To address the challenges of accurately citing Japanese medical literature in English journals, the essential guidelines "Citing Medicine" by the National Library of Medicine were reviewed, focusing on practical adjustments to enhance accessibility. Key proposals include the use of persistent identifiers (Digital Object Identifier, PubMed Identifier, and International Standard Book Number), proper citation of online content, and the inclusion of romanized Japanese article titles. The selection of accessible journal titles and the importance of consistency were also discussed to avoid confusion. Given the significant volume of Japanese medical literature, cross-lingual citation is critical for preventing the isolation of scientific discoveries. These proposals highlight the need for improved citation practices to make Japanese research activities more accessible to the global research community.

Medical illustration serves as a cornerstone for understanding intricate anatomical anomalies, with three-dimensional (3D) rendering emerging as a pioneering tool for emphasizing basic medical concepts and clinical practices. In Japan, the SYNAPSE VINCENT software package (SVSP; Fujifilm Medical Co., Ltd., Tokyo, Japan), internationally known as "SYNAPSE 3D," is a widely embraced solution for 3D rendering. However, despite its prevalence, resources elucidating its practical usage and offering insightful tips are scarce. In this review, we focus on the use of SVSP for 3D rendering of complex anatomical anomalies, particularly in the field of urology. We demonstrate a step-by-step process of 3D rendering. 3D rendering was performed in a sample case of a patient with horseshoe kidney and coexisting bilateral varicoceles through inputting of multiphase contrast-enhanced CT images into the application, followed by segmentation of the renal parenchyma, image registration, and segmentation of the arterial and venous systems as well as the upper urinary tract. Manual adjustments were made using the "Mask edit" and "Diameter setting" tools to ensure accuracy, particularly in cases of significant anomalies. Then, color-coded structures appeared, including the renal parenchyma, arterial and venous systems, and upper urinary tract, which provided a comprehensive visualization of the anatomical anomalies. This review highlights the effectiveness of the SVSP in visualizing complex anatomical abnormalities and detailing the practical rendering process, which could promote wider adoption of the application among urologists despite the challenges associated with the software.

Diabetes mellitus is defined as a group of metabolic diseases characterized by chronic hyperglycemia based on insufficient insulin action. At present, treatment for diabetes aims to prevent micro- and macrovascular complications. Although advances have been made in methods of controlling the risk factors of complications, including blood glucose management, there is still no effective treatment to cure diabetes. This is largely because we do not fully understand what diabetes is. To cure diabetes, it is necessary to elucidate the whole picture of insulin actions including those other than metabolic actions in various tissues and to understand what disorders are caused by its reduction or excess. This article reviews diverse insulin actions in various organs and the effects of their deficiency on diabetes, its complications, and associated diseases.

Introduction: Individual preparedness for large-scale earthquakes is essential for safety and security in Japan, where earthquakes frequently occur. Foreign residents in Japan face barriers to gathering disaster information, and international students are likely to be more vulnerable to the effects of earthquakes due to the shorter duration of their stay in Japan. However, no studies have been conducted on international students' individual preparedness for large-scale earthquakes in Japan. This study aimed to investigate individual preparedness for large-scale earthquakes among international students in Japan.

Methods: This cross-sectional study was conducted from May to August 2023 among 360 international students aged ≥20 years enrolled at seven Japanese-language educational institutions in Osaka, Kyoto, and Hyogo prefectures. Of these, 120 (33.3%) agreed to participate in the mail surveys. Students with invalid answers were excluded and 114 (31.7%) were included in the analysis. The information obtained using a self-administered questionnaire included participants' characteristics, methods used to collect information on individual preparedness for large-scale earthquakes (information sources and languages), and individual preparedness for large-scale earthquakes.

Results: Many international students had not implemented safety measures at home and lacked information about safety confirmation, evacuation sites and routes, items to wear during evacuation, items to take in case of evacuation, or items to stockpile at home. In particular, approximately half of the participants lacked knowledge about nearby evacuation sites, and only 37.7% had confirmed their evacuation routes to nearby evacuation sites. Only 32.5% had prepared bags containing emergency items to take in case of an evacuation, and most had not packed the items, even though they were stocked at home. In addition, only 8.8% had stockpiled radios and emergency portable toilets at home.

