Fukuoka Hospital

Osteoporosis causes fractures which further increase the disease burden of rheumatoid arthritis (RA), however, osteoporosis treatment rates remain low. While several studies have reported that biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) can prevent or improve osteoporosis in RA, our large-scale, real-world study showed that 1 year-b/tsDMARDs use did not arrest osteoporosis progression. This study aimed to examine longer-term changes in bone mineral density (BMD). BMD was observed for up to 5 years in patients receiving b/tsDMARDs for active RA. The primary endpoint was change in BMD (T-score), and the secondary endpoint was change in T-score-related factors. In total, 797 patients (anti-osteoporosis (-), n = 645; anti-osteoporosis (+), n = 152) were included, with a median 3.1-year follow-up (2,489 patient-years). Clinical disease activity index (CDAI) improved in both groups (26.0/24.4 → 6.6/6.8). T-scores decreased significantly in the femoral neck and radius in the anti-osteoporosis (-) group but not in the anti-osteoporosis (+) group [anti-osteoporosis (-): mean change -0.11/-0.33, both p < 0.001; anti-osteoporosis (+):-0.01/-0.10, p = 0.830/0.071]. Overall, 460 patients (58%) experienced a decrease in T-score. A high baseline T-score correlated with a subsequent decrease, while longer osteoporosis treatment duration correlated with an increase. Unexpectedly, the duration of b/tsDMARD use and mean CDAI during observation were not associated with BMD maintenance. Even when RA activity was controlled with b/tsDMARDs, BMD still decreased. This study emphasizes the importance of considering osteoporosis as an independent aspect of RA, beyond inflammation control.

Bronchoscopy frequently precipitates intraprocedural hypoxemia. Although several recent randomized controlled trials suggest that high-flow nasal cannula oxygen (HFNO) reduces intraprocedural hypoxemia during bronchoscopy, the overall certainty of this evidence remains insufficient. Hence, we performed a systematic review and meta-analysis to compare the efficacy of HFNO with that of conventional low-flow oxygen therapy (COT) during adult bronchoscopy. MEDLINE, Embase, and trial registries were searched for randomized controlled trials (RCTs) involving adults (18y or older) undergoing bronchoscopy that compared HFNO with COT. The primary outcome was the incidence of hypoxemia during the procedure. The key secondary outcomes were total procedure time, bronchoscopy interruption, and lowest intraprocedural peripheral oxygen saturation. The pooled risk ratios (RRs) or mean differences (MDs) were calculated, and the certainty of evidence was assessed. The protocol was registered with PROSPERO (CRD420251071548). Eleven RCTs (12 study arms) comprising 1714 participants met the inclusion criteria. HFNO was found to significantly reduce the incidence of hypoxemic events compared with COT (RR: 0.39, 95% CI: 0.26-0.59) and lowered the likelihood of procedure interruption (RR: 0.39, 95% CI: 0.27-0.55). HFNO also maintained a higher nadir SpO2 (MD=4.5%, 95% CI: 3.02-5.99). No statistically significant difference was observed in the total procedure time (MD: -0.87min, 95% CI: -1.99 to 0.25). This meta-analysis showed HFNO reduces the incidence of intraprocedural hypoxemia and interruptions during bronchoscopy. Our findings support a selective approach, suggesting the benefits of HFNO are greater in high-risk patients.

Bronchiectasis predisposes patients to refractory airway infections and significantly reduces their quality of life. Here, we report a case of a 78-year-old woman with refractory Pseudomonas aeruginosa infection complicating bronchiectasis. After P. aeruginosa acquired resistance to quinolones, outpatient treatment became difficult, and the patient experienced repeated exacerbations and hospitalisations. Ceftazidime was effective; however, the patient could not be discharged because symptoms worsened immediately after its discontinuation. Initiating nebulised tobramycin for home use markedly improved symptoms and prevented subsequent exacerbation. Furthermore, P. aeruginosa isolated from sputum 1 year after initiating nebulised tobramycin regained susceptibility to quinolones. This case suggests that nebulised tobramycin is a viable and effective option for long-term management of chronic P. aeruginosa infection complicating bronchiectasis.

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.

