Search

Background and study aims In patients with ascites, percutaneous liver biopsy is generally contraindicated. Because endoscopic ultrasound-guided tissue acquisition (EUS-TA) allows tissue sample obtention from the digestive tract lumen, a biopsy without the intervention of ascites may prevent adverse events (AEs). This study aimed to evaluate the safety of EUS-TA for focal liver lesions in the presence of ascites. Patients and methods A retrospective study was conducted using medical records of cases in which EUS-TA was performed on focal liver lesions between 2016 and 2022. Study participants were classified into two groups: those with ascites and those without it, and the outcomes were compared. The primary outcome was AEs. Results We included 109 cases of EUS-TA for focal liver lesions. Ascites was present in 20.1% of cases (22/109) and absent in 79.8% of cases (87/109). There were no significant differences between the two groups in clinical backgrounds and EUS-TA procedure, although fine-needle biopsy needles were significantly more frequently used in patients without ascites. In the ascites group, puncture without intervening ascites was successful in 90.9% of cases (20/22). The incidence of AEs was 4.5% (1/22) in the ascites group and 1.1% (1/87) in the non-ascites group, showing no significant difference. The two AEs were mild self-limiting abdominal pain. Conclusions In focal liver lesions with ascites, EUS-TA allows biopsy without the intervention of ascites in most cases. The incidence of AEs did not differ significantly between patients with and without ascites., Competing Interests: Conflict of Interest The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

This report is of a systematic review and meta-analysis evaluating the efficacy and safety of transcatheter arterial embolization (TAE) for nonvariceal gastrointestinal bleeding (GIB) with n-butyl cyanoacrylate (NBCA) or coils as the primary embolic agent. The primary outcome was the clinical success rate. The secondary outcomes were technical success rates, 30-day rebleeding rates, major complication rates, and 30-day overall mortality rates. A systematic search was performed in PubMed, Embase, and Cochrane Library. Articles included had been published in English from January 2000 to August 2023 and assessed patients with nonvariceal upper and lower GIB (UGIB and LGIB) who received TAE with NBCA or coils. Single-arm meta-analyses were performed for these outcomes. Subgroup analyses comparing NBCA and coils were conducted if there were more than 10 articles selected for each outcome. Thirty-seven articles were selected for analysis. The pooled rates of TAE for UGIB and LGIB were clinical success 73.0% and 76.5%, technical success 94.9% and 91.4%, 30-day rebleeding 25.0% and 17.1%, major complications 3.5% and 10.0%, and 30-day overall mortality 20.7% and 11.4%, respectively. The subgroup analysis showed a significant difference only for the technical success rates of LGIB between NBCA and the coils (p < 0.001). The systematic review and meta-analysis indicate that TAE with NBCA or coils as the primary embolic agent is safe and effective for both UGIB and LGIB., (© 2024. The Author(s).)

Objectives: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) for focal liver lesions has gained attention as an alternative to percutaneous biopsy. Although the outcomes of EUS-TA for focal liver lesions have been reported to be favorable, no studies have focused on small focal liver lesions (≤2 cm). The aim of this study was to evaluate the outcomes of EUS-TA for small focal liver lesions (≤2 cm)., Methods: The details of EUS-TA performed for focal liver lesions between 2016 and 2022 were retrospectively reviewed. The outcomes were compared between cases involving ≤2 cm lesions and those involving >2 cm lesions. The primary outcomes were diagnostic ability and adverse events., Results: EUS-TA for focal liver lesions was performed in 109 cases. Of the 109 cases, 32 (29.3%) involved ≤2 cm lesions and 77 (70.6%) involved >2 cm lesions. Right lobe lesions and transduodenal puncture were significantly fewer in the ≤2 cm group. There were no significant differences in needle gauge, needle type, or number of punctures between the groups. The sensitivity, specificity, and accuracy rates were 96.8%, 100%, and 96.8%, respectively, in the ≤2 cm group and 97.4%, 100%, and 97.4%, respectively, in the >2 cm group, with no significant differences between the groups. There was no difference in adverse events between the groups (0% in the ≤2 cm group and 2.3% in the >2 cm group)., Conclusions: EUS-TA for small focal liver lesions measuring ≤2 cm has favorable outcomes, which are similar to those for lesions measuring >2 cm., Competing Interests: None., (© 2024 The Author(s). DEN Open published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.)

Background and Purpose: Mild cognitive impairment (MCI) is a predictor of future age-related dementia.　We herein investigated associations of MCI with higher-level functional capacities, as well as with subjective difficulty regarding these functions, in community-dwelling older people, to identify a simple method for early MCI detection., Method: We administered a test battery to 118 community-dwelling older people living in an urban area.　The battery consisted of three tests;the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), the Touch Panel-type Dementia Assessment Scale (TDAS), and the Geriatric Depression Scale-15.　We then excluded participants with possible dementia or depression symptoms, and divided the remainder (n = 67) into an MCI group (n = 16) and a non-MCI group (n = 51), according to TDAS performance., Results: Logistic regression analysis with the MCI and non-MCI groups as dependent variables indicated that TMIG-IC was a significant variable.　Male sex and the perception that preparing meals and filling out pension forms had become more difficult were significantly associated with MCI, each independently increasing the probability of MCI., Conclusions: Subjective difficulty with higher-level functions and impairment in higher-level functional capacity may serve as indices for mass screening for MCI.

Purpose: To evaluate retrospectively the influence of percutaneous cryoablation for small renal tumors on total and affected kidney function and risk factors associated with worsening function of the affected kidney., Materials and Methods: Between April 2016 and March 2022, 27 patients who underwent cryoablation for small renal tumors at our institution participated in this study, which investigated time-dependent changes in postoperative renal function. We evaluated estimated glomerular filtration rates (eGFRs) and split renal function revealed by scintigraphy using 99 m technetium-mercaptoacetyltriglycine (99mTc-MAG3) before cryoablation and at 1 week, 1 month, and 6 months after cryoablation. Numerous variables were analyzed to assess risk factors for worsening renal function., Results: Baseline eGFR (mean ± standard deviation) was 56.5 ± 23.7 mL/min/1.73 m 2 (mean ± SD; range, 20.5-112.5). Mean eGFRs at 1 week, 1 month, and 6 months after cryoablation were 57.4 ± 24.5 (19.1-114.9), 57.1 ± 25.1 (21.5-114.9), and 53.8 ± 23.9 mL/min/1.73 m 2 (20.0-107.5), respectively. Changes were statistically insignificant (p = 1.0000, = 0.6749, and = 0.0761, respectively). Regarding split renal function, mean baseline contribution of the affected kidney determined by 99mTc-MAG3 was 49.7% ± 6.0% (38.8-63.3%); these rates at 1 week, 1 month, and 6 months after cryoablation were 43.7% ± 8.8 (29.1-70.6%), 46.2% ± 7.7% (32.6-70.3%), and 46.0% ± 8.5% (32.5-67.6%), respectively. Differences from baseline were significant for all periods (p < 0001, < 0001, = 0.0001, respectively). Serum C reactive protein and lactate dehydrogenase at 1 day following cryoablation, tumor's nearness to the collecting system or sinus, and volume of ablated normal renal parenchyma were significantly correlated with decreased contributions of the affected kidney by > 10% after cryoablation., Conclusion: Unlike total renal function, affected kidney function could worsen after cryoablation., (© 2024. The Author(s).)

