Used to treat type I allergies, allergen immunotherapy (AIT) can lead to sustained remission even after treatment cessation. In Japan, sublingual immunotherapy (SLIT) is the only therapeutic option for allergic rhinitis caused by Japanese cedar pollinosis (JCP) and house dust mite (HDM) allergies. Clinical studies have shown that SLIT tablets reduce symptom scores by approximately 30% while maintaining a high safety profile; serious adverse events are rare, and most reactions are mild, local irritations. Japanese multicenter studies have also confirmed the safety of concomitant administration of JCP and HDM SLIT tablets within a five-minute interval. Additionally, JCP SLIT shows cross-efficacy against Japanese cypress pollinosis. While a treatment period of 3-5 years is recommended for long-term efficacy, significant clinical benefits are often observed during the first pollen season. Japan maintains a high adherence rate of approximately 80%, underscoring the importance of proper patient selection and pretreatment education. Thanks to its efficacy, safety, and non-invasive nature, SLIT continues to play a central role in the management of allergic rhinitis in Japan.

Purpose: To investigate morphological changes associated with lamellar macular hole (LMH). Methods: We retrospectively reviewed data for all eyes with LMH, as determined by spectral-domain optical coherence tomography (OCT), from patients who had undergone vitrectomy and had at least 12 months of preoperative and 6 months of postoperative follow-up data. Eyes were classified as those with morphological changes in the epiretinal membrane (ERM), macular pseudohole (MPH), or ERM-foveoschisis (ERM-FS) that were observed before LMH formation (group A), and those in which LMH was present at the first visit and remained unchanged until surgery (group B). Follow-up time (from first visit to surgery), time from detection of diseases associated with LMH, and morphological changes were analyzed. Results: Of 14 eyes of 14 patients, 9 were in group A and 5 were in group B, and mean follow-up time was 49.2 ± 23.5 months and 44.4 ± 25.4 months in groups A and B, respectively. In group A, LMH formed through ERM in 1 eye, MPH in 2 eyes, and ERM-FS in 6 eyes; 5 eyes maintained LMH morphology for longer than 12 months. The mean time from associated disease to LMH was 11.2 ± 13.8 months, and 30.3 ± 25.5 months from LMH to surgery. BCVA significantly improved in group A (p<0.05) but not in group B (p=0.0579). Neither time to surgery in group A nor follow-up time correlated with postoperative BCVA. Conclusion: LMH likely forms through progression of associated diseases, and time from LMH to surgery was not significantly associated with visual outcomes.

Background: Oncotype DX is an important tool for guiding perioperative treatment in estrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative breast cancer. Real-world retrospective studies are essential for validating its clinical utility. Methods: We retrospectively evaluated the association of Oncotype DX Recurrence Score (ODRS) with clinical and pathological characteristics, chemotherapy regimen, and recurrence-free survival (RFS) in consecutive patients with ER-positive/HER2-negative primary breast cancer. Results: A total of 133 patients underwent Oncotype DX testing to determine the need for adjuvant chemotherapy. Mean age was 49.2 years, 67.7% of the patients were premenopausal, and 50.4% had nodal metastases. Mean ODRS was 19.5. Patients were categorized into three risk groups: low (ODRS 0-15, 40.6%), intermediate (16-25, 36.1%), and high (≥26, 23.3%). ODRS was significantly correlated with histologic grade, ER, PgR, and Ki-67. Endocrine therapy alone was administered to all low-risk patients. Chemotherapy was administered to 20.8% of patients at intermediate risk and 67.7% of patients at high risk. Multivariate analysis confirmed that ODRS was the strongest predictor of chemotherapy administration. During a median follow-up of 30.4 months, three distant recurrences occurred (in two intermediate-risk patients and one high-risk patient). No recurrence was observed in the low-risk group. RFS was worse in higher ODRS categories. Conclusions: Real-world data demonstrate that ODRS correlates with key pathological characteristics and can guide adjuvant therapy selection, independent of menopausal status or nodal involvement. This suggests that ODRS is useful in tailoring chemotherapy decisions in ER-positive/HER2-negative breast cancer.

