Objective: Patients with advanced or recurrent cancer often suffer from excessive fluid retention, which substantially affects their quality of life. There are no detailed reports regarding cell-free and concentrated pleural effusion reinfusion therapy (CPRT). Thus, we investigated the usefulness of CPRT for pleural effusions in terminal cancer patients.

Methods: We evaluated the efficacy and complications of CPRT in 29 patients treated at Fujita Health University Nanakuri Memorial Hospital between April 2016 and August 2020. Nutritional status before and after CPRT was evaluated by measuring serum albumin (Alb) and transthyretin (TTR) levels as indicators. Clinical symptoms were assessed to evaluate the following nine items: pain, general fatigue, anorexia, dyspnea, depression, nausea, insomnia, constipation, and dry mouth.

Results: CPRT was performed a total of 71 times, with a median of one session per patient. Median volume of drained pleural fluid was 800 mL, and the median volume of reinfused fluid was 120 mL. Regarding nutritional status before and after CPRT, serum Alb and TTR values did not decrease significantly and were maintained. Clinical symptoms showed a tendency toward improvement; dyspnea, depression, and insomnia improved significantly.

No correlation was observed between the volume of pleural fluid drainage and the reduction of dyspnea, but there was a mild correlation with general fatigue and nausea. Conversely, constipation was mildly inversely correlated with the volume of pleural fluid drainage.

Conclusion: CPRT for pleural effusions in patients with terminal cancer was suggested to maintain nutritional status and may be useful in improving clinical symptom.

Objectives: Combined therapy using a bioabsorbable polyglycolic acid sheet (BAPGAS) and fibrin glue (FG) has been employed to prevent postoperative perforation. More recently, this therapy has been applied to ulcers that develop after endoscopic submucosal dissection (ESD) for early digestive tract tumors. This study was performed to evaluate the sealing effect of this combined therapy on ulcers that develop after ESD for early gastric tumors.

Methods: This study included nine patients with early gastric cancer or adenoma who were treated with ESD. Ulcers that developed after ESD were covered with BAPGAS and sealed with FG spray. To assess ulcer bleeding and healing status, endoscopy was performed on postoperative days 1, 7, 28, and 56.

Results: On days 1 and 7, clots were observed in only two patients, and no bleeding occurred in any patient. As a result, endoscopic hemostasis was not required. In one patient, scar healing was achieved by day 28. By day 56, seven of the nine patients’ ulcers had reached the scar stage, and no bleeding was observed in any patient. Changes in hemoglobin levels 1 week after ESD were not significant (from 13.1 to 12.7 g/dL). The average BAPGAS covering time was approximately 40 minutes. No correlation was found between BAPGAS covering time and ESD procedure time, dissection time, or resected area.

Conclusions: Combined therapy with BAPGAS and FG is a promising new treatment for preventing bleeding from artificial ulcers following ESD and may help avoid the need for additional endoscopic hemostasis.

Objectives: Brain-dead organ donations in Japan remain significantly fewer than in other countries, highlighting inadequacies in the organ donation system. This study aimed to examine the state of organ donation systems in hospitals that have conducted brain-dead organ donations and to explore potential in-hospital improvements.

Methods: Among 148 hospitals that carried out at least one brain-dead organ donation between 2018 and 2023, 84 participated in an anonymous, self-administered online survey, yielding a 57% response rate.

Results: A total of 96% of responding hospitals reported having in-hospital donor coordinators (IHCos), with an average of 7.0±6.0. Their IHCo teams included nurses in 98%, physicians in 50%, and administrative staff in 27% of hospitals. A significant positive correlation was observed between the numbers of organ donation options presented and actual organ donations. Hospitals offering more options tended to have six or more IHCos and/or a system for identifying potential donors. Furthermore, hospitals with full-time IHCos had significantly more deceased organ donors.

Conclusions: Appropriate allocation of IHCos and the establishment of a system to identify potential donors can enhance the assessment of patients’ or their families’ willingness to donate organs and support the successful completion of the donation process.

Objectives: Slow-flow or no-reflow events occur as a complication during percutaneous coronary intervention for acute coronary syndrome (ACS). A previous study demonstrated that prolonged perfusion balloon (PB) predilatation combined with intracoronary administration of nicorandil attenuates this phenomenon. This subanalysis compared the efficacy of the PB approach with that of conventional distal protection (DP).