Conclusions: It is necessary to promote individual preparedness for large-scale earthquakes among international students in Japan.

Introduction: Although the associations between lifestyle behavioral changes over time and the risks of cancer and cardiovascular diseases are documented worldwide, evidence specific to the Japanese population remains limited. This study aimed to elucidate the trajectories of lifestyle behaviors and their associations with health conditions.

Methods: We analyzed health checkup data from the Japan Medical Data Center Claims Database from 2005 to 2019, specifically those of individuals who underwent 10 consecutive annual checkups. We focused on smoking, frequency of drinking alcohol, and regular exercise habits as the exposure factors. A group-based trajectory model was employed to estimate the patterns of single and multiple trajectories for three exposures. Furthermore, a linear mixed-effects model was used to assess the association between trajectory patterns and longitudinal changes in health conditions (body mass index, systolic blood pressure [sBP], LDL-cholesterol, and HbA1c).

Results: This study included 51,064 Japanese subjects aged 20-59 years at their initial health checkup. We identified seven trajectory groups (Groups 1-7) that represented a high percentage of subjects in the following order: Group 3 (inactive, 31.0%), Group 5 (long-term smoking, 26.9%), and Group 2 (daily drinkers, 11.0%). The only lifestyle behavioral change observed was smoking cessation. Groups 3 and 5 exhibited higher sBP (Group 3: β = 1.18, standard error [SE] = 0.60, p = 0.05; Group 5: β = 1.33, SE = 0.61, p < 0.05) and LDL-cholesterol levels (Group 3: β = 3.80, SE = 1.36, p < 0.05; Group 5: β = 3.04, SE = 1.37, p < 0.05) than the nonsmoking, nondrinking, and regular exercise groups. Group 2 exhibited significantly high sBP (β = 2.43, SE = 0.62, p < 0.001), with an observed interaction effect over time (p < 0.05).

Conclusions: Regular exercise and abstinence from smoking and drinking may be essential to avoid deterioration of health conditions.

Introduction: Dyslipidemia increases the risk of cardiovascular and cerebrovascular diseases. Visiting a physician for follow-up is essential when dyslipidemia is detected during health checkups. We investigated factors associated with non-attendance at a follow-up visit for dyslipidemia.

Methods: We conducted a retrospective cohort study using linked health checkups and medical claims data from individuals covered by National Health Insurance in Ibaraki Prefecture, Japan. Participants were 40-74 years old, underwent health checkups between April 2018 and March 2019, and had cholesterol levels exceeding the recommended levels to visit a physician. We excluded individuals who had visited physicians for dyslipidemia in the past year. We calculated the proportion of patients who had a follow-up visit with a physician within 180 days after their health checkup. Then, we investigated the demographic and clinical characteristics associated with non-attendance using a multivariable logistic regression model.

Results: Among 33,503 individuals (median age, 66 years [interquartile range, 59-69 years]; females, 58.8%) with dyslipidemia at the health checkup, 18.1% attended follow-up visits. Younger age, male sex, drinking habits, and lack of symptoms were associated with higher odds of non-attendance. Participants who underwent health checkups at public facilities, lacked other abnormal results at health checkups, and had not visited physicians for other diseases were less likely to attend a follow-up visit. Among those with elevated low-density lipoprotein cholesterol (LDL-C) levels, those with relatively lower LDL-C levels were less likely to attend.

Conclusions: Systems that inform high-risk populations of non-attendance and encourage follow-up visits are warranted.

Introduction: In India the prevalence of metabolic syndrome has dramatically increased. Hepatokines have gained considerable interest, and the role of fetuin-A in overweight and obesity incompletely understood. Therefore, this study aimed to investigate the role of serum fetuin-A in overweight and obese adults with and without metabolic syndrome in the northeastern Indian population.

