Japanese Red Cross Nagoya Daiichi Hospital

This study aimed to identify patient groups in which myeloablative conditioning (MAC) or reduced-intensity conditioning (RIC) regimens induced superior progression-free survival (PFS) in patients with acute myeloid leukemia (AML) in complete remission (CR) using a machine-learning approach. Our study included 3273 patients aged 40–69 with AML in CR. The patients were divided into training (N = 2020) and validation cohorts (N = 1253). We employed a machine learning-based group identification model in the training cohort. Subsequently, in the validation cohort, we estimated the impact of the optimal conditioning group compared with the non-optimal conditioning group on PFS using an inverse probability weight analysis. The developed model was consistent with the eight factors and combinations, and the high score suggested that RIC was more appropriate than MAC. In the validation cohort, 127 patients with high scores and who received RIC and 769 patients with low scores and who received MAC were categorized into the optimal conditioning group (896, 71.5%). The weighted hazard ratio for PFS was 0.73 (95% confidence interval: 0.57–0.94) in the optimal conditioning group compared with the non-optimal conditioning group (P = 0.016). In conclusion, we developed an easy-to-use model that helps the physician choose a patient-specific conditioning regimen for patients with AML in CR.

Long-term follow-up (LTFU) outpatient clinics play a primary role in screening, preventing, and addressing late effects after hematopoietic cell transplantation (HCT). Following the 2018 nationwide survey, which led to the development of standardized nationwide tools to deliver information to HCT survivors, we re-evaluated changes in the current status of LTFU clinics. We targeted 267 HCT centers certified by the Japanese society for transplantation and cellular therapy. Several questionnaire categories were retained from the 2018 survey to compare results (e.g., LTFU clinic establishment and institutional practices for late-effect screening). The response rate was high in both adult (90%) and pediatric HCT centers (88%), and the establishment rate of post-HCT LTFU clinics increased to 82% (adult, 90%; pediatric, 64%). Pediatric centers were more likely to continue follow-up of patients who received HCT beyond 5 years post-HCT. Regarding transitional medical care for long-term survivors at non-HCT institutions, only a few HCT centers conducted routine transitions to specific referral facilities. We observed significant changes in recommendations for secondary cancer screenings compared to 2018, with a substantial decrease in the proportions of "not routinely included as a screening issue." In the future, it is essential to create a sustainable follow-up system, establish networks with non-HCT facilities, and educate patients to encourage behavioral changes for lifelong health screenings.

Bladder rupture is a rare condition, typically associated with trauma but occasionally occurring spontaneously. Non-traumatic bladder rupture is particularly challenging to diagnose due to its non-specific symptoms. This case report presents a bladder rupture initially misdiagnosed as ascites due to alcoholic liver disease. A 59-year-old man presented with progressive abdominal distension without abdominal pain or urinary symptoms. His medical history included diabetes, asthma, dyslipidemia, and chronic alcohol consumption. Laboratory tests showed renal impairment but no significant liver dysfunction. Abdominal CT revealed ascitic fluid, leading to a diagnosis of alcoholic liver disease. He was hospitalized, and conservative treatment was started, but his renal function deteriorated. On the fifth day, however, after urinary catheterization, 10 L of urine were drained within six hours, resulting in a rapid decrease in serum creatinine levels. Retrospective review of imaging revealed a rupture at the bladder apex, likely caused by chronic bladder overdistension due to alcohol use and diabetic autonomic dysfunction. The patient recovered with conservative management, and a follow-up cystogram confirmed bladder healing. This case highlights the diagnostic challenge of non-traumatic bladder rupture, especially in the absence of typical symptoms. Clinicians should consider bladder rupture in patients presenting with unexplained ascites, renal impairment, and an unusual diuretic response to catheterization.

Ring chromosome 20 (r[20]) syndrome is a rare epilepsy-associated chromosomal disorder often accompanied by intellectual disability and psychiatric symptoms. It lacks distinctive physical features and typically exhibits normal brain imaging; therefore, its diagnosis is frequently delayed, especially when clinicians are unfamiliar with it. Nonconvulsive status epilepticus (NCSE), a hallmark of this syndrome, can be overlooked even by epilepsy specialists, who interpret it as a psychiatric symptom, particularly in patients with limited expressive capacity. A 42-year-old woman with a long-standing history of drug-resistant epilepsy and behavioral symptoms was ultimately diagnosed with r(20) syndrome. She developed tonic seizures and fear episodes at age 6 and was diagnosed with epilepsy. After age 11, drug-resistant NCSE emerged and was not clearly identified as status epilepticus; it was considered to involve impaired awareness seizures and psychiatric symptoms. At age 41, perampanel (PER) was initiated, triggering aggressive behavior and new backward-falling episodes, further complicating her clinical presentation. Video electroencephalogram (EEG) confirmed NCSE, and chromosomal analysis identified r(20). After PER discontinuation, aggression and backward-falling episodes resolved. Lacosamide was introduced, reducing the frequency of NCSE from several daily episodes to 2-3 per week. This case underscores the diagnostic challenges of r(20) syndrome and the risk of misdiagnosing NCSE as a psychiatric illness. Additionally, PER may exacerbate psychiatric symptoms in r(20) cases with intellectual disability. Precise seizure classification and confirmation by ictal EEG, along with integrated neuropsychiatric care, are essential for accurate diagnosis and effective management.