St. Luke's International Hospital (聖路加国際病院) is a general and teaching hospital located in the Tsukiji district of Chūō, Tokyo, Japan.First opened in 1902, as a medical mission facility by the Episcopal Church in the United States, the hospital is now one of central Tokyo's largest and most comprehensive medical care facilities. It is operated as an adjunct to St. Luke's International University, an affiliated university of the Nippon Sei Ko Kai (Anglican Episcopal Church in Japan).St.St.
In Japan, BRCA genetic testing for the diagnosis of hereditary breast and ovarian cancer is covered by medical insurance. However, other breast cancer (BC) susceptibility genes are rarely examined in these patients, primarily because medical insurance does not cover testing for these genes. A multigene panel testing (MGPT) was conducted on patients with BC who met the clinical criteria for BRCA genetic testing. Of the 494 patients, 45 germline pathogenic variants (GPVs) were identified (9.11
OBJECTIVES:To determine whether anterior fibromuscular stroma (AFS) preservation within an anteroposterior (AP) HoLEP platform independently reduces ultra-early postoperative incontinence. METHODS:We retrospectively analyzed consecutive HoLEP cases (April 2019-June 2025) performed by a single surgeon. Of 719 procedures, 272 consecutive cases using a standardized AP platform were included and classified into conventional AP-HoLEP (CON, n = 60), mucosal incision-first AP-HoLEP (MI, n = 180), and AFS-preserving AP-HoLEP (AFS, n = 32). The primary endpoint was Day-1 incontinence, defined as any objective leakage (> 0 mL) within 24 h after catheter removal on Postoperative Day 2. Multivariable logistic regression was used to identify independent predictors. RESULTS:Day-1 incontinence occurred in 55% (33/60) of CON, 58% (104/180) of MI, and 25% (8/32) of AFS cases (p = 0.003). In multivariable analysis, AFS preservation was independently associated with lower odds of Day-1 incontinence versus CON (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.11-0.80; p = 0.016), whereas MI was not (OR, 1.14; 95% CI, 0.62-2.11; p = 0.680). Perioperative safety outcomes were comparable, with low rates of Clavien-Dindo ≥ III events. CONCLUSIONS:Within an AP-HoLEP platform, AFS preservation was associated with improved Day-1 continence without compromising safety, supporting ventral-support preservation as a key lever for ultra-early continence recovery.
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.
In the Phase III TASUKI-52 trial, nivolumab with carboplatin, paclitaxel (CP), plus bevacizumab significantly prolonged progression-free survival (PFS), and resulted in longer overall survival (OS) in patients with advanced nonsquamous non-small cell lung cancer (NSCLC). This final analysis evaluated 4-year treatment outcomes in terms of OS, PFS and duration of response (DOR) by investigator assessment and safety, as well as the background characteristics and treatment courses associated with 4-year survivors. Patients were randomized 1:1 to receive nivolumab (n = 275) or placebo (n = 275) in addition to CP plus bevacizumab. With a minimum follow-up of 53.1 months, nivolumab with CP plus bevacizumab continued to show improvement in OS (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.58-0.88) and PFS (HR: 0.61; 95% CI: 0.50-0.74) compared to placebo with CP plus bevacizumab. The 4-year OS rate was 34.7% in the nivolumab arm versus 22.1% in the placebo arm, and the 4-year PFS rate was 13.7% in the nivolumab arm versus 3.3% in the placebo arm. Among 4-year survivors, the median DOR was numerically longer in the nivolumab arm than in the placebo arm (34.7 vs. 13.5 months). No new safety signals were observed. Four-year survival in the nivolumab arm was associated with the absence of bone metastases and age < 65, but not with PD-L1 status and tumor size. In conclusion, treatment with nivolumab demonstrated long-term survival benefit and durable response, which supports nivolumab with CP plus bevacizumab as a first-line treatment option for advanced nonsquamous NSCLC. Trial Registration: ClinicalTrials.gov identifier: NCT03117049.
