Tokushima Red Cross Hospital

Abstract Background The optimal treatment protocol for patients with drug-eluting coronary artery stent (DES) restenosis who develop restenosis after treatment with drug-coated balloon (DCB) is unclear. Purpose To investigate independent factors of restenosis after DCB angioplasty for in-stent restenosis (ISR) of DES. Methods We examined 69 patients who underwent percutaneous coronary intervention (PCI) with DCB for ISR of DES from 5 April 2019 to 19 April 2024 at our hospital. A total of 82 lesions were evaluated, including lesions treated multiple times or differently in the same patient. The lesions were divided into two groups based on repeat restenosis verified by coronary angiography or other clinical status (RRVA) after PCI by DCB for DES ISR (PDDI) (RR group, n=26 lesions). The remaining 56 lesions showed no RRVA after PDDI (NR group). The clinical characteristics and laboratory data (mean ± standard error) were compared between the two groups using the t-test and Chi-squared test. In addition, we examined laboratory data at the time of PDDI and RRVA confirmation using multiple logistic regression analyses (MLRA). Moreover, we estimated clinical and intravascular ultrasound (IVUS) characteristics before PDDI using MLRA. Results Age (72.4±1.04 vs. 72.2±1.4 years) and BMI (23.9±0.77 vs. 24.6±0.45 kg/m2) were comparable between the two groups, whereas the proportion of men was higher in the RR group (96%) than in the NR group (78.6%, P=0.0484). Low-density lipoprotein (LDL) level at RRVA confirmation was higher in the RR group (110±9.73) than in the NR group (86.6±4.52, P=0.0182). Hypertension (odds ratio: 0.2541; 95%CI: 0.078–0.8279; P=0.0230) and acute myocardial infarction (odds ratio: 0.0779; 95%CI: 0.0085–0.7129; P=0.0238) at PDDI confirmation were negative predictors for RRVA by MLRA. Further, LDL level at RRVA confirmation was a positive predictor (odds ratio: 1.0207; 95%CI: 1.004–1.0372; P=0.0124). Additionally, high-density lipoprotein (HDL) was a negative risk factor (odds ratio: 0.9299; 95%CI: 0.8778–0.9850; P=0.0134) for RRVA. Moreover, in IVUS before PDDI, calcification of >270° in the lesion (odds ratio: 7.0344; 95%CI: 1.1110–44.3579; P=0.0383) and overlapping of two stents (odds ratio: 29.0249; 95%CI: 3.2999–288.2963; P=0.0024) were strong positive predictors for RRVA. Conclusions High LDL and low HDL levels were predictors for RRVA, suggesting that LDL levels should be as low as possible before PDDI is initiated. Calcification of >270° in the lesion on IVUS was a strong predictor for RRVA. Therefore, these calcifications should be debulked as much as possible using a debulking device before DCB. Additionally, overlapping of two stents was the strongest predictor for RRVA, and should thus be avoided. High LDL, low HDL, extensive calcification, and overlapping stents were predictors for RRVA. Appropriate management strategies should be implemented to mitigate these risk factors

The KCB01 (KIZASHI™) is a novel cutting balloon catheter with blades integrally formed with the balloon. It is designed to overcome the drawbacks of conventional cutting balloons in terms of lesion delivery, crossability and procedural complications while maintaining the same dilation capacity. To evaluate the efficacy and safety of the KCB01, a prospective, open-label, single-arm study was conducted at nine sites in Japan on percutaneous coronary intervention-eligible patients with stenotic lesions that exhibited residual indentation even after conventional balloon dilation at nominal pressure. Seventy-six patients were enrolled between November 2022 and June 2023, and 73 eligible patients were included in the primary analysis. The mean age was 73.5 ± 7.4 years, and 79.5% of the patients were male. The target lesion characteristics included bifurcation lesions (42.5%), in-stent restenosis lesions (20.5%), and severely calcified lesions (54.8%). The primary endpoint was procedural success, defined as the KCB01 crossing the target lesion, no residual indentation, and < 50% residual stenosis rate after KCB01 dilation (assessed using quantitative coronary angiography). The angiographic images obtained during the procedure were evaluated in a core laboratory. The procedural success rate was 87.7% (95% confidence interval [CI]: 77.9–94.2), with the lower limit of the 95% CI (77.9%) exceeding the performance goal of 76.5%. Clinical success rate was achieved in 94.5% of cases (95% CI: 86.6–98.5%), with no major adverse cardiac events reported until discharge. Furthermore, no device deficiencies related to the KCB01 were observed. These results suggest the safety and efficacy of the KCB01.Graphical abstractSupplementary InformationThe online version contains supplementary material available at 10.1007/s12928-025-01205-7.

