Immune checkpoint inhibitors (ICIs) have demonstrated substantial efficacy in the treatment of triple-negative breast cancer (TNBC). However, appropriate management of immune-related adverse events (irAEs) remains essential, and patients with a history of autoimmune disease have an increased risk of developing irAEs. Immune-related uveitis represents an uncommon irAE overall and has been reported most frequently in melanoma, whereas reports among patients with BC remain rare. We describe a case of ICI-associated uveitis occurring shortly after treatment initiation in a patient with a very remote history of autoimmune uveitis. A woman in her 50s with locally advanced TNBC (cT4bN0M0, stage IIIB) and a history of Vogt-Koyanagi-Harada disease-associated uveitis in complete remission for more than 25 years received neoadjuvant chemotherapy combined with pembrolizumab. Three weeks after initiation, decreased visual acuity developed in the left eye, and grade 2 uveitis was diagnosed as an irAE. Pembrolizumab was discontinued, and systemic corticosteroid therapy was initiated, resulting in early ophthalmic improvement. Subsequently, Stevens-Johnson syndrome developed after prophylactic trimethoprim-sulfamethoxazole administration, necessitating steroid pulse therapy and high-dose intravenous immunoglobulin, after which the uveitis completely resolved. Neoadjuvant chemotherapy was continued without pembrolizumab, followed by mastectomy, which revealed ypT1aN0 disease. At 2 years of follow-up, the patient remains disease-free without recurrence of uveitis. This case indicates that a remote history of autoimmune uveitis may represent a risk factor for ICI-associated uveitis, supporting the need for careful pretreatment assessment, vigilant monitoring, and close collaboration with ophthalmologists.
Radiotherapy (RT) is preferred over stent placement for dysphagia in unresectable esophageal squamous cell carcinoma (ESCC); however, low-radial-force self-expandable metallic stents (SEMS) may offer safer and more effective palliation. We aimed to compare the outcomes of RT and low-radial-force SEMS in ESCC patients. This retrospective study included patients with unresectable ESCC and dysphagia who underwent palliative RT or low-radial-force SEMS placement between 2013 and 2023. Adverse events were compared, and treatment efficacy was assessed based on changes in Dysphagia Score (DS) and the duration of maintaining DS ≤ 1 among those who achieved it. The stent and RT groups comprised 34 and 45 patients, respectively. Treatment-related adverse events of Grade ≥ 2 and ≥ 3 occurred in 29.4
Chemical vapor deposition (CVD) is fundamental to semiconductor nanotechnology, yet many aspects of its processes and underlying physical and chemical phenomena remain unexplained. This is because CVD is a complex system involving the elementary growth processes of (1) gas-phase reactions, (2) surface processes, and (3) solid-phase diffusion. This review introduces the following research topics, utilizing theoretical approaches that integrate simulations of each fundamental process: the influence of CVD conditions on the residual impurity concentration, surface morphology, and heterointerface flatness. Through integrated simulation, physical and chemical insights that cannot be obtained from simulations of individual elementary growth processes are revealed.
Gastric cancer remains a significant health burden, especially in Asia. Potassium-competitive acid blockers (P-CABs) provide stronger acid suppression than proton pump inhibitors (PPIs), but their long-term impact on metachronous gastric cancer (MGC) remains unclear. This study evaluated the incidence and duration-dependent risk of MGC in P-CAB/PPI users. This multicenter retrospective cohort study included patients from 15 institutions in Japan who underwent endoscopic or surgical resection for gastric cancer between 2014 and 2022. After exclusions, 7172 patients who had received H. pylori eradication were analyzed. Chronic use of P-CAB/PPI was defined as administration for more than 3 months. The primary outcome was the incidence of MGC. Cox regression models were used, along with subgroup analyses based on duration and initial treatment type (endoscopy versus surgery). During a median follow-up of 5.8 years, MGC developed in 342 patients. The incidence was highest among P-CAB users (20.9 per 1,000 person-years), followed by PPI users (13.5) and non-users (7.1). Both P-CAB and PPI use were independently associated with increased MGC risk (hazard ratio 3.89 and 1.75, respectively). The association between P-CAB use and MGC was stronger with longer durations of use (hazard ratio 3.44 for < 1 year, 3.95 for 1–3 years, and 9.36 for > 3 years) and was particularly evident in the post-endoscopic group (hazard ratio 4.22) in subgroup analyses. Chronic use of P-CAB/PPI were associated with MGC. Longer duration may be associated with increased risk of MGC. Further studies are warranted to validate these findings.
The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of December 2020 was searched in PubMed, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution Service (Minds) technique. A total of 38 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, pathological diagnosis deciding the diagnosis, and causal genes of vascular anomalies. Thus, the Japanese clinical practice guidelines for vascular tumors, vascular malformations, lymphatic malformations, and lymphangiomatosis 2022 have been prepared as the evidence-based guidelines for the management of vascular anomalies.
