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Abstract This paper presents the energy dependence of multiplicity and net-electric charge fluctuations in p+p interactions at beam momenta 20, 31, 40, 80, and 158 $$\text{ Ge }\hspace{-1.00006pt}\text{ V }\!/\!c$$ Ge V / c . Results are corrected for the experimental biases and quantified with the use of cumulants and factorial cumulants. Cumulant ratios are an essential tool in the search for the critical point of strongly interacting matter in heavy ion collisions. Measurements performed in p+p interactions provide a vital baseline estimation in these studies. The measured signals are compared with the string hadronic models Epos1.99 and FTFP-BERT.

Abstract The yields of $$K^0_S$$ K S 0 mesons have been measured in inelastic p+p interactions at incident projectile momenta of 31, 40 and 80 $$\text {Ge}\hspace{-1.00006pt}\text {V}\!/\!c$$ Ge V / c ( $$\sqrt{s_{NN}}=7.7, 8.8$$ s NN = 7.7 , 8.8 and 12.3 $$\text {Ge}\hspace{-1.00006pt}\text {V}$$ Ge V , respectively). The data were recorded by the NA61 $$/$$ / SHINE spectrometer at the CERN Super Proton Synchrotron and the $$K^0_S$$ K S 0 mesons identified via their decays into $$\pi ^{+} \pi ^{-}$$ π + π - pairs. Double-differential distributions are presented as function of transverse momentum and rapidity. The mean multiplicities of $$K^0_S$$ K S 0 mesons were determined to be $$(5.95 \pm 0.19 (stat) \pm 0.30 (sys)) \times 10^{-2}$$ ( 5.95 ± 0.19 ( s t a t ) ± 0.30 ( s y s ) ) × 10 - 2 at 31 $$\text {Ge}\hspace{-1.00006pt}\text {V}\!/\!c$$ Ge V / c , $$(7.61 \pm 0.13 (stat) \pm 0.43 (sys)) \times 10^{-2}$$ ( 7.61 ± 0.13 ( s t a t ) ± 0.43 ( s y s ) ) × 10 - 2 at 40 $$\text {Ge}\hspace{-1.00006pt}\text {V}\!/\!c$$ Ge V / c and $$(11.58 \pm 0.12 (stat) \pm 0.55 (sys)) \times 10^{-2}$$ ( 11.58 ± 0.12 ( s t a t ) ± 0.55 ( s y s ) ) × 10 - 2 at 80 $$\text {Ge}\hspace{-1.00006pt}\text {V}\!/\!c$$ Ge V / c . The results on $$K^{0}_{S}$$ K S 0 production are compared with the production of charged kaons in corresponding reactions and with model calculations (Epos1.99, SMASH 2.0 and PHSD) as well as with published data from other experiments.

Abstract The critical point of strongly interacting matter is searched for at the CERN SPS by the NA61/SHINE experiment in central $$^{40}$$ 40 Ar + $$^{45}$$ 45 Sc collisions at 13 A, 19 A, 30 A, 40 A, and 75 A GeV/c. The dependence of the second-order scaled factorial moments of proton multiplicity distributions on the number of subdivisions in transverse momentum space is measured. The intermittency analysis uses statistically independent data sets for every subdivision in transverse and cumulative-transverse momentum variables. The results obtained do not indicate the searched intermittent pattern. An upper limit on the fraction of correlated protons and the intermittency index is obtained based on a comparison with the Power-law Model.

Abstract The NA61/SHINE experiment at the CERN Super Proton Synchrotron studies the onset of deconfinement in strongly interacting matter through a beam energy scan of particle production in collisions of nuclei of varied sizes. This paper presents results on inclusive double-differential spectra, transverse momentum and rapidity distributions and mean multiplicities of $$\pi ^\pm $$ π ± , $$K^\pm $$ K ± , p and $$\bar{p}$$ p ¯ produced in $$^{40}\hbox {Ar+}^{45}\hbox {Sc}$$ 40 Ar+ 45 Sc collisions at beam momenta of 13A, 19A, 30A, 40A, 75A and 150A $$\text{ Ge }\hspace{-1.00006pt}\text{ V }\!/\!c$$ Ge V / c . The analysis uses the 10% most central collisions, where the observed forward energy defines centrality. The energy dependence of the $$K^\pm $$ K ± / $$\pi ^\pm $$ π ± ratios as well as of inverse slope parameters of the $$K^\pm $$ K ± transverse mass distributions are placed in between those found in inelastic $$p+p$$ p + p and central Pb + Pb collisions. The results obtained here establish a system-size dependence of hadron production properties that so far cannot be explained either within statistical or dynamical models.

Abstract This paper reports measurements of two-pion femtoscopic correlations in Be+Be collisions at a beam momentum of 150 $$A\,\hbox {GeV}\!/\!c$$ A GeV / c (energy available in the center-of-mass system for nucleon pair $$\sqrt{s_{\text {NN}}} = 16.84$$ s NN = 16.84 GeV) by the NA61/SHINE experiment at the CERN SPS accelerator. The obtained momentum space correlation functions can be well described by a Lévy distributed source model. The transverse mass dependence of the Lévy source parameters is presented, and their possible theoretical interpretations are discussed. The results show that the Lévy exponent $$\alpha $$ α is approximately constant as a function of $$m_{\text {T}}$$ m T , and far from both the Gaussian case of $$\alpha = 2$$ α = 2 or the conjectured value at the critical endpoint, $$\alpha = 0.5$$ α = 0.5 . The radius scale parameter R shows a slight decrease in $$m_{\text {T}}$$ m T , which can be explained as a signature of transverse flow. Finally, an approximately constant trend of the intercept parameter $$\lambda $$ λ as a function of $$m_{\text {T}}$$ m T was observed, similar to previous NA44 S + Pb results (obtained with a Gaussian approximation, but unlike RHIC results).

Abstract The critical point of dense, strongly interacting matter is searched for at the CERN SPS in 40Ar + 45Sc collisions at 150A Ge V /c. The dependence of second-order scaled factorial moments of proton multiplicity distribution on the number of subdivisions of transverse momentum space is measured. The intermittency analysis is performed using both transverse momentum and cumulative transverse momentum. For the first time, statistically independent data sets are used for each subdivision number. The obtained results do not indicate any statistically significant intermittency pattern. An upper limit on the fraction of correlated proton pairs and the power of the correlation function is obtained based on a comparison with the Power-law Model developed for this purpose.

