Fukushima Journal of Medical Science最新文献

This meta-analysis aimed to investigate the impact of pretreatment quality of life (QoL) on overall survival (OS) in patients with hematological malignancies. The observational studies with relationship between QoL and OS in patients undergoing either hematopoietic stem cell transplantation (HSCT) or chemotherapy were collected. Stratification by treatment was performed to examine the association between QoL and OS. Six articles were included in the analysis. Overall, significant associations with OS were observed for global QoL (hazard ratio [HR] = 1.04, 95% confidence interval [CI] = 1.01-1.08), physical QoL (HR = 1.06, 95% CI:1.02-1.10), and social QoL (HR = 1.02, 95% CI: 1.00-1.03). When stratified by treatment, HSCT showed significant associations between OS and both global QoL (HR = 1.05, 95% CI:1.00-1.11) and physical QoL (HR = 1.03, 95% CI:1.00-1.06). For chemotherapy, significant associations were also observed between OS and global QoL (HR = 1.04, 95% CI:1.00-1.09), physical QoL (HR = 1.08, 95% CI:1.00-1.17), role QoL (HR = 1.02, 95% CI:1.00-1.04), and social QoL (HR = 1.02, 95% CI:1.00-1.04). No significant associations were observed regarding emotional QoL, which was only analyzed in HSCT. The factors influencing OS may vary depending on the treatment, emphasizing the importance of recognizing QoL from the pretreatment stage.

The diagnosis and treatment of malignant spinal tumors are complex and require an integrated approach known as Jaffe's triangle.　This review discusses recent topics in the diagnosis and treatment of primary and metastatic malignant spinal tumors.　Integrated diagnostic methods, including the development of a dumbbell scoring system for benign-malignant differentiation and the use of positron emission tomography and magnetic resonance imaging (PET-MRI), have improved diagnostic accuracy.　Curative resection techniques such as vertebrectomy, sagittal resection, and posterior resection are crucial for primary malignant tumors.　Heavy particle radiation therapy, such as carbon-ion radiotherapy, shows promise against radiation-resistant tumors, whereas novel drug therapies, such as denosumab, are effective for giant cell tumors of the bone arising in the spine.　For metastatic spinal tumors, the collaborative efforts of the Bone Metastasis Cancer Board and minimally invasive spine stabilization have expanded surgical indications and improved patient outcomes.　The treatment system has shifted towards preventive surgery and outpatient management, aiming to maintain quality of life and continue chemotherapy.　Interdisciplinary collaboration is essential for improving treatment outcomes in both primary and metastatic malignant spinal tumors.Primary malignant spinal cord tumors (PMST) and metastatic spinal tumors (MST) are among the most difficult areas of orthopedic surgery.　Their diagnosis and treatment require multidisciplinary diagnostic and therapeutic strategies that integrate knowledge and skills in orthopedics, pathology, and diagnostic radiology (the so-called Jaffe triangle), as well as in clinical oncology and tumor biology, which have made remarkable progress in recent years.　Here, we review recent topics related to the diagnosis and treatment of PMST and MST.

H3K4 methylation, primarily mediated by MLL family proteins, plays a pivotal role in the epigenetic regulation of gene transcription. Among the MLL family, KMT2A is known for its critical role in hematopoiesis. MLL family proteins feature C-terminal SET catalytic domains, requiring the formation of MLL complexes with proteins like DPY30 to maximize their enzymatic activity. Deletion of DPY30 results in a significant reduction in H3K4me1, H3K4me2, and H3K4me3 levels in bone marrow (BM) cells, underscoring the essential role of DPY30 in facilitating optimal catalytic activity within MLL family complexes. Here, we present a unique case of myelodysplastic neoplasms (MDS) associated with a novel t(2;19)(p23;q13.3) translocation. A 22-year-old pregnant woman initially sought consultation due to thrombocytopenia, which temporarily improved following a miscarriage. However, she later presented with progressive pancytopenia. RNA sequencing analysis of BM mononuclear cells using STAR-Fusion revealed the translocation breakpoint on chromosomes, resulting in the disruption of the DPY30 and CEACAM6 genes. BM failure showed marked improvement following cord blood transplantation. This case represents a novel form of MDS associated with the disruption of the DPY30 gene. Our findings underscore the importance of considering early hematopoietic stem cell transplantation for MDS cases attributed to DPY30 dysfunction.

