Advances in next-generation sequencing technologies are rapidly enabling the implementation of genomic medicine. Within the field, hereditary cancers are a leading focus, for which genetic testing is partially covered by the Japanese National Health Insurance. However, only a fraction of hereditary cancers have identifiable causative genetic variants, as revealed by genetic testing. Although identifying all genetic variants across the entire genome, including previously inaccessible regions, has become feasible, our understanding of the millions of variants discovered at the individual level remains limited. Ongoing extensive research aims to understand the cellular-level effects and disease risks of each variant. Furthermore, developing new methodologies, such as genomic foundation models, can further accelerate advances in genomic medicine.

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In recent years, cancer genomic medicine has been widely implemented in the field of solid tumors, playing a pivotal role in treatment decision-making. In hematologic malignancies, advances in understanding molecular pathogenesis have made genomic information indispensable for diagnosis, prognostication, and the selection of targeted therapies. Conventional diagnostic methods-morphological assessment, immunophenotyping, cytogenetic analysis, FISH, and PCR-could detect only a limited set of abnormalities. However, the hematologic malignancy gene panel test, approved in Japan in 2024 and reimbursed under the national insurance system in 2025, enables comprehensive, one-time analysis of 452 relevant genes. This assay features paired analysis of tumor and normal DNA and RNA-based fusion gene detection. Notably, for Fast-track genes designated by the Japanese Society of Hematology, interim results are returned before full analysis completion, allowing early initiation of optimal therapy. For example, detection of FLT3 mutations in acute myeloid leukemia enables the early addition of FLT3 inhibitors to induction therapy. The implementation of this panel facilitates the detection of rare mutations and fusions, refined molecular subtyping, and expanded eligibility for clinical trials and novel agents. Challenges remain, including shortening turnaround time, ensuring specimen quality, improving analytical accuracy, fostering expert human resources, and addressing ethical issues related to data use. Looking ahead, whole-genome and transcriptome sequencing, AI-assisted variant interpretation, integration with measurable residual disease （MRD） monitoring, and international collaborative research are expected to further enhance the precision and scope of care. The introduction of this panel test marks a critical turning point toward advancing precision medicine and improving clinical outcomes in hematologic malignancies.

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Cancer genomic medicine has expanded beyond guiding targeted therapies to include the identification of hereditary cancer predisposition through possible germline pathogenic variants. In urologic oncology, tumor testing used for treatment selection may therefore generate secondary findings with implications for family members, requiring structured counseling and referral pathways. This review summarizes current practices and key challenges across prostate cancer, urothelial carcinoma, and renal cell carcinoma. In prostate cancer, homologous recombination repair gene alterations, particularly BRCA1 and BRCA2 （BRCA1/2）, support the clinical use of poly（ADP-ribose） polymerase （PARP） inhibitors and have advanced precision oncology. However, implementation is limited by complex testing workflows and reimbursement barriers. Germline BRCA variants indicate hereditary breast and ovarian cancer spectrum, warranting cascade testing, family risk assessment, and surveillance for unaffected carriers. In urothelial carcinoma, fibroblast growth factor receptor 2/3 （FGFR2/3） alterations define a targetable molecular subgroup for FGFR inhibition, marking progress toward routine biomarker-guided therapy. Upper tract urothelial carcinoma is also associated with Lynch syndrome, where tumor-based mismatch repair immunohistochemistry and/or microsatellite instability testing can prompt genetic evaluation and enable family-based management. In renal cell carcinoma, systemic therapy is primarily guided by histologic subtype and clinical risk stratification rather than single-gene companion diagnostics. Nevertheless, pathway-directed therapy such as HIF-2α inhibition describes the translational effects of VHL-HIF biology, and the recognition of hereditary renal tumor syndromes （e.g., VHL, Birt-Hogg-Dubé, and FH-related syndromes） and efficient referral routes are essential. Overall, integrating tumor genomics with hereditary cancer assessment and strengthening multidisciplinary collaboration among specialists in urology, pathology, genetics, and genomic tumor boards are key steps for safe and effective implementation.

