Mie Chuo Medical Center

To identify optimal candidates for Aquablation during the initial adoption phase by determining predictors of operative time and bladder irrigation volume to guide safe implementation. We retrospectively analyzed 123 patients who underwent Aquablation between 2023 and 2025 during the initial implementation of this technique by Aquablation-naïve urologists at our institution. Patients with short operative times and low irrigation volumes were considered optimal candidates. Preoperative variables were assessed using multivariable linear regression. Because prostate volume (PV) demonstrated the strongest association with operative time and irrigation volume, post hoc exploratory locally estimated scatterplot smoothing (LOESS) analysis was performed to define a data-driven PV threshold, and perioperative outcomes were compared above and below this threshold. PV (median, 78 mL; interquartile range, 60-100 mL) was the only independent predictor of long operative times and great irrigation volumes. LOESS identified a PV threshold near 80 mL for bladder irrigation volume and 100 mL for operative time. Patients with PV < 100 mL had more favorable perioperative outcomes. Compared with PV ≥ 100 mL, PV < 100 mL had shorter operative times (median, 56 vs. 81 min; p < 0.05), lower irrigation volumes (median 9000 vs. 14 000 mL; p < 0.05), and smaller hemoglobin reductions (-0.9 vs. -1.6 mg/dL; p < 0.05); rates of Clavien-Dindo ≥ 3 adverse events, transfusion, and refulguration did not differ. A PV < 100 mL appears to be a practical criterion for safe early adoption of Aquablation; accurate preoperative estimation of PV is therefore essential.

Background: We measured soluble C-type lectin-like receptor 2 (sCLEC-2), which is a new biomarker of platelet activation, to investigate clinical implications in patients with acute ischemic stroke (AIS) and TIA (Trial registration numbers: NCT05579405, UMIN 000048954). Methods: Plasma levels of sCLEC-2 were measured by high-sensitivity chemiluminescent enzyme immunoassay in 377 patients with AIS and 62 patients with TIA. Results: sCLEC-2/D-dimer ratio (mean±SD) at baseline (Day 1) was higher in patients with non-cardioembolic stroke/TIA (n=111, 491.9±433.7) than in those with cardioembolic stroke/TIA (n=52, 220.6±287.9) (t-test, p&lt;0.0001) (patients on antithrombotics at baseline were excluded). Baseline sCLEC-2 levels (mean±SD) were 248.8±161.6, 277.6±210.6 (n=50), and 324.0±266.3 pg/ml in mild (NIHSS&lt;6) (n=283), moderate (NIHSS 6-14) (n=50), and severe (NIHSS&gt;14) (n=42) patients with AIS, respectively, which were higher in patients with severe AIS than in those with mild AIS (Tukey test, p=0.031). sCLEC-2 (mean±SD) at baseline was higher in patients with medium/large infarcts (n=97, 282.4±192.8 pg/ml) than in those with small infarcts (n=117, 233.6±115.1 pg/ml) among patients with non-cardioembolic plus non-lacunar stroke (t-test, p=0.012), while it was lower in medium/large infarcts (n=63, 231.9±184.0 pg/ml) than in those with small infarcts (n=26, 341.9±347.0 pg/ml) among patients with cardioembolic stroke (t-test, p=0.003). Mean sCLEC-2 was increased in patients with worsening (recurrence or deterioration) (n=17, +84.4 pg/ml) and decreased in those without worsening (n=271, -10.3 pg/ml) between Day 1 and Day 7 (Welch-corrected t test, p=0.013). Poor outcome (mRS&gt;1) at discharge was more common in patients with increased sCLEC-2 than in those with decreased sCLEC-2 between Day 1 and Day 7 (61.4% vs 39.1%, Fisher’s exact test, p=0.002). Poor outcome at 3 months was more common in patients with high sCLEC-2 levels (156 pg/ml or more) than in those with normal sCLEC-2 levels (&lt;156 pg/ml) at Day 7 (36.1% vs 13.0%, Fisher’s exact test, p=0.024). Conclusions: sCLEC-2 was a promising biomarker for subtyping of AIS/TIA, accessing stroke severity, elucidating pathophysiology, and predicting outcomes in patients with AIS or TIA.

