Imamura Hospital

Abstract Background Three types of Janus kinase (JAK) inhibitors are currently available for the treatment of ulcerative colitis (UC) in Japan. Although several studies have reported their efficacy and safety in clinical practice, real-world data remain limited. Therefore, we investigated treatment outcomes across multiple local medical institutions. Methods This was a multicentre, retrospective study including patients with UC who were prescribed a JAK inhibitor between July 2007 and December 2025. The primary outcomes were clinical remission and response at 4 weeks, 52 weeks, and at the most recent follow-up. The efficacy and safety profiles of each JAK inhibitor were compared descriptively. Results A total of 74 patients with UC were treated with JAK inhibitors during the study period: 23 with tofacitinib, 29 with filgotinib, and 22 with upadacitinib. Clinical remission rates at 4 and 52 weeks were 70.0% and 47.6% for tofacitinib, 86.2% and 60.7% for filgotinib, and 95.2% and 72.2% for upadacitinib, respectively. Among patients who underwent JAK inhibitor intraclass switching, tofacitinib was used in 4.4% (1/23), filgotinib in 6.9% (2/29), and upadacitinib in 68.2% (15/22). Upadacitinib demonstrated higher efficacy than the other JAK inhibitors, including in patients who had previously received a different JAK inhibitor. One case of herpes zoster infection occurred in a patient treated with tofacitinib; however, there was no significant difference in the incidence of adverse events among the three JAK inhibitors. No cases of death, malignancy, or major acute cardiovascular events were observed. In this study, JAK inhibitors were more frequently prescribed for patients intolerant to 5-aminosalicylic acid (5-ASA) (35.1%). Conclusion Upadacitinib demonstrated favourable therapeutic efficacy even in community-based medical settings. The accumulation of further detailed real-world data will help optimise the selection of the most appropriate JAK inhibitor for individual patients with ulcerative colitis. Conflict of interest: Dr. Mori, Statoshi: No conflict of interest Maeda, Nobuhisa: No conflict of interest Kuwazuru, Kosuke: No conflict of interest Sameshima, Yoichi: No conflict of interest Tanaka, Akihito: No conflict of interest Komaki, Yuga: No conflict of interest Kanmura, Shuji: No conflict of interest

Linked color imaging (LCI) was developed to detect gastrointestinal neoplasms. The current study aimed to determine whether the use of LCI, compared with white-light imaging (WLI), can improve the miss rates of colorectal polyp. A multicenter, randomized back-to-back study was conducted in 16 Japanese endoscopy units. Patients were randomized according to examination: tandem colonoscopy with WLI followed by LCI (WLI-LCI group) and with LCI followed by WLI (LCI-WLI group). The detected polyps were evaluated according to location, size, morphology, and histopathological diagnosis. The primary outcome was polyp miss rate per patient (PMR-PP) in total colonoscopy. The secondary outcome was adenoma detection rate (ADR) during the first assessment in each group. The full analysis set comprised 327 participants, and 320 were included in either two groups. The PMR-PPs were 9.3% and 20.6% in the LCI-WLI and WLI-LCI groups, respectively. Regarding location, the PMR-PP of LCI was significantly lower than that of WLI in the transverse and descending colons and rectum. In terms of diminutive adenomas (< 5 mm), the ADR of LCI (38.2%) was significantly higher than that of WLI (29.1%). LCI was superior to WLI in terms of polyp miss rate particularly in the transverse and descending colons and rectum.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-20633-2.

ABSTRACTObjectivesEndoscopic ultrasound‐guided hepaticogastrostomy (EUS‐HGS) is useful in cases of endoscopic retrograde cholangiopancreatography failure. However, the procedure has a high incidence of procedure‐related early adverse events (PRAEs). This study retrospectively evaluated risk factors for such events post‐EUS‐HGS.MethodsThis multicenter study included 222 patients (120 males and 102 females; median age = 73 years) who underwent initial EUS‐HGS. The clinical success rate and PRAE incidence, and risk factors were analyzed. PRAEs were defined as AEs occurring within 2 weeks.ResultsThe median procedure time was 41 min. Metal or plastic stents were used for EUS‐HGS in 107 and 115 patients, respectively. Fistula dilation and concomitant antegrade stenting (AGS) were performed in 166 and 45 patients, respectively. The clinical success rate and PRAE incidence were 85.1% and 22.1%, respectively. Identified PRAEs included acute peritonitis (9.5%), fever (6.8%), abdominal pain (2.3%), and acute pancreatitis (1.4%). Multivariate analysis identified dilation device use (p = 0.01) and AGS (p = 0.03) as PRAE risk factors. AGS in patients who underwent fistula dilation (p = 0.02) and procedure time ≥41 min in those who underwent EUS‐HGS with AGS (p = 0.01) were PRAE risk factors.ConclusionsFistula dilation and AGS are associated with an increased risk of PRAEs post‐EUS‐HGS. Careful postoperative follow‐up for such events is required in patients undergoing fistula dilation for EUS‐HGS with AGS and prolonged procedure time.

