Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers

Giant coronary artery aneurysms (CAAs), defined as dilatations exceeding 20 mm or four times the reference vessel diameter, are rare and risk rupture or thrombosis. Coronary pulmonary artery fistulas may lead to grow aneurysm formation via chronic high-flow shunting. Their coexistence is rare in elderly patients without prior Kawasaki disease. An 83-year-old woman with hypertension, dyslipidaemia, and type 2 diabetes mellitus was referred for evaluation of an abnormal mediastinal contour. Chest computed tomography showed a 43 × 33 mm left anterior descending artery aneurysm with a fistulous to the pulmonary artery, grown from 30 × 20 mm over 10 years. Right heart cardiac catheterization showed no evidence of pulmonary artery hypertension with a mild shunt flow (Qp/Qs: 1.15). Despite being asymptomatic, the aneurysm's size and growth warranted intervention. Considering her age and comorbidities, transcatheter coil embolization was selected over surgical or stent-based therapies. Coils were deployed using intravascular ultrasound (IVUS) and a balloon-assisted technique, successfully occluding the aneurysm without compromising distal flow. Follow-up angiography at 6 months and echocardiography up to 3 years confirmed sustained occlusion. This case highlights that even in asymptomatic elderly patients, large and expanding CAAs with fistulas warrant careful evaluation due to the risk of rupture. Transcatheter coil embolization provided a safe and effective treatment alternative to surgery, especially in high-risk anatomical and clinical settings. IVUS and balloon assistance were critical to procedural success, and long-term follow-up demonstrated sustained aneurysm exclusion.

ABSTRACTBackgroundRemnant gastric cancer (RGC) is associated with higher surgical difficulty and poorer long‐term outcomes than primary gastric cancer. However, the impact of postoperative complications on prognosis in RGC remains unclear.MethodsThis retrospective, multicenter cohort study included 126 patients who underwent curative surgery for RGC across five institutions between 2007 and 2024. Postoperative complications were evaluated using the Clavien–Dindo (CD) classification. Patients were stratified into two groups based on the presence of severe complications (CD grade ≥ 3a). Logistic regression analysis was used to identify risk factors for complications, and Cox proportional hazards models were applied to determine prognostic factors for overall survival (OS) and recurrence‐free survival (RFS).ResultsSevere postoperative complications occurred in 15.9% of patients. Multivariate analysis identified smoking (OR = 8.28, p = 0.0048), operative time ≥ 300 min (OR = 3.52, p = 0.0448), and blood transfusion (OR = 4.82, p = 0.0380) as independent risk factors for severe complications. Kaplan–Meier analysis demonstrated significantly poorer 5‐year OS (32.0% vs. 65.6%, p = 0.002) and RFS (33.6% vs. 64.3%, p < 0.001) in patients with CD grade ≥ 3a complications. CD grade ≥ 3a and pathological Stage II or higher were independent prognostic factors for both OS and RFS.ConclusionsSevere postoperative complications are associated with poor long‐term outcomes in patients undergoing curative surgery for RGC. Identifying and mitigating modifiable risk factors, such as smoking and operative invasiveness, may help improve surgical and oncological outcomes in this challenging population.

Fragility hip fracture (FHF) has been frequently seen in trauma of older people, resulted in decreased mobility and a loss of independence. This study retrospectively assessed the long-term health-related quality of life (HRQOL) and living arrangement in older patients following FHF, and evaluated the factors associating with long-term EuroQol 5D (EQ5D) for 5years or more. This study included 203 Japanese patients (male 26, female 177) with FHF over the age of 60years. We examined the long-term EQ5D and life style at final follow-up, and identified the factors affecting with EQ5D. The mean age at baseline of 79years, the mean observation duration was 6years, and the average value of EQ5D at final follow-up was 0.65. Multivariate analysis presented that EQ5D at final follow-up was significantly predicted by serum albumin, trochanteric fracture, comorbidity stroke, higher BI at post-admission, less length of stay hospital, and living at home at final follow-up. The people living at home at final follow-up (148/203 [72.9%]) was less than the people at baseline (190/203 [93.6%]). In multivariate analysis, the people living at home at final follow-up were younger age at baseline, and higher BI at post-admission. In conclusion the long-term EQ5D after FHF was decreased in patients with lower serum albumin at baseline, with trochanteric fracture, with stroke comorbidity, and with lower BI at post-admission. The people living at home after FHF were young age at baseline and high BI at post-admission.

