Gunma Children's Medical Center

Biliary inflammatory pseudotumor (IPT) of the liver is a rare benign tumor of which radiographic images, such as biliary stricture and dilatation, resemble those of cholangiocarcinoma (CC). Although repeated biliary cytology via endoscopic nasobiliary drainage (ENBD) is performed for differential diagnosis, a correct diagnosis remains difficult. The present study describes the case of a 76-year-old female patient with chronic liver disease. During surveillance, intrahepatic CC was suspected by imaging analyses; however, the carcinoembryonic antigen and CA19-9 levels were within normal ranges. Percutaneous core needle biopsy was not performed due to technical reasons; however, a left lobectomy was performed based on the diagnosis of malignancy by ENBD bile cytology. A pathological examination of the resected liver demonstrated biliary IPT. Reflecting on the cytological diagnosis of this case, a multi-reviewer re-evaluation of the biliary cytology of this IPT case and 2 cases of well-differentiated CC was then performed, which demonstrated difficulty in distinguishing between them. On the whole, ENBD cytology can play a limited role in differentiation between benign and malignant bile strictures. Surgical indication should be carefully determined and percutaneous core needle biopsy may be warranted in patients with normal tumor marker levels.

Several studies have evaluated thin and thick split-thickness scalp skin grafts (STSG); however, detailed outcomes of thick grafts have not been well defined. This study aimed to evaluate the safety, complications, and outcomes associated with thick STSGs harvested from the hairy scalp. This retrospective study included 102 Korean patients who underwent thick STSGs from the hairy scalp using a dermatome depth setting of 0.4mm (16 mils=0.016 inches). Preoperative scalp thickness was measured using ultrasonography. Graft thickness was evaluated histometrically at its thickest portion and compared with the dermatome depth setting. Outcomes and complications were assessed for both donor and recipient sites. The cohort included 71 males and 31 females [mean age: 33.3y (±23.8; range 0.8-78)]. The mean ultrasound-measured scalp thickness was 67.4 mils (±16.8; range: 32-106). The mean dermatome setting was 21.5 mils (±4.5; range: 16-32), and the mean histometric graft thickness was 26.7 mils (±6.9; range: 11-50). Donor site healing averaged 9.7 days (±2.0; range: 6-15). Complications at the recipient site included hypertrophic scarring (n=9), partial graft loss (n=8), contracture (n=7), dyschromia (n=6), and hair transfer (n=6). Vancouver Scar Scale (VSS) scores improved substantially in representative cases, demonstrating favorable aesthetic and functional improvements. All donor sites achieved successful regenerative healing. Thick scalp grafts demonstrated reduced contracture and superior color matching. These findings support the use of the hairy scalp as a safe and effective donor site for thick STSGs.

Central nervous system (CNS) prophylaxis is recommended for patients with diffuse large B-cell lymphoma (DLBCL) who are at high risk of CNS relapse. This study aimed to determine the impact of CNS prophylaxis on CNS relapse rates and overall survival (OS) in this patient population, as well as the optimal method for CNS prophylaxis. This was a retrospective analysis of 178 patients with DLBCL at high risk of CNS relapse who were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) or its derivatives with (N = 60) or without (N = 118) CNS prophylaxis. The 2-year CNS relapse rate was 17.6% in the all-prophylaxis group (HD-MTX 17.4%, IT 48.1%, and HD-MTX + IT 6.2%) and 13.0% in the non-prophylaxis group, with no significant difference between groups. However, HD-MTX + IT decreased the risk of CNS relapse. After a median follow-up of 72.8months, HD-MTX + IT addition significantly improved the 5-year OS (HD-MTX 73.5%, IT 44.4%, HD-MTX + IT 93.2%; non-prophylaxis group 58.0%; p = 0.013). This advantage was maintained in the multivariate analysis (hazard ratio: 0.160; 95% confidence interval: 0.039-0.663; p = 0.012). CNS prophylaxis with HD-MTX + IT improved the prognosis of patients with DLBCL at high risk of CNS relapse.

The authors declare no conflict of interests.

