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Wandering spleen is a relatively rare condition and may be complicated by intestinal obstruction or abnormal intestinal rotation. Herein, we report a case where these three conditions appeared concomitantly. An 18-year-old woman with an intellectual disability was admitted to the hospital because of vomiting and fever. The patient's abdomen was distended. Computed tomography revealed a dilated small intestine, a swollen spleen located in the lower abdomen, as well as twisting and swirling of the splenic artery and vein. The patient was diagnosed with torsion of the wandering spleen and emergency surgery was performed. The vascular pedicle was found to be rotated 900° clockwise, and a markedly enlarged spleen was observed in the lower abdomen. When the splenic torsion was released, the pulsation of the splenic artery was well palpated, suggesting that the spleen could be preserved. Additionally, the sigmoid colon to the cecum was not fixed to the retroperitoneum. Dilatation of the small intestine was observed, but there were no findings of intestinal tract necrosis. Splenic torsion is part of the differential diagnosis for acute abdomen. Familiarity with embryology and anatomy is necessary to select the appropriate surgical technique., Competing Interests: Declarations. Conflict of interest: No conflict of interest for all authors. Ethical approval: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5). Informed consent: Informed consent was obtained from the patient included in the report., (© 2024. Japanese Society of Gastroenterology.)

CD5 expression is seen in 5%-10% of de novo diffuse large B-cell lymphomas (DLBCLs). Primary large B-cell lymphoma of the central nervous system (PCNS-LBCL) also exhibits CD5 expression in a minority of cases, however, clinicopathological and molecular features remain largely unclarified. Here we present the clinical, molecular, and pathological features of 11 CD5-positive ( + ) PCNS-LBCL cases, occupying 6.7% of all 165 PCNS-LBCLs diagnosed in our institutions. While CD5 + systemic DLBCL has been recognized as a distinctive subgroup showing an aggressive clinical course, no obvious differences were found between CD5 + and CD5-negative subgroups among the present CNS patients clinically. MYD88 p.L265P and CD79B p.Y196 mutations were detected in eight (73%) and seven (64%) cases, respectively, supporting previous reports. Notably, the microenvironmental immune cells were universally PD-L1/CD274-positive, and the higher levels tended to present favorable overall survival, as already evidenced in the PCNS-LBCL series. In contrast, neoplastic PD-L1/CD274 expression was undetectable in all cases. Indeed, no structural variations or copy number alterations involving PD-1 ligands were detected by targeted-capture sequencing and fluorescence in situ hybridization. While further studies are warranted, we may have confirmed similarity between PCNS-LBCLs and intravascular large B-cell lymphomas from a molecular standpoint., (© 2024 Japanese Society of Pathology and John Wiley & Sons Australia, Ltd.)

Background: The Esophageal Hypervigilance and Anxiety Scale (EHAS) is an English questionnaire created in the USA to assess these factors in all patients with esophageal diseases. The aim of this study was to develop and validate the Japanese version of EHAS and investigate the relationship between EHAS scores and symptoms in untreated disorders of esophagogastric junction (EGJ) outflow., Methods: This prospective study recruited patients who underwent high-resolution manometry (HRM) at six tertiary centers in Japan. The EHAS was translated to Japanese using standard forward and backward translation methods. Patients completed the following questionnaires: the Japanese EHAS, Eckardt score, Gastroesophageal Reflux Disease Questionnaire, and Hospital Anxiety and Depression Scale for assessment of construct validity. Logistic regression analysis identified factors associated with esophageal symptom severity in untreated disorders of EGJ outflow., Results: Overall, we analyzed 432 patients. Their main symptoms were dysphagia and reflux. The most common HRM diagnosis was normal (35.9%), followed by achalasia (29.4%). The Japanese EHAS demonstrated excellent reliability, and construct validity, with two subscales similar to the original EHAS. Total EHAS score moderately correlated to Eckardt score (r = 0.545, p < 0.001). In 113 patients with untreated disorders of EGJ outflow, multivariable analysis demonstrated that younger age, type II achalasia, and higher EHAS score were independently associated with higher Eckardt score., Conclusions: The Japanese EHAS is a reliable and valid questionnaire. Its subscale scores can be used as in the original version with some caution. Future studies are warranted to assess the appropriateness of factor loading., Competing Interests: Declarations. Conflict of interests: Akinari Sawada: Bristol Myers Squibb (grant).,Daniel Sifrim: Jinshan (speaking, grant, trips), Reckitt Benckiser (speaking, grant, trips).,Tiffany H. Taft: Ayble Health (scientific advisory board), Oak Park Behavioral Medicine LLC (ownership).,John Erik Pandolfino: Medtronic (speaking, consulting, patent, license), Sandhill Scientific/Diversatek (grant), Takeda (speaking), Astra Zeneca (speaking), Torax/Ethicon (speaking, consulting), EndoGastric Solutions (advisory board), Phathom (speaking, consulting).,Yasuhiro Fujiwara: Takeda (speaking), Astra Zeneca (speaking), Astellas (speaking), DaiichiSankyo (speaking), Otsuka (speaking), EA Pharma (speaking).The remaining authors declare no conflicts of interest in this study., (© 2024. The Author(s).)

