National Defense Medical College Hospital

In this nationwide retrospective study, we sought to evaluate the oncologic and functional outcomes and safety of transoral surgery (TOS) for hypopharyngeal and laryngeal squamous cell carcinomas in Japan and to clarify the appropriate indications for various TOS modalities. Data were obtained from the Head and Neck Cancer Registry of Japan. Patients who underwent transoral or endoscopic resection between 2011 and 2016 were selected. Detailed clinical information was collected from 55 institutions using web-based case report forms. Surgical modalities analyzed included endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), endoscopic laryngopharyngeal surgery (ELPS), transoral laser microsurgery (TLM), and transoral videolaryngoscopic surgery (TOVS). In total, 1825 patients were included (hypopharyngeal cancer, 62.5 %; laryngeal cancer, 37.5 %). Most cases (77.5 %) were T1 or lower, and 90.8 % were Stage II or earlier. TLM is predominantly used for glottic cancers, ELPS/ESD for superficial hypopharyngeal lesions, and TOVS for more advanced tumors, reflecting distinct indications for each modality. The 5-year disease-specific survival (DSS), recurrence-free survival (RFS), and overall survival (OS) were 97.1 %, 84.3 %, and 85.4 %, respectively. The laryngeal preservation rate was 98.2 %. Tracheostomy was performed in 5.0 % of cases, mainly for airway protection; major complications, including pneumonia (2.4 %), hemorrhage (1.1 %), fistula formation (0.4 %), and vocal cord fixation (2.6 %), occurred in <3 % of patients. Postoperative functional outcomes were favorable, with persistent dysphagia (Functional Outcome Swallowing Scale stage ≥ 3) in 1.6 % and tube feeding dependence in 1.8 %. Non-robot-assisted TOS demonstrated excellent oncologic control and functional preservation of the larynx with low complication rates in early-stage hypopharyngeal and laryngeal cancers. Each surgical modality has distinct indications depending on the tumor site, depth of invasion, and institutional expertise. These findings support the use of TOS as a safe and effective treatment option for selected patients. Further procedural standardization and data accumulation are required to refine the indications and facilitate their broader adoption in clinical practice.

This study aims to examine the current practice patterns of Japanese urologists in treating male anterior urethral strictures and to compare these results with international trends. A 16-item questionnaire, adapted from surveys conducted in other countries, was distributed to members of the Japanese Urological Association (JUA) in 2024. Statistical analyses, including Pearson's chi-square test and logistic regression, were performed to identify factors influencing treatment preferences. We emailed 9898 JUA members, and 1028 (10.4%) responded. 835 (81.2%) handled five or fewer urethral stricture cases annually. While 968 (94.2%) had experience with urethral dilatation, 937 (91.1%) with direct vision internal urethrotomy (DVIU), only 308 (30.0%) had experience with excision and primary anastomosis, and 102 (9.9%) with any oral mucosal graft urethroplasty. For the two hypothetical clinical cases, referring to specialists was selected in 707 (68.8%) and 618 (60.1%), respectively, whereas urethroplasty was chosen in 133 (12.9%) and 243 (23.6%), respectively. Seven hundred seventy-four (75.3%) felt the literature supported going straight to definitive urethroplasty if necessary, and this was significantly associated with being under 50 years of age, holding instructor status, and limiting the indication for DVIU to strictures ≤ 1 cm. Japanese urologists exhibit limited urethroplasty experience and widely utilize transurethral treatments. The majority of members prefer to refer to a specialist, indicating that, in addition to the difficulty of urethroplasty, making indication decisions is also challenging. It is hoped that evidence-based medical practice will become more widespread.

Reported herein is an extremely rare case of combined LCNEC with enteric-type adenocarcinoma of the lung (EAL) in a 72-year-old male. The LCNEC component was further divided into two subcomponents, based on cohesiveness and immunohistochemical characteristics. Overall, the heterogeneity of this tumor demonstrated an unusual histologic pattern of combined LCNEC.

Whole blood (WB) transfusions are being reevaluated because of their high hemostatic capacity and reduced volume. Fibrinogen γ-chain peptide-coated, adenosine 5'-diphosphate (ADP)-encapsulated liposomes are potent hemostatic adjuvants promoting platelet thrombi formation. This study aimed to elucidate the potential interactions between simultaneous WB transfusion and the administration of fibrinogen γ-chain peptide-coated ADP-encapsulated liposomes. We used a rabbit model of postcardiopulmonary bypass (CPB) coagulopathy. One hour after CPB, the rabbits were transfused with WB (WB group, n = 7) or H12-ADP-liposomes along with WB transfusion (WB + H12-ADP-liposome group, n = 7). Blood cell counts, coagulation activity, platelet function, and bleeding time were evaluated. Hemoglobin concentration, platelet count, activated clotting time, and ADP and collagen test results were comparable between the WB + H12-ADP-liposome and WB groups after transfusion. However, bleeding time was remarkably reduced in the WB + H12-ADP-liposome group (378 ± 150 s) compared with that in the WB group (551 ± 255 s, p < .01), suggesting that H12-ADP-liposomes further enhanced the hemostatic effect of WB transfusion in post-CPB coagulopathy. Administration of H12-ADP-liposomes along with WB transfusion had a synergistic effect on hemostatic performance, providing a greater therapeutic advantage than WB transfusion alone.

Horizon scanning is intended to identify opportunities and threats associated with technology, regulatory, and social change. Here, we report the results of a new horizon scan based on inputs of an international group of 33 participants, focusing on future issues arising from the military use of artificial intelligence (AI) for augmenting human performance. The final list of 12 issues includes topics spanning from the political (educating and training individuals to accept and work with AI), to the regulatory (issues of consent to human-AI teaming and hybridization), to security (the hackability of neural devices that connect to AI), to philosophical (the nature and phenomenology of brain-to-brain interfaces). The early identification of such issues is relevant to researchers, policymakers, military practitioners, and the wider public.