Internal Medicine最新文献

Recent advances in endoscopic equipment have improved the diagnosis of gastrointestinal tumors. Image-enhanced endoscopy, including narrow-band imaging, blue light imaging, and linked color imaging, has unified magnifying observation classification methods and significantly improved the qualitative and quantitative diagnostic performance of gastrointestinal epithelial tumors. Endoscopic submucosal dissection (ESD), a minimally invasive treatment for early-stage gastrointestinal cancer, is widely used. The aging population in Japan has been gradually increasing. Despite this, ESD has shown good outcomes in older adults. However, long-term prognostic analyses should take into account the high mortality rate from other illnesses. Prognostic indicators such as the Charlson Comorbidity Index (CCI) and the Prognostic Nutrition Index (PNI) should be used to determine whether ESD should be performed. Even in cases of noncurative resection, follow-up without additional surgical resection is an option if there are other comorbidities that affect the prognosis.

Inflammatory bowel disease (IBD) is a multifactorial disorder resulting from a complex interplay among genetic predisposition, immune dysregulation, intestinal microbiota, and environmental factors. This dynamic interaction leads to aberrant immune activation within the gastrointestinal tract, ultimately leading to chronic inflammation. Recent advances in elucidating the pathophysiology of this disease have facilitated the development of molecularly targeted therapies. This review provides a critical appraisal of these emerging therapeutic strategies and emphasizes their potential impact on disease management.

The efficacy of the anti-influenza drugs was examined before and after the 2009 H1N1 pandemic. Anti-influenza drugs reduce the viral load, which leads to improvement of symptoms, a reduced illness period, suppression of complications, and protection from transmission. It is desirable to administer antiviral drugs within 48 hours of the onset of symptoms. The use of antiviral drugs is limited mainly to individuals who are hospitalized, those who have severe, complicated, or progressive illness, or those who are at high risk for influenza complications in Western countries. On the other hand, the rapid diagnosis of influenza and treatment with antiviral drugs have been effective in Japan, leading to the suppression of worsening symptoms. Baloxavir, the newest anti-influenza drug, and neuraminidase inhibitors are recommended for use in adult patients.

Progress in the development of molecular-targeted therapies in the field of inflammatory bowel disease has been remarkable. With the advent of molecular-targeted agents, treatment strategies have changed, and higher-level treatment goals have been set. In terms of the long-term prognosis of inflammatory bowel disease, there has been a clear decline in the rate of surgery since 2000 when anti-tumor necrosis factor antibody preparations were introduced. However, a large number of molecular-targeted agents with diverse modes of action have appeared, and their positioning has become complicated and often confusing for clinicians. Furthermore, these agents are expensive and therefore present economic challenges. The selection of therapeutic agents for inflammatory bowel disease based on the mode of action and prediction of treatment effects continues to be a major issue, and it is hoped that artificial intelligence and machine learning will help resolve these problems.

When large-vessel occlusion (LVO) occurs in acute ischemic stroke, accurate differentiation of intracranial atherosclerosis-related occlusion (ICAD-O) from embolism-related occlusion (EMB-O) is critical for guiding treatment decisions. This review focuses on the preoperative prediction of ICAD-O and emphasizes the practical clinical and imaging factors. ICAD-O is often associated with younger age, male sex, and vascular risk factors, such as hypertension and diabetes, and the absence of atrial fibrillation is a key characteristic of its differentiation. Imaging findings, including truncal-type occlusion and non-culprit stenosis, further aid in the identification of ICAD-O. Predictive scales integrating clinical and imaging data, such as the ISAT, REMIT, ABC²D, and ATHE scores, provide structured approaches for distinguishing ICAD-O from EMB-O. By reviewing these predictive tools and findings, this review aims to enhance the accuracy and efficiency of the preoperative diagnosis, supporting better-informed clinical decision-making for stroke patients with LVO.

Phase 3 clinical trials have validated the clinical efficacy of some anti-amyloid β (Aβ) antibody therapies, such as lecanemab and donanemab. To date, several clinical trials of anti-Aβ drugs have been conducted. However, most of these methods have been unsuccessful. Various Aβ aggregates are present during Aβ aggregation. The difference in the clinical efficacy of anti-Aβ antibody therapy may be attributed to variations in the Aβ aggregates targeted. Lecanemab primarily targets protofibrils, and donanemab targets plaques. Solanezumab and bapinezumab target Aβ aggregates of monomers alone or from monomers to low molecular weight oligomers. Anti-Aβ antibody therapies with clinical cognitive efficacy are thus characterized by targeting large-molecular-weight Aβ aggregates, such as protofibrils and plaques. In addition, a positive association was observed between the reduction in amyloid deposition and the inhibition of cognitive decline.

Percutaneous coronary intervention (PCI) has become the standard procedure for patients with angina and acute coronary syndrome. From the perspective of technology and technique, PCI has advanced over the last four decades, resulting in considerably improved clinical outcomes in patients with coronary artery disease in the current era. In this review article, we summarize recent advances, promising technologies, and areas for research in the field of PCI.

Migraine is a prevalent and highly disabling neurological disorder. Recent progress in neuroscientific research has contributed to the development of new therapies for migraine, including triptans, ditans, calcitonin gene-related peptide (CGRP) antagonists, and CGRP-related monoclonal antibodies. Noninvasive neuromodulation devices have also been developed. We herein review the recent advances in research and the current standard of management for migraine patients.

The number of patients with cancer qualifying for treatment with immune checkpoint inhibitors (ICIs) continues to increase, and a clearer understanding of the mechanisms underlying their activity-driven side effects, or immune-related adverse events (irAEs), has become crucial. Patients receiving ICIs can develop irAEs in any organ, and numerous studies have suggested that irAE development may be associated with improved ICI efficacy. However, the robustness and magnitude of such associations are unclear, and little is known about the relationship between irAE development and ICI efficacy at the individual organ level. A precise understanding of these links could improve patient care and provide further insight into the immunological mechanisms underlying both irAE development and ICI efficacy. We herein review the prognostic implications of irAEs occurring in patients with cancer treated with ICIs and discuss outstanding issues that should be addressed in future studies.

In the pathophysiology of Alzheimer's disease (AD), the amyloid hypothesis, which posits that amyloid β-protein (Aβ) abnormally aggregates and damages neurons with tau, has been proposed. It was originally thought that the accumulation of insoluble amyloid fibrils in the brain leads to AD-inducing neurotoxicity; however, in recent years, the positioning of early and intermediate aggregates has also been emphasized. In particular, following the positive results of phase 3 clinical trials of lecanemab and its approval in Japan and the United States, the pathology of protofibrils, which are the target molecules of lecanemab, has attracted attention. Using high-speed atomic force microscopy, we have previously reported that lecanemab, which has a high affinity for protofibrils, binds to and surrounds them. Donanemab, a recombinant monoclonal antibody that primarily targets fibrils composed of N3pG Aβ, has also attracted attention because of its efficacy in phase 3 clinical trials in patients with early stage AD.