Background and Aims: Lobular carcinoma (LC) of the breast exhibits diverse morphology and clinical behaviour. The pleomorphic variant (pLC) displays distinct cytonuclear features and aggressiveness compared to the classic variant (cLC). However, diagnosing pLC remains subjective. This study aims to refine LC's cytonuclear features, focusing on pLC., Methods: Whole slide images of 59 LCs, including both in situ (LCIS) and invasive (ILC) lesions, were analysed. Nuclear measurements, including nuclear size and variability, were scored using QuPath image analysis software. For comparison, selected features were scored in normal cells (n = 10) and pleomorphism score-matched invasive breast carcinoma (IBC) of NST type (n = 33). Additional visual assessment of the pleomorphic ILC (pILC) cohort (n = 90) was conducted for cytomorphological features characterisation., Results: pILC demonstrated larger nuclear area and higher nuclear variability with abundance of cytoplasm than cILC. Compared to lymphocytes, pILC demonstrated a median area ranging from 2.7 to 4.7 times larger. Cut-off values for differentiating pILC from other ILC subtypes included median nuclear area > 48.2 μm 2 and interquartile range (IQR) > 19.4, nuclear perimeter median > 25.2 μm and IQR > 5.3 and maximum diameter > 9.1 μm and IQR > 2.2. Multivariable logistic regression confirmed these parameters as independent predictors of pILC, with the maximum diameter being the most significant (P < 0.001). Visual assessment recognised two pILC subtypes: apocrine and non-apocrine. Apocrine variant showed nuclear roundness, pale vesicular chromatin patterns and prominent nucleoli, while non-apocrine variant exhibited greater nuclear size and shape variation., Conclusions: Objective nuclear measurements, combined with cytoplasmic and architectural features, provide a robust framework for diagnosing LC subtypes, improving diagnostic accuracy and reproducibility., (© 2024 The Author(s). Histopathology published by John Wiley & Sons Ltd.)