Methods: This comparative study included 200 subjects (50 control, 50 overweight, 50 obese without metabolic syndrome and 50 obese with metabolic syndrome) aged 20-70 years. Lipid profile and fasting blood glucose, were measured using a fully automated analyzer. ELISA was employed to measure serum fetuin-A levels. Statistical analyses were conducted using SPSS versions 23.0. Furthermore, t-test was used to analyze the numerical investigational data of the present study. Chi squared test for the categorical data, and Pearson's correlation for the correlation analysis.

Results: Overweight and obese adults with and without metabolic syndrome had higher fetuin-A levels were than the controls. The results of this study indicated a positive correlation between fetuin-A and lipid profile, anthropometric parameters, 12 h fasting blood glucose and blood pressure. Contrarily, HDL-C exhibited a negative correlation with fetuin-A.

Conclusions: Fetuin-A is the first hepatokine associated with metabolic diseases. It controls the entire energy homeostasis of the body probably by regulating glucose and lipid metabolism. The current data belief is that fetuin-A may be a promising biomarker for predicting metabolic syndrome and its associated disorders particularly in overweight and obese adults.

Introduction: This study aimed to compare two groups (9 years or younger [U-9] and 10 years or older [O-10]) of patients with fresh lumbar spondylolysis and elucidate their characteristics.

Methods: This study enrolled 51 elementary school students diagnosed with fresh lumbar spondylolysis through magnetic resonance imaging between March 2015 and March 2022. Study 1 included 10 and 46 patients in the early- and late-grade groups, respectively. Patient characteristics at disease onset (sex, presence or absence of spina bifida occulta [SBO] in the affected vertebra, vertebral level, unilaterality or bilaterality of lesions, presence of a contralateral terminal stage, and disease stage) were compared between the two groups. Meanwhile, Study 2 included 34 patients with confirmed successful or failed bone union. The bone union rates in both groups were compared, and the factors affecting bone union in the entire study cohort were examined.

Results: In Study 1, the proportions of SBO, bilateral, and advanced stage cases were significantly higher in the U-9 group than in the O-10 group. In Study 2, the bone union rate was significantly lower in the U-9 group than in the O-10 group.

Conclusions: The proportions of SBO, bilateral, and advanced stage cases were significantly higher in the U-9 group than in the O-10 group. The bone union rate was significantly lower in the U-9 group than in the O-10 group.

Introduction: This study examined the test-retest reliability of the Kids Brain Balancer, a tablet-based cognitive assessment app, among children in the special education system and gathered preliminary validity evidence by evaluating score agreement with the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV).

Methods: A total of 36 children undergoing special education (aged 7-11 years) completed the Balancer tasks more than three times for over 1 month. Intraclass correlation coefficients (ICCs) facilitated the analysis of score reliability across sessions. Score agreement with Wechsler indices were evaluated for each task.

Results: Of the nine tasks, six demonstrated moderate-to-good reliability for raw or age-adjusted scores. The Full-Scale Intelligence Quotient (FSIQ), composite scores on the WISC-IV, and Balancer index scores on several tasks exhibited moderate-to-strong correlations over three repeated test administrations. Agreement with the FSIQ varied; however, most visuospatial/executive tasks initially correlated better, whereas verbal/working memory tasks converged by the third session. Those with lower baseline scores exhibited improvement in agreement over repeat testing.

Conclusions: This study provides initial evidence supporting the validity and test-retest reliability of the Kids Brain Balancer in evaluating intellectual/cognitive functioning among children undergoing special education. Enhancement and wider testing could establish this convenient tool to support evaluation of diverse developmental needs.

Introduction: Patients with Parkinson's disease (PD) and its related disorders exhibit decreased sleep activity. However, the factors associated with this decreased sleep activity remain unknown. Thus, we aimed to explore the factors associated with sleep activity in patients with PD and its related disorders.

Methods: This study included 33 patients with PD and its related disorders and 57 healthy participants who visited our outpatient clinics between November 2018 and March 2020. We evaluated the patients' muscle masses and measured the number of times they turned during sleep. The limb skeletal muscle index was utilized to evaluate the loss of muscle mass. This study was registered in the UMIN Clinical Trials Registry (Clinical Trials Registry number: UMIN000052436).

