Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
Advance online publication
Displaying 51-100 of 399 articles from this issue
  • 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.

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  • 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.

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  • Josef Finsterer
    Article ID: 3342-23
    Published: 2024
    Advance online publication: March 04, 2024
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  • 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.

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  • 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.

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  • Naoya Kataoka, Teruhiko Imamura
    Article ID: 3366-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
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  • Yu Kurahara, Hitomi Okamori, Kazunari Tsuyuguchi
    Article ID: 3368-23
    Published: 2024
    Advance online publication: March 04, 2024
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  • Koji Suzuki, Mitsuhiro Akiyama, Yasushi Kondo, Shuntaro Saito, Jun Kik ...
    Article ID: 3384-23
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Sjögren's syndrome (SS) can present with extraglandular organs, such as interstitial lung disease (ILD). Anti-SS-A antibody is frequently found in SS cases, whereas anti-centromere antibody (ACA) is detected in some SS cases. Notably, the anti-SS-A and ACA double-positive cases exhibited distinct features with a higher prevalence of ILD. However, there have so far been no reports on the treatment of ILD in anti-SS-A and ACA double-positive cases. We herein present a case of ILD with anti-SS-A and ACA double-positive SS that was successfully treated with immunosuppressive therapy. Our case suggests the potential efficacy of immunosuppressive therapy for this poorly understood condition.

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  • Keigo Kobayashi, Yasuhiro Umekawa
    Article ID: 3389-23
    Published: 2024
    Advance online publication: March 04, 2024
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    A Southeast Asian man in his 30s residing in Japan developed severe disseminated strongyloidiasis during long-term steroid therapy. Initially misdiagnosed as gastroenteritis, his condition was later identified as strongyloidiasis by fecal smears and endoscopy. An endoscopic examination revealed salmon roe-like nodular lesions, indicating an advanced stage. Despite treatment, the patient died of the illness. This case underscores the importance of considering the patient's geographical background and immunosuppressive history in medical assessments. It further highlights the need for early and proactive diagnostic approaches, such as stool testing and gastrointestinal endoscopy, to effectively detect and treat imported infectious diseases.

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  • Yoshiyasu Aizawa, Yu-ki Iwasaki, Kuniya Asai, Takumi Matsumoto
    Article ID: 3487-24
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
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  • Yuki Ueno, Satoshi Ikeda, Tetsufumi Motokawa, Tomohiro Honda, Masaya K ...
    Article ID: 3509-24
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
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  • So Okubo, Taichi Tamagawa, Minako Yamada., Taro Bannai., Tomonari Seki ...
    Article ID: 3528-24
    Published: 2024
    Advance online publication: March 04, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
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  • Hideshige Seki, Kensuke Narukawa, Yurika Mitsui, Yukari Shirasugi, Shi ...
    Article ID: 2505-23
    Published: 2024
    Advance online publication: February 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    An 83-year-old man diagnosed with multiple myeloma presented with renal failure and hyperkalemia. The patient was treated with calcium polystyrene sulfonate (CPS; kalimate) for hyperkalemia. On the 10th day after starting CPS, airway obstruction due to the presence of a mass was observed, and the patient died on that same day. Autopsy revealed that the mass was located between the trachea and epiglottis and it was determined to consist of CPS-related mosaic crystals. There was a protrusion within the trachea surrounding the CPS crystals, inflammatory cells, and granulation tissue. This case suggests that CPS is associated with not only gastrointestinal complications, but also with airway complications.

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  • Tomoaki Shima, Kairi Yamashita, Kanako Furuta, Kohei Tsujino, Saeko Na ...
    Article ID: 2878-23
    Published: 2024
    Advance online publication: February 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Cases of herpes zoster ophthalmicus (HZO) complicated by bilateral ophthalmoplegia are rare, and no cases of bilateral third, fourth, or sixth cranial nerve palsies have been reported. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a rare complication of HZO. We herein report an 80-year-old Japanese woman with right-sided HZO complicated by meningoencephalitis and discuss the pathogenesis of this condition. She developed bilateral third, fourth, and sixth cranial nerve palsies and SIADH almost simultaneously during treatment for HZO. The bilateral cranial palsy spontaneously resolved within a few months.

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  • Takahiro Shimizu, Yu Nagashima, Takashi Matsukawa, Akihiko Mitsutake, ...
    Article ID: 2898-23
    Published: 2024
    Advance online publication: February 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Post-transplant lymphoproliferative disorders (PTLDs) are lymphoproliferative diseases that occur after solid organ transplantation or hematopoietic stem cell transplantation (HSCT). The development of PTLD is often associated with reactivation of Epstein-Barr virus (EBV). A 26-year-old woman with a history of HSCT and total-body irradiation developed spinal cord hemorrhage from a radiation-induced cavernous hemangioma (RICH) shortly after the development of classical Hodgkin lymphoma PTLD with EBV reactivation. Although little is known about the factors leading to hemorrhagic events from spinal cord RICH, we suspect that EBV reactivation may have been a factor contributing to the hemorrhage in the present case.

