Toho University Omori Medical Center

The dose of bendamustine used to treat previously untreated follicular lymphoma (FL) is sometimes reduced based on various clinical considerations, but the impact of such dose reductions on outcomes is unclear. We retrospectively analyzed 92 untreated FL patients treated with bendamustine at seven institutions in Japan. Dose reduction was defined as receiving less than 90% of the planned total dose of 1080 mg/m2 over six cycles. Patients with disease progression observed at ≤ 180 days of treatment initiation were defined as primary bendamustine-refractory (PBR). The 3-year overall survival (OS) and progression-free survival (PFS) were 87.1% and 71.8%, respectively. Seven patients were classified as PBR, six of whom received bendamustine at full dose without dose reduction, and they had significantly worse OS with 3-year OS of 38.1%. We excluded the PBR cases from subsequent analyses of the dose intensity's prognostic significance. The dose-reduction group had a significantly lower CR rate (93.0% vs. 74.4%, p = 0.032). Similarly, the 3-year PFS was significantly worse in the dose-reduction group (86.8% vs. 68.1%, p = 0.005). In univariate and multivariate analyses, dose reduction was associated with inferior PFS. In an analysis limited to patients who completed all six courses, the CR rate was comparable between the two groups, but 3-year PFS was significantly worse in the dose-reduction group (86.8% vs. 68.7%, p = 0.041). Furthermore, even among patients who achieved CR, the 3-year PFS tended to be poorer in the dose-reduction group (85.7% vs. 72.7%, p = 0.062). These findings suggest that PBR cases are resistant to bendamustine itself regardless of the dose intensity. In contrast, among responders including those who achieved CR, dose reduction was associated with poorer PFS, indicating that maintaining treatment intensity is important for improving prognosis in the treatment of bendamustine-responsive FL patients.

Colorectal serrated lesions (SLs) are recognized as precursors of colorectal cancer (CRC); however, their detection rates and prevalence remain inadequately defined. We aimed to assess their detection rates and estimate their prevalence in the Asia-Pacific, as well as to examine their associated factors. This was a multicenter prospective study in the Asia-Pacific. Asymptomatic individuals aged 40-74 years undergoing first-time colonoscopy for CRC screening were prospectively enrolled. To ensure precise prevalence estimates, colonoscopy procedures involved repeated proximal colon inspection using pan-chromoendoscopy with indigo carmine dye. Detection rates of proximal SLs and sessile serrated lesions (SSLs) were calculated. Mixed-effects logistic regression analyses, accounting for institution-level variability, were performed to identify factors associated with proximal SL and SSL detection. Associations between SLs and synchronous advanced colorectal neoplasia (ACN) were evaluated. Among 965 participants, detection rates of proximal SLs and SSLs were 16.1% (95% confidence interval [CI], 13.8-18.5) and 8.6% (6.9-10.6), respectively. Institutional differences affected detection of proximal SLs (adjusted median OR, 1.44; 95% CI, 1.25-1.79) and SSLs (1.34; 1.18-1.62). A family history of CRC was associated with higher SSL detection (adjusted odds ratio [OR], 2.36; 95% CI, 1.29-4.33). Detection of proximal SLs was associated with synchronous ACN (OR, 1.94; 95% CI, 1.24-3.02 and 1.90; 1.18-3.07, respectively). This multicenter study demonstrates that detection rates and estimated prevalence of SLs are higher than previously reported in the Asia-Pacific and highlights the impact of institutional differences, challenging the notion of their low regional prevalence. UMIN-CTR number, UMIN 000042890.

