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子宮頸部腺癌ⅣB期に対してパクリタキセル/シスプラチン+ベバシズマブ+ペムブロリズマブ療法が著効した一例
Get PDF進行子宮頸癌に対する全身化学療法は従来タキサン製剤とプラチナ製剤の併用療法が標準治療であったが、2017年にはベバシズマブを追加したレジメンが標準治療となった。さらに免疫チェックポイント阻害薬の研究が進み、本邦でも2022年にペムブロリズマブが進行子宮頸癌に対する治療として適応承認を得た。今回我々は、73歳の子宮頸部腺癌ⅣB期に対してパクリタキセル/シスプラチン+ベバシズマブ+ペムブロリズマブ療法を3コース行い、明らかな有害事象なく病巣の縮小と腹水の減少を認めた症例を経験した。ペムブロリズマブは活性化T細胞上に発現するPD-1受容体に結合するモノクローナル抗体であり、PD-L1とPD-L2との相互作用をブロックすることで腫瘍細胞が免疫監視を回避するのを阻害する。本症例を通して、進行子宮頸部腺癌に対して免疫チェックポイント阻害薬が有効であることを示した。Traditionally the systemic chemotherapy for advanced cervical cancer has been a combination of taxane and platinum, but in 2017, bevacizumab was combined with the regimen as standard therapy. Recently, the research on immune checkpoint inhibitors has progressed, and pembrolizumab was approved in Japan in 2022 for the treatment of advanced cervical cancer. In this study, we report a case of stage IVb cervical adenocarcinoma with three courses of paclitaxel/cisplatin plus bevacizumab and pembrolizumab therapy. After the treatment, reduction of both primary tumor and metastasis and ascites was observed without any adverse events. Pembrolizumab is a monoclonal antibody that binds to the PD-1 receptor on Tcell and blocks the interaction between PD-L1 / PD-L2 and PD-1, thereby preventing tumor cells from evading immune surveillance. Through this case, we suggest that immune checkpoint inhibitors can be a good treatment option for advanced cervical adenocarcinoma.journal articl
Assessment of therapeutic effects of combined treatment with cisplatin and anti-mouse programmed death (PD)-1 antibody in a mouse urothelial cancer model
No full text浜松医科大学Hamamatsu University School of Medicine博士（医学）Background/Aim: The therapeutic impact of combination treatment with an immune checkpoint inhibitor (ICI) and chemotherapeutic agent on patients with urothelial cancer (UC) remains controversial. Therefore, the present study investigated differences in the therapeutic effects of combination therapy with cisplatin plus anti-mouse programmed death (PD)-1 antibody according to the dose of cisplatin using the mouse bladder tumor model MBT2. Materials and Methods: The effects of treatment with two different doses cisplatin and/or anti-mouse PD-1 antibody on tumor growth after the subcutaneous injection of MBT2 cells were compared. Infiltrating patterns of lymphocytes into tumors after treatment were assessed using immunohistochemical staining. Results: MBT2 tumor volumes were significantly larger in mice receiving high-dose cisplatin alone than in those receiving low-dose cisplatin alone. Combination treatment with cisplatin plus anti-mouse PD-1 antibody exerted significantly stronger growth inhibitory effects on MBT2 tumors than treatment with either agent alone, irrespective of cisplatin doses; however, no significant differences were observed in MBT2 tumor volumes between mice receiving anti-mouse PD-1 antibody plus high-dose cisplatin and those receiving anti-mouse PD-1 antibody plus low-dose cisplatin. Furthermore, CD8+ to CD3+ and CD8+ to CD11b+ T-lymphocyte ratios in MBT2 tumors were both significantly higher in the low-dose cisplatin alone group than in the high-dose cisplatin alone group, whereas no significant differences were noted in either ratio between the two different combination treatment regimens. Conclusion: When combined with ICI, a lower dose of cisplatin may achieve favorable antitumor effects in UC patients by preventing lymphocyte exhaustion
スマートフォンで撮影した画像の特徴検出と色比較処理を用いた尿検査用試験紙の自動判定システムの開発
Get PDF浜松医科大学Hamamatsu University School of Medicine博士（光医工学）doctoral医学系研究科doctoral thesi
DESI-IMS coupled with triple quadrupole mass spectrometry demonstrated the capability of NMN imaging in Shelfordella lateralis tissue
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
Intracranial and extracranial extension of frontal sinusitis: Two cases of Pott’s puffy tumor with subdural empyema
Get PDFPott’s puffy tumor（PPT）は骨膜下膿瘍を伴う前頭骨の骨髄炎であり，副鼻腔炎の合併症の1つである．PPTは10歳台に好発し，頭蓋内病変を合併することも多い．症例はいずれも10歳，発語減少や不穏，意識障害などの症状を契機にPPTと診断された，硬膜下膿瘍合併の副鼻腔炎である．PPTは前頭洞炎からの進展が最多とされ，症例1，2いずれも前頭洞から板間静脈を介した進展と判断された．起炎菌は嫌気性菌や日和見菌のことがあり，複数菌種が関与することもある．治療は内科的・外科的治療を併用することが多く，治療経過や予後の観点から適切な選択が重要である．ここに報告する症例では各々，Fusobacterium sp.とPseudomonas alcaligenesが検出され，複数菌種を想定した抗菌薬加療を行い，2症例とも外科的治療を要した．副鼻腔炎の頭蓋内合併症は速やかに診断し，細菌学的検索，適切な抗菌薬の選択，適切な時期の外科的治療が重要である．Pott's puffy tumor (PPT) is an osteomyelitis of the frontal bone with subperiosteal abscess and is a complication of frontal sinusitis. PPT often presents in the 10-year age group and is often complicated by intracranial lesions. We report here two cases diagnosed with PPT who presented at the age of 10 years with diminished speech, agitation and impaired consciousness, in which frontal sinusitis was thought to have caused frontal osteomyelitis and subdural abscess via the diploic vein. Fusobacterium sp., anaerobic bacteria were detected in one case and Pseudomonas alcaligenes, opportunistic bacteria in the other. When treating PTT and its intracranial complications, antimicrobials should be selected on the basis that multiple organisms may cause the disease, even if only one organism is detected in cultures. Endoscopic sinus surgery for sinusitis and/or perforator drainage for intracranial abscesses should be performed at the appropriate time.journal articl
Impacts of genetic polymorphisms and cancer cachexia on naldemedine pharmacokinetics and bowel movements in patients receiving opioid analgesics
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
Optimal method for measuring invasive size that predicts survival in invasive mucinous adenocarcinoma of the lung
Get PDF浜松医科大学博士（医学）doctoral医学系研究科Purpose
The purpose of this study was to determine the optimal method for measuring pathological invasive size that predicts prognosis in invasive mucinous adenocarcinoma (IMA).