For pancreatic cancer, combination therapies, such as gemcitabine plus nab-paclitaxel (GnP) or FOLFIRINOX (FFX), are recommended as first-line (FL) chemotherapy. Second-line (SL) chemotherapy has been shown to improve survival, but factors predicting eligibility for SL chemotherapy remain unclear. This study aimed to identify factors predicting eligibility for SL chemotherapy and to develop a predictive nomogram. This retrospective multicenter study included 278 patients with unresectable PC who received FL chemotherapy between 2017 and 2023. Patients were divided into the development (n=140) and external validation (n=138) cohorts. Univariate and multivariate logistic regression analyses were performed to identify predictors of eligibility for SL chemotherapy. A nomogram was developed using these independent predictors and was validated via calibration curves and c-statistics. The independent predictors of eligibility for SL chemotherapy included age (<70 years old), C-reactive protein (CRP) levels, and the FL regimen (combination vs. monotherapy). The nomogram demonstrated good predictive accuracy (c-statistic: 0.78) in the development cohort and acceptable accuracy (c-statistic: 0.68) in the validation cohort. The calibration curves showed good agreement between predicted and observed probabilities. The nomogram developed herein is a reliable tool for predicting eligibility for SL chemotherapy among PC patients, thereby facilitating informed treatment decisions.

Background:Autoantibodies such as antinuclear antibodies (ANAs) and anti-smooth muscle antibodies (ASMAs), which are detected in many cases of autoimmune hepatitis (AIH), are not disease-specific; thus, they have limited value in disease diagnosis. In this study, we aimed to identify disease-specific autoantibodies related to AIH diagnosis or pathogenesis.Methods:We analyzed human protein microarrays (containing more than 16,000 human proteins, including membrane, cytoplasmic, and nuclear proteins, synthesized in a wheat germ cell-free system using cDNA). To identify AIH-specific autoantibodies, we performed a cross-sectional study of AIH patients (n=67) and matched healthy controls (HCs) (n=25) via ELISA. An independent cohort of 123 AIH patients and 75 HCs was analyzed for validation. All patient data were collected before corticosteroid therapy. We also evaluated the associations between candidate protein antigen expression and clinical findings in AIH patients. Candidate protein antigen expression in liver tissues was confirmed by immunohistochemistry.Results:According to comprehensive human protein microarray analysis, docking protein 2 (DOK2) was selected from 6 antigens upregulated in AIH patients. The mean anti-DOK2 level was significantly greater in AIH patients (36.1–37.4 AU) than in those with other liver diseases (2.6–9.2) or HCs (1.0–4.5 AU) in the exploration and validation cohorts (p value/AUROC, vs. HCs, <0.0001/0.87–0.90). Serum anti-DOK2 levels were positively correlated with serum IgG levels and liver histological activity. The serum IgG level was an independent predictor of increased anti-DOK2 antibody levels in patients with AIH. Immunostaining revealed that DOK2-positive cells were present in the hepatic lobules and portal tracts of patients with AIH.Conclusions:We provide the first evidence that serum anti-DOK2 antibody levels are associated with the diagnosis and disease activity of AIH patients.

Posttransplant lymphoproliferative disorder is an uncommon complication of immunosuppression following solid organ or hematopoietic stem cell transplants. Primary cutaneous posttransplant lymphoproliferative disorder with isolated skin involvement but without systemic involvement is rare. We report a 50-year-old woman, a renal transplant recipient on long-term immunosuppression, who presented with a rapidly expanding ulcer on her right posterior thigh after a skin incision. Although the clinical presentation was similar to that of pyoderma gangrenosum, pathological investigation confirmed Epstein-Barr virus-associated primary cutaneous B-cell posttransplant lymphoproliferative disorder. Initially, we reduced her immunosuppression. As the ulcer rapidly expanded, we initiated R-CHOP chemotherapy, consisting of rituximab, cyclophosphamide, doxorubicin, and prednisolone. Owing to the complications from cytomegalovirus retinitis, we were only able to administer two courses of chemotherapy. However, after continuous administration of ganciclovir, the skin ulcer regressed and completely healed, leaving a scar five months after her first visit. Since pyoderma gangrenosum is a diagnosis of exclusion, ulcerative skin lesions, similar to the clinical presentation of pyoderma gangrenosum, should be subjected to pathological investigation for accurate diagnosis.