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  • Hiroaki Matsuura, Go Makimoto, Naohiro Oda, Kiichiro Ninomiya, Hisao H ...
    Article ID: 2938-23
    Published: 2024
    Advance online publication: February 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Nuclear protein of the testis carcinoma (NUTC) is a rare and aggressive malignancy. We herein report a case of NUTC in the lung characterized by a bronchial lesion and elevated alpha-fetoprotein levels. A 35-year-old Japanese man presented to our institution with suspected advanced lung cancer based on a histological examination. Subsequently, next-generation sequencing (NGS) yielded a positive BRD4-NUTM1 fusion. In addition, positive NUT immunostaining of the lung biopsy specimen confirmed NUTC in the lungs. Systemic chemotherapy and radiotherapy showed a temporary response, with decreased serum alpha-fetoprotein levels. We highlight this case of a prompt diagnosis by NGS of NUTC in a young individual with a rapidly progressing tumor.

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  • Sho Hitomi, Yorihiko Koeda, Kengo Tosaka, Nozomu Kanehama, Masanobu Ni ...
    Article ID: 2987-23
    Published: 2024
    Advance online publication: February 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective This study examined variations in in-hospital mortality causes and identified independent mortality predictors among patients with acute myocardial infarction (AMI) with and without diabetes mellitus (DM).

    Methods We examined factors influencing in-hospital mortality in a single-center retrospective observational study. Separate multivariate analyses were conducted for both groups to identify independent predictors of in-hospital mortality.

    Patients This study included consecutive patients admitted to Iwate Medical University Hospital between January 2012 and December 2017 with a diagnosis of AMI.

    Results Of 1,140 patients meeting the AMI criteria (average age: 68.2±12.8 years old, 75% men), 408 (35.8%) had diabetes. The DM group had a 1.87-times higher 30-day mortality rate, a lower prevalence of ST-elevated MI (56.6% vs. 65.3% in non-DM, p=0.004), and more frequent non-cardiac causes of death (32% vs. 14% in non-DM, p=0.046) than the non-DM group. Independent predictors of in-hospital mortality in both groups were cardiogenic shock (CS) [DM: hazard ratio (HR) 6.59, 95% confidence interval (CI) 2.90-14.95; non-DM: HR 4.42, 95% CI 1.99-9.77] and renal dysfunction (DM: HR 5.64, 95% CI 1.59-20.04; non-DM: HR 5.92, 95% CI 1.79-19.53). Among patients with DM, a history of stroke was an additional independent predictor of in-hospital mortality (HR 2.59, 95% CI 1.07-6.31).

    Conclusion Notable disparities were identified in the causes of death and predictive factors of mortality between these two groups of patients with AMI. To further improve AMI outcomes, individualized management and prioritizing non-cardiac comorbidities during hospitalization may be crucial, particularly in patients with DM.

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  • Akiko Tanihata, Atsushi Shibata, Kazutoshi Teragaki, Toshitake Yoshida ...
    Article ID: 3032-23
    Published: 2024
    Advance online publication: February 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    We herein report the case of a 46-year-old woman with Takayasu arteritis (TA), severe stenosis in the left main coronary artery (LMCA), and severe aortic regurgitation. Prednisolone and tacrolimus were initiated as TA treatments. Two months after initiating medical therapy, the aortic regurgitation severity improved to a moderate grade, although there was no obvious improvement in LMCA stenosis. Thus, after confirming the resolution of inflammation, we performed coronary artery bypass grafting alone without any aortic valve intervention. In TA patients with severe LMCA stenosis, surgical management of the coronary artery should therefore be considered only after successfully administering anti-inflammatory therapy.

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  • Go Endo, Sachiko Kanai, Hiroto Nishio, Hideki Hashimoto, Yoshimi Higur ...
    Article ID: 3036-23
    Published: 2024
    Advance online publication: February 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    We herein present the first known case of bacteremia caused by Kluyvera georgiana in a 67-year-old female undergoing chemotherapy for recurrent pancreatic cancer. The patient underwent choledochojejunotomy and thereafter developed ascending cholangitis. The diagnosis of K. georgiana was confirmed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. A literature review of Kluyvera spp. infections indicated potential risk factors including an underlying malignancy and immunosuppression. Although Kluyvera spp. infections are typically sensitive to antibiotics, multidrug resistance is possible. This case highlights the importance of the early diagnosis and treatment of K. georgiana and its associated risk factors.

