Nagoya Journal of Medical Science最新文献

{"title":"The clinical utility of metagenomic next-generation sequencing in the management of fever in patients with hematological disorders.","authors":"Jiaying Cheng, Jinle Ni, Yu Zhao, Ling Jiang, Yun Huang, Yujiao Zhang, Ping Yan, Zhiquan Long, Haipeng Fu, Xuejie Jiang","doi":"10.18999/nagjms.88.1.84","DOIUrl":"10.18999/nagjms.88.1.84","url":null,"abstract":"<p><p>Patients with hematological malignancies frequently present with severe and intricate infections that pose life-threatening risks. Conventional pathogen detection methods offer limited clinical insights and therapeutic guidance. This retrospective study evaluated the clinical application of metagenomic next-generation sequencing (mNGS) in hematologic patients who remained febrile despite prolonged antibiotic therapy, which means unresponsive to antibiotic therapy. This retrospective analysis included 204 patients with hematologic malignancies, undergoing conventional pathogen detection and peripheral blood mNGS. The cohort was stratified into neutropenia and non-neutropenia groups to compare the diagnostic and therapeutic implications of mNGS versus conventional microbiological tests (CMT). Among the 204 patients with mNGS, the overall positive detection rate was significantly higher than that of CMT (68.1% vs 30.9%, P<0.001). In both the neutropenia and non-neutropenia group, mNGS demonstrated a higher positivity rate for bacteria than for CMT (bacteria, 36.4% vs 15.6%, P<0.01). mNGS proved notably advantageous for bloodstream infections with clinically relevant drug-resistant strains, particularly in the neutropenia cohort (26.4% vs 12.5%, P<0.001). Using a composite reference standard, mNGS manifested sensitivity and specificity rates of 78.4% and 61.9%, respectively. Patients in the neutropenia group derived superior clinical benefit from mNGS, including higher diagnostic accuracy and treatment efficacy (diagnosis, 56.4% vs 40.6%, P=0.036; treatment, 49.3% vs 31.3%, P = 0.016). Additionally, the 30-days mortality rate was notably higher among mNGS-positive patients who tested compared to those who tested negative (17.3% vs 1.5%, P<0.001). mNGS demonstrated clinical relevance in patients with hematologic malignancy who received prolonged antibiotic treatment and holds promise in predicting patient survival prognosis.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"88 1","pages":"84-98"},"PeriodicalIF":0.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical outcomes and long-term prognosis of patients with tracheobronchial adenoid cystic carcinoma.","authors":"Yuta Kawasumi, Shota Nakamura, Heng Huang, Yoshito Imamura, Shoji Okado, Yuji Nomata, Hiroki Watanabe, Yuka Kadomatsu, Harushi Ueno, Taketo Kato, Tetsuya Mizuno, Toyofumi Fengshi Chen-Yoshikawa","doi":"10.18999/nagjms.88.1.38","DOIUrl":"10.18999/nagjms.88.1.38","url":null,"abstract":"<p><p>Tracheobronchial adenoid cystic carcinoma (ACC) is a rare malignant disease of the central airways. Complete resection is the primary goal for this tumor; however, it remains challenging due to the complexity of reconstruction, tumor submucosal spread, and the risk of dehiscence. Conversely, tracheobronchial ACC has relatively favorable long-term outcomes due to its indolent growth. Due to the rarity of this tumor, a clear treatment guideline has yet to be established. This study aimed to evaluate treatment strategies, perioperative outcomes, and long-term prognosis of tracheobronchial ACC cases at our institution to identify the optimal therapeutic strategy for this challenging disease. We retrospectively analyzed 11 patients who underwent surgical intervention for tracheobronchial ACC at our institution from 2000 to 2024. Clinical, surgical, and oncologic outcomes were assessed, including the impact of surgical margins and adjuvant therapy. Complete resection was achieved in two cases, while nine patients had positive margins requiring postoperative radiotherapy. No local recurrences were observed, but distant metastases occurred in 54.5% of cases. Oligometastatic disease was effectively managed with local therapy. The 5-year and 10-year overall survival rates were 90% and 75%, respectively. Surgical resection remains the cornerstone of treatment for tracheobronchial ACC, however achieving negative surgical margins is not always feasible. In such cases, postoperative radiotherapy is considered an effective strategy to mitigate the risk of local recurrence. Local treatment of oligometastatic disease may provide a survival. These results indicate the importance of a multimodal treatment approach tailored to the specific challenges of tracheobronchial ACC.