Combinatorial immunotherapy using anti-programmed cell death 1 (PD-1) monoclonal antibody (mAb) is being developed to overcome the limited efficacy of monotherapy with anti-PD-1 mAb for patients with advanced gastric cancer (GC). Anti-PD-1 mAb exhibits clinical efficacy by enhancing the function of cytotoxic T lymphocyte (CTL) through the inhibition of the PD-1 pathway;however, there are various immunosuppressive mechanisms that inhibit CTL function, as well as the PD-1 pathway in the tumor microenvironment (TME). Immune suppressive cells and expression of the inhibitory immune checkpoint molecules are included as main inhibitory mechanisms against CTL in the TME. On the other hand, increasing the number of CTLs enhances the efficacy of anti-PD-1 mAb, and immunogenic tumor cell death (ICD) is crucial to induce CTL through the activation of the cancer immunity cycle. In the present review, we discuss the therapeutic potential of developing combinatorial immunotherapy focusing on the inhibitory immune checkpoint molecules and immune suppressive cells in the TME, as well as on the ICD induced by radiotherapy for patients with advanced GC.

Background:Unhealthy dieting behaviors to lose weight in adolescents can cause future health issues such as mineral, hormonal, or bone complications, highlighting the importance of preventive interventions.

Methods:Six classes consisting of 236 first-year high school students were randomly allocated to an intervention group, which participated in interactive healthy eating and dieting programs, or to a control group, which attended a smoking prevention workshop. Data from non-obese students were analyzed, comparing the dieting behaviors of both groups at a two-month follow-up. Self-reported questionnaires assessed conviction and confidence levels about healthy eating and dieting after the intervention.

Results:The two groups did not differ in the proportion of students engaging in dieting behavior after the intervention (intervention:14.9% vs. control:22.7%, p=0.18). The intervention increased the conviction level regarding healthy eating (90.4% vs. 74.7%, p<0.01) but not the confidence level (50.0% vs. 36.0%, p=0.06);it did not significantly impact conviction and confidence levels regarding healthy dieting (62.8% vs. 61.4%, p=0.84;45.7% vs. 37.5%, p=0.26).

Conclusions:The classroom-based intervention failed to prevent unhealthy dieting behavior among non-obese students. Interventions boosting conviction and confidence, thereby preventing unhealthy dieting among all students, regardless of risk factors such as eating disorder tendencies, require further research.

Background:Advances in treatment strategies and interventional radiology have led to the widespread adoption of nonoperative management for liver trauma;however, severe cases still require surgery, and are associated with high mortality. While the widely used American Association for the Surgery of Trauma (AAST) Liver Injury Scale is regularly updated and includes computed tomography (CT) findings, the Japanese Association for the Surgery of Trauma (JAST) Liver Injury Classification is also utilized in Japan but may have limitations in predicting prognosis based solely on imaging. Few studies have compared the prognostic utility of the two systems.

Methods:This retrospective study analyzed patients who underwent laparotomy for liver injury at Fukushima Medical University Hospital (2013-2023). Liver injury-related mortality cases were compared with survivors to assess the predictive accuracy of the AAST and JAST classifications.

Results:Among 23 patients, the overall mortality rate was 34.8%, with 5 liver injury-related deaths. AAST grades IV-V yielded 100% sensitivity and 80% specificity for predicting mortality (p=0.001), whereas JAST had lower sensitivity (60.0%) and specificity (86.7%, p=0.073).

Conclusion:AAST grading may be more effective than the JAST classification for predicting liver injury-related mortality. Future JAST revisions should integrate imaging findings and treatment strategies to enhance its prognostic accuracy.

To clarify the characteristics of children with attention deficit hyperactivity disorder (ADHD) requiring early drug therapy and changes in ADHD treatment over time, we undertook a clinical survey of ADHD children. We retrospectively classified 168 children with ADHD into groups based on the presence [Group 1, (the early treatment Group A, non-early treatment Group B)] or absence (Group 2) of ADHD drug therapy. The older age at first examination and the frequency of patients born with low birth weight in Group 1 were higher than those in Group 2. The ADHD-Rating Scale (ADHD-RS) scores for total (ADHD-RS-T) and trouble scores (TS) in Group 1 were higher than those in Group 2. All patients requiring early drug medication were diagnosed with ADHD at age 6 or older and showed significantly higher ADHD-RS hyperactivity disorder (ADHD-RS-H) and TS. Guanfacine was the main drug prescribed, being the first-line drug in 45.0% of cases. These results suggest that characteristics of patients requiring early ADHD drug medication include age 6 years or older at first examination and high ADHD-RS-H, ADHD-RS-T and TS. Furthermore, an increase in the frequency of prescriptions for guanfacine was observed as a prescription trend for ADHD medications.

Purpose:This study aimed to investigate changes in sciatic nerve stiffness in patients with lumbar disc herniation (LDH) using shear wave elastography (SWE) before and after diskectomy. In addition, we explored the relationship between preoperative sciatic nerve stiffness in the affected side and patient characteristics, leg pain severity, and numbness.

Methods:We assessed sciatic nerve stiffness in 27 patients with LDH (nine females, mean age 45.1±15.3 years) preoperatively and one week postoperatively after diskectomy using SWE. We also measured patient characteristics such as age, height, body weight, leg pain severity, and numbness surgery.

Results:We found a significant decrease in sciatic nerve stiffness on the affected side postoperatively. However, there was no significant change on the unaffected side. In addition, preoperative nerve stiffness on the affected side correlated with preoperative leg pain intensity.

Conclusion:Sciatic nerve stiffness on the affected side was decreased at one week postoperatively compared with preoperatively. In addition, sciatic nerve stiffness on the affected side was correlated with leg pain severity.

