Japanese Red Cross Kochi Hospital

BackgroundPulmonary artery catheter (PAC) entrapment is a rare but serious complication caused by inadvertent suturing to cardiac or vascular structures.Case presentationA 42-year-old man underwent minimally invasive mitral valve repair via right mini-thoracotomy. Thirty minutes after weaning from cardiopulmonary bypass (CPB), pulmonary artery pressure suddenly dropped, and the waveform became identical to that of central venous pressure. Two centimeters of PAC mobility, aspiration of blood from the balloon port, and blood accumulation in the monitor connector were noted. On postoperative day 1, resistance was encountered during catheter withdrawal at 7 cm, and chest radiography revealed abnormal catheter curvature. Reoperation under CPB confirmed PAC entrapment at the left atriotomy suture line, and the catheter was successfully removed.ConclusionsIn minimally invasive mitral valve repair, a left atriotomy approach might be associated with a risk of PAC entrapment, and the option of not inserting a PAC should always be considered.

ABSTRACTBackground and AimEarly gastric cancer (EGC) diagnosis after Helicobacter pylori eradication and differentiation from patchy redness (PR) remains challenging. We developed a novel automated analysis system for microvascular blood flow rate using magnifying endoscopy. This study evaluated its diagnostic performance in differentiating EGC from PR compared with endoscopists in a multicenter setting.MethodsWe analyzed 76 magnifying endoscopy videos, including 36 EGCs and 40 PRs recorded at our institution. Lesions were diagnosed as cancer (EGC) or noncancer (PR) by the analysis system, based on the cut‐off value calculated from the validation data set. Additionally, 30 endoscopists (15 experts and 15 trainees) from three institutions, all skilled in magnifying endoscopy diagnosis, participated. We compared the diagnostic performance between the analysis system and endoscopists.ResultsDiagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value (NPV) were 84.2%, 86.1%, 82.5%, 81.6%, and 86.8%, respectively, for the analysis system, and 84.2%, 80.2%, 87.3%, 83.2%, and 84.9%, respectively, for the endoscopists. Sensitivity and NPV of the analysis system tended to be higher than those of endoscopists. Additionally, the accuracy of the analysis system was comparable to that of all endoscopists and tended to be superior to that of trainees (84.2% [95% CI: 74.0%–91.6%] vs. 81.7% [95% CI: 79.4%–83.8%], respectively).ConclusionsThe automated analysis system for microvascular blood flow rate showed diagnostic performance equivalent to or superior to that of endoscopists skilled in magnifying endoscopy, suggesting its utility as a new diagnostic modality for differentiating EGC and PR in clinical practice.

症例は幼少期にファロー四徴症で心内修復術を受けている52歳の完全内臓逆位の男性．50歳時に左中大脳動脈の脳塞栓症で血栓回収術を受け，後遺症なく回復．Holter心電図，心エコー検査，造影CT検査などで塞栓源が同定できないまま抗凝固療法が開始された．心エコー検査では中等度の大動脈弁閉鎖不全症（AR）を認めたが，左室拡大なく自覚症状もなかった．その後，52歳時に心不全で入院し，ARの増悪と，大動脈基部拡張症，三尖弁閉鎖不全症，単冠動脈，逆位の左上大静脈遺残（PLSVC）が確認された．PLSVCは左房還流型であり，脳塞栓症を生じた奇異性塞栓症の原因病変と診断した．本症例に対し，ベントール手術，三尖弁形成術，PLSVC結紮術を行ったので，文献的考察を加えて報告する．

We developed a robot-assisted transmediastinal esophagectomy (RATME) to reduce the surgical invasiveness of open transthoracic esophagectomy (oTTE). However, the long-term survival outcomes of patients who undergo RATME remain unclear. Patients who underwent RATME for esophageal squamous cell carcinoma (ESCC) between January 2012 and April 2020 were enrolled. Overall survival (OS), relapse-free survival (RFS), and ESCC cause-specific survival (CSS) were analyzed according to clinical stage. Survivals were compared between patients who underwent the RATME and oTTE using propensity score matching analysis. One hundred and twenty-seven patients who underwent RATME were included in the analysis. The 3- and 5-year OS rates were 96.2 and 92.1% for cStage I RATME group, 84.8 and 82.3% for cStage II, and 61.8 and 61.8% for cStage III, respectively. The 3- and 5-year RFS rates were 94.3 and 84.3% for cStageI, 71.7 and 69.3% for cStage II, and 5 48.2 and 48.2% for cStage III, respectively. Survival analysis using 74 paired patients showed that the RATME group had better OS and RFS than the oTTE group (p = 0.0028 and p = 0.016, respectively), but equivalent CSS (p = 0.078). The OS of the RATME group stratified by clinical stage was equivalent to that of the comprehensive registry data from Japan, and showed better OS and RFS than the oTTE group, indicating that RATME radicality is guaranteed with regard to long-term survival.