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"88 1","pages":"38-48"},"PeriodicalIF":0.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knacks and pitfalls of retroperitoneal sarcoma surgery, part 1: preparation for tumor resection.","authors":"Yukihiro Yokoyama, Masaki Sunagawa","doi":"10.18999/nagjms.88.1.1","DOIUrl":"10.18999/nagjms.88.1.1","url":null,"abstract":"<p><p>Although retroperitoneal sarcoma (RPS) is a rare malignancy, it is unlikely that a general surgeon would go through their career without encountering at least one case. Surgical resection remains the only potentially curative treatment and is performed in many institutions worldwide. However, given its low incidence, most centers manage only one or two cases annually, resulting in limited operative experience among surgeons. The clinical presentation of RPS varies widely depending on the tumor location and extent of invasion into adjacent organs and major vessels. This heterogeneity poses a challenge in standardizing surgical techniques and demands a high level of intraoperative adaptability. RPS is commonly found as large tumors, precluding the use of minimally invasive approaches, such as laparoscopy or robotic surgery. The retroperitoneal space also contains critical vascular structures, and inappropriate surgical approaches may lead to life-threatening hemorrhage. At Nagoya University Rare Cancer Center, numerous RPS surgeries have been performed. Through this experience, various technical considerations essential for safe and effective surgery were identified. This article introduces key operative strategies for RPS, including technical \"knacks and pitfalls,\" derived from extensive clinical experience with RPS surgery. Part 1 discusses general preparations that are specifically required for RPS surgery. Part 2 focuses on the details of the practical techniques of the RPS surgery. Finally, part 3 discusses resection of the tumor involving large retroperitoneal vessels, which need special preparations.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"88 1","pages":"1-11"},"PeriodicalIF":0.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of follicular dendritic cell sarcoma with the expression of SRY-box transcription factor 9.","authors":"Genshu Tate","doi":"10.18999/nagjms.88.1.178","DOIUrl":"10.18999/nagjms.88.1.178","url":null,"abstract":"","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"88 1","pages":"178-181"},"PeriodicalIF":0.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A challenging case of giant atypical fibroxanthoma on non-chronically sun-damaged skin: a case report with TP53 somatic mutation (c.375+1 G>A).","authors":"Özge Zorlu, Sevil Karabağ, Semih Aşıkovalı","doi":"10.18999/nagjms.88.1.162","DOIUrl":"10.18999/nagjms.88.1.162","url":null,"abstract":"<p><p>Atypical fibroxanthoma (AFX) is a rare tumor of uncertain histogenetic origin, generally seen in elderly patients' chronically sun-damaged skin, most frequently in the head and neck region. Due to the absence of specific histopathologic features, AFX is a diagnosis of exclusion. Herein, we report clinical, histopathological, and molecular features of a young patient with a recurrent and giant AFX lesion on non-chronically sun-damaged skin. Histologically, the tumor was well-circumscribed, encapsulated, and dermal-based, composed of highly atypical and pleomorphic bizarre spindled cells with hyperchromatic and irregular nuclei and scarce multinucleated giant cells. There was no subcutaneous invasion, necrosis, or perineural/perivascular invasion. Tumoral cells were diffusely and strongly positive for CD10 but negative for melanocytic, cytokeratin, and muscle immunohistochemical markers. Almost five years after the excision, no recurrence and/or distant metastasis was observed. A pathogenic variant of a TP53 somatic mutation (c.375+1 G>A) was identified in the tumor.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"88 1","pages":"162-169"},"PeriodicalIF":0.