Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Advance online publication
Displaying 1-50 of 392 articles from this issue
  • Nao Hanaki, Ryoto Sakaniwa, Takuhiro Moromizato, Jun Miyata, Keiko Ish ...
    Article ID: 2100-23
    Published: 2024
    Advance online publication: March 18, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Background Seasonal influenza affects healthcare demand. However, the efficacy of anti-influenza drugs, particularly among young patients at a low risk of complications, has rarely been evaluated. Therefore, we evaluated the efficacy of anti-influenza drugs against seasonal influenza in healthy young and middle-aged adults.

    Methods A systematic review and network meta-analysis were conducted. The Cochrane Central Register of Controlled Trials and Medical Literature Analysis and Retrieval System Online were searched for original articles reporting double-blind, randomized controlled trials published up to the end of July 2023. Clinical trials that tested the efficacy of anti-influenza drugs in young and middle-aged patients with seasonal influenza were also included. The primary outcome was time to fever alleviation. The efficacy and adverse effects of these treatments were estimated using a Bayesian hierarchical random-effects model and a Markov chain Monte Carlo simulation.

    Results In total, 24 articles with 34 treatments and 8,949 individuals were included. Oseltamivir (300 mg/day for 5 days) showed the largest reduction in time to fever alleviation by -19.1 (95% confidence interval [CI]: -29.4, -10.7) h compared with a placebo. Baloxavir marboxil (40 mg/day) reduced the time to symptom alleviation by -28.2 (95% CI: -42.7, -13.7) h, and peramivir (300 mg/day) administered by intravenous infusion for 1 day reduced the time to resumption of usual activities by -43.5 (95% CI: -72.8, -14.2) h.

    Conclusion Several pharmaceutical treatments were able to reduce the recovery time for fever and symptom alleviation and resumption of usual activities in young and middle-aged adults with seasonal influenza without increasing the risk of complications.

    Download PDF (405K)
  • Fumiya Kaneko, Hiroshi Suzuka, Tomoaki Yoshino, Ryosuke Hinosugi
    Article ID: 2487-23
    Published: 2024
    Advance online publication: March 18, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective Elotuzumab plus lenalidomide and dexamethasone (ELd) was approved in Japan in 2016 for the treatment of relapsed/refractory multiple myeloma (RRMM). This post-marketing surveillance study evaluated the safety and effectiveness of ELd in RRMM patients during routine clinical practice in Japan.

    Methods Elotuzumab safety was assessed by evaluating adverse drug reactions (ADRs), and effectiveness was assessed primarily by the best overall response.

    Patients The study enrolled patients with RRMM who received ELd therapy between November 18, 2016, and June 18, 2017. The safety and effectiveness analysis sets included 831 and 755 patients, respectively.

    Results In the safety analysis set, patients received a median (range) of 12 (1-40) elotuzumab administrations over 108 (1-728) days of treatment. The relative dose intensity of elotuzumab was ≥90% in 74.1% of patients. ADRs and serious ADRs were reported in 41.2% and 15.2% of the patients, respectively. The most common ADR was infection (12.0%), followed by lymphocytopenia (10.1%), infusion reactions (7.5%), secondary malignancies (e.g. gastric cancer and pancreatic carcinoma), cataracts, and interstitial lung disease (0.2% each). While most patients with ADRs recovered, 71 discontinued treatment, and 14 deaths were reported. The presence of comorbidities, particularly cardiovascular disorders, significantly affected the safety. The overall response rate was 41.1%.

    Conclusion This all-case post-marketing surveillance study showed that ELd had an acceptable tolerability profile and promising clinical activity in Japanese patients with RRMM.

    Download PDF (428K)
  • Haruka Imai, Jun Suzuki, Shota Takahashi, Daishi Shimada, Makiko Yoshi ...
    Article ID: 3266-23
    Published: 2024
    Advance online publication: March 18, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective To survey the epidemiology of respiratory pathogens during the COVID-19 pandemic using multiplex polymerase chain reaction (PCR).

    Methods Specimens were assayed using multiplex nested PCR.

    Patients and Materials Specimens were obtained from outpatients who presented with symptoms of upper respiratory tract infection and asymptomatic outpatients who had contact with patients with SARS-CoV-2 infection at Tohoku Medical and Pharmaceutical University Hospital in Sendai, Japan, from November 1, 2020, to May 31, 2023. The analysis included multiple specimens collected from the same patients at different time-points. Data were collected from the electronic records after testing.

    Results This study included 8,335 patients (4,311 men) with a median age of 59 years old, and 11,741 total specimens were collected. At least 1 positive SARS-CoV-2 result was obtained for 1,710 (14.6%) specimens. Furthermore, 15 pathogens were identified in the positive specimens, and rhinovirus/enterovirus was detected more frequently than other viruses. We identified a larger number of SARS-CoV-2-positive specimens in patients ≥10 years old. In contrast, in patients 0-9 years old, we identified a larger number of specimens positive for rhinovirus/enterovirus than for other viruses.

    Conclusions In this study, we examined the epidemiology of circulating respiratory pathogens during the COVID-19 pandemic era.

    Download PDF (329K)
  • Monami Tarisawa, Masaaki Matsushima, Akihiko Kudo, Ken Sakushima, Yasu ...
    Article ID: 3275-23
    Published: 2024
    Advance online publication: March 18, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective In 2022, Wenning et al. proposed the Movement Disorder Society Criteria (MDS Criteria) for the Diagnosis of Multiple System Atrophy (MSA). These criteria were expected to provide useful alternatives to the second consensus statement. We examined trends in these diagnostic criteria.

