Kansai Medical University

As populations age worldwide, breast cancer mortality among older patients continues to rise despite therapeutic advances. This study investigates differences in treatment patterns and outcomes between older and younger patients with metastatic breast cancer. We analyzed clinical data from the Advanced Breast Cancer Database (ABCD) maintained by the Japanese Breast Cancer Research Group. The dataset included patients registered between June 1, 2020, and October 31, 2023, encompassing clinicopathologic information, treatment details, breast cancer specific survival (BCSS), and overall survival (OS). A total of 1629 patients were included. The frequency of chemotherapy and genomic testing decreased with age, yet patients in their 70s demonstrated treatment durations and survival outcomes comparable to those of younger patients. In contrast, patients aged ≥ 80years exhibited shorter duration of second-line therapy (adjusted HR:0.65, 95% CI: 0.43-1.04) and poorer OS (adjusted HR:0.62, 95% CI: 0.37-1.04) and BCSS (adjusted HR:0.66, 95% CI: 0.38-1.14), despite most deaths being attributable to breast cancer rather than non-cancer-related causes. This multicenter retrospective study demonstrates that patients in their 70s can achieve comparable benefits from systemic therapy to younger individuals, emphasizing the importance of not withholding treatment based solely on chronological age. Conversely, the limited effectiveness of later-line therapies in patients aged ≥ 80 highlights the need for individualized treatment strategies that balance efficacy, quality of life, and comorbidities through comprehensive geriatric assessment and shared decision-making.

Transanal total mesorectal excision (TaTME) has been introduced as a novel approach for low rectal cancer, providing excellent visualization and potentially improving distal margin control. However, TaTME often requires a two-team approach, leading to increased equipment and personnel costs, as well as technical complexity. Moreover, dissection of the anterior plane remains anatomically challenging and has been associated with a higher risk of urethral injury [1, 2]. To address these limitations, we developed a new single-team technique in which perineal dissection is first performed under direct vision to safely mobilize the posterior and lateral planes, while the more complex anterior plane is preserved for a subsequent laparoscopic approach. During this step, the rectourethral muscle or rectovaginal septum is dissected with precise anatomical understanding. This report describes the concept, technical details and potential advantages of this modified approach. With the patient in the lithotomy position, perineal dissection is initiated under direct vision and advanced to a level above the levator ani. The posterior and lateral dissection planes are identified, leaving the anterior plane intact. The rectal lumen is temporarily closed, and the procedure then proceeds laparoscopically. The laparoscopic phase continues with conventional total mesorectal excision, connecting to the perineal dissection plane. Finally, a thin band of the rectourethral muscle in males (or longitudinal muscle in females) remains, which can be simply divided to complete the full-thickness rectal excision. This approach eliminates the need for a second surgical team or specialized perineal platforms. The surgical procedure is demonstrated in Video 1. Between July 2024 and October 2025, six patients underwent this procedure (male/female ratio: 4/2; median age: 72 years, range: 66–77 years). Robotic and laparoscopic approaches were used in four and two cases, respectively. The procedures included ISR, APR and Hartmann operations in three, three and one case, respectively. The median perineal dissection time was 33 min (range: 14–52), the total operative time was 386 min (range: 243–642) and median blood loss was 69 mL (range: 5–770). No Clavien–Dindo grade ≥III complications occurred, and all patients achieved R0 resection. Our single-team, perineal-first approach offers a simplified, cost-effective and anatomically safer alternative, providing a precise understanding of the anterior structures of the anal canal for selected patients requiring low rectal resection. Hisanori Miki was responsible for conceptualization, methodology, software, investigation, validation, formal analysis, data curation, visualization, project administration, resources, funding acquisition and writing the original draft. Takumi Yamamoto and Yusuke Kitagawa contributed to conceptualization and data curation. Jun Watanabe and Yosuke Fukunaga contributed to supervision. All authors contributed to writing, reviewing and editing the manuscript, and approved the final version. This research did not receive any specific grant or funding from agencies in the public or not-for-profit sectors. All authors have no conflicts of interest to declare. The study protocol was approved by The Institutional Review Board for Clinical Research of Kansai Medical University (2024199). The patient provided informed consent prior to receiving the treatment. Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.

The use of transesophageal echocardiography (TEE) after esophagectomy remains controversial. Herein, we describe a case in which TEE use was safe and effective during cardiac surgery after esophagectomy with retrosternal gastric tube reconstruction. A 71-year-old man, who had undergone esophagectomy with retrosternal gastric tube reconstruction, was scheduled for removal of a left atrial myxoma via right anterior thoracotomy under cardiopulmonary bypass. A multiplane TEE probe was smoothly inserted into the gastric tube, providing echocardiographic images similar to those acquired by transthoracic echocardiography via the parasternal and subcostal windows. TEE monitoring helped confirm the positions of the devices placed in the great vessels, tumor location, absence of residual air or leakage, and normal heart function. No complications related to the TEE were observed. Intraoperative TEE monitoring is a feasible option even in patients who have undergone esophagectomy with retrosternal gastric tube reconstruction.