Background: Previous reports attempted to evaluate bladder cancer using 18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) by washing out the excreted FDG with a diuretic. The purpose of this study was to evaluate the value of diuretic FDG PET/plain CT (drtPET/CT) and diuretic FDG PET/contrast-enhanced CT (drtPET/ceCT) in the assessment of upper urinary tract cancers., Materials and Methods: A total of 66 patients underwent drtPET/CT for suspected upper urinary tract cancer (UUTC). The study targeted 29 patients who were strongly suspected of having UUTC and underwent magnetic resonance imaging (MRI) of the upper urinary tract. A total of 29 (24 male, five female) patients, with a mean ± SD age of 73 ± 3 (range, 43-84) years, had a suspected neoplasm in the upper urinary tract. They underwent FDG PET/plain and contrast-enhanced CT before and after a diuretic and MRI including diffusion-weighted imaging (DWI). A urologist and a physician board-certified in nuclear medicine and radiology independently interpreted the standard PET/CT (stdPET/CT), drtPET/CT, drtPET/ceCT, ceCT, and MRI with DWI images. Interobserver agreement and the diagnostic performance of each modality were evaluated., Results: The kappa values of stdPET/CT, drtPET/CT, drtPET/ceCT, ceCT, and MRI were 0.381, 0.567, 0.7031, 0.448, and 0.185, respectively, with drtPET/ceCT showing the highest kappa value and the only one with good interobserver agreement (>60%). The area under the curve of drtPET/ceCT was 0.92, which was significantly higher than those of stdPET/CT (P=0.027) and MRI (P=0.047)., Conclusions: In the present study, drtPET/ceCT had the best diagnostic performance and the highest interobserver agreement for detecting upper urinary tract urothelial cancers., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Kochi Medical School Ethics Board issued approval 27-155. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Shimamoto et al.)

Aim: This study aimed to investigate the improvement in gait velocity variability after cerebrospinal fluid (CSF) elimination, and the association between gait velocity variability and gait and cognitive impairment in patients with idiopathic normal pressure hydrocephalus., Methods: The gait velocity of 44 patients with idiopathic normal pressure hydrocephalus was measured using the Timed Up and Go Test (TUG) for a total of 10 times over 3 days each before and after CSF elimination. The coefficient of variation (CV) in the time required for the sequence of actions in TUG (TUG-CV) was calculated using 10 TUG data, and used for measuring intraindividual gait velocity variability. Gait quality was evaluated with the Gait Status Scale Revised (GSSR), and cognitive function was evaluated with the Mini-Mental State Examination and the Frontal Assessment Battery., Results: The TUG, TUG-CV, GSSR and Frontal Assessment Battery results improved significantly after CSF elimination. The analyses using pre-CSF elimination results showed that the TUG-CV significantly and positively correlated with the TUG and GSSR results, and negatively with Mini-Mental State Examination results, but not with age and the Frontal Assessment Battery results. The stepwise multiple regression analysis indicates that the TUG, GSSR and Mini-Mental State Examination results were significant predictors of the TUG-CV. The analysis using data of change after CSF elimination showed that ΔTUG and ΔGSSR were significant predictors of ΔTUG-CV., Conclusions: Gait velocity variability improved after CSF elimination, and gait velocity variability was associated with gait disturbances and cognitive impairment in patients with idiopathic normal pressure hydrocephalus. Geriatr Gerontol Int 2024; 24: 693-699., (© 2024 The Author(s). Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.)

Pus discharge containing black granular materials (1-2 mm in diameter) was found in the abdominal skin of a 13-year-old sterilized female cat. Abdominal ultrasonography revealed a large intra-abdominal mass with abundant blood flow beneath the skin lesion. Laparotomy revealed a large mass that adhered to the spleen and left kidney. Similar small lesions were found in the abdominal wall and mesentery. The masses were surgically removed along with the spleen and kidney. Histopathologically, the mass lesions consisted of granulomas with lesional pigmented fungi, and the cat was diagnosed with phaeohyphomycosis. Uisng genetic analysis, the Exophiala dermatitidis was identified as the causative pathogen.

Objective: This study aimed to investigate the usefulness of endoscopic ultrasound-guided tissue acquisition (EUS-TA) for diagnosing focal liver lesions in patients with a history of multiple primary malignant neoplasms., Methods: Among patients who underwent EUS-TA for focal liver lesions between 2016 and 2022, those with a history of multiple malignant neoplasms were included. A histologically confirmed malignant tumor within the past 5 years before EUS-TA was defined as a history of malignant neoplasm. The primary outcomes were diagnostic ability and adverse events of EUS-TA., Results: This study included 16 patients (median age, 73 [33-90] years), the median tumor size was 32 (6-51) mm, 14 had a history of double malignant neoplasms, whereas two had triple malignant neoplasms. Malignant neoplasms were detected histologically or cytologically in all cases. Immunohistochemistry was performed in 75% (12/16), and the final diagnosis of EUS-TA was metastatic liver tumor in 12 patients, and primary malignant liver tumor in four patients. The primary site could be identified in 11 of 12 metastatic tumor cases. The diagnostic yield of EUS-TA was 100% (16/16) for differentiating benign and malignant tumors and 94% (15/16) for confirming the histological type including the primary site of metastatic lesions. No adverse events were associated with the procedure., Conclusion: EUS-TA is a useful diagnostic modality for focal liver lesions in patients with a history of multiple malignant neoplasms, allowing for the differential diagnosis of primary and metastatic tumors and identification of the primary site of metastatic lesions., Competing Interests: None., (© 2024 The Authors. DEN Open published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.)