Many anomalous phenomena have been observed in NiTi alloys above martensite start temperature, such as softening of the shear constants, increase of internal friction and diffuse scattering of TEM. However, little information has been obtained about the change in the electron system of the parent phase prior to the martensitic transformation, which should be the origin of all pre-martensitic phenomena. In this work, the temperature change of positron annihilation lifetime, which is quite sensitive to electronic-structural changes of matter, were carried out for NiTiCu alloys. The alloys show martensitic transformation from a B2 (cubic) phase to a B19' (monoclinic) phase via a B19 (orthorhombic) phase as the temperature is lowered. We have found anomalous positron lifetime changes in Ni10Ti50Cu40 and Ni15Ti50Cu35 alloys which show a B2–B19–B19' phase transformation. Positron lifetime increases anomalously with decreasing temperature at temperatures higher than the transformation temperature into a B19' phase. On the other hand, positron lifetime does not show any anomaly in the B2 phase of Ni30Ti50Cu20 alloy which shows B2–B19 phase transformation. The positron lifetime of the parent B2 phase shows good agreement with the theoretically-calculated value. Those of the martensite phases of B19 and B19', although, are about 30 ps longer than calculated ones. This big difference between experimental and calculated positron lifetimes cannot be explained by any existing theory.

Background: high recurrence rates of up to 75% within 2 years in pancreatic ductal adenocarcinoma (PDAC) patients resected for cure indicate a high medical need for clinical prediction tools and patient specific treatment approaches. Addition of the EGFR inhibitor erlotinib to adjuvant chemotherapy failed to improve outcome but its efficacy in some patients warrants predictors of responsiveness. Patients and Methods: we analysed tumour samples from 293 R0-resected patients from the randomized, multicentre phase III CONKO-005 trial (gemcitabine ± erlotinib) with targeted sequencing, copy number, and RNA expression analyses. Findings: a total of 1086 mutations and 4157 copy-number aberrations (CNAs) with a mean of 17.9 /tumour were identified. Main pathways affected by genetic aberrations were the MAPK-pathway (99%), cell cycle control (92%), TGFβ signalling (77%), chromatin remodelling (71%), and the PI3K/AKT pathway (65%). Based on genetic signatures extracted with non-negative matrix factorization we could define five patient clusters, which differed in mutation patterns, gene expression profiles, and survival. In multivariable Cox regression analysis, SMAD4 aberrations were identified as a negative prognostic marker in the gemcitabine arm, an effect that was counteracted when treated with erlotinib (DFS: HR=1.59, p = 0.016, and OS: HR = 1.67, p = 0.014). Integration of differential gene expression analysis established SMAD4 alterations with low MAPK9 expression (n = 91) as a predictive biomarker for longer DFS (HR=0.49; test for interaction, p = 0.02) and OS (HR = 0.32; test for interaction, p = 0.001). Interpretation: this study identified five biologically distinct patient clusters with different actionable lesions and unravelled a previously unappreciated association of SMAD4 alteration status with erlotinib effectiveness. Confirmatory studies and mechanistic experiments are warranted to challenge the hypothesis that SMAD4 status might guide addition of erlotinib treatment in early-stage PDAC patients.

Strains of the coccolithophore Emiliania huxleyi (Haptophyta) collected from the subarctic North Pacific and Arctic oceans in 2010 were established as clone cultures and have been maintained in the laboratory at 15 °C and 32 ‰ salinity. To study the physiological responses of coccolith formation to changes in temperature and salinity, growth experiments and morphometric investigations were performed on two strains, namely MR57N isolated from the northern Bering Sea and MR70N at the Chukchi Sea. This is the first report of a detailed morphometric and morphological investigation of Arctic Ocean coccolithophore strains. The specific growth rates at the logarithmic growth phases in both strains markedly increased as temperature was elevated from 5 to 20 °C, although coccolith productivity (estimated as the percentage of calcified cells) was similar at 10–20 % at all temperatures. On the other hand, the specific growth rate of MR70N was affected less by changes in salinity in the range 26–35 ‰, but the proportion of calcified cells decreased at high and low salinities. According to scanning electron microscopy (SEM) observations, coccolith morphotypes can be categorized into Type B/C on the basis of their biometrical parameters. The central area elements of coccoliths varied from thin lath type to well-calcified lath type when temperature was increased or salinity was decreased, and coccolith size decreased simultaneously. Coccolithophore cell size also decreased with increasing temperature, although the variation in cell size was slightly greater at the lower salinity level. This indicates that subarctic and arctic coccolithophore strains can survive in a wide range of seawater temperatures and at lower salinities with change in their morphology. Because all coccolith biometric parameters followed the scaling law, the decrease in coccolith size was caused simply by the reduced calcification. Taken together, our results suggest that calcification productivity may be used to predict future oceanic environmental conditions in the polar regions.

Objectives: This study aimed to assess the prognostic significance of a novel biomarker, the fibrinogen-C-reactive protein-albumin ratio (F-CAR), in pancreatic cancer patients undergoing pancreatectomy., Method: We retrospectively analyzed 163 patients undergoing pancreatectomy for pancreatic cancer. The relationship between F-CAR, calculated from preoperative serum fibrinogen, albumin, and C-reactive protein levels, and long-term outcomes following pancreatectomy was examined., Results: Multivariate analysis revealed that several factors, including age (P < 0.01), high serum carbohydrate antigen 19-9 (CA19-9) level (P < 0.01), high serum carcinoembryonic antigen level (P = 0.049), pT3 or pT4 (UICC) (P < 0.01), pN1 or pN2 (P < 0.01), and high F-CAR (hazards ratio, 1.51; 95% confidence interval, 1.03-2.22; P = 0.04), were independent and significant predictors of disease-free survival. Moreover, factors such as age (P = 0.02), high serum carcinoembryonic antigen level (P < 0.01), preoperative biliary drainage (P = 0.02), preoperative chemotherapy (P = 0.04), lymph node metastasis (P < 0.01), adjuvant chemotherapy (P = 0.046), and high F-CAR (hazards ratio, 1.55; 95% confidence interval, 1.03-2.35; P = 0.04) were found to be independent and significant predictors of overall survival., Conclusions: F-CAR is a useful prognostic factor for disease-free survival and overall survival after pancreatectomy in pancreatic cancer patients., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Disorders associated with the immune system burden multiple organs, although the shared biology exists across the diseases. Preceding family-based studies reveal that immune diseases are heritable to varying degrees, providing the basis for immunogenomics. The recent cost reduction in genetic analysis intensively promotes biobank-scale studies and the development of frameworks for statistical genetics. The accumulating multi-layer omics data, including genome-wide association studies (GWAS) and RNA-sequencing at single-cell resolution, enable us to dissect the genetic backgrounds of immune-related disorders. Although autoimmune and allergic diseases are generally categorized into different disease categories, epidemiological studies reveal the high incidence of autoimmune and allergic disease complications, suggesting the shared genetics and biology between the disease categories. Biobank resources and consortia cover multiple immune-related disorders to accumulate phenome-wide associations of genetic variants and enhance researchers to analyze the shared and heterogeneous genetic backgrounds. The emerging post-GWAS and integrative multi-omics analyses provide genetic and biological insights into the multicategorical disease associations.

