With its increasing incidence, lung cancer has become one of the leading causes of cancer-related deaths worldwide, posing a great threat to the health and lives of patients. Due to varying economic and cultural backgrounds, there are significant differences in clinical treatment practices and related basic research on lung cancer between Japan and China. These differences are mainly reflected in many aspects, such as cancer prevention, cancer treatment, provision of medical insurance, patient compliance, medical education system, and sources of research funding. By understanding these differences, Japan and China can learn from each other, make progress together, and strengthen further exchanges and cooperation, which will help improve the long-term efficacy of lung cancer treatment and improve patients' clinical outcomes.

Objective Anemia frequently complicates cardiovascular disease (CVD) and is associated with high mortality rates. A bioelectrical impedance analysis (BIA) is a noninvasive method for measuring human body composition. A direct association between serum hemoglobin (Hb) levels and the extracellular water-to-total body water (ECW/TBW) ratio, as measured by a BIA in patients with diabetes, has been reported. However, the predictive value of the ECW/TBW ratio for detecting anemia in patients with CVD has not been fully elucidated.

Methods We conducted a study involving consecutive patients admitted to our cardiology department from January 1, 2021, to December 31, 2022. A BIA was performed once during hospitalization for all patients, whenever possible. The correlation between the Hb level and ECW/TBW ratio was assessed. The predictive accuracy for anemia was evaluated using a receiver operating characteristic (ROC) curve analysis.

Results The ECW/TBW ratio was significantly higher in the anemia group than in the non-anemia group [0.41 (0.40, 0.41) vs. 0.39 (0.38, 0.40), p<0.001]. The ECW/TBW ratio exhibited a significant negative correlation with Hb, with an R value of 0.57 and a p value of <0.01. However, this correlation coefficient decreased to 0.45 among subjects with B-type natriuretic peptide (BNP) levels ≥200 pg/mL. The area under the ROC curve (AUC) for the ECW/TBW ratio for detecting anemia was 0.83. However, its predictive performance decreased in patients with BNP levels exceeding 200 pg/mL, with an AUC of 0.71.

Conclusion The BIA-derived ECW/TBW ratio is a valuable predictor of anemia in patients with CVD, provided BNP levels are not elevated.

Objective We conducted a prospective, randomized controlled, open-label study to investigate the efficacy of a combination of cyclosporine and low-dose prednisolone in patients with idiopathic membranous nephropathy (IMN).

Methods We recruited biopsy-proven IMN patients with nephrotic syndrome who had never been treated with immunosuppressants. The patients were randomized into 2 groups treated after randomization with cyclosporine (3 mg/kg/day) alone or with an oral low-dose corticosteroid (prednisolone 15 mg/day) for 24 months.

Results We recruited 30 patients with IMN and nephrotic-range proteinuria, 28 of whom were included in this study. Fourteen patients were randomized for treatment with only cyclosporine (Group A), and 14 were randomized for treatment with cyclosporine plus low-dose corticosteroids (Group B). Cyclosporine monotherapy induced remission in 12 of the 14 patients in Group A, including partial remission in 7 patients (50.0%) and complete remission in 5 patients (36.7%). In Group B, 12 of 14 patients achieved proteinuria remission, including 11 (78.6%) with complete remission and 1 (7.1%) with partial remission. Although there was no marked difference in the overall remission rate, the complete remission rate was significantly higher in Group B than in Group A (p=0.02). Furthermore, there was a statistically significant difference between the groups in the time from the start of the study to complete remission (10.2±7.8 months in Group A; 9.5±6.1 months in Group B, p=0.03).

Conclusion The combination of cyclosporine and low-dose corticosteroid treatment is an effective and important option in the management of patients with IMN with nephrotic-range proteinuria, either as an initial therapy or as a long-term treatment.

Objective Short-acting β₂ agonists (SABAs) are key drugs for the treatment of asthma and chronic obstructive pulmonary disease (COPD). A high-flow nasal cannula (HFNC) is widely used for respiratory failure. Recently, a consensus statement on inhalation therapy with HFNC has been published. However, information regarding the real-world state of inhalation therapy practices in Japan is lacking.

Methods An anonymous online questionnaire survey endorsed by three Japanese associations (the Japanese Respiratory Society, Japanese Society of Intensive Care Medicine, and Japanese Society of Respiratory Care Medicine) was administered from October to November 2023. Responses were stratified into three questions: Question A, "Do you routinely treat patients with asthma and COPD?" Question B "Do you routinely perform high-flow therapy?"; and Question C "How do you provide inhaled SABAs during high-flow therapy in patients with asthma or COPD?"

