Acute myeloid leukemia (AML) is a heterogeneous hematopoietic malignancy accompanied by impaired differentiation and autonomous proliferation of hematopoietic stem cells. Standard induction therapy results in first complete remission among 70% of patients with AML; however, approximately half of these patients relapse and become refractory. Allogeneic hematopoietic cell transplantation is a useful treatment for relapsed and refractory cases. However, transplantation-related mortality is approximately 20%, which is not a low value, and quality of life after transplantation decreases. Therefore, there is a need to stratify the prognosis of each patient and implement this treatment appropriately. Owing to recent advances in genome analysis technology, many gene mutations involved in onset and recurrence of AML have been discovered. These abnormalities and mutations not only have clinical application as prognostic factors and minimal residual disease markers, but they may also contribute to novel molecular targeted drug development. Many new drugs such as first-generation FMS-like tyrosine kinase 3 (FLT3), isocitrate dehydrogenase 1 and 2 (IDH1/2), and B cell lymphoma 2 (BCL2) inhibitors have been developed in the West. In addition, the second-generation FLT3 inhibitors gilteritinib and quizartinib were developed in Japan, and treatment outcomes for patients with AML have improved. However, there is still a large disparity in drug availability between the West, and Japan. As a result, treatment guidelines in the West cannot be applied in the clinical setting in Japan. In this study, we assessed the molecular target drug treatment by gene diagnosis for treatment of AML patients.

Background: Patients with coronavirus disease 2019 (COVID-19) occasionally develop respiratory failure and coagulopathy. We aimed to determine whether coagulation abnormalities at admission and during the course of hospitalization can predict the liberation from respiratory support in critically ill patients with COVID-19 by combining the results of rotational thromboelastometry (ROTEM) with standard laboratory tests. Methods: This single-center, retrospective, observational study included 31 consecutive adult patients with COVID-19 who were admitted to the intensive care unit (ICU) and who required respiratory support between April 2021 and August 2021. We divided the patients into two groups according to the liberation from respiratory support and analyzed the differences between the groups. Results: There were 20 patients in the liberation group and 11 in the non-liberation group. There were no significant differences in the overt disseminated intravascular coagulation scores or abnormal counts in the ROTEM parameters at admission between groups, although there was a significant difference in the highest score in the ICU. The Sequential Organ Failure Assessment and sepsis-induced coagulopathy scores were significantly different between both groups at admission and at the time when the highest values were reported during the ICU stay. Conclusions: High sepsis-induced coagulopathy scores at admission to the ICU were found to be useful predictors of difficulties in the liberation from respiratory support in patients with severe COVID-19. However, increased overt disseminated intravascular coagulation scores and abnormal counts in the ROTEM parameters during the ICU stay were associated with difficulties in the liberation from respiratory support.

Background: Gastric cancer can recur soon after treatment. We evaluated the prognostic nutritional index (PNI), a predictor of postoperative complications, and examined the association of PNI with progression and recurrence of gastric cancer. Methods: We retrospectively investigated data from 697 patients who had undergone surgery for gastric carcinoma (excluding those with stage IV disease) and analyzed associations of age, sex, performance status (PS), American Society of Anesthesiologists (ASA) classification, diabetes, depth of main tumor (T), lymph node metastasis, postoperative complications, recurrence, and survival with PNI. We also performed multivariate analysis to identify factors associated with survival. Results: PNI significantly decreased with age and was significantly lower in women. PNI was significantly positively correlated with PS. PNI was significantly lower for ≥T2 cancers and in patients with lymph node metastasis. There was no association between postoperative complications and PNI. PNI was significantly lower for patients who developed recurrence than for those who did not. The survival rate was examined for groups with a PNI of ≥45 (high PNI) and <45 (low PNI). Both 5-year overall survival (OS) and cancer-specific survival (CS) were significantly worse for the low PNI group. Multivariate analysis showed that PNI was an independent predictor of OS and CS. Conclusions: PNI was associated with progression and recurrence of gastric cancer.