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of oral contraceptive/low-dose estrogen progestin discontinuation on the incidence of alveolar osteitis after third molar extraction: a retrospective study at a single center.","authors":"Kotaro Sato, Kento Takenaka, Naoka Kouyama, Yuriko Ishikawa-Matsumoto, Yukiko Wakayama, Masaki Okazaki, Atsushi Hashizume, Christian Schedeit, Benoît Schaller, Hideharu Hibi","doi":"10.18999/nagjms.88.1.99","DOIUrl":"10.18999/nagjms.88.1.99","url":null,"abstract":"<p><p>Oral contraceptive (OC)/low-dose estrogen progestin (LEP) affects both the coagulation and fibrinolytic systems and may cause alveolar osteitis (AO). However, whether OC/LEP discontinuation affects the incidence of AO has not been evaluated. The aim of this study was to investigate whether preoperative OC/LEP discontinuation influences the incidence of AO after wisdom tooth extraction in outpatients. A total of 130 women aged 18-47 years (median, 27 years) participated, and the total numbers of procedure days and teeth were 205 and 274, respectively. We compared the incidence of AOs between patients who discontinued OC/LEP before wisdom tooth extraction and those who did not. A total of 4/181 teeth (2.21%) in the discontinuation group and 7/93 (7.53%) in the continuation group exhibited AO, and Fisher's exact test revealed a significant difference between the two groups (<i>p</i>=0.049). No serious adverse events, such as thrombosis, were observed. In conclusion, OC/LEP discontinuation was associated with a lower observed incidence of AO after third molar extraction.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"88 1","pages":"99-108"},"PeriodicalIF":0.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secular trends in the prevalence of low birthweight infants in Japan from 1980 to 2020: a joinpoint regression analysis.","authors":"Eri Nonoyama, Koji Tamakoshi, Yuki Takahashi, Akiko Yamada","doi":"10.18999/nagjms.88.1.59","DOIUrl":"10.18999/nagjms.88.1.59","url":null,"abstract":"<p><p>Japan has a higher prevalence of low birthweight infants (LBW, < 2500 g) than other developed countries. In this study, we aimed to clarify the descriptive epidemiological characteristics of LBW prevalence in Japan from 1980 to 2020. LBW prevalence data were obtained from the Vital Statistics of Japan. Trends in crude and age-standardized LBW prevalence rates for total and singleton births separately and rates for full-term births, as well as age-specific prevalence rates by maternal age at delivery, were analyzed using joinpoint regression. The crude LBW rate increased slowly from 5.18 per 100 births in 1980, rose sharply from the late 1980s, peaked at 9.62 in 2007, and then declined slowly to 9.22 in 2020 for the total births. The annual percent changes were 1.35% (1980-1987), 3.37% (1987-2000), 1.81% (2000-2006), and -0.24% (2006-2020), with an average annual percent change (APC) of 1.51%. Age-standardized rates for the singleton and full-term births showed a similar trend. Age-specific rates showed a sharp increase for approximately 10 years after 1985, followed by a decline in the group > 35 years of age. The rate for the 15-19 age group increased gradually, with no change point (APC = 0.60). These findings likely reflect changes in maternal and socio-environmental factors-such as increased maternal age, undernutrition, lower body mass index (BMI), and expanded use of assisted reproductive technology and perinatal care-and emphasize the importance of preconception care and maternal health care, including nutrition and life-course approaches, to reduce low birthweight risk.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"88 1","pages":"59-72"},"PeriodicalIF":0.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent allergic reactions to unrecognized chlorhexidine exposure leading to pulseless electrical activity: a case report.","authors":"Akari Kawaguchi, Yasuhiro Amano, Takahiro Ando, Tasuku Fujii, Takahiro Tamura","doi":"10.18999/nagjms.88.1.149","DOIUrl":"10.18999/nagjms.88.1.149","url":null,"abstract":"<p><p>Chlorhexidine applied to the skin during catheter insertion can cause allergic reactions; however, its potential to cause perioperative anaphylaxis is often overlooked. Herein, we report a case of recurrent allergic reactions to unrecognized chlorhexidine exposure, leading to pulseless electrical activity. A 66-year-old man exhibited an allergic reaction during anesthesia induction for Y-graft replacement for an abdominal aortic aneurysm, and the planned surgery was aborted. Skin tests for anesthetics were negative. Two months later, he experienced itching after epidural catheter insertion but did not report it. During a second anesthesia induction, the patient experienced another allergic reaction of unknown etiology. Although hemodynamics stabilized after vasopressor administration, insertion of a central venous catheter 1 hour later to prevent further hypotension triggered pulseless electrical activity. Chlorhexidine was used as a skin disinfectant during catheter insertion before all four reactions and was confirmed to have caused the anaphylaxes using diagnostic tests. Chlorhexidine should be considered a potential cause of perioperative anaphylaxis.