Background: Depression in later life is associated with dopaminergic dysfunction and increased risk of neurodegenerative disorders, although the relationship between dopamine transporter (DAT) availability and tau accumulation remains unclear. Although previous studies have linked tau and DAT in neurodegenerative diseases, evidence related to depression is limited. Therefore, this study used positron emission tomography (PET) to investigate the association between tau pathology and DAT availability in elderly adults with depression. Methods: Six patients diagnosed with depression according to ICD-10 criteria underwent PET scans with PET radioligands that enable accurate in vivo assessment, namely, florzolotau (18F) for tau and [¹⁸F]FE-PE2I for DAT. Clinical assessments using the Mini-Mental State Examination (MMSE) and Hamilton Depression Rating Scale (HAM-D) were performed for all patients. Tau standardized uptake value ratios (SUVR) in the striatal and cortical regions and DAT binding potentials (BP_ND) in the striatum were calculated. Results: Tau SUVR in all regions was negatively correlated with DAT BP_ND in the striatum, suggesting that greater tau burden may be linked to dopaminergic dysfunction. Tau SUVR in the striatum was negatively correlated with MMSE, indicating that tau accumulation may be related to subtle cognitive decline. DAT BP_ND in the striatum was not correlated with HAM-D. Conclusions: These preliminary results suggest a link between tau pathology and dopaminergic dysfunction in elderly adults with depression.

Background: Peripheral nerve injury induces neuroinflammation in the dorsal root ganglion (DRG), which is a major cause of neuropathic pain. Interferon regulatory factors (IRFs) are a family of transcription factors that regulate the expression of inflammatory genes. Although several IRFs affect nociceptive transmission in the spinal cord, their roles in the DRG remain largely unknown. Methods: Spinal nerve ligation (SNL) was used to develop a rat neuropathic pain model. Pain-related behaviors were assessed by the von Frey test and Plantar test. Gene expression levels of IRF family members were examined using quantitative PCR or immunofluorescence. IRF8 expression was downregulated by intrathecal administration of small interfering RNA (siRNA). Results: IRF1, IRF5, and IRF8 were upregulated 4 days after nerve injury, but their expression gradually declined thereafter. In contrast, IRF4 and IRF7 expression gradually increased during an observation period of 14 days. No significant changes were observed in the expression of IRF2, IRF3, IRF6, or IRF9 after injury despite a slight increase. IRF8, which exhibited the greatest change in expression, was expressed in DRG neurons of naïve rats, and its distribution was not altered by nerve injury. IRF8 knockdown alleviated mechanical allodynia but not thermal hyperalgesia in neuropathic pain. Conclusion: To our knowledge, these results are the first to show that multiple IRFs are upregulated in the DRG after peripheral nerve injury. The upregulated members of IRF family in the DRG after nerve injury may be involved in the pathophysiology of neuropathic pain.

Background: Selenium is an important trace element that helps maintain physiological functions. We calculated the incidence of selenium deficiency in enterally and parenterally fed patients with acute neurologic disorders. Methods: We enrolled 39 consecutive patients who received enteral and/or parenteral nutrition for 14 days or longer (23 men, mean age 74.6 years). Serum selenium was recorded on admission and at 2 weeks and 1 month thereafter. Low selenium was defined as a level lower than 107 μg/L. A diagnosis of selenium deficiency was based on the clinical guidelines for selenium deficiency. Results: The mean serum selenium level at admission was 119.9 μg/L in 38 patients but was lower in the 39th patient, who had undergone prolonged tube feeding. There was a weak negative correlation between selenium level and patient age, and when the age cutoff for detecting low selenium was set to 75 years, the sensitivity was 91.7% and the specificity was 53.8%. No selenium-deficient patients presented with clinical symptoms associated with selenium deficiency (all had subclinical low selenium). Selenium was normal in 26 patients, although 2 presented with low selenium 2 weeks post-admission. At 1 month after admission, no patient had a low selenium level. Conclusion: Our findings suggest that selenium measurement on admission may be advisable for patients aged 75 years or older and for those undergoing hemodialysis or prolonged tube feeding. Selenium deficiency is a concern when neurosurgery patients with acute neurologic disorders are fed enterally or parenterally.

