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PURPOSE The aim of this study is to compare injury patterns, the incidence of snowboard and skiboard injuries with those of ski injuries in 2000-2005. SUBJECTS & METHODS: The subjects were skiers (1,240 cases), snowboarders (2,220 cases) and skiboarders (132 cases) who were injured in two ski resorts located in Niigata prefecture in Japan and visited our clinics in both ski resorts between 2000 and 2005. On visiting the clinic, patients completed a questionnaire reviewing the circumstances surrounding the injury event and an attitude survey on helmets and protectors, and doctors documented the diagnosis. RESULTS: Injury rates, which were based on all the lift-tickets purchased, in snowboarding were decreased gradually, though were still twice as high as those in skiing. Snowboarding and skiboarding have a higher rate of serious injury, fracture and dislocation, and a four times higher stunt injury rate than that in skiing. Interestingly the characteristics of skiboarding injuries were a lower head and neck injury rate and collision injury rate than any other snow sport. CONCLUSIONS: Injury-prevention strategy should focus on coaching correct and safe methods of performing stunts for snowboarders and skiboarders attending the snowboard park. [ABSTRACT FROM AUTHOR]

Posterior spinal artery (PSA) infarctions are rare and challenging to diagnose in the acute phase. Herein, we report two cases of PSA infarctions diagnosed using spinal diffusion-weighted imaging-MRI (DWI-MRI). Case 1 involved a 74-year-old male patient presenting to our hospital with right leg numbness and unsteadiness while walking. Neurological examination revealed muscle weakness in the right lower limb and decreased vibration sensation in the dermadrome below the right Th8 level. Spinal DWI-MRI showed a high-intensity signal in the posterior right Th8, leading to the diagnosis of thoracic spinal cord infarction in the PSA region. In Case 2, a 70-year-old woman visited our hospital complaining of numbness of the left hand. Neurological examination revealed left-sided paresthesia exhibiting a positive Romberg's sign. Spinal DWI-MRI showed a high-intensity signal in the right C2 level posterior region, confirming the diagnosis of cervical spinal cord infarction in the PSA region. A neurological examination for PSA infarction and highlights the usefulness of a spinal cord DWI for auxiliary diagnosis.

A 67-year-old woman with past medical history of chronic myelomonocytic leukemia (CMML) presented with a chief complaint of headache, diplopia, and hearing impairment in the right ear. Examination revealed impaired ocular movement in the left eye and sensorineural hearing loss in the right ear. Cerebrospinal fluid analysis showed increased cell count and protein, and MRI showed contrast enhancement of hypertrophic dura mater. Since there were no other abnormalities which would have been a cause of hypertrophic pachymeningitis, it was considered as systemic autoimmune/inflammatory disorder (SAID) associated with CMML. Treatment with steroid, cyclophosphamide, and methotrexate led to improvement of the symptoms. SAIDs develop in up to 25% of patients with myelodysplastic syndromes (MDS) or CMML, which may be the only symptoms of MDS/CMML. As a phenotype of SAIDs, systemic vasculitis, connective tissue diseases, and neutrophilic diseases are frequently reported; however, isolated involvement of central nerve system is rarely reported. To our knowledge, this is the first report of hypertrophic pachymeningitis as SAID associated with CMML. To clarify the pathogenesis of neurologic involvement of SAIDs, accumulation of cases is necessary.

Herein, we present the case of a 76-year-old man diagnosed with an iliopsoas abscess 3 months prior and consequently administered metronidazole. The patient visited our facility complaining of difficulty in speaking and feeling unsteady when walking. Neurological findings showed dysarthria, nystagmus, and bilateral cerebellar ataxia. Head MRI-FLAIR demonstrated symmetrical hyperintensities in the bilateral cerebellar dentate nuclei, red nucleus, periaqueductal of the midbrain, periventricular third ventricle, and the corpus callosum. Although Wernicke's encephalopathy was among the differential diagnoses based on the imaging findings, the thiamine level was normal and improvement in symptoms and hyperintensity on FLAIR within 5 days of discontinuing metronidazole led to the diagnosis of metronidazole-induced encephalopathy. Although there were many similarities in the imaging findings of metronidazole-induced encephalopathy and Wernicke's encephalopathy, Metronidazole-induced encephalopathy should be initially considered when midbrain red nucleus lesions are observed.