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With the advancement of cancer genomic medicine, treatment selection based on molecular profiles has become increasingly important. Given that comprehensive genomic profiling （CGP） is generally performed after the completion of standard therapy, limited treatment options and deterioration of patients’ general condition often result in a low rate of access to recommended therapies. This study aimed to report the current status of CGP in gynecologic oncology at our institution. We retrospectively analyzed gynecologic patients who underwent CGP between December 2020 and October 2025. The following variables were evaluated: cancer type, age, performance status, type and timing of CGP tests, type of pathogenic variants, rate of recommended therapies, treatment access rate and details, and reasons for failure to access recommended therapies. Among 66 patients, the cancer types were as follows: cervical in 8; endometrial in 29; ovarian, fallopian tube, or primary peritoneal in 26; vaginal in 1; and double primary （endometrial and ovarian） in 2. CGP was most frequently performed after second-line therapy （53％）. FoundationOne^Ⓡ CDx （Foundation Medicine, Cambridge, MA, USA） was used in approximately 75％ of patients. The rate of recommended therapies was high in patients with endometrial and ovarian cancers, in which druggable mutations were relatively common, but was low in those with cervical cancer and uterine sarcoma. Five patients received genotype-matched therapies, yielding an overall treatment access rate of 7.7％. The main reasons for failure to access treatment were deterioration of performance status and ineligibility for clinical trials. Although CGP was often performed in the late-line setting, and overall treatment access rate remained low, it contributed to the expansion of therapeutic options in selected patients. Optimization of CGP timing and patient selection, as well as the establishment of a comprehensive system that includes management of hereditary tumors, will be important in the future.

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The introduction of insurance coverage for comprehensive genomic profiling tests marks a transition toward precision medicine for pancreatobiliary cancers, which are refractory malignancies associated with poor prognosis. This review outlines the current status of genomic medicine in pancreatobiliary cancers and discusses the optimization of tissue acquisition using endoscopic ultrasound-guided fine-needle biopsy, appropriate timing for testing, latest molecular targeted therapies, and surveillance for pancreatic cancer associated with hereditary tumor syndromes.

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Since the national health insurance coverage of cancer gene panel testing in 2019, cancer genomic medicine in Japan has rapidly transitioned from research to routine practice. This article discusses its implementation challenges and future perspectives, focusing on lung cancer, in which genomic medicine is widely applied, as well as sarcoma and cancer of unknown primary （CUP）. In advanced non-small-cell lung cancer, comprehensive evaluation of driver genes before initial treatment is recommended. Appropriate use of multigene companion diagnostics （multi-CDx） on limited specimens to rapidly determine treatment strategies is critical in determining patient prognosis. Indeed, guidance from the Japan Lung Cancer Society strongly recommends the use of multi-CDx to test all target genes without prioritization. At Showa Medical University Hospital, we have standardized testing strategies involving a multidisciplinary team, including pathology and radiology, based on the Respiratory Cancer Board. This system was maintained without interruption even during the COVID-19 pandemic. Consequently, the analysis success rate improved from 64.7％ at introduction to 97.6％ in recent years, highlighting the importance of optimizing the clinical pathway from sample collection to treatment access. Furthermore, the Showa Medical University Comprehensive Cancer Information Center, which centrally manages cancer care data across affiliated hospitals, serves as a foundation to sustain genomic medicine as a data-driven practice. This article presents practical knowledge centered on lung cancer implementation, which can be extended to rare cancers and CUP.

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In Japan, the adolescent and young adult （AYA） generation, defined as individuals aged 15-39 years, is at a life stage marked by important milestones such as schooling, employment, and family formation. The coexistence of pediatric- and adult-type cancers makes data collection and evaluation challenging. Owing to the scarcity of studies that have specifically investigated oral cancer in this population, a comparative study of non-AYA and AYA patients with oral squamous cell carcinoma （OSCC） who underwent primary surgery at our center was conducted. Overall, data of 260 patients who had undergone initial surgery between October 2014 and December 2023 were retrospectively analyzed. The AYA group included 23 patients aged 15-40 years, whereas the non-AYA group included 237 patients. Patient characteristics, including sex, primary site, T classification, N classification, and overall stage, were analyzed, along with 3-year overall survival （OS） and disease-free survival （DFS） data. The AYA group accounted for 8.8％ of all cases, with the tongue as the primary site （91％）, a rate significantly higher than that in the non-AYA group （p＜0.05）. No significant differences were observed in T, N, or stage distribution and in the 3-year OS （AYA 84.8％ vs. non-AYA 88.7％） or DFS （AYA 68.6％ vs. non-AYA 77.4％）. Postoperatively, 16 of the 20 evaluable AYA patients returned to school or work, and 3 experienced childbirth and childcare. These findings suggest that OSCC predominantly arises in the tongue of AYA patients and that their outcomes are comparable with those of non-AYA patients. Standard treatment is applicable to AYA cases. Given their potential for long-term cancer survivorship, they require comprehensive supportive care.

