Fukuyama Cardiovascular Hospital

Refractory overactive bladder (OAB) remains a clinical challenge despite established therapies, such as anticholinergics, β3-agonists, and intradetrusor botulinum toxin (BTX). Emerging evidence suggests that sensory mechanisms within the bladder, including those involving the trigone where superficial afferent networks are present, may contribute to persistent urinary urgency and frequency in some patients. Although intradetrusor BTX injection is effective in selected patients, its impact on these superficial pathways may be limited because the injected drug predominantly distributes within the detrusor. Endoscopic topical application (ETA) therapy delivers BTX directly to the trigone under air cystoscopy, potentially providing targeted modulation of sensory hyperexcitability. We report a 72-year-old woman with long-standing refractory OAB who experienced only partial improvement with repeated intradetrusor BTX injections but achieved clinically meaningful symptom relief after ETA therapy. Nocturia, urgency, urgency urinary incontinence, and voided volume were improved, with no complications other than transient postoperative urethral pain. This case suggests that ETA therapy may represent a promising sensory-focused option for refractory OAB.

Pneumonic-type adenocarcinoma (P-ADC) can closely mimic pneumonia. We report a P-ADC initially diagnosed as pneumonia which developed into a pulmonary abscess and empyema. A 50-year-old Japanese male diagnosed with pneumonia, pulmonary abscess, and empyema was administered antibiotics and a chest tube for drainage, which improved his symptoms and blood test results. However, chest computed tomography showed an enlarged infiltrative shadow. The patient underwent bronchoscopy and was diagnosed with an adenocarcinoma. This case highlights the importance of considering P-ADC in differential diagnoses when a pneumonia-like shadow enlarges post-empyema treatment. Diagnostic and clinical tests, e.g., bronchoscopy, should be performed in such cases.

Taking advantage of the characteristics of the novel compact external loop recorder (ELR; eMEMO®), which is waterproof and has an automatic arrhythmia detection and monitoring function for up to 14 days, we investigated the usefulness of ELR measurement, especially during bathing. We included 294 patients (102 males and 192 females) who presented with palpitations as their main complaint from April 2021 to September 2022, with a mean age of 57.0 ± 17.4 years. The average wearing period of the ELR was 4.5 ± 0.9 days. ELR for longer than 24 h led to the first arrhythmia detection in 170 (21.3%) of the 799 cases of all detected arrhythmias, including 11 with premature atrial contraction, 50 with premature ventricular contraction, 8 with atrial fibrillation, 32 with supraventricular tachycardia, and 21 with sick sinus syndrome. They had low noise contamination during measurement. Arrhythmic events during bathing were observed in 52 patients, effectively detecting arrhythmia during bathing, which was difficult with the usual 24-h Holter electrocardiography (ECG). In addition, the itching and rash of the skin at the electrode attachment over a period of up to 5 days were very mild, indicating the comfort of the waterproof patch-type electrode. The patch-type ELR (eMEMO®) with waterproof design is capable of continuous recording regardless of restrictions such as bathing or exercise and is useful for detecting stable arrhythmias in patients with palpitations.

The capacity of articular cartilage for self-repair is limited. Therefore, wide-ranging cartilage damage rarely resolves spontaneously, leading to the development of osteoarthritis. Previously, we developed human-induced pluripotent stem cell (hiPSC)-derived expandable human limb-bud-like mesenchymal (ExpLBM) cells with stable expansion and high chondrogenic capacity. In this study, various forms of articular cartilage-like tissue were fabricated using ExpLBM technology and evaluated to examine their potential as biomaterials. ExpLBM cells derived from hiPSCs were used to produce particle-like cartilage tissue and plate-like cartilage tissue. The cartilaginous particles and cartilaginous plates were transplanted into a minipig osteochondral defect model, and cartilage engraftment was histologically evaluated. For both transplanted cartilaginous particles and cartilaginous plates, good Safranin O staining and integration with the surrounding tissue were observed. Cartilaginous particles and cartilaginous plates made using hiPSCs-derived ExpLBM cells are effective for the regeneration of cartilage after injury.

Undifferentiated carcinoma with osteoclast-like giant cells (UC-OGC) is a rare pancreatic tumor and typically presents as a giant hypervascular tumor with rapid growth and intratumoral hemorrhage. UC-OGC localized in the main pancreatic duct (MPD) without extraductal invasion is extremely rare and difficult to diagnose preoperatively. Although the tumor rapidly increases in size and often becomes too large for resection, patients with UC-OGC who undergo curative resection show a better prognosis than those with other types of undifferentiated carcinomas and pancreatic ductal adenocarcinoma (PDAC). We must recognize that UC-OGC could present as an MPD-localized tumor and, therefore, should not miss the chance for resection. In this study, we present an unusual case of UC-OGC that was completely localized in the MPD without extraductal invasion. A 77-year-old Japanese man presented to our hospital with excessive thirst. Blood tests showed elevated glycosylated hemoglobin levels (11.9%). Carcinoembryonic antigen, carbohydrate antigen 19-9, Duke pancreatic monoclonal antigen type 2, Span-1, and neuron-specific enolase levels were within normal ranges. Contrast-enhanced computed tomography (CT) showed a 22-mm indistinct nodule with prolonged enhancement in the pancreatic body and dilatation of the distal MPD. Fluorine-18-fluorodeoxyglucose positron-emission tomography with CT showed uptake at the nodule but no evidence of metastasis. Endoscopic ultrasonography showed that the tumor was a heterogeneous hypoechoic nodule localized in the MPD. Pancreatic juice cytology indicated atypical cells but no evidence of malignancy. We suspected PDAC, acinar cell carcinoma, or an intraductal tubulopapillary neoplasm. We performed laparoscopic distal pancreatectomy and splenectomy, along with lymph node dissection. Histopathological examination revealed a 30-mm intraductal tumor with intratumoral hemorrhage, fibrosis, and angiogenesis. The tumor was composed of atypical spindle cells that were partly positive for cytokeratin AE1/3, CAM5.2, and vimentin and scattered osteoclast-like multinucleated giant cells that were positive for CD68. The tumor was completely localized to the MPD without extraductal invasion or lymph node metastasis. The patient received tegafur, gimeracil, and oteracil potassium as postoperative adjuvant chemotherapy for six months and has been recurrence-free for more than five years.UC-OGC demonstrates rapid growth; however, a good prognosis can be expected with curative resection.