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"88 1","pages":"149-156"},"PeriodicalIF":0.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Objective food store access was associated with calcium intake among older Japanese adults: a cross-sectional analysis from the Japan Gerontological Evaluation Study at Taisetsu Community Hokkaido.","authors":"Tomoko Kishi, Emiko Okada, Shigekazu Ukawa, Wenjing Zhao, Sachiko Sasaki, Yukako Tani, Satoshi Sasaki, Katsunori Kondo, Akiko Tamakoshi","doi":"10.18999/nagjms.88.1.73","DOIUrl":"10.18999/nagjms.88.1.73","url":null,"abstract":"<p><p>Preventing osteoporosis in older populations is important for extending healthy life expectancy. Calcium is a crucial nutrient for maintaining bone health in this group. However, more than half of people aged ≥ 65 years have insufficient calcium intake. We investigated the influence of food store access on calcium intake in community-dwelling older adults. Our study employed a population-based cross-sectional design, using data from older adults aged 70-74 years living in three towns in northern Japan. Perceived food store access was assessed using a single question, while objective food store access was measured using a geographic information system. Dietary information was obtained using a brief-type self-administered diet history questionnaire. Insufficient calcium intake was defined as calcium consumption below the estimated average requirement for the participant's age and sex. A log-binomial regression analysis was performed to determine the association between food store access and insufficient calcium intake. A total of 716 participants (mean age, 71.8 ± 1.4 years; 55.3% women) were included in this study. After adjusting for potential confounders, low objective food store access was associated with insufficient calcium intake (adjusted prevalence ratio for low vs high accessibility, 1.24; 95% confidence interval, 1.05-1.46). However, the perceived food store access was not associated with insufficient calcium intake. Our findings showed that low objective food store access is associated with insufficient calcium intake among independent older Japanese adults. Improving access to food stores may help prevent insufficient calcium intake in this population.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"88 1","pages":"73-83"},"PeriodicalIF":0.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endosomal maturation leads to nucleocapsid conformation change in seasonal coronaviruses.","authors":"Miki Umeda, Koji Yoshimura, Yoshitaka Sato, Yasuyuki Miyake, Hiroshi Kimura","doi":"10.18999/nagjms.88.1.109","DOIUrl":"10.18999/nagjms.88.1.109","url":null,"abstract":"<p><p>As seen in the coronavirus pandemic, the social impact of the spread of emerging and re-emerging viral infections is significant. Whilst seasonal human coronaviruses with common cold symptoms have long been identified, there are only few studies on cellular entry pathway into host cells. Human coronavirus (HCoV)-229E, which has a positive single-stranded RNA genome, binds to the host cell surface receptor Aminopeptidase N and is taken up into the cell by endocytosis. The viral genome is then released from the endosome into the cytoplasm via uncoating step, the molecular mechanism of which remains unclear. In the uncoating of influenza A viruses, it is known that after membrane fusion in matured endosomes, unanchored ubiquitin chains present in the viral particle are exposed to the cytoplasmic side, which recruits the host factor histone deacetylase 6 (HDAC6) and promotes M1 uncoating. In this study, purified virus particles were used to investigate the involvement of ubiquitin in the uncoating of coronaviruses, and their properties were determined. The results show that there are few unanchored ubiquitin chains in coronavirus particles, suggesting that they use ubiquitin-independent uncoating different from influenza A virus. More interestingly, acidification within the endosome leads to nucleocapsid condensate formation in vitro. From these results, we would like to propose a new model that coronaviruses with long single-stranded RNA genomes efficiently uncoat their genomes by forming condensates during uncoating, thereby evading the innate immune response from the host. Understanding these molecular mechanisms is expected to lead to drug development.</p>","PeriodicalId":49014,"journal":{"name":"Nagoya Journal of Medical Science","volume":"88 1","pages":"109-121"},"PeriodicalIF":0.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}