Ehime Prefectural Central Hospital

Primary Percutaneous Coronary Intervention (PCI) has significantly contributed to reducing the mortality of patients with ST segment elevation myocardial infarction (STEMI) even in cardiogenic shock and is now the standard of care in most of Japanese institutions. The Task Force on Primary PCI of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) proposed an expert consensus document for the management of acute myocardial infarction (AMI) focusing on procedural aspects of primary PCI in 2018 and updated in 2022 (Ozaki et al. in Cardiovasc Interv Ther 33:178-203, 2018), (Ozaki et al. in Cardiovasc Interv Ther 37:1-34, 2022). Following the publication of the 2023 European Society of Cardiology (ESC) Guidelines for the management of acute coronary syndromes, the CVIT Task Force released another revised version in 2024 (Ozaki et al. in Cardiovasc Interv Ther 39:335-375, 2024). In light of new clinical evidence and technological advances that have emerged since then, the Task Force now proposes an updated expert consensus document for the management of ACS focusing on procedural aspects of primary PCI in 2026 version.

Long-term follow-up (LTFU) outpatient clinics play a primary role in screening, preventing, and addressing late effects after hematopoietic cell transplantation (HCT). Following the 2018 nationwide survey, which led to the development of standardized nationwide tools to deliver information to HCT survivors, we re-evaluated changes in the current status of LTFU clinics. We targeted 267 HCT centers certified by the Japanese society for transplantation and cellular therapy. Several questionnaire categories were retained from the 2018 survey to compare results (e.g., LTFU clinic establishment and institutional practices for late-effect screening). The response rate was high in both adult (90%) and pediatric HCT centers (88%), and the establishment rate of post-HCT LTFU clinics increased to 82% (adult, 90%; pediatric, 64%). Pediatric centers were more likely to continue follow-up of patients who received HCT beyond 5 years post-HCT. Regarding transitional medical care for long-term survivors at non-HCT institutions, only a few HCT centers conducted routine transitions to specific referral facilities. We observed significant changes in recommendations for secondary cancer screenings compared to 2018, with a substantial decrease in the proportions of "not routinely included as a screening issue." In the future, it is essential to create a sustainable follow-up system, establish networks with non-HCT facilities, and educate patients to encourage behavioral changes for lifelong health screenings.

Background There are no comparative studies on provoked coronary microvascular spasm (CMS) in patients undergoing both acetylcholine (ACh) and ergonovine (EM) vasoreactivity testing. Objectives We investigated the incidence of provoked CMS in patients with ischemia with nonobstructive coronary artery disease (INOCA) undergoing ACh and EM vasoreactivity testing. Methods We recruited 494 INOCA patients who underwent both ACh and EM vasoreactivity testing. ACh was injected at incremental doses of 20/50/100/200 μg into the left coronary artery (LCA) and 20/50/80 μg into the right coronary artery (RCA), whereas 40 μg of EM was administered into the RCA and 64 μg into the LCA. Positive CMS was defined as <75% transient coronary constriction, accompanied by typical chest symptoms or ischemic ECG changes. Results Among the 494 patients, CMS was observed in 23 (4.7%) patients. Eighteen patients had CMS alone, and 5 patients had coexisting epicardial spasm. The ACh test alone, EM test alone, and both tests provoked CMSs in 12 patients, 7 patients, and 4 patients, respectively. There were no marked differences in incidence between ACh- and EM-induced CMS (70% vs. 48%, p=0.2307). Conclusions Differences were observed between ACh-induced CMS and EM-induced CMS. The complementary use of vasoreactivity testing is essential for accurately documenting the presence of CMS in real-world settings.

背景．非小細胞肺癌において，BRAF遺伝子変異は稀であり，初回治療にはダブラフェニブ＋トラメチニブ併用投与が推奨されている．症例．72歳女性．嗄声のために近医耳鼻咽喉科を受診し，肺癌を疑われたため当科に紹介となった．精査にて右上葉肺腺癌cT4N3M1a，cStage IVAと診断した．BRAF V600E変異を認めたため，ダブラフェニブ＋トラメチニブ併用投与にて治療を開始したところ，40か月以上の奏効が得られている．結論．BRAF V600E変異陽性肺癌に対してダブラフェニブ＋トラメチニブ併用投与が長期奏効した1例を経験したため，報告する．

Background: A subependymal giant cell astrocytoma (SEGA) grows slowly near the foramen of Monro and develops in tuberous sclerosis complex patients. Large SEGA resection has a high risk of hemorrhage, resulting in irreversible sequelae. Mammalian target of rapamycin (mTOR) inhibitor has been approved for the treatment of SEGA which cannot be curatively treated surgically.Case Description: An 8-year-old boy was found to have two nodules beside bilateral ventricles. After the interruption of regular examination, he was transported to the hospital with seizure, headache, and visual impairment caused by hydrocephalus. Computed tomography (CT) scan revealed two masses: one at each the left (60 × 50 × 60 mm) and right (20 × 10 × 10 mm) ventricles. An emergency ventricular outside shunt was placed, but reduction surgery could not be performed. Everolimus at 3 mg/m2 was orally administered as preoperative therapy. A reduction in tumor size was observed 2 months after everolimus initiation. Reduction surgery for the right-sided tumor was performed after discontinuation of the drug. The tumor at the left septum lucidum and caudate nucleus remained. Everolimus was administered again for residual tumor growth. After a series of surgeries, complete resection of both tumors was performed eventually.Conclusion: This report shows preoperative treatment using mTOR inhibitor to be an effective strategy for unresectable large SEGA.