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Objective: To evaluate the validity of abdominal lift force （ALF） in patients with amyotrophic lateral sclerosis （ALS） by comparing it with measures such as sniff nasal inspiratory pressure （SNIP）, maximal inspiratory mouth pressure （PImax）, and diaphragmatic ultrasound （DUS）. Methods: We enrolled 20 patients with ALS and 14 healthy controls. ALF was measured using a handheld dynamometer; we also measured inspiratory pressures （SNIP, PImax）, pulmonary function, and DUS indices, including diaphragmatic thickness at inspiration （DTi） and expiration （DTe）, thickness ratio （TR＝DTi/DTe）, and maximum excursion （DEmax）. Multiplicity was addressed using hierarchical gatekeeping （Family 1: ALF-SNIP and ALF-PImax; Family 2: ALF vs. DUS, tested only if Family 1 achieved two-sided p＜0.05）. Within Family 2, false discovery rate control was applied using the Benjamini-Hochberg method （q＝0.05）. Results: Patients with ALS exhibited significantly lower ALF （56.4±18.0 vs. 96.8±19.3N）, SNIP （27.0±20.2 vs. 82.4±10.7 cmH₂O）, PImax （28.0±19.7 vs. 65.9±21.7cmH₂O）, DTi （2.2±0.9 vs. 3.5±0.9mm）, TR （1.9±0.7 vs. 2.6±0.6）, and DEmax （33.6±18.8 vs. 54.9±14.9mm） compared with controls （all p≤0.006）. In patients with ALS, ALF correlated strongly with SNIP （rs＝0.831, 95％CI 0.63-0.93, p＜0.001） and moderately with PImax （rs＝0.671, 95％CI 0.31-0.87, p＝0.001）, fulfilling the Family 1 criteria. Additionally, ALF correlated with DTi （rs＝0.685, p＝0.001）, DEmax （rs＝0.507, p＝0.022）, and TR （rs＝0.482, p＝0.031）, all remaining significant after false discovery rate correction （q＝0.0027, 0.031, 0.031）. Sensitivity analyses adjusted for age and body mass index demonstrated minimal attenuation （median Δ＝0.04）, supporting the robustness of the findings. Conclusions: ALF reflects diaphragmatic thickening and caudal displacement and may serve as a reliable alternative or complementary bedside metric when conventional inspiratory pressure measurements are impractical. Its application appears feasible in both clinical and home-based follow-up settings. Larger multicenter longitudinal studies are warranted to confirm reproducibility, interrater agreement, and diaphragmatic specificity.

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Levator aponeurosis-Müller muscle （levator aponeurosis complex） advancement is the most commonly used technique for ptosis surgery at our institution. The upper eyelid white line serves as an important anatomic landmark during surgery, guiding advancement and fixation of the levator aponeurosis or the entire levator aponeurosis complex. However, the visibility of this line varies among patients. We investigated the relationship between upper eyelid white-line visibility and age, sex, and margin reflex distance 1 （MRD-1）―an index of eyelid opening―to determine whether the required advancement of the levator aponeurosis complex for achieving an optimal postoperative MRD-1 could be more accurately predicted. This study included 60 eyes from 35 patients （mean ［SD］ age: 75.2±10.2 years） who underwent ptosis surgery between April 2023 and May 2025 at our institution. Images of the white line were extracted from intraoperative video recordings, and three examiners evaluated visibility using two categories and a four-point scale. Correlations with age, sex, preoperative MRD-1 （pre-MRD）, and change in MRD-1 from before to after surgery （ΔMRD） were analyzed. White-line visibility was weakly-to-moderately positively correlated with age but showed no correlation with sex, pre-MRD, or ΔMRD. Visibility did not differ between sexes and did not influence pre-MRD or ΔMRD, although it tended to increase with age. Surgical records did not document the amount of levator aponeurosis complex advancement, precluding correlation analysis with this variable. Future studies should explore whether preoperative white-line visibility predicts the degree of levator aponeurosis complex advancement necessary for adequate MRD-1 improvement.

