anti–PD‐1 (programmed cell death 1 protein) antibodies. Sera from 31 consecutive patients were prospectively collected before and after anti–PD‐1 antibody treatment and the serum level of sPD‐L1 was evaluated. We found that high sPD‐L1 levels before treatment were associated with better prognosis, and this association was observed only in patients with a low tumor burden. We also found that sPD‐L1 levels were elevated in patients who developed severe irAEs after treatment, and the patients with severe irAEs had significantly higher fluctuations in sPD‐L1 (delta sPD‐L1) than those without severe irAEs. Our study suggests that serum sPD‐L1 level is a useful biomarker to predict tumor response and irAE development in patients with advanced melanoma treated with anti–PD‐1 antibodies. [ABSTRACT FROM AUTHOR]

Objective: Interferon‐λ3 (IFNλ3) is a cytokine with antiviral functions on barrier surfaces, and it is associated with disease activity in autoimmune diseases. This study assessed the clinical significance of serum IFNλ3 levels in polymyositis/dermatomyositis (PM/DM)–associated interstitial lung disease (ILD). Methods: We measured serum IFNλ3 levels in 221 patients with PM/DM‐ILD (155 in the derivation cohort, 66 in the validation cohort) and 38 controls. We evaluated factors associated with mortality risk among 79 patients with anti‐melanoma differentiation–associated gene 5 (MDA5) antibody–positive DM‐ILD. Results: Serum IFNλ3 levels at diagnosis were significantly higher in patients with PM/DM‐ILD than in healthy controls. Remarkably, serum IFNλ3 levels were specifically increased in patients with anti‐MDA5 antibody–positive DM‐ILD in both the derivation and validation cohorts. In anti‐MDA5 antibody–positive DM‐ILD, patients with high IFNλ3 levels (>120 pg/mL) had significantly lower survival rates than those with low IFNλ3 levels (≤120 pg/mL). A multivariate analysis revealed that high IFNλ3 levels, as well as old age and low Pao2, were significantly associated with poor prognoses in patients with anti‐MDA5 antibody–positive DM‐ILD. In a classification analysis of patients with anti‐MDA5 antibody–positive DM‐ILD based on age, IFNλ3 level, and Pao2, patients with old age (>53 years), high IFNλ3 levels (>120 pg/mL), and low Pao2 (<75 mm Hg) had the worst survival. In lung pathologic analyses, IFNλ3‐positive staining was observed in macrophages, airway epithelial cells, the pleural region, and intrapulmonary veins in patients with anti‐MDA5 antibody–positive DM‐ILD. Conclusion: Serum IFNλ3 is a promising biomarker for identifying patients at high risk of poor outcomes in anti‐MDA5 antibody–positive DM‐ILD. [ABSTRACT FROM AUTHOR]

Phototropin (phot) is a blue light (BL) receptor and thermosensor that mediates chloroplast movements in plants. Liverworts, as early‐diverging plant species, have a single copy of PHOT gene, and the phot protein in each liverwort activates the signaling pathway adapted to its specific growing environment. In this study, we functionally compared phot from two different liverworts species: Apopellia endiviifolia (Aephot) and Marchantia polymorpha (Mpphot). The BL‐dependent photochemical activity of Aephot was similar to that of Mpphot, whereas the thermochemical activity of Aephot was lower than that of Mpphot. Therefore, the phot‐mediated signaling pathways of the two plant species may differ more in response to temperature than to BL. Furthermore, we analyzed the functional compatibility of Aephot and Mpphot in chloroplast movements by transiently expressing AePHOT or MpPHOT. The transient expression of AePHOT did not mediate chloroplast movement in M. polymorpha, showing the incompatibility of Aephot with the signaling pathway of M. polymorpha. By contrast, the transient expression of MpPHOT mediated chloroplast movement in A. endiviifolia, indicating the compatibility of Mpphot with the signaling pathway of A. endiviifolia. Our findings reveal both functional similarities and differences between Aephot and Mpphot proteins from the closely related liverworts. [ABSTRACT FROM AUTHOR]