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  • Joe Nemoto, Jun-ichi Ogasawara, Michiaki Koga
    Article ID: 3047-23
    Published: 2024
    Advance online publication: February 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objects This study clarified a variety of neurological phenotypes associated with varicella-zoster virus (VZV) reactivation.

    Methods This retrospective single-center study included consecutive patients with herpes zoster accompanied by neurological disturbances from April 2016 to September 2022. A comparative analysis was performed to examine whether or not the neurological phenotype and severity were associated with the distribution of herpes zoster, clinical and laboratory findings, and treatments.

    Results Twenty-six patients with a median age of 74 years old were enrolled. None of the patients had been vaccinated against herpes zoster. Of the 26 patients, 14 (54%) developed monoparesis, 5 (19%) developed meningitis, 5 (19%) developed encephalitis, 1 (4%) developed paraplegia, and 1 (4%) developed bladder and rectal problems. Monoparesis of the upper limb is associated with herpes zoster involving the cervical and thoracic dermatomes, whereas meningitis and encephalitis often occur in patients with herpes zoster in the trigeminal and thoracic dermatomes. Neurological disability was generally severe [modified Rankin Scale (mRS) score ≥3] on admission [17 of 26 (65%) patients]. Good recovery after admission was associated with a lower mRS value before the onset of neurological disability, clinical meningitis, and elevated cell counts and protein levels in the cerebrospinal fluid. Good recoveries were observed in patients with herpes zoster in the trigeminal or thoracic dermatomes more frequently than in other dermatomes.

    Conclusion This study revealed that VZV-related neurological complications are heterogeneous, commonly leading to severe disability and poor outcomes, and that neurological phenotypes and outcomes are related to the distribution of herpes zoster.

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  • Yuya Kobayashi, Kazuki Kasuga, Yusaku Shimizu, Yoshiki Sekijima
    Article ID: 3094-23
    Published: 2024
    Advance online publication: February 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    We report the case of an 80-year-old man with Frey syndrome that developed 30 years postoperatively, which is an exceptionally long period before its occurrence. Sweating and flushing occurred on only the side of his face where the surgery was performed, and he had no other causative abnormalities. Following treatment with botulinum toxin, the patient's symptoms resolved. Extremely early- and late-onset cases do not fit the conventional paradigm of this pathology. Various surgical methods to prevent this syndrome have been explored, but complete prevention has not yet been achieved. These findings suggest that the underlying pathophysiology of Frey's syndrome may be more complex than previously recognized.

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  • Miki Yarita-Kawana, Satoshi Kidoguchi, Yohei Suehiro, Naoki Sugano, Ta ...
    Article ID: 3116-23
    Published: 2024
    Advance online publication: February 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Introduction Primary aldosteronism is characterized by the autonomous excretion of aldosterone, which may induce bone mineral disorders.

    Patients and methods A total of 96 patients with primary aldosteronism were analyzed to identify differences in the regulation of serum calcium/phosphate balance between patients with unilateral and bilateral aldosterone hypersecretion and to determine whether or not adrenalectomy or mineralocorticoid receptor blockers affected such differences.

    Results Serum phosphate concentrations were significantly lower in patients with unilateral aldosterone hypersecretion than in patients with bilateral aldosterone hypersecretion (2.96±0.45 vs. 3.36±0.55 mg/dL, P<0.05), and recovered after adrenalectomy (2.96±0.45 vs. 3.49±0.32 mg/dL, P<0.01). In patients with bilateral aldosterone hypersecretion, the baseline serum phosphate levels were significantly lower in responders to mineralocorticoid receptor blocker treatment, defined as post-treatment plasma renin activity ≥1 ng/mL/h, than in non-responders. In responders, these levels tended to recover after treatment. A weak negative correlation between the plasma aldosterone concentration (PAC) and serum phosphate was observed, but there were no associations between the PAC and serum calcium concentration or between the aldosterone renin ratio and serum calcium and phosphate concentrations.

    Conclusions The effects on calcium/phosphate homeostasis may differ according to the primary aldosteronism subtype.