We investigated the prognostic value of cardiac myosin-binding protein C (cMyC), a novel cardiospecific marker, both independently and in combination with N-terminal pro-B-type natriuretic peptide (NT-proBNP), for predicting 6-month all-cause mortality in patients without acute coronary syndrome (ACS) treated at medical (nonsurgical) cardiac intensive care units (CICUs). Admission levels of cMyC, high-sensitivity cardiac troponin T (hs-cTnT), and NT-proBNP were measured in 1032 consecutive patients (mean age; 70 years) without ACS hospitalized acutely in medical CICUs for the treatment of cardiovascular disease. Serum cMyC was closely correlated with hs-cTnT and moderately with NT-proBNP (r = 0.92 and r = 0.49, respectively, p < 0.0001). During the 6-month follow-up period after admission, there were 109 (10.6%) all-cause deaths, including 72 cardiovascular deaths. Both cMyC and NT-proBNP were independent predictors of 6-month all-cause mortality (all p < 0.05). Combining cMyC and NT-proBNP with a baseline model of established risk factors improved patient classification and discrimination beyond any single biomarker (all p < 0.05) or the baseline model alone (both p < 0.0001). Moreover, patients were divided into nine groups using cMyC and NT-proBNP tertiles, and the adjusted hazard ratio (95% confidence interval) for 6-month all-cause mortality in patients with both biomarkers in the highest vs. lowest tertile was 9.67 (2.65-35.2). When cMyC was replaced with hs-cTnT, similar results were observed for hs-cTnT. In addition, the C-indices for addition of cMyC or hs-cTnT to the baseline model were similar (0.798 vs. 0.800, p = 0.94). In conclusion, similar to hs-cTnT, cMyC at admission may be a potent, independent predictor of 6-month all-cause mortality in patients without ACS treated at medical CICUs, and their prognostic abilities may be comparable. Combining cMyC or hs-cTnT with NT-proBNP may substantially improve early risk stratification of this population., Competing Interests: Declarations. Conflict of interest: Dr Nishimura reports no conflicts. Dr J. Ishii received a research grant from Sysmex Corp. Mr. Takahashi, Mr. Ishihara, Mr. Nakamura, Mr. Kitagawa, and Dr Sakaguchi report no conflicts. Ms. Sasaki is an employee of Sysmex R&D Center Europe GmbH. Dr Kawai, Dr Muramatsu, Dr Harada, Dr Yamada, Dr Tanizawa-Motoyama, Dr Naruse, Dr Sarai, and Dr Yanase report no conflicts. Dr H. Ishii received honoraria from AstraZeneca KK, Bayer Pharmaceutical Co., Ltd., Boehringer Ingelheim Japan, Bristol-Myers Squibb Inc., Daiichi-Sankyo Pharma Inc., Kowa, MSD K. K., Mitsubishi Tanabe Pharma Co., Ltd., Mochida Pharmaceutical Co., Ltd., Novartis Japan, Otsuka Pharmaceutical Co. Ltd., and Pfizer Japan Inc. Dr Watanabe reports no conflicts. Dr Ozaki received research grants from Takeda Pharmaceutical Co. Ltd., Sanofi KK, Mitsubishi Tanabe Pharma Corp., Otsuka Pharmaceutical Co. Ltd., Bayer Yakuhin, Ltd., Daiichi Sankyo Co. Ltd., Sumitomo Dainippon Pharma Co. Ltd., and Public Health Research Foundation. Dr Izawa received research grants from grant support through his institution from Bayer Yakuhin Ltd., Sumitomo Pharma Co. Ltd., PDR Pharma Co. Ltd., Biotronik Japan Co Ltd, Abbott Japan Co. Ltd., Boston Scientific Japan Co. Ltd., Japan Lifeline Co. Ltd., and Medtronic Japan Co. LtD., and honoraria for lectures from Otsuka Pharmaceutical Co. Ltd., Novartis Co. Cool., Eli Lilly Japan Co. Ltd., Bayer Yakuhin, Co. Ltd., Nippon Boehringer Ingelheim Co. Ltd., and Daiichi Sankyo Co. Ltd., (© 2024. Springer Nature Japan KK, part of Springer Nature.)

Background: Financial toxicity impacts the treatment choices, daily life, and health-related quality of life (HRQoL) of cancer patients. We investigated future variations in financial toxicity and HRQoL of patients with gynecologic cancer, evaluated using the COmprehensive Score for financial Toxicity (COST) questionnaire., Methods: This multicenter study enrolled patients with gynecologic cancer incurring co-payments for anti-cancer drug treatment for over 2 months. Questionnaires were administered at baseline and at the end of follow-up. Patients completed the COST, EORTC-QLQ-C30, EORTC-QLQ-OV28, EORTC-QLQ-CX24, EORTC-QLQ-EN24, and EQ-5D-5L. Paired t-tests were used to compare the initial and follow-up responses. Spearman's rank test was used to examine correlations between COST and HRQoL scores., Results: Ninety-one patients (ovarian, 40; cervical, 18; endometrial, 33) completed the questionnaires at baseline and follow-up. The mean COST score was not significantly different between baseline and end of follow-up (19.56 ± 6.63 and 19.97 ± 7.47, respectively; p = 0.439). Significant correlations were found between COST scores and emotional functioning (r = 0.251, p = 0.023), cognitive functioning (r = 0.254, p = 0.020), and financial difficulties (r = - 0.298, p = 0.006), attitude toward disease/treatment (r = 0.356, p = 0.033), poor body image (r = - 0.362, p = 0.042), back and pelvis pain (r = - 0.451, p = 0.010), and taste change (r = - 0.359, p = 0.040)., Conclusions: During anticancer drug therapy for gynecologic cancer, the COST score remained stable and did not correlate with overall HRQoL, although higher scores were associated with worse HRQoL for specific functions and symptoms., Competing Interests: Declarations. Competing interests: Kazunori Honda received research funding from Pfizer Japan Inc. outside the submitted work. Yusuke Kajimoto is an employee of MSD K.K. Ataru Igarashi received research funding from Abbott, AbbVie GK, Becton, Dickinson and Company, Creative Ceuticals, Eli Lilly Japan K.K., Gilead Sciences, Intuitive Surgical, Milliman, Pfizer Japan Inc., Sanofi Pasteur, and Terumo and personal fees from Astellas Pharma Inc., Chugai Pharmaceutical Co., CSL Behring, FUJIFILM, Sanofi, and Takeda, outside the submitted work. The other authors have no conflicts of interest to declare., (© 2024. The Author(s) under exclusive licence to Japan Society of Clinical Oncology.)

