Fuchu Hospital

Studies launched in Japan on once-weekly teriparatide (1/W-TPTD) and twice-weekly teriparatide (2/W-TPTD) are limited. Therefore, we examined the effects of sequential therapy using anti-resorptive agents after administering 1/W-TPTD and 2/W-TPTD using dual-energy X-ray absorptiometry (DXA) and DXA-based 3D modeling. This was a multicenter retrospective study following a phase 3 clinical trial called the TWICE study. Two-year follow-up data were collected after administering 1/W-TPTD or 2/W-TPTD for 1 year (follow-up after the phase 3 clinical trial). 20 subjects in the group of pre-treatments with 1/W-TPTD followed by sequential administration of bisphosphonate or denosumab (1/W-TPTD [BP/denosumab]), and 22 in the group 2/W-TPTD (BP/denosumab) were included in the analysis of changes in the BMD by post-treatment. In the 1/W-TPTD (BP/denosumab) group, a significant increase in L2-4 BMD was observed. In the 2/W-TPTD (BP/denosumab) group, a significant increase in total hip, neck, and L2-4 BMD values was observed. Analysis by 3D-SHAPER revealed that both the 1/W-TPTD (BP/denosumab) and 2/W-TPTD (BP/denosumab) groups demonstrated significant increases in cortical sBMD and vBMD 2 years after the initiation of post-treatment. In subjects who received 1/W-TPTD and 2/W-TPTD for about 1 year followed by sequential administration of BP or denosumab, significant improvements in BMD were continuously observed. Furthermore, significant improvements in cortical sBMD and vBMD were also demonstrated by analysis using 3D-SHAPER. Both 1/W-TPTD and 2/W-TPTD were effective in the treatment of osteoporosis by using anti-resorptive agents for sequential administration.

Undifferentiated sarcoma is a malignant tumor characterized by the absence of a distinct cellular origin, as determined by morphological and immunohistochemical analyses, and is known for its highly invasive and proliferative behavior [...].

Background: This study aimed to evaluate the impact of image enhancement techniques on the interobserver reliability of tear break-up time (TBUT), tear meniscus height (TMH), corneal fluorescein staining (CFS) scoring, and conjunctivochalasis detection using the Smart Eye Camera (SEC), a portable device for anterior segment examination. Methods: A retrospective analysis was conducted on video recordings captured by the SEC from 46 patients with dry eye disease (DED). Separate sets of images were created for each level of enhancement: unenhanced (G0), mildly enhanced (G3), and strongly enhanced (G7). These sets were not intermixed, ensuring that each enhancement level was assessed independently. Three observers—two DED specialists and one general ophthalmologist—assessed TBUT, TMH, CFS scores, and conjunctivochalasis. Interobserver reliability was evaluated using intraclass correlation coefficients (ICCs) for each image set. Results: Interobserver reliability for CFS scores significantly improved with G3, yielding an ICC of 0.8413. In contrast, G7 improved reliability for TBUT measurements (ICC = 0.7381), but led to a notable decrease in reliability for both CFS scoring (ICC = 0.2259) and conjunctivochalasis detection (ICC = 0.0786). Furthermore, the assessment of TMH demonstrated a progressive decline in accuracy with increasing levels of image enhancement. Conclusions: Image enhancement using the SEC improved the diagnostic consistency of dry eye specialists and general ophthalmologists, especially for TBUT and CFS assessments. However, excessive enhancement may obscure key diagnostic features, indicating the need for careful optimization of image processing techniques depending on the diagnostic focus.

Sacubitril/valsartan, an angiotensin receptor neprilysin inhibitor (ARNI), is becoming more common in the treatment of heart failure and hypertension. Neprilysin is highly expressed in the renal tubules, and reports have shown increases in urinary C-peptide reactivity (CPR) levels after administration of ARNI. However, the effect of ARNI on serum CPR levels, a critical marker of insulin secretion in diabetes, remains underexplored. We evaluated the effect of ARNI on serum CPR levels in patients with type 2 diabetes and its impact on the assessment of endogenous insulin secretion. We retrospectively investigated the medical records of patients with type 2 diabetes at two hospitals, where fasting plasma glucose and serum CPR levels were measured before and after administration of ARNI. All eleven patients (five males, six females) who met the criteria showed an increase in median fasting serum CPR levels following ARNI administration. The levels rose from a median of 1.78ng/mL (IQR: 1.26-2.02) to 3.19ng/mL (IQR: 2.71-5.12), accompanied by significant increases in the C-peptide index. Immunoreactive insulin levels barely changed after ARNI administration, but the ratio of immunoreactive insulin to CPR decreased significantly, from 3.3 (IQR: 2.5-3.9) to 1.6 (IQR: 1.3-1.9). The increase in serum CPR levels is attributed to inhibition of CPR degradation rather than an increase in endogenous insulin secretion, as fasting blood glucose levels remained unchanged. These findings suggest the need for caution when using serum CPR levels to evaluate endogenous insulin secretion in patients treated with an ARNI, which are increasingly being prescribed for heart failure and hypertension.

