Yokkaichi Municipal Hospital

We herein report four patients who were unable to receive idecabtagene vicleucel (ide-cel) due to disease progression, despite undergoing leukapheresis within specification. The median age of the patients was 70 (range, 68-77) years old. Two patients had nonsecretory subtypes at the diagnosis. The median number of prior therapy lines was 4.5 (range, 4-6), and 3 patients were penta-refractory. All patients were refractory to the latest treatment. The median time from apheresis to ide-cel cancellation was 44.5 (range: 24-71) days. Our findings suggest that the nonsecretory subtype and penta-refractoriness may increase the risk of treatment discontinuation. Early ide-cel application and improved bridging therapy are warranted to enhance treatment completion after leukapheresis.

First application of carbon dioxide digital subtraction enterography for stricture evaluation in Crohn's disease Fig. 1 Panels (a-d) show serial CDDSE digital subtraction images.Compared with the pre- image, areas with greater CO 2 accumulation appear white (blue arrows), whereas those with less CO 2 appear black (orange arrows), reflecting CO 2 flow and enabling assessment of the intestine.The stricture is visualized as indicated by the red arrowhead. Fig. 2 Balloon dilation was performed using a 15-mm balloon dilator, maintained for 1 minute.

BackgroundIn definitive radiotherapy for localized prostate cancer, the seminal vesicle is included in the target volume for intermediate- and high-risk cases, though this increases the risk of toxicity to the bowel and rectum. This study retrospectively examined clinicopathological data to assess the absence of seminal vesicle invasion (SVI) in prostate cancer patients without radiological evidence of SVI using preoperative magnetic resonance imaging (MRI).Materials and methodsPatients with cT1c–cT3a prostate cancer who underwent radical prostatectomy between March 2010 and February 2024 were retrospectively selected, excluding those with distant metastasis, missing MRI data, preoperative systemic therapy, or delayed surgery post-biopsy. Preoperative risk factors [age, initial prostate-specific antigen (PSA), grade group (GG), clinical T stage, positive core ratio] and postoperative pathology were analyzed to assess SVI risk. The impact of GG changes between biopsy and postoperative pathology on risk classification and SVI treatment intensity in radiotherapy was also examined.ResultsOf 368 patients, 308 met the inclusion criteria. SVI was observed in 26 patients (8.4%). Significant predictors of SVI included GG, initial PSA ≥ 8.6, and positive core ratio, with a positive core ratio < 0.5 and GG ≤ 3 indicating an SVI risk under 10%. GG discrepancies between biopsy and surgery were noted in 182 cases (59.1%), but had minimal impact on risk classification and SVI risk.ConclusionsPatients with a positive core ratio <0.5 had a low risk of SVI. GG discrepancies did not significantly underestimate prostate cancer risk, minimizing the risk of failing to treat true SVI.

The potassium voltage-gated channel subfamily H member 1 is encoded by the KCNH1 gene. Mutations in KCNH1 result in Temple-Baraitser (TBS) and Zimmermann-Laband (ZLS) syndromes, which are characterized by developmental delay, epilepsy, and nail dysplasia. These syndromes have clinical overlap and are found in patients with atypical TBS/ZLS phenotypic features. Although KCNH1 -related diseases are associated with a high incidence of epilepsy, electroencephalogram (EEG) changes over time have not been studied. In this study, we investigated the longitudinal evolution of EEG findings and types of seizures from the neonatal period to 6 years of age in a patient with a KCNH1 variant. A 6-year-old girl showed features of KCNH1 -related disease. Exome analysis revealed a heterozygous de novo missense variant (NM_172362.3; c.1481T>C; p.Ile494Thr) in KCNH1 . She presented generalized tonic-clonic seizures (GTCS) at the age of 3 years and 1 month. She also presented with myoclonus in the neonatal period, determined to be involuntary movement because of the absence of corresponding EEG discharges and persistence. The EEG findings evolved as follows: normal at 1 month of age, multifocal spikes started at 3 months of age, and high-voltage slow waves started at 3 months of age, which initially appeared during awake periods. Patients with a KCNH1 variant may have GTCS and involuntary movements including myoclonus. Furthermore, high-voltage slow waves in EEG, which are characteristic of patients with KCNH1 variants, were not observed immediately after birth but appeared at several months of age.