Magrolimab (ONO-7913) is an anti-cluster of differentiation 47 (CD47) monoclonal antibody. This was a phase 1, open-label, uncontrolled, dose-escalation study that assessed the tolerability and safety of intravenous magrolimab (priming dose: 1 mg/kg; maintenance dose: 20 mg/kg [Cohort 1] or 30 mg/kg [Cohort 2]; 28-day treatment cycle) in Japanese adult patients with histologically or cytologically confirmed advanced or metastatic solid tumors, ≥ 1 measurable lesion, an Eastern Cooperative Oncology Group performance score of 0–1, and an expected survival ≥ 3 months. Seven patients were enrolled and received magrolimab (Cohort 1, n = 4; Cohort 2, n = 3) with the median follow-up of 170.0 (34–491) days. All 7 patients discontinued the magrolimab monotherapy, and 4 (57.1%) patients completed the study as per the protocol. No dose-limiting toxicities were observed in both cohorts, and the maximum tolerated dose was not reached. All patients experienced treatment-emergent adverse events (TEAEs) but not any serious adverse events, TEAEs leading to treatment discontinuation or interruption, or TEAE-related deaths. No complete or partial responses occurred, while the disease control rate was 42.9% (best overall response: stable disease, n = 3; disease progression, n = 3; not evaluable, n = 1). Magrolimab was well tolerated in Japanese patients with advanced or metastatic solid tumors. Trial registration: NCT04403308, submitted on May 21, 2020.

Diabetic polyneuropathy (DPN) decreases health-related quality of life (HRQOL) and physical function. Exercise therapy improves the physical function of patients with DPN; however, its effect on HRQOL remains unknown. Therefore, we subanalyzed the effect that teleguidance for exercise therapy by physiotherapists has on HRQOL in older patients with DPN by using our previously obtained data. The physiotherapist who participated in this study is a specialist in exercise therapy for diabetes. Participants with DPN were categorized into the teleguidance for exercise therapy by physiotherapists (TelePhysio) and control groups (n = 18 and 19, respectively). Both groups underwent the same moderate-intensity exercise therapy program. In the TelePhysio group, teleguidance for exercise therapy was provided for 30min once a week for six months. In the control group, no telephone intervention was provided, and patients were interviewed at the hospital only at 3 months after discharge. For the comparison between parameters at baseline and six months later, in the TelePhysio group, the EuroQol 5-dimensional (EQ-5D) score and knee extension force (KEF) did not decrease, whereas the Diabetes Treatment Satisfaction Questionnaire (DTSQ) score significantly improved (24.2 ± 5.7 to 26.7 ± 6.0; P < 0.05). In contrast, in the control group, the EQ-5D score and KEF were significantly decreased, whereas the DTSQ score remained unchanged. TelePhysio is effective in improving treatment satisfaction and may help prevent decline in HRQOL and physical function in older patients with DPN. Our findings suggest that TelePhysio may be a treatment option for older patients with DPN. The online version contains supplementary material available at 10.1007/s13340-026-00884-8.

A defining feature of circadian clocks that enables adaptation to Earth's rotation is their ability to sustain an approximately 24 h period with precision, regardless of environmental factors such as temperature. This remarkable reliability of circadian timing can be reconstituted in vitro using only three cyanobacterial clock proteins: KaiA, KaiB, and KaiC. In vivo circadian rhythms, however, are governed not only by this Kai protein-based oscillator but also by transcription-translation feedback loops and additional clock components. The contribution of the Kai protein-based circadian oscillator to the overall reliability of the in vivo circadian rhythm remains unclear. In this study, we compared over 20 KaiC period mutants with periods ranging from 15 to 60 h under in vitro and in vivo conditions. In both cases, the period was insensitive to environmental conditions, suggesting a compensatory mechanism independent of metabolic state or rhythm amplitude. The ATPase activity of KaiC, the pacemaker of the cyanobacterial circadian clock, exhibited a stronger correlation with in vitro circadian frequency than in vivo circadian frequency. These results indicate that the KaiC ATPase-driven protein-based circadian oscillator inherently encodes a reliable circadian period independent of rhythm amplitude or environmental conditions. This intrinsic property likely plays a critical role in preserving the precision and stability of circadian timing in vivo while being influenced by the intracellular environment.

We aimed to examine the psychometric properties of the second version of the Brief Evaluation of Psychosis Symptom Domains (BE-PSD-V2.0) and its correspondence with the Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression-Severity scale (CGI-S) scores. This cross-sectional study was conducted at 18 institutes in Japan. We performed correlational analyses to test the convergent and divergent validity of the BE-PSD-V2.0. Inter-rater reliability was assessed using intraclass correlation coefficients (ICCs). The equipercentile equating method was employed to examine the linking of the BE-PSD-V2.0 with the PANSS and the CGI-S. A total of 353 patients with schizophrenia spectrum disorders were included. Spearman's rank correlation coefficients between the BE-PSD-V2.0 item scores and their corresponding PANSS factor scores ranged from 0.64 to 0.86, indicating sufficient convergent validity. These specific correlation coefficients were consistently the highest among all item-to-factor comparisons, indicating sufficient divergent validity. In 34 patients, ICCs for the BE-PSD-V2.0 itemand total scores ranged from 0.60 to 0.94, showing sufficient inter-rater reliability. Conversion tables were established between the BE-PSD-V2.0 total score and the PANSS total score, between the BE-PSD-V2.0 total score and the CGI-S score, and between the BE-PSD-V2.0 item scores and their corresponding PANSS factor scores. A correspondence between symptomatic remission criteria using the PANSS and BE-PSD-V2.0 was confirmed. The BE-PSD-V2.0 possesses sufficient psychometric properties and corresponds to the PANSS and CGI-S. It is a sound and reliable brief rating scale for assessing symptoms in schizophrenia spectrum disorders, and its established conversion correspondences facilitate score interpretation within existing clinical paradigms for both clinical practice and research.