Noguchi Hospital

ABSTRACTIntroductionAnti‐melanoma differentiation‐associated gene 5 antibody‐positive interstitial lung disease is a rare but fatal adverse event following immune checkpoint inhibitor treatment for cancers. However, such cases have not been previously reported in patients with urothelial carcinoma.Case PresentationA 79‐year‐old Japanese woman with advanced unresectable bladder cancer was treated with first‐line enfortumab vedotin plus pembrolizumab. During the second treatment cycle, interstitial lung disease developed, and the patient immediately received steroid pulse therapy. As interstitial lung disease rapidly progressed after the initiation of steroid pulse therapy, immunosuppressive treatment with cyclophosphamide and tacrolimus was added. However, interstitial lung disease did not improve, and the patient died on day 54 after initiating treatment. Detailed antibody examination revealed positive anti‐melanoma differentiation‐associated gene 5 antibodies.ConclusionWe report the first case of anti‐melanoma differentiation‐associated gene 5 antibody‐positive interstitial lung disease induced by enfortumab vedotin plus pembrolizumab in a patient with advanced urothelial carcinoma.

Fluorescence ureteral navigation (FUN) using near-infrared devices (e.g., NIRC™ and IRIS) can assist in the visualization of ureters and the prevention of iatrogenic injury during complex colorectal procedures. However, its adoption in Japan remains limited. A nationwide anonymous web-based survey was conducted among surgeons in Japan from May 1 to June 30, 2025 to assess awareness, usage, and barriers related to FUN. A total of 124 valid responses were collected. The majority of the respondents specialized in lower gastrointestinal surgery (66.1%), and 63.7% had more than 11 years of clinical experience. Among the respondents, 74.2% were aware of FUN, but only 25.8% had used it. Notably, 96.0% of respondents felt that there were cases in which they would like to use FUN, and 89.5% perceived FUN as educationally valuable for junior surgeons. The most desired indications included locally advanced rectal or sigmoid cancer (84.7%), recurrent cancer (77.4%), and diverticulitis (59.7%). Among respondents who were aware of FUN, 42.9% reported having encountered cases for which they wanted to use FUN but could not. The main barriers included difficulty coordinating with urologists (53.8%), high device cost (28.2%), and a lack of compatible fluorescence imaging systems (23.1%). Psychological concerns, such as hesitancy due to the perceived burden on urology departments (51.6%) and scheduling complexity (42.7%), were also notable. Only 7.3% of surgeons had experience inserting ureteral catheters, although 35.5% had assisted with the procedure. This nationwide survey highlights the strong clinical and educational demand for FUN among Japanese surgeons as well as persistent logistical and institutional barriers. Facilitating surgeon-led implementation through improved access to devices, structured training, and interdisciplinary collaboration may support broader clinical adoption.

Chronic heart failure with reduced ejection fraction (HFrEF) is a progressive syndrome associated with substantial residual morbidity and mortality despite contemporary guideline-directed medical therapy (GDMT) - angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs)/angiotensin receptor-neprilysin inhibitors (ARNIs), beta-blockers, mineralocorticoid receptor antagonists (MRAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) [1]. Consequently, the need for novel therapeutic strategies has led to the exploration of new drug classes and pathways. In HF, impaired nitric-oxide (NO) signaling, reduced soluble guanylate cyclase (sGC) responsiveness/abundance, and downstream attenuation of cyclic guanosine monophosphate (cGMP) contribute to disease progression [2]. Vericiguat-an oral sGC stimulator-sensitizes sGC to endogenous NO and directly stimulates the enzyme, thereby restoring cGMP signaling in vascular smooth muscle and cardiomyocytes.