Purpose . The aim of this study was to assess the repeatability of the SUV normalized by liver volume (SUVL) between two liver receptor SPECT/CT studies performed on different days in patients with ICG-R15 values within normal range. Methods . 935 patients who underwent liver receptor scintigraphy between January 2010 and August 2018 were included. Patients who underwent liver resection, hepatic arterial embolization or had ICG-R15 >10% between scans were excluded, and 38 patients were finally included in the analysis. The repeatability of SUVL between scans was assessed using the intraclass correlation coefficient (ICC) (1.1) between SUVLmax, SUVLpeak and SUVLmean at the first and second scan and the additive and proportional errors from the Bland-Altman analysis. Results . In ICC (1,1), SUVLmax, SUVLpeak and SUVLmean were all greater than 0.8, indicating almost perfect repeatability; neither additive nor proportional errors were observed in the Bland-Altman analysis. Conclusions . In patients with ICG-R15 values within the normal range, the SUV Liver (SUVL) between two liver receptor SPECT/CT studies performed on different days was repeatability over time. It was suggested that the SUVL of liver receptor scintigraphy could be an indicator that could be used for follow-up over time in the assessment of liver fibrosis., (© 2024 IOP Publishing Ltd.)

The caudate lobe of the liver is located deep within the body and surrounded by major blood vessels, such as inferior vena cava, portal vein, and hepatic veins. Thus, percutaneous biopsy is technically challenging. Herein, we report seven patients with focal liver lesions in the caudate lobe who underwent endoscopic ultrasound-guided tissue acquisition (EUS-TA). Their median age was 56 (25-79) years, consisting five males and two females, and the median lesion size was 44 (19-77) mm. Transgastric EUS-TA was performed in all patients. The needles used were 22G and 25G in six patients and one patient, and the median procedure time was 18 (13-30) min. In all patients, adequate specimens were collected, and pathological diagnosis was possible (three intrahepatic cholangiocarcinoma, two metastatic tumors from pancreatic cancer, one hepatocellular carcinoma, and one focal nodular hyperplasia). No adverse events associated with the procedure were observed. EUS-TA can be the first choice for tissue acquisition of the caudate lobe lesions., (© 2024. Japanese Society of Gastroenterology.)

Purpose: To conduct a systematic review and meta-analysis of publications to evaluate the analgesic efficacy and safety of percutaneous thermal ablation (PTA) plus percutaneous cementoplasty (PCP) (PTA + PCP) for painful bone metastases., Methods: We searched PubMed, Cochrane Library and Embase for articles published up to October 2022. Outcomes were a 10-point pain scale, morphine equivalents daily dose (MEDD) and complications. A subgroup confined to spinal bone metastases was analyzed., Results: Twenty-one articles were selected for the analysis. The 21 selected articles involved a total of 661 cases. The pooled pain scales at pre-PTA + PCP, 1 day, 1 week and 1-, 3-, and 6 months post-PTA + PCP were 7.60 (95% confidence interval [CI], 7.26-7.95, I 2  = 89%), 3.30 (95% CI, 2.25-4.82, I 2  = 98%), 2.58 (95% CI, 1.99-3.35, I 2  = 94%), 2.02 (95% CI, 1.50-2.71, I 2  = 93%), 1.78 (95% CI, 1.26-2.53, I 2  = 95%), and 1.62 (95% CI, 1.14-2.31, I 2  = 88%), and in the subgroup, 7.97 (95% CI, 7.45-8.52, I 2  = 86%), 3.01 (95% CI, 1.43-6.33, I 2  = 98%), 2.95 (95% CI, 1.93-4.51, I 2  = 95%), 2.34 (95% CI, 1.82-3.01, I 2  = 68%), 2.18 (95% CI, 1.57-3.03, I 2  = 78%), and 2.01 (95% CI, 1.16-3.48, I 2  = 86%). Mean MEDD decreased up to 3 months post-PTA + PCP in 4 articles. The overall pooled major complication rate was 4% (95% CI, 2-6%, I 2  = 2%)., Conclusions: The updated systematic review and meta-analysis indicates that PTA + PCP for painful bone metastases is safe, and can lead to rapid and sustained pain reduction., (© 2024. The Author(s) under exclusive licence to Japan Society of Clinical Oncology.)

Objective: To evaluate the differences in FDG accumulation in arteries throughout the body between digital and standard PET/CT., Methods: Forty-six people who had FDG-PET examinations with a digital PET/CT scanner for health screening between April 2020 and March 2021 and had previous examinations with a standard PET/CT scanner were the study participants. FDG accumulation in arteries throughout the body was visually assessed in each segment. Scan was considered positive when arterial FDG accumulation was equal to or greater than that of the liver. The positivity rates for general arteries and each arterial segment were compared between the two kinds of scanners. If any one of the arterial segments was considered positive, the general arteries were classified as positive. Moreover, the rate of change in results from the standard PET/CT to the digital scanner in the same individual (negative to positive, positive to negative) was examined., Results: In the evaluation of general arteries, the positivity rates were 21.7% (10 cases) for the standard PET/CT, whereas positive rates were 97.8% (45 cases) for the digital PET/CT (p < 0.001). In all arterial segments, the positivity rate was significantly higher with the digital PET/CT compared to the standard PET/CT; those with the digital PET/CT were, respectively, 95.7%, 87.0%, 73.9%, 37.0%, 34.8%, and 21.7% in the femoral, brachial, aortic, subclavian, iliac, and carotid arteries. On the other hand, those with the standard PET/CT were 13.0%, 13.0%, 19.6%, 2.2%, 0%, and 4.4% in segments in the above order. Changes from negative to positive were shown in many cases; 35 cases (76.0%) of general arteries, 38 cases (82.6%) for the femoral artery, and 34 cases (73.9%) for the brachial artery. The exception was one case in which a change from positive to negative was confirmed in the carotid artery. In all arteries considered to be positive, FDG accumulation was not greater than but was equal to that in the liver with both scanners., Conclusions: Arterial FDG accumulation was significantly higher with digital PET/CT compared to conventional PET/CT. With digital PET/CT, an arterial FDG accumulation equal to the liver may not to be considered as abnormal accumulation., (© 2023. The Author(s) under exclusive licence to The Japanese Society of Nuclear Medicine.)

Introduction: The purpose of this study was to determine the effect of proximal splenic artery embolization (SAE) in cirrhotic patients with splenomegaly who underwent surgical laparotomy., Material and Methods: This retrospective observational study included 8 cirrhotic patients with splenomegaly. They underwent proximal SAE before- ( n  = 6) or after ( n  = 2) laparotomy. Vascular plugs or coils were placed in the proximal splenic artery. The diameter of the portal vein and the splenic volume were recorded. Clinical outcome assessments included platelet counts, the model for end-stage liver disease (MELD) score, and complications., Results: After embolization, the portal venous diameter was significantly smaller (pre: 13.6 ± 2.7 mm, post: 12.5 ± 2.3 mm, p  = 0.023), the splenic volume was significantly decreased (pre: 463.2 ± 145.7 ml, post: 373.3 ± 108.5 ml, p  = 0.008) and the platelet count was significantly higher (pre: 69.6 ± 30.8 × 10 3/ μl, post: 86.8 ± 27.7 × 10 3/ μl, p  = 0.035). Before embolization, the median MELD score was 12; after embolization, it was 11 ( p  = 0.026). No patient developed post-treatment complications after embolization., Conclusions: The reduction of hypersplenism by perioperative proximal SAE may be safe and reduce the surgical risk in cirrhotic patients with splenomegaly.