Background: Prognostically meaningful tricuspid regurgitation (TR) is not well-defined in the mitral transcatheter edge-to-edge repair arena. We aimed to explore the prevalence, correlates, and consequences of TR grades and postprocedural trends in this setting., Methods and Results: A single-center registry of isolated, first-time interventions was retrospectively assessed for pre-, intra-, and postprocedural aspects up to 1 year, of them the primary composite outcome of all-cause deaths or heart failure (HF) hospitalizations, all according to TR severity at baseline and at 1 month following mitral transcatheter edge-to-edge repair. Overall, 1287 individuals (60.3% men, age 78 [interquartile range, 69-85] years, 52.9% with functional mitral regurgitation) were included. Below-moderate, moderate, and above-moderate TR affected 48.4%, 29.5%, and 22.1% of patients, respectively. Increasing TR severity was accompanied by higher rates of functional, severe mitral regurgitation, greater comorbidity, and more advanced heart failure. Although not affecting technical and echocardiographic procedural success, moderate-and-above TR degrees were associated with higher incidence of mortality, heart failure admissions, and functional class III to IV postprocedure, with moderate-to-severe and greater TR independently conferring increased risk for the various outcomes (primary end point; HR, 1.36 [95% CI, 1.21-1.80]; P =0.027). One-month postprocedural TR severity directly correlated with, and was mostly similar to or worse than, its baseline counterpart. Rather than the change between the two, moderate-and-above grade at 1 month, observed in 37.1% of eligible cases, emerged as predictive of the primary outcome's risk., Conclusions: Among patients undergoing mitral transcatheter edge-to-edge repair, above-moderate TR at baseline and the closely related moderate-and-above TR at 1 month postprocedure are highly prevalent and signal a suboptimal course.

Brachytherapy (BT), especially in high dose rate (HDR), has become increasingly complex owing to the use of image-guided techniques and the introduction of advanced applicators. Consequently, radiotherapy technologists and medical physicists (RTMPs) require substantial training to enhance their knowledge and technical skills in image-guided brachytherapy. However, the current status of the RTMP workload, individual abilities and quality control (QC) of BT units in Japan remains unclear. To address this issue, we conducted a questionnaire survey from June to August 2022 in all 837 radiation treatment facilities in Japan involving RTMPs. This survey focused on gynecological cancers treated with HDR-BT (GY-HDR) and permanent prostate implantation using low-dose-rate BT (PR-LDR). The responses revealed that the average working time in the overall process for HDR varied: 120 min for intracavitary BT and 180 min for intracavitary BT combined with interstitial BT. The QC implementation rate, in accordance with domestic guidelines, was 65% for GY-HDR and 44% for PR-LDR, which was lower than the 69% observed for external beam radiation therapy (EBRT). Additionally, the implementation rate during regular working hours was low. Even among RTMP working in facilities performing BT, the proportion of those able to perform QC for BT units was ~30% for GY-HDR and <20% for PR-LDR, significantly lower than the 80% achieved for EBRT. This study highlights the vulnerabilities of Japan's BT unit QC implementation structure. Addressing these issues requires appropriate training of the RTMP staff to safely perform BT tasks and improvements in practical education and training systems., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Japanese Radiation Research Society and Japanese Society for Radiation Oncology.)