Microscopic polyangiitis (MPA) affects small and medium vessel, which sometimes leads to arterial aneurysms. In English database, only 15 reports refer to ruptured aneurysms in MPA. We experienced a fatal case with MPA who developed multiple visceral aneurysms, resulting in rupture of the hepatic aneurysm. For the better knowledge of aneurysmal rupture in MPA, we reviewed the feature of 16 cases, including our case. Organ involvement observed was glomerulonephritis 100%, pulmonary involvement 25%, peripheral neuropathy 25%, and purpura 12.5%. Locations of ruptured aneurysms were left gastric artery 31.25%, renal and hepatic artery 18.75% each, intracranial and splenic artery 12.5% each, and gastroepiploic and mesenteric artery 6.25% each. Median time to rupture was 45 days after systemic symptom onset, and 15 days after immunosuppressive treatment induction. Symptoms at rupture were visceral pain 68.75% and hemodynamic instability 62.5%. Pathological findings of ruptured aneurysms were acute vasculitis in 5, no evidence of active inflammation in 3. Causes of death were aneurysmal rupture in 5, treatment complications in 3, and total mortality rate was 50%. In conclusion, the initial presentation of MPA resulting in ruptured aneurysms tends to be renal-limited vasculitis. Aneurysms of abdominal medium-sized arteries tend to rupture, from 4 weeks after systemic symptom onset to 2 weeks after immunosuppressive treatment induction. Most aneurysms are less than 10 mm in diameter, develop asymptomatically in a few days, and are recognized when they rupture. Early induction of immunosuppressive treatment has the potential to shrink aneurysms and prevent rupture., Competing Interests: Declarations. Ethics approval: Written informed consent was obtained from the patient’s family. Disclosures: None., (© 2025. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

Aim: This study aimed to investigate the associations between bed-rest time and food intake and between bed-rest time and constipation in older nursing home residents., Methods: We conducted a cross-sectional study using data from the Long-term Care Information System for Evidence (LIFE) database. We used data collected from older nursing home residents registered in the LIFE database between April 2022 and March 2023. We compared outcome data between the short-bed-rest group (≥9 h out of bed per day) and the long-bed-rest group (<9 h out of bed per day). The outcomes were the percentage of food intake provided in the last 3 days, the percentage of energy sufficiency (the percentage of energy intake to energy requirements), and the incidence of constipation., Results: The short-bed-rest group consisted of 265 people (53.9%). The short-bed-rest group showed a significantly higher percentage of food intake (93.1 ± 12.3 vs. 85.2 ± 21.6), a higher percentage of energy sufficiency (104.8 ± 19.4 vs. 92.2 ± 26.2), and a lower incidence of constipation (6.0% vs. 18.5%) than the long bed-rest group. Multivariable analyses revealed that shorter bed-rest time was independently and significantly associated with the percentage of food intake (standardized coefficient: 0.28, P < 0.001), the percentage of energy sufficiency (standardized coefficient 0.30, p < 0.001), and incidence of constipation (odds ratio: 0.12, P < 0.001)., Conclusion: Bed-rest time is associated with food intake and constipation in older nursing home residents. Geriatr Gerontol Int 2025; ••: ••-••., (© 2025 The Author(s). Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.)

Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune disease characterized by optic neuritis and transverse myelitis, with an unclear genetic background. A genome-wide meta-analysis of NMOSD in Japanese individuals (240 patients and 50,578 controls) identified significant associations with the major histocompatibility complex region and a common variant close to CCR6 (rs12193698; p = 1.8 × 10 -8 , odds ratio [OR] = 1.73). In single-cell RNA sequencing (scRNA-seq) analysis (25 patients and 101 controls), the CCR6 risk variant showed disease-specific expression quantitative trait loci effects in CD4 + T (CD4T) cell subsets. Furthermore, we detected somatic mosaic chromosomal alterations (mCAs) in various autoimmune diseases and found that mCAs increase the risk of NMOSD (OR = 3.37 for copy number alteration). In scRNA-seq data, CD4T cells with 21q loss, a recurrently observed somatic event in NMOSD, showed dysregulation of type I interferon-related genes. Our integrated study identified novel germline and somatic mutations associated with NMOSD pathogenesis., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Japanese Black beef is known for its high intramuscular fat content, an important factor in its distinctive Wagyu aroma. Wet aging, which involves vacuum-packing meat and storing it at low temperatures, enhances flavor, texture, and tenderness and is essential for maintaining and improving meat quality. In this study, changes in metabolites and lipid profiles were investigated during the wet aging of Japanese Black and Holstein beef. Methods/Results: Gas chromatography-mass spectrometry identified 113 metabolites in Japanese Black beef and 94 in Holstein beef, with significant increases in metabolites like aspartic acid and maleic acid over the aging period. Regarding lipid composition, total free fatty acids significantly increased with wet aging, with Japanese Black beef showing significantly higher concentrations of oleic and linoleic acids than Holstein beef. Additionally, lipid analysis by liquid chromatography-mass spectrometry revealed a reduction in specific phospholipids, particularly lysophosphatidylcholine (LPC) and lysophosphatidylethanolamine (LPE), with notable decreases in LPC (18:1), LPC (18:2), LPE (18:1), and LPE (18:2). Conclusions: These results suggest that wet aging influences the stability of membrane lipids, facilitating the degradation of phospholipids into free fatty acids, and improving the flavor of Japanese Black beef.