Chemotherapy-induced neutropenia has been identified as a potential prognostic marker for multiple cancers. However, only one retrospective study, NN-2301, has investigated the relationship between neutropenia and treatment effects of nanoliposomal irinotecan/5-fluorouracil/folinic acid (NFF) in pancreatic cancer. In this prospective study, we aimed to clarify whether NFF-induced neutropenia could serve as a prognostic marker in pancreatic cancer. Data were analyzed from the prospective cohort of the NAPOLEON-2 trial, an observational study involving patients with unresectable pancreatic cancer treated with NFF. Neutropenia severity was categorized into three cutoffs: Cutoff A (Grade [Gr] 0 vs. Gr 1-4), cutoff B (Gr 0-1 vs. Gr 2-4), and Cutoff C (Gr 0-2 vs. Gr 3-4), using the Common Terminology Criteria for Adverse Events version 5.0, owing to conformity with previous studies and simplicity. The primary endpoint was overall survival (OS); progression-free survival (PFS) was the secondary endpoint. The neutropenic groups included Gr 1, 2, 3, and 4, with 79, 23, 34, and 7 patients, respectively. At each cutoff, OS and PFS were significantly better in the severe neutropenia groups. Higher neutropenia grades correlated with improved OS (log-rank trend test: χ2 = 8.62, p < .01). Multivariate Cox regression analysis revealed significant differences for all cutoffs: adjusted hazard ratios were 0.57 (95% confidence interval [CI] 0.40-0.83) (Cutoff A), 0.53 (95% CI 0.36-0.78) (Cutoff B), and 0.52 (95% CI 0.34-0.80) (Cutoff C). NFF-induced neutropenia is a valuable prognostic marker in pancreatic cancer and may guide treatment selection.

The indolent adult T-cell leukemia-lymphoma prognostic index (iATL-PI) uses soluble interleukin-2 receptor (sIL-2R) levels of 1,000 and 6,000 U/mL as a cut-off. The disadvantage of the iATL-PI is that approximately half of the patients are classified as intermediate risk (1,000 ≤ sIL-2R < 6,000). Here, we aimed to develop a novel prognostic model for indolent ATL using a prospectively registered database. We identified 375 patients with indolent ATL. Median age was 61 years. The median follow-up of surviving patients was approximately 62 months. In multivariate analysis for overall survival (OS), sIL-2R level (as log(sIL-2R), HR 4.58), male sex (HR 1.41) and LDH > ULN (HR 1.68) were independent prognostic factors. The best cut-off value for sIL-2R to predict OS was 2,870 U/mL. Including the cut-off of 3,000 U/mL in the original iATL-PI, the probabilities of 5-year OS were 88.9% in the low group (sIL-2R < 1,000), 67.5% in the low-intermediate group (1,000 ≤ sIL-2R < 3,000), 34.0% in the high-intermediate group (3,000 ≤ sIL-2R < 6,000) and 17.0% in the high group (sIL-2R ≥ 6,000). The c-index for predicting OS was higher with the modified iATL-PI than with the original iATL-PI (0.749 vs. 0.725). The addition of sex and LDH levels did not improve the c-index. In conclusion, we developed a novel prognostic index of indolent ATL.

【背景および目的】脳卒中診療に関心を持つ若手医師の育成は重要な課題であり，脳卒中診療に興味に与える因子を明らかにすることを目的とした．【方法】対象は当院で研修経験がある卒後1–7年目までの医師とし，質問紙調査を行った．主要アウトカムは当科での研修前後における脳卒中への興味の変化とし，探索的因子分析後に得られた因子を元に多変量解析を行った．【結果】58/85名（68.2%）から回答が得られた．多変量解析では因子（救急外来での診療，個別医師によるマンツーマンの講義，スクラブイン，脳血管造影検査での動脈穿刺などの手技の参加）のみが独立して脳卒中診療への興味増加に関与していた（調節オッズ比7.6，95%信頼区間1.39–57.1，p=0.018）．【結論】実践的な経験の提供と，達成感や自己効力感の獲得を両輪とすることが，脳卒中診療への興味や志望の向上につながる可能性が示唆された．

Here, we report a rare case of relapsed adult T-cell leukemia-lymphoma (ATL) with evidence of clonal relapse 26years after initial diagnosis. The patient had been diagnosed with an aggressive form of lymphoma-type ATL 26years prior and did not receive further ATL treatment for approximately 26years after achieving complete remission. We used nested PCR to identify the amplification of ATL clone-specific accumulation sites in DNA from hematoxylin and eosin-stained specimens from the patient. Furthermore, the sequence of amplicons obtained from peripheral blood mononuclear cells and lymphoma cells from the previously diagnosed ATL were identical, indicating that a human T-cell leukemia virus-type 1 (HTLV-1)-infected clone identical to the one that recently caused ATL was present in the original lymphoma tissue. Although we were unable to identify this clone as the cause of the previous ATL, the peripheral leukemia cells revealed an ATL clone that was present in the tumor cells of a lymph node diagnosed 26years earlier. To our knowledge, this is the first report demonstrating survival of HTLV-1-infected clones for a quarter of a century in a patient with recurrent ATL.