Ohkubo Hospital

BackgroundVarious methods have been devised for catheter ablation of persistent atrial fibrillation (AF). However, it remains difficult to understand the mechanism of AF and to determine the optimal method.ObjectiveThis study aimed to evaluate the effectiveness of rotor modification (RM) compared to posterior wall isolation (PWI) in the treatment of persistent AF.MethodsThe study included 50 patients in the RM group (mean age: 67.0 ± 8.7 years; 76% with long-standing persistent AF) and 50 patients in the PWI group (mean age: 66.8 ± 8.9 years; 66%). In the RM group, in addition to cryoballoon isolation of the pulmonary veins, rotors in both atria were identified using a phase mapping system and ablated at low power. In the PWI group, the pulmonary vein antrum and posterior wall were isolated together using a radiofrequency catheter. The primary end point was the maintenance of sinus rhythm, defined as freedom from atrial tachycardia, AF, and atrial flutter over a 36-month postoperative follow-up period.ResultsSurvival curve analysis using the log-rank test revealed a statistically significant difference (P < .001), demonstrating the superiority of RM.ConclusionRM is suggested to be as effective as PWI or more effective in maintaining sinus rhythm in patients with persistent AF.

We retrospectively examined whether anesthetic fade (AF) occurred in brain tumor surgery with direct motor field stimulation motor evoked potential (dMEP) and transcranial stimulation MEP (tcMEP), and whether it could have been avoided by compound muscle action potential (CMAP) after peripheral nerve stimulation normalization, and examined the causes of AF. In 108 muscles in 40 patients where tcMEP was performed and 24 muscles in 24 cases where dMEP was performed, and whether AF could be avoided by CMAP normalization was examined. In 108 muscles where tcMEP was performed, the relative amplitude of surgery with an operative time of 190 minutes or more was 1.07±0.88, which was significantly lower than the relative amplitude of surgery with an operative time of less than 190 minutes (1.67±2.69) (P=0.0447, Student’s t-test). The relative amplitude values under CMAP normalization were also 1.29±1.62 over 190 minutes and 1.24±1.48 under 190 minutes, indicating no significant difference (P = 0.4430).The relative amplitude of surgery with an operative time of 360 minutes or more was 0.56±0.26 in the 24 muscles where dMEP was performed, and a significant difference was observed between the relative amplitude of surgery with an operative time of less than 360 minutes (1.43±0.75) (P = 0.0045). The relative amplitude values under CMAP normalization were 0.57±0.25 over 360 minutes and 1.48±0.72 under 360 minutes, which was also significant (P = 0.0038). AF was also more intense in dMEP and could not be avoided by CMAP normalization. Although there were few cases and it required consideration of direct invasion of the pyramidal tract in brain tumor surgery, it is suggested that a decrease in the transmissibility of neuromuscular junctions is considered to be a cause of AF that and a decrease in excitability of motor field pyramidal cells may be more active at 6 hours or more.

BackgroundThe efficacy of adjuvant chemotherapy for high-risk stage II colon cancer (CC) has not been well established. Using propensity score matching, we previously reported that the 3-year disease-free survival (DFS) rate was significantly higher in patients treated with uracil and tegafur plus leucovorin (UFT/LV) against surgery alone. We report the final results, including updated 5-year overall survival (OS) rates and risk factor analysis outcomes.MethodsIn total, 1902 high-risk stage II CC patients with T4, perforation/penetration, poorly differentiated adenocarcinoma/mucinous carcinoma, and/or < 12 dissected lymph nodes were enrolled in this prospective, non-randomized controlled study based on their self-selected treatment. Oral UFT/LV therapy was administered for six months after surgery.ResultsOf the 1880 eligible patients, 402 in Group A (surgery alone) and 804 in Group B (UFT/LV) were propensity score-matched. The 5-year DFS rate was significantly higher in Group B than in Group A (P = 0.0008). The 5-year OS rates were not significantly different between groups. The inverse probability of treatment weighting revealed significantly higher 5-year DFS (P = 0.0006) and 5-year OS (P = 0.0122) rates in group B than in group A. Multivariate analyses revealed that male sex, age ≥ 70 years, T4, < 12 dissected lymph nodes, and no adjuvant chemotherapy were significant risk factors for DFS and/or OS.ConclusionThe follow-up data from our prospective non-randomized controlled study revealed a considerable survival advantage in DFS offered by adjuvant chemotherapy with UFT/LV administered for six months over surgery alone in individuals with high-risk stage II CC.Trial registrationJapan Registry of Clinical Trials: jRCTs031180155 (date of registration: 25/02/2019), UMIN Clinical Trials Registry: UMIN000007783 (date of registration: 18/04/2012).

The purpose of this Special Issue, "Clinical Epidemiology of Diabetes and Its Complications" is to bring more attention to diabetes and its complications and share the latest findings with the medical community [...].

