Ikeda Municipal Hospital

The disease burden of respiratory syncytial virus (RSV) infection in Japanese adults has been attracting attention. Nasopharyngeal swabs were collected from 141 patients aged 18 years and older who visited a Japanese clinic from August 2024 to July 2025 with symptoms of an acute respiratory infection. These samples were tested using rapid immunochromatographic antigen tests for SARS-CoV-2, influenza viruses A and B, and RSV. The results showed that 32 patients tested positive for SARS-CoV-2, 31 for influenza virus A, and one for influenza virus B, whereas no RSV-positive patients were detected. Compared with five previous reports using polymerase-chain reaction (PCR) testing (RSV-positive: 88 of 2974 patients), the number of RSV-positive patients was lower (chi-squared test p=0.04123), suggesting that the rapid immunochromatographic antigen test is not useful for diagnosing RSV infections in adults in Japan.

Abstract Background Serum leucine-rich alpha-2 glycoprotein (LRG) is a biomarker reflecting endoscopic activity in patients with ulcerative colitis (UC) and, may serve as treatment target for advanced therapy (AT), like C-reactive protein (CRP). However, unlike CRP, serum LRG is produced also by intestinal epithelium in response to stimulation not only by Interluekin-6 (IL-6) but also tumor necrosis factor (TNF) and IL-22. Therefore, a certain number of cases exist where serum LRG is elevated even when CRP is negative. This study aimed to investigate the optimal selection of AT based on serum LRG levels in patients with UC with serum CRP-negative. Methods This was a multicentre prospective cohort study including 259 patients with UC who received AT from January 2019 to March 2024 at 16 hospitals. Among them, 134 patients with UC with CRP-negative who received one of four classes of AT—anti-TNF, vedolizumab (VDZ), ustekinumab (UST), or Janus kinase inhibitor (JAKi)—were included in the present analysis [anti-TNF, n = 27; VDZ, n = 41; UST, n = 42; JAKi, n = 24]. The effectiveness and safety of AT was assessed by comparing the proportion of clinical remission (CR) at week 52 and the incidence rate of adverse events (AE) requiring discontinuation of AT using the person-year (PY) method. We defined CR as a partial Mayo score ≤2, with each subscore ≤1 and no-bleeding, CRP-negative as < 0.20 mg/dL and the low-LRG group as < 14.0 μg/mL, the high-LRG group as ≥ 14.0 μg/mL. Results Among 134 patients with UC who had negative CRP (female, 43%; pancolitis, 73%; AT exposure, 38%), 59 patients (44%) were classified as the high-LRG group. At week 0, median serum LRG and CRP levels were 13.1 μg/mL [Interquartile range (IQR) 10.7-17.9] and 0.04 mg/dL [IQR 0.00-0.09]. Concomitant corticosteroids and immunomodulators were used in 65 (49%) and 47 (35%) patients. In high-LRG group, the proportion of patients achieved CR at week 52 tended to differ among the four AT classes and that in patients received VDZ was only <50% (P = 0.091; anti-TNF, 88%; VDZ, 42%; UST, 60%; JAKi, 75%), and there was no difference in the incidence rate of AEs (anti-TNF, 0; VDZ 0.9; UST, 3.0; JAKi, 0 per 100PY). In low-LRG group, the proportion of CR at week 52 was significantly different among the four AT classes and that in patients received VDZ or UST was >70% (P = 0.013; anti-TNF, 39%; VDZ, 75%; UST, 73%; JAKi, 33%), and there was no difference in the incidence rate of AEs (anti-TNF, 0; VDZ 0.9; UST, 3.0; JAKi, 0 per 100PY) Conclusion For AT selection in CRP-negative UC patients, ATs other than VDZ can be prioritized in the high-LRG group, whereas VDZ and UST are appropriate in the low-LRG group. Conflict of interest: Dr. Amano, Takahiro: No conflict of interest Yoshihara, Takeo: No conflict of interest Sakakibara, Yuko: No conflict of interest Yamada, Takuya: No conflict of interest Hiyama, Satoshi: No conflict of interest Murayama, Yoko: No conflict of interest Ogiyama, Hideharu: No conflict of interest Uema, Ryotaro: No conflict of interest Tsujii, Yoshiki: No conflict of interest Inoue, Takahiro: No conflict of interest Shinzaki, Shinichiro: Shinichiro Shinzaki has received grant support from AbbVie, EA Pharma, Nippon Kayaku, advisor fees from AbbVie, EA Pharma, Gilead Sciences, Janssen Pharmaceutical, Sekisui Medical and Takeda Pharmaceutical and honoraria from AbbVie, EA Pharma, Gilead Sciences, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Nippon Kayaku, Pfizer, Sekisui Medical, and Takeda Pharmaceutical. Iijima, Hideki: No conflict of interest Hayashi, Yoshito: No conflict of interest