Background/aim: This study aimed to evaluate the safety and recommended dose of nab-paclitaxel in combination with carboplatin and thoracic radiotherapy for locally advanced non-small cell lung cancer (NSCLC)., Patients and Methods: Nab-paclitaxel was administered weekly with escalating doses, combined with carboplatin area under the curve (AUC) 2 and concurrent standard thoracic radiotherapy. Escalating doses of nab-paclitaxel were as follows: level 0, 30 mg/m 2 ; level 1, 35 mg/m 2 ; level 2, 40 mg/m 2 ; level 3, 45 mg/m 2 Results: Twelve patients were enrolled and received the treatment according to the protocol; seven patients (58%) had squamous cell carcinoma and all cases had stage III disease. At level 1, none of the three patients experienced dose limiting toxicity (DLT). At level 2, one of the first three patients experienced a fatal DLT of bronchopulmonary hemorrhage. None of the three more additional patients experienced DLT. At level 3, two of the three patients experienced a DLT of grade 3 febrile neutropenia and grade 4 neutropenia, respectively. Consolidation chemotherapy was provided to 10 of 12 patients. Radiation pneumonitis developed in five of 12 patients (42%). Eight patients (66.7%) showed partial response, and four (33.3%) showed stable disease. For the above reasons, level 2 (40 mg/m 2 ) was considered the recommended dose in this study., Conclusion: Concurrent chemoradiotherapy with weekly nab-paclitaxel (40 mg/m 2 ) and carboplatin (AUC 2) is a feasible and well-tolerated regimen in patients with previously untreated locally advanced NSCLC. A phase II trial with this regimen is warranted., (Copyright © 2024, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Objective Clinical practice guidelines in Japan recommend surgery for all nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs), regardless of their size or associated symptoms. Because pancreatic resection is highly invasive, follow-up for small NF-PNETs is often chosen in clinical practice. However, the natural history of NF-PNET remains poorly understood. We aimed to examine the natural history of pathologically confirmed NF-PNET. Methods This single-center retrospective case series investigated NF-PNETs that were pathologically diagnosed using endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) at our hospital between 2014 and 2018. Patients who were followed up without treatment due to their general condition or their wish were included in the study. Patients' background characteristics, imaging findings, pathological findings, and long-term prognoses were investigated using medical records. Results Overall, 26 patients were diagnosed with NF-PNET by EUS-FNA during the observation period. Of these, 9 patients (3 men and 6 women; median age: 64 years old) were followed up without treatment. All of these patients were asymptomatic, and localization was noticed in 3 cases in the head, body, and tail (1 each), with a median size of 12 (range: 4-18) mm. Neuroendocrine tumor (Grade 1 [G1]) was pathologically diagnosed in all patients with EUS-FNA. The median observation period was 63 (range: 26-90) months. Tumor growth and distant metastasis were not observed in any of the nine patients who remained asymptomatic. Conclusion Follow-up is a feasible option for asymptomatic NF-PNET ≤20 mm in size with a pathological grade of G1.

Retroperitoneal hemangiosarcoma (RPHSA) is a rare tumor in dogs with a poorly understood prognosis after surgery. The objectives of this study were to investigate the clinical features and prognosis of canine RPHSA that had undergone surgical resection. In this single-center, retrospective cohort study, we reviewed the medical records of dogs that had undergone surgical resection for retroperitoneal tumors and received a histopathologic diagnosis of HSA between 2005 and 2021. The median progression-free survival (PFS) and overall survival (OS) were 77.5 days and 168 days, respectively. In the present study, canine RPHSA had an aggressive biological behavior similar to visceral HSA. Further studies in larger canine populations are needed to evaluate the efficacy of adjuvant chemotherapy.

Collective decision-making plays a crucial role in information and communication systems. However, decision conflicts among agents often impede the maximization of potential utilities within the system. Quantum processes have shown promise in achieving conflict-free joint decisions between two agents through the entanglement of photons or the quantum interference of orbital angular momentum (OAM). Nonetheless, previous studies have shown symmetric resultant joint decisions, which, while preserving equality, fail to address disparities. In light of global challenges such as ethics and equity, it is imperative for decision-making systems to not only maintain existing equality but also address and resolve disparities. In this study, we investigate asymmetric collective decision-making theoretically and numerically using quantum interference of photons carrying OAM or entangled photons. We successfully demonstrate the realization of asymmetry; however, it should be noted that a certain degree of photon loss is inevitable in the proposed models. We also provide an analytical formulation for determining the available range of asymmetry and describe a method for obtaining the desired degree of asymmetry., (© 2023. Springer Nature Limited.)

This study (1) evaluated the perceptual and objective physical quality of digital radiographic chest images processed for different purposes (routine hospital use, lung cancer screening, and pneumoconiosis screening), and (2) quantified objectively the quality of chest images visually graded by the Japan National Federation of Industrial Health Organization (ZENEIREN). Four observers rated the images using a visual grading score (VGS) according to ZENEIREN's quality criteria. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured. Between groups, differences were assessed using ANOVA (followed by Bonferroni multiple comparisons) or unpaired t-test. The Pearson's correlation coefficients were calculated for the correlation between perceptual quality and objective physical image quality. The image quality perceived by the observers and the SNR measurements were highest for the images generated using parameters recommended for lung cancer screening. The images processed for pneumoconiosis screening were rated poorest by the observers and showed the lowest objective physical quality measurements. The chest images rated high quality by ZENEIREN generally showed a higher objective physical image quality. The SNR correlated well with VGS, but CNR did not. Highly significant differences between the processing parameters indicate that image processing strongly influences the perceptual quality of digital radiographic chest images.