Results: Age, maximal grip strength, presarcopenia, phase angle (legs), history of hypertension, diabetes mellitus, dyslipidemia, orthopedic diseases, and the number of turns during sleep were associated with PD and its related disorders. The number of turns was independently associated with PD and its related disorders. Receiver operating characteristic curve analysis revealed that the cutoff value for the number of turns was 6 (area under the curve, 0.986; sensitivity, 93.9%; specificity, 96.5%). The cutoff numbers of turns for men and women were 9 and 6, respectively (area under the curve, 1.0 and 0.981; sensitivity, 100% and 94.7%; specificity, 100% and 95.2%; respectively).

Conclusions: The number of turns during sleep is significantly associated with PD and its related disorders and may decrease before patients present with sarcopenia. In addition, PD and its related disorders may coexist in men who turn less than nine times during sleep.

Introduction: Long hospital stay is associated with high costs and poor quality of life in elderly patients with heart failure (HF). This study aimed to investigate the association of early administration of tolvaptan with length of hospital stay among elderly patients with HF.

Methods: The cohort included elderly patients (age ≥ 75 years) admitted to Shinonoi General Hospital between July 2016 and December 2018 with a primary diagnosis of acute decompensated HF treated with tolvaptan. Patients who died during hospitalization, patients who had acute coronary syndrome, patients who required treatment in the intensive care unit, and patients who had already taken tolvaptan before admission were excluded. Patients were divided into two groups according to the median duration of admission to tolvaptan administration: those who received tolvaptan within 1 day (24 h) after admission (early treatment group) and those for whom tolvaptan was prescribed after 1 day (24 h) or more from hospitalization (add-on group). We compared the length of hospital stay between the two groups and investigated the relationship between early tolvaptan administration and length of hospital stay.

Results: Of 110 enrolled patients (median age 85 years), 56 (51%) received tolvaptan within 1 day (24 h) after admission. The median length of hospital stay was 22 [14-35] days. The length of hospital stay was significantly shorter in the early treatment group (16 [11-22] days vs. 30 [21-46] days, p < 0.001). On multivariable regression analysis, early tolvaptan was associated with shorter hospital stay after adjusting for age, sex, serum creatinine, B-type natriuretic peptide, continuous dobutamine, and whether they live alone (partial regression coefficient −16.213, p < 0.001). Linear regression analysis showed a positive relationship between time of tolvaptan administration and length of hospital stay (R² = 0.564, p < 0.001).

Conclusions: Early tolvaptan administration was associated with reduced length of hospital stay in elderly HF.

Introduction: This study investigated the relationships between changes in renal prognosis-related factors after initiating tofogliflozin and the corresponding baseline values in clinical practice in Japanese patients with type 2 diabetes.

Methods: We investigated the relationships between changes in hematocrit, hemoglobin, systolic blood pressure (sBP), urinary protein excretion (uPE), serum uric acid (sUA), and estimated glomerular filtration rate (eGFR) 12 months after initiating tofogliflozin (20 mg) and their corresponding baseline values in 130 patients with type 2 diabetes. The subjects were divided into two groups: normal (≥60 mL/min/1.73 m², n = 87) and low (<60 mL/min/1.73 m², n = 43) eGFR.

Results: Although the change in eGFR was negatively correlated with the baseline value in the normal-eGFR group, no significant correlation was found between the change in eGFR and baseline value in the low-eGFR group. Although changes in hematocrit (r = −0.39, P = 0.01) and hemoglobin (r = −0.36, P = 0.02) levels were significantly negatively correlated with corresponding baseline values in the low-eGFR group, no significant correlations were observed in the normal-eGFR group. Changes in sBP, uPE, and sUA were significantly negatively correlated with the corresponding baseline values in both the normal- and low-eGFR groups. None of the correlation coefficients between the normal- and low-eGFR groups showed a significant difference.

Conclusions: Favorable changes in renal prognosis-related factors after tofogliflozin therapy may contribute to renoprotection in patients with type 2 diabetes and poor corresponding baseline values, despite the presence of renal impairment.