Gastric adenoma and cancer are common in Asia, with early detection critical for prognosis. Synchronous multiple early gastric cancers (SMEGCs) occur in 6% to 14% of cases, but their clinicopathological characteristics remain unclear. This study analyzed synchronous multiple gastric neoplasms treated by endoscopic resection or surgery to aid early detection. Among 2,991 cases of early gastric cancer or adenoma diagnosed at our institution, 173 patients with 346 synchronous lesions (January 2016-March 2024) were analyzed. All lesions were mucosal or submucosal. Lesions were categorized as "1st" (larger) and "2nd" (smaller), and clinicopathological characteristics were compared using Chi-square and Fisher's exact tests with Cramér's V. Patients had a mean age of 73.2 years; 72.8% were male. Most lesions were in the lower/middle stomach, differentiated (92.2%), depressed (52.9%), and brownish on narrow-band imaging (65.3%). Mean tumor diameter was 13.4 mm. Although 1st lesions were larger, other features showed high concordance (≥ 0.25 Cramér's V) in location, morphology, histology, invasion depth, and coloration. Survival was 94.8% (nine unrelated deaths). Synchronous multiple gastric neoplasms tend to have similar endoscopic and histopathologic features and often occur within the same belt-like region along the short axis of the stomach. This pattern was named boundary equal lesions trends (BELT). When detecting one lesion, considering BELT is essential.

Although zinc oxide ointment is commonly used to treat diaper dermatitis in infants, there exists limited evidence of pharmacists suspecting hyperzincemia due to zinc oxide ointment and early intervention for mitigation of severity. This case study is female infant who was born at 27 weeks and 1 d of gestation and weighing 542 g. On postnatal 49 d, the serum zinc concentration was 65 µg/dL. Thereafter, treatment with oral zinc acetate hydrate (2 mg/kg/d) began on 56 d for ameliorating hypozincemia. Zinc oxide ointment was administered on 86 d as a treatment for diaper dermatitis. Despite of attaining hyperzincemia (427 µg/dL), treatment with zinc acetate hydrate and zinc oxide ointment continued because diarrhea and nausea had not developed. On 105 d, the serum zinc concentration was 199 µg/dL and the dermatitis conditions showed a marked improvement. Consequently, the pharmacist considered that zinc oxide ointment might have contributed to the hyperzincemia and consulted with the physician. Subsequently, both the zinc acetate hydrate and zinc oxide ointment were discontinued. Although zinc acetate hydrate was restarted on 114 d, serum zinc concentration was 101 µg/dL on 128 d. The Naranjo Adverse Drug Reaction Probability Scale score was 9 points, which is categorized as "definitive." Administration of zinc oxide ointment to diaper dermatitis with decrease skin barrier may have increased percutaneous absorption of zinc, resulting hyperzincemia. The pharmacist may be able to conduct early intervention for hyperzincemia by monitoring not only serum zinc concentration but also changes in the dermatitis conditions in infant patients.

Rationale. The aim of the study is to analyze the associations of regional characteristics with the individual risk of comorbidity in the elderly population in the subjects of the Russian Federation. Materials and methods. The material of the cross-sectional study «Epidemiology of cardiovascular diseases in the regions of the Russian Federation» (ESSE-RF-3), conducted in 2020—2022, was used as individual data. The analysis included 10535 men and women aged 60—74 years. The presence of comorbid conditions was assessed using 4 methodological approaches: 1 — according to the Order of the Ministry of Health of the Russian Federation dated 07/01/2021 No. 698n.; 2 — according to the Eurasian guidelines; 3 — according to the Charlson index; 4 — in accordance with the recommendations on the organization of prioritization of patients in the framework of follow-up. To describe the regional living conditions, an integral index assessment was used, which was previously performed using the principal component method. The association of comorbidity with regional indices was assessed using logistic regression analysis, with the calculation of odds ratios (OR) and a 95% confidence interval. Results. The deterioration of economic living conditions and the shift in the age structure of the region’s population towards older age is associated with comorbidity, regardless of the method of its assessment. An increase in the industrial development of the region is associated with a decrease in the probability of comorbidity, calculated according to the «Charlson index» OR=0.93 (0.90—0.97) and according to the «Methodological Recommendations» OR=0.94 (0.90—0.97). Conclusion. The conducted study demonstrated the influence of economic, industrial and demographic regional living conditions on the individual probability of comorbidity.

