Chiba Hokusou Hospital

Two-year effectiveness of tyrosine kinase 2 inhibitor deucravacitinib is unknown for psoriasis in real-world, especially in patients with different histories of systemic therapy. To evaluate the 104-week effectiveness of deucravacitinib in patients with psoriasis, stratified by prior use of apremilast or biologics. We studied 131 patients with moderate-to-severe psoriasis who received deucravacitinib 6 mg/day. Psoriasis area and severity index (PASI) and dermatology life quality index (DLQI) were analyzed in subgroups stratified by prior apremilast or biologic therapy. Deucravacitinib decreased PASI and DLQI through 104 weeks regardless of prior apremilast or biologic therapy. Week 104 achieving PASI 100 and absolute PASI ≤ 1 were higher in apremilast-naïve patients (15.4% and 53.8%) than in apremilast-experienced patients (0% and 25%, respectively). Week 104 achieving PASI 75, PASI 90, PASI 100, and absolute PASI ≤ 1 were higher in biologic-naïve patients (84.6%, 57.7%, 15.4%, and 53.8%) than in biologic-experienced patients (25%, 25%, 0%, and 25%, respectively). Deucravacitinib reduced PASI and DLQI through 104 weeks in patients with psoriasis regardless of prior apremilast or biologic therapy, with lower sustainability of PASI 100 or absolute PASI ≤ 1 achievements in patients with prior apremilast or biologic treatment.

ABSTRACTFigure‐of‐eight stabilizing shoulder taping immediately reduced pain and restored joint centering in a patient with traumatic recurrent massive rotator cuff tear. When combined with real‐time ultrasound‐guided exercise therapy, it facilitated selective posterior cuff activation and enabled short‐term functional recovery, offering a feasible conservative option for patients declining surgery.

Real-world data are limited on 2 year effectiveness of tyrosine kinase 2 inhibitor deucravacitinib for psoriasis, especially that stratified by body mass index (BMI) or age. This study is aimed to evaluate 104 week effectiveness of deucravacitinib in patients with psoriasis, stratified by BMI (< 25 versus ≥ 25 kg/m2) or age (< 65 versus ≥ 65 years). We included 127 patients with moderate-to-severe psoriasis who received deucravacitinib 6 mg once daily. Psoriasis area and severity index (PASI) decreased throughout 104 weeks in whole patients. In between-group comparisons, mean percent reduction of PASI did not significantly differ at any time point in either BMI or age stratification. The amount of decreasing PASI and achievement rates of PASI 75, 90, and absolute PASI ≤ 2 through week 16 to 68 were slightly higher in BMI < 25 than in BMI ≥ 25, thereafter inverted order. The achievement rates of PASI 100 or absolute PASI ≤ 1 were higher in BMI < 25 throughout 104 weeks; week 104 PASI 100 or absolute PASI ≤ 1 rates were 16.7% or 54.2% in BMI < 25 while 0% or 40% in BMI ≥ 25, respectively. Percent reduction of PASI and achievement rates of PASI 75 and 90 were slightly higher in age ≥ 65 years than in age < 65 years by week 52, thereafter inverted order. Week 104 achievement rates of PASI 100 or absolute PASI ≤ 1 were 28.6% or 57.1% in age < 65 years while 0% or 46.7% in age ≥ 65 years, respectively. Deucravacitinib reduced PASI throughout 104 weeks in whole patients. Patients with BMI < 25 or age ≥ 65 years might show slightly higher response to deucravacitinib at early time points around 1 year compared to slightly higher response at later time points in those with BMI ≥ 25 or age < 65 years. Patients with BMI ≥ 25 or age ≥ 65 years might have difficulty in keeping PASI 100 through week 104.

While minimally invasive pancreaticoduodenectomy (MIPD) has become increasingly common, biliary reconstruction remains a formidable technical hurdle. Ensuring the reproducibility of hepaticojejunostomy, particularly when performed by procedure-naïve surgeons, is a critical challenge. We retrospectively analyzed consecutive patients who underwent MIPD with laparoscopic hepaticojejunostomy using a standardized technique employing a handmade double-armed suture. All procedures were performed by a procedure-naïve U40 surgeon under expert supervision. The anastomotic safety and reconstruction time were evaluated to assess reproducibility. A total of 23 patients were included. No bile leakage was observed, and anastomotic stricture occurred in 1 patient. The reconstruction time showed minimal variability throughout the series, indicating stable procedural performance from the early phase. A standardized laparoscopic hepaticojejunostomy technique can be safely and reproducibly performed by a procedure-naïve surgeon with sufficient foundational experience under structured supervision. Technique-based standardization may complement existing training strategies and facilitate sustainable dissemination of MIPD.