Objectives: No comprehensive study has examined short‐ and long‐term adverse outcomes of endoscopic ultrasound (EUS)‐guided treatment of pancreatic fluid collections (PFCs) including walled‐off necrosis (WON) and pseudocysts. Methods: In a multi‐institutional cohort of 357 patients receiving EUS‐guided treatment of PFCs (228 with WON and 129 with pseudocysts), we examined PFC type‐specific risk factors for procedure‐related adverse events (AEs), clinical failure, and recurrence. Odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were computed using the logistic and Cox regression models, respectively, adjusting for potential confounders. Results: Adverse events were observed predominantly in WON, and risk factors were WON extension to the pelvis (OR 2.49; 95% CI 1.00–6.19) and endoscopic necrosectomy (OR 5.15; 95% CI 1.61–16.5). Risk factors for clinical failure in WON treatment included higher Charlson Comorbidity Index (OR for ≥3 vs. ≤2, 2.58; 95% CI 1.05–6.35), extension to the pelvis (OR 3.63; 95% CI 1.57–8.43), nonuse of a lumen‐apposing metal stent (OR 2.88; 95% CI 1.10–7.54), and percutaneous drainage (OR 3.73; 95% CI 1.27–10.9). Patients with pseudocysts extending to the paracolic gutter and the need for more than two endoscopic/percutaneous procedures had ORs for clinical failure of 5.28 (95% CI 1.10–25.3) and 5.52 (95% CI 1.61–18.9), respectively. Pseudocysts requiring the multigateway approach were associated with a high risk of recurrence (HR 4.00; 95% CI 1.11–11.6). Conclusion: The adverse outcomes at various phases of EUS‐guided PFC treatment may be predictable based on clinical parameters. Further research is warranted to optimize treatment strategies for high‐risk patients. [ABSTRACT FROM AUTHOR]

Pembrolizumab demonstrated an acceptable safety profile and promising antitumor activity in Japanese patients with advanced melanoma in the phase 1b KEYNOTE‐041 (Study of Pembrolizumab [MK‐3475] in Participants With Advanced Melanoma) trial. To evaluate the long‐term efficacy and safety of pembrolizumab in Japanese patients with advanced melanoma in KEYNOTE‐041. The current analysis reports results of additional follow‐up of approximately 12 months since the initial analysis. Eligible patients had locally advanced (unresectable stage III) or metastatic (stage IV) melanoma not amenable to local therapy and had received two or fewer prior systemic therapies. Pembrolizumab 2 mg/kg was given every 3 weeks for up to 2 years or until confirmed progression or unacceptable toxicity. Primary end points included safety, tolerability, and overall response rate (ORR) per Response Evaluation Criteria in Solid Tumors version 1.1 by independent central review. The data cutoff for this analysis was August 30, 2017. Forty‐two patients were followed up for a median of 22.3 months (range, 2.63–30.82 months). The ORR was 24.3% (nine of 37 evaluable patients [95% confidence interval (CI), 11.8%–41.2%]). Two patients with partial response at the time of the initial analysis achieved complete response. The median overall survival (OS) was 25.1 months (95% CI, 13.1–not reached] and the 30‐month OS rate was 46.3% (95% CI, 29.8%–61.3%). The median duration of response was not reached. Treatment‐related adverse events (TRAEs) were reported in 78.6% of patients; the incidence of grade 3 to 5 TRAEs was 23.8%. No additional treatment‐related deaths occurred since the initial analysis. Pembrolizumab provided durable antitumor activity and an acceptable safety profile in Japanese patients with advanced melanoma. [ABSTRACT FROM AUTHOR]