In lateral lymph node dissection (LLND) for locally advanced or recurrent rectal cancer, concomitant resection of the internal iliac vessels is sometimes required. Because the bladder receives its primary blood supply from branches of the internal iliac artery, concerns arise regarding bladder perfusion when these vessels are resected. However, the extent to which bladder perfusion depends on the internal iliac system remains unclear. Between 2020 and 2023, 25 patients with locally advanced or recurrent rectal cancer who underwent total pelvic exenteration (TPE) with bilateral LLND were prospectively enrolled. After division of all ventral branches of the internal iliac vessels, including the umbilical, obturator, and vesical vessels, bladder perfusion was evaluated intraoperatively using indocyanine green (ICG) fluorescence imaging. Time to visualization of bladder perfusion was recorded. Bladder perfusion was successfully visualized in all patients without complications. Median time to visualization was 30 s (interquartile range, 20-50). Perfusion originated exclusively from the pubic side, and fluorescence of the entire bladder wall was confirmed after mobilization. Patients were classified into early (≤ 30 s) and delayed (> 30 s) visualization groups. Older age was significantly associated with delayed visualization (p = 0.044), whereas no other clinical or surgical factors showed associations. Bladder perfusion was maintained even after complete interruption of both arterial supply and venous drainage from the internal iliac vessels, owing to blood supply from the pubic side. These findings support the safety of internal iliac vessel resection during extended LLND in rectal cancer surgery.

Pulsed radiofrequency (PRF) is recognized as an effective pain relief for treating chronic pain, though the mechanism of the analgesic effect remains unclear. Recent studies have focused on the potential anti-inflammatory effect in analgesia through PRF. Therefore, we investigated the anti-inflammatory effects of PRF using the knee pain mouse models induced by monoiodoacetic acid. Our findings demonstrated that PRF on the sciatic nerve significantly reduces knee pain, synovitis, and inflammatory cytokines, thereby supporting the hypothesis that PRF exerts an anti-inflammatory effect. Moreover, a tracer study and western blotting analysis revealed that PRF inhibited axonal transport in small dorsal root ganglion (DRG) neurons in the spinal cord and suppressed the secretion of calcitonin gene-related peptide (CGRP) and substance P (SP), both of which are associated with persistent inflammation, into the knee joint. Finally, the administration of both CGRP and SP agonists to the knee joint nullified the analgesic and anti-inflammatory effects of PRF. In conclusion, our studies revealed that PRF exerted analgesic effects based on anti-inflammatory effects through inhibition of CGRP and SP secretion caused by impaired axonal transport in small DRG neurons. We hope that these findings will lead to further dissemination of PRF treatment in the future.

The EMPA-REG OUTCOME trial confirmed empagliflozin reduced mortality and heart failure hospitalization risk. These findings raised the possibility that empagliflozin may modulate cardiac autonomic function in patients with type 2 diabetes (T2D). The EMPYREAN study was a prospective randomized open-label assessor-blinded multicenter investigation of patients with T2D without prior antidiabetic therapy with sodium-glucose cotransporter 2 or dipeptidyl peptidase 4 inhibitors. Electrocardiographic monitoring was performed at study onset and after 12 and 24 weeks of treatment. Heart rate variability was analyzed using the MemCalc method. The primary endpoint was the change in the low frequency (LF; 0.04-0.15 Hz)/high frequency (HF; 0.15-0.4 Hz) ratio from baseline to 24 weeks. In all, 113 patients were randomized. The median age in the empagliflozin and sitagliptin groups was 60 and 63 years, respectively. There were no significant differences in serial changes in the LF/HF ratio (0.52, 95% confidence interval [CI] -0.15 to 1.19, P=0.126) or HF (16.13, 95% CI -11.58 to 43.84, P=0.251) between the 2 groups. In time domain analysis, serial changes in root mean square successive difference (1.90, 95% CI -0.56 to 4.38, P=0.12) and percent of difference between adjacent normal RR intervals >50 ms (1.04, 95% CI -0.32 to 2.41, P=0.13) were not significantly different. The effects of empagliflozin and sitagliptin on autonomic nerve activity did not differ significantly in patients with T2D.