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  • Hikaru Mamizu, Hiroki Kohda, Yuusuke Tomita, Takuma Hatakeyama, Maiko ...
    Article ID: 3141-23
    Published: 2024
    Advance online publication: February 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Amiodarone, a prominent antiarrhythmic drug, may cause lung injury. We herein report the case of an 87-year-old man who had been taking amiodarone for 5 years and was subsequently referred due to respiratory failure. Chest computed tomography revealed multiple consolidations with air bronchograms in both lungs. Despite administering steroid pulse therapy, his respiratory failure worsened, and he died 3 days later. Autopsy revealed hyaline membrane formation and organic formation with fibrin deposition. Drug-induced lung injury caused by amiodarone was confirmed by autopsy. Caution is therefore required when fibrin deposition in the alveolar spaces is observed in such cases, which are prone to suffer a rapid deterioration.

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  • Makoto Mori, Junji Komatsu, Daiki Muramatsu, Kenjiro Ono
    Article ID: 3143-23
    Published: 2024
    Advance online publication: February 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
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  • Kosuke Mochizuki, Naohiro Toda, Masaaki Fujita, Satoshi Kurahashi, His ...
    Article ID: 3169-23
    Published: 2024
    Advance online publication: February 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Atypical hemolytic uremic syndrome (aHUS) is a type of HUS. We herein report a case of aHUS triggered by pancreatitis in a patient with a heterozygous variant of membrane cofactor protein (MCP; P165S), a complement-related gene. Plasma exchange therapy and hemodialysis improved thrombocytopenia and anemia without leading to end-stage kidney disease. This MCP heterozygous variant was insufficient to cause aHUS on its own. Pancreatitis, in addition to a genetic background with a MCP heterozygous variant, led to the manifestation of aHUS. This case supports the "multiple hit theory" that several factors are required for the manifestation of aHUS.

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  • Hiroaki Kawano, Tetsufumi Motokawa, Yoshinobu Eishi, Akito Setoguchi, ...
    Article ID: 3174-23
    Published: 2024
    Advance online publication: February 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 67-year-old woman was admitted to our hospital because of a complete right bundle branch block. She had been treated with minocycline for skin sarcoidosis and her symptoms had ameliorated four years previously. Gallium scintigraphy revealed an abnormal uptake in the heart but not in the skin or lungs. She was diagnosed with cardiac sarcoidosis, although an endomyocardial biopsy could not detect any sarcoid lesions. Immunohistochemical staining for Cutibacterium acnes was positive for granulomas of the skin lesions which had been previously biopsied. One year after starting the administration of steroids, her condition improved.

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  • Mitsuhito Koizumi, Sho Ishikawa, Kaori Marui, Masahito Kokubu, Yusuke ...
    Article ID: 3178-23
    Published: 2024
    Advance online publication: February 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 70-year-old woman presented with stage III pancreatic head cancer. After endoscopic sphincterotomy, a fully covered self-expandable metallic stent (FCSEMS) was placed in the common bile duct to manage jaundice. The patient developed a fever and abdominal pain 40 days after stent placement, with a suspected diagnosis of infected pancreatic pseudocyst. Purulent discharge from the papilla was observed during FCSEMS removal, and pancreatography revealed a pseudocyst connected to the main pancreatic duct. The pancreatic pseudocyst resolved after transpapillary drainage. Pancreatic pseudocysts should be suspected after biliary FCSEMS placement, and prompt removal and endoscopic drainage of the FCSEMS should be considered.

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  • Nozomi Okuno, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Toshitaka Fuk ...
    Article ID: 3207-23
    Published: 2024
    Advance online publication: February 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective Adverse events such as bile leakage and bleeding are among the issues that need to be resolved in EUS-guided choledochoduodenostomy (EUS-CDS). To overcome this problem, we developed a new EUS-CDS technique using a 19-G Franseen needle without tract dilation. This study aimed to evaluate the safety and efficacy of the new EUS-CDS technique.

    Methods This single-center retrospective study included 20 consecutive patients who underwent EUS-CDS for primary drainage using a 19-G Franseen needle between March 2020 and May 2023. The primary endpoint was the technical success rate of EUS-CDS without tract dilation.

    Results The technical success rate of EUS-CDS was 20/20 (100%). None of the patients required any additional tract dilation, such as by using a balloon or electric cautery. The median procedure time was 7.8 (range, 3.2-19.4) min. No early adverse events were observed.

    Conclusion The 19-G Franseen needle appeared to have a sufficient dilatory effect during puncturing. This EUS-CDS technique appears to be safe and effective and has the advantages of no adverse events and it is also a simplified procedure, which suggests its potential for widespread use in primary drainage.

