Hiratsuka City Hospital

ABSTRACTBackgroundRhythm control therapy improves the quality of life and prognosis of patients with atrial fibrillation (AF). We assessed the characteristics and clinical outcomes of AF patients with stable coronary artery disease (CAD) undergoing rhythm control therapy.MethodsWe analyzed 2215 participants from the Atrial Fibrillation and Ischemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease (AFIRE) trial, including 588 patients who received rhythm control therapy and 1627 who did not.ResultsAt baseline, patients who received rhythm control therapy were generally younger, exhibited a higher prevalence of paroxysmal AF, experienced less heart failure, and had lower CHADS2 scores (CHF, hypertension, age ≥ 75 years, type 2 diabetes, and previous stroke or transient ischemic attack [doubled]) than those who did not. Among the rivaroxaban monotherapy and combination therapy groups, patients with a history of rhythm control therapy showed a lower incidence of the primary efficacy endpoint (a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death). However, following multivariate analysis and propensity score matching, no statistically significant difference in the primary efficacy endpoint was observed between patients with and without prior rhythm control therapy (adjusted HR 0.75, 95% CI 0.37–1.51, p = 0.43 in the rivaroxaban group; adjusted HR 0.75, 95% CI 0.43–1.30, p = 0.30 in the combination therapy group).ConclusionsThe initially observed benefit of rhythm control therapy was not significant after adjusting for baseline characteristics in patients with AF and stable CAD treated with rivaroxaban with or without additional antiplatelet therapy.

We describe a technique for repairing Crawford type IV thoracoabdominal aortic aneurysms using a midline abdominal incision with left transverse extension, performed in the supine position without thoracotomy. Six patients (median age, 73 years) underwent this approach for true aneurysms, chronic dissection, or aortoduodenal fistula. Aortic reconstruction was performed with four-branched or bifurcated grafts under selective visceral perfusion. All patients were discharged home; one required reoperation for bleeding, and one developed an abdominal wall incisional hernia. This approach provided sufficient exposure for proximal and distal anastomoses and facilitated concurrent abdominal procedures while minimizing respiratory complications.

This retrospective cohort study aimed to emulate the ADVANCE trial population and directly compare the Endurant and Excluder using propensity score matching. Patients were included if endovascular aneurysm repair was performed for abdominal aortic aneurysm using either Endurant or Excluder at 10 hospitals in Japan between January 2012 and July 2022. Cases were selected according to the modified ADVANCE trial inclusion and exclusion criteria. To minimize selection bias and simulate a randomized controlled trial setting, propensity score matching was performed using patient and anatomical characteristics. The primary outcome measure was the proportion of patients with sac regression ≥ 5mm at 1year. The secondary outcome measures were rates of freedom from late complications, T1aEL, sac enlargement ≥ 5mm, and overall survival. Outcomes were first analyzed in patients within the instructions for use (IFU) and then in all matched patients including outside IFU patients. After matching, the within-IFU group included 124 pairs and the total cohort of 266 pairs. The primary outcome measures for Endurant and Excluder were met in 38.9% and 36.6% (p = 0.74) in the within-IFU group and 33.5% and 35.0% (p = 0.74) in the total cohort, respectively. No significant differences were observed in any secondary outcome measures. However, T2EL and use of additional proximal cuff were significantly more frequent for Excluder in both the within-IFU and total cohort. Furthermore, T1b and T5ELs occurred significantly more for Endurant in the total cohort. There were no significant differences in all clinical outcome measures between Endurant and Excluder. Level IV, multicenter retrospective cohort study.

Introduction and importanceMale breast cancer is a rare disease that accounts for less than 1 % of all breast cancer cases. The most common surgical treatment for male breast cancer is mastectomy, but breast-conserving surgery has been performed increasingly in recent years. This report describes a case of male breast cancer that was treated by breast-conserving surgery.Case presentationA 61-year-old man visited our hospital complaining of a painless mass in his left breast. Imaging revealed a well-defined cystic mass, aspiration of which revealed bloody fluid. Cytology was inconclusive, but the findings were suggestive of malignancy. A left lumpectomy was performed for diagnostic purposes. Postoperative pathology revealed invasive ductal carcinoma with a predominant intraductal component. The surgical margins were negative. The patient declined adjuvant hormone therapy and radiotherapy and has been kept under follow-up in the year since surgery. There has been no recurrence during this time.Clinical discussionAs in women, the goals of treatment for breast cancer in men are oncological safety and satisfactory cosmetic results. In the absence of specific guidelines for the treatment of male breast cancer, mastectomy is currently the standard treatment. However, in recent years, breast-conserving surgery has been performed for tumors that are discovered early and do not invade the nipple and areola. If curability and safety can be guaranteed, breast-conserving surgery can be considered for male breast cancer.ConclusionBreast-conserving surgery can be an effective treatment option in men with breast cancer.

