Nishimura, Yoshito

Background: Nasal and sinonasal findings have been reported in patients with Behçet’s syndrome, but their frequency, clinical significance, and relationship to underlying disease remain unclear. We performed a scoping review to map the published literature on epidemiology, clinical characteristics, and management. Methods: Following PRISMA-ScR guidance, we systematically searched MEDLINE, EMBASE, and Web of Science from inception through June 2026 for peer-reviewed primary studies reporting nasal or sinonasal findings in patients with Behçet’s syndrome. Two reviewers independently screened studies and extracted data. Results: Fifteen eligible studies, including seven case reports and eight observational studies, were identified. Reported frequencies of nasal or sinonasal findings varied substantially across studies. A spectrum of nasal and sinonasal symptoms was noted among the literature, including direct mucosal lesions, sinonasal symptoms and functional abnormalities such as olfactory impairment or delayed mucociliary clearance, and secondary nasal conditions occurring in patients with Behçet’s syndrome. Oral ulcers were consistently reported in the limited studies describing associated systemic features. Treatment data were sparse, and no evidence-based management approach specific to nasal disease was identified. Conclusions: The published literature suggests that a range of nasal and sinonasal findings may occur in patients with Behçet’s syndrome. However, the available evidence is sparse, heterogeneous, and insufficient to determine true prevalence, attribution, or optimal management. Future studies should distinguish direct Behçet-related nasal lesions from secondary or nonspecific findings and use standardized clinical assessment.

Background and Objectives: The Middle East and North Africa (MENA) region has one of the highest age-standardized diabetes prevalence rates globally, yet all-age, diabetes-specific evidence incorporating GBD 2023 estimates through 2023 remains limited. Materials and Methods: Using Global Burden of Disease (GBD) 2023 estimates for 21 MENA countries from 1990 to 2023, this ecological time-trend analysis quantified 33-year trends in incidence, prevalence, mortality, and disability-adjusted life-years (DALYs); compared pre-2019 and post-2019 trajectories using joinpoint regression; characterized age- and sex-specific burden patterns; and quantified contributions of modifiable risk factors. Results: Age-standardized incidence increased 92%, from 251.7 (95% uncertainty interval [UI]: 231.5 to 272.4) to 482.5 (95% UI: 451.5 to 516.4) per 100,000, and prevalence more than doubled, from 5564 (95% UI: 5088 to 6024) to 11,247 (95% UI: 10,382 to 12,132) per 100,000. In 2023, males exhibited higher DALY rates than females in most adult age groups from age 15 years onward, shifting away from the female-predominant pattern seen in 1990; female rates remained higher at several of the oldest age groups. Children aged 0 to 14 years were the only group with declining DALY rates (−52% to −57%). Post-2019 incidence was higher in 15 of 21 countries, and six countries had higher DALY trends with non-overlapping confidence intervals. Because we only have four to five years of data, these short trends are preliminary and require care when evaluating. High body-mass index was the leading modifiable risk factor. Conclusions: These data support country-specific prevention and chronic-care strategies across the MENA region.

Background/Objectives: Cardiovascular disease (CVD) burden decreased in the North Africa and Middle East (NAME) region between 1990 and 2019. This study used Global Burden of Disease (GBD) 2023 data to examine whether trends in mortality, disability-adjusted life years (DALYs), incidence, and prevalence continued through 2023 across all 21 NAME countries. Methods: We analysed age-standardised CVD mortality, incidence, prevalence, and DALY rates from 1990 to 2023. Joinpoint regression identified changes in temporal trends and calculated the annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals (CIs). Results: Age-standardised CVD mortality decreased from 579.6 per 100,000 in 1990 to 358.2 in 2023 (AAPC: −1.42%; 95% CI: −1.48 to −1.35). However, no significant reduction occurred between 2019 and 2023 (APC: −0.33%; 95% CI: −1.37 to 1.75). DALY, incidence, and prevalence rates followed similar patterns, with no significant decline in the final years of this study. Egypt was the only country with a long-term increase in CVD mortality, which accelerated after 2020 (APC: +5.20%; 95% CI: 1.20 to 12.87). High systolic blood pressure, dietary risks, lead exposure, and air pollution were the leading modifiable risk factors. Conclusions: The earlier decline in CVD burden in the NAME region did not clearly continue after 2019. The region is currently off track to meet Sustainable Development Goal 3.4 by 2030. Future progress may depend on improved blood pressure control, lipid management, dietary habits, and environmental risk reduction.

