Our hospital, a 923-bed capacity university hospital located in a large city, is responsible for both advanced acute medical care and regional medical support. Many patients are highly dependent on medical care, and a home medical care department was established in 2018 to provide medical care not only during hospitalization but also at home. Doctors in our general medicine department concurrently work in the home medical department. We report on progress achieved within five years in which we have been working with nursing staff and clerical workers. For inpatients or outpatients at our hospital, we consider not only physical factors, such as diseases and comorbidities, but also various situations, such as recuperation environment and the need for nursing care. Additionally, doctors in the general medicine department conduct regular home visits during the day based on requests from the main department, which provides emergency care at night and on holidays. Home-visit nursing has been practiced for a long time and has played a role in returning unstable patients to a stable condition immediately after discharge from the hospital. Even though our facility is a university hospital, we have the flexibility to go out to the community, and as a medical education institution, medical students and initial resident physicians accompany us to experience home medical care; this will contribute to human resource development that will support future medical care.

Multiple myeloma (MM) is a hematological malignancy originating from plasma cells producing immunoglobulin. Introducing high-dose melphalan therapy followed by auto stem cell transplantation (ASCT) and novel drugs has improved the survival of patients with MM. The importance of maintenance therapy after induction therapy has been investigated to obtain a long duration of progression-free survival (PFS) after induction therapy. The role of maintenance therapy in MM is to inhibit disease progression after induction therapy without physical and financial burden for patients. Physical burden mainly refers to the side effects of treatment. Preventing relapse with minimum burden is beneficial. Here, we review the updated progress of maintenance therapy for transplant-eligible and -ineligible patients with MM. The results of clinical studies about maintenance therapies using thalidomide, lenalidomide, bortezomib, and ixazomib are demonstrated. The possible choice of treatment based on these results is suggested, and the utility of drug combination as a maintenance therapy is discussed. Furthermore, we describe the outline of the clinical trial we just commenced. We started an ixazomib maintenance therapy for transplant-ineligible patients intolerant to lenalidomide (IMTIL) study (UMIN000048285) to determine the efficacy and safety of ixazomib maintenance therapy in transplant-ineligible patients with MM who cannot be treated with standard doses of lenalidomide due to adverse reactions or frailty during or after induction therapy. In addition, the relationship between the efficacy of ixazomib in maintenance therapy and driver mutation and immune status is assessed.

Recent advances in reconstructive surgery, such as microvascular free flap transfer, have contributed to the development of other surgical specialties to achieve improved performance of surgery. Although microvascular free flap transfer is one of the most frequently used methods, it has several limitations and shortcomings, such as donor-site morbidity and insufficient flap function. We refined conventional methods of free flap transfer and developed various types of novel flaps to overcome these shortcomings. However, although many technical refinements are being developed, the restoration of complex organs to their original status remains difficult. We believe that there are two solutions for reconstruction of complex organs: 1) vascularized composite allotransplantation and 2) artificial flaps using regenerative medicine. In this article, we aimed to present the current status of reconstructive surgery and discuss its future.

ANCA-associated rapidly progressive glomerulonephritis has been treated with steroid pulse therapy (mPSL pulse), cyclophosphamide pulse therapy (IVCY), rituximab (RTX), and plasma exchange (PE), but the differences in renal and life outcomes are not fully understood. To determine the long-term prognostic impact of plasma exchange in ANCA-associated rapidly progressive glomerulonephritis, we conducted a retrospective observational study with stratification by treatment modality to determine the prognostic impact of plasma exchange in ANCA-associated rapidly progressive glomerulonephritis. Eighty patients with ANCA-associated glomerulonephritis who underwent renal biopsy at our hospital were divided into 5 groups, and the renal and life prognosis were evaluated. IVCY and RTX significantly improved renal survival compared with steroid therapy and PE. PE and PSL oral groups did not improve renal prognosis, but survived without death during the observation period. PE is introduced in patients requiring hemodialysis at biopsy to rapidly reduce ANCA levels with favorable life prognosis.

Posterior capsule opacification is a common complication following cataract surgery. However, its incidence varies depending on the type of intraocular lens (IOL) used. In this study, we analyzed the adhesion and movement of lens epithelial cells (LECs) in the early stages after cataract surgery by continuously observing LECs seeded on the surfaces of different types of IOLs. PY-60AD and XY1 hydrophobic acrylic IOLs were used. Each posterior surface was modified to increase the adhesion. The IOLs were placed in culture dishes with an exposed posterior or anterior surface (three each). LECs extracted from white rabbit lenses by trypsinization were seeded onto IOLs. LEC movement and shape were recorded by microscopy using a cell culture observation system after 6 h of contact between LECs and IOLs. The cumulative distance traveled was calculated from the LEC trajectories after comparing the shapes of the LECs. We observed that LECs were more likely to adhere to XY1 modified posterior surface. The speed of LEC movement decreased after adhesion. These findings support the conclusion that increasing the adhesiveness of IOL surfaces inhibits the LEC movement.

Objective: We retrospectively examined whether easy Z-score imaging system (eZIS)-specific volume of interest analysis (SVA) using brain perfusion single photon emission computed tomography (SPECT) imaging or the cingulate island sign score (CIScore) could distinguish between Alzheimer's disease (AD) and dementia with Lewy bodies (DLB).

Methods: This study included 22 AD and 22 DLB patients who underwent ^99mTc-ECD SPECT at Dokkyo Medical University Saitama Medical Center from November 2011 to February 2023.

