INTRODUCTION: Primary cardiac angiosarcoma (PCA) is an exceptionally rare and aggressive malignant tumor characterized by a poor prognosis. Although complete surgical resection is the most effective treatment for survival, recurrence and metastasis occur frequently even after radical excision. CASE PRESENTATION: We report a rare case of PCA in a 40-year-old woman in whom long-term survival of 68 months was achieved through aggressive multimodal therapy. She underwent urgent complete resection of a right atrial tumor, followed by preoperative chemotherapy and repeat resection with tricuspid valve replacement for recurrent disease and pulmonary metastasis. Postoperative adjuvant chemotherapy resulted in disease-free survival of 41 months. The subsequent hepatic and pulmonary metastases were managed with chemotherapy and radiotherapy before the patient succumbed to multiple organ failure. CONCLUSIONS: Individualized, aggressive, and multimodal treatment-including repeat surgical resection and sustained systemic therapy-can achieve durable disease control and prolonged survival in selected patients with PCA, a malignancy otherwise associated with extremely poor outcomes.
BACKGROUND:Establishing an effective stroke care system for patients with acute intracranial artery occlusion is particularly challenging in regions affected by aging and depopulation with limited medical resources. We conducted a study, termed the Fukushima Large Vessel Occlusion (LVO) Stroke Registry, to clarify real-world treatment practices and patient pathways in such a setting. METHODS:This prospective multicenter registry enrolled consecutive patients with acute intracranial artery occlusion admitted within 24 h of symptom onset across 12 hospitals in Fukushima Prefecture between July 2020 and June 2022. Patients receiving mechanical thrombectomy or medical treatment were analyzed. Functional independence was defined as a modified Rankin Scale (mRS) score of 0-2 on Day 90. Among patients undergoing mechanical thrombectomy, the treatment pathways were classified as mothership, patient transfer, or physician transfer. RESULTS:A total of 210 patients were enrolled in this study. The median age was 81 years, and the median National Institutes of Health Stroke Scale (NIHSS) score was 18. Functional independence at 90 days was achieved in 68 patients (32.4%), while symptomatic intracranial hemorrhage occurred in 7 (3.3%), and 90-day mortality occurred in 53 (25.2%). Among 147 patients treated with mechanical thrombectomy, successful reperfusion (defined by a modified Thrombolysis in Cerebral Infarction (mTICI) 2b or 3) was achieved in 107 (72.8%). Functional independence was associated with younger age (76.5 vs. 82 years, P = 0.016), premorbid mRS score 0-2 (98.0% vs. 88.7%, P = 0.042), mothership pathway (60.0% vs. 38.1%, P = 0.012), lower NIHSS score (16 vs. 21, P < 0.001), higher Alberta Stroke Program Early CT Score (ASPECTS) (10 vs. 8, P < 0.001), shorter puncture-to-recanalization time (38 vs. 67 minutes, P < 0.001), and higher successful reperfusion rate (92.0% vs. 62.9%, P < 0.001). In multivariate analysis, age (odds ratio (OR) 0.959, 95% confidence interval (CI) 0.925-0.995; P = 0.024), NIHSS score (OR 0.914, 95% CI 0.864-0.968; P = 0.002), ASPECTS (OR 1.519, 95% CI 1.146-2.013; P = 0.004), and mTICI 2b or 3 (OR 8.741, 95% CI 2.581-29.597; P < 0.001) were independently associated with functional independence. Although unadjusted functional independence differed among the pathways, no clear differences in safety outcomes were observed. CONCLUSIONS:In aging and depopulated regions, a hybrid stroke care system integrating mothership, patient transfer, and physician transfer pathways can maintain patients' access to mechanical thrombectomy with acceptable safety. These findings highlight the importance of a flexible region-specific stroke network and the need for workflow optimization to improve clinical outcomes in resource-limited settings.