Advanced gastric and gastroesophageal junction cancers (GC/GEJCs) harbor diverse molecular signatures, highlighting the need for intricate evaluations to identify potential therapeutic targets. Although whole‐transcriptome sequencing (WTS) has emerged as a useful tool for understanding these molecular intricacies, its clinical implications have yet to be fully elucidated. This study evaluated the correlation between immunohistochemistry (IHC) and WTS, compared their clinical significance, and identified potential therapeutic targets undetectable through IHC alone. We enrolled 140 patients with advanced GC/GEJC and assessed them using IHC for six pivotal biomarkers: claudin‐18 (CLDN18), human epidermal growth factor receptor 2 (HER2), multiple receptor tyrosine kinases (RTKs), and programmed death ligand 1 (PD‐L1). Concurrently, WTS was employed as part of the analyses in MONSTAR‐SCREEN‐2, a multicenter multiomics study. IHC analysis revealed 16.4% HER2, 39.3% CLDN18 (2+/3 + ≥75%), and 15.8% PD‐L1 (combined positive score ≥ 10) positivity, among other molecular markers. Significant correlations were observed between IHC and WTS for all six pivotal biomarkers. Among nineteen HER2 IHC‐positive patients treated with anti‐HER2 therapeutics, ERBB2 status in WTS was significantly associated with progression‐free survival (ERBB2‐high vs. ‐low: median 9.0 vs. 5.6 months, log‐rank p = 0.046). IHC‐based molecular profiling revealed significantly high expression of CLDN18 in RTK‐negative patients, with 78.4% positive for either CLDN18 or PD‐L1. Additionally, WTS revealed elevated expression of pivotal biomarkers in patients displaying negative targetable biomarkers via IHC. Our findings highlighted the significant correlation between IHC and WTS, reinforcing the clinical utility of WTS. A subset with IHC‐negative but WTS‐positive status may benefit from specific biomarker‐targeted therapies. [ABSTRACT FROM AUTHOR]

Prostatitis is a major urological disease affecting 25%–50% of men over their lifetime. However, prostatitis is often overlooked in nonurologic departments due to its sometimes indeterminate symptoms. In this review, we describe how to recognize and treat acute bacterial prostatitis, which manifests as a clinical problem in other departments as well as urology, to help prevent this disease from being overlooked. There are several possible negative effects of not recognizing acute bacterial prostatitis (ABP). First, initial treatment can fail. In the hyperacute phase, common antibiotics are often effective, but in rare cases, such antibiotics may not be effective. In addition, once ABP progresses to form a prostate abscess, potentially avoidable surgical interventions are often needed. A second issue is the transition to chronic prostatitis. If chronic bacterial prostatitis progresses, treatment requires long‐term antibiotic administration and the response rate is not high. Some patients may have to deal with urinary tract infections for the rest of their lives. Finally, there is the problem of overlooking the underlying disease. ABP is rare in healthy adult men without underlying disease, including sexually transmitted diseases as well as benign prostatic hyperplasia, urinary stones, and malignant tumors, and may not be obvious. When examining patients with fever of unknown origin, it is necessary to exclude not only infectious diseases but also collagen diseases and malignant tumors. If there are any doubts, we recommend a rectal exam and consultation with a urologist. [ABSTRACT FROM AUTHOR]

Background. Gestational diabetes insipidus (DI) is a very rare complication of pregnancy. We present a case of gestational DI combining two different types of DI. Case Presentation. A 39-year-old pregnant woman suddenly presented with thirst, polydipsia, and polyuria after 31 gestation weeks (GWs). Based on laboratory findings of hypotonic urine (78 mOsm/kgH2O) with higher plasma osmolality (298 mOsm/kgH2O) and higher serum sodium levels (149 mEq/L), gestational DI was suspected, and the clinical course was monitored without therapy until the results of a measurement of plasma arginine vasopressin (AVP) levels were available. However, she subsequently developed acute prerenal failure and underwent an emergency cesarean section at 34 GWs. Her resected placenta weighed 920 g, nearly twice the normal weight. Immediately following delivery, intranasal 1-desamino-8-D-arginine vasopressin was administered, and her symptoms promptly disappeared. Afterward, her predelivery plasma AVP level was found to have been inappropriately low (0.7 pg/mL) given her serum sodium level. The patient's serum vasopressinase level just before delivery was 2,855 ng/mL, more than 1,000 times the upper limit of the normal range, suggesting excess vasopressinase-induced DI. The presence of anti-rabphilin-3A antibodies in the patient's blood, a hypertonic saline infusion test result, and loss of the high-intensity signal of the posterior pituitary on fat-suppressed T1-weighted magnetic resonance images without thickening of the stalk and enlargement of the neurohypophysis suggested concurrent central DI-like lymphocytic infundibulo-neurohypophysitis (LINH). Conclusion. In addition to the degradation of AVP by excess placental vasopressinase due to the enlarged placenta, an insufficient compensatory increase in AVP secretion from the posterior pituitary gland due to LINH-like pathogenesis might have led to DI symptoms. [ABSTRACT FROM AUTHOR]