Background: Eribulin therapy has been reported to prolong overall survival (OS) but not progression-free survival, probably because it prevents the development of metastatic lesions; however, this effect has not yet been confirmed. Methods: We reviewed the medical charts of 50 patients with metastatic breast cancer who underwent eribulin monotherapy at our hospital between 2014 and 2019. Patients were divided into two groups, namely, those who discontinued eribulin because of disease progression due to development of new lesions (NL group) and those who discontinued eribulin for other reasons, such as lesion growth and unacceptable side effects (non-NL group). Survival times were estimated for both groups and we investigated if eribulin-mediated suppression of new metastasis increased OS. Results: Median OS for all patients, from eribulin initiation, was 14.4 months (range 1.2-60.1), whereas it was 4.6 months (range 1.7-24.7) in the NL group and 16.8 months (range 1.2-60.1) in the non-NL group. OS was significantly poorer in the NL group than in the non-NL group (p < 0.05). Conclusion: Eribulin monotherapy-mediated suppression of new metastatic lesions results in a better prognosis in patients with metastatic breast cancer.

Background: Nasopharyngeal swabs (NPS) are generally used as specimen samples for antigen qualitative tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The principle of the reaction to the antigen protein is the same when saliva is used, and saliva samples were reported to be as accurate as NPS for real-time reverse transcription quantitative polymerase chain reaction (RT-qPCR) testing to identify SARS-CoV-2. Unlike NPS collection, self-collected saliva does not expose healthcare workers to the risk of infection. In this study, we evaluated the feasibility of using saliva samples for a SARS-CoV-2 antigen qualitative test (TA2107SA) under development. Methods: Saliva samples were collected from patients with confirmed or suspected COVID-19 infection and analyzed. The sensitivity, specificity, and concordance index of the antigen qualitative test were calculated using an RT-qPCR test as reference. Results: Saliva samples were collected from 105 patients. The mean interval from onset to specimen collection was 5.7 days. The mean cycle threshold (Ct) value of RT-qPCR was 31.3. The sensitivity, specificity, and concordance index were 70.7%, 100%, and 0.85, respectively. In 33 patients with Ct values <30, the results of both the RT-qPCR and antigen tests were positive. The sensitivity of the saliva-based TA2107SA SARS-CoV-2 antigen qualitative test was slightly lower than that of the conventional antigen qualitative test using NPS samples from the same patient. Conclusion: Saliva-based antigen qualitative tests for SARS-CoV-2 are an alternative option during a pandemic.

Background: Management of transcondylar fracture of the humerus in older adults remains a challenging issue in trauma surgery. Both single- and double-plate fixation are used, and the best procedure is yet to be determined. This retrospective study evaluated and compared the clinical and radiological outcomes of single- and double-plate fixation for transcondylar humeral fracture. Methods: This study included older adults (age >65 years) with transcondylar fractures of the humerus (AO/OTA 13A2-3; transverse, transmetaphyseal fracture) treated at our hospital between 2002 and 2019. The patients were divided into two groups based on the fixation procedures they underwent, namely, single (group S) or double (group D) locking plate osteosynthesis. Postoperative outcomes were investigated. Results: Group S and group D comprised 11 (11 women) and 17 (2 men; 15 women) patients, respectively. In group S, the elbow was immobilized in a long-arm cast or splints for 2 weeks to prevent early displacement of fracture. Residual numbness of the ulnar digits was observed in two patients in group S and in nine patients in group D. No significant difference was noted between the two groups in the ratio of loss of reduction, loosening of the medial screw, ulnar nerve disturbance, or clinical outcomes. The ratio of elbow contracture significantly differed between 2 groups. The elbow flexion angle was significantly lower in group S. Conclusions: Open reduction and internal fixation with a double plate appears to be the optimal choice for early postoperative mobilization and maintenance of flexion and arc of the elbow joint.