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This retrospective, single-center study compared the surgical outcomes of laparoscopic sacrocolpopexy （LSC） and robot-assisted sacrocolpopexy （RSC） for the treatment of pelvic organ prolapse （POP）, with all procedures performed by a single experienced surgeon. A total of 56 patients were included, comprising 38 LSC and 18 RSC cases treated between June 2016 and August 2023. The analysis evaluated patient characteristics, operative parameters, perioperative outcomes, complications, and recurrence rates. No statistically significant differences were observed between the two groups with respect to baseline characteristics, intraoperative blood loss, complication rates, or recurrence, indicating comparable safety and clinical effectiveness of both surgical approaches. Stepwise procedural analysis demonstrated that RSC significantly reduced the time required for posterior vaginal wall manipulation, particularly during suturing, suggesting improved precision and maneuverability in deep pelvic spaces. However, RSC required longer operative time for uterine procedures and anterior vaginal wall dissection, possibly due to reduced tactile feedback. Overall, RSC appears to offer superior maneuverability within confined pelvic anatomy while maintaining outcomes comparable to LSC. Both LSC and RSC are safe and effective treatment options for POP, although larger multicenter studies with long-term follow-up are required to further validate these findings.

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Arytenoid dislocation is typically caused by external factors such as tracheal intubation, upper gastrointestinal endoscopy, or trauma and is generally considered difficult to reduce if diagnosed more than 8 weeks after onset. We report a rare case of arytenoid dislocation in which nonsurgical reduction was successfully performed despite a delayed diagnosis. A 70-year-old woman developed hoarseness following upper gastrointestinal endoscopy and was referred to our department 4 weeks after symptom onset. Initial laryngeal endoscopy suggested idiopathic right vocal fold paralysis. At 8 weeks after onset, persistent symptoms prompted repeat laryngeal endoscopy, which revealed anteromedial displacement of the right arytenoid with absent passive gliding movement, confirming the diagnosis of right arytenoid dislocation. Endoscopic reduction using a balloon catheter under local anesthesia produced limited improvement, necessitating forceps-assisted reduction under general anesthesia. Although no reduction “click” was observed intraoperatively, multiple maneuvers using cotton swabs were performed. While immediate improvement was apparent, by postoperative day 47, both arytenoid position and voice quality had significantly improved.

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Over 20 years have passed since the Temporomandibular Disorders Clinic （hereafter referred to as this clinic） at Showa Medical University Dental Hospital was estbalished in September 2004. This report presents a statistical analysis of patients diagnosed with temporomandibular disorders （TMDs） who visited the clinic during the most recent five-year period. This aim of this review is to update patient-related information and serve as a reference for future treatment strategies. Statistical analyses were performed on data from patients diagnosed with TMDs who visited the department between January 2020 and December 2024. The total number of patients during this five-year period was 3,553 （averaging 711 per year）, comprising 1,086 males and 2,467 females, with a male-to-female ratio of 1：2.3. The age distribution showed a bimodal pattern, with peaks in the 20s and 50s age groups. Pain was the most common chief complaint （53％）. According to the classification of the Japanese Society of Temporomandibular Joint Disorders, Type I was the most prevalent （51％）. Tooth contacting habit was observed in 98％ of patients. Guidance on habit correction was the most common treatment modality （94％）. Treatment resulted in symptom improvement in 70％, 68％, and 63％ of Type Ⅰ, Ⅱ, and Ⅲb cases, respectively. However, approximately 20％ of cases in each classification showed unclear treatment effects. These data provide useful information for developing patient education materials and refining future treatment planning.

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