Background: The COVID-19 pandemic had a profound impact on cancer screening, diagnosis, and treatment procedures. We speculated that during the COVID-19 pandemic, sufficient medical resources were maintained in board-certified hospitals, resulting in favorable short-term outcomes, whereas hospital functions in non-board-certified hospitals declined, leading to mortality increase. The aim of this study is to investigate the impact of COVID-19 pandemic on short-term outcomes after esophagectomy, based on the scale of the facilities., Methods: Data of patients who underwent esophagectomy for esophageal cancer between January 2018 and December 2022 were analyzed using the National Clinical Database (NCD) of Japan. We selected the Authorized Institutes for Board-certified Esophageal Surgeons (AIBCESs) certified by the Japan Esophageal Society (JES) at the hospital level for evaluating the difference in outcomes between institutions. Operative mortality rates and other morbidities were evaluated using the standardized mortality and morbidity ratio (SMR, the ratio of the number of observed patients to the expected number of patients)., Results: Within the study period, the annual mean operative mortality rate was higher in non-AIBCESs than in AIBCESs. The SMR showed no significant difference after the COVID-19 pandemic in non-AIBCES for mortality, as well as that in AIBCES., Conclusions: In non-AIBCESs, no worsening of results caused by the COVID-19 pandemic was observed despite the shortage of medical resources. Our findings highlighted the high quality of esophageal surgery in Japan during the COVID-19 pandemic, a critical situation with limited medical resources., Competing Interests: Declarations. Conflict of interest: Yuko Kitagawa reports grants and personal fees from ASAHI KASEI PHARMA CORPORATION, grants, personal fees, and others from ONO PHARMACEUTICAL CO., LTD., grants and personal fees from Otsuka Pharmaceutical Factory, Inc., grants and personal fees from Nippon Covidien Inc., grants, personal fees, and others from TAIHO PHARMACEUTICAL CO., LTD, grants, personal fees, and others from CHUGAI PHARMACEUTICAL CO., LTD., grants and personal fees from KAKEN PHARMACEUTICAL CO., LTD., personal fees from AstraZeneca K.K., personal fees from Ethicon Inc., personal fees from Olympus Corporation, personal fees from SHIONOGI & CO., LTD., personal fees from Bristol-Myers Squibb K.K., personal fees from MSD K.K., personal fees from Smith & Nephew KK, personal fees from ASKA Pharmaceutical Co., Ltd., personal fees from MIYARISAN PHARMACEUTICAL CO., LTD., personal fees from Toray Industries, Inc., personal fees from DAIICHI SANKYO COMPANY, LIMITED, personal fees from Chugai Foundation for Innovative Drug Discovery Science, personal fees from Nippon Kayaku Co., Ltd., grants from Yakult Honsha Co., Ltd., grants from TSUMURA & CO., grants from Sumitomo Pharma Co., Ltd., grants and personal fees from EA Pharma Co., Ltd., grants from Eisai Co., Ltd., grants from Kyowa Kirin Co., Ltd., grants from MEDICON INC., grants from Takeda Pharmaceutical Co., Ltd., grants from TEIJIN PHARMA LIMITED, and personal fees from Intuitive Surgical G.K., outside the submitted work. Hideki Endo and Hiroyuki Yamamoto are affiliated with the Department of Healthcare Quality Assessment at the University of Tokyo. The department is a social collaboration department supported by the National Clinical Database, Johnson & Johnson K.K., Nipro Corporation, and Intuitive Surgical Sàrl., (© 2024. The Author(s) under exclusive licence to The Japan Esophageal Society.)

Background and Aim: Werner syndrome (WS) is an autosomal recessive, adult-onset, progeroid syndrome caused by WRN mutations. As refractory skin ulcers significantly affect the quality of life of patients with WS, this study identified ulcer risk factors and assessed prevention methods., Methods: We analyzed the data of 51 patients with WS enrolled in the Japanese Werner Syndrome Registry between 2016 and 2022. A cross-sectional analysis was performed to determine the association with skin ulcers at baseline. Statistical analyses were conducted, including Welch's and Pearson's chi-square tests. Age was adjusted using a logistic regression model., Results: The mean patient age was 48.8±7.6 years, and 66.7% of patients presented with skin ulcers. Univariate analysis showed that patients with skin ulcers were older than those without ulcers. Systolic blood pressure (SBP) was higher in patients with skin ulcers. Patients without skin ulcers received metformin and pioglitazone treatment significantly more often than those with ulcers. Logistic regression analysis adjusted for age showed that higher SBP remained a significant risk factor for skin ulcers. Patients administered pioglitazone had lower ulcer morbidity., Conclusions: Age and SBP are risk factors for skin ulcers in patients with WS. Moreover, pioglitazone treatment may prevent skin ulcers.