Background: Extracorporeal membrane oxygenation (ECMO) is a resource-intensive life support therapy associated with high complication rates. Blood products are a major cost driver, yet their impact on outcomes under the Japanese health insurance system remains unclear. This study investigated the association between transfusion burden and clinical outcomes in ECMO patients. Methods: We retrospectively analyzed data from 112 adult patients who received ECMO at Nippon Medical School Hospital between 2014 and 2023. Baseline characteristics, laboratory findings, and transfusion volumes of red blood cells (RBCs), fresh frozen plasma (FFP), and platelets were compared in relation to survival and death. Sixty-day mortality was assessed using Kaplan-Meier analysis and Cox proportional hazards models. Predictors of transfusion burden were evaluated with multivariable regression. Results: Transfusion of FFP (hazard ratio [HR] 2.00, 95% confidence interval [CI] 1.15-3.46) and RBCs (HR 2.37, 95%CI 1.14-4.93) were independently associated with increased 60-day mortality, whereas platelet transfusion was not. Nonsurvivors required significantly larger volumes of all blood products. Transfusion burden was primarily determined by longer ECMO duration and lower fibrinogen levels. Blood products accounted for 56.1% of drug-related expenditures during ECMO. Conclusions: Transfusion burden was a key determinant of mortality and cost in ECMO patients and was mainly affected by prolonged ECMO duration and low fibrinogen levels. These findings highlight the clinical and economic impact of transfusion practices and underscore the need for prospective multicenter validation to establish evidence-based transfusion strategies in Japan.

Psoriasis is a condition characterized by chronic inflammation of the skin, epidermal hyperproliferation, and dysregulated differentiation driven by acceleration of the tumor necrosis factor-alpha/interleukin (IL)-23/IL-17 axis. Herein, we report a case of generalized pustular psoriasis initially managed with etretinate, apremilast, and risankizumab in a Japanese man. Because of side effects, a therapeutic transition was made to brodalumab at 7 months after the initial consultation. His dermatological symptoms improved; however, hemoglobin concentration decreased to 7.6 g/dL after 4 months of treatment. Diagnostic investigation revealed warm autoimmune hemolytic anemia (AIHA). To our knowledge, this is the first report of AIHA during treatment with brodalumab for generalized pustular psoriasis. The etiological association between AIHA and psoriasis is unclear. Future studies should investigate whether AIHA accompanies pustular psoriasis or results from drug-induced AIHA secondary to brodalumab administration. Our findings suggest that the risk of AIHA in patients with psoriasis treated with brodalumab warrants careful consideration.

We present a case of permanent bilateral lower limb paralysis after epidural anesthesia. A 71-year-old woman (height 159 cm; weight 48.5 kg; American Society of Anesthesiologists Physical Status 2) with a history of hypertension (treated with nifedipine), benign goiter (under surveillance), surgeries for appendicitis, and a previous left humerus fracture had received general anesthesia with epidural anesthesia during two surgical procedures, namely, laparoscopic-assisted low anterior resection with colostomy and laparoscopic-assisted colostomy closure. She developed left-predominant lower limb paralysis after the first epidural anesthesia (using ropivacaine and levobupivacaine). The symptoms had no identifiable cause, persisted after removal of the epidural catheter, and gradually resolved during rehabilitation. Her lower limb paralysis recurred and progressed, however, after the second epidural anesthesia (using levobupivacaine alone), and she has abnormal spinal reflexes and elevated myelin basic protein in cerebrospinal fluid. Although these findings suggested that bilateral lower limb paralysis was caused by a lesion in the central nervous system (thoracolumbar spinal cord), postoperative MRI scans of the vertebrae/spinal cord and head failed to identify the site of the damage. We concluded that permanent bilateral lower limb paralysis was likely caused by epidural anesthesia, but the mechanism could not be identified.

Parastomal hernia of the ileal conduit (PHIC) is a long-term complication of radical cystectomy (RC) for bladder cancer. A systematic review reported an estimated incidence of PHIC after RC of 17%. Several surgical techniques have been reported for treating parastomal hernias. However, few studies have investigated treatment of PHIC, and there are no guidelines for the optimal approach for PHIC repair. Here, we describe a case in which good results were achieved using the laparoscopic Sugarbaker (LS) technique with a tailored mesh for PHIC. An 80-year-old Japanese woman underwent robot-assisted radical cystectomy for bladder cancer. Ten months after surgery, she was diagnosed as having bowel obstruction due to PHIC. The LS technique was performed using a tailored mesh. Severe small-intestinal adhesions from previous surgeries were safely divided using laparoscopic surgery. No hernia recurrence was observed at 2 years postoperatively. We used the LS technique to treat PHIC, and severe small-intestinal adhesions were safely treated using laparoscopic surgery. The LS technique appears to be a viable therapeutic option for such cases.