The Japanese Dermatological Association aimed to prepare a second edition of guidelines for the management of diabetic ulcer/gangrene with emphasis on the diagnosis and treatment of skin symptoms. This new edition serves as a tool to improve the quality of the diagnosis and treatment in each patient and, further, to improve the level of care for such skin conditions. All sections have been updated by collecting documents published since the publication of the first edition. In the antibacterial drug treatment for bacterial infection of ulcers, oral administration was added after consideration. In the treatment of antibacterial drugs for bacterial infection of ulcers, not only infusion but also oral administration was mentioned. In addition, clinical questions (CQs) for imaging tests for diagnosing ischemia of the limbs were newly created. The titles of some CQs were changed to conform to the actual clinical setting. (i) The content has been updated by adding and collecting documents for all sections; (ii) we have additionally included oral antibiotic treatment for bacterial infection of ulcers; (iii) we have added CQs pertaining to imaging tests for diagnosing ischemia of the limbs; and (iv) we have revised the titles of some CQs to conform to the actual clinical setting. In particular, the recommendation levels of dressing materials newly covered by Japanese national health insurance are mentioned. In addition, CQs regarding the initial treatment of electrical (CQ15) and chemical burns (CQ16), and the use of escharotomy (CQ22) have been created.

Identifying the cause of myelopathy is difficult because associated clinical and imaging findings are nonspecific. The onset pattern and magnetic resonance imaging (MRI) findings are important for the diagnosis. Herein, we present the case of a 70-year-old woman hospitalized with acute-onset weakness of the lower limbs. Blood and cerebrospinal fluid tests did not reveal any abnormalities that could have been the cause. Cerebrospinal fluid was negative for varicella-zoster virus (VZV)-DNA. Spinal cord MRI revealed an H-sign in the central gray matter of the conus medullaris, suggesting myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD)-induced spinal cord inflammation. Intravenous methylprednisolone (IVMP) was initiated; however, the patient's symptoms did not improve. No anti-MOG antibodies were detected. During hospitalization, shingles appeared on the skin at the same level as the spinal cord lesions. In the repeat cerebrospinal fluid test, VZV-DNA was negative the first time, but later turned positive. We subsequently initiated treatment with acyclovir, and paralysis and bladder-rectum disorders improved. This case study provides important insights for patients with myelopathy. First, it is difficult to distinguish herpes zoster myelopathy from MOGAD because herpes zoster myelopathy presents as an H-shaped lesion in the conical area. Second, when treating myelopathy, virological confirmation via cerebrospinal fluid examination should be repeated until other diseases are diagnosed.

The identification of potential gap sites after pulmonary vein isolation (PVI) and prevention of these warning points during ablation are crucial. We evaluated the changes in peak frequency (PF) on electrograms and examined the relationship between its value and the residual pulmonary vein (PV) gap after PVI. We included patients with a PV gap after PVI with a power setting of 50 W using a novel irrigated-tip catheter (TactiFlex, Abbott). The PF on bipolar electrograms in the ablation catheter was recorded immediately before and after ablation at all available ablation points, using Omnipolar technology near field. We compared the pre- and post-PF values, changes in PF, contact force, and impedance drop between points with and without a PV gap following PVI. A total of 695 ablation points in 13 patients were analyzed. There were 19 and 676 points with and without the PV gap, respectively. The PV gap group demonstrated significantly lower PF drop and contact force (-14 ± 43Hz vs. 61 ± 57Hz, p < 0.001; and 8 [7-10] g vs. 10 [4-14] g, p = 0.039), and higher post-PF (226 ± 49Hz vs. 176 ± 47Hz, p < 0.001) than in the non-PV gap group. The PF drop had the highest area under the curve of 0.878 (95% confidence interval: 0.791-0.964) on receiver operating characteristic curve analysis for predicting the PV gap, with a cutoff value of 10.5Hz (sensitivity, 81.8%; specificity, 89.5%). PF drop during PVI is a useful parameter for predicting the non-PV gap with a high probability.