    Methods We used patient data registered with the Hokkaido Rare Disease Consortium for Multiple System Atrophy, which has been recruiting patients with MSA through medical facilities in Hokkaido since November 2014. Patients were evaluated according to the MDS criteria based on neurological examinations and imaging findings at three separate times: the first evaluation, the time of enrollment (diagnosis), and the most recent evaluation (final evaluation).

    Results The MDS criteria were examined in 68 of 244 patients enrolled between November 2014 and July 2022. At the initial evaluation, the classifications were as follows: clinically established (n=27; 39.7%); clinically probable (n=13; 19.1%); possible prodromal (n=12; 17.6%); and negative (did not meet criteria (n=16; 23.5%). At the time of diagnosis, the classifications were as follows: clinically established (n=45; 66.2%); clinically probable (n=12; 17.6%); possible prodromal (n=4; 5.9%); and negative (n=7; 10.3%). At the final evaluation, the classifications were as follows: clinically established (n=52; 76.5%); clinically probable (n=9; 13.2%); possible prodromal (n=2; 2.9%); and negative (n=5; 7.4%).

    Conclusions We were able to clarify the changes in the criteria values and transition of patients due to the clarification of imaging and supportive findings in the MDS criteria.

    Download PDF (570K)
  • Haruka Maruyama, Shadia Constantine
    Article ID: 3289-23
    Published: 2024
    Advance online publication: March 18, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Download PDF (175K)
  • Norihiko Terada, Taku Sawafuji
    Article ID: 3383-23
    Published: 2024
    Advance online publication: March 18, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Download PDF (478K)
  • Shogo Komaki, Akatsuki Kubota, Kazuto Katsuse, Asuka Kitamura, Meiko M ...
    Article ID: 3435-23
    Published: 2024
    Advance online publication: March 18, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Calpainopathy is primarily an autosomal recessive inherited myopathy; however, dominantly inherited cases with a pathogenic variant of c.1333G>A have been reported. A 13-year-old Japanese girl presented with toe walking and elevated serum creatine kinase levels. Genetic panel testing revealed compound heterozygosity for c.1333G>A and a novel variant of c.1331C>T in CAPN3, leading to a diagnosis of calpainopathy. A genetic analysis of her parents revealed the possibility that c.1333G>A was de novo. In this patient, the onset age was earlier than that of the reported autosomal dominant cases, suggesting the influence of the novel variant in the contralateral allele.

    Download PDF (922K)
  • Yuki Kondo, Masaru Ishida, Takenori Ishisone, Masanobu Niiyama, Takuya ...
    Article ID: 3476-24
    Published: 2024
    Advance online publication: March 18, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective We aimed to reveal detailed on-treatment lipid profiles, lipid-related surrogate markers, and factors predicting failure to achieve the guideline-recommended lipid management goal following guideline-recommended statin treatment in Japanese patients with acute myocardial infarction (AMI).

    Methods and Results Sixty AMI patients who underwent coronary intervention and had received rosuvastatin 10 mg/day since the start of their hospitalization were assessed for on-treatment lipid-related profiles, including high-sensitivity C-reactive protein, small dense low-density lipoprotein cholesterol (sd LDL-C), and lipoprotein (a), at the 12-week follow-up. Patients who failed to achieve the guideline-recommended lipid management at 12 weeks were defined as the "unachieved group." Univariate and multivariate logistic regression analyses were performed to evaluate the predictors of inclusion in the unachieved group after high-dose statin treatment. Despite the use of high-dose rosuvastatin, 61.7% of the enrolled AMI patients were included in the unachieved group. In addition, the unachieved group had higher sd LDL-C and lipoprotein (a) levels than the achieved group. Logistic regression analyses demonstrated that low baseline high-density lipoprotein cholesterol (HDL-C) levels and the absence of diabetes were predictors of inclusion in the unachieved group.

    Conclusion More than half of the Japanese AMI patients treated with rosuvastatin 10 mg/day did not achieve the guideline-recommended goal of lipid management and still had lipid-related residual risk at 12 weeks. Particular attention should be paid to patients with low baseline HDL-C levels and those without diabetes with regard to their on-treatment lipid profiles.

    Download PDF (684K)
  • Fumihiro Kashizaki, Taiki Kano, Yohei Kameda, Hiroyuki Osawa
    Article ID: 3500-24
    Published: 2024
    Advance online publication: March 18, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Download PDF (339K)
  • Shogo Shirota, Hiroaki Nishioka
    Article ID: 3612-24
    Published: 2024
    Advance online publication: March 18, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Download PDF (94K)
  • Kazuya Matsumoto, Suguru Kakite, Takaaki Sugihara, Eijiro Yamashita, K ...
    Article ID: 2822-23
    Published: 2024
    Advance online publication: March 11, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective Abdominal ultrasonography (AUS) is used to screen for abdominal diseases owing to its low cost, safety, and accessibility. However, the detection rate of pancreatic disease using AUS is unsatisfactory. We evaluated the visualization area of the pancreas and the efficacy of manipulation techniques for AUS with fusion imaging.

    Methods Magnetic resonance imaging (MRI) volume data were obtained from 20 healthy volunteers in supine and right lateral positions. The MRI volume data were transferred to an ultrasound machine equipped with a fusion imaging software program. We evaluated the visualization area of the pancreas before and after postural changes using AUS with fusion imaging and assessed the liquid-filled stomach method using 500 ml of de-aerated water in 10 randomly selected volunteers.

    Patients This study included 20 healthy volunteers (19 men and 1 woman) with a mean age of 33.0 (21-37.5) years old.

    Results Fusion imaging revealed that the visualization area of the entire pancreas using AUS was 55%, which significantly improved to 75% with a postural change and 90% when using the liquid-filled stomach method (p=0.043). Gastrointestinal gas is the main obstacle for visualization of the pancreas.

    Conclusion Fusion imaging objectively demonstrated that manipulation techniques can improve pancreatic visualization.