Aim: Prognosis of pancreatic cancer is improved by combining postoperative adjuvant chemotherapy and preoperative adjuvant chemotherapy with surgery, while the importance of extended dissection surgery has decreased. To better understand prognostic factors of recurrence, we focused on the timing of postoperative adjuvant chemotherapy in patients with pancreatic cancer., Methods: One hundred patients who underwent pancreatectomy or pancreaticoduodenectomy and chemotherapy for pancreatic cancer were classified into early and late postoperative adjuvant therapy initiation groups. Prognosis was evaluated retrospectively using known prognostic factors., Results: On receiver operating characteristic analysis, optimum cut-off between the early (<52 days; n = 60) and late adjuvant initiation groups (≥52 days; n = 40) was 52 days. The two groups were well-matched, except the early initiation group had more surgeries with D2 lymph node dissection (75 % vs 48 %; p = 0.01); fewer postoperative complications (17 % vs 59 %; p = 0.04), including less postoperative pancreatic fistula (13 % vs 35 %; p = 0.03); and longer disease-free survival (0.7 years v 0.5 years; p = 0.02). On multivariate evaluation, early initiation and completion of adjuvant therapy were associated with increased overall survival, while early initiation was associated with prolonged disease-free survival., Conclusions: Prognosis of patients with pancreatic cancer is improved by earlier rather than later initiation of postoperative adjuvant therapy., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024. Published by Elsevier Ltd.)

Objectives: On 18 F-Fludeoxyglucose (FDG) PET/CT, active sarcoid lesions are often difficult to differentiate from malignant lesions. We investigated the potential of the glucose metabolic rate (MR glc , mg/min/100 mL), a new quantification of glucose metabolic kinetics derived from direct reconstruction based on linear Patlak analysis, to distinguish between sarcoidosis and malignant lesions., Materials and Methods: A total of 100 patients with cardiac sarcoidosis (CS) and 67 patients with cancer who underwent four-dimensional FDG PET/CT were enrolled. The lesions with a standardized uptake value (SUV) ≥ 2.7 on the standard scan were included as active lesions in the analysis. SUV and MR glc were derived using data acquired between 30 min and 50 min on four-dimensional FDG PET/CT. The mean value in the volume of interest (size 1.5 cm 3 ) was measured. The diagnostic performance of sarcoidosis using MR glc and SUV was evaluated using receiver-operating-characteristic (ROC) analysis., Results: A total of 90 sarcoidosis lesions from 44 CS patients (18 males, 63.4 ± 12.2 years) and 87 malignant lesions from 57 cancer-bearing patients (32 males, 65 ± 14 years) were analyzed. SUV and MR glc for sarcoid lesions were significantly lower than those for malignant lesions (SUV, 4.98 ± 2.00 vs 6.21 ± 2.14; MR glc , 2.52 ± 1.39 vs 3.68 ± 1.61; p < 0.01). ROC analysis indicated that the ability to discriminate sarcoid patients from those with malignancy yielded areas under the curves of 0.703 and 0.754, with sensitivities of 64% and 77% and specificities of 75% and 72% for SUV 5.025 and MR glc 2.855, respectively., Conclusion: MR glc was significantly lower in sarcoid lesions than malignant lesions, and improved sarcoid lesions identification over SUV alone., Clinical Relevance Statement: MR glc improves sarcoid lymph node identification over SUV alone and is expected to shorten the examination time by eliminating delayed scans., Key Points: Active sarcoid lesions are sometimes associated with FDG accumulation and should be differentiated from malignant lesions. SUV and metabolic rate of glucose (MRglc) strongly positively correlated, and MRglc could differentiate sarcoid and malignant lesions. MRglc allows for accurate evaluation and staging of malignant lesions., Competing Interests: Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Michinobu Nagao. Conflict of interest: The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. Statistics and biometry: No complex statistical methods were necessary for this paper. Informed consent: Written informed consent was obtained from all subjects (patients) in this study. Ethical approval: Institutional Review Board approval was obtained. The study complied with the declaration of Helsinki, and the protocol was approved by the ethics committee of Tokyo Women’s Medical University (2021-0153). Study subjects or cohorts overlap: None. Methodology: Retrospective Cross-sectional study Performed at one institution, (© 2024. The Author(s), under exclusive licence to European Society of Radiology.)

Background: Photoimmunotherapy (PIT) is a potent modality for cancer treatment. The conventional PIT regimen involves the systemic delivery of an antibody-photoabsorber conjugate, followed by a 24-h waiting period to ensure adequate localisation on the target cells. Subsequent exposure to near-infrared (NIR) light selectively damages the target cells. We aimed to improve the efficacy of PIT in vivo by evaluating the effects of the different routes of conjugate administration on treatment outcomes., Methods: Subcutaneous Lewis lung carcinoma tumours were established in mice, targeting cluster of differentiation (CD)44 with an anti-CD44 antibody conjugated to IRDye700DX (IR700). The conjugate was administered via the intravenous or intratumoural route followed by the assessment of antibody binding and therapeutic effects of PIT., Findings: Compared to intravenous administration, intratumoural delivery of the CD44-IR700 conjugate significantly increased the number of cells binding to the conjugate by >five-fold. This method, combined with NIR light irradiation, halved tumour growth when compared to intravenous delivery. Reducing the interval between intratumoural injection and NIR light exposure to 30 min did not diminish efficacy, thereby demonstrating the feasibility of a 1-h procedure., Interpretation: Intratumoural administration of the antibody-photoabsorber conjugate enhanced the efficacy of PIT in vivo. A simplified, 1-h procedure involving conjugate tumour injection followed by irradiation emerged as a potent cancer treatment strategy., Funding: This study was supported by the Japan Society for the Promotion of Science, the Japan Agency for Medical Research and Development, Japan Science and Technology Agency, and the Osaka Medical Research Foundation for Intractable Diseases., Competing Interests: Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.)

Nontuberculous mycobacterial pulmonary disease (NTM-PD), mainly caused by Mycobacterium avium complex (MAC), and pulmonary tuberculosis (TB) are emerging health problems worldwide. However, because their clinical features are often similar, it remains difficult to differentiate NTM-PD from TB when the diagnosis cannot be made by sputum culture. To investigate potential serum biomarkers, we conducted non-targeted proteome analysis on serum extracellular vesicles (EVs) collected from 10 patients with MAC pulmonary disease (MAC-PD), 7 patients with TB, and 10 healthy controls. A total of 2614 proteins were identified in the discovery cohort. The EV protein signature from patients with NTM-PD and TB reflected infectious diseases and inflammatory response pathways. Among the identified proteins, the expression of Na + /H + exchanger regulatory factor 2 (NHERF2) was significantly elevated in patients with MAC-PD compared with healthy controls and patients with TB. Moreover, upregulation of NHERF2 was confirmed by immunoblotting of serum EVs and immunohistochemistry of lungs with mycobacterial infection. Our findings highlight that NHERF2 in serum EVs might be a potential biomarker for distinguishing MAC-PD from TB, possibly reflecting the pathogenesis of MAC-PD.