Competing Interests: Y. Takeuchi is a member of the Editorial Board of Endoscopy. X. H. Ma, K. Kasuga, A. Isshiki, S. Ishihara, T. Masuo, and T. Uraoka declare that they have no conflict of interest.

Aim: Describe the current phenotypes and clinical laboratory data regarding polycystic ovary syndrome (PCOS) in Japan, taking into account ethnic differences and obesity status., Methods: Data for 986 PCOS cases and 965 control cases were collected using a nationwide survey in Japan. Obese/overweight (body mass index [BMI] ≥25 kg/m 2 ) and non-obese/overweight (BMI <25 kg/m 2 ) cases were compared., Results: Japanese PCOS cases predominantly involved non-obese/overweight patients, accounting for 75% of all cases. Among non-obese/overweight PCOS cases, the incidence of both amenorrhea and clinical/biochemical hyperandrogenism was significantly lower than in obese/overweight PCOS cases, whereas the rate of elevated serum luteinizing hormone (LH) level was significantly higher. Even though the incidence of hirsutism in Japan is only 13.5%, the detection rate for hyperandrogenism increased by as much as 30.4% when hirsutism was added to the Japan Society of Obstetrics and Gynecology (JSOG) criteria for the diagnosis of hyperandrogenism in addition to elevated serum total testosterone level. When evaluated based on timing of blood sampling, the LH level and LH/follicle-stimulating hormone ratio determined at the initial consultation involving a chief complaint of irregular menstrual cycle (after confirming the absence of follicles measuring ≥1 cm in diameter) were significantly higher than on days 2-3 or 4-6 of the menstrual cycle., Conclusions: Ethnic differences, including obesity status, affected the phenotype and clinical laboratory data of Japanese PCOS patients, such as the incidence rates of clinical/biochemical hyperandrogenism and the rate of elevated basal LH level. Adding hirsutism to the JSOG 2024 criteria would enhance the accuracy of PCOS diagnosis and enhance consistency with the Rotterdam 2003 criteria. Measuring basal LH level is useful for assessing the endocrinologic characteristics of Japanese PCOS cases, as well as lean Asian PCOS cases, but the timing of blood sampling can affect the result., (© 2024 Japan Society of Obstetrics and Gynecology.)

Purpose: Assessing spatial resolution in MRI is challenging due to non-linearity. Despite the widespread use of 3D imaging in clinical practice for lesion detection and multi-planar reconstruction (MPR), the extended acquisition time poses a shortcoming. To address this, the "Slice resolution" parameter is utilized; however, its impact on MPR images is unclear. This study aims to assess spatial resolution using the ladder method, investigate the effects of diverse slice resolution settings in various imaging sequences, and propose optimal conditions., Methods: Images were acquired using various 3D imaging sequences-SPACE T1WI, SPACE T2WI, and VIBE T1WI-with different slice resolutions. Axial cross-section images were acquired and reconstructed into coronal cross-sections. The ladder method was employed for objective evaluation, including spatial frequency analysis. Additionally, visual evaluation was conducted and compared with ladder method results., Results: For three imaging sequences, the evaluated value of ladder method remained relatively constant from 100 % to 80 % slice resolution. However, the evaluated value decreased in low-spatial frequency for slice resolution below 70 %., Conclusions: Results from both ladder method and visual evaluations indicated image quality remained stable when the slice resolution was decreased to 80 %, potentially enabling a 20 % reduction in imaging time while preserving resolution in other cross-sections reconstructed by MPR., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Atopic dermatitis is common in children and often treated with topical corticosteroids (TCs). A boy in his late teens who had been using TCs for atopic dermatitis was diagnosed with liver damage during a health checkup. A medical examination revealed severe steatotic liver disease and elevated liver enzyme levels despite the absence of typical symptoms such as central obesity. After discontinuation of TCs, an improvement in liver enzyme levels was observed, leading to the diagnosis of drug-induced steatohepatitis. This case underscores the potential liver risks associated with prolonged TC use in children, highlighting the need for parental education.

