We developed genomic DNA-targeting long-distance polymerase chain reaction (LD-PCR) to detect ALK fusion genes with various partner genes in ALK+ hematological tumors. DNA was obtained from 3 anaplastic large cell lymphoma (ALCL) cases with NPM1::ALK, 2 ALCL cases with ATIC::ALK, 1 ALCL case with TRAF1::ALK, 1 ALK+ large B-cell lymphoma case with CLTC::ALK, 1 acute myeloid leukemia case with RANBP2::ALK, and 5 additional ALK+ ALCL cases, in which the ALK fusion gene had not been characterized. Forward primers were designed for exons of NPM1, TPM3, ATIC, TRAF1, TFG, CLTC, and RANBP2 and a reverse primer for ALK exon 20. We obtained PCR products representing the fusion sequences in 8 cases with known partners using the corresponding primer combination. For 5 ALCL cases with uncharacterized fusion genes, we performed LD-PCR using combinations of the forward primers for the 7 genes and ALK reverse primer. The results showed that ALK fused to ATIC in 3, TRAF1 in 1, and TFG in 1. A total of 13 ALK breakpoints were randomly distributed within intron 19 and those of the NPM1, ATIC, and TRAF1 genes were located within introns 4, 7, and 6, respectively, without creating subclusters or recurrent breakpoints. This study indicates that LD-PCR can effectively detect the ALK fusion gene in the majority of ALK+ ALCL cases and is useful for rapid diagnosis of the disease.

Purpose: The purpose of this study was to survey the participants of the “2023 Lecture on Regional Medical Cooperation” held by Hospital A about necessary measures for cooperation between the hospital and the community by multidisciplinary professionals, and to provide data to improve future efforts.Methods: Answers were provided via Google Forms. Participants were divided into two groups based on the function of the hospital to which they belonged: “advanced acute/acute care and acute care hospitals” and “convalescent care and chronic care hospitals and other facilities.” Mann-Whitney U test was conducted between the two groups to determine whether the lecture deepened mutual understanding between the hospital and the community and whether it was useful for improving future work. Participants were asked to freely describe “what is needed for cooperation,” and the descriptions were coded, subcategorized, and categorized by the two groups.Ethical considerations: The study was conducted after obtaining approval from the Institutional Review Board of Tenri Hospital (Approval No. 1348; February 28, 2023).Results: Responses were received from 69 participants (response rate, 41.12%). No significant differences were found between the two groups in their evaluation of the lecture in response to the following questions: "Has the mutual understanding of the roles and functions of the community and the hospital been deepened?" and "Is this helpful for future work?" From the free descriptions regarding "What is needed for cooperation?", 21 codes, six subcategories, and two categories were extracted for the advanced acute/acute care and acute care hospitals, and 31 codes, nine subcategories, and three categories were extracted for the convalescent care and chronic care hospitals and other facilities.Conclusion: Our findings suggest that even in medical institutions that prioritize treatment, it is necessary to provide assistance from the viewpoint of daily life after discharge even before hospitalization, that it is important to share with the community the details of decision-making support provided to patients and their families in response to changes in treatment policies, that it is necessary to secure and train personnel who understand the community-based comprehensive care system and can serve as a bridge between the hospitals and the community, and that it is necessary to consider opportunities for education and a place to accumulate and share experiences of collaborative support among multiple professions and institutions.

Patients with BRCA-gene pathogenic variants are at increased risk of developing breast and ovarian cancers, a condition known as hereditary breast and ovarian cancer (HBOC) syndrome. HBOC patients have an increased risk of pancreatic and prostate cancers; however, prophylactic resection is not feasible for these cancer types and screening tests are not covered by insurance. Herein, we report a case of pancreatic cancer that occurred in a patient with bilateral breast cancer who was identified as having germline BRCA pathogenic variants, and discuss current issues.