We report a rare case of Legionella pneumonia complicated by pneumatocele and recurrent pneumothorax. A previously healthy man in his 70s was diagnosed with Legionella pneumonia and treated with levofloxacin, resulting in initial improvement. However, he developed progressive hypoxemia with diffuse ground-glass opacities and traction bronchiectasis, requiring corticosteroid therapy. A 5-cm pneumatocele subsequently appeared in the right lower lobe, followed by two episodes of right-sided pneumothorax. Surgical bullectomy was performed to control the recurrence. The pneumatocele resolved spontaneously by discharge. Pneumatoceles are typically associated with necrotizing infections but have not been previously reported following Legionella pneumonia. This case underscores a previously undocumented structural complication and highlights the importance of radiological monitoring and surgical readiness in selected patients with post-Legionella respiratory deterioration.

Carboplatin, pemetrexed, and pembrolizumab are established as a key first-line regimen for metastatic non-small cell lung cancer, although selecting the optimal therapy for each patient remains challenging in real-world clinical practice. This retrospective multicenter study compared the efficacy and safety of two atezolizumab-based combination regimens, ACnP (carboplatin, nab-paclitaxel, atezolizumab) and ABCP (carboplatin, paclitaxel, bevacizumab, atezolizumab), in patients with non-small cell lung cancer in real-world clinical practice. A total of 91 patients treated between May 2018 and December 2023 at six Japanese hospitals were analyzed: 40 received ACnP and 51 received ABCP. Patient characteristics, treatment outcomes, and adverse events were compared, with subgroup analyses adjusted by inverse probability of treatment weighting using propensity scores. The objective response rates were 55.0% with ACnP and 45.1% with ABCP. Median progression-free survival was 5.5 months for ACnP and 6.9 months for ABCP, while median overall survival was 16.2 and 18.3 months, respectively. Subgroup analyses showed significantly improved progression-free survival with ABCP in patients with brain metastases, liver metastases, EGFR-positive tumors, PD-L1-positive tumors, and impaired renal function (CCr < 45 mL/min). ABCP also conferred overall survival benefits in patients with brain and liver metastases. However, ACnP was associated with a lower incidence of neutropenia, peripheral neuropathy, and skin rash. These findings suggest that ABCP may offer superior efficacy in specific non-small cell lung cancer subgroups, while ACnP remains a valuable option for patients requiring a more tolerable safety profile.

A 74-year-old woman underwent endoscopic retrograde cholangiopancreatography because of obstructive jaundice, caused by pancreatic cancer. The patient received a plastic biliary stent (half-pigtail type) placement into the left hepatic bile duct for biliary drainage. After 28days, the patient presented to our hospital with fever and jaundice. Emergent endoscopic retrograde cholangiopancreatography revealed bleeding from the papilla and blood clots filling the entire bile duct. To treat the hemobilia, endoscopic nasobiliary drainage was performed after placement of a self-expandable metallic stent in the common bile duct. Frequent irrigation of the bile duct failed to remove the clots. Although endoscopic retrograde cholangiopancreatography was repeated to remove the clots, fresh blood flowed from the bile duct. Enhanced computed tomography revealed a left hepatic artery pseudoaneurysm that had likely ruptured into the bile duct. Following successful transcatheter arterial embolization, there was no recurrent bleeding. Since the tip of the stent was located at the site of the pseudoaneurysm, it was suspected that stent insertion caused the complication. This report describes a rare case of hemobilia of a hepatic artery pseudoaneurysm caused by insertion of a half-pigtail type biliary stent into the left hepatic duct. The case was successfully treated with embolization.