A woman in her early 80 s was followed up in our hospital for chronic hepatitis C after viral eradication. We detected rapid-growing lymph node metastasis of hepatocellular carcinoma (HCC) after treatment with transcatheter arterial chemoembolization and/or radiofrequency ablation. We found that the metastasis was operable, but the size and location of the metastasis obliged the patient to receive pancreatoduodenectomy, which was too invasive. Then we initiated systemic chemotherapy to perform radical minimally invasive surgery. We treated the patient with 3 weekly cycles of atezolizumab 1200 mg plus bevacizumab 15 mg/kg. The patient tolerated the treatment well, and treatment-emergent adverse events included deterioration of hypertension and increased uric protein. After a total of 4 cycles of therapy, abdominal computed tomography findings showed that the metastasis evidently decreased, and a complete response was achieved based on the Revised Response Evaluation Criteria in Solid Tumors (RECIST) guidelines (version 1.1). Seventeen days later, the metastasis was dissected. Subsequently, we confirmed that there was no pathological metastatic lesion in the resected lymph node. Our case is the first report of successful application of the radical therapy to lymph node metastasis of HCC via combination therapy with atezolizumab/bevacizumab., (© 2024. Japanese Society of Gastroenterology.)

Purpose: The optimal management of degenerative meniscal tears remains controversial. Extracorporeal shockwave therapy (ESWT) has been shown to promote tissue repair in both preclinical and clinical studies; however, its effect on degenerative meniscal tears remains unknown. This study aimed to examine whether ESWT improves meniscal degeneration., Methods: This randomized trial was conducted between 2020 and 2022 and involved patients with degenerative medial meniscal tears. Patients were allocated to receive either focused ESWT (0.25 mJ/mm 2 , 2000 impulses, 3 sessions with a 1-week interval) or sham treatment. Patients were evaluated using magnetic resonance imaging (MRI) before treatment and at 12 months after treatment. The primary endpoint was improvement in meniscal degeneration, as assessed by the change in T2 relaxation time from baseline on MRI T2 mapping. Knee pain and clinical outcomes were also examined at the same time., Results: Of 29 randomized patients, 27 patients (mean age 63.9 ± 8.7 years; females 37%; ESWT group 14 patients; control group 13 patients) were included in the final analysis. At 12 months postintervention, patients in the ESWT group showed a greater decrease in the T2 relaxation time (ESWT group -2.9 ± 1.7 ms vs. control group 1.0 ± 1.9 ms; p < 0.001) and had less knee pain (p = 0.04). The clinical outcomes at 12 months post-treatment were not statistically significant. No adverse events were reported., Conclusion: ESWT decreased the T2 relaxation time in the meniscus at 12 months post-treatment. ESWT also provided pain relief, but no differences were observed in clinical outcomes., Level of Evidence: Level II., (© 2024 The Author(s). Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Environmental factors have well-documented impacts on brain development and mental health. Therefore, it is crucial to employ a reliable assay system to assess the spatial preference of model animals. In this study, we introduced an unbiased quadrant chamber assay system and discovered that parental pup-gathering behavior takes place in a very efficient manner. Furthermore, we found that test mice exhibited preferences for specific environments in both spontaneous and parental pup-gathering behavior contexts. Notably, the spatial preferences of autism spectrum disorder model animals were initially suppressed but later equalized during the spontaneous behavior assay, accompanied by increased time spent in the preferred chamber. In conclusion, our novel quadrant chamber assay system provides an ideal platform for investigating the spatial preference of mice, offering potential applications in studying environmental impacts and exploring neurodevelopmental and psychiatric disorder models., Competing Interests: Declaration of Competing Interest The authors declare no competing interests, (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: This study aimed to identify cases in which lateral lymph node (LLN) dissection (LLND) can be excluded by clarifying preoperative factors, including an evaluation of the middle rectal artery (MRA), associated with LLN metastasis., Methods: Fifty-five consecutive patients who underwent preoperative positron emission tomography-computed tomography (PET/CT) and total mesorectal excision with LLND for rectal cancer were included. We retrospectively investigated the preoperative clinical factors associated with pathological LLN (pLLN) metastasis. We analyzed the regions of pLLN metastasis using MRA., Results: pLLN metastasis occurred in 13 (23.6%) patients. According to a multivariate analysis, clinical LLN (cLLN) metastasis based on short-axis size and LLN status based on PET/CT were independent preoperative factors of pLLN metastasis. The negative predictive value (NPV) was high (97.1%) in patients evaluated as negative based on PET/CT and cLLN short-axis size. MRA was detected in 24 patients (43.6%) using contrast-enhanced CT, and there was a significant relationship between pLLN metastasis and the presence of MRA. pLLN metastasis in the internal iliac region but not in the obturator region was significantly correlated with the presence of MRA., Conclusion: Combined cLLN metastasis based on short-axis size and PET/CT showed a higher NPV, suggesting this to be a useful method for identifying cases in which LLND can be excluded., Competing Interests: Declarations. Conflict of interest: The authors declare no conflicts of Interests for this article., (© 2024. The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.)