Introduction: Few studies have explored the preventive efficacy of vaginal progesterone (VD) treatment for preterm delivery (PTD) in Japanese clinical practice. In this study, the efficacy of the VD treatment in pregnant women with a short cervix (sCX) diagnosed after 24 weeks is evaluated, focusing on perinatal outcomes.

Methods: A retrospective historical cohort study. Clinical data of 273 singleton women hospitalized for preventing PTD were extracted. Inclusion criteria are diagnosed sCX at 24-33 weeks. We excluded women with factors including treatment start before 24 weeks, medically induced PTD, PTD on admission day, and fetal demise. Consequently, logistic regression analyses were conducted on data from 79 women during Period 1 (November 2015 to March 2018, using prolonged intravenous ritodrine hydrochloride) and 82 women during Period 2 (August 2018 to August 2022, implementing VD treatment), adjusting maternal age, parity, body mass index, gestational age, cervical length, and histological chorioamnionitis. The primary outcomes involved PTD <37 and <34 weeks and neonatal intensive care unit admission. Secondary outcomes included the interval from the diagnosis of sCX to delivery <14 and <28 days, infant intubation, and surfactant administration. Since VD use is off-label in Japan, we obtained written informed consent prior to treatment.

Results: VD treatment (Period 2) significantly decreased the incidence of PTD (birth < 37 weeks) (adjusted odds ratios [ORs] 0.43, 95% confidence intervals [CIs] 0.19-0.96), impending delivery within 14 and 28 days after confirming sCX (adjusted OR 0.12, 95% CI 0.06-0.72; adjusted OR 0.25, 95% CI 0.09-0.74, respectively), and neonatal intubation rate (adjusted OR 0.17, 95% CI 0.04-0.75).

Conclusions: The VD treatment can prevent PTD in asymptomatic women with sCX diagnosed after 24 weeks of gestation. Although further validation is warranted, these findings may contribute to expanding the use of VD treatment in Japanese clinical practice.

Introduction: Similar to other countries, in Japan, the demand for primary care pediatricians has increased due to the surge in pediatric allergic diseases, and with the change in a paradigm shift regarding the prevention of pediatric allergic disease in the last 20 years, they have had an increased need for retraining. To offer better support to children and their caregivers, educational needs for bridging the gap between knowledge and practice must be met. Therefore, we developed an educational program including practical and interactive approaches for pediatricians in 2012.

Methods: To evaluate the effectiveness of a 2-week program, behavioral changes, knowledge and skill improvements in clinical practice, and the satisfaction level of participants before and after the course were investigated. Kirkpatrick's four levels of training evaluation were employed to assess the educational effect. Seven years (April 2014 to March 2021) worth of results were assessed.

Results: A total of 65 pediatricians voluntarily participated in the program. Most of them were <40 years old and came from various regions of Japan. Results of pretraining and posttraining questionnaires in terms of their knowledge and skills on a four-point scale revealed significant improvements. Participants also reported their behavioral changes after 6 months of the course and evaluated the program's practicality. Each participant set new goals to be achieved in 6 months, and 36 (76.6%) of them set objectives for implementing oral food challenge tests.

Conclusions: The results revealed that the program not only enhanced their knowledge and skills for practice but also changed their behaviors toward clinical practice. In pediatric allergy, where community primary pediatricians have important roles to play, such an educational program should be further developed.

This is an outline of the prevention of postpartum depression in obstetric institutes, with a focus on support through multidisciplinary collaboration in Japan. The onset of postpartum depression among women can be prevented by finding solutions to background factors causing mental health problems and providing multidisciplinary support.

In October 2023, Herat Province in Afghanistan was devastated by three earthquakes, resulting in 1,480 fatalities and 1,950 injuries, affecting approximately 154,000 people. The destruction included over 21,300 buildings, including 40 healthcare facilities, intensifying an existing humanitarian crisis under Taliban rule since August 2021. A comprehensive and coordinated response is vital for sustainable recovery and resilience, transcending political barriers to address the immediate and long-term needs of the Afghan population.

