Higashiosaka College & Higashiosaka Junior College

Almost 10% of all pregnant women are diagnosed with placental location abnormalities (PLA), including placenta previa and low-lying placenta; however, most of PLA resolve as pregnancy process. Despite of placental migration, postpartum hemorrhage (PPH) is often experienced in those cases. The association between the timing of placental migration and the risk of PPH has remained unclear. The aim of this study is to investigate the relationship between the timing of placental migration and the PPH, and to establish a cutoff value to accurately predict the risk of PPH in cases who underwent the placental migration during course of pregnancy. This was a retrospective cohort study using electronic medical records in Osaka University Hospital (Japan). Patients diagnosed with PLA after 22 gestational weeks using transvaginal ultrasonography were eligible for inclusion. All patients delivered at our hospital between 2009 and 2022. Focusing on the cases in which placental migration (more than 2 cm away from the internal cervical os) were observed, the association between the timing of placental migration and the PPH was investigated only in vaginal delivery using the multivariate analyses with collecting covariates that could affect the PPH. Based on the results, receiver operating characteristic curves were generated to determine the optimal cutoff for the number of weeks of placental migration to predict PPH. One hundred and forty-five patients were diagnosed with PLA after 22 gestational weeks and delivered at our hospital between 2009 and 2022. Seventy-six after-placental migration cases with successful vaginal delivery were analyzed. The median gestational age of placental migration was 32 weeks, and the median amount of hemorrhage during delivery was 777 mL. PPH (500-1000 mL) occurred in 34 cases (44.7%), >1000 mL in 26 (34.2%). In the univariate analysis, a positive correlation was observed between the timing of placental migration and the amount of hemorrhage (r=0.365, P<.01). Furthermore, multivariate analysis showed that the timing of placental migration is the most strongly influential covariate (standardized partial regression coefficient: 0.31, P=.0036) for predicting the amount of hemorrhage. In addition, the timing of placental migration was a significant risk for PPH (more than 500 mL) (adjusted unit OR 1.26 [95% CI: 1.07-1.49]). The receiver operating characteristic curve indicated that the moderate cutoff of the timing of placental migration to predict the risk of PPH (more than 500 mL) was 29 gestational weeks. In comparison between the groups in which placental migration was confirmed before 29 gestational weeks (n=19) and after 30 gestational weeks (n=57), the incidences of PPH (more than 500 mL) were significantly higher in the group in which placental migration was confirmed after 30 gestational weeks (52.6% vs 87.7%, P=.0012). The timing of placental migration is positively correlated with the occurrence of PPH. In particular, cases in which placental migration is confirmed after 30 gestational weeks should be monitored carefully as high risk for PPH, as the risk of PPH is not eliminated.

Background/AimImmune checkpoint inhibitors (ICIs) have become central in the treatment of non-small cell lung cancer (NSCLC). The occurrence of immune-related adverse events (irAEs) is a critical issue in the management of patients with NSCLC receiving ICIs. Recent studies have suggested that patients who develop irAEs may have a better prognosis than those who do not. However, the most problematic cases involved the development of severe irAEs. This study aimed to investigate the clinical impact of severe irAEs (grade ≥3) in patients with NSCLC treated with ICIs.Patients and MethodsWe analyzed 122 patients from a prospective database of consecutive patients with NSCLC who received first-line ICI-containing treatment between November 2018 and October 2024. Patients were classified into two groups: 48 treated with anti-programmed death-ligand 1 (anti-PD-L1) therapy and 74 treated with anti-programmed death-1 (anti-PD-1) therapy. We retrospectively compared the incidence of severe irAEs between the two groups and evaluated the clinical outcomes of severe irAEs on the survival.ResultsAmong 122 patients, 24 (19.7%) experienced severe irAEs. The incidence of severe irAEs was significantly higher among patients treated with anti-PD-1 than among those treated with anti-PD-L1. The incidence of irAE-related death was also higher in the anti-PD-1 group than in the anti-PD-L1 group, with pneumonitis accounting for most of these fatalities (87.5%). There were no significant differences in the progression-free or overall survival between patients with and without severe irAEs. A multivariable analysis showed that the use of anti-PD-1 therapy was associated with a worse overall survival.ConclusionTreatment with anti-PD-1 was associated with an increased risk of severe irAEs. The incidence of severe irAEs was not associated with an improved survival rate.