Objective: Somapacitan is a long‐acting growth hormone (GH) derivative developed for the treatment of GH deficiency (GHD). This study evaluates the efficacy and tolerability of somapacitan in Japanese children with GHD after 104 weeks of treatment and after switch from daily GH. Design: Subanalysis on Japanese patients from a randomised, open‐labelled, controlled parallel‐group phase 3 trial (REAL4, NCT03811535). Patients and Measurements: Thirty treatment‐naïve patients were randomised 2:1 to somapacitan (0.16 mg/kg/week) or daily GH (0.034 mg/kg/day) up to Week 52, after which all patients received somapacitan. Height velocity (HV; cm/year) at Weeks 52 and 104 were the primary measurements. Additional assessments included HV SD score (SDS), height SDS, bone age, insulin‐like growth factor‐I (IGF‐I) SDS, and observer‐reported outcomes. Results: At Week 52, observed mean HV was similar between treatment groups (10.3 vs. 9.8 cm/year for somapacitan and daily GH, respectively). Similar HVs between groups were also observed at Week 104: 7.4 cm/year after continuous somapacitan treatment (soma/soma) and 7.9 cm/year after 1‐year somapacitan treatment following switch from daily GH (switch). Other height‐related endpoints supported continuous growth. IGF‐I SDS increased in both groups with mean IGF‐I SDS within −2 and +2 during the study. Somapacitan was well tolerated, one mild injection site reaction was reported, with no reports of injection site pain. Patient preference questionnaires showed that most patients and their caregivers (90.9%) who switched treatment at Week 52 preferred once‐weekly somapacitan over daily GH treatment. Conclusions: Somapacitan showed sustained efficacy in Japanese children with GHD over 104 weeks and for 52 weeks after switching from daily GH. Somapacitan was well tolerated and preferred over daily GH. [ABSTRACT FROM AUTHOR]

Questions: Agricultural expansion is one of the dominant drivers of forest and biodiversity loss, and shifting cultivation is the most widely used form of agriculture in many tropical forest regions. Where forests have been cleared, they have the potential to recover once the land is abandoned. However, legacies of land use are often overlooked in successional studies, and a deeper understanding of this legacy effect is needed to define efficient restoration practices using natural or assisted regeneration. Here, we analysed how land‐use history affects soil properties and early succession on abandoned agricultural fields in two contrasting Mexican socio‐ecological systems. Location: Mexico, Oaxaca and Chiapas. Methods: We sampled soil and monitored vegetation for 2 years after agricultural abandonment, and interviewed landowners about their land‐use practices. Results: Land‐use practices were clearly influenced by landowners' social context (residence time, rural or urban origin), and topography and soil type also constrained or facilitated land‐use practices. Soil characteristics were strongly affected by three land‐use practices: mechanical tillage decreased soil N and K; frequent herbicide and pesticide use increased N and K; and for pasture systems, stocking density increased soil bulk density and decreased pH and N. High‐intensity land management practices, specifically use of machinery, had the highest impact on early forest succession. When machinery was not used, the frequency of land‐use practices, particularly weeding frequency, is the main factor influencing tree cover and sapling diversity. Conclusions: To facilitate post‐agricultural forest recovery, we recommend restoration efforts using natural regeneration in areas with low previous land‐use intensity and frequency. [ABSTRACT FROM AUTHOR]

Background: Benralizumab is an anti‐interleukin‐5 receptor α monoclonal antibody approved as an add‐on maintenance treatment for patients with uncontrolled severe asthma. Prior Phase 3 studies have evaluated benralizumab in patients aged ≥12 years with severe uncontrolled asthma. The TATE study evaluated the pharmacokinetics (PK), pharmacodynamics (PD), and safety of benralizumab treatment in children. Methods: TATE was an open‐label, Phase 3 study of benralizumab in children aged 6–11 years from the United States and Japan (plus participants aged 12–14 years from Japan) with severe eosinophilic asthma. Participants received benralizumab 10/30 mg according to weight (<35/≥35 kg). Primary endpoints included maximum serum concentration (Cmax), clearance, half‐life (t1/2), and blood eosinophil count. Clearance and t1/2 were derived from a population PK (popPK) analysis. Safety and tolerability were also assessed. Results: Twenty‐eight children aged 6–11 years were included, with an additional two participants from Japan aged 12–14 years also included in the popPK analysis. Mean Cmax was 1901.2 and 3118.7 ng/mL in the 10 mg/<35 kg and 30 mg/≥35 kg groups, respectively. Clearance was 0.257, and mean t1/2 was 14.5 days. Near‐complete depletion of blood eosinophils was shown across dose/weight groups. Exploratory efficacy analyses found numerical improvements in mean FEV1, mean ACQ‐IA, patient/clinician global impression of change, and exacerbation rates. Adverse events occurred in 22/28 (78.6%) of participants; none led to discontinuation/death. Conclusion: PK, PD, and safety data support long‐term benralizumab in children with severe eosinophilic asthma, and were similar to findings in adolescents and adults. Trial Registration: ClinicalTrials.gov‐ID: NCT04305405. [ABSTRACT FROM AUTHOR]