Background: Families of critically ill patients in the intensive care unit (ICU) need a variety of information about the patient. Meeting these information needs improves the quality of communication between the family and ICU staff, as well as reduces the risk of post-intensive care syndrome-family (PICS-F). However, information needs continue to be unmet, and information regarding which specific information needs are met or unmet is insufficient. Additionally, the unmet needs that affect PICS-F are unknown. Therefore, this study aims to identify the unmet information needs of families of patients admitted to the ICU in terms of communication with ICU staff and determine their association with PICS-F., Methods: This study will be a single-center cross-sectional study using a questionnaire survey. The participants will include family members of patients admitted to the emergency ICU of the Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital in Japan. Eligibility for participation will be assessed from medical records, and family members of patients who meet the eligibility criteria will be identified and sent a questionnaire. PICS-F and unmet information needs will be assessed 1 to 12 months after patients leave the ICU. PICS-F assessment will include the evaluation of anxiety, depression, post-traumatic stress disorder, and prolonged grief disorder. Univariate and multiple logistic regression analyses will be used to examine the association between PICS-F and unmet information needs., Discussion: This study will fill a research gap in communication between ICU staff and families of ICU patients by examining the information that tends not to be provided or understood by families, thereby providing an understanding of the information that is likely to be an unmet information need. Additionally, this study can contribute to the development of future communication strategies by investigating which unmet information needs are associated with PICS-F risk, thus emphasizing the information needs that should be given priority when developing effective communication strategies., Trial Registration: University Hospital Medical Information Network Center Clinical Trials Registry UMIN 000053813., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Central Ethics Committee of the Nippon Medical School Foundation (approval no. M-2023-152; approval date: February 19, 2024). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Purpose: The number of frozen-thawed embryo transfers (FETs) has recently increased, and FET must be completed in the ovulatory (NC-FET) or programmed hormone replacement cycle (HRC-FET). However, the relationship between FET and abnormal placentation is unclear. This study aimed to determine whether the two distinct endometrial preparation protocols affect the incidence of several pathologic conditions caused by abnormal placentation, such as placenta with velamentous umbilical cord insertion (VCI), hypertensive disorders of pregnancy (HDP), and placenta accreta spectrum (PAS)., Methods: For this retrospective cohort study, the medical records of 1,161 singleton term FET-conceived and -delivered cases were reviewed from January 2016 to July 2024. The study population was categorized into HRC-FET (Group A: n = 846) and NC-FET (Group B: n = 315) cases. After adjusting for confounding factors, the odds ratios (ORs) of the investigated targeted variables in Group A compared to Group B were calculated using multivariate logistic regression., Results: The incidence of VCI and PAS in Groups A and B was 7.0% and 2.5% for VCI and 5.1% and 1.0% for PAS, respectively, with a significant difference (P < 0.01). The adjusted ORs for VCI, PAS, and HDP in Group A compared to those in Group B were 3.07 (P < 0.01), 5.73 (P < 0.01), and 1.24 (P = 0.42), respectively., Conclusion: Pregnancies achieved through HRC-FET have higher risks of developing abnormal placentation (i.e., VCI and PAS) than those achieved through NC-FET. These pregnancies are high risk and should be managed carefully for a healthy perinatal course., Competing Interests: Declarations. Conflict of interest: The authors have no relevant financial or non-financial interests to disclose. Ethical approval: The study protocols conformed to the provisions of the Declaration of Helsinki (revised in Tokyo, 2004) and were approved by the Kubonoya Women’s Hospital Ethics Committee and Review Board, which approved the use of an electronic medical record database for this clinical study (approval no. 2024–1). Informed consent: The requirement to obtain informed consent from the patients involved was waived because of the study’s observational retrospective cohort design. Consent to publish: Not applicable., (© 2025. The Author(s).)

Competing Interests: Disclosures: The authors declare no conflicts of interest.

Purpose: Inflammatory, nutritional, and immune biomarkers are associated with the prognosis of patients with various tumors. Recently, a comprehensive predictive biomarker, the hemoglobin, albumin, lymphocyte, and platelet (HALP) score, was introduced to predict clinical outcomes. We investigated the prognostic impact of preoperative HALP scores in patients who underwent hepatectomy for colorectal liver metastasis (CRLM)., Method: The subjects of this study were 209 patients who underwent hepatectomy for CRLM between February, 2005 and September, 2023. The HALP score was defined as (albumin [mg/dL] × hemoglobin [g/L] × lymphocyte [count/L]) / platelet [count/L]. The cutoff value was calculated according to the receiver operating characteristic curve based on 3-year survival., Results: The cutoff value of the HALP score was 35, and a low HALP score was confirmed in 107 patients (51%). Multivariate analysis of disease-free survival identified lymph node metastasis (HR 1.53, p = 0.03), extrahepatic lesions (HR 2.48, p < 0.01), and a low HALP score (HR 2.0, p < 0.01) as independently poor prognostic factors. Multivariate analysis of overall survival identified extrahepatic lesions (HR 2.98, p < 0.01), a high CEA (HR 1.78, p = 0.02), and a low HALP score (HR 1.92, p = 0.02) as independently poor prognostic factors., Conclusions: The HALP score is a useful prognostic factor for patients undergoing hepatectomy for CRLM., Competing Interests: Declarations. Conflict of interest: We have no conflicts of interest or funding to declare., (© 2025. The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.)