Flexor tendon injuries of the hand are challenging to treat, with open surgical repair causing tissue damage, postoperative edema, and range-of-motion limitations. Minimally invasive endoscopic techniques may address these issues, but no reports describe endoscopic tendon suturing. This IDEAL-D Stage 0 (Preclinical) study presents a cadaveric case report and research protocol for a novel endoscopic flexor tendon repair technique. The case report used the left ring finger of an 88-year-old male cadaver, employing a loop suture technique under endoscopic guidance to visualize and suture tendon ends. Sutures facilitated tendon gliding, withstood 5 N tension, and caused no neurovascular injuries. The protocol involves five cadaver specimens from Fukushima Medical University, excluding those with deformities or prior hand injuries. The primary outcome is the success rate of endoscopic repair, defined as proper tendon alignment, tension, and integrity without complications. Secondary outcomes include suturing time, gap distance, complications, a proposed tendon injury classification system, and a surgical technique video. Results will be analyzed using descriptive statistics with 95% confidence intervals. This technique may offer a minimally invasive, precise solution for flexor tendon injuries.

We investigated the impact of proteinuria on the therapeutic effect before lenvatinib administration as second-line treatment after atezolizumab-bevacizumab. We examined 64 patients who were administered lenvatinib as second-line treatment after discontinuation of atezolizumab and bevacizumab. Proteinuria assessed before lenvatinib administration was considered severe if the qualitative value test (QV) was 3+ or the urine protein/creatinine ratio (UPCR) was ≥ 2.0 (group A, n = 13) and non-severe if the UPCR was < 2.0 or the QV was ≤ 2+ (group B, n = 51). In the entire cohort, the modified albumin-bilirubin grades were grades 1, 2a, 2b, and 3 in 12, 21, 26, and 5 patients, respectively. Regarding the Barcelona Clinic of Liver Cancer stage, 2, 22, and 40 patients had stages A, B, and C, respectively. The objective response rate (ORR) was 14.0% and the disease control rate (DCR) was 59.3%. The median survival time and progression free survival after administration of lenvatinib was 14.8 (95% confidence interval [CI], 11.3-18.4) and 5.5 (95% CI, 3.6-7.5) months, respectively. The ORR and DCR were 0% and 38.4% for group A (n = 13) and 17.6% and 64.7% for group B (n = 51), respectively. The median time to treatment failure was 2.2 months in group A and 4.2 months in group B (p = 0.120). Severe proteinuria before lenvatinib as a second-line therapy after atezolizumab-bevacizumab treatment may affect the duration of lenvatinib administration and treatment efficacy.

We aimed to evaluate the surgical results for ectopic pregnancy (EP) treated at Fukushima Red Cross Hospital for over a 20-year period from 2002 to 2021. We evaluated the incidence, surgical procedures, site of implantation, amount of hemoperitoneum, and the proportion of cases with risk factors of EP. Two hundred and fifty-nine cases of EP were treated surgically. The incidence of EP seemed to be gradually decreasing in recent years. By pregnancy site, 235 (90.7%) of EPs were tubal pregnancies (TPs), 13 in interstitial pregnancies (IPs), 7 in ovarian pregnancies, and 4 in peritoneal pregnancies. For IPs, human chorionic gonadotropin (hCG) levels were statistically higher than with TP and intraperitoneal bleeding was less than with other EP sites. Thirty-nine patients (15.0%) were with massive hemoperitoneum (>500 mL), and laparoscopic surgery was performed in all patients with massive hemoperitoneum except in two patients. The proportion of cases with risk factors for EP such as Chlamydia trachomatis infection or history of smoking was 5.4% and 40.6%, respectively. Epidemiological research shows that the number of patients with chlamydia infection, rates of smokers, or the occurrence of EP with assisted reproductive technology has been decreasing in recent years in Japan. Appropriate surgical intervention should be selected while considering such as facility capabilities, context, and surgeon skill, especially in critical cases, such as cases involving massive hemoperitoneum and hemorrhagic shock. The recent presumed decrease in the occurrence of EP may partly be associated with the decrease in the occurrence of risk factors.