Aim: This study examined the associations between geriatric factors and decreased opportunities for conversation among older adults amid a period of self‐restraint during the COVID‐19 pandemic. Methods: A cross‐sectional questionnaire‐based survey was carried out in October 2020. The participants were 204 residents aged ≥65 years staying at a private care home in Kyoto city, Japan. Logistic regression analysis was carried out with the reduction of conversation opportunities as the dependent variable, and geriatric factors as independent variables after adjusting for age and sex. We compared the decreased frequency of opportunities between residents in the assisted living wing and in the nursing care wing of the private care home. Results: The percentages of respondents who reported a decrease in the opportunities for conversation among themselves were 43.9% for residents in the assisted living wing and 19.7% for those in the nursing care wing. After adjusting for age and sex, the opportunities for conversation was significantly associated with the basic activities of daily living (OR 1.07, 95% CI 1.01–1.12), instrumental self‐maintenance (OR 1.25, 95% CI 1.08–1.46), intellectual activity (OR 1.35, 95% CI 1.09–1.66), depression (OR 1.13, 95% CI 1.04–1.23), depressive mood (OR 3.83, 95% CI 1.98–7.42), decreased motivation (OR 3.11, 95% CI 1.58–6.12), appetite loss (OR 4.32, 95% CI 1.54–12.07), swallowing function (OR 1.05, 95% CI 1.00–1.10), chewing difficulty (OR 2.50, 95% CI 1.31–4.75) and eating alone (OR 2.5, 95% CI 1.35–4.62). Conclusion: Decreased opportunities for conversation was more perceived among older adults with higher daily functioning, suggesting that it is associated with depressed mood, oral function and solitary eating. Geriatr Gerontol Int 2024; 24: 385–391. [ABSTRACT FROM AUTHOR]

Backgrounds: We aimed to clarify the outcomes of postoperative radiotherapy (PORT) after salvage neck dissection for cervical lymph node (LN) recurrence in oral cavity cancer. Methods: We retrospectively evaluated overall survival (OS), recurrence‐free survival (RFS), recurrence patterns, and adverse events of 51 patients with high‐risk features receiving PORT after salvage neck dissection between 2009 and 2019. Results: After a median follow‐up of 7.4 years from PORT initiation, the 7‐year OS and RFS rates were 66.3% (95% CI: 54.0–81.3) and 54.6% (95% CI: 42.1–70.9), respectively. Age <70 years and isolated LN recurrence were significantly associated with longer OS and RFS. Among the 22 patients who experienced recurrence, 14 experienced recurrence within the radiation field. PORT‐related grade 3 acute mucositis (35%) and late adverse events (osteoradionecrosis [4%] and laryngeal stenosis [2%]) were observed. Conclusions: PORT after salvage neck dissection for cervical LN recurrence achieved good survival with acceptable toxicity. [ABSTRACT FROM AUTHOR]