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  • Makoto Hoyano, Kazuyuki Ozaki, Naoki Kubota, Shintaro Yoneyama, Takesh ...
    Article ID: 3210-23
    Published: 2024
    Advance online publication: February 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 37-year-old man with a history of Kawasaki disease presented with total occlusion of the right coronary artery. The patient underwent percutaneous coronary intervention (PCI) with excimer laser coronary angioplasty (ELCA) and plain balloon angioplasty (POBA). Three months after PCI, a coronary aneurysm with restenosis was detected at the PCI site, and PCI was performed again using a small balloon. The aneurysm healed three months after the second PCI procedure. This is the first report describing the long-term outcome after an aneurysm caused by PCI with ELCA and POBA.

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  • Wakaki Kami, Motoo Baba, Tetsu Chinen, Jiro Fujita
    Article ID: 3226-23
    Published: 2024
    Advance online publication: February 26, 2024
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  • Atsuhiko Suenaga, Naoki Sawa, Yuki Oba, Daisuke Ikuma, Akinari Sekine, ...
    Article ID: 3247-23
    Published: 2024
    Advance online publication: February 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    We experienced three cases of a fever and subsequent severe, prolonged gross hematuria after COVID-19 vaccination. A kidney biopsy revealed immunoglobulin A (IgA) nephropathy, and electron microscopy showed two types of podocytopathy (podocyte damage): loss of foot processes from the glomerular basement membrane and foot process effacement. Mesangial interposition was also present in cases 1 and 3 but not in case 2. Podocytopathy is known to be a cause of proteinuria; however, the reactions to COVID-19 vaccination described here suggest that it may also be related to hematuria in IgA nephropathy.

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  • Satoru Hagiwara, Koichi Nakagawa, Yoriaki Komeda, Naoshi Nishida, Akih ...
    Article ID: 3270-23
    Published: 2024
    Advance online publication: February 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    In October 2021, a 51-year-old woman developed a skin rash. Abdominal computed tomography revealed a large splenic artery aneurysm and an intrahepatic portovenous shunt. As her splenic artery aneurysm was at risk of rupture, she was referred to the Kindai University Hospital and underwent coiling surgery. In October 2023, approximately two years after she had been initially referred, contrast-enhanced ultrasound revealed findings suggestive of focal nodular hyperplasia. No reports have confirmed the occurrence of liver masses in patients with hereditary hemorrhagic telangiectasia, which is considered to be an interesting finding when investigating the mechanism of tumor development.

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  • Fumitaka Shimizu
    Article ID: 3281-23
    Published: 2024
    Advance online publication: February 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
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  • Naoya Kataoka, Teruhiko Imamura
    Article ID: 3293-23
    Published: 2024
    Advance online publication: February 26, 2024
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  • Soichiro Kojima, Mitsuru Matsuki, Nana Fujii, Naoki Kunitomo, Akihiro ...
    Article ID: 3464-24
    Published: 2024
    Advance online publication: February 26, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
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  • Yukimi Uotani, Nobuo Sasaki, Mika Nakashima, Rie Akiyama, Naoto Oguri, ...
    Article ID: 2466-23
    Published: 2024
    Advance online publication: February 19, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective Atrial fibrillation (AF) is the most common cause of tachycardia-induced cardiomyopathy (TIC). However, which patients with AF are prone to developing TIC remains unclear. In this study, we investigated the clinical features of AF patients with TIC.

    Methods This single-center study included 722 patients with AF (average age, 63.1±10.2 years old; 191 women) who underwent radiofrequency catheter ablation. We defined TIC as an initial left ventricular ejection fraction (LVEF) of <40% and a >20% recovery of the LVEF after successful AF ablation and compared the clinical characteristics between the TIC and control groups.

    Results The proportions of type 2 diabetes (30.5% vs. 14.7%), renal dysfunction (34.2% vs. 23.8%), hypertension (67.1% vs. 54.8%), and persistent AF (62.2% vs. 32.2%) were significantly higher in the TIC group (n=82) than in the control group (n=640). The atrioventricular nodal effective refractory period (AVNERP) (303±72 ms vs. 332±86 ms; p=0.017) was significantly shorter in the TIC group than in the control group. A multivariable analysis found that persistent AF [odds ratio (OR), 3.19; 95% confidence interval (CI), 1.94-5.24], renal dysfunction (OR, 1.87; 95% CI, 1.06-3.32), and type 2 diabetes (OR, 2.30; 95% CI, 1.31-4.05) were significantly associated with TIC.

    Conclusion Comorbid renal dysfunction and type 2 diabetes were clinical features of AF patients with TIC. Persistent AF, and short AVNERP may be involved in the development of TIC.