Patient-derived xenograft (PDX) models, in which tumor tissues resected from cancer patients are transplanted into immunocompromised mice, have been recently considered the most reliable preclinical models that quite accurately stimulate the real-world characteristics and microenvironments of tumors in patients. The ethical uniqueness of the PDX model, which lies in the fact that it is a hybrid of living human tumor tissue and a carrier mouse, raises several ethical concerns. This study presents four ethical points for consideration and a model ethical governance policy for the implementation and use of PDX models for research. First, PDX models carrying living tumor tissues originating from individual patients with dignity must be treated ethically as materials and data in compliance with the principle of respect for persons. Second, although PDX models themselves are patentable and can be commercialized, it is a standard view, as represented by the Oviedo Convention by the Council of Europe, that those living tumor tissues carried by PDX models shall not give rise to financial gain since those tissues are human body parts; therefore, they should be treated according to a recent ethical approach with the custodianship model as the trust property of patients of origin and shall not be subjected directly to monetary transactions. Third, PDX models must be treated with due care in an ethical manner in line with experimental animal ethics. Finally, the implementation and use of PDX models for research purposes must comply with national and international regulations on both animal experimentation and human subject research. These four points should be carefully examined and properly institutionalized as an ethical governance policy in each institution that plans on utilizing or implementing PDX models for research.

"Letters to the Editor" that address original articles significantly contribute to medical literature. Utilizing letters published in obstetrics and gynecology journals as a study model, I aimed to classify letters according to their context, providing a valuable framework for readers to comprehend the significance of letters and for authors to effectively write them. Using a sample of 40 recent letters from the Journal of Obstetrics and Gynaecology Research (JOGR), I classified letters into three main categories based on their attitude to addressed articles: Disagreement, Agreement, and Complementary. I further subclassified each category into subcategories, including "Interpretation claim," "Data addition," and "Historical viewpoint." The same procedure was carried out for the 24 most recent letters from BJOG and the American Journal of Obstetrics and Gynecology and also for the JMA Journal. Disagreement letters were prevalent in all three OBGYN journals, accounting for 1/2 to 2/3 of all letters. The rest letters were categorized either as "Agreement" or "Complimentary." Subcategorizations demonstrated different ratios of letters of the three categories among journals. I believe that the attempt to categorize and subcategorize letters offers valuable insights into the letters, potentially enhancing clarity in medical literature communication.

I have long harbored the impression that professors of clinical medicine specialties tend to produce fewer first-authored papers after their professorship appointments, despite their prior output of first-authored papers. This humble experiment attempted in providing some suggestions for this issue. I identified 11 chief professors of the obstetrics and gynecology departments of Japanese medical universities who were appointed professorships during 201X − 201X + 3 (covering 4 years). The numbers of PubMed-indexed first-authored papers were retrieved: 7-4 years prior (Period 1), 3-0 years prior (Period 2), and 1-4 years after (Period 3) their professorship appointments. 1) The "total" number of papers in Periods 1, 2, and 3 was 38, 33, and 4, respectively. 2) The "median" number of papers written by an individual professor in Periods 1, 2, and 3 was 3, 2, and 0, respectively. 3) "Annual average" paper numbers per person before (Periods 1 + 2) versus after (Period 3) was 0.81 ( (38 + 33) / (11 persons × 8 years) ) and 0.09 (4/ (11 × 4) )/person/year, respectively. I did the same for "corresponding-authored papers or last-authored papers." The results were as follows: 1) the "total" was 50, 74, and 143, respectively; 2) the "median" was 4, 5, and 7, respectively; and 3) the "annual average" was 1.41 versus 3.25/person/year. Thus, immediately after professorship appointments, the number of first-authored papers markedly decreased, although that of corresponding- or last-authored papers increased. The reason for this phenomenon may be multifactorial. However, societies should create an atmosphere where professors are relieved from excessive burdens and should be encouraged to engage in first-author paper writing as before if they desire. Societies want to hear professors' own voices which enrich academic discourse. Although the present experiment targeted only Japanese obstetrics and gynecology professors for a limited time, I hope to provoke some discussion regarding paper writing and professorship.

