National Hospital Organization Nagara Medical Center (国立病院機構長良医療センター) is a hospital located in Gifu, Japan, which is administered by the National Hospital Organization of Japan. This hospital was established in March 2005, from the merger of two hospitals, National Hospital Organization Gifu Hospital and National Hospital Organization Nagara Hospital.There are 500-800 employees working at the hospital.
Background The prognosis and recurrence patterns of early-diagnosed pancreatic ductal adenocarcinoma (PDAC), particularly following surgical resection, remain unclear. Methods This multicenter retrospective study analyzed patients who underwent surgical resection for PDAC between 2005 and 2023. Patients were categorized according to pathological stages 0, I, and II. Recurrence patterns and survival outcomes were compared among the three groups. Multivariate analysis was performed to identify independent risk factors for remnant pancreatic recurrence, including early-stage disease, postoperative follow-up of more than 5 years, and receipt of adjuvant chemotherapy. Results A total of 349 patients were included: 51 with stage 0, 77 with stage I, and 221 with stage II PDAC. The 5-year overall survival rates were 87%, 71%, and 49% for patients with stage 0, I, and II PDAC, respectively. Remnant pancreatic recurrence was observed in 10% of patients with stage 0 PDAC and 18% of patients with stage I PDAC, compared with 5% of those with stage II PDAC. Recurrence was significantly more frequent in stage I (P < 0.001) and tended to be higher in stage 0 (P = 0.062) than in stage II. Multivariate analysis identified pathological stage 0-I and postoperative follow-up of > 5 years as independent risk factors for remnant pancreatic recurrence. Conclusions Patients with early-stage PDAC exhibit a higher risk of remnant pancreatic recurrence than those with stage II disease. These findings underscore the importance of long-term pancreas-focused surveillance in early-stage PDAC to enable timely detection of late recurrence and potentially improve patients outcomes.
BACKGROUND:In treatment of pulmonary arterial hypertension (PAH), the prostacyclin (PGI2) pathway is targeted by oral selexipag and parenteral PGI2 analogs. Although guidelines recommend therapeutic strategies based on disease severity and etiology, there are limited data on real-world use of selexipag and parenteral PGI2 analogs in Japan. This study aimed to characterize the use of these drugs in treatment of PAH in Japan, with a focus on differences related to patient characteristics and PAH etiology. METHODS:Patients with PAH registered in the Japan PH Registry (JAPHR) from November 2016 to March 2023 were evaluated. Patients who met the inclusion criteria were further stratified by PAH etiologies, drug used, severity of disease, treatment strategies, time from diagnosis to drug initiation, and pulmonary hemodynamics. RESULTS:A total of 235 patients were treated with selexipag and 121 patients with parenteral PGI2. Selexipag and parenteral PGI2 analogs were most frequently used for idiopathic PAH (IPAH) or heritable PAH (HPAH), at 56.2 % (132/235) and 82.6 % (100/121), respectively. Selexipag was also used more frequently than parenteral PGI2 analogs for PAH associated with connective tissue disease and congenital heart disease. Most patients received triple therapy, with 76.2 % (179/235) and 59.5 % (72/121) receiving selexipag and parenteral PGI2 analogs, respectively. Regarding New York Heart Association functional class (NYHA-FC), selexipag was primarily administered to Class II-III patients and parenteral PGI2 analogs to Class III patients. Both mean pulmonary artery pressure and pulmonary vascular resistance values were lower in the selexipag group than in the parenteral PGI2 group. CONCLUSION:Parenteral PGI2 analogs tend to be used mainly in patients with severe IPAH/HPAH, while selexipag is used in patients with a broader range of etiologies around NYHA-FC II-III. Choice of selexipag and parenteral PGI2 analogs for treatment of PAH is influenced by disease severity and etiology.
Introduction: Pulmonary sclerosing pneumocytoma (PSP), formerly known as sclerosing hemangioma, is a rare tumor that is typically found incidentally and can closely mimic malignancy on imaging and biopsy, making it challenging to distinguish from lung malignancy. Presentation of case: A 67-year-old man presented with an incidental finding of a nodule in the left upper lobe. Chest computed tomography revealed a 2.2-cm, well-circumscribed nodule adjacent to the pulmonary hilum of the upper lobe. Bronchoscopic biopsy suggested adenocarcinoma, and the patient underwent left upper lobectomy with lymph node dissection via posterolateral thoracotomy. Final histopathological findings resulted in a diagnosis of PSP. Discussion: Accurate preoperative diagnosis of PSP is difficult because the tumor contains heterogeneous histologic components, and limited biopsy samples may capture only areas resembling malignancy. As illustrated in this case, preoperative biopsy may lead to misdiagnosis, and complete resection is often required for a definitive diagnosis. Conclusion: This case highlights the diagnostic difficulty of PSP and underscores the importance of considering PSP when evaluating solitary pulmonary nodules. A brief review of the relevant literature is also provided.
The phase 3 DREAMM-8 (NCT04484623) trial assessed belantamab mafodotin + pomalidomide + dexamethasone (BPd) vs bortezomib + Pd (PVd) in lenalidomide-exposed patients with relapsed/refractory multiple myeloma (RRMM) and ≥ 1 prior therapy. Here, we present findings from Japanese patients (data cutoff: 27-May-24). The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall response rate (ORR), duration of response (DoR), and safety. Overall, 21 patients were randomized 1:1 to BPd (N = 10) and PVd (N = 11). Median follow-up was 13.8 months (range 0.23–26.71). For BPd vs PVd, median PFS was not reached (NR; 95
Background:The New International Chronic Thromboembolic Pulmonary Hypertension (CTEPH) Registry, conducted between 2015 and 2019, revealed the significant impact of pulmonary endarterectomy (PEA) and balloon pulmonary angioplasty (BPA) on the long-term survival of CTEPH patients. The objective of the current pre-specified analysis was to evaluate the effect of medical treatment, including the approved oral guanylate cyclase stimulator (sGC) riociguat, in patients with or without mechanical intervention. Methods:1009 newly diagnosed patients were included in the study, with recruitment conducted at 34 centres across 20 countries. At the outset of the registry, sGC was available in 85% of the countries involved. Results:52% of all patients included were treated with pulmonary hypertension (PH) drugs. The proportion of patients receiving PH drugs was 38% among the 605 patients who underwent PEA, 78% among the 185 patients who underwent BPA and 76% among the 219 remaining patients who did not undergo PEA or BPA. In the "BPA" and "no PEA/BPA" groups, the 3-year survival was superior in patients who received sGC in comparison with other PH drugs. Cox regression confirmed that sGC treatment was associated with reduced mortality in the global cohort, in the BPA group and in the "no PEA/BPA" group. Conclusion:This international CTEPH registry suggests that, although an increasing proportion of patients with CTEPH benefited from mechanical treatment, medical treatment with sGC may be associated with a survival advantage in patients undergoing BPA or no intervention. These observations confirm the results of previous randomised controlled trials in a real-world setting.
