Hoshigaoka Medical Center

Background:Lymphedema is a lifelong complication for cancer survivors, highlighting the need to address the regional disparities in its treatment. To assess the current regional disparities in surgical treatment for lymphedema, we conducted a comprehensive nationwide survey of medical institutions through questionnaires.Methods:Japanese surgical treatment facilities were categorized into 9 regions, distinguishing between designated cancer hospitals and other medical institutions, as well as high-volume and low-volume hospitals. We examined variations in the number of surgical procedures per capita across regions and analyzed differences in surgical indications between high-volume and low-volume hospitals based on the clinical classification of the International Society of Lymphology.Results:There was a 17.4-fold difference in the number of lymphedema surgical treatments per population between the region with the highest and lowest numbers. A strong correlation was found between the number of procedures in a region and the percentage of procedures performed at high-volume hospitals (ρ = 0.73, P = 0.03). High-volume hospitals had a significantly higher proportion of cases deemed suitable for surgery at an early stage of lymphedema than low-volume hospitals (P < 0.001 and P = 0.0032 in stages 0 and I in the upper extremity, and P < 0.001 in stages 0 and I in the lower extremity).Conclusions:Significant regional variations exist in both the frequency of lymphedema surgery and surgical indication patterns across healthcare facilities, even in an environment where surgical treatment is covered by insurance. Standardized studies evaluating treatment outcomes are needed to assess the appropriateness of treatment indications.

It remains unclear whether patients with metastatic castration-sensitive prostate cancer (mCSPC) are suitable for upfront docetaxel therapy. Therefore, we retrospectively evaluated patients with metastatic castration-resistant prostate cancer (mCRPC) who could not receive ≥6 cycles of docetaxel for mCRPC. This study enrolled 274 patients diagnosed with mCSPC who later developed mCRPC, with data at diagnosis, including blood test results, available from 17 hospitals between 2008 and 2022. Failure to receive ≥6 cycles of docetaxel was defined as receiving ≤5 cycles of docetaxel for mCRPC or dying due to prostate cancer without docetaxel therapy. Factors at mCSPC diagnosis associated with failure to receive ≥6 cycles of docetaxel were evaluated using logistic regression analysis. Ninety-three patients were not able to receive ≥6 cycles of docetaxel for mCRPC. Multivariate analysis revealed that high lactate dehydrogenase levels and Gleason grade group 5 were significantly associated with failure receive ≥6 cycles of docetaxel for mCRPC. Furthermore, in patients with these factors at mCSPC diagnosis, receiving ≥6 cycles of docetaxel was significantly associated with better overall survival. Patients with mCSPC who have high lactate dehydrogenase levels and a Gleason grade 5 may be candidates for upfront docetaxel therapy, as they may otherwise miss the chance to receive adequate doses for prostate cancer.

Post-operative delays in blood oxygen recovery are sometimes observed after total knee arthroplasty (TKA), with obstructive sleep apnoea (OSA) being a contributing factor. This study aimed to examine the prevalence of OSA and its correlation with post-operative oxygen saturation (SpO2) recovery in patients undergoing TKA for knee osteoarthritis (OA). This was an observational case-control study including patients with knee OA who underwent TKA between January 2018 and October 2021. Pre-operative symptoms of OSA were assessed, and the apnoea-hypopnoea index, 3% oxygen desaturation index (ODI), average SpO2 and sleep body positions were measured using sleep testing devices. Knee function was evaluated using the 2011 Knee Society Score and range of motion (ROM). A total of 240 patients (41 males and 199 females) with a mean age of 74 years (range 51-93 years) were included in this study. Of the 240 patients, 49 (20.4%) had no OSA, 104 (43.3%) had mild OSA and 87 (36.3%) had moderate to severe OSA. OSA severity increased with a higher body mass index. Diabetes prevalence increased as the severity of OSA increased. OSA severity did not affect pre-operative knee function scores or ROM. However, higher ODI and lower pre-operative SpO2 were associated with increased OSA severity. Additionally, patients with severe OSA exhibited a greater proportion of supine sleep time and delayed post-operative oxygen discontinuation. Patients with knee OA scheduled for TKA have a high prevalence of OSA. Increased OSA severity delay oxygen discontinuation after TKA.

The human body has the potential to integrate with technology to enhance its intrinsic capabilities. Human enhancement technology requires the methodology of augmenting body functions and training brain functions to facilitate the effective use of the modified novel body. This study presents human locomotor adaptation to a novel force field generated by an elastic exotendon web suit and tests the effects of assistance provided by the passive soft exosuit from kinematic, kinetic, and physiological perspectives. Our primary results suggest that the elastic exotendon web suit was effective for slow walking, improving energy economy by a maximum of 8.0% at a walking speed of 0.7 m/s. The effect of the exotendon web suit was comparable to that of recent passive exoskeletons for locomotion.

Most cases of patellar dislocation can be reduced spontaneously or manually without sedation. To date, only one case of arthroscopic reduction for a lateral locked patellar dislocation has been reported, with a short follow-up period. Herein, we report the case of a 22-year-old man with a lateral locked patellar dislocation for whom we performed arthroscopic reduction and repair of the medial structure, which stabilized the patella medially. The patient was followed up for five years postoperatively and experienced no recurrence of patellar dislocation or difficulties in daily life.

