Introduction: Because of increasing medical costs and antibiotic resistance, a blood-culture contamination rate of less than 3% is recommended. This study involved the conceptualization of a novel ICU blood culture sample-collection protocol and an investigation of the effect of its implementation on ICU blood culture contamination rate. Considering the difficulty of sample collection via venipuncture in ICU patients, blood culture sample collection via single venipuncture was evaluated as an alternative method. Materials and Methods: Adults who were admitted to the ICU and provided blood culture samples collected between June 1, 2018, and May 31, 2021, were prospectively enrolled in this single-center, interventional study. The primary outcome was the change in the blood-culture contamination rate from before to after the introduction of the seven-item ICU blood culture protocol (Intervention 1); the secondary outcome was the change in the blood-culture contamination rate and true positive rate from before to after the introduction of the single venipuncture method (Intervention 2). Results: During the study period, there were 524 sets of ICU blood culture sample collections. Intervention 1 significantly decreased the blood-culture contamination rate from 20% to 1.8% (p=0.01). Compared with the double venipuncture method, Intervention 2 did not significantly increase the blood-culture contamination or true positive rate. Discussion: The implementation of the ICU blood-culture sample-collection protocol and subsequent improvements in the quality of blood-culture sample collection significantly decreased the blood-culture contamination rate. The single venipuncture method did not increase the rate of contamination; however, the clinical usefulness of the single venipuncture method should be ascertained.

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Adipose-derived mesenchymal stem cells (AdMSCs) are capable of self-renewal and multipotential differentiation and are expected to be utilized in a broad swathe of therapeutic applications. There have been very few studies on the effects of cellular senescence on the differentiation ability of AdMSCs. The purpose of this study is to determine how chronological and biological aging affects the potential of human-derived AdMSCs. We assessed the cellular senescence of AdMSCs isolated from donors in their 20s, 60s, and 80s by conventional assays such as cell proliferation and senescence-associated β-galactosidase (SA- β-Gal) assays. We also performed differentiation assays using early- and late-passage AdMSCs from all age groups. There were no differences in cell proliferation potential among all groups, furthermore, all evaluations for cellular senescence except SA- β-Gal activity and NAMPT gene expression, were comparable among all age groups at the early passage. At the late passage, AdMSCs from all age groups underwent cellular senescence, although those from the elder groups seemed more prominent than those of the 20s. Differentiation potentials tested in this study tended to decline over passages regardless of age, intriguingly, potentials for chondrocyte and osteoblast differentiations were retained across all ages at the early passage. Our results demonstrate that cellular senescence has a more pronounced effect than chronological age on AdMSC functions. Furthermore, this suggests that although early-passage AdMSCs of elderly donors may have already started altering cellular context toward cellular senescence, they are useful in developing some regenerative therapies for elderly patients with autologous cells.

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Purpose: To evaluate the refractive power and changes in the depth of the anterior chamber after cataract surgery with or without simultaneous vitreous surgery. Methods: 28 eyes of 22 cases who received cataract surgery (PEA group) and 30 eyes of 30 cases who received cataract surgery simultaneously with vitreous surgery (Vit group) were enrolled prospectively. A vitrectomy was performed for a macular hole or epiretinal membrane. Refractive outcomes, axial length, and the anterior chamber depth were measured before, immediately after, as well as 1, 3, 6, and 12 months after the surgery using an Auto Ref/keratometer, the ultrasound biometry, the Pentacam, and IOL Master. Results: The mean postoperative difference in refractive power immediately after surgery was -0.01±0.66 D and -0.19±0.62 D in the PEA and Vit groups, respectively. Postoperatively, the Vit group showed a significant increase in myopia compared to the PEA group in ultrasound results at all time points (p <0.05), whereas no difference was observed between the groups in IOL Master. For both measures, the postoperative refractive error in the Vit group was more myopic than predicted. Furthermore, there was a significant increase in anterior chamber depth in both groups after surgery, as observed with Pentacam and IOL Master (p <0.0001). Conclusions: A significant myopic shift occurred in the Vit group compared to the PEA group after surgery, as indicated by the ultrasound results. Both groups showed a significant increase in anterior chamber depth after surgery in both measurements.