Since anti‐PD‐1 Abs can cause irreversible immune‐related adverse events (irAEs), the associations between their efficacies and the incidence of irAEs are important to evaluate the use of anti‐PD‐1Abs for the treatment of melanoma, especially in the adjuvant setting. The purpose of this post hoc analysis study was to retrospectively analyze the associations between recurrence‐free survival (RFS) at 12 months and the onset of any irAEs in 31 non‐acral cutaneous and 30 acral melanoma cases treated with anti‐PD‐1 Abs therapy at the adjuvant setting in Asians. There were 20 cases with greater than grade 1 AEs in both the acral and non‐acral cutaneous groups. Of the acral melanoma, 10 cases were nails or toes, and 20 cases were soles and heels. The log‐rank test showed that RFS was better in cases with AEs than in cases without AEs. The present study suggested that the different profiles of irAEs between non‐acral cutaneous and acral melanoma might correlate with the different response to anti‐PD1 Abs of melanoma in the adjuvant setting. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Renal cell carcinoma as a secondary malignant neoplasm is relatively rare; however, the possibility of secondary renal cell carcinoma following chemoradiotherapy for childhood nephroblastoma should be considered. The occurrence of secondary renal cell carcinoma (RCC) following chemoradiotherapy for nephroblastoma is relatively rare, especially in microphthalmia transcription factor family translocation renal cell carcinoma. A 13‐year‐old Japanese male was referred to our department for treatment of a right kidney mass. The patient had undergone open left nephrectomy and adjuvant chemotherapy for nephroblastoma, 12 years before. Diagnostic imaging revealed a tumor in the right kidney and a lesion suspected to be metastasis in the left eighth rib. Chromophobe RCC or translocation RCC was suspected from the imaging pattern. TNM classification was cT1aN0M1, and the clinical stage was IV. Partial nephrectomy by robot‐assisted surgery for the right renal tumor and resection of the left eighth rib were performed. Pathologically, the renal tumor was diagnosed as translocation RCC, and the rib lesion demonstrated no evidence of malignancy. We are currently undergoing imaging follow‐up and the patient has been recurrence‐free for 15 months. In this study, we present a rare case of secondary translocation RCC after successful treatment of nephroblastoma. [ABSTRACT FROM AUTHOR]

This article presents the findings of a retrospective multicenter study conducted in Japan on the use of enfortumab vedotin (EV) in patients with advanced urothelial carcinoma (UC). The study included 78 patients who had previously received platinum-containing chemotherapy and immune checkpoint inhibitors. The results showed that EV had a satisfactory response rate, although the progression-free survival (PFS) and overall survival (OS) were slightly shorter compared to clinical trials. High levels of C-reactive protein (CRP) and poor performance status (PS) were identified as key prognostic factors in these patients. The study acknowledges its limitations and suggests that further research is needed to confirm the findings. [Extracted from the article]

Background: We evaluated clinical and dosimetric outcomes of radiotherapy using two anterior oblique portals (AOP), to reduce the dose to the bilateral internal carotid arteries (CAs) and pharyngeal constrictor muscle (PCM) during early‐stage glottic cancer (ESGC) treatment. Methods: We identified patients with ESGC who underwent definitive radiotherapy between June 2014 and May 2020. Results: Among the 66 patients, 32 (48%) underwent radiotherapy using AOP, and the remaining underwent typical radiotherapy using parallel opposed lateral portals (POLP). The median follow‐up duration was 53 months. No significant differences were observed in the 5‐year local failure (0%/9.4%), progression‐free survival (90.6%/90.8%), and overall survival (90.6%/91.0%) rates between the two groups. The grade ≥2 acute mucositis incidence rate was significantly lower in the AOP group (44%/85%). Radiotherapy using AOP maintained an adequate dose coverage to the target while markedly reducing the CAs and PCM doses. Conclusion: Radiotherapy with AOP resulted in favorable clinical and dosimetric outcomes. [ABSTRACT FROM AUTHOR]

Background: Total pharyngolaryngectomy (TPL) is standard treatment for hypopharyngeal cancer. However, extensive thyroidectomy and paratracheal nodal dissection (PTND) can cause hypoparathyroidism. We sought to determine the optimum extent of resection. Methods: We analyzed the clinicopathological information of 161 pyriform sinus cancer patients undergoing TPL from 25 Japanese institutions. Rates of recurrence and risk factors for hypoparathyroidism, as well as incidence of pathological contralateral level VI nodal metastasis and stomal recurrence, were investigated. Results: The extent of thyroidectomy and nodal dissection were not independent risk factors for recurrence. Incidences of contralateral level VI nodal involvement and stomal recurrence were 1.8% and 1.2%, respectively. Patients undergoing hemithyroidectomy/ipsilateral PTND did not develop stomal recurrence and had the lowest incidence of hypoparathyroidism. Prognosis in patients without tracheostomy prior to hemithyroidectomy/ipsilateral PTND was comparable to that with more extensive resections. Conclusions: Hemithyroidectomy/ipsilateral PTND may be sufficient for pyriform sinus cancer cases without tracheostomy. [ABSTRACT FROM AUTHOR]