Purpose: The aim of this study was to validate the potential of substituting an observer in a paired comparison with a deep-learning observer., Methods: Phantom images were obtained using computed tomography. Imaging conditions included a standard setting of 120 kVp and 200 mA, with tube current variations ranging from 160 mA, 120 mA, 80 mA, 40 mA, and 20 mA, resulting in six different imaging conditions. Fourteen radiologic technologists with >10 years of experience conducted pairwise comparisons using Ura's method. After training, VGG16 and VGG19 models were combined to form deep learning models, which were then evaluated for accuracy, recall, precision, specificity, and F 1 value. The validation results were used as the standard, and the results of the average degree of preference and significance tests between images were compared to the standard if the results of deep learning were incorporated., Results: The average accuracy of the deep learning model was 82%, with a maximum difference of 0.13 from the standard regarding the average degree of preference, a minimum difference of 0, and an average difference of 0.05. Significant differences were observed in the test results when replacing human observers with AI counterparts for image pairs with tube currents of 160 mA vs. 120 mA and 200 mA vs. 160 mA., Conclusion: In paired comparisons with a limited phantom (7-point noise evaluation), the potential use of deep learning was suggested as one of the observers.

Vaginal cuff dehiscence after total hysterectomy or total cystectomy had been increasing since laparoscopic or robotic surgery became a common surgery among gynecologists and urologists. A 52-yearold woman underwent laparoscopic radical total cystectomy for muscle invasive bladder carcinoma at Rakuwakai Otowa Hospital. She was emergently admitted with a fist-sized lump protruding from her vagina four months after surgery. Physical examination and her past history on admission disclosed vaginal cuff dehiscence after cystectomy. Computed tomographic scan and magnetic resonance imaging showed no bowel evisceration in the lump. We confirmed that the content of lump was peritoneal tissue and removed it by laparoscopic surgery. Simultaneously, we repaired the vaginal cuff dehiscence with a gracilis myocutaneous flap. There was no subsequent recurrence of vaginal dehiscence or bladder carcinoma in one-year follow-up.

Purpose: To validate the effects of subject position on single energy metal artifact reduction (SEMAR) of a reverse shoulder prosthesis using computed tomography (CT)., Methods: A water phantom with a reverse shoulder prosthesis was scanned at four positions on the XY plane of the CT gantry (on-center, 50 mm, 100 mm, and 150 mm from on-center in the negative direction of the X axis, respectively). We obtained images with and without SEMAR. The artifact index (AI) was measured via physical assessment. Scheffé's (Ura) paired comparison methods were performed with the amount of metal artifact by ten radiological technologists via visual assessment., Results: The AI was significantly reduced when using SEMAR. As the phantom moved away from the on-center position, the AI increased, and metal artifacts increased in Scheffé's methods., Conclusion: SEMAR reduces metal artifacts of a reverse shoulder prosthesis, but metal artifacts may increase as the subject position moves away from the on-center position.

