Tokyo Rosai Hospital

We aimed to compare the incidence of severe infections between mycophenolate mofetil (MMF) and other immunosuppressants in patients with systemic lupus erythematosus (SLE) on maintenance therapy using data from the Lupus Registry of Nationwide Institutions in Japan. This study employed a prospective cohort design, including patients with SLE undergoing maintenance therapy. Exposure was defined as MMF treatment, and the control group included individuals who received other immunosuppressants (non-MMF) treatments. Severe infections requiring hospitalisation were the primary outcomes, whereas secondary outcomes included all-cause hospitalisation, changes in prednisolone dosage, disease activity and organ damage. Statistical analyses employed marginal structural models with stabilised inverse probability of treatment weighting to adjust for confounders. The analysis included 1004 patients; the incidence of severe infections was 6.5% in the MMF group and 7.5% in the non-MMF group, with no significant difference (OR 0.69, 95% CI 0.34 to 1.39). Similarly, all-cause hospitalisation rates were comparable between the groups (OR 0.72, 95% CI 0.47 to 1.09). Prednisolone dosage was significantly reduced in the MMF group (-0.66 mg/day, 95% CI -1.09 to -0.23). The organ damage score was modestly reduced in the MMF group (-0.19 points, 95% CI -0.37 to -0.01), whereas the change of disease activity score was comparable between the groups (-0.10 points, 95% CI -0.74 to 0.55). MMF does not significantly increase the risk of severe infections compared with other immunosuppressants in SLE maintenance therapy. MMF may contribute to reducing the dose of prednisolone.

Spontaneous and refractory hypoglycemia in malignancy poses diagnostic challenges, since its exact underlying mechanisms remain unclear. A 62-year-old female patient with a 10-year type 2 diabetes mellitus history presented with abdominal pain and spontaneous hypoglycemia despite discontinuation of her diabetic treatments. An initial computed tomography (CT) scan revealed a large perinephric tumor, and a second CT, performed a week later, demonstrated significant tumor growth. On admission, she had no neuroglycopenic symptoms despite a serum glucose level of 25 mg/dL (1.39 mmol/L). She showed suppressed insulin and insulin-like growth factor (IGF)-1 levels, elevated lactate levels, a pH of 7.434 with an anion gap of 24.1, and a negative test for anti-insulin antibody. A percutaneous CT-guided tumor biopsy revealed diffuse large B-cell lymphoma. She received continuous dextrose supplementation and prednisolone to alleviate the severe hypoglycemia, but she died from the tumor burden on the sixth day of hospitalization. Postmortem serum immunoblotting revealed the absence of partially processed IGF-2 precursors. The patient's refractory hypoglycemia and hyperlactatemia were consistent with tumor-associated aerobic glycolytic lactate production, known as the Warburg effect. This case illustrates the importance of increased awareness of this underrecognized oncologic emergency in the differential diagnosis of profound spontaneous hypoglycemia in malignancy.

We thank the authors for their interest in our article and thoughtful comments.Just as you have said, caffeine can be consumed daily, and it seems that the consumption of caffeinated beverages by young people, especially athletes and healthcare workers, is indeed increasing.Athletes in particular may be motivated by factors such as increased energy and improved performance, while healthcare workers may be influenced by long and irregular working hours and demanding nature.Although moderate caffeine intake is generally considered safe for most people, its excessive intake can lead to addiction.Symptoms of poisoning are wide-ranging and include effects on the central nervous system, circulatory system, respiratory system, digestive system, renal endocrine system, and skeletal muscle system.In severe cases, symptoms include headaches, insomnia, nausea, arrhythmia, and convulsions, which can be fatal.Therefore, we would like to spread awareness about the possibility of caffeine poisoning from drinking water containing caffeine and the symptoms of poisoning.If caffeine poisoning is suspected, it is important to determine the amount ingested.Measuring caffeine and theophylline concentrations is a very effective tool for the management and treatment of patients with addiction and for verifying the effectiveness of treatment.

Severe hypoglycemia (SH) is a significant risk, particularly in the elderly, and adrenal insufficiency (AI) may be a contributing factor. This study examines six cases of late dumping syndrome (LDS)-induced reactive hypoglycemia (RH), with AI as a potential trigger. Three of the six patients were diagnosed with AI, and one experienced a hypoglycemic coma. A significant correlation between blood glucose and insulin levels was found in the AI group. These findings suggest the potential role of AI in the development of SH in LDS patients after gastrectomy. Further research is needed for confirmation.