Aim:This study aimed to examine phosphoethanolamine (PEA) in postpartum women and its association with postpartum depression (PPD).

Methods:This prospective study, performed between July 2020 and August 2021 at Fukushima Medical University Hospital, included 67 women. They answered two questionnaires, the Edinburgh Postpartum Depression Scale (EPDS) and the Patient Health Questionnaire-9 (PHQ-9). EPDS is the screening tool for PPD, and the PHQ-9 scores can evaluate the degree of depressive symptom severity. Blood was collected at 5 and 40 days postpartum, and PEA levels were measured.

Results:The PEA levels of all postpartum women on day 5 were significantly lower than those on day 40. EPDS and PHQ-9 scores were significantly lower on day 40 than those on day 5 postpartum. No significant correlation was observed between the PPD-suspected (EPDS≥9) women and PEA levels, and no significant correlation was found between plasma PEA levels and PHQ-9 scores on postpartum days 5 and 40.

Conclusions:This study found that PEA levels on postpartum day 5 were lower than on postpartum day 40. It also suggested that there was no association between the degree of postpartum depression and plasma PEA concentrations.

Abstract

A 27-year-old man with no medical history developed a fever and sore throat 5 days before visiting a primary care doctor. He was admitted to our hospital due to worsening symptoms, with a fever of 38.3ºC, redness of the pharynx, left tonsillar hypertrophy, uvular deviation to the right, and left submandibular lymph node enlargement with tenderness. Plain computed tomography (CT) revealed an enlarged left tonsil and lymph node. As it was difficult to differentiate between peritonsillar abscess (PTA) and peritonsillar cellulitis by plain CT, bedside cervical ultrasonography as point-of-care ultrasound (POCUS) was performed. A low echogenic area was observed in the center of the image. The mass with a low signal area on contrast-enhanced CT (CECT) was diagnosed as PTA. The patient was transferred to the otolaryngology department for pus drainage and was discharged 5 days later.

Complications of PTA are rare but potentially fatal, warranting early diagnosis and prompt, appropriate management. CECT is useful for the diagnosis of PTA, but given the risk of complications by contrast agents and radiation, appropriate patient selection is important when performing CECT. POCUS was useful in diagnosing PTA that could not be diagnosed by plain CT.

Background:Bladder inguinal hernias are relatively rare, accounting for 0.5-5% of all inguinal hernias. They often present with nonspecific symptoms, making diagnosis challenging. Without timely treatment, complications such as urinary tract infection, bladder obstruction, or renal dysfunction may occur. Early recognition is crucial, and computed tomography (CT) is particularly effective in identifying bladder involvement, providing detailed anatomical information needed for surgical planning.

Methods:We evaluated three cases of bladder inguinal hernia successfully diagnosed preoperatively using CT and treated with transabdominal preperitoneal repair (TAPP). These cases highlight the diagnostic value of CT and the safety and efficacy of TAPP.

Results:Three patients, aged 65, 80, and 81, presented with groin pain or urinary symptoms. CT confirmed bladder prolapse in all cases. TAPP was performed without major complications. Operative times ranged from 97 to 106 minutes, with minimal blood loss. All patients were discharged within 3 days, and no recurrences were observed during 1-4 years of follow-up.

Conclusions:CT is effective for diagnosing bladder involvement in inguinal hernias and should be considered for all suspected cases. TAPP offers a safe and effective way to manage this condition.

Background:Transient abnormal myelopoiesis (TAM) is a transient abnormal leukemoid reaction that occurs in approximately 5–10% of Down syndrome cases. TAM is typically self-limiting, however, it can be life-threatening because of severe pulmonary or hepatic complications. Approximately 20% of these patients develop acute megakaryoblastic leukemia after remission by the age of 4 years. Here, we report a case of TAM with trisomy 21, tetrasomy 21, and trisomy 19.

Case report:The patient was a 1-day-old male neonate with nuchal translucency measured by fetal ultrasonography at 16 weeks of gestation. He was suspected to have Down syndrome due to his characteristic facial appearance at birth. G-band staining of the peripheral blood when TAM was diagnosed showed trisomy 21, tetrasomy 21, and trisomy 19. The blasts disappeared from the peripheral blood at 4 months of age. G-band staining of the peripheral blood at the time of blast disappearance demonstrated that tetrasomy 21 and trisomy 19 had resolved.

Conclusion:It was inferred from the course of the disease that the cells with tetrasomy 21 and trisomy 19 might be blast cells of TAM.

The Fukushima Field Trip Course (Harvard T.H. Chan School of Public Health, GHP549, Winter Session 2025) offered a unique educational experience for 15 graduate students from various disciplines at Harvard University, to examine ongoing recovery challenges in Fukushima following Japan’s 2011 triple disaster, which included a massive earthquake with powerful aftershocks, a tsunami, and explosive meltdowns at a coastal nuclear power plant. The course included interactions with diverse stakeholders in Fukushima and Tokyo and site visits to foster a comprehensive understanding. Organized into three groups (Health Monitoring, Risk Communication, and Environmental Decontamination), students presented their reports and results at Fukushima Medical University on January 21, 2025. The Health Monitoring group recommended enhancing the Fukushima Health Management Survey through community engagement, mixed-method approaches, and integrated data systems. The Risk Communication group proposed a national 15th anniversary campaign to revise and renew public perceptions of Fukushima in Japan and abroad. The Environmental Decontamination group suggested leveraging international solidarity to create a global network around reconstruction after disasters and promoting “Hope Tourism.” The course is designed to connect Fukushima with the world and prepare future leaders in community rebuilding after major crises.