BACKGROUND:Real-world attainment of contemporary guidelines-recommended, stringent low-density lipoprotein cholesterol (LDL-C) targets for secondary prevention of cardiovascular events in patients with coronary artery disease (CAD) remains inadequate. This study aimed to assess LDL-C control in patients within a regional ischemic heart disease (IHD) referral system after the 2022-2023 guideline updates and examine its association with long-term cardiovascular outcomes. METHODS:We retrospectively analyzed annual serum LDL-C levels and achievement of guideline-recommended serum LDL-C target level (<70 mg/dL) of 1334 patients with CAD [acute coronary syndrome (ACS) or chronic coronary syndrome (CCS)] enrolled in a regional IHD referral system and followed up at Shizuoka City Shizuoka Hospital (2021-2024). The primary endpoint was the annual serum LDL-C level trend; secondary endpoints were major adverse cardiovascular events (MACE: cardiovascular death, nonfatal myocardial infarction, and coronary revascularization) and their associations with serum LDL-C levels. RESULTS:The mean serum LDL-C level declined from 80.2 ± 22.0 mg/dL in 2021 to 71.8 ± 20.7 mg/dL in 2024, with improved target attainment (29.8 % vs. 46.3 %; p < 0.001 for both). MACE occurred in 14.2 % of patients (mean follow-up period, 6.1 years), with its incidence in patients who achieved the target level significantly lower than in those who did not (6.8 % vs. 18.6 %, p < 0.001). Patients with ACS and CCS had similar benefits. In multivariate Cox regression analysis, target level attainment was independently associated with a reduced MACE risk (hazard ratio 0.326; 95 % CI 0.21-0.52; p < 0.001). CONCLUSIONS:In a real-world cohort of patients with CAD managed under a structured IHD referral system, serum LDL-C levels progressively decreased over time, and patients who achieved stricter LDL-C control experienced a significantly lower incidence of major cardiovascular events.
This study aimed to assess the clinical utility of serum interferon-lambda 3 (IFN-λ3) as a sequential biomarker for treatment response and disease control in patients with anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive dermatomyositis (DM)-associated interstitial lung disease (ILD). Serum IFN-λ3 levels were measured in 24 patients with anti-MDA5 antibody-positive DM-ILD at diagnosis and 1 month after initiating immunosuppressive therapy. Patients were categorized into two groups based on clinical outcomes: a good control group (n = 16; survived without relapse for ≥ 1 year) and a poor control group (n = 8; died from ILD progression or relapse within 1 year). Changes in serum IFN-λ3 levels and differences between groups were analyzed. In the good control group, serum IFN-λ3 levels significantly decreased from 94.6 to 12.7 pg/mL (p < 0.001), whereas no significant change was observed in the poor control group (129.0 to 118.8 pg/mL). Furthermore, serum IFN-λ3 levels at 1 month were significantly lower in the good control group than in the poor control group (p = 0.004). Serum IFN-λ3 levels may reflect short-term treatment response and could serve as a useful sequential biomarker for assessing disease control in patients with anti-MDA5 antibody-positive DM-ILD.
Nodular pulmonary amyloidosis is a rare, localized form of amyloid deposition in the lung and an uncommon cause of solitary pulmonary nodules. Its radiological features may closely mimic that of primary lung cancer if spiculation or fluorodeoxyglucose uptake is present, making preoperative diagnosis challenging. Here, we report the case of a woman in her 60s who was referred to our hospital after an abnormal opacity was detected by routine chest radiograph. Chest computed tomography revealed a 21 mm × 12 mm solid nodule with partial spiculation in the left lower lobe. Fluorodeoxyglucose positron emission tomography/computed tomography demonstrated mild uptake (maximum standardized uptake value; 2.5). Bronchoscopic biopsy results were inconclusive, and diagnostic video-assisted thoracoscopic left basal segmentectomy was performed because malignancy could not be excluded. Histopathological examination under polarized light microscopy demonstrated Congo red-positive amyloid deposition with apple-green birefringence, confirming nodular pulmonary amyloidosis. This case highlights that nodular pulmonary amyloidosis can mimic primary lung cancer on imaging and diagnostic surgical resection may provide definitive diagnosis and local treatment if bronchoscopic biopsy is inconclusive. Long-term follow-up is warranted, considering its reported association with lymphoproliferative disorders.
INTRODUCTION:Intraoperative bile spillage during laparoscopic cholecystectomy (LC) frequently prompts drain placement. However, its utility in mitigating postoperative infectious complications and reducing hospitalization remains unclear. This study aimed to evaluate the impact of drain placement on short-term postoperative outcomes in patients undergoing LC with bile spillage. METHODS:A retrospective analysis of 99 patients undergoing LC with intraoperative bile spillage between January 2020 and December 2024 was performed. Patients were categorized into the drain group (n = 72) and no-drain group (n = 27). Propensity score matching was employed to investigate short-term postoperative outcomes. RESULTS:Infectious complication rates were comparable between the drain group (5.6%) and the no-drain group (3.7%) (p = 1.000). The hospitalization period was significantly longer in the drain group than in the no-drain group (p < 0.001). Following propensity score matching (19 patients per group), infectious complications rates remained similar (5.3% in the drain group vs. 0.0% in the no-drain group, p = 1.000), while postoperative hospitalization was tended to be prolonged in the drain group (p = 0.087). CONCLUSION:Drain placement in patients undergoing LC with bile spillage might not influence infectious complication rates but might be associated with extended hospitalization.