Background: Antibody testing is essential for accurately estimating the number of people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to investigate the influence of background factors on seroprevalence by testing for anti-SARS-CoV-2 antibodies in blood samples obtained from the staff of three hospitals. Methods: This cross-sectional observational study was conducted from June 8 to July 4, 2020, as part of a mandatory health examination. Leftover blood samples collected during the health examinations at each hospital were used to test for the presence of anti-SARS-CoV-2 antibodies. The Elecsys Anti-SARS-CoV-2 RUO assay was used for antibody detection. The relationship between staff age, gender, body mass index, blood pressure, work environments with different exposure risks, place of residence, and campus location and seroprevalence was investigated. The data were anonymized prior to analysis. Results: A total of 3,677 individuals were included in the study, comprising 2,554 females (69.5%) and 1,123 males (30.5%). Anti-SARS-CoV-2 antibody (immunoglobulin G) was detected in 13 participants (0.35%). Seroprevalence was slightly higher in males than females (0.62% vs. 0.23%, P=0.08). By occupation, anti-SARS-CoV-2 antibodies were found in 6 (0.75%) physicians, 6 (0.31%) nurses, and one individual (0.11%) in the medical personnel group, with slightly higher levels in physicians. No significant difference was noted in the seroprevalence in terms of all background factors. Conclusions: Our study shows that the background factors do not impact seropositivity rates. Thorough daily infection control and adherence to recommended health guidelines were found to reduce infection risk.

Background: Noninvasive prenatal testing (NIPT) is used to screen for fetal chromosomal abnormalities, such as fetal aneuploidy, and has been offered at our hospital since 2013. We analyzed data from our center to determine if NIPT screenees could be given more-accurate information on NIPT outcomes. Methods: This retrospective observational study included 819 pregnant women who requested NIPT at Nippon Medical School Hospital from November 2013 to October 2021. We examined medical records for data on NIPT results and clinical outcomes. Results: Of the 819 women, 764 (93.2%) underwent NIPT, and 55 (6.7%) did not. Of the 764 women who underwent NIPT, 17 received a positive result (2.2%), of whom 2 (11.8%), 4 (23.5%), and 11 (64.7%) received a positive result for trisomy 13, 18, and 21, respectively. The true-positive rates after definitive diagnoses of trisomy 13, 18, and 21 were 1 (50%), 3 (75%), and 11 (100%), respectively. Of the 17 positive results, there were two false-positive results (11.8%) (for trisomy 13 and trisomy 18). Eleven women with fetal aneuploidy terminated their pregnancies, and four cases resulted in intrauterine fetal death. Five neonates with negative NIPT results had congenital disease without chromosomal abnormality. Two patients had indeterminate results from the first blood sampling, possibly because of treatment with unfractionated heparin. The results of repeat testing after heparin cessation were negative. Conclusions: Our results were generally similar to nationwide data for Japan. NIPT providers can provide more detailed and individualized genetic counseling for each situation by understanding their own medical facility's data in detail.

Background: Because choking quickly leads to cardiopulmonary arrest, it is crucial that bystanders remove foreign bodies effectively. Although oral instructions in video calls by dispatchers have improved the quality of cardiopulmonary resuscitation, it is unclear whether video calls improve the quality of first aid for choking infants. Therefore, this simulation study aimed to determine whether video calls with dispatchers improve the quality of first aid for infants with foreign body airway obstruction (FBAO). Methods: Seventy first-year college students randomly assigned in pairs to communicate by video or audio calls participated in simulated emergency calls for infants with FBAO. Both groups began with oral instruction in voice calls until the transition was made to video calls in the video group. The primary outcome was quality of first aid performance, which was categorized as excellent, acceptable, or poor on the basis of existing guidelines. Results: There were 17 simulations in the video-call groups and 16 in the voice-call groups. After initial oral instruction, the proportion of rescuers that received an evaluation of excellent or acceptable did not differ significantly between the groups (video, 41% vs. voice, 50%; P=0.61); however, evaluations for seven rescuers improved after transitioning to video calls. Ultimately, the proportion receiving a poor evaluation was significantly lower in the video-call group than in the voice-call group (50% vs. 82%, P=0.049). Conclusion: Oral instruction communicated by video calls improved the quality of first aid for infants with FBAO.