ObjectivesHelicobacter pylori eradication reduces but cannot eliminate the risk of gastric cancer (GC). The prevalence of post‐eradication GC has been rising. Characterization of the endoscopic findings of post‐eradication GC may facilitate its early detection. We performed a meta‐analysis and systematic review to clarify endoscopic risk factors to accelerate the early diagnosis of post‐eradication GC.MethodsMedline and PubMed were searched for randomized controlled trials, cohort studies, and case‐control studies published in the English‐language medical literature between January 1997 and July 2023. The included articles assessed the correlation between post‐eradication GC and pre‐ and post‐eradication endoscopic findings, and associated post‐eradication GC with gastric atrophy, intestinal metaplasia (IM), map‐like redness, and xanthoma.ResultsA total of 963 articles were retrieved. In these articles, 66 papers were finally included, comprising randomized controlled trials, cohort studies, and case‐control studies. The included articles addressed gastric atrophy (16 studies), IM (eight studies), map‐like redness (six studies), and xanthoma (two studies). Risk ratio (RR) of incident post‐eradication GC was 3.40 (95%confidence interval [95%CI]: 1.98–5.84; p < 0.001) in cases of severe atrophy, 5.38 (95%CI: 3.62–8.00) in cases of severe IM, 2.34 (95%CI: 1.16–4.68) in cases with post‐eradication map‐like redness, and 2.75 (95% CI: 1.78–4.26) in cases with xanthoma.ConclusionsEndoscopic atrophy, IM, and xanthoma observed at pre‐ and post‐eradication time points and post‐eradication map‐like redness were suggested as endoscopic risk factors for post‐eradication GC. Further studies are needed to clarify the risk of post‐eradication GC based on these risk factors.

PurposeTo determine prognostic parameters, we extensively examined whether physical, biochemical, and histological factors were associated with clinical outcomes in metastatic hormone sensitive prostate cancer (mHSPC) patients.MethodsA total 822 mHSPC patients were retrospectively investigated and examined the associations between prognosis and clinicopathological parameters including BMI, initial PSA level, TNM classification, Hb, Alb, CRP, AST, ALT, LDH, ALP, Gleason grade group, and EOD score.ResultsAccording to the CHAARTED criteria, 338 (41.1%) and 484 (58.9%) patients were classified into low- and high-volume disease, respectively. In univariate and multivariate analyses, Gleason grade group, Alb, CRP, LDH, and ALP were determined as significant predictors for both PFS and OS. When mHSPC patients were classified into three group including favorable (none of risk factors), intermediate (one or two risk factors) and poor (more than three risk factors) according to these four parameters, the survival curves were significantly stratified according to the risk classification. When the risk classification was applied on the patients with low- or high-volume disease in CHAARTED criteria, worse prognosis was found in poor risk group patients with low-volume disease and favorable prognosis was found in favorable risk group patients with high-volume disease.ConclusionThese results suggested that Gleason grade, CRP, LDH, and ALP were the independent predictors for mHSPC patients regardless of metastatic burden.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00345-025-05862-4.

Background and aims Endoscopic mucosal resection (EMR) is a standard preventive method for colorectal cancer. Managing patients on anticoagulants during EMR is challenging because of balancing bleeding and thrombotic risks. Updated guidelines recommend continuing anticoagulants over heparin bridging; however, data on bleeding risks with continuing anticoagulants remain limited. This multicenter prospective study evaluated bleeding rates in patients who continued oral anticoagulants during EMR. Methods Patients on warfarin or direct oral anticoagulants (DOACs) undergoing EMR were enrolled from 12 tertiary hospitals. Warfarin was maintained on the day of EMR, while DOACs were paused on the day of EMR and resumed afterward. Post-EMR mucosal defects were closed with clips per protocol. Adverse events were monitored for 30 days. The primary endpoint was the major bleeding rate, defined as immediate bleeding requiring difficult hemostasis or delayed bleeding necessitating endoscopic intervention. The secondary endpoints were minor bleeding, other adverse events, and differences in bleeding rates between warfarin and DOACs. Results Among 107 patients (341 polyps; mean size = 6.7 mm), major bleeding occurred in five (4.7%) patients (95% confidence interval: 2.0%-10.5%), and all cases were managed endoscopically. Minor bleeding and thromboembolism events occurred in eight (7.5%)patients and one (0.9%) patient, respectively. No significant differences in bleeding rates were observed between warfarin and DOACs. Major bleeding rates were lower than those reported for heparin bridging. Conclusions Continuing anticoagulanttherapy during EMR was associated with a low major bleeding rate (4.7%) and minimal thrombotic events, supporting its safety as an alternative to heparin bridging.