Introduction. Human bocavirus 1 (HBoV1) is a member of Bocaparvovirus primate1 and is associated with paediatric respiratory infections. Although genetic grouping has been described, it remains unclear whether temporal genetic changes occur among clinically circulating HBoV1 strains. Hypothesis/Gap Statement. HBoV1 shows limited genetic diversity, but temporal genetic changes may occur in circulating strains. Aim. To investigate whether temporal genetic changes are present in HBoV1 isolates collected in Fukushima, Japan, between 2018 and 2024. Methodology. Nasopharyngeal swabs were collected from paediatric inpatients with acute respiratory infections. Thirty-two HBoV1 isolates were obtained using air-liquid interface cultures of human bronchial/tracheal epithelial cells. Nearly complete genomes were sequenced by next-generation sequencing and analysed together with additional reference sequences (total n=100, including outgroups) using phylogenetic and time-scaled methods. Results. Phylogenetic analyses classified the 32 Fukushima isolates into Group 1 (n=12) and Group 2 (n=20). Group 2 predominated in 2018, Group 1 from 2019 to 2021 and Group 2 again from 2022 to 2024, indicating temporal shifts in circulating strains. The average number of nucleotide differences among HBoV1 genomes was 13.9 (maximum 55), with Groups 1 and 2 diverging around 2004-2005. Divergence was concentrated in the VP genes, and synonymous substitutions within VP genes overlapped the ORFx reading frame, leading to distinct amino acid differences in ORFx. Conclusion. Clinically circulating HBoV1 undergoes temporal genetic change, with group differentiation determined primarily by VP genes and uniquely by ORFx at the amino acid level. These findings suggest a potential biological role for ORFx in the HBoV1 life cycle. Understanding these temporal genetic shifts is important for enhancing the accuracy of molecular surveillance tools, particularly for distinguishing genetically diverse HBoV1 strains.
BACKGROUND:Atrial fibrillation (AF) is a common comorbidity in patients receiving implantable cardioverter-defibrillators (ICD) or cardiac resynchronization therapy (CRT) and is associated with increased mortality. However, most evidence comes from Western cohorts dominated by ischemic cardiomyopathy (ICM), limiting applicability to populations in which non-ICM (NICM) is more prevalent. Because NICM and ICM fundamentally differ in myocardial pathology and remodeling, the prognostic impact of AF may not be uniform across etiologies. OBJECTIVE:This study aimed to determine whether the prognostic impact of AF differs between NICM and ICM in ICD/CRT patients. METHODS:We analyzed data from 4,623 patients in a nationwide cardiac device registry. Outcomes were all-cause death, cardiac death, heart failure hospitalization, and ICD therapies. Multivariable Cox and Fine-Gray competing risk models were constructed using literature-based, MAGGIC-derived, and stepwise covariate selection strategies. Propensity score matching was performed within ICM and NICM subgroups. RESULTS:AF was associated with higher risks of mortality, cardiac death, and heart failure hospitalization in NICM across all models. In contrast, the association between AF and mortality in ICM was attenuated and no longer statistically significant after multivariable adjustment. After propensity score matching, AF remained associated with increased mortality in NICM but not in ICM. AF impact on rates of ICD therapies did not differ between etiologies. CONCLUSION:The prognostic impact of AF among ICD/CRT recipients differs markedly by cardiomyopathy etiology. AF identifies a high-risk subgroup within NICM, whereas its effect is attenuated in ICM. Etiology-specific risk assessment should be incorporated into clinical management.
In Japan, nationwide surveillance of acute respiratory infections (ARI) was launched in April 2025, enabling monitoring of multiple respiratory pathogens. Human parainfluenza virus type 3 (HPIV3) is an important cause of respiratory infections. In 2025, HPIV3 increased from spring to summer, and Japanese media raised concerns about the emergence of a novel pathogen because public surveillance data on HPIV3 trends had not previously been available. In this study, phylogenetic analysis of HPIV3 isolates obtained in eastern Japan in 2025 was performed using nearly complete genome sequences. The isolates were grouped within previously circulating clusters (C1 and C2), and several sequences were closely related to viruses detected in Fukushima between 2018 and 2024, suggesting continued circulation of HPIV3 within the same geographic region (Fukushima Prefecture and surrounding areas), although broader circulation cannot be excluded. Some sequences were related to strains reported outside Japan, suggesting possible introduction from abroad. Overall, the sequences were highly similar and no distinct lineage forming a new cluster was observed. These findings indicate that the HPIV3 strains detected in 2025 belong to previously circulating lineages and do not represent the emergence of a new lineage.