The central venous port has been widely used for patients who require long-term intravenous treatments, and the number of palcement has been increasing. The Japanese Society of Interventional Radiology developed a guideline for central venous port placement and management to provide evidence-based recommendations to support healthcare providers in the decision-making process regarding the central venous port. The guideline consisted of two parts: (i) a comprehensive review of topics including preoperative preparation, techniques for placement or removal, complications, and maintenance methods and (ii) recommendations for the six clinical questions regarding blood vessels for central venous port placement, port implantation site, prophylactic antibiotic therapy, imaging guidance for puncture, disinfectant prior to accessing the central venous port, and the optimal procedure at the end of drug administration via the central venous port, generated on the basis of the rating quality of evidence by systematic review., Competing Interests: Hidefumi Mimura received grants from Terumo Corporation and Toray Medical Co., Ltd. Shunsuke Sugawara received honorarium from Becton, Dickinson and Company (Medicon). Tomoaki Yamanishi received honorarium from Terumo Corporation and Stryker Corporation., (© 2023 Japanese Society of Interventional Radiology.)

Purpose: This retrospective study aimed to investigate the validity and reliability of FDG-PET/CT visual assessment using Deauville criteria to predict pathological invasiveness of early lung adenocarcinoma prior to surgery., Materials and Methods: Between April 2020 and January 2022, 51 patients who underwent surgery for pathological stage 0/I lung adenocarcinoma were enrolled. The pulmonary lesions were divided into two groups according to pathological invasiveness: less invasive (including adenocarcinoma in situ and minimally invasive adenocarcinoma and invasive adenocarcinoma. We compared CT size (total and solid size), SUVmax, and Deauville score between the two groups. Furthermore, we investigated inter-rater and intra-rater agreements regarding the Deauville score. Receiver operating characteristic (ROC) curve analysis was performed to identify the diagnostic performance of each method., Results: Based on pathologic diagnoses, 51 lesions in the 51 patients were divided into 6 less invasive and 45 invasive adenocarcinoma lesions. According to quadratic-weighted Kappa statistics, inter-rater (k = 0.93) and intra-rater (k = 0.97) agreements among all five components of the Deauville score indicated high agreement. There was a statistically significant difference in CT solid size, SUVmax, and Deauville score between the two groups. There were no significant differences between CT solid size and FDG-PET/CT assessments (AUC = 0.93 for Deauville score and SUVmax, AUC = 0.84 for CT solid size)., Conclusion: FDG-PET/CT visual assessment using the Deauville score could assist in deciding upon minimally invasive surgery for early lung adenocarcinoma., (© 2023. The Author(s).)

Background: Detecting unknown atrial fibrillation (AF) would provide an opportunity to prevent ischemic stroke by instituting appropriate anticoagulation. Although opportunistic screening of older patients is recommended in current guidelines, which patients may benefit from intensive AF screening remains unclear. We sought to clarify the risk factor profile for newly diagnosed AF in annual health examinations of a Japanese adult cohort., Methods: Among 141 441 Japanese patients who underwent annual health examinations in 2014, 87 872 patients aged ≥20 years without known AF who had undergone electrocardiography were analyzed (mean age: 47 ± 12 years; 64% men). The absence of known AF was confirmed by prior electrocardiography in 2012 and/or 2013. Newly diagnosed AF was observed in 244 patients in 2014-2017 (mean age: 62 ± 12 years; 83% men)., Results: In the multivariable analysis, waist circumference obesity (hazard ratio [HR], 1.5; 95% confidence interval [CI], 1.13-1.99; p  = .005) high blood pressure (HR, 1.9; 95% CI, 1.01-3.59; p  = .047), on-treatment hypertension (HR, 1.53; 95% CI, 1.01-2.31; p  = .046), and daily alcohol drinking (HR, 2.18; 95% CI, 1.52-3.12; p  < .001) were significantly associated with newly diagnosed AF., Conclusions: In this Japanese cohort, waist circumference obesity, hypertension, and alcohol drinking were independent predictors of newly diagnosed AF in annual medical examinations. This finding encourages further evaluation of systematic AF screening programs in at-risk populations., Competing Interests: Authors declare no conflict of interests for this article., (© 2023 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.)

Quantum walks (QWs) have a property that classical random walks (RWs) do not possess-the coexistence of linear spreading and localization-and this property is utilized to implement various kinds of applications. This paper proposes RW- and QW-based algorithms for multi-armed-bandit (MAB) problems. We show that, under some settings, the QW-based model realizes higher performance than the corresponding RW-based one by associating the two operations that make MAB problems difficult-exploration and exploitation-with these two behaviors of QWs.

Niemann-Pick disease (NP) type C is an autosomal, recessive, and inherited neurovisceral genetic disorder characterized by the accumulation of unesterified cholesterol and glycolipids in cellular lysosomes and late endosomes, with a wide spectrum of clinical phenotypes. This study aimed to determine the molecular genetic alterations in two cases of felines with NP in Japan, a Siamese cat in 1989 and a Japanese domestic (JD) cat in 1998. Sanger sequencing was performed on 25 exons of the feline NPC1 gene and 4 exons of the feline NPC2 gene, using genomic DNA extracted from paraffin-embedded tissue specimens. The sequenced exons were compared with reference sequences retrieved from the GenBank database. The identified mutations and alterations were then analyzed using different prediction algorithms. No pathogenic mutations were found in feline NPC1 ; however, c.376G>A (p.V126M) was identified as a pathogenic mutation in the NPC2 gene. The Siamese cat was found to be homozygous for this mutation. The JD cat was heterozygous for the same mutation, but no other exonic NPC2 mutation was found. Furthermore, the JD cat had a homozygous splice variant (c.364-4C>T) in the NPC2 gene, which is not known to be associated with this disease. The NPC2 :c.376G>A (p.V126M) mutation is the second reported pathogenic mutation in the feline NPC2 gene that may be present in the Japanese cat population.