Clostridioides difficile infection (CDI) remains a leading cause of healthcare-associated diarrhea worldwide, with high morbidity, recurrence, and healthcare burden. Timely and accurate diagnosis, effective treatment, and preventive strategies are critical in improving patient outcomes. This review presents a comprehensive overview of CDI and focuses on diagnostic criteria, severity classifications, recurrence risk prediction, and therapeutic approaches, emphasizing both international and Japanese perspectives. The use of the Bristol Stool Scale and appropriate stool testing protocols helps ensure diagnostic accuracy and avoid overtreatment. Japan's adoption of the MN severity criteria, which incorporate clinical, laboratory, and imaging findings, contrasts with laboratory-based classifications in international guidelines. While both structured diagnostic algorithms and evidence-based treatment guidelines offer prognostic value, MN criteria may better reflect real-world clinical decision-making in Japan. CDI recurrence remains a significant clinical challenge. This review highlights two predictive models-CHIEF score and the novel Days of Antibiotic Spectrum Coverage (DASC) metric-developed in Japanese cohorts. Both tools enable early identification of high-risk patients and support decisions on prophylactic or tailored therapy. Therapeutic options include fidaxomicin (FDX), vancomycin, and metronidazole (MTZ). Recent international guidelines favor FDX due to its superior microbiota-sparing properties and reduced recurrence rates. However, MTZ remains an option for mild cases in Japan because of cost considerations and differences in CDI strain prevalence. By comparing local and global practices, this review underscores the importance of region-specific data in optimizing CDI management and encourages further integration of emerging risk stratification tools and treatment strategies to improve care across diverse clinical settings.

Laparoscopic hepatectomy (Lap-H) is increasingly being performed in Japan, but the high cost and handling complexity of laparoscopic ultrasonographic (US) probes remain a barrier to its wider adoption. Intraoperative ultrasonography is essential for safe liver resection; however, specialized laparoscopic probes are expensive, have a limited field of view, and are difficult to manipulate. To overcome these limitations, we developed a practical technique using an open-surgery-type microconvex US probe in Lap-H. The probe is inserted via an umbilical incision using a Lap Protector mini™ and EZ Access™, and probe manipulation is achieved through a cord-based control system. We applied this method in over 150 Lap-H cases before the introduction of a dedicated laparoscopic US system. This technique enabled the acquisition of axial and sagittal images with a wide and deep field of view, enhancing anatomical orientation and lesion visualization. There were no complications such as air leaks or equipment failure. The method allowed for the use of contrast-enhanced ultrasound and minimized interference with the operative field. The use of open-surgery-type US probes in Lap-H offers a cost-effective, safe, and practical alternative to expensive laparoscopic US systems. This innovation may lower the barrier for institutions initiating Lap-H programs and promote the broader adoption of high-quality intraoperative ultrasonography in minimally invasive liver surgery.

BACKGROUNDRefractory ascites severely impairs quality of life in patients with liver cirrhosis (LC) and cancer-related peritonitis. For individuals who are intolerant to medical therapy and require frequent large-volume paracentesis, a peritoneovenous shunt (PVS) offers a potential treatment option. However, PVS placement is associated with high complication rates, perioperative mortality, and lacks well-defined indications.AIMTo identify prognostic factors for PVS placement and develop a novel postoperative survival scoring model for LC with refractory ascites.METHODSA total of 100 patients who underwent PVS placement for refractory ascites due to LC in our department between 1998 and 2024 were analyzed. Patients were stratified into two groups: Those who survived more than 180 days after PVS placement (L-group) and those who survived for less than 180 days (S-group). Prognostic factors were compared between groups, and four variables (sex, age, Child-Pugh score, and liver volume) were selected for the creation of a new scoring system.RESULTSSignificant differences between the S- and L-groups were observed for age, sex, Child-Pugh score and preoperative liver volume. Based on these variables, we developed a scoring system as follows: 1 point each for age ≥ 60 years, Child-Pugh score ≥ 10, female sex, and preoperative liver volume < 1057 mL. Patients scoring 0-2 points were classified as PVS grade A, and those scoring 3-4 points as PVS grade B. Survival analysis showed that overall survival was significantly higher in PVS grade A compared with PVS grade B. Multivariate analysis confirmed PVS grade as an independent prognostic factor.CONCLUSIONThe proposed PVS scoring system may be a useful tool for predicting postoperative prognosis following PVS placement in patients with LC and refractory ascites.

Long-term (2-year) effectiveness of bimekizumab for psoriasis is unknown in real-world practice. This study is aimed at evaluating 104-week real-world effectiveness of bimekizumab in patients with psoriasis, stratified by the presence or absence of prior biologic treatment. From May 2022 to May 2025, we prospectively assessed 66 Japanese patients With psoriasis who received bimekizumab 320 mg every 4 weeks (Q4W) until week 16, thereafter Q4W (n = 28) or Q8W (n = 38) assigned based on patients' preference. Both Q4W and Q8W bimekizumab regimens rapidly decreased the psoriasis area and severity index (PASI) to approximately 0 by week 16, which was sustained through week 104. The speed of achieving PASI 90, 100, or static physician's global assessment (sPGA) 0/1 was faster for biologic-experienced patients compared to naïve ones in the Q4W regimen while faster for biologic-naïve patients in the Q8W regimen. The above achievement rates in biologic-naïve patients were maintained through week 104 while those in biologic-experienced patients slightly reduced later than week 68 or 92 in the Q4W or Q8W regimen, respectively. Taken together, Q4W and Q8W treatment with bimekizumab rapidly improved symptoms of psoriasis, and the improvement was mostly maintained through week 104. The achievement rates of PASI 90, 100, or sPGA 0/1 were mostly sustained through week 104 in biologic-naïve patients while slightly reduced in biologic-experienced patients at later phases of treatment.