Abstract Background Immune-related adverse events disrupt immune checkpoint inhibitor therapy and impact quality of life. Peripheral edema is common among patients with cancer, however the causality of peripheral edema can be unclear in the context of multidrug regimens. Methods PubMed/MEDLINE, Embase, and Web of Science were searched to identify phase 3 randomized controlled trials (RCTs) evaluating immune checkpoint inhibitors reporting peripheral edema incidence. The incidence of edema was calculated according to adverse event, immune checkpoint inhibitor, and treatment patterns. A random-effects meta-analysis pooled odds ratios (ORs) of edema incidence between immune checkpoint inhibitor and non–immune checkpoint inhibitor groups. A systematic review characterizing the interventions for immune-related peripheral edema was also conducted. Results From 58 RCTs (22 590 patients), treatment-related peripheral edema (grade 1-5) occurred in 2.80% (n = 195 of 6969) of patients receiving immune checkpoint inhibitor monotherapy, 4.96% (n = 112 of 2257) of patients receiving immune checkpoint inhibitor with chemotherapy, and 8.73% (n = 205 of 2349) of patients receiving immune checkpoint inhibitor with targeted therapy. Meta-analysis showed immune checkpoint inhibitor monotherapy had lower treatment-related peripheral edema incidence compared with chemotherapy (OR = 0.45, 95% CI = 0.27 to 0.73; P = .001, I2 = 69%) with the lowest relative incidence among programmed cell death protein 1 vs chemotherapy (OR = 0.41, 95% CI = 0.23 to 0.73; P = .003) and immune checkpoint inhibitor vs taxane chemotherapy (OR = 0.32, 95% CI = 0.18 to 0.58; P < .001). A systematic review of treatment outcomes for immune-related peripheral edema among 40 patients (19 studies) revealed 82.5% (n = 33 of 40) of cases received glucocorticoid treatment, and immune checkpoint inhibitors were permanently discontinued in 35% (n = 14 of 40). Conclusions Peripheral edema is a rare but potentially serious adverse event associated with immune checkpoint inhibitors. Immune checkpoint inhibitors likely confer less peripheral edema risk than taxane therapy. To avoid unnecessary treatment interruptions, treatment discontinuation requires careful consideration, particularly when edema develops following immune checkpoint inhibitor combination therapy.

Background/Objectives: Racial/ethnic and regional disparities in neoplasm-related mortality remain a significant public health challenge. In this study, we aimed to evaluate long-term trends in county-level neoplasm-related mortality rates by race/ethnicity in the United States and examine associations with social determinants of health. Methods: We conducted a cross-sectional ecological study using population-based data from the Global Burden of Disease Study, including individuals residing in 50 states of the United States and the District of Columbia from 2000 to 2019. We analyzed age-standardized neoplasm-related mortality rates by ethnicity/race. Joinpoint regression analysis was used to identify significant changes in mortality trends, summarized as average annual percentage change. County-level correlations between mortality and key social determinants of health were also assessed. Results: Neoplasm-related mortality rates declined across all racial/ethnic groups from 2000 to 2019; however, disparities persisted. The age-standardized neoplasm-related mortality rates per 100,000 population decreased in all racial/ethnic subgroups. The average annual percentage change ranged from −0.94% (Hispanic and non-Hispanic American Indian or Alaska Native) to −1.90% (Black). Sex-specific analyses revealed similar trends. Southeastern states experienced slower declines than Northeastern states did. County-level smoking and poverty rates were positively correlated, whereas the primary care physician-to-population ratio, excessive alcohol consumption rate, mammography screening rate, and median household income were inversely correlated with neoplasm-related mortality rate, varying by race/ethnicity. Conclusions: Targeted, community-specific interventions are required to reduce inequities in cancer outcomes.

ABSTRACTIdiopathic multicentric Castleman disease (iMCD) is a rare lymphoproliferative disorder classified into three recognized clinical subtypes—idiopathic plasmacytic lymphadenopathy (IPL), TAFRO, and NOS. Although clinical criteria are available for subtyping, diagnostically challenging cases with overlapping histopathological features highlight the need for an improved classification system integrating clinical and histopathological findings. We aimed to develop an objective histopathological subtyping system for iMCD that closely correlates with the clinical subtypes. Excisional lymph node specimens from 94 Japanese iMCD patients (54 IPL, 28 TAFRO, 12 NOS) were analyzed for five key histopathological parameters: germinal center (GC) status, plasmacytosis, vascularity, hemosiderin deposition, and “whirlpool” vessel formation in GC. Using hierarchical clustering, we visualized subgroups and developed a machine learning‐based decision tree to differentiate the clinical subtypes and validated it in an external cohort of 12 patients with iMCD. Hierarchical cluster analysis separated the IPL and TAFRO cases into mutually exclusive clusters, whereas the NOS cases were interspersed between them. Decision tree modeling identified plasmacytosis, vascularity, and whirlpool vessel formation as key features distinguishing IPL from TAFRO, achieving 91% and 92% accuracy in the training and test sets, respectively. External validation correctly classified all IPL and TAFRO cases, confirming the reproducibility of the system. Our histopathological classification system closely aligns with the clinical subtypes, offering a more precise approach to iMCD subtyping. It may enhance diagnostic accuracy, guide clinical decision‐making for predicting treatment response in challenging cases, and improve patient selection for future research. Further validation of its versatility and clinical utility is required.