Companion diagnostics(CDx)are in vitro diagnostic products that are used to predict the efficacy and adverse effects of therapeutic drugs prior to administration, and are co-developed and co-approved with the therapeutic drugs in principle. In Japan, 40 CDx products have been approved by January 2024, and 39 products are used to determine if therapeutic drugs are applicable for cancer treatment. In the CDx products for cancer treatment, PCR, immunohistochemistry, or in situ hybridization is used to clarify the mutations(point mutations, insertions/deletions, fusions, etc.)in cancer-related genes or the expression levels of cancer-related molecules in the cancer tissues. The results of the analysis determine whether a particular therapeutic drug could be used or not for the treatment of the corresponding patient. Recently, several next-generation sequencing(NGS)-based CDx products have been approved and utilized for cancer treatment. The rise of NGS-based diagnostics has made it possible to comprehensively analyze mutations in many cancer-related genes in a single test and to determine whether each of several therapeutic drugs is applicable to the patient at once. On the other hand, with the increase in the number of CDx products, several regulatory issues have arisen, including an issue related to the co-development of CDx and a therapeutic drug and an issue related to the interchangeable use of CDx products that detect the same mutations of the cancer-related genes. The revision of CDx-related guidance is being considered in Japan and overseas in response to this situation.

A 74-year-old woman taking dulvalumab for lung adenocarcinoma developed muscle tonicity in the extremities and trunk. Painful paroxysmal muscle spasms with profuse sweating were frequently observed, and surface electromyography showed simultaneous contraction of the active and antagonist muscles. Blood tests were strongly positive for anti-amphiphysin antibodies, and stiff-person syndrome (SPS) was diagnosed. Intravenous immunoglobulin therapy and clonazepam were initiated, and the paroxysmal painful muscle spasms disappeared. As the primary tumor was under control, and the onset occurred approximately six weeks after the resumption of immune checkpoint inhibitors, we considered SPS to be an immune-related adverse event. Although extremely rare, it should be considered a neuromuscular disease that can occur in association with immune checkpoint inhibitors.

This article detailly describes the subtemporal-transtentorial STA-SCA bypass technique. Through temporal base drilling, copious cerebrospinal fluid evacuation before retraction, and sufficient retraction of the temporal lobe preserving the veins of the temporal base would be primodial to obtain an appropriate surgical field. Refrection of the tentrial free edge and identification of recipient SCA posterior to the entry point of the trochlear nerve into the cavernous sinus is a micro-anatomical key. Bilateral bayonet-type needle holders and forceps should be used not to shadow the surgical corridor with one's hands.

Since the insurance coverage of colorectal stents for bowel obstruction due to colorectal cancer in 2012, the use of colorectal stenting for palliation has rapidly spread. We report a case of ascending colon cancer in which a colorectal stent was placed for palliation, but the stent was reimplanted due to obstruction, followed by radical resection. The patient was a 92- year-old woman who was brought to the emergency room at the age of 90 years with repeated vomiting and abdominal pain, and was diagnosed as colorectal cancer ileus caused by ascending colon cancer, and a colorectal stent was inserted. She received palliative care and had been asymptomatic for 1 year and 3 months, but due to in-stent stenosis, she had bowel obstruction and sent to emergency room, and another stent was installed. The patient had a good course, but 4 months after the second stenting, she was concerned about restenosis and referred to the department of surgery, then performed a radical resection. The indication for colorectal stents for palliative purposes should be considered on a case-by- case basis, including ADL, stage of the disease, and prognosis.