A 35-year-old woman who had been treated for systemic lupus erythematosus presented with coughing and slight fever that had persisted for two weeks. Computed tomography of the chest revealed a mass-like infiltrate as well as cystic lesion in the right upper lobe with a defect of the posterior segmental bronchus, and antibiotic treatment was initiated. On detecting a deteriorating infiltrate with fluid retention in the cyst a week later, we performed bronchoscopic examination and identified the absence of the orifice of the right posterior segmental bronchus, leading to a diagnosis of congenital bronchial atresia. Although the infiltrate improved with the administration of other antibiotics, considering the possibility of recurrent infection in the future, we performed thoracoscopic segmentectomy. Due to the fact that antibiotic treatment for obstructive pneumonia with bronchial atresia is sometimes difficult, it is important to determine appropriate timing for surgical resection of the affected segment.

We describe two patients with diffuse large B-cell lymphoma (DLBCL)/high-grade B-cell lymphoma (HGBL) that carried t(3;8)(q27;q24)/BCL6::MYC. In case 1, the patient was an 82-year-old man who presented with widespread bone marrow (BM) involvement and leukemic manifestation. Lymphoma cells in BM and peripheral blood were composed of not only large cells but also small cells, and those in the lymph node (LN) biopsy exhibited the germinal center B-cell (GCB) phenotype and carried t(14;18)(q32;q21), suggesting transformation of previously low-grade follicular lymphoma. In case 2, the patient was a 55-year-old man who presented with generalized lymphadenopathy and M protein in serum. Lymphoma cells exhibited the non-GCB/activated B-cell phenotype and included plasma cell-stage cells that expressed CD38 at high levels, indicating that lymphoma cells originated from mature B-cells that had exited GC to secrete immunoglobulins. G-banding revealed a subtle difference between chromosome 3 and 8 homologues in both cases, and fluorescence in situ hybridization revealed co-localization of 3′ BCL6 and 3′ MYC signals at the telomeric end of der(3) and that of 5′ MYC and 5′ BCL6 signals at the telomeric end of der(8), confirming BCL6::MYC gene fusion. The case 1 patient died soon after of disease progression, while the case 2 patient survived for 3 years and 6 months following the initial treatment. LN biopsies in both cases revealed DLBCL/HGBL histopathology with a high Ki-67 proliferation index and MYC expression in 90% of lymphoma cells; however, t(3;8)(q27;q24)/BCL6::MYC may not be regarded as “true” MYC/BCL6 double-hit.

Hearing loss is a common sensory disorder and an important risk factor for dementia; however, whether hearing loss causes dementia or shares a common causative factor with it, such as vascular insufficiency, remains unclear. Recent studies have reported that hearing compensation may prevent the progression of dementia, suggesting that hearing loss is a causative factor. The hypothesized mechanism is: increased cognitive load, cortical modulation following deafferentation, and isolation from social activity. Hearing loss is also related to depression, disequilibrium, and shortened life expectancy, in addition to dementia; however, these risks are poorly recognized. Conductive hearing loss can be cured with surgery. Treatment-resistant conductive hearing loss and moderate sensorineural hearing loss can be compensated with hearing aids. To maximize the effect of hearing aids, practical goal setting, careful fitting, and adequate rehabilitation are mandatory. It is important that patients understand these processes, as it is necessary to use hearing aids appropriately to maximize their benefits. Profound hearing loss patients who get insufficient benefit from hearing aids are candidates for cochlear implantation. In cochlear implantation surgery, the internal device is inserted under the periosteum of the temporal area. The electrode is inserted into the cochlea via the facial recess after mastoidectomy. The battery and the microphone are included in the external device, meaning that the internal device does not require battery replacement and can be used for the patient's lifetime. Cochlear implant users can usually understand face-to-face conversation without visual cues. Cochlear implants are covered by public insurance in Japan. Medical subsidy systems for those with severe mental and physical disabilities and medical aid for livelihood protection are also available.