    Download PDF (1543K)
  • Youichi Yanagawa, Hiroki Nagasawa, Noriko Torizawa, Ikuto Takeuchi
    Article ID: 3002-23
    Published: 2024
    Advance online publication: March 11, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 47-year-old woman with a history of substance abuse, depression, and insomnia experienced a collapse. Upon arrival at the hospital, the patient displayed low systolic blood pressure, confusion, dehydration, and renal failure. Urine tests confirmed an amphetamine and opioid overdose. Her condition fluctuated with reduced consciousness, myoclonic movements, fever, and suspected psychogenic seizures. Brain magnetic resonance imaging revealed abnormalities in the splenium of the corpus callosum, which later resolved. The patient's condition gradually improved without any specific treatment. This unique case represents the first report of mild encephalopathy/encephalitis with reversible splenial lesions associated with amphetamine and opioid use.

    Download PDF (1321K)
  • Shingo Yokoyama, Kota Kakeshita, Teruhiko Imamura, Tomoko Shima, Hayat ...
    Article ID: 3113-23
    Published: 2024
    Advance online publication: March 11, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Pegylated liposomal doxorubicin (PLD) has emerged as a recent innovation within the realm of antineoplastic agents, distinguished by its incorporation of doxorubicin within the liposomal bilayer. Given the low risk of cardiotoxicity, the clinical use of PLD has been expanding. We encountered a patient who underwent extended PLD therapy for recurrent malignancy and subsequently developed PLD-associated thrombotic microangiopathy, which was diagnosed by a detailed pathophysiological assessment. This case underscores the importance of considering thrombotic microangiopathy as a potential differential diagnosis in patients presenting with unexplained hypertension and renal impairment during prolonged PLD monotherapy.

    Download PDF (1495K)
  • Mayumi Sakata, Katsuichi Miyamoto, Jinsoo Koh, Yasuhiro Nagashima, Tom ...
    Article ID: 3171-23
    Published: 2024
    Advance online publication: March 11, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective Mucuna pruriens (MP) is a legume whose seeds contain levodopa (LD), which has potential therapeutic effects against Parkinson's disease (PD). However, further research is needed to thoroughly evaluate its efficacy and safety for treating this condition. In this study, we analyzed the pharmacokinetics of MP grown in Japan and investigated its mechanism of action in PD.

    Methods MP seeds ground after roasting (containing 4.02% LD per MP powder) were used as the reagent and compared with an equivalent LD/carbidopa (CD) preparation. This clinical trial was conducted using a crossover design among PD patients attending our institution. Each patient received a single dose of 100/10 mg LD/CD tablets and 11 g of MP reagent.

    Results Among the seven patients with PD, MP prolonged the ON time 2-fold compared to LD/CD. The LD concentrations after MP intake were higher than those after LD/CD intake, whereas dyskinesia did not increase. An analysis of the LD metabolites showed that the 3-O-methyl-dopa/LD metabolic ratio was significantly lower after MP ingestion than after LD/CD ingestion, indicating that MP has a catechol-O-methyl transferase inhibitory effect.

    Conclusions This is the first report of a pharmacokinetic analysis conducted on actual patients with PD showing that MP significantly prolongs the ON time. The advantages of MP as a treatment for PD have been confirmed: it is inexpensive, as effective as LD, works faster and longer than LD, and does not increase dyskinesia.

    Download PDF (486K)
  • Keiko Suzuki, Satoshi Suzuki, Hiroki Yamaguchi, Yasutaka Kakinoki
    Article ID: 3225-23
    Published: 2024
    Advance online publication: March 11, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Yezo virus is a novel virus transmitted by tick bites that causes fever with thrombocytopenia. To date, two reports have been published on patients with Yezo virus infection. However, the clinical characteristics of Yezo virus infection remain unclear. A patient who presented with fever, fatigue, headaches, and muscle pain and was admitted to our hospital. The patient had thrombocytopenia, leukopenia, and elevated liver enzyme and serum ferritin levels. The patient was diagnosed with Yezo virus and Borrelia miyamotoi coinfection based on the detection of Yezo virus in a blood sample by PCR and the detection of elevated serum antibody titers to Yezo virus and Borrelia miyamotoi.

    Download PDF (141K)
  • Takayuki Katayama, Kae Takahashi, Osamu Yahara, Issei Matuura, Yasuyuk ...
    Article ID: 3243-23
    Published: 2024
    Advance online publication: March 11, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective We aimed to investigate the relationship between tortuosity of the extracranial internal carotid artery (ICA) or vertebral artery (VA) and vascular risk factors among residents of Asahikawa, northeast Japan.

    Methods We retrospectively surveyed participants of "brain dock" medical brain checkups, which involved magnetic resonance imaging and angiography. We measured the tortuosity of the ICA and VA, and evaluated vascular risk factors based on medical interviews, questionnaires, and medical records.

    Results A total of 218 participants were enrolled in the study. ICA tortuosity (right and left) was significantly correlated with age [odds ratio (OR): 2.452, 95% confidence interval (CI): 1.695-3.548, p<0.001]. A more pronounced correlation was observed in females than in males (OR: 1.678, 95% CI: 1.004-2.807, p=0.048). VA tortuosity (right and left) was significantly correlated with age (OR: 1.786, 95% CI: 1.250-2.550, p=0.001) and smoking history (OR: 2.140, 95% CI: 1.235-3.707, p=0.007), and was more pronounced in females than in males (OR: 1.864, 95% CI: 1.107-3.137, p=0.019).

    Conclusion ICA tortuosity was correlated with age, while VA tortuosity was correlated with age and smoking history. ICA and VA tortuosity were more pronounced in females than in males.