Background: The guidelines recommend anticoagulation management with uninterrupted warfarin or direct thrombin inhibitors (DTIs) during the atrial fibrillation (AF) ablation periprocedural period., Objectives: To clarify the Japanese real-world latest periprocedural anticoagulation management during AF ablation., Methods: This multicenter observational study included 6232 consecutive AF patients (68.7 ± 10.9 years, 4346 men) who underwent periprocedural anticoagulation therapy using direct oral anticoagulants (DOACs) between January 2022 and August 2023., Results: The mean CHADS 2 and CHA 2 DS 2 VASc scores were 1.2 ± 1.1 and 2.3 ± 1.5. Bleeding and thromboembolic events occurred in 79 (1.3%) and eight (0.12%) patients. During the periprocedural period, factor Xa inhibitors (FXaIs) were used in 3063 patients (rivaroxaban in 624, apixaban in 1093, and edoxaban in 1345) and DTIs in 3170 including 2583 in whom DTIs were switched from FXaIs. Both the bleeding (0.85% vs. 1.69%, p  = .003) and thromboembolic event rates (0.03% vs. 0.23%, p  = .036) were significantly lower in the DTI- than FXaI-group. A multivariate analysis showed periprocedural FXaI use was significantly associated with both bleeding events (odds ratio [OR] = 1.92, 95% confidence interval [CI] = 1.20-3.08, p  = .006) and cardiac tamponade (OR = 2.74, 95% CI = 1.27-5.9, p  = .01). The interval between the last DOAC administration and the procedure was significantly shorter in the DTI- than FXaI-group (4.2 ± 4.9 vs. 19.3 ± 10.7 h, p  < .01). In the FXaI-group, the bleeding rate tended to be lower in the minimally interrupted ( n  = 2105) than uninterrupted group ( n  = 821) (1.47% vs. 2.56%, p  = .06). Two patients in the uninterrupted FXaI-group required surgical management for cardiac tamponade., Conclusions: Our multicenter real-world data demonstrated that anticoagulation with DTIs was a reasonable periprocedural anticoagulation regimen to reduce periprocedural complications., Competing Interests: The authors declare no conflicts of interest., (© 2025 The Author(s). Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.)

Mutations in ERBB2 (encoding HER2) occur in 2% to 4% of non-small cell lung cancer (NSCLC) and confer poor prognosis. ERBB-targeting tyrosine kinase inhibitors, approved for treating other HER2-dependent cancers, are ineffective in HER2-mutant NSCLC due to dose-limiting toxicities or suboptimal potency. We report the discovery of zongertinib (BI 1810631), a covalent HER2 inhibitor. Zongertinib potently and selectively blocks HER2, while sparing EGFR, and inhibits the growth of cells dependent on HER2 oncogenic driver events, including HER2-dependent human cancer cells resistant to trastuzumab deruxtecan. Zongertinib displays potent antitumor activity in HER2-dependent human NSCLC xenograft models and enhances the activities of antibody-drug conjugates and KRASG12C inhibitors without causing obvious toxicities. The preclinical efficacy of zongertinib translates in objective responses in patients with HER2-dependent tumors, including cholangiocarcinoma (SDC4-NRG1 fusion) and breast cancer (V777L HER2 mutation), thus supporting the ongoing clinical development of zongertinib. Significance: HER2-mutant NSCLC poses a challenge in the clinic due to limited options for targeted therapies. Pan-ERBB blockers are limited by wild-type EGFR-mediated toxicity. Zongertinib is a highly potent and wild-type EGFR-sparing HER2 inhibitor that is active in HER2-driven tumors in the preclinical and clinical settings., (©2024 The Authors; Published by the American Association for Cancer Research.)

Background: AT-rich interaction domain 4B (ARID4B) is a transcriptional activator that regulates the phosphatidylinositol 3-kinase (PI3K)/AKT pathway in prostate cancer. However, the role of ARID4B in hepatocellular carcinoma (HCC) has remained unclear., Methods: This study included 162 patients who had undergone primary hepatic resection for HCC between 2008 and 2019. Their HCC samples were immunohistochemically stained for ARID4B, and ARID4B score was calculated from the intensity and percentage of staining. We retrospectively investigated the association of ARID4B score with disease-free and overall survival, and primary recurrence patterns of HCC. Furthermore, human HCC cell lines (HuH-1 and HuH-7) were knocked down for ARID4B using small-interfering RNA (siRNA), and the expression of PI3K/AKT proteins, cell proliferation, migration, and invasion ability were assessed., Results: In multivariate analyses, negative HBs-antigen (p = 0.02), multiple tumors (p < 0.01), microvascular invasion (p = 0.03), and high ARID4B score (p = 0.01) were independent predictors of disease-free survival, while tumor size >5 cm (p = 0.03), microvascular invasion (p < 0.01), and high ARID4B score (p = 0.04) were independent predictors of overall survival. A high ARID4B score was associated with high serum α-fetoprotein (AFP) level (p = 0.04), poor tumor differentiation (p < 0.01), and microvascular invasion (p < 0.01). ARID4B scores were significantly lower in the no recurrence, intrahepatic recurrence, and extrahepatic recurrence groups, in that order. Knockdown of ARID4B using siRNA in human HCC cell lines significantly suppressed the PI3K/AKT pathway, cell proliferation, migration, and invasion., Conclusions: ARID4B may activate the PI3K/AKT signaling pathway in HCC and may be a prognostic factor after hepatic resection for HCC., Competing Interests: Disclosures: Munetoshi Akaoka, Mitsuru Yanagaki, Hoshiho Kubota, Koichiro Haruki, Kenei Furukawa, Tomohiko Taniai, Shinji Onda, Ryoga Hamura, Masashi Tsunematsu, Yoshihiro Shirai, Michinori Matsumoto, Masayuki Shimoda, and Toru Ikegami declare no conflicts of interest that may be relevant to the contents of this study. The authors would like to thank Mr Mitsunobu Arizono and Ms Risako Suzuki (the Jikei University School of Medicine) for their excellent assistance with the in vitro experiments. Ethical Approval: This study protocol was approved by the Ethics Committee of the Jikei University School of Medicine (approval number 27-177). Informed Consent: Individual consent was waived because of the anonymous nature of the data., (© 2025. Society of Surgical Oncology.)

Introduction: Pleomorphic adenoma is a benign tumor that frequently occurs in the salivary glands; however, it occurs in the breast rarely. There have been few reports of breast cancer complicated by pleomorphic adenoma of the mammary gland., Case Presentation: A 70-year-old woman was found to have a mass lesion in her left breast during a medical examination. A needle biopsy was performed, and a diagnosis of pleomorphic adenoma was made. We performed a partial mastectomy with a margin of several millimeters from the tumor. Pathological examination revealed a diagnosis of pleomorphic adenoma with ductal carcinoma in situ. The resection margin was sufficient, and the patient was followed up., Conclusions: Pleomorphic adenoma arising in the mammary gland is difficult to differentiate from adenomyoepithelioma, mucocele-like tumor, and metaplastic carcinoma. Since the tumor can become malignant, resection with a narrow margin is recommended, along with special efforts not to damage the capsule at diagnosis., Competing Interests: The authors have no related conflicts of interest to declare., (© 2025 The Author(s). Published by Japan Surgical Society.)