Patients This questionnaire was distributed to all members of the three societies.

Results Of the 567 participants who completed the questionnaire, 387 responded to all 3 questions. When a nebulizer was included in high-flow devices, the frequencies of using an ultrasonic nebulizer, jet, vibrating mesh, other, or not performing nebulization were 49.1%, 30.8%, 5.4%, 0.5%, and 14.2%, respectively; when a nebulizer was included in high-flow devices, these frequencies were 24.0%, 11.1%, 16.0%, 0%, and 48.9%, respectively.

Conclusion Various techniques for inhalation therapy are being employed, revealing a discrepancy between current practices in Japan and the recommendations outlined in the consensus statement.

Approximately 20% of patients with Takotsubo syndrome (TTS) develop complications such as left ventricular outflow tract obstruction (LVOTO). The published data suggest that a significant proportion of these patients have predisposing septal hypertrophy or sigmoid septum. However, the pathophysiology regarding this connection has not yet been fully elucidated. We herein present the case of a 75-year-old female patient with TTS complicated by LVOTO, which was successfully managed. During the follow-up, mild basal septal hypertrophy was observed. Subsequent exercise and dobutamine stress echocardiography were performed to reveal the mechanism of LVOTO in TTS.

A 65-year-old woman was admitted to our hospital with heart failure secondary to aortic regurgitation and paroxysmal atrial fibrillation (AF). During surgery for valve-sparing aortic root replacement, a biopsy was obtained from the right atrium because of paroxysmal AF and mild left ventricular hypokinesis. A histopathological examination revealed atrial natriuretic peptide amyloidosis, and the patient was clinically diagnosed with isolated atrial amyloidosis (IAA). Although IAA is rarely diagnosed clinically, it should be considered in patients with AF and heart failure.

A 21-year-old woman with renovascular hypertension secondary to bilateral renal artery stenosis secondary to fibromuscular dysplasia was admitted to our hospital. Successful percutaneous renal angioplasty was performed for the bilateral stenotic renal arteries using intravascular ultrasound guidance to determine the balloon size and pressure wire to confirm the improvement in pressure differences and avoid stent implantation. Her blood pressure improved from 175/113 to 100/70 mmHg without medication.

A 45-year-old woman with Basedow's disease, who was later diagnosed with slowly progressive type 1 diabetes mellitus (SPIDDM), developed iron deficiency anemia. Despite normal vitamin B12 levels, the endoscopic findings of the residual fundic glands and severe atrophy predominantly in the body of the stomach and fundus, along with serological tests, confirmed a diagnosis of autoimmune gastritis (AIG). This case highlights the significance of an early AIG diagnosis in non-elderly patients with type 1 diabetes mellitus (T1DM) and autoimmune thyroid disease (AITD) because of the risk of developing pernicious anemia and gastric neoplasms.

Anamorelin is a selective ghrelin receptor agonist that is used to treat cancer-related cachexia. Ghrelin stimulates growth hormone (GH) secretion. However, the association between anamorelin and hyperglycemia remains unclear. We herein report a case of anamorelin induced hyperglycemia in a patient with type 1 diabetes mellitus. A 67-year-old woman with a history of type 1 diabetes was hospitalized because of a pleural effusion. After hospitalization, the patient was administered anamorelin. Four days after starting anamorelin treatment, her blood glucose and GH levels increased. These results suggest that anamorelin stimulates GH secretion and induces hyperglycemia. Our findings suggest the need to take special care of hyperglycemia when anamorelin is prescribed to patients with type 1 diabetes.

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome that results from tumors that secrete fibroblast growth factor 23 (FGF23). This leads to chronic hypophosphatemia. Burosumab, an anti-FGF23 antibody, is an effective treatment when surgery is not possible; however, it complicates FGF23 measurements and postoperative monitoring. We describe the first case report of TIO in which the responsible tumors were discovered during burosumab therapy and successfully resected. Despite tumor removal, the serum FGF23 levels remained elevated. In the postoperative monitoring of patients treated with burosumab, physicians should focus on the serum and urine levels of phosphate rather than FGF23.

