Myelofibrosis (MF) is a myeloproliferative neoplasm associated with significant morbidity and mortality, and allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only curative approach. While the optimal conditioning regimen before allo-HSCT for MF patients remains to be determined, recent studies have suggested that a thiotepa-busulfan-containing dual-alkylator regimen, FBT regimen, may be associated with favorable outcomes. In Japan, however, thiotepa is not indicated for MF. Here we describe the results of 6 cases of MF treated with melphalan-busulfan containing dual-alkylator regimen, FBM regimen, followed by their first allo-HSCT at a single institution. Neutrophil and platelet engraftment was achieved in all patients. And a full donor chimerism was confirmed in all patients at ＋30 days after allo-HSCT. The relatively small size and short observation period of our study make it difficult to draw a definitive conclusion ; however, our results suggest that a dualalkylator regimen of FBM may be a candidate for an conditioning for allo-HSCT for MF, which should be verified with a large cohort of patients.

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Background : In Japan, patients with coronavirus disease 2019 (COVID-19)^＊ requiring a high-flow nasal cannula (HFNC) are often initially treated in non-specialized facilities and transferred to an intensive care unit if tracheal intubation is required. We aimed to investigate the factors associated with severe respiratory failure requiring tracheal intubation at an early stage in patients with COVID-19 treated using HFNCs.
Methods : This retrospective cohort study compared the clinical features of consecutively enrolled patients with polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus-2 infection admitted to two centers in Japan between early February 2020 and late June 2021.
Results : A total of 35 patients with COVID-19 treated using HFNCs were included. Treatment success and failure occurred in 25 and 10 patients, respectively. The oxygen saturation (ROX) index (ratio of oxygen saturation [SpO₂] to fraction of inspired oxygen [FiO₂] and the respiratory rate) 12 h post-HFNC insertion was a useful predictor of HFNC failure (success group, 8.0 ; failure group, 6.5 : P＝0.0005). Moreover, the time from symptom onset to respiratory failure was significantly shorter in the failure group than in the success group (3.0 and 5.0 days, P＝0.004).
Conclusions The ROX index and time from symptom onset to respiratory failure were useful predictors of HFNC failure.

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The case is a 68-year-old man. He was treated with fourth-line atezolizumab for adenocarcinoma of the left upper lobe of the lung and achieved tumor shrinkage. Hemoptysis began on day 6 of the third course, and he was intubated and ventilated. Angiography revealed that the left bronchial artery and left internal thoracic artery formed a shunt with the pulmonary artery, which was thought to be the source of the bleeding. It is thought that the tumor formed a shunt because it invaded the blood vessel. Transcatheter arterial embolization was performed at the same site and hemostasis was achieved, suggesting that the significant shrinkage of the tumor caused by atezolizumab may have contributed to the massive hemoptysis.

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Mycotic intracranial aneurysms (MIAs) are rare infection-mediated arterial wall destructions that result in focal vessel weakness and dilatation. They commonly involve the anterior cerebral circulation, usually following hematogenous embolization from infective cardiac vegetation, and are associated with an elevated risk of rupture. MIAs arising from a posterior inferior cerebellar artery (PICA) are uncommon, and those resulting from contiguous infections are extremely rare. Here, we present a case report and review the literature on rare MIAs involving the distal PICA segment following meningitis after endoscopic endonasal transsphenoidal surgery. A 75-year-old man presented with a 2-year history of progressive visual impairment of the left eye, for which initial cranial magnetic resonance imaging suggested optic perineuritis ; however, conservative management with high-dose steroid therapy did not improve the patient's condition. He subsequently had biopsy, which confirmed an optic nerve sheath meningioma, for which optic nerve decompression via the endoscopic endonasal approach (EEA) and follow-up radiation therapy was done. He developed postoperative meningitis and subsequently had rupture of left PICA mycotic aneurysm (angiography done a month earlier demonstrated normal left PICA). Risk factors for meningitis were invasive cranial intervention, prolonged steroid use, and radiation therapy. Coil embolization was successfully performed ; however, the patient succumbed to irreversible herniation and infection. MIAs arising from the PICA following meningitis are rare, but complications following surgical intervention and rupture are associated with high morbidity and mortality. A high index of suspicion and early intervention before rupture may prevent poor outcomes.

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