Bone is the most common metastatic site in prostate cancer (PCa). Although the extent of disease (EOD) grade is used for evaluating burden of bone metastasis, the accuracy of bone metastasis classification needs improvement. Bone scan index (BSI) was developed as a quantitative tool to enhance the interpretability and clinical relevance of the bone scan. This study aimed to explore the role of BSI using BONENAVI® software in determining the prognosis and treatment efficacy in castration-sensitive PCa (mCSPC) patients with bone metastasis. We retrospectively reviewed 61 mCSPC patients with bone metastasis who had received primary androgen deprivation therapy (PADT) at our institution. All patients received PADT with luteinizing hormone-releasing hormone agonist or surgical castration accompanied by first-generation antiandrogen, bicalutamide. Bone scans were performed with ⁹⁹[m]Tc-MDP. BSI (%) was divided into two groups (＜1.0 and ≧1.0), and BSI response rates(change at 0 months to after 6 months) were determined using thresholds of 45% decline. Castration-resistant prostate cancer (CRPC) -free survival (CRPC-FS) and Overall survival (OS) rates were analyzed using the Kaplan-Meier method. The median follow-up was 41. 9 months. Overall, 16 patients (26. 2%) died. Multivariate analysis on pretreatment factors revealed that hemoglobin (P＝0.03) and BSI (P＝0.04) were independent prognostic factors for OS. The 5-year OS rates in patients with low BSI and high BSI were 84.6% and 39.2%, respectively (P＝0.02). In 40 patients who had a bone scan before and after PADT, OS rates in patients with a good response (≧45%) were significantly higher than those with a poor response (＜45%) (P＝0.001). Nadir PSA titers within 6 months after the start of treatment (P＝0.005), Hb (P＝0.003), and BSI change (P＝0.014) were independent prognostic factors for OS. In mCSPC patients with bone metastases, BSI at diagnosis was an important predictor of CRPC progression and OS as a pre-treatment factor, and BSI change rate and PSA nadir as post-treatment factors.

Oral anticoagulants for atrial fibrillation are the standard approach to prevent stroke in patients with atrial fibrillation. However, oral anticoagulant therapy carries the risk of cerebral infarction recurrence, not to mention hemorrhagic complications, even under appropriate drug therapy. Surgical treatments targeting the left atrial appendage include left atrial appendage closure( LAAO) and left atrial appendage resection (LAAR). Our hospital uses AtriClip (approved and available in Japan since 2018) as a device for LAAO, and we investigated the early and long-term results of LAAO using AtriClip in our hospital. As a result, stable early to long-term results were expected for left atrial appendage closure using AtriClip device, suggesting that it may be an option that can be considered as a method for preventing stroke in patients with atrial fibrillation. But further investigation is required in the future.

Aim: This study clarified the association between the amount of physical activity and apathy after one year among community-dwelling older adults., Methods: Two hundred community-dwelling older adults (mean age: 74.3±5.0 years old, female: 52.5%) who participated in the 2018 and 2019 "Kasama Longevity Health Examination" were included. Apathy was assessed using the Apathy Scale (0-42 points; the higher the score, the lower the motivation), physical activity by Physical Activity Scale for the Elderly (PASE), and Geriatric Depression Scale-15 (GDS). The 2018 PASE data were grouped into tertiles. A multiple regression analysis was performed with the 2019 Apathy Scale as the dependent variable and the 2018 PASE as the independent variable, and the sex, age, years of education, economic situation, body mass index, chronic illness, smoking history, alcohol drinking habits, physical function, cognitive function, GDS, and the 2018 Apathy Scale as adjustment variables. The PASE subcategories (leisure-time, household, and work-related activities) were examined using a similar method., Results: The mean Apathy Scale in 2019 was 14.0±6.2 for the low physical activity group, 12.8±6.0 for the medium physical activity group, and 10.1±5.9 for the high physical activity group. The high physical activity group showed a significant negative association with the Apathy Scale (B=-1.56, 95% confidence interval=-2.91 to -0.21, p=0.023). No association was found for any activity of the PASE sub-items., Conclusions: A high level of physical activity may protect against apathy among community-dwelling older adults.

Microvascular decompression for trigeminal neuralgia was successfully performed following the secure surgical steps. The most crucial step involves creating a safe operative field in the dural opening. The petrotentorial junction should be identified without cerebellar retraction before proceeding to the deeper areas. Dissecting the petrosal vein and opening the horizontal fissure contributed to the expansion of the operative field. Bleeding often occurs from the dorsal cerebellar bridging vein and junction of the petrosal vein into the superior petrosal sinus. Transposition of the most common offenders, the superior and anterior inferior cerebellar arteries, is effectively achieved by dissecting both the proximal and distal sides of the neurovascular compression site. Teflon should be placed at a sufficient distance to prevent contact with the nerve, which can lead to recurrence. Treating vertebrobasilar artery-related cases is challenging and involves the risk of cranial nerve injuries. Multiple offending vessels are commonly involved. In such cases, it is essential to be aware of the course of the trochlear and abducens nerves during decompression. Applying the most effective and least risky maneuver is necessary for treating cases involving the vertebrobasilar artery.

