記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Postoperative delirium (POD) is a common complication that is associated with adverse outcomes. However, differences between surgical patients in intensive care unit (ICUs) and non-ICUs are unclear. This study investigated POD incidence, prognostic significance, and risk factors in ICU and non-ICU settings. METHODS: We retrospectively analyzed data from 20,338 adults who underwent general anesthesia at Nippon Medical School Hospital between July 2021 and March 2025. Patients were classified as ICU (n=2,451) and non-ICU patients (n=17,887). POD was defined by an Intensive Care Delirium Screening Checklist score of ≥4 or prescription of antipsychotics. Logistic regression was used to identify risk factors, and Kaplan-Meier analysis assessed 180-day mortality. Subgroup analysis evaluated differences between early (≤2 days) and late (3-7 days) POD. RESULTS: The overall incidence of POD was 4.4% (889/20,338) and was higher in ICU patients (19.1%) than in non-ICU patients (2.3%; p<0.001). POD was positively associated with 180-day mortality in both groups (p<0.001). Among non-ICU patients, survival was worse among patients with late POD than among those with early POD (p<0.001), whereas onset timing had no impact in ICU patients. Risk profiles differed: advanced age, higher American Society of Anesthesiologists class, and cerebrovascular disease were associated with POD in non-ICU patients, while male sex and dialysis were significant factors for ICU patients. Excessive positive fluid balance and prolonged operative time increased POD risk in both groups, but gradients were steeper in non-ICU patients. CONCLUSIONS: POD was independently positively associated with excess mortality across settings, but the risk factors and prognostic implications varied. These findings highlight the need for ward-specific preventive strategies and tailored perioperative management.

DOI： 10.1272/jnms.JNMS.2026_93-207

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Hemophagocytic lymphohistiocytosis (HLH) involves pathological histiocytes and phagocytosis of normal blood cells through activation of inflammatory cytokines. We report a case of Epstein-Barr virus-HLH in a 75-year-old woman who presented with fever, thrombocytopenia, and loss of consciousness. Epstein-Barr virus-HLH was diagnosed after we identified massive hemophagocytosis in bone marrow and Epstein-Barr virus DNA in cerebrospinal fluid. The HLH-2004 protocol was applied, and lactate dehydrogenase levels-which reflect HLH disease status-decreased. However, persistent loss of consciousness and multiple organ failure led to the patient's death on day 18. Most cases of primary and secondary HLH involve pediatric patients; adult cases are rare. Few cases of central nervous system involvement in older adults have been reported. Therefore, accumulation of more data will help in developing better treatment strategies.

DOI： 10.1272/jnms.JNMS.2023_90-105

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: The MEAM regimen consisting of ranimustine (MCNU), etoposide (ETP), cytarabine (Ara-C), and melphalan (MEL) is widely used before auto-peripheral blood stem cell transplantation (auto-PBSCT) for malignant lymphoma in Japan. The MEAM regimen generally consists of 200-400 mg/m2 for 4 days, but we decided to increase the dosage of Ara-C from the standard to 2 g/m2 for 2 days with the aim of increasing drug transferability to the central nervous system. We evaluate the safety and therapeutic efficacy of high-dose Ara-C MEAM therapy. METHODS: The high-dose Ara-C MEAM protocol consisted of MCNU 300 mg/m2 on day -7, ETP 200 mg/m2 on days -6, -5, -4, -3 and Ara-C 2 g/m2 on day -4 -3, and MEL 140 mg/m2 on day -2. We retrospectively analyzed 37 cases of malignant lymphoma at our institution between May 2014 and July 2020. RESULTS: All patients got engraftment and there were no cases of treatment-related mortality. In all cases, the 3-year overall survival (OS) and progression-free survival (PFS) after transplantation were 80.6% and 65.7%, respectively. Twenty-one cases of diffuse large B-cell lymphoma recurrence, for which there is proven usefulness of auto-PBSCT, showed good results after transplantation, with the 3-year OS and PFS after transplantation being 100% and 74.3%, respectively. CONCLUSION: The safety and efficacy of high-dose Ara-C MEAM therapy were demonstrated, but the expected therapeutic effect on central nervous system lesions could not be fully evaluated owing to the small number of cases.

DOI： 10.1111/ajco.13780

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記述言語：英語   出版者・発行元：(一社)日本血液学会  

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記述言語：日本語   出版者・発行元：(一社)日本血液学会-東京事務局  

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記述言語：日本語   出版者・発行元：(一社)日本内科学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：英語   出版者・発行元：(一社)日本骨髄腫学会  

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