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  • Yuequan Shi, Xiaoxiao Shi, Haiyun Wang, Zijuan Zhou, Lei Zhang, Limeng ...
    Article ID: 2631-23
    Published: 2024
    Advance online publication: February 19, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Parvovirus B19 infection can cause chronic pure red cell aplasia in immunosuppressed hosts or acute and transient aplastic crises in immunocompetent hosts. In dialysis patients, only transient aplastic crisis induced by parvovirus B19 infection has been reported. We herein report the first case of an adult dialysis patient who developed chronic pure red cell aplasia associated with parvovirus B19 infection. Repeated pneumonia and heart failure may contribute to an immunocompromised status, making the patient more vulnerable to parvovirus B19 infection. This case expands on the differential diagnosis of chronic anemia in patients undergoing dialysis.

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  • Shota Mochizuki, Junnosuke Miura, Satoshi Takagi, Mikako Takita, Hirok ...
    Article ID: 2703-23
    Published: 2024
    Advance online publication: February 19, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective To examine the impact of lifestyle changes caused by the first emergency declaration issued in 2020 on glycemic control and body weight changes in Japanese individuals with type 1 diabetes mellitus.

    Methods This study included Japanese individuals with type 1 diabetes mellitus who visited Tokyo Women's Medical University Hospital between January 2019 and September 2020 (n=278). Seasonal changes in glycated hemoglobin (HbA1c) levels and the body mass index (BMI) were compared. A self-administered questionnaire regarding changes in treatment, diet, exercise, sleep, and telecommuting was used to assess lifestyle changes.

    Results Although HbA1c levels decreased from winter to summer in 2019 and 2020, the annual change was slightly but significantly greater in 2020 than in 2019. Seasonal changes in the BMI between 2019 and 2020 were also significantly different. An increase in the daily insulin dose, overall blood glucose level, diurnal change in blood glucose level, and food intake were significantly associated with increased HbA1c levels. Furthermore, HbA1c levels decreased with increasing moderate physical activity and sleep duration. The change in the BMI increased with increasing insulin dose, overall high blood glucose levels, and food intake. However, an increase in moderate physical activity was associated with a decrease in the BMI. HbA1c levels were significantly lower after the first emergency declaration in individuals with type 1 diabetes mellitus than that before the emergency declaration, even after accounting for seasonal variations.

    Conclusions Decreased HbA1c levels were associated with a decreased food intake, increased moderate exercise, and increased sleep duration during the state of emergency. The BMI remained relatively unchanged.

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  • Mihoko Shiio, Nobuya Maeda, Atsushi Iwata, Kenji Ishibashi, Kenji Ishi ...
    Article ID: 2844-23
    Published: 2024
    Advance online publication: February 19, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 73-year-old woman with posterior cortical atrophy (PCA) presented with progressive apperceptive visual agnosia, alexia, agraphia, ventral simultanagnosia, prosopagnosia, and allocentric (stimulus-centered) left-sided hemispatial neglect. All of these symptoms were attributed to damage to the bilateral occipito-temporal cortices, consistent with ventral variant PCA. While the Pittsburgh compound B uptake was extensively distributed throughout the occipito-parietal (dorsal) and occipito-temporal (ventral) areas, the THK5351 (ligand binding to tau aggregates/astrocyte gliosis) accumulation was limited to the ventral area. These findings suggest that local accumulation of tau proteins and/or astrocyte gliosis over the occipito-temporal cortices can result in ventral variant PCA.

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  • Akira Saito, Chisaki Mochida, Atsushi Mizuno, Keita Masuda
    Article ID: 3000-23
    Published: 2024
    Advance online publication: February 19, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 20-year-old man was resuscitated after ventricular fibrillation (VF). Electrocardiography revealed Wolff-Parkinson-White (WPW) syndrome. Intracoronary acetylcholine provocation testing was performed to induce VF secondary to the coronary vasospasm. The administration of acetylcholine to the coronary artery induced atrial fibrillation (AF) with pre-excitation, followed by VF without coronary vasospasm. Electrophysiological studies revealed an accessory pathway managed by catheter ablation. Subsequent intracoronary acetylcholine provocation testing (ACH test) induced the occurrence of AF without preexcitation. To our knowledge, this case report is the first to demonstrate the utility of the ACH test in confirming WPW syndrome as a cause of VF.

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  • Hayato Tada, Nobuko Kojima, Akihiro Nomura, Masayuki Takamura
    Article ID: 3033-23
    Published: 2024
    Advance online publication: February 19, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    We herein report the first family of Japanese individuals with familial hypobetalipoproteinemia caused by the c.1468C>T mutation in apolipoprotein B (APOB). A 13-year-old boy with extremely low levels of low-density lipoprotein (LDL) cholesterol (24 mg/dL) was referred to our hospital. The patient had no secondary causes of hypobetalipoproteinemia. His father and grandmother also exhibited low LDL cholesterol levels. A genetic analysis confirmed that they all had this variant in APOB (c.1468C>T). None of the patients exhibited atherosclerotic cardiovascular diseases or any other complications associated with low LDL cholesterol levels, including fatty liver, neurocognitive disorders, and cerebral hemorrhaging.