Background: Maternal hypotension is a common hemodynamic consequence of spinal anesthesia during cesarean delivery, but low-dose spinal anesthesia (<9 mg bupivacaine) ensures stable hemodynamics and reduces motor block. The purpose of this retrospective observational study was to examine the effects of baricity of intrathecal administration of diluted bupivacaine in combined spinal-epidural anesthesia (CSEA) for cesarean delivery on maternal hypotension and motor block after surgery. Methods: The anesthesia and nursing records of 35 patients who had given birth by cesarean delivery under CSEA with intrathecal administration of plain or hyperbaric bupivacaine diluted in cerebrospinal fluid were reviewed. All patients were assigned to who received hyperbaric bupivacaine (hyperbaric group) or plain bupivacaine (plain group). Definition of feasibility of cesarean delivery by diluted low dose bupivacaine was set as no requirement of epidural administration of levobupivacaine during surgery. The incidences of hypotension (nadir blood pressure less than 80% of preanesthetic value) and motor block were reviewed. Results: In 24 of the patients (68%), no additional epidural anesthesia was needed during surgery. One patient (3%) required additional epidural anesthesia before delivery. Feasibility of cesarean delivery was not different between hyperbaric group and plain group (p>0.99). Eighteen of the patients (51%) did not require vasopressors, while 17 (49%) developed hypotension. There was no difference in incidence of maternal hypotension between hyperbaric and plain group. Only 6 patients (17%) required more than 3 times of administration of vasopressors among all patients. Modified Bromage scale scores were recorded in 28 of the patients (80%); scores of 0 (no motor block) were recorded in seven of them, and 1 in eight of them. Conclusion: Low-dose either plain or hyperbaric bupivacaine diluted in cerebrospinal fluid to approximately twice the volume may provide sufficient analgesia, fast motor recovery. Incidence of maternal hypotension was similar in hyperbaric and plain group.

Small-intestinal metastasis from lung cancer, although relatively rare, often causes intestinal obstruction, gastrointestinal perforation, and gastrointestinal bleeding, making it an oncological emergency. Many patients have undergone emergency surgery for treatment of rapid progression of an intestinal metastatic lesion; however, information on changes in such metastases is lacking. We analyzed data from 4 patients with small-intestinal metastases from lung cancer who were treated during a 10-year period (January 2011 to December 2020) and for whom data on change in tumor diameter were available. The average rate of growth in tumor volume was 1.48-fold (range, 1.31- to 1.78-fold) during a median observation period of 22 (4-39) days, a rapid increase. Histopathological analysis showed that, in patients with a high degree of primary tumor atypia, rapid tumor growth may be caused by intratumoral hemorrhage, which was the reason for the rapid increase in tumor volume.

Cutaneous ossification is a rare benign dermatological condition in which bone forms in the dermis or subcutaneous tissue. It is classified as primary when it emerges without a pre-existing condition and secondary when it is associated with an underlying condition such as trauma, scars, inflammation, or neoplastic disease. The secondary form accounts for most cases of cutaneous ossification. The pathogenesis of cutaneous ossification is not clear. Keloids are benign fibroproliferative skin disorders characterized by chronic inflammation. Their pathogenesis is also not fully understood. We report two cases of postoperative secondary ossification in lower abdominal keloids and review the literature on secondary ossification of the skin. We speculate that severe chronic inflammation in keloids drives osteoblastic transformation of mesenchymal stem cells, endothelial cells, or fibroblasts in the keloids.

