Kyoto Medical Center

Tumor rupture is a rare complication of uterine leiomyosarcoma. We report a case of ruptured uterine leiomyosarcoma diagnosed after the onset of abdominal pain following endoscopic examination of the lower gastrointestinal tract. The patient was a 56-year-old woman who was diagnosed with anemia at 48 years of age when she was first referred to our medical team. Contrast-enhanced magnetic resonance imaging (MRI) revealed a 48 × 50 mm mass in the anterior wall of the uterine body, which was diagnosed as a uterine fibroid. After 8 years of regular follow-up once or twice a year, the patient developed abdominal pain after undergoing lower gastrointestinal endoscopy, which was prompted by a positive fecal occult blood test result. Contrast-enhanced computed tomography (CT) showed that the uterine mass had enlarged to 90 × 69 mm. T2-weighted contrast-enhanced MRI demonstrated moderate signal intensity and restricted diffusion, whereas contrast-enhanced T1-weighted MRI revealed high signal intensity, suggestive of hemorrhage. The outlines of the tumor and uterus were interrupted cephalad to the lesion, raising the suspicion of rupture of a malignant uterine mesenchymal tumor. Therefore, total hysterectomy, bilateral salpingo-oophorectomy, and partial omentectomy were performed. Intraoperatively, tumor rupture and adhesion of the ruptured tissue to the ileum were observed, necessitating partial ileectomy. Pathological examination of the resected specimen revealed irregularly proliferating spindle cells with marked nuclear atypia, 12 mitotic figures per 10 high-power fields, coagulative necrosis, and multinucleated giant cell infiltration. Another notable finding was the presence of ectopic osteosarcoma and chondrosarcoma.

Severe hypoglycemia (SH) is a major complication in adults with type 1 diabetes mellitus (T1DM). The multifactorial etiology of T1DM highlights the need for predictive tools that integrate clinical, behavioral, and technological factors. This study aimed to develop and evaluate machine learning (ML) models for predicting SH by incorporating hypoglycemia problem-solving ability, diabetes technology, and continuous glucose monitoring (CGM) indices. We analyzed data from 247 adults with T1DM (mean age 50.4 ± 13.7 years; 38.1% male; glycosylated hemoglobin 7.7 ± 0.9%) from the FGM-Japan study. A total of 22,517 feature-model combinations were evaluated across 11 ML algorithms, including logistic regression, L1-regularized regression, random forest, LightGBM, XGBoost, SVM, Naïve Bayes, SGD, neural networks, and k-nearest neighbors. Eleven candidate predictors included impaired awareness of hypoglycemia (IAH), diabetic peripheral neuropathy (DPN), CSII, rtCGM, and seven domains of hypoglycemia problem-solving ability. The model performance was assessed with fivefold cross-validation using the receiver operating characteristic-area under the curve (ROC-AUC), accuracy, precision, recall, and F1 score. Class imbalance was addressed using SMOTE. The mean ROC-AUC across models was 0.64 (range: 0.151-0.916). The average accuracy was 0.90, but the precision and recall were consistently low, with a mean recall of 0.08. The high-performing models (ROC-AUC > 0.90) were primarily Random Forest and LightGBM, which frequently incorporated domains such as problem perception, identifying problem attributes, seeking preventive strategies, evaluating strategies, and immediate management. factors. Tree-based models significantly outperformed logistic regression, Naïve Bayes, SVM, and SGD (adjusted p < 0.001), whereas the differences among the tree-based algorithms were not clinically meaningful. Tree-based ML models demonstrated superior discriminative ability for predicting SH in patients with T1DM. Hypoglycemia problem-solving ability was the strongest predictor, underscoring the importance of integrating behavioral self-management skills with clinical and technological factors. University hospital Medical Information Network (UMIN) Center: UMIN000039475), Approval date 13 February 2020.