BackgroundUltrasound hip screening is crucial for the early detection of developmental dysplasia (DDH), but little is known about standardized training approaches for nurses. This study aimed to evaluate an educational program combining web-based learning and objective structured clinical examination (OSCE) training to improve nurses’ knowledge and skills in ultrasound hip screening and DDH prevention during universal neonatal and infant home visits.MethodsThe program targeted two objectives: (1) to enable nurses to understand the Graf method and acquire standard plane ultrasound images, and (2) to equip them to provide preventive health education on DDH. The intervention included five web-based modules and a two-day OSCE-based hands-on program, supervised by orthopedic pediatric surgeons. Outcomes included (1) knowledge test scores obtained from the web-based modules (range: 0–50 points), (2) OSCE scores (36 items, range: 0–360; global rating ≧3 on a 1–6), including delivery of preventive health education, (3) ability to capture a standard plane image using a phantom within three minutes, and (4) ability to capture a standard plane image with infant volunteers, assessed by medical supervisors.ResultsNineteen participants (18 public health nurses and one midwife) from three municipalities completed the program. The mean knowledge test score was 47.2 (SD: 2.2), and the mean OSCE score was 329.3 (SD: 21.7), with a global rating of 4.4 (SD: 0.7). All participants conducted the preventive health education component. Eighteen participants (right hip) and 17 (left hip) successfully captured standard plane images using a phantom within three minutes. In scans of 39 infant volunteers, 34 scans (87.2%) successfully captured the standard plane; participants self-reported 31 as successful, though two were objectively classified as failures.ConclusionsThe educational program improved nurses’ ultrasound hip-screening skills and their capacity to deliver preventive health education during universal home visits. These findings support the potential feasibility of expanding nurse-led ultrasound screening and DDH prevention efforts in community settings.Trial registrationThis study was registered with the University Hospital Medical Information Network Clinical Trial Registry before starting the study (No. UMIN000051929, August 16, 2023).

PurposeNivolumab plus ipilimumab (Nivo-Ipi) combination therapy is an effective first-line treatment for advanced non-small cell lung cancer (NSCLC). However, its effectiveness and feasibility in elderly patients (aged ≥ 75 years) remain unclear. This study aimed to investigate the efficacy and safety of first-line Nivo-Ipi therapy in elderly patients with NSCLC.MethodsThis retrospective study included 57 patients with NSCLC (52 men and 5 women), aged ≥ 75 years (range: 75–86) who received first-line Nivo-Ipi therapy from December 2020 to November 2022 at four institutes in Japan. Patient characteristics, therapeutic efficacy, and the incidence and severity of adverse events (AE) were assessed.ResultsThe overall response rate was 42.1%, the disease control rate was 73.6%, the median progression-free survival (PFS) was 7.1 months, and the median overall survival (OS) was 14.1 months. Common Grade ≥ 3 AEs included pneumonitis, elevated aspartate transaminase, elevated alanine transaminase, adrenal insufficiency, and colitis. No treatment-related deaths were reported. PFS and OS were longer in patients who experienced treatment-related AEs. Patients with and without AEs had a median PFS of 11.7 and 2.8 months, respectively. Similarly, the median OS of patients with and without AEs was 20.4 and 9.0 months, respectively.ConclusionFirst-line Nivo-Ipi therapy is effective in elderly patients with NSCLC. Although there was an increased incidence of pneumonitis, the treatment was manageable and presented as a viable treatment option. Notably, the occurrence of treatment-related AEs was associated with improved clinical outcomes, suggesting a potential prognostic value of AEs in this population.

Karyopherin alpha 2 (KPNA2) has been reported to be associated with cancer aggressiveness and treatment resistance via transporting several cargo proteins into the nucleus, such as cancer-promoting E2F and DNA repair-related MRN complex. Recent studies have highlighted the KPNA2 functions in tumorigenesis and the progression of various cancers. However, the importance of KPNA2 expression has yet to be elucidated in clinical neuroblastoma patients. This study aimed to analyze the clinical impact of KPNA2 expression in neuroblastoma. KPNA2 expression in 81 resected neuroblastoma sections was examined using immuno-histochemical staining. The significance and prognostic value of tumoral KPNA2 expression were analyzed using our cohort and R2 database. The KPNA2 was expressed in the nucleus of neuroblastoma cells. The expression level of nuclear KPNA2 was not associated with clinicopathological factors in neuroblastoma. Among our cohort (n=81), non-radically resected neuroblastoma patients (n=37) with high KPNA2 expression had poorer prognoses than those with low KPNA2 expression. The R2 database analysis validated that the high KPNA2 expression was related to the poor prognosis in the large-scale neuroblastoma cohort. KPNA2 expression evaluation in neuroblastoma is a promising indicator of prognosis in non-curative resected cases. KPNA2 targeting may be a promising therapeutic strategy against advanced neuroblastoma.