Although several clinical trials have suggested the usefulness of drug-coated balloons (DCB) for side-branch lesions, their efficacy and safety have not yet been established. The Osaka Cardiovascular Conference (OCVC) will conduct a multicenter, randomized, open-label, controlled trial aiming to examine whether additional DCB treatment for the side branch after main vessel stenting followed by kissing balloon inflation (KBI) is superior to only KBI by conventional balloons in PCI patients with coronary bifurcation lesions. The primary endpoint is restenosis of side branches documented by scheduled or symptom-driven coronary angiography during 9-month follow-up period after the index PCI. The key secondary endpoints include major adverse cardiac event which consists of cardiac death, myocardial infarction, target lesion revascularization, and stent thrombosis, and optical coherence tomography findings. A total of 300 patients will be enrolled and followed up to 1year. The OCVC-BIF trial is a randomized controlled trial designed to assess whether additional DCB treatment for side branch is superior to only KBI by conventional balloons in patients with coronary bifurcation lesions undergoing PCI with main vessel stenting.

Abstract We analyzed the differences in bacterial composition between 475 Japanese patients with advanced gastric cancer (median age 70 years, median BMI 20.0) and 106 healthy individuals using a comprehensive metagenome shotgun analysis. Among the patients with advanced gastric cancer, 71% were male, 37.% patients had relapsed, and 55.5% previously underwent gastrectomy. Bifidobacterium , Anaerostipes , and Parabacteroides were predominant in healthy individuals, whereas Streptococcus , Lactobacillus , and Odoribacter were predominant in patients with advanced gastric cancer. Additionally, Kyoto Encyclopedia of Genes and Genomes pathway analysis showed that butanoate and pyruvate metabolism was enriched in healthy individuals, whereas factors such as ABC transporters and ribosomes were enriched in patients with advanced gastric cancer. Clustering analysis broadly classified patients with advanced gastric cancer and healthy individuals into two clusters; however, clustering using pathway data enabled a clearer classification of patients with advanced gastric cancer and healthy individuals than clustering using flora analysis. Moreover, healthy individuals showed higher bacterial flora diversity than patients with advanced gastric cancer. Thus, we successfully identified the molecular characteristics of microbial genera and functional pathways in the gut of patients with advanced gastric cancer. Our results suggest that fecal metagenomic shotgun sequencing analysis can be used to detect gastric cancer.

Intraductal papillary neoplasms of the bile duct (IPNBs) have a high propensity for malignant transformation; therefore, surgical resection remains the standard first-line treatment. In cases where hepatic lobectomy is not feasible, however, controlling biliary drainage can be challenging. We present herein a case of unresectable IPNB complicated by jaundice and cholangitis due to mucin production by the tumor. Stereotactic body radiation therapy (SBRT) has been used as a treatment modality, resulting in favorable outcomes. An 80-year-old male patient presented to the emergency room with symptoms of cholangitis, for which he had previously undergone endoscopic lithotripsy for the removal of choledochal stones. The persistent symptoms and viscous bile led to suspicions of IPNB; therefore, the patient underwent a peroral cholangioscopy with biopsy to confirm the diagnosis. Due to his compromised cardiac function, however, surgical resection was not deemed a viable option, and biliary drainage was attempted instead. Unfortunately, frequent mucin-induced obstructions of the catheter made it difficult to control the cholangitis; therefore, SBRT was administered to achieve local tumor control and reduce mucin production. The radiation was delivered using a 10 MV beam with a volumetric-modulated arc therapy, fiducial gold markers, and suspended exhalation. A total dose of 60 Gy was administered across eight fractions (planning target volume D95), and one month post-SBRT, the biliary dilation and cholangitis had resolved. No local tumor regrowth or recurrent cholangitis occurred for at least one year after treatment, nor were any significant adverse effects related to the SBRT observed. According to the Surveillance, Epidemiology, and End Results (SEER) database, SBRT has been performed for IPNB; however, only a few case reports have been identified, all of which were cases in which brachytherapy was performed. To our knowledge, this is the first case report detailing a treatment regimen of SBRT with a definite radiation dose. This case suggests that SBRT may be of value as an alternative therapy for cases in which surgical resection is not an option.