Introduction: An ilio-iliac arteriovenous fistula (IIAVF) secondary to the rupture of a common iliac artery aneurysm (CIAA) is rare. Sudden arteriovenous shunting and subsequent fistula enlargement can result in acute cardiac failure. Immediate diagnosis and treatment are required; however, the clinical symptoms differ from those of a free wall rupture of an aortic aneurysm, making a quick diagnosis difficult. Thus, we reported the case of a patient with severe right-sided cardiac failure, due to an arteriovenous shunt formation secondary to an IIAVF who underwent an artificial blood vessel replacement with favorable results., Case Presentation: A 71-year-old male patient presented to our hospital with polypnea and palpitations. Initial early-phase computed tomography (CT) revealed a 60-mm-in-diameter right CIAA and an inferior vena cava (IVC) dilatation. Severe congestive heart failure, due to an arteriovenous shunt formation secondary to an IIAVF was diagnosed. The massive shunt of blood flowed from the right common iliac artery (CIA) to the right common iliac vein (CIV). He underwent an emergency open abdominal aortic replacement. The IVC ran anomalously anterior to the giant right CIAA and strongly adhered to the IVC and right CIV. Two guidewires were inserted from the bilateral femoral veins into the IVC intraoperatively. Moreover, an occlusion balloon was inserted into the right CIV. Thus, bleeding from the fistula was well-controlled by the time of aneurysm opening. The proximal side of the artificial graft was anastomosed to the abdominal aorta, while the right and left peripheral branches of the prosthesis were anastomosed to the right external iliac artery and left CIA, respectively., Conclusions: We reported the case of a giant right CIAA that directly created a shunt into the right CIV. Contrast-enhanced CT is a useful method for confirming the working diagnosis of an IIAVF. In particular, in cases of IVC anomalies or strong perivenous tissue adhesions, bleeding can be controlled using devices, such as occlusion balloons and a meticulous surgical plan., Competing Interests: The authors declare that they have no competing interests., (© 2025 The Author(s). Published by Japan Surgical Society.)

Pancreatic cancer is known as a disease with an extremely poor prognosis. Although surgery is the only curative treatment, most pancreatic cancer is already advanced at the time of diagnosis. With advances in multidisciplinary treatment such as chemotherapy, radiation therapy, and heavy-ion therapy, more cases of unresectable(UR)pancreatic cancer are being treated with surgery in recent years. Therefore, the term"conversion surgery"has been newly included in the 8th edition of the General Rules for Study of Pancreatic Cancer, and the treatment strategy for UR pancreatic cancer has entered a new phase. Conversion surgery for UR-LA pancreatic cancer is expected to be effective as the indications for chemoradiation and heavy-ion radiation therapy expand. On the other hand, UR-LA pancreatic cancer is not only a locally advanced disease but also a systemic disease, and there have been reports of patients with early postoperative recurrence, so the indication for surgery remains a controversial field. Furthermore, there are increasing reports of conversion surgery for UR-M pancreatic cancer. There are concerns about complications and increased mortality due to extended resection, and early recurrence, so usefulness is not clear at present. Among UR-M, positive peritoneal washing cytology(CY1)is considered to be a preliminary stage of peritoneal dissemination, and is now treated as distant metastasis since the 8th edition of General Rules. CY-positive pancreatic cancer is easier to control than other distant metastases, and CY-negative conversion is expected to be equivalent to that of patients with CY0 at the initial diagnosis. Further evidence for multidisciplinary treatment, including conversion surgery, is expected to be accumulated.