    Download PDF (219K)
  • Nobuaki Ozaki, Yuri Hayashi, Atsushi Kiyota
    Article ID: 3284-23
    Published: 2024
    Advance online publication: March 11, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Hereditary coproporphyria (HCP) is caused by a partial deficiency of coproporphyrinogen oxidase during heme biosynthesis. Givosiran is approved for the treatment of acute hepatic porphyria. We herein report the case of a 47-year-old woman with HCP. Monthly givosiran administration improved her subjective symptoms and reduced her δ-aminolevulinic acid (ALA) and porphobilinogen (PBG) levels to the normal range. However, givosiran was discontinued after six months due to a decreased renal function. The patient's ALA and PBG levels remained within the normal ranges, and her HCP-related symptoms resolved more than 2 years after the discontinuation of givosiran.

    Download PDF (141K)
  • Hideaki Yamakawa, Hiroki Ohta, Hidekazu Matsushima, Akiko Adachi
    Article ID: 3292-23
    Published: 2024
    Advance online publication: March 11, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Download PDF (786K)
  • Takuya Terakawa, Yuya Hayasaka, Yuka Umeki, Mako Ikeda, Yoshiki Matsuo ...
    Article ID: 3337-23
    Published: 2024
    Advance online publication: March 11, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Vascular occlusive events are notable adverse effects of tyrosine kinase inhibitors (TKIs), which are promising treatments for chronic myeloid leukemia (CML). We herein report the case of a patient with CML who developed cerebrovascular occlusion of the circle of Willis during TKI treatment. Our patient did not meet the diagnostic criteria for moyamoya disease due to the insignificant development of moyamoya vessels. The lack of moyamoya vessel development may be explained by the suppression of tyrosine kinases that are responsible for angiogenesis. Cerebrovascular occlusion of the circle of Willis, without significant development of moyamoya vessels, may be an important phenotype of TKI-associated vasculopathy.

    Download PDF (1181K)
  • Sotaro Ozaka, Ryusuke Soma, Haruhiko Takahashi, Yuta Shimomori, Masahi ...
    Article ID: 3388-23
    Published: 2024
    Advance online publication: March 11, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 35-year-old man with fever and diarrhea visited our hospital because of white string-like fecal excretion. Based on a morphological examination of the excreted object, a Diphyllobothrium infection was suspected. Additionally, Gram staining of a fecal sample revealed Campylobacter infection. After the intraduodenal administration of meglumine/diatrizoate sodium, the tapeworm was excreted. A polymerase chain reaction-based DNA sequence analysis demonstrated that the tapeworm excreted in this case was Diphyllobothrium nihonkaiensis. This report presents a rare case of coinfection with Diphyllobothrium nihonkaiensis and Campylobacter jejuni. Therefore, it is important to consider the coexistence of other intestinal infections when diagnosing parasitic infections in patients with fever.

    Download PDF (800K)
  • Shogo Funakoshi, Mitsuru Nishiyama, Masahiro Komori, Masamitsu Hyodo, ...
    Article ID: 3390-23
    Published: 2024
    Advance online publication: March 11, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 59-year-old man was admitted to our hospital with hyponatremia. An endocrine examination indicated panhypopituitarism, and magnetic resonance imaging revealed a mass-like lesion in the pituitary gland. Sinus endoscopy revealed a fungal mass in the sphenoid sinus, and the patient was diagnosed with hypopituitarism due to aspergillosis of the central nervous system (CNS). The patient's hyponatremia resolved with hydrocortisone replacement. Although the right internal carotid artery was eventually occluded, antifungal medications were administered for the aspergillosis, and the patient's general condition improved. The patient's CNS lesions have remained under control since discharge. This is the first case to suggest that ACTH secretion may be relatively preserved in Aspergillus-induced hypopituitarism.

    Download PDF (777K)
  • Naoko Ogawa, Hidekazu Kondo, Yumi Ishii, Kazuki Mitarai, Kumiko Akiyos ...
    Article ID: 1701-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    We report the case of a family afflicted with cardiac laminopathy who showed atrial fibrillation (AF) and complete atrioventricular block across three generations. Implantable cardioverter defibrillators (ICDs) implantation, or cardiac resynchronization therapy (CRT) were delivered to the three patients (proband; 61 years old, proband's mother: 84 years old, and proband's daughter; 38 years old) to prevent sudden cardiac death or suppress heart failure progression. A novel frameshift mutation (LMNA Exon 9: c.1550dupA;p. N518Efs*34) was found in all three cases through genetic testing, and this mutation may potentially result in the relatively late appearance of a phenotype of left ventricular systolic dysfunction.

    Download PDF (1033K)
  • Shotaro Okanoue, Hiroyuki Sakae, Kenji Yokota, Takehiro Tanaka, Yuka O ...
    Article ID: 1851-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective Although the characteristics of Helicobacter pylori infection have been extensively reported, there is a lack of consensus regarding its characteristics in young adults. The present study examined the endoscopic and histological characteristics of young adults who underwent eradication therapy for H. pylori infection.

    Methods We examined the H. pylori infection status of first-year students at Okayama University School of Medicine and Dentistry between 2014 and 2020. A total of 152 (6.8%) students who were positive for H. pylori antibody or pepsinogen tests were enrolled in the study. Among them, 107 students underwent endoscopy, and their biopsy samples were investigated. Seventy-five students were diagnosed with H. pylori infections.

    Results Of 75 H. pylori-positive patients, 57 (76.0%) had endoscopic atrophic gastritis, and 42 (56.0%) had histological atrophy. A few patients had severe atrophic gastritis. All 65 patients who underwent an eradication assessment were successfully treated. After successful eradication, 26 patients underwent endoscopic follow-up. The mean follow-up period was 32.9 months. A histological evaluation revealed that gastric antrum atrophy had subsided in 11 of 14 patients, and atrophy in the lesser curvature of the gastric body had subsided in 7 of 8 patients.