Apalutamide, an oral androgen receptor signaling inhibitor, is approved for the treatment of non-metastatic castration-resistant prostate cancer and metastatic prostate cancer. In the international randomized placebo-controlled clinical trials, apalutamide was associated with a higher rate of rash than placebo. However, given that reports from a dermatological perspective are limited, the skin manifestations and histopathology of the skin lesions caused by apalutamide are largely unknown. Here, we report a case of apalutamide-induced drug eruption. A 66-year-old man developed itchy maculopapular erythema on the trunk and extremities 10 weeks after starting apalutamide for progressive prostate cancer. A biopsy specimen showed interface dermatitis with perivascular lymphocytic infiltration in the upper dermis. The lymphocyte transformation test was positive for apalutamide. The skin manifestations improved after discontinuation of apalutamide and treatment with topical corticosteroids and systemic prednisolone. A review of the dermatology literature on apalutamide-induced drug eruption yielded only six cases, including our case. Dermatologically, there were four cases of maculopapular rash and two of toxic epidermal necrolysis and histopathologically, there were three cases of interface dermatitis, two of epidermal necrosis, and one of spongiotic dermatitis. Four patients had peripheral eosinophilia. A lymphocyte transformation test was performed in three cases and was positive for apalutamide in all cases. Except for the two cases of toxic epidermal necrolysis, which were fatal, the skin eruptions appeared 10 weeks after starting apalutamide. Considering the increasing number of patients with prostate cancer being treated with apalutamide, cases of apalutamide-induced drug eruption need to be accumulated and analyzed.

Background: Many invasive procedures performed in the emergency room (ER) have potential risks and complications. Because of their limitations, in particular size, portable X-ray devices are generally not used during such procedures. However, miniaturized units enable physicians to obtain X-ray images without assistance. Methods: We developed a safe, compact, and lightweight X-ray unit that was used during five invasive procedures in the ER. In all procedures, a chest X-ray image was obtained, to confirm the utility of the unit. Results: Case 1 (central venous catheter placement): After needle and guidewire insertion and catheter placement, the location of the catheter could be confirmed. Case 2 (chest tube insertion): During insertion of a chest tube into the pleural space, the tip of the thoracic tube was confirmed to be at the correct location. Case 3 (percutaneous tracheostomy or cricothyroidotomy): After needle and guidewire insertion, the guidewire was visualized in the right main bronchus and was inserted into the trachea. Case 4 (resuscitative endovascular aortic balloon of the aorta): The captured image revealed that the catheter was located in zone I before balloon inflation. Case 5 (Sengstaken-Blakemore tube): The image revealed that the balloon was located in the stomach. Conclusions: The portable X-ray unit improved medical safety during invasive procedures frequently performed in the ER.

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a disease in which peripheral sensory and motor nerves of the four limbs are impaired due to autoimmune mechanism-induced demyelinating changes through a 2-month or longer chronic course. The incidence of complication by cranial neuropathy has been reported to be 15%, but there have been very few reports on disorder of the vagus nerve and its branch, the recurrent nerve. We report a patient who developed left recurrent nerve palsy with CIDP. The patient was a 48-year-old male. The disease developed as progressive muscle weakness and numbness of the four limbs 3 years before and was diagnosed as CIDP. The symptoms had been improved by high-dose intravenous gamma-globulin therapy. However, from 2 months before he became aware of breathy hoarseness, and bilateral decreased grip strength and sensory disturbance of the upper and lower limbs recurred and progressed. On laryngoscopy disorder of left vocal fold movement and glottal closure incompetence during phonation were observed, and neurogenic changes were detected in the left thyroarytenoid muscle by needle electromyography for the intrinsic laryngeal muscles. High-dose intravenous gamma-globulin therapy was performed and left vocal fold movement recovered with recovery of bilateral grip strength and sensory disturbance of the upper and lower limbs, and phonation was also normalized.