Background: In an aging society, percutaneous coronary intervention (PCI) for super-elderly patients is commonly performed in clinical practice. However, data are scarce regarding the clinical features and outcomes of this population., Methods: This multicenter observational study enrolled patients aged over 90 years who underwent PCI across 10 hospitals between 2011 and 2020. The study included patients presenting with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS). The occurrence of all-cause and cardiac deaths during hospitalization and after discharge was investigated., Results: In total, 402 patients (91.9 ± 2.0 years, 48.3 % male) participated in the study, of whom 77.9 % presented with ACS. The rate of in-hospital death was significantly higher in patients with ACS compared to patients with CCS (15.3 % vs. 2.2 %, p < 0.001). The estimated cumulative incidence rates of all-cause death were 24.3 %, 39.5 %, and 60.4 % at 1, 3, and 5 years, respectively. No significant difference was observed in the occurrence of all-cause death between patients with ACS and CCS. Regarding causes of death after discharge, non-cardiac deaths accounted for just over half of the cases., Conclusion: This study highlights the clinical features and long-term clinical course of patients aged over 90 years who underwent PCI in a real-world setting. Patients presenting with ACS exhibited a higher rate of in-hospital mortality compared to those with CCS. Following discharge, both ACS and CCS patients experienced comparable and substantial increases in the incidence rates of both cardiac and non-cardiac mortality over time, and a more holistic management approach is warranted., Competing Interests: Declaration of competing interest H.I. received lecture fees from Astellas Pharma Inc., AstraZeneca Inc., Daiichi-Sankyo Pharma Inc., and MSD K. K. Y.U. received lecture fees from Otsuka Pharma Ltd. T.M. received lecture fees from Bayer Pharmaceutical Co Ltd., Daiichi-Sankyo Co Ltd., Dainippon Sumitomo Pharma Co Ltd., Kowa Co Ltd., MSD K. K., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co Ltd., Novartis Pharma K. K., Pfizer Japan Inc., Sanofi-Aventis K. K., and Takeda Pharmaceutical Co Ltd. T.M. received unrestricted research grant for Department of Cardiology, Nagoya University Graduate School of Medicine from Astellas Pharma Inc., Daiichi-Sankyo Co Ltd., Dainippon Sumitomo Pharma Co Ltd., Kowa Co Ltd., MSD K. K., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co Ltd., Novartis Pharma K. K., Otsuka Pharma Ltd., Pfizer Japan Inc., Sanofi-Aventis K. K., Takeda Pharmaceutical Co Ltd., and Teijin Pharma Ltd. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Docetaxel is metabolized by cytochrome P450 3A4 (CYP3A4), and is transported by organic anion transporting peptides (OATPs) and ABCB1, and its blood concentration is known to affect the risk of some docetaxel-related adverse drug reactions (ADRs). Thus, the concomitant use of docetaxel with drugs that inhibit or induce these transporters or CYP3A4 requires careful attention. A 58-year-old woman was receiving clarithromycin (400 mg twice daily), rifampicin (450 mg once daily) and ethambutol (500 mg once daily) for nontuberculous mycobacteriosis. The patient was diagnosed as having stage IV HER2-positive breast cancer, which was treated with a regimen of trastuzumab (8 mg/kg), pertuzumab (first dose: 840 mg; second dose onward: 420 mg) and docetaxel (75 mg/m 2 ) every 3 weeks. To predict the risk of serious drug interactions with rifampicin and clarithromycin, the blood concentration of docetaxel was analyzed after administration of the first course. The docetaxel levels at 22 and 159 h after administration were 36.1 and 6.5 ng/ml, respectively, which were higher than previously reported data. In addition, the calculated elimination half-life of 55.7 h was ~3 times longer than previously reported data. Although the docetaxel level was high, the same dosage was used in subsequent courses because no serious ADRs were observed during the first course of therapy. After 4 months of chemotherapy, the patient received complete remission. In conclusion, concomitant use of rifampicin and clarithromycin may increase the blood concentration of docetaxel., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2024, Spandidos Publications.)