    Conclusion More than half of young adults with H. pylori infection had atrophic gastritis. We found mild atrophy in young adults, which subsided shortly after eradication treatment. This study provides a foundation for future studies to evaluate the validity of eradication therapy in preventing gastric cancer in patients.

    Download PDF (831K)
  • Taku Suzuki, Katsuhiko Hayakawa, Takuji Iwamoto
    Article ID: 2748-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Download PDF (238K)
  • Tsutomu Yasuda, Jun Shimizu, Toji Miyagawa, Yuri Tsutsumi, Takeshi Iwa ...
    Article ID: 2894-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 77-year-old female with a subacute progression of ataxia and serum anti-Yo antibodies was suspected to have paraneoplastic cerebellar degeneration (PCD). An examination of an underlying cancer showed no abnormality in the gynecological organs, but the findings did show a mass in the Douglas fossa. The mass was resected and diagnosed as stage IIB peritoneal serous papillary carcinoma (PSPC), a rare gynecologic cancer that is difficult to diagnose in the early stages. PCD was treated with intravenous immunoglobulin (IVIG). For an early diagnosis and treatment, PSPC should be included in the list of malignancies that cause PCD with anti-Yo antibodies.

    Download PDF (617K)
  • Junya Aoki, Kazumi Kimura, on behalf of the ADS investigator
    Article ID: 2926-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective Although the body mass index (BMI) is considered a meaningful parameter for evaluating obesity, the association between the BMI and acute non-cardioembolic stroke remains unclear. We investigated how the BMI was related to patients' background, type of infarction, and infarction location in patients with non-cardioembolic stroke using an acute dual study (ADS) cohort.

    Methods The ADS trial was conducted between May 2011 and June 2017 in Japan. The BMI classifications were those proposed by the World Health Organization classification: underweight, <18.5 kg/m2; normal weight, 18.5-24.9 kg/m2; overweight, 25-29.9 kg/m2; and obese, ≥30 kg/m2.

    Results Data from 1136 patients were analyzed. The median BMI was 23.6 kg/m2 (interquartile range: 21.6-25.8 kg/m2), with a BMI ≥30 kg/m2 in 63 patients (6%), 25-29.9 kg/m2 in 321 (28%), 18.5-24.9 kg/m2 in 692 (61%), and <18.5 kg/m2 in 60 (5%). The group with a BMI ≥30 kg/m2 was the youngest, and the group with a BMI <18.5 kg/m2 was the oldest (p<0.001). The proportion of patients with a history of hypertension (p<0.001), diabetes (p<0.001), dyslipidemia (p<0.001), and statin therapy (p=0.005) increased with increasing BMI. Pontine infarcts were frequent in the following order: obese, overweight, normal weight, and underweight (24%, 18%, 14%, and 13%, respectively; p=0.034). In contrast, cortical infarct were frequent in the order of underweight, normal weight, overweight, and obese at 20%, 19%, 14%, and 3%, respectively (p=0.007).

    Conclusion Acute stroke patients with a high BMI have more atherosclerosis-related factors in their backgrounds than those with lower BMIs. In addition, the BMI may be a determinant of infarct location in patients with acute stroke.

    Download PDF (185K)
  • Yuya Yoshida, Sakura Toriyabe, Hiroo Imai, Keiju Sasaki, Yuki Kasahara ...
    Article ID: 2931-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Recently, immune checkpoint inhibitors (ICIs) have been used to treat several cancer types. ICIs have been reported to cause a wide variety of immune-related adverse events, including endocrine, neurologic, gastrointestinal, and cutaneous disorders. Thrombotic thrombocytopenic purpura (TTP) is an autoimmune hematologic disorder characterized by the presence of autoantibodies against a disintegrin and metalloprotease with thrombospondin-1, member 13. Several previous cases of TTP were thought to have been caused by ICI treatment. We herein report a rare case of TTP that developed after long-term treatment with an ICI (nivolumab) for gastric tube cancer.

    Download PDF (706K)
  • Tetsuya Akaishi, Kunio Tarasawa, Kiyohide Fushimi, Chiharu Ota, Sumire ...
    Article ID: 3022-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective

    The changes in the prevalence of acute meningitis during the coronavirus disease 2019 (COVID-19) pandemic remain unclear. This study aimed to compare the prevalence of acute meningitis before and during the COVID-19 pandemic in Japan.

    Methods

    We retrospectively reviewed the Japanese nationwide administrative medical payment system database, Diagnosis Procedure Combination (DPC), from 2016 to 2022. A total of 547 hospitals consistently and seamlessly offered DPC data during this period. The study period was divided into the following three periods: April 2016 to March 2018 (fiscal years 2016-2017), April 2018-March 2020 (2018-2019), and April 2020-March 2022 (2020-2021).

    Results Among the 28,161,806 patients hospitalized during the study period, 28,399 were hospitalized for acute meningitis: 16,678 for viral/aseptic type, 6,189 for bacterial type, 655 for fungal type, 429 for tuberculous, 2,310 for carcinomatous type, and 2,138 for other or unknown types of meningitis. A significant decrease during the pandemic was confirmed in viral (n=7,032, n=5,775, and n=3,871 in each period; p<0.0001) and bacterial meningitis (n=2,291, n=2,239, and n=1,659; p<0.0001) cases. Meanwhile, no decrease was observed in fungal meningitis (n=212, n=246, and n=197; p=0.056) or carcinomatous meningitis (n=781, n=795, and n=734; p=0.27). The decrease in the number of tuberculous meningitis cases was equivocal (n=166, n=146, and n=117; p=0.014). The decrease during the pandemic was more remarkable in younger populations aged <50 years than in older populations, both for viral and bacterial meningitis.