Background: Pulmonary atresia (PA) with ventricular septal defect (VSD) and major aortopulmonary collateral arteries (MAPCAs), a life-threatening congenital heart defect (CHD), is frequently associated with abnormal pulmonary blood flow and vascular remodeling, causing hypoxia and heart failure. Segmental pulmonary hypertension (PH), a distinct PH type, may exist in some patients. Pulmonary vasodilators have been considered for treatment; however, evidence of their efficacy and safety remains lacking. Methods: A systematic review was conducted using PubMed, MEDLINE, The Cochrane Library, and Ichushi Web, encompassing studies from inception to May 2023. Inclusion criteria focused on patients with PA/VSD/MAPCAs treated with PH medications. Results: Of 86 studies screened, 6 met the inclusion criteria, including 1 cohort study and 5 case reports, comprising 22 patients. The most frequently administered medications were sildenafil (14 cases) and bosentan (12 cases), with 16 patients receiving monotherapy. Clinical improvements were observed in pulmonary vascular resistance (8/8 patients), oxygen saturation (8/19 patients), and symptoms (19/21 patients). Adverse effects were noted in five patients, including treatment discontinuation in two. Conclusions: PH medications may benefit some patients with PA/VSD/MAPCAs; however, the extremely limited sample size (n = 22) and substantial heterogeneity in anatomy, age, surgical status, and treatment regimens severely limit interpretability and clinical applicability. Considering the potential benefits and risks associated with these medications, their use should be considered cautiously and restricted to specialized centers with expertise in CHD and PH management.

With the increase in Japan's aging population, the number of total colonoscopies (TCS) performed in individuals aged over 80 years is rising. However, TCS carries an increased risk of complications in older individuals, raising concerns about its utility in this population. This study aimed to evaluate the clinical value of TCS in older individuals diagnosed with advanced colorectal cancer (CRC) at our institution. We conducted a retrospective review of patients aged ≥80 years who underwent TCS between January 2010 and December 2021. Patients diagnosed with advanced CRC were categorized into symptomatic and asymptomatic groups based on the presence or absence of symptoms. The groups were compared in terms of clinical characteristics, pathological features, and long-term outcomes. Among 4,130 older patients who underwent TCS, 297 (7.2%) were diagnosed with advanced CRC. Of these, 221 (74%) were symptomatic, and 76 (26%) were asymptomatic. Compared with symptomatic patients, asymptomatic patients had significantly higher body mass index (23.6 vs. 21.5 kg/m²), serum albumin levels (3.7 vs. 3.5 g/dL), and lower carcinoembryonic antigen (CEA; 3.9 vs. 5.6 ng/mL) and carbohydrate antigen 19-9 (CA19-9; 13.4 vs. 19.7 U/mL) levels (all p<0.05). The asymptomatic group also had a higher rate of early-stage disease (68.4% vs. 36.2%) and a greater history of prior TCS (21.1% vs. 5.4%, p<0.001). Five-year overall and disease-specific survival rates were significantly higher in the asymptomatic group (68.3% and 88.3%, respectively) compared to the symptomatic group (38.7% and 65.5%) (p<0.001). No severe complications, such as perforation, were observed. TCS facilitates early detection and improves prognosis in older patients with advanced CRC, supporting its use in appropriately selected individuals.

ObjectivesThis is a protocol for a Cochrane Review (intervention). The objectives are as follows:To evaluate the benefits and harms of midline catheters versus PICCs for intravenous therapy in adults.

ABSTRACTBackground/PurposePeroral cholangioscopy (POCS) has emerged as a valuable endoscopic modality for the diagnosis and treatment of biliary tract diseases. Despite its growing clinical application, no standardized clinical practice guidelines have previously been established in Japan. In response, here we describe how the Japan Biliary Association (JBA) developed evidence‐based guidelines to support the safe and effective implementation of POCS.MethodsFollowing the Minds 2020 methodology, a multidisciplinary committee formulated 31 key clinical, background, and future research questions across six domains: definitions, indications and roles, procedures, special cases, adverse events, and diagnostic/therapeutic outcomes. Recommendations were based on a systematic review of literature, supplemented by expert consensus where evidence was limited.ResultsKey topics include appropriate indications, management of antithrombotic therapy, necessity of papillary intervention, antibiotic prophylaxis, procedural risks, and the role of POCS‐guided biopsy and lithotripsy. Notably, the guidelines highlight the utility of POCS in evaluating indeterminate biliary strictures, papillary cholangiocarcinoma, and difficult bile duct stones, while addressing adverse events such as cholangitis and perforation.ConclusionsThese guidelines are intended to serve as a practical reference for clinicians and endoscopists involved in biliary endoscopy, with the flexibility of their adaptation based on institutional practices and patient characteristics.