BACKGROUND: Endocan was reported to affect breast cancer patients negatively and was able to be detected from patients’ blood.OBJECTIVE: This study aimed to investigate if the measurement of blood endocan in breast cancer patients with high ESM1 expression could be an effective tool to detect postoperative recurrence compared with existing tumor markers.METHODS: Blood was collected before and after the tumor resection from the mouse models of breast cancer, and endocan levels were measured while visualizing metastatic recurrence with noninvasive luminescence imaging. In clinical settings, blood was withdrawn from 16 breast cancer patients before and after the tumor resection, and the effect of lumpectomy on blood endocan level was evaluated. Additionally, the blood endocan from 20 patients diagnosed with postoperative recurrence was measured, and their positivity rate for endocan was compared with that for serum carcinoembryonic antigen (CEA) or cancer antigen 15-3 (CA15-3).RESULTS: Our preclinical and clinical experiments revealed that blood endocan levels reflected tumor burden. Furthermore, over 60% of patients suffering from postoperative recurrence who tested negative for CEA or CA15-3 were positive for endocan.CONCLUSIONS: Our results support the clinical significance of endocan in breast cancer patients for detecting breast cancer recurrence.

ObjectivePrevention of subsequent primary cancer (SPC) is crucial for cancer survivors, particularly those who developed the disease during childhood, adolescence, and young adulthood (CAYA). The aim of this study was to assess the current status of SPC prevention among female CAYA cancer survivors.MethodsA survey regarding long-term health issues after cancer treatment was conducted using questionnaires that targeted women aged ≥20 years who had developed cancer before the age of 40 years. The survey assessed various health issues, and this paper focuses on the items related to the respondents’ perceptions and attitudes toward SPC prevention.ResultsA total of 1,026 respondents were analyzed. Over 60% of respondents were aware of SPC and the need for screening. The percentages of respondents who underwent regular SPC screening were 53.8%, 51.8%, 29.5%, 43.7%, and 41.1% for cervical, breast, colon, lung, and gastric cancers, respectively. After adjusting for age, type of first cancer, and current follow-up, we found that receiving recommendations for SPC screening was the most critical factor in SPC screening uptake (odds ratio=3.836; 95% confidence interval=2.281–6.451; p<0.001 by logistic regression analysis). However, only 40.4% of the respondents received recommendations for SPC screening from their physicians.ConclusionDespite good awareness of SPC prevention, the uptake rate for cancer screening among cancer survivors was inadequate, indicating that preventive measures for SPC should be promoted. Because recommendations from others strongly influence SPC screening uptake, healthcare professionals should have accurate knowledge and provide guidance regarding SPC prevention.

The predictive validity of disease-specific quality of life (QOL) remains unknown in patients with systemic lupus erythematosus (SLE), although disease-specific measures are equally or more responsive to changes than generic QOL. We aimed to examine the predictive validity of the Lupus Patient-Reported Outcome (PRO) for damage accrual. Patients with SLE and ≥2 measurements over time were included in the Japanese nationwide multicentre registry (LUNA). The Lupus PRO questionnaire contains both health-related (HR) and non-HR QOL measures. Damage accrual was evaluated using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). We examined the association between the Lupus PRO score at baseline and longitudinal SDI scores using mixed-effects models adjusted for prognostic factors. Among 1295 patients, those with higher HR-QOL of Lupus PRO at baseline demonstrated a significantly lower increase in SDI (-0.005/year, 95% confidence interval [CI]: -0.007 to -0.004, P < 0.001). According to the categorization of HR-QOL based on tertile, a similar dose-dependent effect of HR-QOL on longitudinal SDI was identified (second vs first tertile category: -0.101/year, 95% CI: -0.172 to -0.030; third tertile category: -0.211/year, 95% CI: -0.281 to -0.142). Non-HR-QOL was not significantly associated with the SDI scores. Among the HR-QOL domains, cognition, procreation and physical health were significantly associated with the total SDI scores over time. HR-QOL was associated with corticosteroid-dependent and -independent SDI scores. A higher HR-QOL of Lupus PRO was associated with a lower increase in SDI scores. Our findings imply the importance of disease-specific HR-QOL measurements in assessing prognosis.