Methods: The study had a retrospective, single-center, observational design and included patients who underwent percutaneous coronary intervention for ACS between April 2020 and April 2022. The patients were divided into a PB group and a DP group. The PB group underwent thrombus aspiration, followed by 3 minutes of predilatation using the Ryusei^® PB, with simultaneous intracoronary administration of nicorandil 2 mg without a DP device and subsequent placement of a drug-eluting stent. The DP group underwent direct stenting or predilatation with a standard balloon combined with a DP device without a PB. Primary endpoints included the incidence of slow-flow or no-reflow events.

Results: Sixty-four patients with ACS were enrolled (PB group, n=32; DP group, n=32). The incidence of slow-flow or no-reflow events was significantly lower in the PB group (3.1% vs. 46.8%, p<0.01), as was procedure time (87.1±26.4 minutes vs. 108.6±42.3 minutes, p=0.02) and volume of contrast used (186.0±65.0 mL vs. 228±75.8 mL, p=0.02).

Conclusions: PB predilatation with intracoronary nicorandil significantly reduced the number of slow-flow or no-reflow events, shortened procedure time, and reduced the volume of contrast used. This method could be at least as effective as DP.

Background: In home care nursing, nurses are required to assess not only the care recipient’s condition but also their living environment. However, conventional paper-based case studies make it difficult for students to grasp the actual living environment.

Objective: This study aimed to develop a learning support application (app) that combines 360-degree camera images with a paper-based case scenario and evaluate its usability among nursing students.

Methods: Four areas inside the home of a single home care recipient were comprehensively photographed using a 360-degree camera. Thereafter, an app was developed to enable the users view the 360-degree images online by scanning with a smart device a QR code attached to a paper-based case scenario. To evaluate its usability, nursing students used the app and participated in semi-structured interviews. The data were analyzed using text mining techniques.

Result: Text mining analysis revealed a co-occurrence network comprising four subgraphs. The representative keywords for each subgraph are as follows:

Subgraph 1: Consider, Home, Fall, Risk, Environment

Subgraph 2: Think, Danger, Imagination, Watch

Subgraph 3: Assessment, Learning support app, Residential environment, Home settings, Use

Subgraph 4: Life, See, Person, Situation

Conclusion: The app supported students in understanding the home care environment and contributed to the development of care planning competence. Future studies should increase the number of cases and perform quantitative comparisons.

Objective: Small dosimeters such as optically stimulated luminescence dosimeters (OSLDs) and thermoluminescence dosimeters (TLDs) are used in anthropomorphic phantoms to measure actual organ exposure in X-ray computed tomography (CT) examinations. Nagase-Landauer currently supplies nanoDot dosimeters that employ OSLDs. The flat structure of nanoDot dosimeters causes their sensitivity to fluctuate according to the direction of the incident X-rays. We evaluated the effect of OSLD angle on measured values when dosimeters were placed within an anthropomorphic phantom and dosimetry was performed to mimic X-ray CT examinations.

Methods: The dependence of OSLD placement angle on measured values was evaluated at eight points in the thorax and abdomen of the anthropomorphic phantom including the lung field, near the center of the phantom, near the body surface, and near the tissue boundary.

Results: The system error for OSLDs positioned at different angles in the anthropomorphic phantom was 6.58%. Variation of measured values with the OSLD placement angles in the phantom resulted in errors ranging from –7.3% to +5.4%.

Conclusion: Placement angle had little effect on measurement values when system error was considered. Therefore, it is not necessary to consider placement angle when measuring organ doses using OSLDs.

Objectives: Patients with lumbar spinal stenosis (LSS) exhibit significantly different scoring patterns on the visual analogue scale (VAS) chart for low back pain (LP), buttock and lower limb pain (PL), and buttock and lower limb numbness (NL). This study investigated the usefulness of these preoperative scoring patterns on the VAS chart in predicting surgical outcomes in older adults undergoing LSS surgery.

Methods: Time-course data from patients aged ≥65 years who underwent LSS surgery at two institutions were retrospectively assessed. All participants completed the Zurich Claudication Questionnaire and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, which included the VAS chart, before surgery and at 6 months and 1 year postoperatively.

Results: In total, 334 participants were evaluated. Patients with equal preoperative scores across all three scales showed the highest average postoperative reduction in the three VAS scores. By contrast, those with the highest preoperative VAS scores for LP or NL had the lowest reductions. Based on the multivariable analysis, the highest preoperative VAS scores for LP (relative risk: 2.1) and NL (relative risk: 2.1) were significantly associated with poor surgical improvement in older adults with LSS.

