Matsunami General Hospital

Background/Objectives: Accurate prediction of severe adverse events (SAEs) is crucial for optimizing supportive care while maintaining treatment intensity in diffuse large B-cell lymphoma (DLBCL). We evaluated the predictive value of the Geriatric Nutritional Risk Index (GNRI) for SAEs in de novo DLBCL and examined potential interactions with treatment regimen and age. Methods: This multicenter retrospective study included 555 adults treated with standard immunochemotherapies. SAEs, defined as grade ≥ 3 non-hematological adverse events or febrile neutropenia, were independently assessed by board-certified hematologists. Results: Multivariable logistic regression identified GNRI as an independent predictor of SAEs (odds ratio 0.982, 95% confidence interval 0.967-0.997). Restricted cubic spline modeling revealed a significant non-linear association between GNRI and SAE risk (p = 0.045). No significant interaction was observed between GNRI and regimen or age (p = 0.894 and 0.217, respectively), a finding consistent across subgroups in forest plot analyses. Conclusions: This study showed that lower diagnostic GNRI was independently associated with higher SAE risk regardless of treatment regimen or age. These findings highlight the potential utility of GNRI as a simple clinical indicator for identifying patients at higher risk of treatment-related toxicity, although they are derived from a retrospective, tertiary-care cohort and require confirmation in external prospective studies.

ObjectiveThis study aimed to assess the methodological quality of published systematic reviews of exercise therapy in knee osteoarthritis and summarise their reported effectiveness on quality of life, knee joint function, or adverse events.DesignOverview of systematic reviews.Data sourcesPubMed, Embase, CINAHL, Web of Science and CENTRAL (searched on 14 April 2025), plus grey literature (PROSPERO, Epistemonikos, OpenGrey).Eligibility criteria for selecting studiesWe included systematic reviews of randomised controlled trials in patients diagnosed with knee osteoarthritis by imaging or clinical criteria and treated conservatively with exercise therapy; we excluded reviews that enrolled patients scheduled for surgery, with acute inflammation or osteoarthritis of other joints (hand, hip, ankle), for which relevant author data could not be obtained after one contact attempt, or that did not report at least one primary outcome (quality of life, knee joint function or adverse events).Data extraction and synthesisTwo reviewers independently extracted data on study characteristics, interventions and outcomes, and assessed methodological quality using the AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews 2) tool. Due to heterogeneity in outcome measures across systematic reviews, meta-analysis was not conducted. Effectiveness was defined as any reported beneficial outcome of exercise therapy on predefined outcomes, including quality of life, physical function, pain or adverse events.Results58 systematic reviews were selected. Muscle-strengthening (74.1%) and aerobic (48.2%) exercises were the most commonly prescribed exercise-based interventions. SF-36 (36-Item Short Form Health Survey) and the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) were the most popular outcome-evaluation tools. Furthermore, 63.7% of the systematic reviews revealed that exercise therapy improved all outcomes. The number of intervention-related adverse events was small. Notably, almost all systematic reviews (87.4%) had a critically low quality.ConclusionsCurrent evidence on exercise therapy for knee osteoarthritis is inadequate. Nevertheless, exercise therapy can be considered for conservative treatment of knee osteoarthritis. Future studies should use network meta-analyses to compare the effects of different exercise therapies and determine their superiority over other conservative therapies.

Simultaneous overlapping cancers are defined as two or more primary malignancies diagnosed within six months of each other. The treatment strategy is highly individualized and depends on the localization and progression of each cancer. Although radical surgery is sometimes performed at the first instance, patients might be hesitant to undergo extensive resection due to the risk of surgical complications, depending on their condition. Herein, we describe the case of an 80-year-old male patient, diagnosed with concurrent pancreatic head and upper gastric cancer. He underwent a two-stage surgical treatment with favorable results.The patient was initially diagnosed with gastric cancer (cT1b, cN0, cM0, cStage1) and pancreatic head cancer (cT1, cN0, cM0, cStage1A) based on gastrointestinal endoscopy and computed tomography findings. Due to the highly invasive nature of simultaneous surgical resection, the patient opted to avoid a one-stage surgical resection. Furthermore, the treatment plan prioritized surgery for pancreatic cancer, which included subtotal stomach-preserving pancreaticoduodenectomy, m-Child reconstruction, and the Blumgart method. Postoperative pathology showed a pT3 (with duodenal invasion), pN0, cM0, and pStage2A pancreatic cancer. The patient received S-1 (tegafur/gimeracil/oteracil potassium) as an adjuvant chemotherapy for pancreatic cancer. This treatment resulted in a significant shrinkage of the gastric cancer after three months. However, one year after the surgery, the gastric cancer progressed, spreading from the upper gastric body to the middle. Despite administering two courses of S-1, it did not shrink. A total gastrectomy with Roux-en-Y reconstruction was performed, and the pathological findings indicated ypT1b, ypN0, ycM0, and ypStage1A gastric cancer. The patient remained alive even 31 months after the surgery, without recurrence.Our patient was an older adult, raising concerns about the complications with one-stage surgical resection. We successfully managed the patient by adopting a two-stage surgical approach with adjuvant chemotherapy in between. It resulted in recurrence-free survival at 31 months after the operation.