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  • Takashi Ueda, Hirohiko Sato, Takashi Ogimi, Ryuzo Deguchi, Hidekazu Su ...
    Article ID: 3063-23
    Published: 2024
    Advance online publication: February 19, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    An 87-year-old man experiencing lower abdominal discomfort resulting from the ingestion of a fish bone underwent conservative management involving endoscopic extraction of the fish bone lodged in the sigmoid colon. Most patients with lower gastrointestinal tract perforations typically develop peritonitis or abscesses, necessitating surgical intervention. Notably, endoscopic management of lower gastrointestinal tract perforations is infrequently employed. Patients presenting with localized abdominal symptoms along with a stable overall health condition may benefit from conservative therapeutic approaches that utilize endoscopic methods. Notably, the transition from endoscopic procedures for foreign body removal to surgical intervention requires close collaboration with a surgeon and must be executed judiciously.

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  • Shizuka Harada, Yoshiteru Azuma, Yohei Misumi, Hirotaka Hayashi, Soich ...
    Article ID: 3101-23
    Published: 2024
    Advance online publication: February 19, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    We herein report a case of VPS13D-related disorder with a novel homogeneous variant. A 58-year-old Japanese woman was referred to our hospital with slowly progressive gait disturbance and cognitive impairment. A neurological examination revealed decreased spontaneity, recent memory impairment, Parkinsonism, cerebellar ataxia, pyramidal signs, and autonomic dysfunction. Dopamine transporter single-photon-emission computed tomography showed a markedly reduced uptake in the striatum bilaterally. Whole-exome sequencing revealed a novel homozygous missense variant of the VPS13D gene (Arg3267Pro). Our case suggests that mutations in VPS13D may cause parkinsonism, in addition to the previously reported cerebellar ataxia and spastic paraplegia.

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  • Ryuzo Deguchi, Takashi Ueda, Motoki Kaneko, Yoshitaka Arase, Kota Tsur ...
    Article ID: 3136-23
    Published: 2024
    Advance online publication: February 19, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 71-year-old woman was found to have submucosal tumor-like lesion on colonoscopy (CS) before gastric surgery, and computed tomography (CT) showed a 12-mm structure at the base of the appendix. The lesion could not be clearly detected on CT nine months later, but it had enlarged again on CT one year later; therefore, CS and endoscopic ultrasound (EUS) were performed. The lesion was determined to be cystic with viscous contents, and laparoscopic appendicectomy was performed. This is the first report of low-grade appendiceal mucinous neoplasm (LAMN) diagnosed by a histopathologic examination of a resected specimen showing shrinkage and re-expansion of the appendix.

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  • Yuya Tanaka, Takehiko Kobayashi, Shigeki Shimizu, Yu Kurahara
    Article ID: 3144-23
    Published: 2024
    Advance online publication: February 19, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
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  • Mitsuhiro Kawano
    Article ID: 3154-23
    Published: 2024
    Advance online publication: February 19, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    IgG4-related disease (IgG4-RD) is a systemic and chronic inflammatory disorder that can affect every part of the body. The formation of tertiary lymphoid tissues (TLT) in the affected organs may be a key phenomenon in understanding the pathogenesis of this disease because T follicular helper (Tfh) 2 cells play an important role in IgG4 class switching within TLT in the affected organs or tissues. TLT formation leads to the formation of masses or swelling of the affected organs. Interleukin (IL)-4 and IL-10 are critical cytokines for IgG4-class switching and are produced in TLT. Other factors, such as CD4-positive (CD4+) cytotoxic T cells, M2 macrophages, and LAG3+ Tfh cells, have been identified as disease-specific contributors to lesion formation. In this review, I describe the current knowledge necessary to understand the pathogenesis of this disease and recent developments in treatment strategies beyond B-cell depletion therapy.

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  • Yuya Sumichika, Jumpei Temmoku, Kenji Saito, Shuhei Yoshida, Haruki Ma ...
    Article ID: 3211-23
    Published: 2024
    Advance online publication: February 19, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Coronavirus disease 2019 (COVID-19) is a respiratory viral disease, and several cases of autoimmune diseases have been reported after infection. This report presents the case of a 38-year-old Japanese woman who developed systemic lupus erythematosus (SLE) following COVID-19. Clinical manifestations included dermatological complications, joint pain, and positive autoantibodies. The patient met the SLE classification criteria, and renal involvement was observed. Her symptoms improved with immunosuppressive therapy. A literature review identified 10 similar cases, those with lymphopenia and renal involvement. SLE should be considered in patients with persistent nonspecific symptoms after COVID-19 infection, particularly when hematologic and renal involvement are present.