ABSTRACTBackgroundEfficient discharge planning is crucial for improving hospital capacity and patient care. Multidisciplinary rounds (MDRs) have been shown to enhance communication and coordination, yet their impact on resident teaching teams’ discharge efficiency is less studied.AimsTo examine how embedding dedicated case managers (CMs) and social workers (SWs) into internal medicine (IM) resident teams impacts discharge efficiency.MethodsWe conducted a retrospective cross‐sectional study at The Queen's Medical Center comparing two resident multidisciplinary teaching (MDT) teams that included dedicated CMs and SWs with two resident standard care teams over an 8‐month period (October 18 2023–June 25 2024). The outcomes assessed included length of stay (LOS), expected discharge date (EDD) accuracy, readmission rates and the rate of conditional discharge orders placed.ResultsA total of 1944 patients were included. The MDT teams showed significantly improved EDD accuracy (72.0% vs 66.7%, P = 0.0120) and more frequently placed conditional discharge orders (61.7% vs 43.8%, P < 0.0001) compared to standard care teams. No significant difference was observed in LOS or readmission rates.ConclusionEmbedding dedicated CMs and SWs within resident teams improved EDD accuracy and the rate of conditional discharge orders placed, suggesting an opportunity to integrate MDRs as a standard within IM residency training to enhance discharge planning efficiency.

AimsKikuchi‐Fujimoto disease (KFD) is a rare disease that typically manifests with fever and cervical lymphadenopathy. Little is known about the risk factors associated with recurrence and their correlation with clinicopathologic features.Methods and ResultsWe analysed 112 patients with KFD, predominantly female (61/112, 54.5%), with an average age of 29.4 years. The incidence was higher in males up to the age of 20 and higher in females from their 30s onwards. Of the 70 patients with follow‐up data, 23% experienced recurrence. Recurrence was associated with lower C4 levels (P = 0.038) and higher antinuclear antibody (ANA) rates (P = 0.007) compared to transient disease. The mean duration of symptoms was 71.5 days. Lymph node histology in 98 cases (excluding 14 needle biopsy specimens) was classified into three patterns: proliferative (n = 75, 77%), necrotizing (n = 22, 22%), and xanthomatous (n = 1, 1%). The necrotizing pattern associated with significantly enlarged lymph nodes (P = 0.047) and a longer symptom duration (P = 0.009) than the proliferating pattern. The number of CD4‐positive lymphocytes was significantly lower in the necrotizing type than in the proliferative type (P < 0.001).ConclusionThese results indicated that low C4 levels and positive ANA were associated with KFD recurrence. Although the aetiology of KFD remains elusive, given that some cases develop autoimmune disease, the results suggest that patients with recurrent KFD represent an intermediate status between those with transient KFD and those with overt autoimmune disease. The comprehensive clinicopathological findings of this study may be useful for elucidating its pathogenesis and predicting the clinical course.

A man in his 80s presented with 3 weeks of lower back pain, generalised weakness, poor appetite and intermittent melena, without genitourinary symptoms or recent trauma. CT showed an old L1 compression fracture and new sclerotic lesions in the L3 and L4 vertebrae, as well as mildly enlarged abdominal lymph nodes. 3 days later, he returned to the emergency department with worsening symptoms, including new left hemiparesis. A head CT revealed a right subdural haematoma (SDH) with a midline shift. Despite treatment for disseminated intravascular coagulation, the patient’s condition deteriorated, leading to a suspicion of spontaneous intracranial hypotension. An autopsy revealed disseminated metastatic adenocarcinoma with dura and leptomeningeal metastases, ultimately causing spontaneous SDH and subsequent transtentorial herniation. This case highlights the impact of anchoring bias in clinical decision-making and the importance of early recognition of underlying malignancy as the aetiology of spontaneous SDH in patients presenting with signs and symptoms of metastatic cancer.