    Conclusion

    The number of hospitalized cases of acute meningitis clearly decreased during the COVID-19 pandemic, especially for viral and bacterial meningitis in younger populations aged <50 years.

    Download PDF (311K)
  • Yudai Tanaka, Shunichi Yoda, Katsunori Fukumoto, Takumi Hatta, Keiichi ...
    Article ID: 3039-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective This retrospective study aimed to investigate the association between therapeutic strategies and the development of major cardiac events (MCEs) in intermediate-risk patients by using the J-ACCESS risk model in combination with the stress phase bandwidth (SPBW), an index of left ventricular dyssynchrony.

    Methods Patients were followed-up for three years to confirm their prognosis. Based on the estimated propensity scores, the patients who underwent revascularization within the first 60 days after SPECT and those who did not were matched 1:1 (n = 367 per group). The composite endpoint was the occurrence of MCEs, consisting of cardiac death, non-fatal myocardial infarction, and severe heart failure. SPBW was calculated by a phase analysis using the Heart Risk View-F software program, and the MCE rate was compared between the two groups by applying the normal value of SPBW (38°).

    Patients The study included 2,053 patients with either known or suspected CAD who underwent electrocardiogram-gated single-photon emission computed tomography myocardial perfusion imaging and were at intermediate risk of MCE according to the J-ACCESS risk model.

    Results During follow-up, 54 of the 734 patients (7.4%) experienced MCEs. The overall incidence of MCE in intermediate-risk patients was not significantly different between the two groups. However, the incidence of MCE in patients with an abnormal SPBW was significantly lower in those who underwent early revascularization (4.8% vs. 11.9%, P = 0.0407).

    Conclusion The combination of the J-ACCESS risk model and the SPBW is thus considered to be an optimal treatment strategy for patients at intermediate risk of MCE, and early revascularization may lead to an improved prognosis in intermediate-risk patients with an abnormal SPBW.

    Download PDF (1980K)
  • Shinji Unome, Kenji Imai, Takao Miwa, Tatsunori Hanai, Atsushi Suetsug ...
    Article ID: 3071-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Combined hepatocellular cholangiocarcinoma is a rare and challenging primary liver malignancy that lacks any established standard treatments for unresectable cases. We herein present the first known case of a 49-year-old woman diagnosed with unresectable combined hepatocellular-cholangiocarcinoma, who underwent novel chemotherapy involving durvalumab plus tremelimumab combination therapy. The treatment was temporarily discontinued owing to immune-related adverse events, such as rash, and the patient was subsequently managed with systemic steroid therapy; however, the disease progressed after two courses of this treatment. Further studies are needed to validate the efficacy and safety of immune checkpoint inhibitors such as durvalumab and tremelimumab for the treatment of unresectable combined hepatocellular cholangiocarcinoma.

    Download PDF (3756K)
  • Tomoko Takezawa, Naohisa Matsunaga, Atsushi Miki, Toshihiko Arizumi, A ...
    Article ID: 3078-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Vibrio fluvialis is a bacterium that can be found in both seawater and freshwater, and it is responsible for causing gastroenteritis and cholangitis. V. fluvialis bacteremia has rarely been reported. We report a case of V. fluvialis bacteremia due to cholangitis in an immunocompetent adult who was exposed to seawater regularly as a sushi chef.

    The increased risk of V. fluvialis entry into the body resulting from frequent consumption of raw fish and regular exposure to seawater, bile outflow impairment caused by transient inflammation of the bile duct, and the presence of multiple bile acid resistance-related genes in V. fluvialis may lead to the development of acute cholangitis and subsequent bacteremia in immunocompetent patients.

    Download PDF (152K)
  • Yuuki Ito, Noriko Mori, Ken Matsuo, Satoshi Tanaka, Kiyoshi Mori, Nao ...
    Article ID: 3082-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Tosufloxacin tosilate is classified as a new quinolone antibacterial agent, which has been reported to cause crystal nephropathy. However, the origin of these crystal deposits has not yet been elucidated. We encountered a case of renal failure that progressed slowly owing to crystal-forming interstitial nephritis after long-term exposure to tosufloxacin. Mass spectrometry of the renal specimens revealed that tosufloxacin was deposited in the kidneys. The patient's renal function improved slowly with the withdrawal of tosufloxacin and steroid therapy. This is the first case to demonstrate the presence of crystal deposits consisting of tosufloxacin.

    Download PDF (693K)
  • Tsuyoshi Hamaguchi, Ichizo Nishino, Yasuki Hirano, Nobuaki Uchida, Mic ...
    Article ID: 3092-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    We report the case of a 46-year-old female patient who developed a subacute progression of axial and proximal muscle weakness. Laboratory findings revealed mildly elevated serum creatine kinase levels. No monoclonal gammopathy was detected. A muscle biopsy revealed that she had nemaline myopathy. Serological tests and a lip biopsy revealed Sjögren's syndrome (SjS). We diagnosed her as having sporadic late-onset nemaline myopathy without monoclonal gammopathy of undetermined significance associated with SjS. Her symptoms improved after methylprednisolone pulse therapy followed by intravenous immunoglobulin therapy. A good response to immunotherapy demonstrates the necessity of making a correct diagnosis, for which a muscle biopsy is required.

    Download PDF (586K)
  • Taisuke Nakagawa, Yasuaki Kotetsu, Katsumi Takizawa, Michihiro Yoshimi ...
    Article ID: 3096-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    We present the case of a 61-year-old man who developed Coronavirus disease 2019 (COVID-19) and died during treatment for relapsing polychondritis. The patient was intubated and treated with steroid pulse therapy, remdecivir, antibacterial agents, baricitinib, and tocilizumab. However, his respiratory condition worsened, and he died 108 days after disease onset. An autopsy revealed diffuse alveolar damage in the fibrotic phase in all lung lobes, diffuse pulmonary ossification, and cytomegalovirus-infected cells in the middle lobe of the right lung. We herein discuss the clinical features and pathological findings of COVID-19 in immunosuppressed patients.