Results: The SVA of AD and DLB patients showed that the threshold was exceeded in 77.3% for severity, 72.7% for extent, and 63.6% for ratio in AD, and in 86.4% for severity, 77.3% for extent, and 72.7% for ratio in DLB, with no significant difference between the two patient groups. The CIScore threshold of 0.281 allowed DLB to be discriminated from AD with an accuracy, sensitivity, and specificity of 63.6%, 77.2%, and 50.0%, respectively. The mean CIScore was significantly lower in DLB patients than in AD patients (p = 0.028, Mann-Whitney U test). A significant positive correlation was found between the CIScore and age of AD and DLB patients by Spearman's rank correlation coefficient analysis.

Conclusion: SVA is useful for the diagnosis of dementia with AD and DLB. CIScore is an adjunctive assessment method to distinguish between AD and DLB. Although CIScore can distinguish AD and DLB, it was strongly affected by age.

Herein, we report a rare, resected case of a hemorrhagic hemangioma originating in contiguity with a peribiliary cyst, which was misdiagnosed as an intraductal papillary neoplasm of the bile duct (IPNB).

A 74-year-old woman was referred to our department for the inspection of a nodular lesion that had emerged within a cystic lesion in the posterior segment of the liver. The cystic lesion had originally been pointed out 7 years before the appearance of the nodule; the nodule increased in size over a short period and was accompanied by contrast enhancement. In addition, a plain CT after an endoscopic retrograde cholangiography (ERC) suggested a communication between the cystic lesion and the bile duct.

As a malignant neoplasm such as IPNB could not be ruled out, surgery was performed. The pathological results revealed that the nodule was a hemorrhagic hemangioma and the cystic lesion was a peribiliary cyst; the hemangioma had compressed the cyst. Several reports of hemorrhagic liver cysts can be found in medical literature, but the coexistence of a hemorrhagic hemangioma and a peribiliary cyst has not been previously reported. A surgical approach is recommended when the possibility of a neoplastic cystic lesion cannot be ruled out by imaging studies.

A 57-year-old male with low back pain and hyperphosphatasemia was diagnosed as disseminated carcinomatosis of the bone marrow (DCBM) originating from cancer of unknown primary. Although an iliac bone marrow biopsy showed cancer metastasis, gastrointestinal endoscopy, imaging studies, tumor markers tests, and immunohistochemistry of the biopsy material failed to identify the primary tumor. Five courses of carboplatin and paclitaxel (CBDCA/PTX) therapy and two courses of gemcitabine (GEM) therapy were performed for cancer of unknown primary, but there was no therapeutic effect, and the patient died after the treatment during about 7 months. Autopsy revealed signet-ring cell carcinoma of the stomach, which was an early cancer limited to the small part of the antrum. Tumor size was 5 millimeters, the depth of submucosal invasion was about 500 micrometers, and neither vascular nor lymphatic infiltration was found. Reportedly, the most common primary tumor of DCBM is gastric cancer, most of which are advanced cancers. However, as in the present case, early cancer could be the cause. Besides, DCBM is known to develop long after surgery. Thus, the gastric cancer patients, especially when histological subtype is poorly differentiated adenocarcinoma or signet-ring cell carcinoma, should be followed up with reference to serum ALP and FDP, considering the rare occurrence of DCBM.

We report a hepatocellular carcinoma (HCC) case with vascular invasion successfully treated by conversion hepatectomy after treatment by atezolizumab-bevacizumab. A 74-year-old male patient was diagnosed with HCC and referred to our hospital. The tumor at the anterior section was 12.3 cm in diameter. It had invaded a portal vein branch of subsection 5 (S5) and peripheral branches of the middle hepatic vein. Serum alpha-fetoprotein (AFP) level was extremely high at 177408.3 ng/ml. The patient first received atezolizumab-bevacizumab treatment. After three cycles of atezolizumab-bevacizumab therapy, the tumor had decreased in size, the invasion into a portal and hepatic vein disappeared, the tumor enhancement completely vanished in the CT scan, and the tumor markers became within normal range. We decided to perform a conversion hepatectomy. The tumor was removed entirely by S5 partial resection, and pathological analyses showed a complete response to atezolizumab-bevacizumab treatment. There was no perioperative complication. The patient has survived for nine months without recurrence so far. Atezolizumab combined with bevacizumab might be an effective and appropriate option for the multidisciplinary treatment aiming for curative surgical resection.

Acute aortic dissection may result in various comorbidities due to vascular complications. Working-age patients commonly develop this disease and require rehabilitation. Three male patients (42-year-old, 40-year-old, and 43-year-old) with acute aortic dissection and vascular complications (cerebral infarction, spinal cord infarction, and peripheral arterial occlusion) underwent cardiac rehabilitation and rehabilitation for comorbidities, including higher brain dysfunction, paraplegia, and above-knee amputation. The patients also had obesity, diabetes mellitus, pressure ulcers, heterotopic ossification, and mental disorders. They gained independence in their activities of daily living in the convalescent ward. Improvements in comorbidities have enabled exercise therapy and education regarding disease and lifestyle. Continuous outpatient rehabilitation and treatment by various clinical departments, including cardiovascular surgery, dermatology, urology, orthopedics, internal medicine, and psychiatry, allowed them to continue working and exercising and prevented the recurrence of major adverse cardiovascular events. Working-age patients with acute aortic dissection and comorbidities need to undergo rehabilitation not only to achieve independence and be discharged home but also to work and have a good long-term prognosis. Therefore, the importance of psychological factors, disease characteristics, and comorbidities should be recognized.