There has been no systematic analysis of coping strategies for behavioral and psychological symptoms of dementia (BPSD) using large-scale cumulative data. We preliminarily examined the characteristics of successful and unsuccessful coping strategies for BPSD. We employed a deductive and inductive analysis (hybrid approach) of the data derived from "Ninchisho Chienowa-net," a web-based system that collects caregivers' coping strategies for BPSD. Antecedent control procedure and consequence manipulation in applied behavior analysis (ABA) were used as theory-driven codes for deductive classification. We targeted 1049 cases except "others" among BPSD's categories submitted from January 2016 to January 2019, and finally, 1027 were selected. Subsequently, nine sub-codes of coping strategies were inductively generated through a trial classification in the first BPSD category, applying these to remaining categories. Success frequencies varied significantly across coping strategy sub-codes: strategies "assisting the person in performing other activities," "addressing setting events," "listening to the person and accepting her/his challenges," and "multi-coping strategies" had higher success frequencies than expected. Conversely, "explaining reality" and "inhibiting BPSD" had higher failure frequencies than expected. As for the BPSD category "problems due to forgetting," "prompting the person to do an appropriate behavior" was more successful than other coping strategies. This investigation systematically elucidated the efficacy of various coping strategies, delineating successful ones from those that were not. The discerned patterns across all categories of BPSD and within each individual category will provide valuable insights for caregivers.

The purpose of this study was to systematically review the existing literature on grief in family carers of people with dementia in Japan and to synthesise the evidence on the prevalence and associated factors of pre- and post-death grief of the carers. CiNii Research, J-STAGE, and ICHUSHI were searched for studies published in Japanese and MEDLINE, PsycINFO, and CINAHL for studies written in English up to 30 November, 2023. Of the 315 references identified, eight studies that met the eligibility criteria were included: six studies investigated pre-death grief, and two studies investigated post-death grief. One low-quality study reported the prevalence of pre-death grief (28.6%), and no studies reported the prevalence of complicated grief as post-death grief. Less social support and greater levels of depressive symptoms and caregiving burden were associated with greater levels of pre-death grief, while no studies reported significant factors associated with complicated grief. Most of the studies had small sample sizes and poor study quality. Limited evidence makes it difficult to draw conclusions about the prevalence of pre-/post-death grief and associated factors among family carers of people with dementia in Japan. Future studies focusing on grief using validated measures are needed.

Malignant peripheral nerve sheath tumours (MPNSTs) are malignant tumours arising from a peripheral nerve or displaying nerve sheath differentiation. Most MPNSTs are found on the head, body trunk and extremities, whereas cases in the gastrointestinal are extremely rare. About half arise in neurofibromatosis type 1 patients and 10% arise post-irradiation. This is probably the first small bowel MPNST post-radiation therapy case reported. A 72-year-old female who received radiotherapy 30years ago for cervical cancer was admitted with progressive abdominal pain and weight loss. Computed tomography revealed a mass with inhomogeneous enhancement in the lumen of the small intestine. Tumour excision was performed with ileocecal and sigmoid colon resection due to suspicion for peripheral tissue invasion. Histopathological examination revealed spindle-shaped cells with focal cartilage differentiation. Together with immunochemistry stain showing complete loss of H3K27me3, a final diagnosis of MPNST was made. The patient is presently under regular follow-ups, and has remained disease-free for 24months.

Mouth rinsing with a carbohydrate (CHO) solution has emerged as a sports nutrition strategy to increase endurance performance. This study aimed to clarify the effects of two forms of CHO sensing in the mouth (i.e., CHO mouth rinse (CMR) and CHO mouth spray (CMS)) on exercise performance during prolonged exercise, including ultra-high intensity intermittent exercise over time. We conducted the following experimental trials: (1) 6% glucose solution (G), (2) 6% CMR, (3) 6% CMS, and (4) water (WAT). These trials were conducted at least 1 week apart in a randomized crossover design. Eight male college students performed constant-load exercise for 60 min (intensity 40% VO2peak), four sets of the Wingate test (three 30 s Wingate tests with a 4 min recovery between each test), and a constant-load exercise for 30 min (intensity 40% VO2peak). The mean exercise power output (Watt), ratings of perceived exertion, and blood glucose levels were measured. We found that the mean power values of the CMR and CMS in the third and fourth sets was significantly higher than that of WAT (p < 0.05), and that the G trial did not show a significant difference from any other trial. Thus, when compared to G or WAT, CMR and CMS can help improve endurance exercise performance.