We report the case of a 62-year-old man who presented with bilateral adrenal enlargement and systemic lymphadenopathy. Imaging and clinical findings led to the diagnosis of bilateral adrenal hemorrhage. Bone marrow aspiration and lymph node biopsy confirmed TAFRO syndrome, which met the established diagnostic criteria. Although adrenal hemorrhage in TAFRO syndrome is exceedingly rare, this case is unique, as it represents the first reported instance of massive bilateral adrenal hemorrhage with confirmed progression. This case underscores the need for awareness regarding this potential complication of TAFRO syndrome.

Familial hypercholesterolemia (FH), a genetic disorder characterized by the early onset of coronary artery disease, is found in one of 300 people. In the 2022 Japanese FH guidelines, a cut-off value for Achilles tendon thickness measured using ultrasound has been added, enabling the diagnosis of FH during a Workers' Compensation Insurance Secondary Health Examination. In individuals for whom the possibility of FH could not be ruled out based on low-density lipoprotein cholesterol levels, we measured the Achilles tendon thickness by ultrasound and found four cases of FH. The detection of FH in asymptomatic workers is crucial for long-term cardiovascular risk management.

Collagenofibrotic glomerulopathy is a rare, incurable kidney disease characterized by severe proteinuria and extensive type III collagen deposition in mesangial and subendothelial spaces. To date, no effective treatment has yet been reported. A 45-year-old Japanese woman was treated daily with 10 mg dapagliflozin. Her eGFR slope improved from -3.61 mL/min/1.73 m²/year over 4 years before treatment to 0.11 mL/min/1.73 m²/year after 3 years of treatment. Additionally, her nephrotic-range proteinuria, initially exceeding 4 g/gCr, decreased to <2 g/gCr after dapagliflozin treatment. To our knowledge, this is the first documented case of effective treatment for collagenofibrotic glomerulopathy.

Kabuki syndrome is a rare genetic disorder that causes multiple congenital anomalies, including characteristic facial features reminiscent of Kabuki syndrome. It is often associated with congenital anomalies of the kidneys and urinary tract as well as immune abnormalities. While various autoimmune diseases have been reported in patients with this syndrome, only one case of membranoproliferative glomerulonephritis has been documented. We herein report a case of Kabuki syndrome in which immunoglobulin A nephropathy developed in a renal allograft, which subsequently improved with the administration of pulse steroids and an angiotensin II receptor blocker.

Recently, several Japanese patients have developed interstitial nephritis or acute tubular injury/necrosis, both accompanied by Fanconi syndrome, after consuming a specific red yeast rice supplement. In most cases, the renal function did not fully recover even after discontinuation of supplements and glucocorticoid treatment. A 52-year-old woman developed interstitial nephritis and Fanconi syndrome after receiving supplements. A renal biopsy revealed mild lymphocytic infiltration. Her renal function recovered after discontinuing the supplement without glucocorticoids. The supplement was contaminated with puberulic acid, a known cause of tubular necrosis; however, the cause of interstitial nephritis remains uncertain. Biopsy findings guided the decision to avoid glucocorticoids.

Evans syndrome (ES) is characterized by the development of autoimmune hemolytic anemia and immune thrombocytopenic purpura and is often linked to autoimmune diseases, such as systemic lupus erythematosus (SLE). Standard treatment includes prednisolone and intravenous immunoglobulin; however, relapse commonly occurs when prednisolone is tapered or stopped. Rituximab is increasingly used for refractory ES with SLE, although its efficacy in new-onset cases remains unclear. We herein report a 67-year-old woman with new-onset ES and SLE with lupus nephritis class IV-G whose condition improved with rituximab after prednisolone, hydroxychloroquine, and mycophenolate mofetil. The patient remained relapse-free for one year, suggesting that rituximab is a potentially viable first-line therapy.

Although there have been several reports of drug-induced pneumonitis caused by herbal medicines in recent years, herbal medicine-induced diffuse alveolar hemorrhage (DAH) is rare. We herein report two cases of DAH associated with herbal medicines. Patient 1 developed dyspnea and hemoptysis after receiving jidabokuippo. Patient 2 developed a fever and dyspnea after taking otsuji-to. Both patients exhibited severe respiratory failure, and bronchoalveolar lavage revealed bloody fluid that confirmed the diagnosis of DAH. In both patients, discontinuation of herbal medicines and corticosteroid therapy resulted in significant improvement. These cases highlight the potential risks of DAH associated with herbal medicines.