BackgroundPlatelet-rich plasma (PRP), which is prepared by concentrating platelets in autologous blood, shows efficacy in chronic skin wounds via multiple growth factors. However, it exhibits heterogeneity across patients, leading to unstable therapeutic efficacy. Human induced pluripotent stem cell (iPSC)-derived megakaryocytes and platelets (iMPs) are capable of providing a stable supply, holding promise as materials for novel platelet concentrate-based therapies. In this context, we evaluated the effect of iMPs on wound healing and validated lyophilization for clinical applications.MethodsThe growth factors released by activated iMPs were measured. The effect of the administration of iMPs on human fibroblasts and human umbilical vein endothelial cells (HUVECs) was investigated in vitro. iMPs were applied to dorsal skin defects of diabetic mice to assess the wound closure rate and quantify collagen deposition and angiogenesis. Following the storage of freeze-dried iMPs (FD-iMPs) for three months, the stability of growth factors and their efficacy in animal models were determined.ResultMultiple growth factors that promote wound healing were detected in activated iMPs. iMPs specifically released FGF2 and exhibited a superior enhancement of HUVEC proliferation compared to PRP. Moreover, an RNA-seq analysis revealed that iMPs induce polarization to stalk cells and enhance ANGPTL4 gene expression in HUVECs. Animal studies demonstrated that iMPs promoted wound closure and angiogenesis in chronic wounds caused by diabetes. We also confirmed the long-term stability of growth factors in FD-iMPs and their comparable effects to those of original iMPs in the animal model.ConclusionOur study demonstrates that iMPs promote angiogenesis and wound healing through the activation of vascular endothelial cells. iMPs exhibited more effectiveness than PRP, an effect attributed to the exclusive presence of specific factors including FGF2. Lyophilization enabled the long-term maintenance of the composition of the growth factors and efficacy of the iMPs, therefore contributing to stable supply for clinical application. These findings suggest that iMPs provide a novel treatment for chronic wounds.

Patients with advanced cancer present various symptoms as their disease progresses. Among these, fatigue is a frequent symptom in patients with advanced cancer and is associated with decreased quality of life (QOL). However, there are few reports regarding its association with thiamine deficiency (TD). We report a case in which we found TD in a patient with advanced lung cancer who presented with weight loss, significant fatigue, and appeared to have a worsening general condition, for whom symptoms were dramatically improved within a short period of time by intravenous administration of thiamine. The patient was a 76-year-old woman who had been diagnosed with lung cancer and liver metastases 6 months earlier. Due to interstitial pneumonia, she was not a candidate for chemotherapy and so palliative care was started. At 8 months after initial diagnosis, the patient complained of fatigue during a medical examination, so a blood sample was taken. A week later, she visited the hospital with a cane. She felt extremely fatigued and was unable to stand, but results from the previous blood test revealed that a TD. The fatigue disappeared 15 minutes after intravenous administration of thiamine and she was able to return home without the cane. Fatigue is a frequent symptom in advanced cancer patients, and TD may be the underlying cause. Inclusion of TD in the differential diagnosis may contribute to improving patient QOL.

Abstract Background: Complete endoscopic resection of superficial non-ampullary duodenal epithelial tumors (SNADETs) is technically challenging, especially with an extremely high risk of adverse event (AE), although various endoscopic resection methods including endoscopic mucosal resection (EMR), underwater EMR (UEMR), and endoscopic submucosal dissection (ESD) have been tried for SNADETs. Hence, a novel simple resection method that can completely resect tumors with a low risk of AEs should be developed. Aims: A resection method of Noninjecting Resection using Bipolar Soft coagulation mode (NIRBS) which has been reported to be effective and safe for colorectal lesions is adapted for SNADETs. In this study we evaluated its effectiveness, safety, and simplicity for SNADETs measuring ≤20 mm. Results: This study included 13 patients with resected lesions with a mean size of 7.8 (range: 3–15) mm. The pathological distributions of the lesions were as follows: adenomas, 77% (n = 10) and benign and non-adenomatous lesions, 23% (n = 3). The en bloc and R0 resection rate was 100% (n = 13). The median procedure duration was 68 sec (32–105). None of the patients presented with major AEs including bleeding and perforation. Conclusions: NIRBSs for SNADETs measuring ≤20 mm may be a method to resect SNADETs efficiently, safely, and in a short procedure duration.

In 2020, the Japan Community Healthcare Organization (JCHO) Hoshigaoka Medical Center started providing information to community pharmacies about patients admitted to the acute care ward using discharge medication summaries (the summaries). We conducted an online self-recording survey of 149 pharmacies belonging to the Hirakata City Pharmacists Association to clarify the usability of the summaries, any related issues, and to further discuss future collaboration between hospitals and pharmacies. 46 pharmacies have received the summaries in the past, of which 44 pharmacies answered that they have utilized the summaries with patient instruction and prescription queries of doctors. However, two pharmacies responded they did not utilize the summaries, and the reasons were (a) the information was not timely and (b) patients whom the discharge medical summary was sent for did not come to the pharmacy. There were some requests regarding the summaries such as, “I would like to know what kind of information hospital pharmacists want from community pharmacists.” Preference for sharing information other than the summaries (e.g., online tools) with hospital pharmacists was related to whether the pharmacy was providing home pharmaceutical visit services. The survey revealed that, in addition to the usability of the summaries, there are also events that prevent them from being utilized. Some of the challenges include the timing of sending the summaries, the accurate identification of the family pharmacy and the communication of follow-up after discharge from hospital. Collaborating with pharmacies providing home pharmaceutical visit services would be beneficial in creating new system of bidirectional information sharing.