Conclusions: This study demonstrated the potential clinical utility of the preoperative VAS chart in predicting surgical improvement in older patients with LSS. Patients with equal preoperative VAS scores for LP, PL, and NL were more likely to have favorable surgical outcomes, while those with the highest preoperative scores for LP or NL were at higher risk for poor outcomes.

Objective: Life Whisperer Viability (LW) is a software that evaluates embryos from a single image of blastocyst using artificial intelligence and is expected to improve the objectivity of embryo evaluation. In the present study, we retrospectively analyzed the clinical utility of LW.

Methods: This study included 198 cycles in 135 patients who underwent frozen single embryo transfer. LW scores of transferred embryos were obtained from images taken approximately 116 h after fertilization. Based on LW scores, patients were divided into four groups (poor: 0–2.4; fair: 2.5–7.4; good: 7.5–8.9; excellent: 9.0–10), and rates of positive fetal heartbeat were compared among the groups. In addition, logistic regression analysis was performed to evaluate the association between LW score and the presence or absence of fetal heartbeat.

Results: The rate of positive fetal heartbeat was significantly higher in the excellent group (64.3%, 36/56) than in the poor group (27.6%, 8/29) (P<0.05). Logistic regression analysis showed that the odds ratio for LW score was 1.150 (95% confidence interval: 1.040–1.280; P<0.05), indicating a significant association between LW score and presence or absence of fetal heartbeat.

Conclusion: LW enables selection of embryos with a high potential for clinical pregnancy, demonstrating its clinical utility.

Objectives: SMARCA4, a core component of the SWI/SNF chromatin remodeling complex, is frequently mutated in non-small cell lung cancer (NSCLC). SMARCA4-deficient cancer cells are associated with increased replication stress, one of the major causes of genomic instability, which may lead to cancer. SMARCAD1, a chromatin remodeler, is known as replication fork progressor, and SMARCAD1 dysregulation is also closely related to cancer development. This study aimed to investigate the role of the SMARCA4-SMARCAD1 axis in the toleration of replication stress in NSCLC, focusing on the regulatory relationship between SMARCA4 and SMARCAD1 during replication stress conditions.

Methods: Human NSCLC cell lines (Calu-6, NCI-H1975, Calu-1, and NCI-H460) were used for experiments. SMARCA4 and SMARCAD1 expression levels were analyzed by quantitative RT-PCR and immunoblotting. Transcriptional regulation of SMARCAD1 was analyzed by chromatin immunoprecipitation assay. Immunofluorescent analysis was performed to assess SMARCAD1 accumulation at stalled replication forks. Clonogenic assays were conducted to evaluate the roles of SMARCA4 and SMARCAD1 in cell survival.

Results: SMARCAD1 was highly expressed in SMARCA4-depleted cells under replication stress. Immunofluorescent analysis revealed significant accumulation of SMARCAD1 at stalled replication forks in SMARCA4-depleted cells. Chromatin immunoprecipitation assays demonstrated that SMARCA4 bound to the transcriptional regulatory region of SMARCAD1, and that this efficacy was decreased under replication stress, suggesting that SMARCA4 is a transcriptional suppressor of SMARCAD1. In a clonogenic analysis either SMARCA4 or SMARCAD1 is required for cell survival.

Conclusions: The SMARCA4-SMARCAD1 axis is a novel mechanism that provides tolerance for replication stress.

Reports regarding coronavirus disease 2019 (COVID-19) with Fontan circulation are limited. Most studies indicate a relatively good clinical outcome in which SARS-CoV-2 infection is abated; however, COVID-19 can still cause severe pneumonia, and some studies report circulatory breakdown associated with acute respiratory distress syndrome in patients with Fontan circulation.

We present the case of a 32-year-old Japanese woman with right isomerism and a single right ventricle who had undergone a fenestrated extracardiac total cavopulmonary connection (Fontan operation), atrioventricular valve replacement, and pacemaker implantation. Despite receiving three doses of the severe acute respiratory syndrome coronavirus 2 mRNA vaccine, the patient contracted COVID-19 and presented with pneumonia. Although her symptoms were mild, the patient was classified as high-risk based on the European Society of Cardiology risk stratification guidelines for COVID-19 in patients with adult congenital heart disease and was admitted to the hospital. Initially, the patient received only symptomatic treatment. However, 2 days later, the patient’s COVID-19 condition worsened to moderate grade level II (SpO₂ ≤93%, oxygen demand), with SpO₂ dropping from 95% to 88% on room air. Treatment with remdesivir and dexamethasone following Japanese treatment protocols resulted in clinical improvement and discharge without hemodynamic complications.