    Download PDF (1389K)
  • Kohei Yamamoto, Shinsuke Shiotsu, Misaki Sasakura, Shunya Tanaka, Shih ...
    Article ID: 3115-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Combination therapy with ipilimumab and nivolumab is indicated for many types of cancers; however, several patients experience immune-related adverse events (irAEs). We herein report a case of cytokine release syndrome (CRS) in a 63-year-old woman with stage IV left clear cell renal cell carcinoma. Our patient developed CRS while taking prednisolone, 43 days after the start of ipilimumab and nivolumab administration. The patient was treated with steroid pulse therapy, which improved the symptoms of shock and respiratory failure. Increased vascular permeability and relative adrenal insufficiency are considered to be the main pathogeneses. The early administration of high-dose steroids is crucial as a replacement for corticosteroids.

    Download PDF (860K)
  • Yasuhiko Hamada, Takumi Aota, Hayato Nakagawa
    Article ID: 3117-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Download PDF (564K)
  • Kazutoshi Ono, Takahiro Masuda, Yuko Ono, Erika Hishida, Hiromichi Yos ...
    Article ID: 3156-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 79-year-old male patient with type 2 diabetic nephropathy and hypertension was admitted to our hospital because of acute kidney injury with significantly elevated serum creatinine (8.12 mg/dL) and urinary β2-microglobulin (β2MG, 31,748 μg/L) levels. α-Glucosidase inhibitor (α-GI) miglitol, started two weeks prior to presentation, was discontinued because drug-induced acute interstitial nephritis (AIN) was suspected. Renal biopsy revealed AIN and diabetic nephropathy. The drug-induced lymphocyte stimulation test for miglitol was also positive. After the discontinuation of miglitol, the urinary β2MG levels decreased to the normal range. This case raises the possibility that α-GI miglitol can worsen the renal function in patients with underlying renal dysfunction.

    Download PDF (899K)
  • Hiroki Sato, Shozaburo Fujii, Tetsuhiro Okada, Hidemasa Kawabata, Yuki ...
    Article ID: 3194-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A woman in her 60s presented with a small pancreatic head tumor. Imaging studies revealed a 13-mm well-defined pancreatic head tumor. A neuroendocrine neoplasm was suspected, and the patient opted for observation at that time. After 8 months, the patient began experiencing sweating while fasting, and blood tests during regular follow-up visits showed hypoglycemia. Hypoglycemia was induced during fasting test. The tumor exhibited clear features of an insulinoma during follow-up observation. While small neuroendocrine neoplasms are often managed through observation, caution should be exercised regarding their transformation into functional neuroendocrine tumors.

    Download PDF (2493K)
  • Bao Wu, Chongming Wu, Dandan Li, Zhanmin Yang, Ying Liu, Hai-Xia Zhang ...
    Article ID: 3221-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Ovary microcystic stromal tumor (MCST) is an extremely rare subtype of sex cord-stromal neoplasm, and only 57 cases have been reported. We herein report a unique case of ovarian MCST with positive nestin expression in a 39-year-old Chinese woman. The tumor showed microcystic stromal histological structures and characteristically expressed the CD10, WT-1, and Ki67 proteins. A molecular analysis identified a point mutation (c.110C > T) in exon 3 of the CTNNB1 gene. To our knowledge, no report has described a case of ovarian MCST with positive staining for nestin protein. Our study provides new insights into the tumor biology of ovarian MCST.

    Download PDF (1712K)
  • Shinsuke Akiyama, Shigeo Hara, Tetsuro Inokuma
    Article ID: 3235-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Download PDF (495K)
  • Masashi Ito, Kozo Morimoto, Mikio Saotome, Akiko Miyabayashi, Keiko Wa ...
    Article ID: 3263-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    We present the case of a 58-year-old female patient with primary ciliary dyskinesia (PCD). She was born to parents with a consanguineous marriage. Chest computed tomography conducted at age 41 years indicated no situs inversus, and findings of bronchiectasis were limited to the middle and lingular lobes. Despite long-term macrolide therapy, bronchiectasis exacerbations frequently occurred. PCD was suspected because of the low nasal nitric oxide level (20.7 nL/min). Electron microscopy revealed outer and inner dynein arm defects, and a genetic analysis identified a homozygous single-nucleotide deletion in the DNAAF1 gene. Based on these results, the patient was diagnosed with PCD due to a biallelic DNAAF1 mutation.

    Download PDF (819K)
  • Koji Suzuki, Mitsuhiro Akiyama, Yasushi Kondo, Katsuya Suzuki, Yuko Ka ...
    Article ID: 3295-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Rosai-Dorfman disease (RDD) is a rare histiocytic proliferative disorder characterized by lymphadenopathy and extra-nodal manifestations. Some patients with RDD require systemic treatment, but there is no consensus on the treatment strategy owing to its extreme rarity. Overexpression of tumor necrosis factor α (TNF-α) has been reported in lesions of patients with RDD and is thought to be involved in its pathogenesis. We herein report the first case of RDD with cutaneous involvement and arthritis that was successfully treated with methotrexate and infliximab. This case highlights the potential efficacy of anti-TNF-α therapy for RDD, offering a novel treatment option for this rare condition.

