Japanese Red Cross Narita Hospital

Total gastrectomy (TG) is commonly performed as the standard treatment for upper third advanced gastric cancer (AGC). Proximal gastrectomy (PG) may be a potential alternative procedure for upper-third AGC. However, its oncologic safety remains uncertain. This study aimed to compare the long-term outcomes of PG and TG for upper-third AGC and to evaluate the oncological safety of PG. We retrospectively analyzed the data of patients who underwent PG or TG for clinical T2-T4aNanyM0 upper-third gastric cancer at six institutions between 2018 and 2022. To minimize selection bias, propensity score matching (PSM) was performed at a 1:1 ratio. The primary endpoint was overall survival (OS). A total of 208 patients with upper-third AGC were included. After PSM, 104 patients were selected for analysis, with 52 patients in each group. The 3-year OS rates were 81.8% in the PG group and 70.8% in the TG group, with no statistically significant difference between the two groups (P =.167), with a hazard ratio for PG of 0.58 (95% confidence interval, 0.27-1.27; P =.173). Subgroup analysis revealed that the hazard ratio for OS was significantly lower in the PG group than in the TG group among patients with tumor diameters <50mm. The long-term survival outcomes of PG and TG for upper-third AGC patients are comparable, suggesting that PG may be an oncologically acceptable option in carefully selected patients.

Lymphoproliferative disorders associated with human herpes virus 8 (HHV8) include Kaposi's sarcoma-associated herpesvirus (KSHV)/HHV8-positive multicentric Castleman disease (MCD), primary effusion lymphoma (PEL)/extracavitary PEL (EC-PEL), and KSHV/HHV8-positive diffuse large B-cell lymphoma (DLBCL). These lymphoproliferative disorders occur primarily in patients with HIV infection and immunodeficiency. HIV-negative KSHV/HHV8-positive MCD is extremely rare in Japan. We encountered a patient with KSHV/HHV8-positive large B-cell lymphoma with a history of HIV-negative, KSHV/HHV8-positive MCD. Although the KSHV/HHV8-positive MCD was in long-term remission with rituximab treatment, the patient developed refractory KSHV/HHV8-positive large B-cell lymphoma four years after the onset of MCD. The KSHV/HHV8-positive large B-cell lymphoma was refractory to chemotherapy, and the patient died. The course of this case suggests that HIV-negative KSHV/HHV-8-positive MCD may eventually lead to refractory KSHV/HHV8-positive large B-cell lymphoma, even after long-term remission with rituximab therapy.

Acknowledgements We thank all the local investigators and assistant personnel for their great effort. Furthermore, we thank all the POTTER-AF collaborators.

Background/AimMetastatic breast cancer is a recalcitrant disease with a poor prognosis. Novel targets and therapies are necessary to improve the survival rate of patients with metastatic breast cancer. Previous pre-clinical and clinical studies, have demonstrated the effectiveness of oral recombinant methioninase (o-rMETase) against breast cancer. The present case report shows that combination treatment with radiation, immunotherapy, a low-methionine diet, and o-rMETase led to rapid eradication of extensive bone and other metastases in a patient with breast cancer.Case ReportA patient with breast cancer with extensive metastases to the liver, lymph nodes, pleura and bones was diagnosed using [18F]fluorodeoxyglucose positron emission tomography (FDG-PET). The patient was immediately started on systemic drug therapy with tamoxifen and leuprorelin, but it failed to suppress the tumor. Then, combination treatment with radiation, immunotherapy with biological response modifier (BRM)-activated killer (BAK), a low-methionine diet, and o-rMETase was started as second-line treatment. Five months after beginning of the combination treatment, the patient had a subsequent FDG-PET scan and extensive eradication of almost all metastases was observed, with only a metastasis remaining in the liver.Conclusiono-rMETase in combination with immunotherapy and irradiation eradicated extensive metastases in a patient with breast cancer. Further investigation of this combination treatment for breast cancer is necessary including clinical trials.

None.

Cytokine storm syndrome (CSS), commonly associated with hemophagocytic lymphohistiocytosis (HLH), is a fatal hyperinflammatory syndrome. Differentiating the underlying diseases responsible for CSS is essential for timely therapeutic decisions. This study explored the clinical usefulness of serum cytokine profiling in distinguishing underlying diseases in patients with CSS. Serum samples were collected from 143 adult and pediatric patients with CSS and 22 healthy controls. The cohort included patients with various diagnoses of primary and secondary HLH and Kawasaki disease (KD)-like hyperinflammatory syndromes. Serum levels of 48 cytokines were analyzed in 97 patients using a bead-based multiplex immunoassay (Luminex assay). Serum levels of interferon alpha (IFN-α), interleukin-18 (IL-18), IL-6, CXCL9, and soluble tumor necrosis factor receptor II (sTNF-RII) were measured in 165 participants using enzyme-linked immunosorbent assay (ELISA). Luminex assay categorized patients with CSS into five clusters based on serum cytokine patterns. ELISA revealed distinct cytokine patterns, wherein patients with histiocytic necrotizing lymphadenitis-associated HLH and systemic lupus erythematosus-associated macrophage activation syndrome (MAS) showed elevated IFN-α; systemic juvenile idiopathic arthritis-associated and adult-onset Still's disease-associated MAS, X-linked inhibitor of apoptosis protein deficiency with HLH, and NLRC4-associated autoinflammatory disorder exhibited higher IL-18 levels. Additionally, KD shock syndrome had higher IL-6 levels than the other groups. CXCL9 was significantly elevated in patients with virus-associated HLH, familial HLH, malignant lymphoma-associated HLH, and KD-MAS. Multisystem inflammatory syndrome in children and toxic shock syndrome also showed moderate elevations of CXCL9 and IL-6 levels. Serum cytokine profiling effectively differentiates CSS subtypes, facilitating better diagnosis and personalized treatment strategies based on specific disease backgrounds.

AimImproving sleep quality is a crucial clinical objective in schizophrenia care; however, the association between evidence‐based pharmacological treatment and sleep outcomes remains unclear. This study aimed to examine whether guideline adherence, assessed using the individual fitness score (IFS), correlated with actigraphy‐measured sleep in long‐term hospitalized patients.MethodsWe included 40 inpatients aged <65 years who were diagnosed with schizophrenia. Guideline adherence was assessed using the IFS and actigraphy was used to measure total sleep time (TST), sleep latency (SL), and sleep efficiency (SE). In 33 patients, these measures were re‐evaluated after 6 months.ResultsCross‐sectional analysis showed a positive correlation between IFS and TST (rho = 0.362, P = 0.022), which persisted after adjusting for Brief Psychiatric Rating Scale scores (β = 0.318, P = 0.024). IFS was not associated with SL or SE, and differences in hypnotic use did not significantly affect the sleep parameters. Additionally, longitudinal changes in IFS over 6 months were not significantly associated with changes in TST, SL, or SE (all P > 0.05).ConclusionIn this cohort of long‐term hospitalized patients with schizophrenia, guideline adherence (higher IFS) was associated with increased TST. However, no clear longitudinal effects of IFS on sleep were observed. These findings emphasize the importance of guideline adherence in optimizing sleep, although extended follow‐ups and larger sample sizes are required to confirm the long‐term impact of guideline‐based treatments on sleep in patients with schizophrenia.