Methods
We analyzed patients who underwent complete surgical resection for lung IMA. The invasive size of IMA was measured using two methods: (1) excluding lepidic method (ELM), that is, lepidic component was excluded from the invasive area regardless of alveolar mucin and (2) including lepidic method (ILM), that is, lepidic component was included as invasive area if alveolar space was filled with mucin. The prognostic predictability of ELM and ILM on survival was assessed using univariable and multivariable Cox regression models. The discriminative power was assessed using concordance probability estimate (CPE) and Akaike’s information criteria (AIC), and the prognostic impact of the newly redefined pathological stage according to ELM or ILM was also assessed.
Results
A total of 101 patients were included. The median invasive size via ELM and ILM was 1.4cm (range, 0.0-7.7cm) and 2.1cm (range, 0.0-14.2cm), respectively. ELM had better discriminative power than ILM (ELM, HR=1.38, AIC=110.19, CPE=0.671; ILM, HR=1.19, AIC=111.52, CPE=0.655). Although the survival curves based on ILM crossed between T3 and T4, the overall survival (OS) curves based on ELM were sufficiently distinct from one another.
Conclusions
ELM has higher discriminative power for OS, and thus the optimal method for measuring the pathological invasive size of IMA should exclude the lepidic component regardless of alveolar mucin.doctoral thesi
Predicted effect-site concentrations of remimazolam for i-gel insertion: a prospective randomized controlled study
Get PDF浜松医科大学Hamamatsu University School of Medicine博士（医学）doctoral医学系研究科thesi
A case of successful pregnancy following acquired uterine arterial embolization for a uterine arteriovenous malformation using an inferior vena cava filter and internal iliac artery balloon occlusion catheter
Get PDF後天性の子宮動静脈奇形 (uterine arteriovenous malformation：UAVM) は、致死的な大量出血を来すことがあり、その治療として妊孕性を温存する場合子宮動脈塞栓術 (uterine artery embolization：UAE) が第一選択となる。しかしUAEには妊孕性への影響や、肺塞栓などの重篤な合併症の報告もある。今回、後天性のUAVMに対してUAEで治療し、その後生児を得た症例を経験した。35歳、1妊0産、凍結胚盤胞移植後、双胎妊娠となったが、妊娠9週0日に進行流産となった。流産から146日目に大量の性器出血を認め、当院受診され、UAVMの穿破による大量出血と診断した。UAVMの血流が高流量であったため、下大静脈フィルターと、内腸骨動脈バルーンオクルージョンカテーテルを挿入した後にUAEを施行した。UAE後7か月で妊娠し、妊娠39週に経腟分娩で生児を得た。UAEを施行する前に、下大静脈フィルターとオクルージョンカテーテルを挿入することは合併症を予防するとともに、高流量のUAVMに対する有効な治療選択肢となりうる。An acquired uterine arteriovenous malformation (UAVM) is a rare condition, sometimes provoking abnormal lifethreatening uterine hemorrhage. Uterine artery embolization (UAE) is a first-line treatment for symptomatic UAVMs. However, UAE is associated with several potential problems. It may diminish ovarian reserve and reduce uterine perfusion, and other complications. This report highlights the case of a 35-year-old woman who was treated with unilateral embolization due to heavy uterine bleeding from an acquired UAVM after a miscarriage.
Because of the high-flow and high-velocity UAVM, an inferior vena cava filter was inserted to protect against pulmonary embolism caused by high venous return through the UAVM, and an internal iliac artery balloon occlusion catheter was inserted to control blood flow to the shunt. The patient was successfully treated with unilateral UAE. Seven months after the UAE, she conceived, and at 39 weeks of gestation, she delivered a live baby. The insertion of an inferior vena cava filter and transarterial balloon occlusion prevented complications and could be an effective treatment option for high-flow UAVMs.journal articl
Endocannabinoid 2-arachidonoylglycerol levels in the anterior cingulate cortex, caudate putamen, nucleus accumbens, and piriform cortex were upregulated by chronic restraint stress
Get PDF浜松医科大学Hamamatsu University School of Medicine博士（医学）doctoral医学系研究科thesi