Allergic rhinitis (AR) is a type I allergic disease characterized by sneezing, watery rhinorrhea, and nasal obstruction. An epidemiological survey found that approximately 50% of Japanese individuals have AR.Histamine is a major chemical mediator that induces AR symptoms through its binding to histamine H1 receptor(H1R). We demonstrated that antihistamines have a blocking effect on histamine signaling of H1R, and the suppressive effect on histamine-induced up-regulation of transcriptional activation, and the suppressive effect on basal transcription of H1R in the absence of histamine which may be part of the inverse agonist action of antihistamine. Sublingual immunotherapy (SLIT) with a standardized Japanese cedar (JC) pollen significantly improved nasal symptoms and AR-related sleep disturbance in patients with JC pollinosis. Dual SLIT with JC pollen and house dust mites (HDM) suppressed both JC pollen-induced seasonal and HDM-induced perennial nasal symptoms in bisensitized patients with AR. Dual SLIT was more effective in suppressing nasal obstruction at the peak JC pollen period than mono SLIT with JC pollen. Posterior nasal neurectomy (PNN) improved nasal symptoms and medication scores in patients with severe perennial AR. Herein, we describe recent advances in the management of AR. J. Med. Invest. 72 : 14-20, February, 2025.

BackgroundMolecular linkage between thymoma-associated lymphocytes and myasthenia gravis (MG) remain to be clarified. Therefore, we searched for MG-related gene candidates in the thymoma transcriptome.MethodsBased on bulk thymoma RNA-seq data from The Cancer Genome Atlas (TCGA), we performed a weighted gene co-expression network analysis (WGCNA) focusing on genes associated with tumor-infiltrating immune cells and inflammation. For each identified co-expression variation gene group (module), correlation analysis with metadata (presence of MG) and gene set enrichment analysis (GSEA) were performed. Based on the candidate genes identified, immunohistochemical staining was performed on thymoma surgical specimens (N=9, 4 with MG, 5 without MG). The proportion of naïve T cells, regulatory T cells (T reg), Th17 cells and follicular T cells (Tfh) among CD4+ lymphocytes were analysed by multiple immunostaining (mIHC).ResultsThe results of the WGCNA identified two modules that correlated significantly with the presence of MG. One module was positively correlated with MG, while the other was correlated in the opposite direction. Forty-five of the positively correlated one module and 63 of the negatively correlated another module were components of the PI3K-Akt signaling pathway. Immunohistochemical staining of the Akt, the hub molecule of the PI3K-Akt-mTOR pathway, was positive in 3 out of 4 (75%) MG-associated cases. CD4-positive lymphocyte subset analysis using mIHC showed more Th17 cells and fewer T reg cells in thymoma with MG compared to thymoma without MG.ConclusionsThe PI3K-Akt-mTOR pathway is activated in thymomas, leading to increased Th17 and decreased Treg, which could influence to MG association, an autoimmune condition.

Abstract Purpose This study aimed to examine the role of citrulline in the lung cancer microenvironment and its potential synergistic effects with other therapies. Methods Murine lung cancer cells (CMT167) were subcutaneously implanted into mice to establish tumor models, followed by treatment with the anti-PD-1 antibody either alone or in combination with arginine or arginine and citrulline. Tumor growth, survival rate, cytokine levels, immune cell populations, and metabolic marker expression were assessed using histological, immunostaining, flow cytometry, and serum analyses. Results Mice in the treatment groups exhibited significantly lower tumor volumes than those in the control group (control, 1161.59 ± 294.73; anti-PD-1, 427.38 ± 355.34; anti-PD-1 plus arginine, 452.10 ± 332.04; anti-PD-1 plus arginine and citrulline, 198.45 ± 236.22 mm3; P < 0.0001). Furthermore, the anti-PD-1 plus arginine and citrulline group exhibited significantly improved progression-free survival compared with that of the control group (P = 0.00039). The anti-PD-1 plus arginine and citrulline group also showed a significantly higher number of tumor-infiltrating CD8+ lymphocytes per high-power field (hpf) than the control group (control, 24.22 ± 9.13; anti-PD-1, 29.20 ± 9.41; anti-PD-1 plus arginine, 34.33 ± 8.81; anti-PD-1 plus arginine and citrulline, 46.56 ± 10.01 cells/hpf). Conclusion Arginine and citrulline supplementation facilitated CD8+ lymphocyte infiltration into the tumor microenvironment, thereby augmenting the efficacy of lung cancer immunotherapy.

Although anomalies of the celiac and/or superior mesenteric arteries are occasionally encountered during abdominal surgery, anomalous venous confluence is seldom reported during pancreatic surgery. Herein, we present a rare case of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) for the treatment of a solid pseudopapillary neoplasm in an asymptomatic 37-year-old male with an anomalous splenic vein (SpV) confluence. Computed tomography angiography (CTA) revealed an anomaly of the SpV, which coursed transversely through the superior border of the pancreas, over the celiac artery and into the portal vein, along the superior line of the common hepatic artery. We successfully performed an LSPDP without peripancreatic vessel injury by exposing the SpV and splenic artery through an approach from the superior position of the pancreas. Preoperative imaging, especially CTA, is crucial to ensuring a safe, successful laparoscopic pancreatectomy.