This study evaluated the outcomes of simultaneous pancreas-kidney transplantation (SPK) at Fukushima Medical University between 2001 and 2024.　We retrospectively reviewed ten adult patients who underwent SPK.　We aimed to clarify the important aspects of patient management in patients undergoing SPK, focusing on perioperative outcomes and long-term complications.The median postoperative observation period was 1,968 days.　Postoperative complications were observed in all patients.　Most were classified as Clavien-Dindo (CD) grade I or II, but major complications, including CD grade IIIa or higher, were observed in four patients (40%) with zero mortality.　Despite the loss of one kidney graft due to primary non-function, the 5-year survival rates for both patients and pancreatic grafts remained at 100%.　However, there was one case each of pancreatic graft loss, kidney graft loss, and patient death after 5 years post-transplantation, all attributed to late-onset complications, including recurrent type 1 diabetes, focal segmental glomerulosclerosis, and cardiovascular disease.The short-term outcomes of SPK at our institution were favorable, with a trend toward a reduction in the comprehensive complication index (CCI) observed in the latter five cases compared with the first five cases, suggesting potential improvements in perioperative management.　Long-term monitoring and collaboration with physicians are essential to enhance patient outcomes.　.

Meta-iodobenzylguanidine (MIBG) is an analog of norepinephrine and guanethidine, and MIBG scintigraphy is useful to diagnose tumors of the sympathetic nervous system, such as pheochromocytoma, paraganglioma, and neuroblastoma.　To date, there have been few reports of MIBG accumulation in gastrointestinal stromal tumors (GISTs), so the mechanism and frequency of MIBG accumulation in GISTs are unknown.　Herein, we report and discuss three cases of GIST in which scintigraphy that was performed to exclude pheochromocytoma showed MIBG accumulation.

Objectives: In inflammatory bowel disease therapy, thiopurines have been essential.　However, several reports have investigated factors affecting thiopurine metabolism to date.　This study investigated factors affecting intracellular concentrations of 6-thioguanine nucleotide (6-TGN) and 6-methylmercaptopurine (6-MMP) in a real-world setting.

Methods: Between May 2013 and October 2021 in one institution, 44 patients (median age 44 years;male 35, female 9;ulcerative colitis 32, Crohn's disease 12) receiving thiopurines were reviewed.　Intracellular 6-TGN/6-MMP concentrations were measured by high-performance liquid chromatography, and the initial measurement in each patient was used for the study.

Results: The 6-TGN level was significantly higher in females, with mild disease activity, absence of NUDT15 polymorphism, and allopurinol administration.　A higher trend was observed with high thiopurine dosage (>50 mg).　6-MMP levels were significantly lower with concomitant use of time-dependent 5-aminosalicylic acid (5-ASA) and allopurinol, and higher with high thiopurine dosage.　On multivariate analysis of variance, logarithmically transformed 6-TGN levels were significantly higher in females, with high thiopurine dosage, and allopurinol administration.　Similarly, logarithmically transformed 6-MMP levels were significantly higher with time-dependent 5-ASA administration and high thiopurine dosage.

Conclusions: Patients who received allopurinol, a high dose of thiopurine, or were female showed higher 6-TGN levels.