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  • Kiyoshi Iida, Masakazu Matsuzaki, Osamu Saito, Naoya Matsumoto
    Article ID: 2051-23
    Published: 2024
    Advance online publication: February 12, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective Exercise therapy as part of cardiac rehabilitation is one of the most effective treatments for patients with chronic heart failure (HF). The anaerobic threshold (AT) determined by an exhaled gas analysis during cardiopulmonary exercise testing (CPX) is used to prescribe the appropriate level of exercise therapy. However, CPX using an exhaled gas analysis is not widely performed because of its cost, complexity, and the need for skilled staff. Therefore, a simpler and inexpensive method for determining AT without respiratory gas measurements is required in patients with HF. The present study elucidated the relationship between the AT determined by the CPX ventilatory method (CPX-AT) and the AT determined by cardiac acoustic biomarkers (CABs), which are measured by acoustic cardiography (CAB-AT), in HF patients.

    Methods Patients underwent symptom-limited ramp CPX twice using a cycle ergometer. The ATs determined from the exhaled gas analysis were identified by three independent physicians. CABs, including S1 and S2 intensities (peak-to-peak amplitudes), electromechanical activation time (EMAT) defined as the time interval from the Q wave onset on electrocardiography to the first heart sound (S1), heart rate (HR), and other parameters, were collected during CPX.

    Patients Forty patients with HF were included in this study.

    Results A significant correlation (R=0.70; p<0.001) was found between CPX-AT and CAB-AT, using the double product of S1 intensity and heart rate. CAB-AT using S1 intensity also showed a significant correlation with CPX-AT (R=0.71; p<0.001).

    Conclusion The present study suggests a possible new method for determining AT without respiratory gas measurements in patients with HF.

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  • Shuhei Aoki, Hiroyuki Takaoka, Joji Ota, Tomonori Kanaeda, Takayuki Sa ...
    Article ID: 2615-23
    Published: 2024
    Advance online publication: February 12, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective Although magnetic resonance imaging (MRI) is the gold standard for evaluating abnormal myocardial fibrosis and extracellular volume (ECV) of the left ventricular myocardium (LVM), a similar evaluation has recently become possible using computed tomography (CT). In this study, we investigated the diagnostic accuracy of a new 256-row multidetector CT with a low tube-voltage single energy scan and deep-learning-image reconstruction (DLIR) in detecting abnormal late enhancement (LE) in LVM.

    Methods We evaluated the diagnostic performance of CT for detecting LE in LVM and compared the results with those of MRI as a reference. We also measured the ECV of the LVM on CT and compared the results with those on MRI.

    Patients or Materials We analyzed 50 consecutive patients who underwent cardiac CT, including a late-phase scan and MRI, within three months of suspected cardiomyopathy. All patients underwent 256-slice CT (Revolution CT Apex; GE Healthcare) with a low tube-voltage (70 kV) single energy scan and DLIR for a late-phase scan.

    Results In patient- and segment-based analyses, the sensitivity, specificity, and accuracy of detection of LE on CT were 94% and 85%, 100% and 95%, and 96% and 93%, respectively. The ECV of LVM per patient on CT and MRI was 33.0% ±6.2% and 35.9% ±6.1%, respectively. These findings were extremely strongly correlated, with a correlation coefficient of 0.87 (p <0.0001). The effective radiation dose on late-phase scanning was 2.4±0.9 mSv.

    Conclusion The diagnostic performance of 256-row multislice CT with a low tube voltage and DLIR for detecting LE and measuring ECV in LVM is credible.

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  • Kosuke Suzuki, Takuya Ataka, Noriyuki Kimura, Etsuro Matsubara
    Article ID: 2681-23
    Published: 2024
    Advance online publication: February 12, 2024
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    We herein report the a 42-year-old man with early-onset cerebral amyloid angiopathy (CAA) and a history of traumatic brain injury and neurosurgery in childhood. Computed tomography revealed cognitive impairment and recurrent lobar intracerebral hemorrhaging. Magnetic resonance imaging indicated cerebral microbleeds, and Pittsburgh compound B positron emission tomography detected brain amyloid deposition, mainly in the region of trauma and occipital lobes. Interestingly, the patient had no genetic predispositions or relevant family history. This case suggests that a single traumatic brain injury or neurosurgery in childhood can cause early-onset CAA.

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