Takashimadaira Chuo General Hospital

Patients with ovarian cancer often present with massive ascites, leading to significant protein loss during surgical procedures. Although cell-free concentrated ascites reinfusion therapy (CART) is used in palliative settings to mitigate protein loss, its application in intraoperative settings remains unexplored. We retrospectively evaluated patients who underwent intraoperative CART for ovarian cancer treatment between March 2022 and 2025, compared two ascitic fluid collection methods (syringe and roller pumping), and analyzed operative parameter, fluid collection efficiency, albumin recovery, and adverse event-related data. Among the 12 patients included in this study, seven (58.3%) underwent CART using the roller pumping method, which significantly reduced the collection time compared with the syringe method (9 vs. 22 min, p < 0.05). The median collection speed was also significantly higher with the roller pumping method (404 vs. 140 mL/min, p < 0.05). Approximately 70% of the albumin in the collected ascitic fluid was successfully reinfused. Adverse events included transient hypotension (16.7%) and hypertension (25.0%), both of which resolved without intervention. Intraoperative CART is a feasible and safe technique for protein loss management in patients undergoing surgery for ovarian cancer. The roller pumping method significantly shortened ascites collection time and reduced surgical burden.

症例は70歳の男性．転倒から約１カ月後に腹部症状が増悪し救急搬送された．腹部造影CTにて肝右葉の大部分を占めるような巨大肝囊胞と肝周囲に腹水貯留を認めた．腹膜刺激症状を呈していたことから，破裂巨大肝囊胞による腹膜炎の診断のもと，緊急腹腔鏡下肝囊胞天蓋切除術を施行した．術後経過は良好であり，術後８日目に退院した．緊急手術が必要となる破裂巨大肝囊胞においても，通常の巨大肝囊胞に対する腹腔鏡下天蓋切除術と同様に，安全で低侵襲な術式選択が可能であると考えられた．

症例は29歳，男性．2001年，24歳時に健診で心室期外収縮の頻発と非持続性心室頻拍を指摘され当科で精査したところ，不整脈源性右室心筋症（arrhythmogenic right ventricular cardiomyopathy : ARVC）と診断され，β遮断薬の投与と運動制限により，その後は症状なく安定して経過していた．しかし2006年3月，29歳時に激しい運動の直後に心室細動となり，ただちにby-stander CPRを開始されて近医へ搬送されたが，死亡した．剖検によりARVCに合致する所見が認められ，また心室細動の原因として考えうるその他の所見は認められなかった．当科で行ったARVC関連遺伝子の検索により，plakophilin-2（PKP2）をコードする遺伝子PKP2の変異（c.C2119T，p.Q707X）が認められた．PKP2はデスモゾームの構成蛋白であり，この遺伝子異常により細胞間接着に異常を生じたため，ARVCをきたしたと考えられた．PKP2遺伝子変異が同定されたARVCの剖検症例は貴重と考えられたので報告する．

ObjectiveWe investigated the prevalence of restless legs syndrome (RLS) in Japanese patients with type 2 diabetes and assessed the efficacy of pramipexole therapy.DesignOne hundred patients with type 2 diabetes without secondary causes of RLS were sequentially screened for the 12-week, prospective, single arm study. RLS was screened by essential diagnostic criteria developed by the International Restless Legs Study Group. Diabetic neuropathy was diagnosed by nerve conductance study. Severity of RLS and sleep quality were assessed by the International Restless Legs Rating Scale (IRLS) and the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J), respectively. Pramipexole was administered for 12 weeks. The primary end point was change in the IRLS score in 12 weeks and secondary end points were change in PSQI-J and glycated haemoglobin (HbA1c) in 12 weeks.ResultsRLS was diagnosed in 8 of 100 participants (8%). Diabetic neuropathy was most likely associated with RLS (OR 3.81, 95% CI 0.85 to 17.05, p=0.111). The IRLS score was improved from 19.0±5.6 to 5.4±4.8 by pramipexole in 12 weeks (p<0.001). The change in the score was −13.6 (95% CI −15.5 to −11.7; p<0.05). PSQI-J was improved from 6.0±4.4 to 1.5±1.3 in 12 weeks (p<0.05). Change in PSQI-J was −4.5 (95% CI −6.8 to −2.1; p<0.05). HbA1c was slightly decreased from 7.19±0.56% (55±6 mmol/mol) to 6.90±0.48% (52±5 mmol/mol) in 12 weeks (p<0.05). Change in HbA1c was −0.29% (−3 mmol/mol) (95% CI −0.37% to −0.20% (−4 to −2 mmol/mol;) p<0.05).ConclusionsWe find that type 2 diabetes is a possible risk factor for RLS in the Japanese population, and that pramipexole treatment can improve the symptoms of RLS as well as the quality of sleep and glycaemic control in these patients.Trial registration numberUniversity hospital Medical Information Network in Japan (UMIN000008347).