A 41-year-old man with a history of obesity, hypertension, and smoking suffered from numbness and weakness in both lower limbs. He was diagnosed with ossification of the posterior longitudinal ligament and ligamentum flavum in the cervical and thoracic spine by X-rays, CT, and MRI. The patient underwent laminectomies at T2 and T3 levels, along with posterior fusion from T1 to T4, to address an upper thoracic spine lesion causing sensory deficits up to T5 and gait disturbances. The surgeries were T2 and T3 laminectomies and posterior T1-T4 fusion. The intraoperative and postoperative courses were uneventful. However, on the twelfth postoperative day, the patient suddenly experienced severe back pain followed by complete paralysis of both lower extremities, accompanied by significant swelling at the surgical site. An urgent MRI revealed a large hematoma dorsal to the dura mater, extending from T1 to T4. Emergent evacuation of the hematoma was performed, and no active bleeding was observed. Over time, a gradual improvement in the strength of the lower limbs was observed. Follow-up at two years postoperatively indicated the patient could walk unassisted for up to 1 km, although he continued to experience nocturnal urinary incontinence and erectile dysfunction. This case highlights the importance of recognizing that postoperative spinal epidural hematoma can develop even more than 10 days after spinal surgery. Patient and staff education is crucial to ensure prompt recognition and intervention.

ABSTRACTThe fluorinated thymidine analogue trifluridine (FTD) is a chemotherapeutic drug commonly used to treat cancer; however, the mechanism by which FTD induces cytotoxicity is not fully understood. In addition, the effect of gain-of-function (GOF) missense mutations of theTP53gene (encoding p53), which promote cancer progression and chemotherapeutic drug resistance, on the chemotherapeutic efficacy of FTD is unclear. Here, we revealed the mechanisms by which FTD induced aberrant mitosis and contributed to cytotoxicity in both p53-null and p53-GOF missense mutant cells. In p53-null mutant cells, FTD induced DNA double-stranded breaks, single-stranded DNA accumulation, and the associated DNA damage repair responses during G2 phase. Nevertheless, FTD-induced DNA damage and the related responses were not sufficient to trigger strict G2/M checkpoint arrest. Thus, these features were carried over into mitosis, resulting in chromosome breaks and bridges, and subsequent cytokinesis failure. Improper mitotic exit eventually led to cell apoptosis, caused by the accumulation of extensive DNA damage and the presence of micronuclei encapsulated in the disrupted nuclear envelope. Upon FTD treatment, the behavior of the p53-GOF-missense-mutant, isogenic cell lines, generated by CRISPR/Cas9 genome editing, was similar to that of p53-null mutant cells. Thus, our data suggest that FTD treatment overrode the effect on gene expression induced by p53-GOF mutants and exerted its anti-tumor activity in a manner that was independent of p53 function.

Genetic Creutzfeldt–Jakob disease (gCJD) with V180I prion protein gene (PRNP) mutation shows weaker prion protein (PrP) deposition histologically compared with sporadic CJD, and it is more difficult to detect protease‐resistant prion protein in immunoblotting. However, we previously reported the autopsy case of a patient with V180I gCJD who was treated with pentosan polysulfate sodium (PPS); this case had increased protease‐resistant PrP deposition. It has been suggested that PPS might reduce protease‐resistant PrP; however, the detailed pharmacological and histopathological effects of PPS in humans remain unknown. We examined autopsied human brain tissue from four cases with V180I gCJD that were added to our archives between 2011 and 2021: two cases treated with PPS and two cases without PPS. We conducted a neuropathological assessment, including immunohistochemistry for PrP. We also performed immunoblotting for PrP on homogenate samples from each brain to detect protease‐resistant PrP using both a conventional procedure and size‐exclusion gel chromatography for the purification of oligomeric PrP. Both PPS‐treated cases showed long survival time over 5 years from onset and increased PrP deposition with a characteristic pattern of coarse granular depositions and congophilic PrP microspheres, whereas the cases without PPS showed around 1‐year survival from onset and relatively mild neuronal loss and synaptic PrP deposition. Although cortical gliosis seemed similar among all cases, aquaporin 4‐expression as a hallmark of astrocytic function was increased predominantly in PPS cases. Immunoblotting of non‐PPS cases revealed protease‐resistant PrP in the oligomeric fraction only, whereas the PPS‐treated cases showed clear signals using conventional procedures and in the oligomeric fraction. These unique biochemical and histopathological changes may reflect the progression of V180I gCJD and its modification by PPS, suggesting the possible existence of toxic PrP‐oligomer in the pathophysiology of V180I gCJD and beneficial effects of PPS toward the aggregation and detoxication of toxic PrP‐oligomer.

