Kensei Hospital

The Sangai (Rucervus eldii eldii) is found only in the Manipur’s Keibul Lamjao National Park (KLNP). The Sangai is peculiar, being the "only deer to adapt to a floating wetland habitat." The reasons why there is threats to the Sangai's very existence will, for the purpose of this paper, assume that there are efforts to learn more about the basic characteristics that define the deer, regarding its population and approaches to conservation. Despite a population recovery from near-extinction in 1960s, the species remains in danger of extinction due to its habitat deterioration by Loktak Hydro Electric Project, loss of genetic diversity, poaching and disturbance on the overall ecosystem of Loktak Lake by human activities.

ABSTRACTBackgroundPractice‐Based Research Networks (PBRNs) have historically been effective support mechanisms for primary care research. Although the number of PBRNs worldwide has increased, their numbers in Japan are relatively limited. This study aims to elucidate the current PBRN landscape in Japan and the process of establishing a new PBRN to encourage the formation of similar networks.MethodsWe conducted a national cross‐sectional descriptive study in which six PBRNs in Japan were identified using the Agency for Healthcare Research and Quality PBRN Registry. Detailed information regarding their PBRN characteristics and activities was collected using a standardized Excel template. We further conducted an embedded illustrative case study of the experiences and lessons learned from initiating a PBRN, using data gathered from the steering committee members of the network and document review.ResultsSix primary care‐focused PBRNs were found in regions ranging from large cities to isolated islands. Their relationships with academic external stakeholders also vary. All networks were established within the past 15 years, with most encountering funding challenges. The illustrative case study highlighted several key lessons, including the significance of motivation, necessity for clear membership and defined roles of PBRN members, the governance structure of the PBRN organizational diagram, and the importance of sustainable activities and funding.ConclusionsPBRNs play a crucial role in building a sustainable foundation of evidence for primary care research. Support from the Japan Primary Care Association committees and the Global PBRN Initiative significantly aids in advancing PBRN activities, ultimately enhancing primary care research in Japan.

Amrubicin monotherapy has been used in Japan for patients with refractory, relapsed, small cell lung cancer (SCLC). However, the clinical guidelines do not specify a recommended initial dose for elderly patients. This retrospective study aimed to explore the appropriate initial dose of amrubicin for elderly patients with refractory, relapsed SCLC. This study included elderly patients (aged ≥70years) with refractory, relapsed SCLC who received amrubicin monotherapy at Nagoya City University Hospital between April 2009 and March 2023. Patients were divided into two groups based on the initial dose: the low-dose group (<40mg/m2) and the high-dose group (≥40mg/m2). Forty-seven patients were included, thirty-eight in the low-dose group and nine in the high-dose group. Median progression-free survival was significantly longer in the low-dose group than in the high-dose group (3.64 vs. 1.5months, P=0.04), whereas overall survival was not significantly different (10.18 vs. 8.18months, P =0.58). Febrile neutropenia occurred in seven patients. Treatment discontinuation due to adverse events was more frequent in the high-dose group (44.4%) than in the low-dose group (13.5%). Non-infectious adverse events such as interstitial pneumonia, arrhythmia, and myocardial infarction were observed in five patients who discontinued treatment. Both hematological and non-infectious adverse events may have contributed to shorter progression-free survival in the high-dose group. Low-dose administration, granulocyte colony-stimulating factor support, and close monitoring for non-infectious toxicities may be important in elderly patients.

症例は70歳台女性。8年前に特に誘因なく両下腿の疼痛・しびれ，足趾の不随意運動が出現した。複数の医療機関で精査を行ったが原因は不明だった。他院でむずむず脚症候群として西洋薬で治療されたが症状は不変だった。転居に伴い当院を受診し，精査の後に painful legs and moving toes 症候群（PLMT）と診断した。ミロガバリン，アミトリプチリンなどを処方したが効果を認めず，眠気などの副作用が強かった。東洋医学的所見から陰証，虚証で水滞と裏寒を伴うことより，真武湯を処方したところ，下腿の痛みと痺れ，足趾の不随意運動は軽減した。附子末を併用，漸増することで，さらに下肢症状の軽減が得られ，アレルギーのあるトラマドール製剤から離脱できた。西洋医学的治療に難渋する PLMT に対して，漢方治療は選択肢の一つとなりうると推測した。