An 84-year-old man with gastric cancer, cT2N0M0, cStage Ⅰ underwent laparoscopic distal gastrectomy, D1+dissection, and Roux-en-Y reconstruction. We started enteral nutrition on the second postoperative day, but milky drainage appeared from the drain on the fifth postoperative day. The triglyceride in the ascites was markedly elevated, and it was diagnosed as a lymphorrhea. Neither conservative treatment nor lymphangiography were successful. We decided to perform surgical intervention because the lymphorrhea did not improve for about 1 month after gastrectomy. At laparotomy, we detected the lymphatic ducts using enteral nutrition of fat formulas during surgery and successfully closed the lymphatic ducts by suturing and ligation on the 38th postoperative day. Prolonged lymphorrhea causes extreme deterioration of the patient's general condition. Prolonged total parenteral nutrition also increases the risk of infection. It is important to perform surgical treatment for intractable lymphorrhea that does not improve with conservative treatment without hesitation.

A 69-year-old woman was admitted to a territory hospital because of severe right hypochondoralgia after 2 weeks of internal medicine for persistent epigastralgia. Gastroduodenal endoscopy revealed a large tumor with a fistula in the duodenal bulb that expanded to the stomach. Histopathologically, the biopsy specimen indicated a poorly differentiated adenocarcinoma and HER2 negative. Computed tomography revealed that the tumor invaded the left lobe of the liver. The patient was referred to our hospital for cancer treatment. After 1 course of chemotherapy with S-1 and CDDP, laparoscopic gastroenterostomy bypass was performed because of tumor hemorrhage and poor food intake. However, the tumor hemorrhage and poor food intake continued, and the tumor enlarged. Therefore, left hemihepatectomy and distal gastrectomy with resection of the duodenal bulb were performed 1 month after bypass surgery. Histological testing confirmed the diagnosis of duodenal large-cell neuroendocrine carcinoma invading the liver without lymph node metastasis. Adjuvant chemotherapy was not administered, and the patient has been alive without recurrence for 7 years and 3 months. Neuroendocrine carcinoma of the non-ampullary duodenum is very rare; however, a large cell type without lymph node metastasis may be a factor in the long-term prognosis.

Malperfusion syndrome of the visceral branches associated with acute aortic dissection brings an extremely poor outcomes leading to perioperative and long-term mortality in both Stanford type A and type B acute aortic dissection. The conventional surgical strategy for these cases has been to prioritize aortic repair and to improve blood flow of true lumen in aorta and visceral branches. Today, various techniques for early reperfusion have been reported. For bowel ischemia, it is necessary to evaluate substantial ischemia of the intestinal tract and hypoperfusion of the superior mesenteric artery( SMA) using contrast-enhanced computed tomography( CT) and intraoperative transesophageal echocardiography in addition to clinical presentation. The most important factor of the surgical intervention is the improvement of true luminal blood flow by reconstruction of the central aorta. However, an intervention to SMA prior to central aortic repair might be an important process for patients with Stanford type A acute aortic dissection to avoid irreversible bowel necrosis. In type B aortic dissection, thoracic endovascular aortic repair (TEVAR) with or without provisional extension to induce complete attachment (PETTICOAT) technique and additional SMA intervention based on intraoperative contrast findings are necessary. Renal malperfusion is also a risk factor of postoperative accute kidney injury( AKI) and perioperative mortality. The revascularizations of renal arteries might improve outcomes when renal blood flow was not recovered with central aortic repair.