The Japanese Society for Sentinel Node Navigation Surgery conducted a multi-institutional prospective cohort study to compare sentinel node biopsy (SNB) with SNB followed by axillary lymph node dissection (ALND) in breast cancer patients with positive sentinel lymph node (SLN). Female patients with breast cancer with cT1-3N0-1M0 were eligible. In cases of one to three positive micro- or macrometastases in the SLN confirmed by histological or molecular diagnosis, SNB alone (SNB group) or additional ALND (ALND group) was performed under physician's discretion. The primary endpoint was the 5-year regional node (RN) recurrence rate in the SNB group. Propensity score matching (PSM) was performed to compare the prognosis between the two groups. Of the 871 eligible cases registered between 2013 and 2016, 308 underwent SNB alone. At the median follow-up of 6.3years, 5-year RN recurrence rate was 2.7%. After PSM, 209 cases were matched in each group. Breast-conserving surgery and mastectomy were performed in 225 (54%) and 193 cases (46%), respectively. One-positive SLN was recorded in 366 cases (88%), two in 48 (11%), and three in 4 (1%). Macro- and micrometastases in SLN were diagnosed in 271 (65%) and 147 cases (35%), respectively. Regional nodal irradiation (RNI) was performed in 42 (20%) and 13 (6%) cases of the SNB and ALND group. The 5-year RN recurrence rate was 2.1% and 2.0%, respectively. ALND is not necessary for early breast cancer patients with one-positive SLN despite type of breast surgery.

Retrospective multicenter study. To evaluate how preoperative neck pain influences clinical outcomes following posterior decompression for cervical ossification of the posterior longitudinal ligament (OPLL). Fourteen medical institutions in Japan. We enrolled 90 patients with cervical OPLL who underwent posterior decompression and were followed for a minimum of two years. We collected demographic data, medical history, and imaging findings. Patients were divided into two groups based on preoperative neck pain presence (Pre-op. neck pain (-) and (+) groups), and their outcomes were compared. There were no significant differences in patient demographics between the Pre-op. neck pain (-) and (+) groups. Both groups showed similar distributions of ossification types and K-line positivity. Perioperative complications were comparable between the two groups. Radiographic analysis revealed no significant differences in C2-7 angles or cervical range of motion, pre- and postoperatively. Both groups demonstrated significant improvement in postoperative Japanese orthopedic association (JOA) scores, but there were no significant differences in scores or recovery rates. In the Pre-op. neck pain (-) group, factors associated with appearance of postoperative neck pain included pre- and postoperative lower JOA scores and larger C2-7 angles in neutral and extension positions. It emerges that lower pre- and postoperative JOA scores or larger C2-7 angles in neutral and extension positions predispose to postoperative neck pain even in those patients without preoperative neck pain. Therefore, this is worth discussing at the time of consenting patients for surgical decompression and fixation.

A 74-year-old woman with no history of trauma visited our hospital with right-sided abdominal pain and general malaise. Blood tests revealed elevated inflammatory markers. A computed tomography (CT) scan revealed a 8 cm mass and subcapsular hematoma on the lower pole side of the right kidney. She was diagnosed with a malignant tumor or renal abscess combined with subcapsular hematoma and inflammation and was treated conservatively with antibiotics. The symptoms quickly improved. Although kidney biopsy was performed, no obvious malignant cells were found. Since a subsequent CT scan could not exclude the possibility of kidney cancer, radical nephrectomy was performed. The histopathological diagnosis was clear cell renal cell carcinoma. She has not experienced recurrence within 10 months after the surgery. Clear cell renal cell carcinoma combined with subcapsular blood is relatively uncommon and can be difficult to diagnose, requiring careful decision-making regarding treatment indications.

Lung metastasis is the second most common type of metastasis in colorectal cancer. Specific treatments for lung metastasis have not been developed since the underlying mechanisms are poorly understood. The present study aimed to elucidate the molecular basis of lung metastasis in colorectal cancer. In a mouse model, cell lines that were highly metastatic to the lungs were established by injecting colorectal cancer cells through the tail vein and removing them from the lungs. Differential gene expression comparing the transfected cells with their parental cells was investigated using DNA microarrays. The results were functionally interpreted using gene enrichment analysis and validated using reverse transcription-quantitative PCR (RT-qPCR). The isoforms of the identified genes were examined by melting curve analysis. The present study established colorectal cancer cell lines that were highly metastatic to the lungs. DNA microarray experiments revealed that genes (N-cadherin, VE-cadherin, <i>Six4</i>, Akt and VCAM1) involved in motility, proliferation and adhesion were upregulated, and genes (<i>tissue inhibitor of metalloproteinase-3</i> and <i>PAX6</i>) with tumor-suppressive functions were downregulated in metastatic cells. <i>Profilin 2</i> (<i>PFN2</i>) expression was upregulated in multiple metastatic cell lines using RT-qPCR. Two <i>PFN2</i> isoforms were overexpressed in metastatic cells. <i>In vitro</i> and <i>in vivo</i> models were established and genes associated with lung metastasis were identified to overcome the heterogeneity of the disease. Overall, aberrant <i>PFN2</i> expression is unreported in lung metastasis in colorectal cancer. In the present study, two <i>PFN2</i> isoforms with differential tissue distribution were upregulated in metastatic cells, suggesting that they promote lung metastasis in colorectal cancer.