Aims: Iron deficiency (ID) is common in patients with heart failure (HF) and is reportedly associated with exercise intolerance and impaired quality of life. Iron supplementation therapy in HF patients with ID improves exercise capacity. Conversely, protective roles of iron depletion in the development of diabetes mellitus (DM) and its complications have been proposed. This study aimed to determine the impact of ID on physical function in HF patients with and without DM. Methods and results: We enrolled consecutive patients who were admitted to our institute for HF diagnosis and management. The short physical performance battery (SPPB) was used to evaluate physical function, and low physical function was defined as an SPPB score of <10 points as individuals with SPPB scores of <10 points are most likely to be classified as frail and are at high risk for disability and future adverse events, including death. ID was defined as serum ferritin < 100 or 100–299 ng/mL when transferrin saturation (TSAT) was <20% according to the HF guidelines. Among the 562 HF patients (72 ± 14 years old; 56% male), 329 patients (58%) and 191 patients (34%) had ID and low physical function, respectively. Multivariate logistic regression analysis showed that TSAT as a continuous variable, but not ID, was a predictor of low physical function (odds ratio: 0.980, P = 0.024). Subgroup analysis showed that a significant association between low TSAT and low physical function was lost in HF patients with DM (P for interaction < 0.001). A spline dose–response curve for the relationship between TSAT and risk of low physical function with adjustments for covariates associated with low physical function in non‐DM patients was almost linear with an increase in the risk of low physical function as the TSAT increased, but such a relationship was not found in the analyses of DM patients. A lack of close TSAT–SPPB relationship in HF patients with DM was confirmed also in a propensity‐score‐matched cohort. Conclusions: TSAT as a continuous variable, but not ID, was independently associated with physical function in HF patients, and a significant association was lost in patients with HF and DM, suggesting a limited impact of iron supplementation therapy in HF patients with DM. [ABSTRACT FROM AUTHOR]

Background and Objective: The lung immune prognostic index (LIPI), a simple index calculated from the blood lactate dehydrogenase level and derived neutrophil‐to‐lymphocyte ratio, is thought to be associated with host immune status. However, the utility of LIPI in patients with idiopathic interstitial pneumonias (IIPs) is unknown. Methods: In this multicentre, retrospective, observational study, an association between LIPI and the survival of patients with IIPs was evaluated. Results: Exploratory and validation cohorts consisting of 460 and 414 patients with IIPs, respectively, were included (159 and 159 patients had idiopathic pulmonary fibrosis [IPF], and 301 and 255 had non‐IPF, respectively). In the exploratory cohort, patients with IPF and a low LIPI had significantly better survival than those with a high LIPI (median of 5.6 years vs. 3.9 years, p = 0.016). The predictive ability of LIPI for the survival of patients with IPF was validated in the validation cohort (median of 8.5 years vs. 4.4 years, p = 0.003). In a multivariate Cox proportional hazard analysis, LIPI was selected as an independent predictive factor for the survival of IPF patients. There was no significant association between LIPI and survival of non‐IPF patients in the exploratory and validation cohorts. Conclusion: The LIPI was a predictive factor for the survival of patients with IPF and could aid the management of IPF. [ABSTRACT FROM AUTHOR]

Objectives: No protocol for esophagogastroduodenoscopic examination of the duodenum has been established. We examined the feasibility and ability to detect neoplasms of a novel duodenal examination protocol. Methods: This was a two‐facility, prospective, observational study. Our protocol, the Seven Pictures Rule (7PR), requires pictures of the following seven locations: anterior and posterior to the bulb, area of and contralateral to the superior duodenal angle, area of and contralateral to the ampulla, and the transverse duodenum. The primary outcome was rate of completion of 7PR. Secondary outcomes were overall rates of detecting neoplasms, rates of detecting neoplasms for each location, examination time, and completion rates for standard or ultrathin endoscopes. Results: There were 1549 participants. The 7PR completion rate was 81.1% and the detection rates of overall neoplasms, adenomas, and carcinomas were 0.84%, 0.71%, and 0.06%, respectively. The area in which most neoplasms was detected was contralateral to the ampulla (69.2%), and the fewest the transverse duodenum (0%). Mean duration of duodenal examination was 53.1 s. Completion rates for standard vs. ultrathin were 84.4% (1077/1276) vs. 65.6% (179/273) (P < 0.01), respectively. Conclusions: Seven Pictures Rule is acceptable for duodenal examination and a potential quality indicator. [ABSTRACT FROM AUTHOR]