    Download PDF (990K)
  • Shun Sasaki, Kazuhiro Ota, Taro Iwatsubo, Noriaki Sugawara, Akitoshi H ...
    Article ID: 3305-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 70-year-old man who had undergone treatment for gastroesophageal reflux disease (GERD) by a family doctor presented to our hospital with severe heartburn and dysphagia despite taking vonoprazan (20 mg) for 3 months. A diagnosis of vonoprazan-refractory nonerosive reflux disease was made based on esophagogastroduodenoscopy and esophageal function examinations. The patient elected to undergo endoscopic treatment for GERD. Therefore, we performed endoscopic treatment using the endoscopic submucosal dissection (ESD-G) technique developed at our institution. After endoscopic treatment, his GERD symptoms disappeared and he no longer required GERD-related medications. An examination of his esophageal function revealed the improvement of items related to GERD.

    Download PDF (642K)
  • Yoh Arita, Kota Takaki, Yuto Suetani, Kana Shichijo, Nobuyuki Ogasawar ...
    Article ID: 3324-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 74-year-old woman presented to our hospital with syncope after a coronavirus disease 2019 (COVID-19) infection. Upon admission, she passed out, and an 8-second sinus arrest was detected during telemetry monitoring. During the next syncope episode, telemetry monitoring showed that her heart rate decreased from 80 to 36 bpm, accompanied by a 2.4-second pause. A permanent pacemaker was implanted; however, the patient still experienced syncope. The head-up tilt test revealed a vasodepressor reflex syncope. The need for permanent pacemakers in patients with syncope following COVID-19 therefore remains controversial.

    Download PDF (378K)
  • Naomi Shimizu, Sanshiro Nakao, Hidekazu Hasunuma, Chiaki Nakaseko, Tom ...
    Article ID: 3325-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective We previously reported that patients with acute leukemia and malignant lymphoma (ML) demonstrated significantly increased serum soluble LR11 (sLR11) levels compared to normal controls. Accurately diagnosing ML of the central nervous system (CNS ML) using cytology is frequently difficult. Therefore, we evaluated the use of cerebrospinal fluid (CSF) sLR11 and soluble interleukin-2 receptor (sIL-2R) as diagnostic and treatment response markers for CNS ML.

    Methods We retrospectively evaluated the CSF results for CNS ML using clinical data at our institution, and then analyzed the usefulness of sLR11 and sIL-2R in CSF for both the diagnosis and as surrogate markers that reflect the therapeutic effect.

    Patients We enrolled patients with CNS ML who received intrathecal anticancer drugs between 2017 and 2023. We analyzed the sLR11 and sIL-2R levels in CSF and cytological malignant grades. We studied 22 patients, including 17 with central nervous system (CNS) clinical conditions and five who received prevention treatment.

    Results The CSF sLR11 levels were significantly and positively correlated with CSF sIL-2R levels. The CSF sLR11 and sIL-2R levels in patients with CNS ML were significantly higher than those in the prevention group. A receiver operating characteristic (ROC) curve analysis showed the cut-off value of sLR11 for CNS invasion to be 21.7 ng/mL. Moreover, the chemotherapy-responder group demonstrated significantly decreased CSF sLR11 and sIL-2R levels after treatment.

    Conclusion CSF sLR11 and sIL-2R of CSF were found to be useful biomarkers for the diagnostic and treatment response evaluation in patients with CNS ML.

    Download PDF (150K)
  • Josef Finsterer
    Article ID: 3342-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Download PDF (95K)
  • Minako Wakasugi, Ichiei Narita
    Article ID: 3343-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective Patients with rapidly progressive glomerulonephritis (RPGN) are at a high risk of progression to end-stage kidney disease (ESKD), requiring renal replacement therapy (RRT). The present study examined recent trends in the incidence of RRT due to RPGN in Japan.

    Methods The number of patients with incident RRT due to RPGN by sex from 2006 to 2021 was extracted from the Japanese Society of Dialysis Therapy Registry. The incidence rates of RRT were calculated for four-year periods with the census population as the denominator. Standardized incidence ratios (SIRs) and age-specific incidence rates were also calculated.

    Results From 2006 to 2021, the crude number of patients with incident RRT due to RPGN increased by 34% and 58% in men and women, respectively. The SIRs decreased significantly in 2010-2013 relative to the first period (2006-2009) for both men (0.90 [95% confidence interval {CI} 0.85-0.96]) and women (0.92 [0.86-0.99]) but then increased to 1.01 (0.96-1.07) for men and 1.20 (1.13-1.27) for women in 2018-2021. In the older age groups (≥70 years old), age-specific incidence rates initially decreased in 2010-2013 but increased thereafter, peaking in 2018-2021.

    Conclusion From 2006 to 2021, the number of patients with incident RRT due to RPGN increased, with an increase in the age-specific incidence of RRT due to RPGN in the older age groups (≥70 years old), suggesting that the number of patients with incident RRT due to RPGN will continue to increase as the population ages in Japan.

    Download PDF (190K)
  • Yuko Morishima, Nobuyuki Hizawa
    Article ID: 3353-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Asthma and chronic obstructive pulmonary disease (COPD) have long been debated regarding their similarities and differences in clinical presentation and pathology. There has also been a discussion about how common therapeutics should be used differently for each disease. Traditionally, a "one size fits all" stepwise treatment has been chosen based on the severity of each case after categorizing the diseases, such as asthma or COPD. However, recently, the need for a precise approach for the treatment of individual patients beyond the disease category has been emphasized, especially in severe cases. To achieve precise personalized therapy, it has become necessary to focus on the individual phenotypes and underlying causal molecular mechanisms (endotypes) and to identify key therapeutic targets, which are called treatable traits. This review discusses the evidence for the importance of identifying treatable traits and therapeutic strategies based on the broader perspective of chronic obstructive airway disease rather than on individual diseases such as asthma or COPD.

    Download PDF (231K)
  • Naoya Kataoka, Teruhiko Imamura
    Article ID: 3366-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Download PDF (92K)
  • Yu Kurahara, Hitomi Okamori, Kazunari Tsuyuguchi
    Article ID: 3368-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Download PDF (780K)
feedback
Top