The surgical treatment of inguinal lymph node (ILN) metastases secondary to anorectal adenocarcinoma remains controversial. This study aimed to clarify the surgical treatment and management of ILN metastasis according to its classification. This retrospective, multi-centre, observational study included patients with synchronous or metachronous ILN metastases who were diagnosed with rectal or anal canal adenocarcinoma between January 1997 and December 2011. Treatment outcomes were analysed according to recurrence and prognosis. Among 1181 consecutively enrolled patients who received treatment for rectal or anal canal adenocarcinoma at 20 referral hospitals, 76 (6.4%) and 65 (5.5%) had synchronous and metachronous ILN metastases, respectively. Among 141 patients with ILN metastasis, differentiated carcinoma, solitary ILN metastasis and ILN dissection were identified as independent predictive factors associated with a favourable prognosis. No significant difference was found in the frequency of recurrence after ILN dissection between patients with synchronous (80.6%) or metachronous (81.0%) ILN metastases. Patients who underwent R0 resection of the primary tumour and ILN dissection had a 5-year survival rate of 41.3% after ILN dissection (34.1% and 53.1% for patients with synchronous and metachronous ILN metastases, respectively, P=0.55). The ILN can be appropriately classified as a regional lymph node in rectal and anal canal adenocarcinoma. Moreover, aggressive ILN dissection might be effective in improving the prognosis of low rectal and anal canal adenocarcinoma with ILN metastases; thus, prophylactic ILN dissection is unnecessary.

To clarify the efficacy of perioperative chemotherapy for the patients with resectable colorectal liver metastases (CLM), we conducted a multicenter randomized phase III trial to compare surgery followed by postoperative FOLFOX regimen with perioperative FOLFOX regimen plus cetuximab in patients with KRAS wild-type resectable CLM. Patients who had KRAS wild-type resectable CLM having one to eight liver nodules without extrahepatic disease were randomly assigned to the postoperative chemotherapy group, wherein up-front hepatectomy was performed followed by 12 cycles of postoperative modified FOLFOX6, and the perioperative chemotherapy group (experimental), wherein six cycles of preoperative modified FOLFOX6 plus cetuximab were performed followed by hepatectomy and six cycles of postoperative modified FOLFOX6 plus cetuximab. The primary endpoint was progression-free survival (PFS). There were 37 patients in postoperative chemotherapy group and 40 patients in the perioperative chemotherapy group who were analyzed. Baseline characteristics were well-balanced between groups. The PFS and overall survival (OS) showed no significant difference (PFS, hazard ratio 1.18 [95% confidence interval 0.69-2.01], P = 0.539: OS, 1.03 [0.46-2.29], P = 0.950). In the postoperative chemotherapy group, 35.1% had a 3-year PFS, and 86.5% had a 3-year OS. Meanwhile, in the perioperative chemotherapy group, 30.0% had a 3-year PFS, and 74.4% had a 3-year OS. There was no difference in survival found between the group of the perioperative chemotherapy plus cetuximab and that of the postoperative chemotherapy in the cohort of our study. The study was registered in the University Hospital Medical Information Network (UMIN000007787).

Abstract Recurrent glioblastoma remains a clinical problem with no standard treatment and quite a few effective treatment options. We evaluated the efficacy of photodynamic therapy (PDT) using talaporfin sodium (TS) as a treatment for recurrent glioblastoma in a retrospective analysis of 70 patients who underwent PDT with surgery (PDT group) between 2014 and 2018, and 38 patients who underwent surgery alone (control group) during the same period. The median overall survival (OS) of the PDT and control groups were 16.03 and 12.75 months, respectively (P=0.0311). The median progression-free survival (PFS) of these two groups were 5.67 and 2.2 months, respectively (P=0.00428). Univariate and multivariate analyses showed PDT with surgery and preoperative Karnofsky Performance Scale as significant independent prognostic factors for both PFS and OS.On the other hand, IDH mutation and previous pathology before recurrence were not significant prognostic factors in this study. In the PDT group, there was no significant difference in PFS and OS between patients with GBM from the previous pathology before recurrence and those with malignant transformation to GBM from lower-grade glioma. Furthermore, there was also no significant difference in TS accumulation in the tumor between these two groups. These results suggest that additional PDT treatment for recurrent glioblastoma can have potential survival benefits and that its efficacy is independent of the pathology before recurrence or IDH status.

In the present study, the initial treatment efficiency of combination therapy using testosterone replacement therapy (TRT), herbal medicine and phosphodiesterase 5 inhibitors (PDE5i) in male patients with late-onset hypogonadism (LOH) were assessed. A total of 21 patients were enrolled and after 12 weeks, the clinical efficacy was evaluated based on improvement of LOH symptoms via laboratory parameters and several questionnaires, including the Ageing Males' Symptoms (AMS) scale. The overall AMS scores, as well as the psychological, physical and sexual AMS factors prior to and after treatment in the TRT, testosterone enanthate (T enanthate) monotherapy and T enanthate + PDE5i treatment groups were significantly improved. In the herbal medicine group, only the AMS physiological factors were significantly improved after treatment compared with the baseline. The improvement of the overall AMS scores, as well as the physiological and sexual AMS factors, were significantly negatively correlated with the free testosterone (FT) value prior to treatment. In conclusion, treatment with combination therapy using TRT, herbal medicine and PDE5i improved AMS scores in patients with LOH syndrome. Particularly in patients with LOH syndrome and low FT, the symptoms were significantly improved following combination therapy.