Kashiwa Municipal Hospital

BackgroundMarine-Lenhart syndrome is a rare clinical condition, and most thyroid nodules combined with Marine-Lenhart syndrome are benign nodules. In this case, Marine-Lenhart syndrome was combined with a malignant nodule and a papillary thyroid carcinoma, which is even rarer.Case presentation: We report a case of Marine-Lenhart syndrome in which the 99m TcO4 scan indicated a “hot nodule” in the thyroid. However, due to the patient’s thyroid ultrasound revealing a TI-RADS 4a categorized nodule, we performed a thyroid fine-needle aspiration biopsy followed by subsequent thyroid lobectomy with isthmusectomy. Both the results of pathological analysis confirmed the presence of papillary thyroid carcinoma.ConclusionsAfter confirming the presence of Graves’ disease, it is still essential to consider the possibility of thyroid hyperfunctioning adenoma, namely Marine-Lenhart syndrome. Although most thyroid nodules associated with Marine-Lenhart syndrome are benign and often present as “hot nodules,” it is crucial not to disregard the small probability of thyroid malignancy in such cases.

Abstract Background Obesity is a major risk factor for atherosclerotic cardiovascular disease (ASCVD), which promotes the formation and progression of coronary atherosclerosis. Given expected rise in obesity prevalence, effective anti-atherosclerotic strategies are essential for obese patients. Lowering LDL-C level is a guideline-recommended strategy to mitigate risk of ASCVD. However, whether obese patients favorably respond to lowering LDL-C levels has not yet been fully characterized. The OPTIMAL study was a randomized controlled trial which employed intravascular imaging to compare the efficacy of continuous glucose monitoring-guided and HbA1c-guided glycemic control on coronary atherosclerosis in statin-treated type 2 diabetic patients with CAD. The current study is a sub-analysis of the OPTIMAL study which evaluates coronary plaque progression in response to lowering LDL-C levels in obese and non-obese patients with type 2 diabetes mellitus (T2DM). Purpose To compare the effect of achieving LDL-C <1.8 mmol/L on coronary plaque progression in non-obese and obese subjects with T2DM. Methods This analysis included a total of 78 statin-treated type 2 diabetic patients with CAD. Serial IVUS imaging was conducted to measure percent atheroma volume (PAV) at non-culprit segments at both baseline and 48 weeks. Clinical characteristics and change in PAV were compared in obese (BMI≥25kg/m2, n=31) and non-obese patients (BMI<25kg/m2, n=47) according to achieved LDL-C level <1.8mmol/L at 48-weeks, respectively. Results LDL-C target attainment was similar in obese and non-obese individuals (41.9% vs. 57.4%, p=0.23). In non-obese patients, clinical characteristics and NIRS/IVUS parameters did not differ between those with and without achieved LDL-C <1.8mmol/L (Table 1). Achieving LDL-C level <1.8mmol/L was not necessarily associated with a significant change in PAV [-0.36% (-1.62, +0.90), p=0.57] (Figure 1). In obese patients, those achieving LDL-C <1.8 mmol/L were more likely to receive high-intensity statins (100% vs. 66%, p=0.03) and β-blockers (92% vs. 55%, p=0.04) with a lower frequency of metformin use (23% vs. 66%, p=0.03) (Table 2). On serial IVUS imaging analysis, following adjustment of clinical demographics and medication use, a greater regression of PAV was observed in association with achieving LDL-C <1.8 mmol/L [-1.06% (-1.93, -0.18), p=0.02] (Figure 2). Conclusions Plaque regression in response to achieving LDL-C <1.8 mmol/L differed by obesity, with significant benefit observed in obese T2DM patients. These findings highlight the need for aggressive LDL-C lowering in obese individuals to further reduce their cardiovascular risk.Table 1 and Figure 1 non-obese patients Table 2 and Figure 2 obese patients

Surgery remains the mainstay of treatment for retroperitoneal sarcoma (RPS); however, definitive therapeutic strategies for patients with insufficient surgical margins and unresectable disease owing to locally advanced RPS remain unclear. Carbon ion radiotherapy (CIRT) has been employed in patients with unresectable RPS. This study aimed to evaluate the effectiveness of CIRT in this patient population. A retrospective analysis was conducted in 76 patients with unresectable RPS treated with CIRT. Of these, 95% had a confirmed prognosis until 2022. In 74 patients, the prescribed relative biological effectiveness dose was 70.4 Gy, delivered in 16 fractions over 4 weeks. Respiratory gating was used, and spot scanning irradiation has been performed in all patients since 2016. The 3- and 5-year overall survival rates for the entire cohort were 68.3% and 49.4%, respectively, with a median overall survival time of 58.1 months. The 3- and 5-year local control rates were 79.0% and 72.0%, respectively. Among 47 naïve patients with treatment-naïve tumors, the 3- and 5-year abdominal recurrence-free survival rates were 51.1% and 29.1%, respectively. Late adverse events of grade 3 or higher occurred in 4 (5.2%) patients. CIRT represents a definitive treatment option for patients with unresectable RPS. In the future, multicenter studies should be conducted to evaluate the effectiveness of CIRT for RPS in larger patient cohorts.

Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis and is a leading cause of cancer mortality. Early diagnosis is difficult due to the anatomical characteristics of the pancreas, which is a long and thin organ located dorsal to the stomach and large intestine. The aim of the present study was to search for protein biomarkers for PDAC in serum extracellular vesicles (EVs) using mass spectrometry, and to validate identified biomarkers using an enzyme-linked immunosorbent assay (ELISA) of sera from patients. Comprehensive and targeted proteomic analyses for biomarker discovery and verification were performed using EVs from serum of patients with PDAC, patients with chronic pancreatitis (PT) and healthy volunteers (HVs). For validation, the discriminatory power of candidate proteins was evaluated using an ELISA. Of the 3,043 proteins analyzed, 45 were identified as potential biomarkers, with receptor expression-enhancing protein 5 (REEP5) selected for further analysis. The serum level of fucosylated REEP5 was significantly higher in PDAC cases compared with in PT and HVs (P<0.001). The areas under the curve (AUC) of the receiver operator characteristic were 0.928 for fucosylated REEP5 and 0.805 for carbohydrate antigen 19-9 (CA19-9) in PDAC vs. non-cancer controls. The AUCs were 0.962 for fucosylated REEP5 and 0.810 for CA19-9 in stages I and II of PDAC. These results indicate that fucosylated REEP5 is a novel serum EV biomarker for detection of early stage PDAC. Further analysis in a larger cohort is warranted to evaluate the clinical utility of fucosylated REEP5 as a biomarker for PDAC.

目的：嚥下造影検査（VF）は嚥下障害の診断や治療法の決定において重要な情報源となる．現行の評価法は主観的要素が強く，客観的評価の臨床活用が望まれる．本研究では嚥下障害の対照群と疾患群との比較研究から，疾患群の嚥下障害の病態を定量的に示すことを目指した．

A clinical survey was performed on 252 patients who underwent orthognathic surgery at the Department of Oral and Maxillofacial Surgery, Chubu Rosai Hospital, during the 7 years from April 1, 2017 to December 31, 2023.The results were as follows.1 During the 7 years, 252 patients (74 males and 178 females) with dentofacial deformities underwent orthognathic surgery.2 The average age of the patients was 27.7 7.4 years old (16-57) .Patients in their twenties accounted for the largest number (53.6) .3 The most common diagnosis was mandibular asym-metrymandibular prognathism (25.8) , followed by mandibular prognathism (21.0) .4 The most frequently performed operation was sagittal split ramus osteotomy (SSRO) , accounting for 133 cases (52.8) , followed by the combination of Le

ABSTRACTINTRODUCTIONPancreatic solid pseudopapillary neoplasms (SPNs) are rare tumors, accounting for 1%–3% of all pancreatic tumors, with a predilection for young women. Owing to their often asymptomatic nature, SPNs are typically discovered incidentally. Spontaneous rupture of SPNs is extremely rare, with few reported cases. Herein, we report a case of spontaneous SPN rupture and review the literature on similar cases.CASE PRESENTATIONA 17-year-old girl presented with sudden, severe left upper abdominal pain and hemorrhagic shock. Contrast-enhanced computed tomography revealed a 13-cm heterogeneous pancreatic tail tumor with internal extravasation and massive ascites, indicative of intraperitoneal hemorrhage. The patient underwent distal pancreatectomy and splenectomy. Histopathological examination confirmed SPN with no vascular invasion. Immunohistochemistry was positive for β-catenin, CD10, CD56, and synaptophysin, with a low Ki-67 index (1%–2%). The patient had an uneventful recovery and was discharged on postoperative day 13.CONCLUSIONSSpontaneous SPN rupture is an exceedingly rare occurrence, and its underlying mechanisms remain unclear. Ruptured SPNs may pose a higher risk of recurrence and peritoneal dissemination, necessitating long-term follow-up. Further studies are needed to elucidate the factors influencing SPN rupture and its long-term implications.

This study aims to develop a prognostic model that estimates the post-operative risk of cancer-specific mortality in patients with bladder cancer who underwent radical cystectomy (RC). We analyzed the data from patients with bladder cancer who had undergone radical cystectomy without receiving adjuvant chemotherapy across 36 institutions in the Japan Urological Oncology Group. The data were randomly split into training (N = 1348) and validation sets (N = 674) in a 2:1 ratio. Twenty-five variables were analyzed, and a multivariable Cox regression model predicting cancer-specific mortality was developed and validated. Prognostic scores were categorized into good and poor prognostic groups based on the upper tertile. The performance of the model was compared against the CheckMate 274 risk classification as a reference, which is used for determining the indication of adjuvant nivolumab therapy. The final model incorporated eight variables. In the validation set, it outperformed the CheckMate 274 risk classification with superior time-dependent area under the curves (5-year: 0.81 vs. 0.67) and was well-calibrated. Furthermore, our model reclassified 27.8% of patients categorized as high-risk by the CheckMate 274 risk classification into the good prognosis group. We developed and validated a prognostic model for patients with bladder cancer who underwent RC. This model will be beneficial in identifying patients with poor prognosis and those who are potential candidates for clinical trials of adjuvant therapy.