In recent years, the misuse of over-the-counter (OTC) medications has been increasing in psychiatric clinical settings in Japan. This study aimed to compare individuals who misuse codeine (COD) with those who misuse dextromethorphan (DXM) to clarify the clinical characteristics of DXM misusers and to consider the support measures needed for this population. We used data from the 2024 National Survey on Drug-Related Disorders in Psychiatric Inpatient Facilities. Individuals who primarily misused OTC containing COD (COD group) and DXM (DXM group) were extracted from the database. We examined demographic characteristics, ICD-10 subcategories, and comorbid psychiatric disorders and compared the two groups using Fisher's exact test. Factors associated with DXM misuse were further analyzed using multivariable logistic regression. The study included 160 individuals in the COD group and 72 in the DXM group. Compared with the COD group, the DXM group had higher proportions of females and younger individuals, as well as higher rates of drug use within the past year and a history of self-harm or suicide attempts. The DXM group also showed significantly higher comorbidity rates of "acute intoxication" and "mood disorders (F3)" based on ICD-10. In the multivariable logistic regression analysis, younger age (AOR = 2.558, 95% CI: 1.218-5.371), acute intoxication (AOR = 2.73, 95% CI: 1.254-5.942), and comorbid mood disorders (AOR = 2.201, 95% CI: 1.146-4.227) were significantly associated with DXM misuse. These findings highlight the importance of acute-phase management, assessment of comorbid psychiatric disorders, and interventions that include suicide-risk evaluation in supporting individuals who misuse DXM. Furthermore, preventive education incorporating perspectives on mental-health-focused suicide prevention, as well as regulatory measures for OTC medication sales, are urgently needed.

Abstract Objectives Determinants of functional injury severity in young athletes remain incompletely understood. Conventional assumptions emphasize contact sport participation and skeletal immaturity as major drivers of severe injury; however, severity definitions based on surgery or time loss are strongly influenced by health-care systems and competition contexts. We investigated factors associated with early functional severity after lower-extremity sports injury using a large clinical cohort. Methods This cross-sectional observational study analyzed 4,829 lower-extremity sports injury cases in athletes aged ≤22 years who presented to a specialized sports injury clinic between January 2017 and November 2025. Severe injury was defined as inability to walk independently at the initial visit. Multivariable logistic regression analysis was performed to evaluate associations between severe injury and age, sex, sport type, injury mechanism, injury location, and physeal status. Results Severe injury was most strongly associated with acute injury compared with overuse injury (odds ratio [OR], 31.1; 95% confidence interval [CI], 17.7–54.6; p &lt;.001). Injuries involving the knee and ankle were also significantly associated with severe injury (OR, 2.73; 95% CI, 2.04–3.64; p &lt;.001). Female sex showed a modest independent association (OR, 1.40; 95% CI, 1.06–1.84; p =.017), whereas participation in contact sports, physeal status, and age were not independently associated. Conclusion Early functional severity after lower-extremity sports injury in young athletes was primarily associated with injury acuity and anatomical involvement of the knee and ankle rather than with sport type or skeletal maturity. These findings challenge conventional exposure-based assumptions and support function-oriented phenotyping for injury surveillance and targeted prevention strategies.

The Paris System for Reporting Urinary Cytology (TPS) has clearly and simply identified the criteria for the accurate diagnosis of high-grade urothelial carcinoma (HGUC); however, the urine cytological findings of secondary tumours have not been fully assessed. Therefore, we evaluated the urine cytological features of colorectal adenocarcinoma cells that invaded the urinary tract. Thirty urine cytology specimens with cells considered colorectal adenocarcinoma were retrieved by clinicopathological review, subject to the following criteria: no urothelial carcinoma history, diagnosed as HGUC by TPS and supported by CDX-2 immunocytochemistry. Cases were morphologically re-evaluated. CDX-2 immunostaining, performed in four available cases, showed nuclear positivity in all cases. Tall columnar carcinoma cells were identified in 12/30 cases, tumour cells with pale or vacuolated cytoplasm in 4/30, large and eosinophilic nucleoli in most atypical cells in 4/30, large cells simulating HGUC cells in 27/30 and small cells with irregularly shaped or crescentic nuclei in 27/30. A histological review of transurethral or colorectal resection specimens revealed morphologically identical small cells on the surface of all well-to-moderately differentiated adenocarcinomas, demonstrating desquamated and degenerated adenocarcinoma cells. One cytological specimen from a poorly differentiated adenocarcinoma showed dispersed isolated tumour cells with uniform and round nuclei containing finely granular chromatin and prominent nucleoli. Colorectal adenocarcinoma cells in the urine may not only be large and tall columnar or vacuolated, but can also simulate HGUC cells or have small round or crescentic nuclei. Recognising this morphological diversity is important for accurate diagnosis.