COVID-19 pneumonia risks disrupting Fontan circulation in affected patients. This case illustrates the importance of prompt risk stratification using anatomical and physical evaluation and adherence to treatment guidelines in the management of patients with Fontan circulation and COVID-19.

Objectives: Advances in critical care have increased antimicrobial use in intensive care units (ICUs), often extending to end-of-life patients without clear clinical benefit. This systematic review and meta-analysis investigated antimicrobial use in critically ill ICU patients with end-of-life care status.

Methods: A comprehensive search of Medline (PubMed) and Embase identified articles published from January 2000 through August 2023. Interventional and observational studies focusing on antimicrobial use for critically ill ICU patients with end-of-life status were included. Study types, demographics, clinical characteristics, and antimicrobial use (i.e., continuation or discontinuation) were extracted. A meta-analysis was conducted to estimate the proportion of antimicrobial use, with subgroup analyses by region and national income status.

Results: From 13,542 publications, 26 studies met the inclusion criteria; no randomized or prospective studies were identified. Thirteen studies (50.0%) reported antimicrobial use and were included in the quantitative synthesis. The pooled proportion of antimicrobial prescriptions was 0.35 (95% CI, 0.18–0.54) with significant heterogeneity (I²=99.7%, P<0.01). Subgroup analysis revealed regional differences: 0.50 (95% CI, 0.11–0.89) in North America, 0.40 (95% CI, 0.10–0.76) in Europe, and 0.24 (95% CI, 0.10–0.76) in the Asia-Pacific region.

Conclusions: Despite increasing emphasis on judicious antimicrobial use, studies comprehensively assessing antimicrobial prescribing in ICU patients with end-of-life care status remain scarce. Based on the limited available evidence, approximately one-third of such patients received antimicrobials. Regional differences in prescribing patterns were also observed, potentially influencing overall antimicrobial consumption in ICUs.

Introduction: While various immune-related adverse events (irAEs) have been associated with the use of immune checkpoint inhibitors (ICIs), gastritis as an irAE remains a rarely documented condition. We report a case of immune-related gastritis following cemiplimab administration, accompanied by a review of the relevant literature.

Case: A 75-year-old woman, gravida 4, para 2, underwent six cycles of cemiplimab as second-line treatment for FIGO stage IIB squamous cell carcinoma of the cervix. Cemiplimab was discontinued 140 days after the initial dose due to the onset of anorexia, nausea, and vomiting. However, her symptoms did not improve during the subsequent follow-up. Upper gastrointestinal endoscopy revealed erythema and edematous changes of the mucosa, predominantly in the pyloric region, along with friable, easily bleeding mucosa and white exudate. Histopathological examination of the biopsied tissue showed dense intraepithelial infiltration of CD8-positive lymphocytes. These findings were consistent with irAE gastritis. As fasting alone failed to improve the symptoms, prednisolone (PSL) was initiated, resulting in amelioration of both symptoms and endoscopic findings.

Conclusion: Cemiplimab-induced immune-related gastritis can be diagnosed based on its characteristic endoscopic and histopathological features, similar to irAE gastritis caused by other immune checkpoint inhibitors.

Objectives: We aimed to develop and validate a model to predict gait independence at discharge from inpatient rehabilitation in individuals with subacute hemiparetic stroke who have very severe gait disorder.

Methods: Overall, 298 individuals with subacute hemiparetic stroke and completely dependent gait were selected in one hospital as the training cohort. Seventy-seven individuals were selected in another hospital as the validation cohort. The prediction model was developed using multivariable logistic regression analysis, with individual characteristics selected based on a p-value threshold (<0.10) in the training cohort. Sensitivity, specificity, and area under the curve of the receiver operating characteristic curve were calculated in the training cohort, and external validation was conducted using the validation cohort.

Results: In total, 102 (34.2%) and 40 (52.0%) individuals in the training and validation cohorts achieved independent gait while hospitalized, respectively. The prediction model factors were age, days from onset to admission, stroke type, affected side, severity of paresis, unaffected side function, and cognitive function. The sensitivity, specificity, and area under the curve in the training cohort were 0.81, 0.80, and 0.88, respectively. Corresponding values in the validation cohort were 0.82, 0.70, and 0.83, respectively.

Conclusions: A model combining age, days from onset to admission, stroke type, affected side, severity of paresis, unaffected side muscle strength, and cognitive function effectively predicted gait independence at discharge in individuals with very severe gait disorder due to subacute hemiparetic stroke.