This report describes the case of a 53-year-old woman with chronic kidney disease (CKD) exacerbated by a gout flare who presented with renal tubular acidosis (RTA), hypokalemia, and hyperuricemia. Despite outpatient management for gouty nephropathy, the patient experienced progressive hypokalemia, leading to hospitalization. Upon admission, she was diagnosed with type 1 RTA, characterized by metabolic acidosis and severe hypokalemia, refractory to initial potassium supplementation. The patient's medical history included gout, chronic renal failure, and other comorbidities, complicating her condition. Treatment included aggressive potassium replacement and ongoing management of her gout and CKD. Over several hospital days, her potassium levels stabilized, and she was discharged on oral potassium supplements. This case emphasizes the importance of monitoring electrolyte imbalances and managing uric acid levels in patients with chronic gout and kidney disease to prevent complications such as RTA. Comprehensive management strategies, including dietary and pharmacological interventions, are critical to prevent the progression of gouty nephropathy and improve patient outcomes.

In this study, we aimed to evaluate and compare the effects of intravitreal aflibercept (IVA) and intravitreal faricimab (IVF) injections on the blood flow of retinal vessels in the peripapillary region and optic nerve head (ONH) in eyes with diabetic macular edema (DME) using laser speckle flowgraphy (LSFG). This study included 20 eyes of 18 patients treated with IVA and 15 eyes of 11 patients treated with IVF for DME. The mean blur rate (MBR) of the ONH and retinal artery and vein of the peripapillary region were measured using LSFG at baseline and 1 month after injection. Central retinal thickness (CRT) and best-corrected visual acuity (BCVA) were measured for all patients. CRT decreased significantly in both IVA-treated (p = 0.0003) and IVF-treated groups (p = 0.0004). Some of the MBR-related parameters of the ONH, such as MBR of all areas (MA), MBR of vascular areas (MV), and MBR of tissue areas (MT), decreased significantly 1 month after IVA and IVF compared to baseline values (MA of IVA, p < 0.0001; MT of IVA, p = 0.0220; MA of IVF, p = 0.0002; MT of IVF, p = 0.0461). MBR of the retinal artery (MBR-A) and vein (MBR-V) also decreased significantly 1 month after IVA and IVF compared with baseline values (MBR-A of IVA, p = 0.0002; MBR-V of IVA, p = 0.0010; MBR-A of IVF, p = 0.0368). No significant difference in ocular perfusion was observed between the IVA-treated and IVF-treated groups. Intravitreal injection led to a reduction in ocular blood flow in both retinal peripapillary vessels and the ONH in both IVA-treated and IVF-treated groups. No significant difference was observed in MBR reduction between the IVA-treated and IVF-treated groups. Our findings warrant further long-term investigations to reveal differences between aflibercept and faricimab.

ABSTRACT Objectives: Patients with myeloproliferative neoplasms (MPNs) are at higher risk of developing secondary malignancies. In this study, we focused on patients with MPNs that complicated lymphoid neoplasms. To analyze the real-world status of lymphoid neoplasm treatment in patients with pre-existing MPNs in Japan, we conducted a multicenter retrospective study. Methods: Questionnaires were sent to collect the data on patients who were first diagnosed with either polycythemia vera, essential thrombocythemia or myelofibrosis and who later were complicated with lymphoid neoplasms defined as malignant lymphoma, multiple myeloma, or chronic lymphocytic leukemia/small cell lymphoma. Results: Twenty-four patients with MPNs complicated by lymphoid neoplasms were enrolled (polycythemia vera, n = 8; essential thrombocythemia, n = 14; and primary myelofibrosis, n = 2). Among these, diffuse large B-cell lymphoma (DLBCL) was the most frequently observed (n = 13, 54.1%). Twelve (92.3%) of the patients with DLBCL received conventional chemotherapy. Among these 12 patients, regarding cytoreductive therapy for MPNs, 8 patients stopped treatment, one continued treatment, and two received a reduced dose. Consequently, most patients were able to receive conventional chemotherapy for DLBCL with a slightly higher dose of granulocyte colony-stimulating factor support than usual without worse outcomes. All 3 patients with multiple myeloma received a standard dose of chemotherapy. Conclusion: Our data indicate that if aggressive lymphoid neoplasms develop during the course of treatment in patients with MPNs, it is acceptable to prioritize chemotherapy for lymphoma.