Primary cutaneous CD8-positive aggressive epidermotropic cytotoxic T-cell lymphoma (PCAE-CTL) is a rare subtype of cutaneous T-cell lymphoma with a poor prognosis. We herein report a case of PCAE-CTL accompanied by anti-Ma2 antibody-positive paraneoplastic encephalitis. A 33-year-old woman with erythema and disturbance of consciousness was diagnosed with PCAE-CTL by a skin biopsy. Head magnetic resonance imaging revealed bilateral medial temporal lobe hyperintensity, and anti-Ma2 antibody in the cerebrospinal fluid was positive. She was diagnosed with concurrent anti-Ma2 antibody-positive paraneoplastic encephalitis. In cases of lymphoma with brain lesions, invasion of the central nervous system by lymphoma and paraneoplastic encephalitis should be considered.

This is the first report of therapy-related mixed-phenotype acute leukemia (MPAL) characterized by B-cell, T-cell, and myeloid lineage phenotypes. A 68-year-old man, who was in complete remission after chemoradiotherapy for recurrent esophageal cancer, developed bacterial pneumonia with increasing blasts in the peripheral blood, and a subsequent bone marrow biopsy revealed 85.2% blasts. A flow cytometric analysis revealed cytMPO+, CD19+, cytCD22+, and cytCD3+ markers. The patient was diagnosed with therapy-related MPAL (B/T/myeloid lineage). After the initiation of venetoclax and azacitidine, the patient achieved complete remission, and cord blood transplantation was performed. This case provides novel insights into the therapeutic options for therapy-related trilineage MPAL treatment.

An 80-year-old woman presented with the sudden onset of vertigo and vomiting and was diagnosed with acute cerebellar infarction. Twelve days after the onset, she experienced positional vomiting, predominantly in the lying-down position, triggered by postural changes with immediate or delayed onset. Over 1 month, 23 episodes of vomiting occurred. Brain computed tomography revealed edema in the infarcted area, fourth ventricular outlet compression, and lateral ventricular enlargement. These findings suggest that fluctuations in intracranial pressure are associated with intermittent obstructive hydrocephalus exacerbated by the patient's posture. This case highlights the importance of considering postural triggers in patients with recurrent vomiting associated with cerebellar infarctions.

Anti-synthetase syndrome (ASyS) is a subset of idiopathic inflammatory myopathies characterized by a triad of myositis, interstitial lung disease, and arthritis. Patients with ASyS are generally treated with glucocorticoids, immunosuppressants, or both. We encountered a 53-year-old woman who developed anti-OJ autoantibodies-positive anti-synthetase syndrome following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and CoV-2 messenger RNA (mRNA) vaccination. Her dyspnea and rash resolved within 4 weeks of the initial examination, achieving spontaneous remission without treatment 52 weeks after the diagnosis. This case suggests a potential association between SARS-CoV-2 infection, mRNA vaccination, and the transient development of anti-OJ antibodies-positive ASyS.

Variable-vessel vasculitis is a rare presentation of systemic vasculitis. We herein report a Japanese woman with large- and small-vessel vasculitis accompanied by basal cell carcinoma. The clinical course of our patient suggested paraneoplastic variable-vessel vasculitis. Our case suggests that there are two aspects that need to be considered. First, clinicians should consider cancer-related complications when treating variable-vessel vasculitis. Second, the evaluation of variable-vessels is needed when treating paraneoplastic vasculitis.

A 48-year-old man with Fisher syndrome was admitted to our hospital for amino acid-containing peripheral parenteral nutrition. On day 19 of his hospital stay, he became febrile and Bacillus cereus was isolated from blood cultures. Vancomycin was administered, and the entire infusion set was replaced. The cultures were prepared from the infusion set. B. cereus was detected in several connectors and hubs, although catheter tip culture was negative. Echocardiography revealed cephalic venous thrombophlebitis. In cases with no improvement despite effective antibiotic use, clinicians should consider the possibility that the infusion set might have become contaminated.

Aortic angiosarcoma is an extremely rare malignancy that is often diagnosed postoperatively or during autopsy. We present a case that was diagnosed through random skin biopsy. A 75-year-old woman with Alzheimer's disease and chronic kidney disease presented with persistent fever and elevated C-reactive protein levels. Contrast-enhanced computed tomography showed irregular thickening of the aortic wall, which was initially suspected to be atherosclerosis. A random skin biopsy revealed tumor cells that were positive for vascular endothelial markers. The patient died 69 days later, with an autopsy confirming aortic angiosarcoma. Random skin biopsies may aid in the diagnosis of aortic angiosarcoma by detecting metastatic lesions when invasive procedures are not feasible.