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Purpose: Early detection and treatment of cancer are important for prolonging life expectancy. hPG80 (circulating progastrin) is an 80-amino acid protein that could prove useful for detecting and following up cancer patients. However, no studies have clarified hPG80 levels in Japanese populations. Patients and Methods: From 2018 to 2022, we prospectively measured hPG80 levels in 40 cancer patients and 18 healthy volunteers. A receiver operating characteristic (ROC) curve was used to assess the optimal cut-off for hPG80. According to this cut-off, we divided participants into a high-hPG80 group (n=30) and a low-hPG80 group (n=10) and compared clinical characteristics between groups. Results: Levels of hPG80 were higher in cancer patients (5.9 pM) than in healthy volunteers (2.3 pM; p=0.036), especially for gastric cancer (7.2 pM). We identified an optimal cut-off for hPG80 at 3.42 pM. At this cut-off, the sensitivity was 93.3% and specificity 83.3% for gastric cancer. The proportion of gastric cancer patients (46.7% vs. 10.0%; p=0.040) was higher in the high-hPG80 group. Among gastric cancer patients, 7 of 8 patients (87.5%) with early-stage cancer showed high hPG80 levels. Conclusion: Plasma hPG80 levels appear useful for early detection of cancer patients, especially gastric cancer.

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Background: Microsatellite instability (MSI) testing is not only an indicator of immune checkpoint inhibitor (ICI) use but also offers an important test regarding the use of adjuvant chemotherapy. However, the percentage of MSI-high (MSI-H) among colorectal cancer patients is low, so few reports have examined actual treatment strategies and prognosis after detecting MSIH. The purpose of this report is to investigate the background characteristics, clinical significance, and prognosis of patients with MSI-H using a Japanese real-world multicenter database. Case presentation: Seventeen patients diagnosed with MSI-H were examined. Ten patients had metastatic or recurrent colorectal cancer, including 3 had metastatic disease (to the peritoneum, brain, and paraaortic lymph nodes), 7 had recurrent disease after curative resection (4 local recurrences, 2 in lymph nodes, and 1 in the peritoneum). CEA was elevated in 6 patients (60%) and CA19-9 was elevated in 3 patients (30%). Two patients (20%) showed KRAS mutations, and 5 patients (50%) were BRAF-positive. ICIs were administered to 9 patients (90%). Among these, 4 patients (44%) achieved complete response, 3 patients (33%) achieved partial response, and 2 patients (22%) showed stable disease. One patient treated with pembrolizumab developed interstitial pneumonia. All patients who received ICIs achieved progression-free survival. Seven patients were after curative colorectal cancer surgery. MSI was measured in 4 cases to investigate the likely utility of adjuvant therapy and in 3 cases to rule out familial colorectal cancer due to a family history of colorectal cancer. One patient with stage III received AC, but no other stage II patients received AC. All patients remain alive without recurrent disease as of the end of the study period. Conclusion: For patients with metastatic or recurrent colorectal cancer or after curative resection requiring adjuvant chemotherapy, it is important to ensure that MSI status is measured.

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Background: Early ligation of the inferior pancreaticoduodenal artery (IPDA) has been proposed to control intraoperative blood loss during pancreaticoduodenectomy (PD). This study aimed to evaluate the feasibility and utility of IPDA early ligation technique for PD. Methods: The subjects of this study were 141 patients who underwent consecutive PD. The clinical characteristics, operative variables, and postoperative outcomes of patients who were divided into an IPDA early ligation group (n=93) and a no IPDA early ligation group (n=48) were retrospectively analyzed. Results: The blood loss was significantly lower in the IPDA early ligation group than in the no IPDA early ligation group (p<0.001). In addition, the percentage of blood transfusion was significantly lower in the IPDA early ligation group than in the No IPDA early ligation group (p=0.020). Conclusions: The IPDA early ligation technique is simple, feasible, and versatile to reduce blood loss and the rate of blood transfusion during PD.