Purpose: To perform a systematic review and meta-analysis of publications to evaluate the analgesic efficacy and safety of percutaneous splanchnic nerve neurolysis (SNN) for cancer-related pain., Methods: We searched PubMed, Cochrane Library, and Ichushi-Web for English or Japanese articles published up to July 2022 and reporting patients who underwent percutaneous SNN for cancer-related pain. The outcome measures assessed in the systematic review and meta-analysis were the pain measurement scales and morphine equivalents daily dose (MEDD) before and after the intervention and the rate of complications., Results: Pooled pain measurement scores at pre-intervention, 1-2 weeks, and at 1, 2, 3, and 6 months post-intervention were 6.65 (95% confidence interval [CI], 5.77-7.67, I 2  = 97%), 2.79 (95% CI, 2.00-3.88, I 2  = 88%), 2.82 (95% CI, 2.49-3.20, I 2  = 55%), 2.86 (95% CI, 2.64-3.10, I 2  = 0%), 2.99 (95% CI, 2.56-3.46, I 2  = 82%), and 3.09 (95% CI, 1.44-6.65, I 2  = 70%), respectively. Mean MEDD was described in 8 of the 11 included articles. In all 8 articles, MEDD decreased up to 3 months post-intervention. The pooled minor complication rates for diarrhea and hypotension were 28% (95% CI, 13-49%, I 2  = 85%) and 31% (95% CI, 16-51%, I 2  = 80%), respectively. The pooled major complication rate was 2% (95% CI, 1-2%, I 2  = 0%)., Conclusions: Analysis indicates that percutaneous SNN for cancer-related pain can be performed safely with sustained reduction of pain measurement scales while reducing the administration of opioids., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Multiscale entropy (MSE) has been widely used to examine nonlinear systems involving multiple time scales, such as biological and economic systems. Conversely, Allan variance has been used to evaluate the stability of oscillators, such as clocks and lasers, ranging from short to long time scales. Although these two statistical measures were developed independently for different purposes in different fields, their interest lies in examining the multiscale temporal structures of physical phenomena under study. We demonstrate that from an information-theoretical perspective, they share some foundations and exhibit similar tendencies. We experimentally confirmed that similar properties of the MSE and Allan variance can be observed in low-frequency fluctuations (LFF) in chaotic lasers and physiological heartbeat data. Furthermore, we calculated the condition under which this consistency between the MSE and Allan variance exists, which is related to certain conditional probabilities. Heuristically, natural physical systems including the aforementioned LFF and heartbeat data mostly satisfy this condition, and hence, the MSE and Allan variance demonstrate similar properties. As a counterexample, we demonstrate an artificially constructed random sequence, for which the MSE and Allan variance exhibit different trends., (© 2023 Author(s). Published under an exclusive license by AIP Publishing.)

We encountered a case of complex isolated spontaneous celiac artery dissection with a patent false lumen with both entry and re-entry and extensive aneurysmal degeneration of the splenic artery. The dissection entry was wide and was located at the origin of the celiac artery. The false lumen extended to the distal part of the splenic artery, obstructed the true lumen, and was connected to the true lumen at the splenic hilum via the re-entry. Treatment was successful by stent-graft placement for the occlusion of the entry and embolization of the re-entry with microcoils via the false lumen of the splenic artery., Competing Interests: Disclosure StatementAll authors have no conflicts of interest., (© 2023 The Editorial Committee of Annals of Vascular Diseases.)

Introduction: Early detection and intervention are important to prevent dementia. Gait parameters have been recognized as a potentially easy screening tool for mild cognitive impairment (MCI); however, differences in gait parameters between cognitive healthy individuals (CHI) and MCI are small. Daily life gait change may be used to detect cognitive decline earlier. In the present study, we aimed to clarify the relationship between cognitive decline and daily life gait., Methods: We performed 5-Cog function tests and daily life and laboratory-based gait assessments on 155 community-dwelling elderly people (75.5 ± 5.4 years old). Daily life gait was measured for 6 days using an iPod-touch with an accelerometer. Laboratory-based 10-m gait (fast pace) was measured using an electronic portable walkway., Results: The subjects consisted of 98 CHI (63.2%) and 57 cognitive decline individuals (CDI; 36.8%). Daily life maximum gait velocity in the CDI group (113.7 [97.0-128.5] cm/s) was significantly slower than that in the CHI group (121.2 [105.8-134.3] cm/s) ( p = 0.032). In the laboratory-based gait, the stride length variability in the CDI group (2.6 [1.8-4.1]) was significantly higher than that in the CHI group (1.8 [1.2-2.7]) ( p < 0.001). The maximum gait velocity in daily life gait was weakly but significantly correlated with stride length variability in laboratory-based gait ( ρ = -0.260, p = 0.001)., Conclusion: We found an association between cognitive decline and slower daily life gait velocity among community-dwelling elderly people., Competing Interests: The authors have no conflicts of interest to declare., (© 2023 The Author(s). Published by S. Karger AG, Basel.)

Preoperative assessment of the degree of liver fibrosis is important to determine treatment strategies. In this study, galactosyl human serum albumin single-photon emission-computed tomography and ethoxybenzyl (EOB) contrast-enhanced magnetic resonance imaging (MRI) were used to assess the changes in hepatocyte function after liver fibrosis, and the standardized uptake value (SUV) was combined with gadolinium EOB-diethylenetriaminepentaacetic acid to evaluate its added value for liver fibrosis staging. A total of 484 patients diagnosed with hepatocellular carcinoma who underwent liver resection between January 2010 and August 2018 were included. Resected liver specimens were classified based on pathological findings into nonfibrotic and fibrotic groups (stratified according to the Ludwig scale). Galactosyl human serum albumin-single-photon emission-computed tomography and EOB contrast-enhanced MRI examinations were performed, and the mean SUVs (SUVmean) and contrast enhancement indices (CEIs) were obtained. The diagnostic value of the acquired SUV and CEIs for fibrosis was assessed by calculating the area under the receiver operating characteristic curve (AUC). In the receiver operating characteristic analysis, SUV + CEI showed the highest AUC in both fibrosis groups. In particular, in the comparison between fibrosis groups, SUV + CEI showed significantly higher AUCs than SUV and CEI alone in discriminating between fibrosis (F3 and 4) and no or mild fibrosis (F0 and 2) (AUC: 0.879, vs SUV [P = 0.008], vs. CEI [P = 0.023]), suggesting that the combination of SUV + CEI has greater diagnostic performance than the individual indices. Combining the SUV and CEI provides high accuracy for grading liver fibrosis, especially in differentiating between grades F0 and 2 and F3-4. SUV and gadolinium EOB-diethylenetriaminepentaacetic acid-enhanced MRI can be noninvasive diagnostic methods to guide the selection of clinical treatment options for patients with liver diseases., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

We encountered a patient with an infection related to an implanted central venous port-catheter that necessitated removal of the system. As the catheter had tightly adhered to the venous wall, removal was impossible with standard methods. After trial and error, we used a guiding catheter that was advanced over the implanted catheter to detach the fibrin sheath on the implanted catheter that had adhered to the vessel wall. At that time, a pull-through technique was used. After we succeeded in detaching the adhesion with the guiding catheter, we were able to withdraw the implanted catheter.

Apathy is frequently observed in idiopathic normal pressure hydrocephalus (iNPH) and worsens cognitive impairment and gait disturbance. In this study, we evaluated the regions associated with apathy in iNPH using statistical imaging analysis on the whole brain, both in terms of cerebral blood flow and gray matter volume. Twenty-seven patients with iNPH were assigned to two groups based on their scores on the neuropsychiatric inventory items related to apathy; 18 patients were assigned to the group with apathy (iNPH + APA) and 9 to the group without apathy (iNPH - APA). The magnetic resonance images and cerebral blood flow single-photon emission computed tomography data of the two groups were compared using statistical parametric mapping 12. The regional gray matter volume of the right precuneus was significantly larger in the iNPH + APA group than in the iNPH - APA group, but the regional cerebral blood flow in any region of the brain was not significantly different between the two groups. These results suggested that the larger gray matter volume, which is thought to reflect gray matter compression, in the precuneus might be involved in apathy in iNPH., (© 2022. The Author(s).)