ObjectiveTranssphenoidal surgery for lactotroph pituitary neuroendocrine tumor (PitNET) lowers serum prolactin concentrations, occasionally below the normal range. However, the clinical significance of postoperative hypoprolactinemia is still unclear. In this study, we retrospectively reviewed the female patients with lactotroph PitNET who were treated with transsphenoidal surgery to elucidate the influence of postoperative hypoprolactinemia on regular menstruation restoration and endocrinological remission.ResultsThe serum prolactin levels in all thirty three participating females had decreased following surgery. Serum prolactin levels in seven patients had decreased below the lower limit of normal ranges (hypoproactinemia group) and in the remaining twenty six patients, it was within the normal range (non-hypoproractinemia group). In hypoprolactinemia group, regular menstruation was restored in all patients with only lactotroph axis deficiency. Nine patients from the non-hypoprolactinemia group experienced re-elevation of serum prolactin concentration (27%). No patient in hypoprolactinemia group experienced the relapse of hyperprolactinemia. These data suggest that early postoperative hypoprolactinemia after transsphenoidal surgery for lactotroph PitNET is not only a good predictive factor for endocrinological remission but also no unfavorable effects on regular menstruation restoration.

not-yet-known not-yet-known not-yet-known unknown Background: The innate immune system is activated at the onset of food protein-induced enterocolitis syndrome (FPIES) symptoms. However, the precise mechanism through which this immune response is initiated remains unclear. Objective: We aimed to investigate the proteomic profile of FPIES during symptom development through in-depth serum and saliva proteomic analyses. Methods: We enrolled 17 patients with a previous diagnosis of egg yolk FPIES who underwent an oral food challenge test (OFC) with 5 g of heated egg yolk. Six patients showed positive OFC results, whereas 11 showed negative OFC results. Serum and saliva samples were collected before OFC and 1 and 2 h after ingestion. Serum was also collected at symptom onset. We analyzed serum and saliva peptides using data-independent acquisition-mass spectrometry and compared levels to identify protein groups and pathways important in FPIES symptom development. Results: We detected 4,138 and 7,202 proteins in the serum and saliva, respectively. The OFC-positive group exhibited 609 serum proteins with more than a two-fold change in expression 2 h after OFC, including proteasome subunits and neddylation-related proteins. We identified 304 proteins associated with symptom onset, including those related to the degradation response and neutrophil extracellular trap formation. Proteins related to neutrophil activation increased both in the serum and saliva, regardless of the onset of symptoms. Conclusion: Our findings suggest that changes in protein levels, including proteasome and neddylation-related proteins, may be involved in FPIES pathogenesis and warrant further investigation to address the growing clinical burden imposed by gastrointestinal allergies.

BackgroundThe efficacy of adjuvant chemotherapy for high-risk stage II colon cancer (CC) has not been well established. Using propensity score matching, we previously reported that the 3-year disease-free survival (DFS) rate was significantly higher in patients treated with uracil and tegafur plus leucovorin (UFT/LV) against surgery alone. We report the final results, including updated 5-year overall survival (OS) rates and risk factor analysis outcomes.MethodsIn total, 1902 high-risk stage II CC patients with T4, perforation/penetration, poorly differentiated adenocarcinoma/mucinous carcinoma, and/or < 12 dissected lymph nodes were enrolled in this prospective, non-randomized controlled study based on their self-selected treatment. Oral UFT/LV therapy was administered for six months after surgery.ResultsOf the 1880 eligible patients, 402 in Group A (surgery alone) and 804 in Group B (UFT/LV) were propensity score-matched. The 5-year DFS rate was significantly higher in Group B than in Group A (P = 0.0008). The 5-year OS rates were not significantly different between groups. The inverse probability of treatment weighting revealed significantly higher 5-year DFS (P = 0.0006) and 5-year OS (P = 0.0122) rates in group B than in group A. Multivariate analyses revealed that male sex, age ≥ 70 years, T4, < 12 dissected lymph nodes, and no adjuvant chemotherapy were significant risk factors for DFS and/or OS.ConclusionThe follow-up data from our prospective non-randomized controlled study revealed a considerable survival advantage in DFS offered by adjuvant chemotherapy with UFT/LV administered for six months over surgery alone in individuals with high-risk stage II CC.Trial registrationJapan Registry of Clinical Trials: jRCTs031180155 (date of registration: 25/02/2019), UMIN Clinical Trials Registry: UMIN000007783 (date of registration: 18/04/2012).