Abstract Rationale: Airway–esophageal fistulas often occur in patients with mainly lung and esophageal cancers because of chemotherapy, radiotherapy, or tumor invasion. As a result, oral intake is difficult or impossible, and performance status and quality of life will worsen. Airway stenting is a major treatment choice; however, there are few reports on whether patients can restart their oral intake. Methods: All patients with airway-esophageal fistulas who underwent rigid bronchoscopic intervention between September 2014 and March 2022 at our hospital (Nagoya Medical Center) were analyzed retrospectively. The main endpoints were the proportion of patients who restarted oral intake and the clinical benefits of airway stents. Results: During the study period, 42 patients (median age, 67.5 [range, 55-83], 90.5% males) who underwent airway stenting were analyzed. The most common underlying disease was esophageal cancer (34 patients, 81.0%). Twenty-nine (69.0%) patients were treated only with airway stents, seven (16.7%) had esophageal stents already in place, and six (14.3%) had undergone bypass surgery. The proportion of patients who were able to resume oral intake (including those who were able to drink only fluids) was 47.6% (n = 20). Fifteen patients could eat after airway stent monotherapy (15/29, 51.7%). There was no relationship between resuming or not resuming oral intake and postoperative pneumonia (5/20 vs. 4/22, respectively, p = 0.714). Other complications were observed in only six cases (14.3%). The median overall survival time of patients resuming oral intake was longer than that of patients without oral intake; however, the difference was not statistically significant (3.8 months vs. 2.4 months, p = 0.154). Conclusions: Among patients with airway-esophageal fistulas, 47.6% were able to resume oral intake. The safety of stenting was acceptable; therefore, airway stenting is an effective method for immediately resuming oral intake. Founding source: none

Mapping biopsy (MB) can evaluate superficial ductal spread (SDS) through the histopathological diagnosis of cholangiocarcinoma, enabling the selection of an appropriate surgical procedure. This retrospective study evaluated the efficacy of MB using a novel sheath system in distal cholangiocarcinoma (dCCA) cases. A total of 199 cholangiocarcinoma cases underwent preoperative diagnosis. Among them, 40, 21, and 26 cases underwent direct, sheath, and peroral cholangioscopy (POCS) MB, respectively, for dCCA. Each group was compared regarding their technical success rate and the diagnostic accuracy for SDS. Although all cases achieved technical success, the median procedure time of POCS (48-min) tended to be longer than direct (33-min) and sheath MB (30-min) (p overall = .092). Diagnostic specificity and accuracy were significantly higher in the sheath group (95.2%, 95.2%) compared to the direct (71.0%, 70.0%) and POCS (60.9%, 57.7%) MB groups (p overall = .019 and .0094). Multivariate analysis revealed that the sheath MB group was an independent significant factor for the accurate margin diagnosis (OR 0.11; 95% CI: 0.01-0.86, p = .0358). The sheath MB method provided the most accurate histopathological diagnosis of SDS in dCCA. To obtain a larger tissue sample and avoid tumor cell contamination, sheath MB is worth performing to assess the accuracy of the preoperative SDS diagnosis.

In coronary artery disease (CAD), lipid-core-containing plaque (LCP) in nontarget lesions detected using near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) was related to increased major adverse cardiovascular events in patients with CAD. In the endovascular therapy field, few previous studies using NIRS-IVUS revealed the presence of LCPs in severe stenotic lesions of femoropopliteal disease. This study aimed to assess the plaque morphology of nontarget lesions, especially LCPs, and compare it with that of target lesions using NIRS-IVUS in patients with femoropopliteal disease. This single-center prospective observational study included 14 patients who underwent endovascular therapy for FP disease. NIRS-IVUS assessment was performed on the entire FP arterial segment. Forty-one LCP lesions with a maximum lipid-core burden index in any 4-mm region (max LCBI4mm) > 100 were detected using NIRS-IVUS. We evaluated the patient and lesion characteristics. LCP lesions were divided into the target (n = 18) and nontarget (n = 23) lesion groups for comparison. Patient characteristics were notable for advanced age (76.8 ± 6.6 years); high proportion of males (78.7%); and high incidence of hypertension (100%), dyslipidemia (78.6%), diabetes (64.3%). Regarding NIRS findings, the target lesion group exhibited a significantly smaller proportion of LCPs concerning the lesion length (25.9 ± 15.7% vs. 50.6 ± 29.2%, p = 0.002) than the nontarget lesion group. Conversely, there were no significant differences in the value of max LCBI4mm (284.4 ± 153.4 vs. 289.5 ± 113.1, p = 0.90), length of LCP lesion (9.8 ± 9.7 mm vs. 10.7 ± 6.9 mm, p = 0.74), and distribution of LCPs (p = 0.08) between the groups. In addition, the number of LCPs in the target FP artery positively correlated with max LCBI4mm in the target FP artery (r = 0.671, p = 0.008). NIRS-IVUS findings demonstrated the presence of LCPs in nontarget lesions in patients with FP disease. Moreover, the abundance of LCPs in nontarget lesions was similar to that in target lesions in FP disease.