We describe four new species of Asian Clawed salamanders of the genus Onychodactylus (Caudata: Hynobiidae), basedon fresh material collected during fieldwork in Japan, Korea, the Russian Far East and northeastern China between 2003and 2010, as well as older voucher specimens deposited in several museums. Our analyses comprise all species currentlyrecognized within this genus across its entire distribution range. We follow an integrative taxonomic approach bycombining detailed morphological comparative analyses with molecular phylogenetic analyses. We find significantdifferences among species in this genus, based on morphological and molecular data, which resulted in the recognitionand description of four new species within this genus. The new species have uncorrected molecular divergences of over4.5–7.4% and 1.9–4.1% to their closest relatives in the mitochondrial COI and 16S rRNA genes respectively. In themolecular analyses, we found two very divergent lineages in Korea and Japan that need further investigation, as detailedmorphological data are not available for them. We also discuss our approach to delimit species on salamanders. For thenew species described in this group we evaluate their threat status according to IUCN criteria: O. koreanus sp. nov. Min,Poyarkov &amp; Vieites and O. nipponoborealis sp. nov. Kuro-o, Poyarkov &amp; Vieites are classified as Least Concern, whileO. zhaoermii sp. nov. Che, Poyarkov &amp; Yan and O. zhangyapingi sp. nov. Che, Poyarkov, Li &amp; Yan are classified as Vulnerable (Vu2a).

Summary Background We examined the circadian periodicity of acute myocardial infarction (AMI) onset to identify any existing specific pattern using 17-year AMI registration data. Methods Data were obtained from the Takashima AMI Registry, which covered a stable population of approximately 55,000 in Takashima County in central Japan. Out of 429 registered first-ever AMI events from 1988–2004, there were 352 events with classifiable onset time. AMI onset was categorized as occurring at night (midnight to 6a.m.), morning (6a.m. to noon), afternoon (noon to 6p.m.) or evening (6p.m. to midnight). Results There was a significant diurnal variation in AMI incidence ( P Conclusion A diurnal pattern of AMI onset was observed in a Japanese population with a morning peak and nighttime trough, and the pattern was similar across seasons of the year and days of the week.

Objective: Successful acute stroke intervention depends on early hospitalization. The time interval between stroke onset to hospitalization was examined to identify the factors influencing the interval and also to determine whether treatment time window expansion will translate into more treatment. Methods: Data was obtained from Takashima Stroke Registry covering approximately 55,000 residents in Japan. During 1988–2002, the interval between stroke onset and hospitalization was available for 1,446 registered patients (men 761, women 685). Multivariate regression analyses were performed to evaluate the factors influencing early and late admission. Results: The proportions of the patients who arrived within 3 h of onset were 61.4%. Only 8.7% of the patients arrived during a 3- to 6-hour interval. A substantial proportion (29.9%) of patients arrived after 6 h. Early stroke hospitalization was significantly associated with the severity of the stroke event and time of stroke onset. Conclusion: Clinically more severe stroke patients were hospitalized earlier and nocturnal strokes had delayed admission. Even expanding the therapeutic time window from ≤3 to ≤6 h, there are possibilities that a substantial proportion of patients would not benefit from acute intervention. Future research should focus not only on developing therapies for expanding the treatment time window, but also place emphasis on reducing the interval between onset and hospitalization.