Whether the level of the inferior mesenteric artery ligation affects the incidence of anastomotic leakage remains unclear. To assess the impact of the level of inferior mesenteric artery ligation on blood flow to the anastomotic site and the incidence of anastomotic leakage using indocyanine green fluorescence imaging. A post hoc analysis of the EssentiAL trial. This study was conducted at 41 tertiary referral centers in Japan. A total of 839 patients with rectal cancer (<12 cm from the anal verge) were included. The incidence of anastomotic leakage and perfusion status were compared between the high and low ligation groups. The median fluorescence time was similar at 25 seconds in both groups (p = 0.74). Although no statistical difference was noted, the high ligation group was more likely to have greater outliers in fluorescence time compared to the low ligation group. The high ligation group demonstrated higher poor perfusion rates than the low ligation group (2.8% vs 1.5%). In the high ligation group, anastomotic leakage occurred in 1 case of poor perfusion where additional resection was not performed by the surgeon's intraoperative judgment. In addition, the additional resection rate nearly doubled with the use of indocyanine green fluorescence imaging. After propensity score matching (129 patients per group), the overall anastomotic leakage rate was 13.2% in the high ligation group and 10.9% in the low ligation group ( p = 0.57). This study was a post hoc analysis, the sample size was small, and the anastomosis methods varied. The level of inferior mesenteric artery ligation did not affect blood flow at the anastomotic site or the incidence of anastomotic leakage statistically, but assessing bowel perfusion using indocyanine green fluorescence imaging can offer clinical benefits, optimizing patient outcomes. See Video Abstract . The Japan Registry of Clinical Trials (jRCTs-CRB3180007), the Japanese Clinical Trials Registry (UMIN-CTR000030240). ANTECEDENTES:No está claro si el nivel de la ligadura de la arteria mesentérica inferior afecta la incidencia de fuga anastomótica.OBJETIVO:Evaluar el impacto del nivel de ligadura de la arteria mesentérica inferior en el flujo sanguíneo al sitio de la anastomosis y la incidencia de fuga anastomótica mediante imágenes de fluorescencia con verde de indocianina.DISEÑO:Análisis post hoc del ensayo EssentiAL.ESCENARIO:Este estudio se realizó en 41 centros de referencia terciarios en Japón.PACIENTES:839 pacientes con cáncer rectal (<12 cm desde el márgen anal).PRINCIPALES MEDIDAS DE RESULTADOS:Se compararon la incidencia de fuga anastomótica y el estado de perfusión entre los grupos de ligadura alta y baja.RESULTADOS:El tiempo de fluorescencia medio fue similar a 25 segundos en ambos grupos (p = 0.74). Aunque no se observó ninguna diferencia estadística, el grupo de ligadura alta tuvo más probabilidades de tener mayores valores atípicos en el tiempo de fluorescencia en comparación con el grupo de ligadura baja. El grupo de ligadura alta demostró tasas de perfusión deficiente más altas que el grupo de ligadura baja (2.8 % frente a 1.5 %). En el grupo de ligadura alta, se produjo una fuga anastomótica en un caso de perfusión deficiente en el que no se realizó una resección adicional según el criterio intraoperatorio del cirujano. Además, la tasa de resección adicional casi se duplicó con el uso de imágenes de fluorescencia con verde de indocianina. Después de la comparación por puntaje de propensión (129 pacientes por grupo), la tasa general de fuga anastomótica fue del 13.2 % en el grupo de ligadura alta y del 10.9 % en el grupo de ligadura baja ( p = 0.57).LIMITACIONES:Este estudio fue un análisis post hoc, el tamaño de la muestra fue pequeño y los métodos de anastomosis variaron.CONCLUSIONES:El nivel de ligadura de la arteria mesentérica inferior no afectó estadísticamente el flujo sanguíneo en el sitio de la anastomosis ni la incidencia de fuga anastomótica, pero la evaluación de la perfusión intestinal mediante imágenes de fluorescencia con verde de indocianina puede ofrecer beneficios clínicos, optimizando los resultados del paciente. (Traducción-Dr. Jorge Silva Velazco)REGISTRO DEL ENSAYO:Registro japonés de ensayos clínicos (jRCTs-CRB3180007), Registro japonés de ensayos clínicos (UMIN-CTR000030240).

日本超音波医学会より公示された，超音波検査の「パニック所見：緊急に対応すべき異常所見」の，泌尿器領域のパニック所見のポイントについて解説した．泌尿器領域の「緊急所見」は，腎外傷や腎腫瘍の破裂などに起因する後腹膜腔の液体貯留が該当する．腎は後腹膜に位置しGerota筋膜に囲まれているという解剖学的な特徴から，直ちに治療しなければ死に至る頻度は低い．バイタルサインと合わせて超音波所見を確認し，「準緊急所見」として対応できる場合が多いと思われる．泌尿器領域の「準緊急所見」は2つあり，一つは両側腎盂（腎杯）の拡張である．腎盂だけが拡張する腎外腎盂はパニック所見とする必要はない．片腎が無機能腎の場合は，対側の腎盂腎杯の拡張もパニック所見である．もう一つは発熱や圧痛を伴う腫瘤像（内部エコーを伴う液体貯留）である．発熱や圧痛を伴う腎感染症で，腫瘤像（内部エコーを伴う液体貯留），腎内気腫像，デブリを伴う腎盂拡張を認める場合は「準緊急所見」である．