Introduction: We investigated the drug resistance status of Pseudomonas aeruginosa (P. aeruginosa) focusing on its isolation sites and types of diseases.　Materials and methods: A microbiological laboratory database was searched to identify all clinical cultures positive for P. aeruginosa.　Clinicopathologic features and susceptibility of P. aeruginosa to any antibiotics were evaluated in patients admitted to the division of upper (Upper-GI group) or lower gastrointestinal surgery (Lower-GI group).　In addition, we investigated the susceptibility of P. aeruginosa to any antibiotics based on the isolation site.　Results:P. aeruginosa was frequently detected in the sputum and urine of the Upper-GI and Lower-GI groups, respectively.　Among P. aeruginosa isolates from drain discharge, a significantly higher rate of resistance to imipenem, amikacin, and ciprofloxacin was observed; among P. aeruginosa isolates from wounds, a substantially higher proportion had resistance to imipenem and cefozopran in the Upper-GI group.　However, there was no difference between the two groups in the drug resistance of P. aeruginosa isolated from urine, sputum, blood, and ascites.　P. aeruginosa isolated from sputum showed more resistance to imipenem and ciprofloxacin than those isolated from other sites.　Conclusion: There were significant differences in the drug resistance of P. aeruginosa based on the isolation sites and types of diseases.　.

Since 2000, rapid antigen detection kits and anti-influenza drugs have been used for the early diagnosis and treatment of influenza in Japan, respectively.　The main drugs available in clinical practice are the neuraminidase inhibitors oseltamivir, zanamivir, laninamivir, and peramivir, as well as the cap-dependent endonuclease inhibitor baloxavir marboxil.　Antiviral therapy with neuraminidase inhibitors has been practiced for many years, especially in Japan; it can shorten the febrile period and reduce complications.　Despite having similar structures, the pharmacologic background of neuraminidase inhibitors differs significantly, as reflected in their varying clinical efficacy.　Due to its inhibitory mechanism, baloxavir marboxil can rapidly reduce the viral load than neuraminidase inhibitors.　However, the duration of symptoms was similar after the administration of baloxavir marboxil and oseltamivir, and variants with reduced drug susceptibility have been detected in 20%-30% of pediatric patients treated with baloxavir marboxil.　Clinical trials of several novel anti-influenza drugs are currently underway.　When these drugs are first marketed, the characteristics of the influenza virus and the pharmacologic background of the drugs must be clarified before their administration to patients in clinical practice.

Acute pancreatitis in children in Japan is often caused by an anatomical abnormality of the pancreatic and bile duct, resulting in fever, abdominal pain, vomiting, diarrhea, and other symptoms.　Crohn's disease, however, is a chronic granulomatous inflammatory bowel disease with ulcerative lesions of the intestinal tract of unknown cause that occurs mainly in young people, with symptoms similar to those of acute pancreatitis.　We report a case of acute pancreatitis diagnosed in a patient not only with incomplete fusion of the pancreatic duct but also with Crohn's disease.　A 14-year-old girl, healthy by nature, presented to our hospital with complaints of abdominal pain and diarrhea.　She was initially diagnosed as having acute pancreatitis due to incomplete pancreas divisum.　However, a high level of fecal calprotectin led to endoscopic examination, which resulted in the diagnosis of Crohn's disease.　Fecal calprotectin can be useful in the diagnosis of inflammatory bowel disease associated with acute pancreatitis in children.　Although the relationship between inflammatory bowel disease and acute pancreatitis has not yet been clarified, we suggest that in the present case, acute pancreatitis may have manifested as a complication of Crohn's disease and an underlying case of incomplete pancreas divisum.

Fukushima Medical University (FMU) organizes annual International Symposiums on the Fukushima Health Management Survey (FHMS) to share up-to-date Survey findings.　In response to radiation released from the Tokyo Electric Power Company's Fukushima Daiichi Nuclear Power Plant after the Great East Japan Earthquake, the FHMS was established with the aim of providing long-term follow-up for the physical and mental health of Fukushima residents, and maintaining and improving their health into the future.　This year, the sixth annual symposium was convened in Tokyo on Saturday, March 2, 2024, with the theme, "3.11:Sharing Lessons of Fukushima with Japan and the World."