Purpose: To perform a systematic review and meta-analysis of published studies to evaluate the analgesic efficacy and safety of computed tomography (CT)-guided single celiac plexus neurolysis (CPN) with the injection of a neurolytic agent into the celiac plexus in one session (CT-guided single CPN)., Methods: PubMed, the Cochrane Library, and Ichushi-Web were searched for English or Japanese articles published up to February 2022, which reported findings about patients who underwent CT-guided single CPN. The outcome measures assessed in the systematic review and meta-analysis were the pain measurement scales from 0 to 10 before and after the intervention and the rate of minor and major complications., Results: The pooled pain measurement scales at pre-intervention and 1- or 2-, 7-, 30-, 60-, 90-, and 180-day post-intervention was 6.72 (95% confidence interval [CI], 4.77-9.46, I 2  = 98%), 2.31 (95% CI 2.31-4.44, I 2  = 92%), 2.84 (95% CI 1.39-5.79, I 2  = 95%), 3.36 (95% CI 1.66-6.77, I 2  = 98%), 3.19 (95% CI 1.44-7.08, I 2  = 59%), 3.87 (95% CI 1.88-7.97, I 2  = 0%), and 3.40 (95% CI 3.02-3.83, I 2  = not applicable), respectively. The pooled minor complication rates of diarrhea, hypotension, nausea or vomiting, and pain associated with the procedure were 18% (95% CI 8-37%, I 2  = 45%), 16% (95% CI 2-58%, I 2  = 76%), 6% (95% CI 2-16%, I 2  = 1%), and 7% (95% CI 2-21%, I 2  = 17%), respectively. There was no major complication in the included studies., Conclusion: CT-guided single CPN can be performed safely and provides immediate analgesic efficacy although the amount of heterogeneity is characterized as large. Further investigation of its long-term analgesic efficacy is required., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Assessment-oriented group action (AGA) could be used to empower community-dwelling older adults to maintain their health by groups. AGA can be implemented with the support of a health professional to provide feedback to older adults on physical and cognitive function., Objective: To evaluate the effects of AGA., Methods: For this feasibility study, we enrolled 23 and 20 participants in the intervention and control groups, respectively. Thοse in the intervention group received feedback of their assessments and devised exercise plans with professional support. The participants performed their exercises over 12 weeks; the follow-up examination was conducted at 40 weeks. The control group only received feedback. The change in health-related consciousness and behavior was evaluated. Muscle strength and mass were measured and the timed up and go test, and the Brief-balance evaluation system test (BESTest) were performed., Results: There were no significant differences in consciousness or behavior between the groups. The score was higher in the intervention than in the control group at 40 weeks in Section-I of the Brief-BESTest, indicating that the muscle strength contributed to balance function., Conclusion: AGA did not show positive changes in consciousness or behaviors but demonstrated significant improvements and lasting effects in balance function.

The aim of this study is to perform a systematic review and meta-analysis of published studies to evaluate the efficacy and safety of computed tomography (CT)-guided percutaneous biopsy for retroperitoneal lesions. PubMed and the Cochrane Library were searched for English-language articles published up to October 2021 and reporting findings about patients with retroperitoneal lesions who underwent CT-guided percutaneous biopsy. The outcome measures assessed in this systematic review and meta-analysis are accuracy, false negative rate, and rate of minor and major complications. Heterogeneity among studies was evaluated by testing Cochran's Q and the inconsistency index statistics. Seven studies published from 1975 to 2021 were selected for the analysis of accuracy, false negative rates, and rate of major and minor complications. The pooled accuracy of CT-guided percutaneous biopsy for retroperitoneal lesions was 93.6% [95% confidence interval (CI), 88.1-96.6%], with high heterogeneity. The pooled false negative rate was 6.3% (95% CI, 3.3-11.7%) with high heterogeneity. Pooled rates of minor and major complications were 3.7% (95% CI, 1.6-8.6%) with moderate heterogeneity and 0.7% (95% CI, 0.4-1.1%) with low heterogeneity, respectively. CT-guided percutaneous biopsy for retroperitoneal lesions has been reported to have high accuracy with a limited rate of major complications.

Objective: The purpose of this retrospective study was to investigate the utility of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F FDG-PET/CT) to predict spread through air spaces (STAS) in clinical stage I lung adenocarcinoma., Methods: Between April 2020 and January 2022, 52 patients (55 lesions) who underwent surgery for clinical stage I lung adenocarcinoma were enrolled. The lesions were divided into two groups according to the presence of STAS. 18F FDG-PET/CT parameters, specifically the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG), were calculated. The SUVmax, MTV, and TLG were compared between the two groups upon surgical pathological examination. Receiver operating characteristic (ROC) curve analysis was performed to identify a cut-off value., Results: Nineteen lesions (35%) were positive for STAS and 36 lesions were negative for STAS. According to the presence of STAS, significant differences were detected in the SUVmax (5.21 [range 1.52-16.50] vs. 2.42 [range 0.74-11.80], p = 0.0040) but not MTV (3.44 [range 0.65-24.36] vs. 2.95 [0.00-20.07], p = 0.20) and TLG (7.92 [range 0.93-47.82] vs. 5.63 [0.00-58.66], p = 0.14). SUVmax had an AUC value of 0.74 (95% CI 0.61-0.87) with a sensitivity of 89.5% and specificity of 52.8% at a cut-off of 2.48., Conclusions: SUVmax rather than MTV and TLG were shown to be valuable indices for the prediction of STAS in clinical stage I lung adenocarcinoma., (© 2022. The Author(s) under exclusive licence to The Japanese Society of Nuclear Medicine.)

Purpose: We examined the effectiveness of the "positive diary," in which family caregivers of people with dementia write down three good things that happened with reasons at the end of each day., Design and Methods: In this randomized controlled trial, the intervention group used the "positive diary," while the control group kept a record of each meal for 4 weeks., Findings: The intervention group showed improvement on several measures of wellbeing including Neuropsychiatric Inventory Questionnaire and Center for Epidemiologic Studies Depression Scale., Practice Implications: The "positive diary" is a useful self-care tool for caregivers of people with dementia., (© 2021 The Authors. Perspectives in Psychiatric Care published by Wiley Periodicals LLC.)