Background: Acute asthma exacerbation in children is often caused by respiratory infections. In this study, a coordinated national surveillance system for acute asthma hospitalizations and causative respiratory infections was established. We herein report recent trends in pediatric acute asthma hospitalizations since the COVID‐19 pandemic in Japan. Methods: Thirty‐three sentinel hospitals in Japan registered all of their hospitalized pediatric asthma patients and their causal pathogens. The changes in acute asthma hospitalization in children before and after the onset of the COVID‐19 pandemic and whether or not COVID‐19 caused acute asthma exacerbation were investigated. Results: From fiscal years 2010–2019, the median number of acute asthma hospitalizations per year was 3524 (2462–4570), but in fiscal years 2020, 2021, and 2022, the numbers were 820, 1,001, and 1,026, respectively (the fiscal year in Japan is April to March). This decrease was observed in all age groups with the exception of the 3‐ to 6‐year group. SARS‐CoV‐2 was evaluated in 2094 patients from fiscal years 2020–2022, but the first positive case was not detected until February 2022. Since then, only 36 of them have been identified with SARS‐CoV‐2, none of which required mechanical ventilation. Influenza, RS virus, and human metapneumovirus infections also decreased in FY 2020. In contrast, 24% of patients had not been receiving long‐term control medications before admission despite the severity of bronchial asthma. Conclusion: SARS‐CoV‐2 was hardly detected in children with acute asthma hospitalization during the COVID‐19 pandemic. This result indicated that SARS‐CoV‐2 did not induce acute asthma exacerbation in children. Rather, infection control measures implemented against the pandemic may have consequently reduced other respiratory virus infections and thus acute asthma hospitalizations during this period. However, the fact that many hospitalized patients have not been receiving appropriate long‐term control medications is a major problem that should be addressed. [ABSTRACT FROM AUTHOR]

Purpose: Spermatogenesis requires a large amount of energy, which is primarily produced by the mitochondrial electron transfer chain. Mitochondrial dysfunction affects male infertility, suggesting a relationship between the electron transfer chain and male infertility. COXFA4L3 (C15ORF48) is an emerging subunit protein of cytochrome oxidase specifically expressed in germ cells during spermatogenesis, and it may be involved in male infertility. Therefore, to investigate whether COXFA4L3 could be a marker of mitochondrial dysfunction in the sperm, this study examined the protein expression and localization profile of COXFA4L3 in the sperm of male patients with infertility. Methods: Twenty‐seven semen samples from a male infertility clinic at the Reproductive Center of Yokohama City University Medical Center were used to analyze sperm quality parameters and the expression and localization of energy production‐related proteins. These data were compared with the outcomes of infertility treatment. Results: The expression levels of COXFA4L3 varied significantly between samples. Furthermore, COXFA4L3 was ectopically localized to the acrosome. Conclusions: Ectopic expression of COXFA4L3 and PNA‐stained acrosomes may be useful parameters for fertility treatment selection. Assessing the acrosomal localization of COXFA4L3 will expedite pregnancy treatment planning. [ABSTRACT FROM AUTHOR]

Raman optical activity (ROA) is commonly measured with green light (532 nm) excitation. At this wavelength, however, Raman scattering of europium complexes is masked by circularly polarized luminescence (CPL). This can be avoided using near‐infrared (near‐IR, 785 nm) laser excitation, as demonstrated here by Raman and ROA spectra of three chiral europium complexes derived from camphor. Since luminescence is strongly suppressed, many vibrational bands can be detected. They carry a wealth of structural information about the ligand and the metal core, and can be interpreted based on density functional theory (DFT) simulations of the spectra. For example, jointly with ROA experimental data, the simulations make it possible to determine absolute configuration of chiral lanthanide compounds in solution. [ABSTRACT FROM AUTHOR]