Self-expanding metal stents (SEMS) are widely used as a bridge to surgery in obstructive colon cancer, offering short-term benefits by reducing postoperative complications and avoiding emergency stoma creation. Additionally, early initiation of systemic chemotherapy may improve oncological outcomes. However, the safety and feasibility of preoperative chemotherapy following SEMS placement remain unclear. This study aims to evaluate the safety and efficacy of neoadjuvant CAPOX chemotherapy after SEMS placement in patients with obstructive colon cancer. This is a prospective, multicenter, single-arm Phase II trial involving patients with clinical stage II or III obstructive colon cancer. Eligible patients undergo successful SEMS placement followed by two cycles of CAPOX chemotherapy prior to elective surgery. The primary endpoint is the incidence of severe perioperative complications, defined as a composite of stent-related adverse events and Clavien - Dindo Grade III or higher postoperative complications. Secondary endpoints include chemotherapy-related adverse events, pathological response, and 2-year relapse-free survival. A total of 75 patients are planned for enrollment across 16hospitals in Japan over 1.5 years. The study is registered in the Japan Registry of Clinical Trials (jRCTs051240077).

ABSTRACTAimsHelicobacter pylori (H.pylori) eradication therapy often fails to eradicate clarithromycin (CAM)‐resistant strains. Individualized therapy with proton pump inhibitors and metronidazole instead of CAM could be effective for first‐line eradication based on CAM sensitivity tests. However, on the basis of these tests, whether vonoprazan (VPZ) can be used for the eradication of H. pylori remains unknown. Therefore, this study investigated the effectiveness of VPZ‐based triple therapy for the eradication of H. pylori based on CAM sensitivity tests.MethodsOf 2920 patients who underwent H. pylori culture testing, 1223 tested positive, and 771 H. pylori‐positive patients received VPZ‐based triple therapy (VAC [VPZ 20 mg b.i.d., amoxicillin 750 mg b.i.d., CAM 200 mg or 400 mg b.i.d.; n = 631] or VAM [VPZ 20 mg b.i.d., amoxicillin 750 mg b.i.d., MNZ 250 mg b.i.d.; n = 140] therapy for 7 days based on CAM sensitivity).ResultsBoth the VAC and VAM therapy groups were equivalent in terms of patient backgrounds. The VAM therapy‐associated eradication rate of CAM‐resistant strains was higher than the VAC therapy‐associated eradication rates of both CAM‐resistant and CAM‐sensitive strains (p < 0.01 and p = 0.02, respectively). The incidences of adverse events associated with VAC and VAM therapies were similar.ConclusionsBased on CAM susceptibility, VPZ‐based triple therapy, VAM, afforded a high eradication rate of CAM‐resistant H. pylori strains; whereas VAC was not effective for the eradication. Additionally, drug sensitivity tests are recommended when VPZ‐based triple therapy is administered.

To investigate clinical outcomes, treatment, and survival rates of men aged ≥75 years with prostate cancer in Japan. The study used data from the Prostate Cancer Research International: Active Surveillance (PRIAS)-JAPAN, a nationwide, multicentre prospective cohort study of men with clinically localised prostate cancer managed with active surveillance (AS). The original eligibility criteria were clinical stage T1c-T2 disease, prostate-specific antigen (PSA) level ≤10 ng/mL, PSA density (PSAD) <0.20 ng/mL/mL, and Gleason Score ≤3 + 3 with two or fewer positive biopsy cores. In 2021, magnetic resonance imaging use expanded eligibility to include patients with a PSA level ≤20 ng/mL, PSAD <0.25 ng/mL/mL, and Gleason Score ≤3 + 4 with <50% of biopsy cores positive. PSA was monitored every 3-6 months, and biopsies were scheduled at 1, 4, 7, and 10 years, and every 5 years thereafter. The outcomes in those aged ≥75 years (older group) were compared with those aged <75 years (younger group). Of the 1274 eligible patients enrolled by 29 February 2024, 231 were in the older group and 1043 were in the younger group. In the older group, the median age at enrolment was 77 years. At diagnosis, patients in the older group had significantly larger prostate volumes, higher proportion of Gleason Score 3 + 4, and more T2 disease than those in the younger group. The protocol biopsy acceptance rate decreased over time (first: 82.9%, second: 63.6%, third: 42.2%, fourth: 22.4%), with no significant difference between age groups. The 10-year AS persistence rate in the older group was 8.8%. The overall survival was significantly lower in the older group than in the younger group (hazard ratio: 0.32, 95% confidence interval 0.14-0.74); however, the 10-year metastasis-free survival and cancer-specific survival rates in the older group were both 100%. In some patients aged ≥75 years an observation-focused management approach may be appropriate, in which AS is initiated as a structured monitoring phase with planned de-intensification and transition to watchful waiting, to prevent overtreatment while maintaining excellent cancer-specific outcomes.