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We report a rare case of volar lunate subluxation that occurred after volar locking plate fixation for a volarly displaced distal radius fracture. The patient was a 63-year-old male who was injured when his motorcycle collided with a car. He had a right volarly displaced distal radius fracture (AO/OTA classification 2R3B3), an ipsilateral femoral neck, segmental shaft, and distal femur fracture that extended to the knee joint, as well as a traumatic subarachnoid hemorrhage as complicating injuries. The distal radius fracture was internally fixed with a volar locking plate (VALCP Plate). At re-examination five months postoperatively, plain radiographs and computed tomography images showed that the distal radius fragments were fused while being volarly displaced and the lunate was volarly subluxated. Although the patient only reported mild pain, radiocarpal arthrodesis, and ulnar head resection were performed nine months after the original procedure due to concerns about future rupture of the finger flexor tendon. As of 12 months after the additional operation, the patient was engaged in design work, as he was before the injury, and had 'good' wrist function, achieving 70 points in the evaluation criteria by the Japanese Society for Surgery of the Hand. The causes of postoperative volar subluxation of the lunate were thought to be insufficient fixation force on volar lunate fossa fragments, femoral fractures as complicating injuries, and axial pressure applied to the radial joint surface when the patient used his hands to walk with a walker or stand up.

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A 73-year-old Japanese man was admitted with heart failure due to AL amyloidosis caused by left ventricular hypertrophy and IgA-kappa monoclonal gammopathy. However, endomyocardial biopsy revealed eosinophilic amorphous material in the myocardium, which was positive for Congo red staining and transthyretin (TTR), but negative for the kappa chain. The patient was diagnosed with wild-type amyloid TTR (ATTR) amyloidosis and monoclonal gammopathy of uncertain significance. Among the different types of amyloidosis including AL amyloidosis (primary amyloidosis from an abnormality of plasma cells), AA amyloidosis (secondary amyloidosis in association with chronic inflammatory disease), and dialysis-related amyloidosis (deposition of beta-2 microglobulin), ATTRwt amyloidosis is a slowly progressive disease that affects most commonly the hearts of elderly in elderly patients who sometimes have other diseases. Thus, pathological examination is important for the diagnosis of amyloidosis.

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Background: Medullary carcinoma of the colon, formerly classified as poorly differentiated adenocarcinoma, was classified as a special type as a new concept in the 8th edition of the Japanese Code of Treatment of Colorectal Cancer, revised in July 2013. The prognosis is relatively good, with a high degree of microsatellite instability and a predilection for the right-sided colon. Case presentation: A 90-year-old woman was referred to our hospital for a semi-peripheral type 2 tumor that was found in the ascending colon after a lower gastrointestinal endoscopy was performed by a local doctor to investigate slowly progressive anemia. Histopathological examination of the biopsy specimen revealed adenocarcinoma. Contrast-enhanced computed tomography of the thorax and abdomen showed irregular wall thickening and contrast effect in the ileocecal region, with no obvious extramural extension, enlarged lymph nodes, or distant metastasis. She underwent laparoscopic ileal resection + D3 dissection for cT2N0M0 cStage I ascending colon cancer. The postoperative course was good, and the patient was discharged on postoperative day 11. Postoperative histopathological examination revealed a well-defined, enlarged nucleolus within a large, stained nucleus, hyperplastic linear epithelium with acidophilic cytoplasm, and numerous tumor-infiltrating lymphocytes, leading to a diagnosis of colorectal medullary carcinoma pT3N0M0 pStage IIa. The patient is currently alive and recurrence-free 1 year after surgery. Conclusion: We report a rare case of resection of medullary carcinoma of the colon arising in the ascending colon. The histology has a characteristic clinical presentation and prognosis, requiring appropriate diagnosis and follow-up.

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