The Fukushima Model of Outpatient Pharmacotherapy for Breast Cancer was developed to improve the pharmacological treatment of patients with breast cancer in the vast region of Fukushima Prefecture. This model addresses the challenges posed by the area's lower-than-average density of breast cancer specialists. In the core medical institutions of the prefecture's most populous municipalities, we introduced a telephone consultation service managed by pharmacists at local dispensing pharmacies. The novelty of the Fukushima model lies in two distinct elements: a structured checklist-style tracking report and comprehensive patient information sheets. This innovative tool streamlines a range of processes, including patient self-assessment of symptomatology associated with treatment-related side effects, subsequent medical interventions, and a standardized protocol for reporting severe side effects to healthcare practitioners. This approach facilitates the safe administration of breast cancer pharmacotherapy in home settings. In the future, this model could be used beyond Japan to underserved regions globally, thereby increasing the standard of breast cancer care on a wider scale.

Hemophilia B is a quantitative or qualitative factor IX anomaly that manifests as an X-linked recessive inheritance pattern in which females are carriers. Postoperative epidural hematoma emerges as a typical complication in spinal surgery, although its incidence is infrequent. No documentation of postoperative epidural hematoma in carriers of hemophilia B exists. A 64-year-old female patient presented with progressive pain and muscle weakness in both lower limbs. Despite a history of childbirth and prior colorectal cancer surgery, the patient displayed no abnormal bleeding tendencies. Subsequently undergoing decompression surgery for lumbar spinal canal stenosis, the patient experienced paralysis and pain in both legs within 5 hours postoperatively. A magnetic resonance imaging scan revealed severe spinal canal compression attributed to a postoperative epidural hematoma, prompting emergency decompression surgery that ameliorated symptoms. The application of gelatin-thrombin matrix sealants (GTMS) facilitated hematoma removal, resulting in an uneventful recovery. In a postoperative interview, it was revealed that her grandson was undergoing treatment for hemophilia B. Additionally, she exhibited diminished factor IX levels and was diagnosed as a hemophilia B carrier. A definitive preoperative diagnosis of the carrier status is imperative. In instances where surgical intervention is warranted, the implementation of factor IX replacement and intraoperative hemostasis with GTMS is promising for potentially averting the onset of postoperative epidural hematoma.

T-cell prolymphocytic leukemia (T-PLL) is a rare and highly aggressive mature T-cell neoplasm. Although the response rate to alemtuzumab, an anti-CD52 antibody, is high, it is difficult to cure the disease with this agent alone. Therefore, hematopoietic stem cell transplantation is recommended for eligible patients. However, there are few effective salvage therapy options for patients ineligible for hematopoietic stem cell transplantation. In this study, we report the case of an elderly patient with relapsed or refractory T-PLL who underwent salvage therapy with methotrexate, hydrocortisone, vincristine, sobuzoxane, and etoposide (MTX-HOPE).

The patient was an 85-year-old man. He was administered alemtuzumab twice (at the time of initial treatment and relapse) and cyclophosphamide, vincristine, and hydrocortisone chemotherapy. Furthermore, novel therapeutic drugs (venetoclax and tofacitinib) were administered based on previous case reports. However, the patient was resistant to all treatments, and the tumor cells lost CD52 expression. We administered MTX-HOPE, and the patient survived for approximately 8 months. Although red blood transfusions were necessary because of disease progression, no adverse events were observed because of treatment, and the patient was able to maintain activities of daily living until immediately before death.

MTX-HOPE is a combination of classical chemotherapy agents originally developed for palliative chemotherapy in frail patients with refractory lymphoma. MTX-HOPE has been reported to be effective against T-cell tumors. Severe nonhematologic adverse events are rarely reported; however, bone marrow suppression is commonly observed. Grade 3-4 neutropenia has been documented in approximately half of the patients. Therefore, patients should be closely monitored, particularly at the onset of therapy. Consideration should be given to suspending treatment, adjusting the administration interval, or administering G-CSF if necessary. The treatment interval can be appropriately adjusted, making it a valuable treatment option for refractory T-PLL.