Background: Biliary stricture is a common complication after living-donor liver transplantation (LDLT), but its management is challenging. We herein report a case of successful internal drainage achieved through combination of the gun-sight technique and dual hepatic vascular embolization (DHVE)., Case Presentation: A 54-year-old woman with primary biliary cholangitis underwent ABO-incompatible LDLT with the right lobe. Duct-to-duct biliary anastomosis was performed, and V5 and V8 of the graft were reconstructed using a vein graft. However, 5 months after surgery, magnetic resonance cholangiopancreatography revealed stricture of the bile duct anastomosis. Endoscopic stenting could not be attempted because of the sigmoidal bending of the bile duct. Instead, percutaneous transhepatic cholangiographic drainage (PTCD) of the anterior and posterior branches was performed. We attempted to remove the PTCD tube by an endofistulization technique. We performed the gun-sight technique, originally employed for transjugular intrahepatic portosystemic shunt procedures, to create a pathway for internal drainage of the posterior segment. The anterior lobe was abandoned by applying DHVE, resulting in no external drainage tubes., Conclusion: Application of the gun-sight technique with DHVE for sigmoidal refractory biliary stricture after LDLT appears to be a feasible treatment., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Kenei Furukawa reports financial support was provided by JSPS KAKENHI. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background/aim: To investigate risk factors of late acute remnant pancreatitis after pancreatoduodenectomy (PD), we propose the use of a suturing pitch calculated based on the diameter of the main pancreatic duct and the number of sutures used in the pancreatic duct-to-mucosa anastomosis. This study aimed to determine whether the suturing pitch can predict late acute pancreatitis following PD., Patients and Methods: This study included 142 patients who underwent elective PD. The suturing pitch was defined as the distance between the ligations of the duct-to-mucosa anastomosis of the pancreatojejunostomy. It was calculated using the formula: main pancreatic duct size × π ÷ suturing number. Late acute pancreatitis was defined as acute pancreatitis occurring more than 30 days after PD. We retrospectively evaluated clinical parameters, including the suturing pitch, to identify predictors of late acute remnant pancreatitis., Results: Late acute remnant pancreatitis occurred in seven patients, and the 5-year and 10-year cumulative incidence rates were 8.5% and 12.7%, respectively. A narrow suturing pitch was significantly associated with male sex (p=0.037), younger age (p=0.003), soft pancreas (p<0.001), narrow pancreatic duct stent size (p<0.001), narrow main pancreatic duct size (p<0.001), and the occurrence of late acute remnant pancreatis (p=0.006). In multivariate analysis, the narrow suturing pitch was a significant and independent risk factor of late acute remnant pancreatitis (p=0.041), but not of postoperative pancreatic fistula (p=0.106)., Conclusion: To prevent late acute remnant pancreatitis, the pancreatic duct-to-mucosa anastomosis should not be sutured too tightly., (Copyright © 2025 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: Lipoprotein(a) (Lp(a)) is a complex protein involved in the transport of insoluble lipids in plasma. Its expression is predominantly genetically determined, with 70% to over 90% influenced by the number of Kringle IV type 2 domains. This study investigated the association between preoperative serum Lp(a) level and development of post-pancreatectomy nonalcoholic fatty liver disease (NAFLD) in patients who underwent pancreatectomy., Patients and Methods: Serum Lp(a) level was measured preoperatively and retrospectively evaluated together with other known risk factors for NAFLD, which was defined using a computed tomography-based Hounsfield unit (HU) value for liver parenchyma below 40 HU at the anteroposterior midpoint., Results: NAFLD developed after pancreatectomy in 40 patients (17.5%) in the high Lp(a)-group, which was significantly lower compared to the 30 patients (53%) in the low Lp(a)-group (p=0.01). There were no other significant background factors related to preoperative Lp (a) level. Multivariate analysis indicated that low Lp(a) level is an independent risk factor for postoperative NAFLD, as well as pancreatic head resection, a small residual pancreatic volume, poor intake of pancrelipase, and postoperative diarrhea., Conclusion: NAFLD after pancreatectomy could be predicted preoperatively to a certain extent by examining serum Lp(a) level., (Copyright © 2025 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background: This study aimed to investigate the effects of changes in clinicopathological factors during preoperative chemotherapy for pancreatic cancer, including skeletal muscle volume, on recurrence and prognosis after pancreatectomy., Methods: Data from 41 patients who underwent resection for pancreatic cancer after preoperative chemotherapy from 2012 to 2021 were retrospectively reviewed. Skeletal muscle volume was substituted for the psoas muscle area (PMA) at the level of the third lumbar vertebra. We investigated the relationship of clinicopathological factors during preoperative chemotherapy with disease-free survival (DFS) and overall survival (OS). The association between clinicopathological factors and a decrease in PMA was investigated., Results: In the multivariate analyses for DFS and OS, the factors associated with recurrence were as follows: decrease in PMA ( P = 0.003) and the absence of adjuvant therapy ( P = 0.03), and the factors associated with poor prognosis were as follows: decrease in PMA ( P = 0.04) and the absence of adjuvant therapy ( P = 0.008), and the resectability of borderline resectable and unresectable-locally advanced tumors ( P = 0.033). All patients with partial response according to the Response Evaluation Criteria in Solid Tumors (version 1.1) had no decrease in PMA ( P = 0.01). The proportion of patients with Evans classification ≥ II was significantly higher in the group without a decrease in PMA ( P = 0.02). The proportion of patients with an average relative dose intensity of adjuvant therapy ≥0.6 was significantly higher in the group without a decrease in PMA ( P = 0.02)., Conclusion: Changes in preoperative skeletal muscle volume during preoperative chemotherapy for pancreatic cancer is a potential predictor of recurrence and prognosis after pancreatectomy., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: This study aimed to identify postoperative recurrence and prognostic factors, including osteosarcopenia for borderline resectable (BR) and unresectable locally advanced (UR-LA) pancreatic cancer and to examine the impact of postoperative pancreatic enzyme replacement therapy (PERT)., Methods: We retrospectively examined 32 resected patients with BR and UR-LA pancreatic cancer. We investigated independent factors in the disease-free survival and overall survival. The relation of osteosarcopenia with the clinicopathological factors was investigated. Additionally, the association of the administration of a standard dose of pancrelipase, the amount of lipase required for patients with pancreatic exocrine insufficiency, for ≥6 months postoperatively with improvement of sarcopenia, osteopenia, and osteosarcopenia and completion rate of adjuvant chemotherapy was investigated., Results: Multivariate analyses identified osteosarcopenia ( P = 0.049) and lymph node metastasis ( P = 0.01) as independent recurrence predictors, and osteosarcopenia ( P = 0.002), maximum tumor diameter ≥40 mm ( P = 0.006), and no adjuvant therapy ( P = 0.01) as independent prognostic predictors. In the osteosarcopenia group, serum CA19-9 levels were higher ( P = 0.03). The administration of a standard dose of pancrelipase for ≥6 months postoperatively was none in the osteosarcopenia group (0% vs 42.9%, P = 0.01), while significantly improved postoperative sarcopenia (33% vs 0%, P = 0.004), increased number of cycles of adjuvant chemotherapy (n = 6 vs n = 3, P = 0.03), and the completion rate of adjuvant chemotherapy in excluding cases interrupted because of recurrence (86% vs 25%, P = 0.007)., Conclusions: Osteosarcopenia was an independent recurrent and prognostic factor in patients after pancreatectomy for locally advanced pancreatic cancer. Appropriate postoperative PERT may contribute to a better prognosis by improving sarcopenia and increasing the completion rate of adjuvant chemotherapy., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Kidney transplantation (KT) in children and adolescents with severe motor and intellectual disabilities (SMID) has been a topic of controversy. A multicenter study in Japan showed that KT was not contraindicated for children with multiple handicaps, but no consensus has been reached on KT for patients with SMID. This study aimed to determine whether KT is a viable treatment option for children and adolescents with SMID., Methods: A single-center, retrospective study was conducted on children and adolescents with SMID who underwent KT. SMID was defined based on Oshima's classification. Clinical information was collected through a review of medical records., Results: Of 453 children and adolescents who underwent KT between 1983 and 2023 in our institution, six (1.3%) patients with SMID were identified. One patient received KT twice. All patients underwent living KT. Five patients used medical devices, including gastrostomy and a ventriculoperitoneal shunt, prior to KT. Perioperative complications, including hemothorax related to central venous catheter insertion, ventilator-associated pneumonia, and common iliac artery thrombosis requiring graftectomy, occurred in three patients. One patient required vesicostomy owing to refractory urinary tract infection. There was no significant difference in the graft survival rate between patients with SMID and those without SMID. One patient developed graft failure and died after selecting conservative kidney management., Conclusion: Our study showed a favorable graft survival in children and adolescents with SMID who underwent KT. Although careful perioperative management and continued medical care are required, KT may be a viable option for these patients., Competing Interests: Declarations. Conflict of interest: The authors declared that they have no conflict of interest. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number 2023–0106) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent: Informed consent was waived by providing the patients’ guardians an opportunity to opt out., (© 2024. The Author(s), under exclusive licence to Japanese Society of Nephrology.)