Gluteal compartment syndrome is a rare disorder and no definitive treatment has yet been established. Fasciotomy is often the treatment of choice for gluteal compartment syndrome, but there have been only a few cases that have improved with conservative therapy. A 26-year-old male with a body mass index of 40.5 who underwent femoral nail extraction surgery had severe pain in the right buttock and numbness in the right lower extremity. Initially, we suspected transient pain due to prolonged exposure to the same posture, but muscle weakness in the lower extremities and worsening of renal function appeared over time. Orthopedic evaluation revealed physical examination findings and MRI imaging findings consistent with gluteal compartment syndrome. Conservative treatment with temporary dialysis was chosen instead of fasciotomy because of the time required for diagnosis. Dialysis was started on postoperative day 3, renal function and muscle weakness recovered over time, and the patient was discharged home on postoperative day 37. At six months post-op, the patient was walking without pain and he had no changes in his peripheral neurologic examination compared to his preoperative baseline. Orthopedic surgeons should always be aware of the possibility of gluteal compartment syndrome when especially obese patients with prolonged operation times appeal to acute buttock pain. Diagnosis should be made as early as possible to get a good prognosis.

&lt;div&gt;Abstract&lt;p&gt;The IL6 family of cytokines, including IL6 and leukemia-inhibitory factor (LIF), are induced during inflammation and are also expressed in many types of cancer where they play an important role in tumor development. IL6 family cytokines mainly activate the JAK–STAT3 pathway via the coreceptor, gp130, and IL6 is known to activate the Src family kinase (SFK)–Yes-associated protein (YAP) pathway. The current study investigated the role of autocrine LIF in human esophageal squamous cell carcinoma (ESCC) that highly expresses LIF. &lt;i&gt;LIF&lt;/i&gt; knockdown had various effects on cancer cells, including profound changes in gene expression, suppression of cell proliferation, migration/invasion and sphere formation, and induction of apoptosis. Similar to IL6, LIF activated the SFK–YAP pathway as well as the JAK–STAT3 pathway. LIF-induced YAP activation was more important for cancer cell proliferation than LIF-induced STAT3 activation, and concomitant YAP and STAT3 activation completely compensated for the role of LIF in human ESCC growth. We also confirmed that SFK activation and LIF expression were correlated with YAP activation in human ESCC clinical samples. Furthermore, simultaneous inhibition of the SFK–YAP and JAK–STAT3 pathways in human ESCC cells was more effective at suppressing cell proliferation than single inhibition, and autocrine LIF signaling promoted human ESCC growth &lt;i&gt;in vivo&lt;/i&gt;. Therefore, the LIF–SFK–YAP axis may represent a new therapeutic target for human ESCC.&lt;/p&gt;Implications:&lt;p&gt;Autocrine LIF signaling promotes human ESCC progression via SFK-dependent YAP activation and is a new potential target of treatment for human ESCC.&lt;/p&gt;&lt;/div&gt;

BackgroundChemotherapy and chemoradiotherapy are common treatments for esophageal squamous cell carcinoma with distant metastasis; however, the prognosis remains poor, and complete remission is difficult to achieve. Here, we report a case of an older adult patient with esophageal squamous cell carcinoma who underwent surgery following combined treatment of immunotherapy and chemotherapy and achieved pathological complete response.Case presentationAn 80-year-old woman presenting with difficulty swallowing was referred to our hospital. She was diagnosed with esophageal squamous cell carcinoma with distant metastasis of the lymph node at the dorsal side of the IVC and the left supraclavicular lymph node. She was treated with pembrolizumab, cisplatin, and 5-fluorouracil. After four pharmacotherapy courses, primary tumor and metastatic lymph node shrinkage was observed. The patient underwent thoracoscopic subtotal esophagectomy and regional lymph node dissection. The lymph node at the dorsal side of the IVC was not resected, and the left supraclavicular lymph node was removed. Histological examination revealed complete response with no residual tumor or lymph node metastasis. The patient had no recurrence 10 months postoperatively without adjuvant chemotherapy.ConclusionsConversion surgery following preoperative therapy, including immunotherapy, may be an effective treatment strategy for improving survival in patients with esophageal squamous cell carcinoma even among older adult patients.