Objectives: To investigate the dose length product (DLP) and outcomes of CT fluoroscopy (CTF)-guided interventions using a novel 320-detector row CT scanner with deep-learning reconstruction (DLR) and a new bow-tie filter ( i.e., Aquilion ONE Prism Edition) and compare with a 320-detector row CT system without DLR and the new bow-tie filter ( i.e., Aquilion ONE Vision Edition) (Vision)., Methods: CTF-guided interventions performed using Prism and Vision were retrospectively investigated in terms of the technical success rates, clinical success rates of biopsies, complications, DLPs of total CT scans (total DLPs) from February 2019 to January 2021. The total CT scans included pre-interventional CT scans, CTF scans during the CTF-guided procedure, additional CT scans for additional treatment, CTF scans for additional treatment, and post-interventional CT scans., Results: In this study, 87 and 85 CTF-guided interventions were performed using Vision (Vision group) and Prism (Prism group), respectively. There was no significant difference in the technical success rate (96.6% vs 98.8%, p = 0.621), clinical success rate of biopsies (92.9% vs 93.4%, p = 1.000), and minor (8.0% vs 7.1%, p = 0.807) and major (0% vs 3.5%, p = 0.119) complications between the Prism and Vision groups. The total DLPs for the Prism group were significantly lower than those for the Vision group regardless of the procedure (278 vs 548 mGy*cm, p < 0.001, in the biopsy and 246 vs 667 mGy*cm, p < 0.001, in the drainage and aspiration)., Conclusions: CTF-guided interventions on Prism reduce the total DLP without performance degradation of the intervention., Advances in Knowledge: The total DLPs of biopsies and drainages/aspirations in the Prism group decreased by 49 and 63%, respectively.

Purpose: To evaluate the safety and efficacy of CT fluoroscopy-guided percutaneous cryoablation (PCA) after lipiodol marking and embolization (LME) in patients with renal cell carcinoma (RCC)., Material and Methods: This study included 29 patients (18 men, 11 women; mean age 69 years, range 22-89 years) with 42 RCCs. They underwent CT fluoroscopy-guided PCA after LME between March 2016 and March 2020. The mean tumor diameter was 21 mm (range 7-50 mm). LME was performed with lipiodol and gelatin particles. PCA was considered successful when the ice ball encapsulated the entire tumor and the margin was sufficient on post-ablation CT scans., Results: LME was successfully performed in 39 of 40 tumors (97.5%). PCA after LME was successful in all 39 of 39 tumors (100%). During the follow-up period (mean 13.9 ± 12.1 months), one of the 39 tumors (2.6%) developed local tumor progression. A significant complication (reversible hypertensive crisis) was encountered in only one of 37 (2.7%) procedures. The mean eGFR was 64.2 ± 26.8 before and 63.3 ± 26.4 after PCA ( p  = .44)., Conclusion: LME using iodized oil and gelatin particles to improve visualization of the RCC facilitated tumor localization on unenhanced CT images. PCA after LME might be a safe and effective for treatment in patients with RCC.

Background: Exercise has been one of the key strategies for preventing frailty. While training programs for preventing frailty have been mainly developed in person, which have now become difficult to perform due to the coronavirus disease pandemic. It would be worthwhile to explore a feasibility of methods for a remote-based training with information and communications technology (ICT) in the pre-frail/robust older adults living at home., Methods: We assessed the feasibility of a remote-based training with ICT device in terms of 1) a measurement accuracy and 2) whether it could be used for remote-based training of different intensities. To evaluate a measurement accuracy of the ICT device, we evaluated an inter-rater reliability between a true score and scores obtaining from the ICT device in 20 participants aged 65 years and older. Intraclass correlation was calculated. To evaluate a feasibility of remote-based training interventions of different intensities, we did a parallel, randomized, active controlled trial. Participants aged 65 years or older were randomly allocated to the two 3-month intervention programs with different intensity of exercise with the ICT (i.e., an Exercise-Intensive program and a Light-load exercise program). The primary outcome was 3-month scores of the 30-s chair-stand test (CS-30), which was compared between two groups using mixed models for repeated measures to account for within-person correlations., Results: The ICT device showed a high intraclass correlation of over 0.99 for all outcomes including CS-30. Between Aug and Oct 2020, 70 participants (36 and 34 in the Exercise-Intensive and Light-load exercise programs, respectively) were randomized. After 3 months of intervention, CS-30 scores and other physical function improved in both groups. Difference in the 3-month CS-30 scores between two programs was found to be 0.08 (95% confidence interval: - 2.64, 2.79; p = 0.955), which was not statistically significant. No harmful incidents, such as falls, occurred in either group., Conclusion: We showed a remote-based training with ICT device in the older adults living at home was feasible. Further studies are warranted to determine what kind of remote exercise intervention programs is more effective for maintaining a physical performance and, beyond that, preventing frailty., Trial Registration Number: UMIN000041616 (05/09/2020) https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&recptno=R000047504&type=summary&language=E., (© 2022. The Author(s).)

Hepatocellular carcinoma is one of the leading causes of cancer-related death both in Japan and globally. In the advanced stage, hepatic arterial infusion chemotherapy (HAIC) is one of the most commonly used treatment options for liver cancer in Japan, and implantation of a catheter system (called a port system) in the body is a treatment method that has evolved mainly in Japan. The Guideline Committee of the Japanese Society of Interventional Radiology and the Japanese Society of Implantable Port Assisted Treatment jointly published clinical practice guidelines for HAIC with a port system to ensure its appropriate and safe performance in Japanese in 2018. We have written an updated English version of the guidelines with the aim of making this treatment widely known to experts globally. In this article, the evidence, method, indication, treatment regimen, and maintenance of the system are summarized., Competing Interests: Kazuomi Ueshima received honoraria and consulting or advisory fees from Bayer AG, Eisai Co. Ltd., Merck Sharp & Dohme, Eli Lilly and Company, Chugai Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Pfizer Inc., Otsuka Pharmaceutical Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Taiho Pharmaceutical Co., Ltd., EA Pharma Co., Ltd., and Kowa Co., Ltd. and consulting or advisory fees from Eisai Co., Ltd., Eli Lilly and Company, Chugai Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., and Pfizer Inc. Atsushi Komemushi, Takeshi Aramaki, Hideki Iwamoto, Shuntaro Obi, Yozo Sato, Toshihiro Tanaka, Kiyoshi Matsueda, Hiroya Saito, Miyuki Sone, and Yoshitaka Inaba have no relevant conflicts of interest to disclose. Michihisa Moriguchi received honoraria from Bayer, Eisai, Eli Lilly, and Chugai and consulting or advisory fees from Bayer, Eli Lilly, and Chugai. Takuji Yamagami received a research grant from Guerbet Japan, Nihon Medi-Physics, Eisai, Fujifilm Toyama Chemical Co. Ltd., GE Healthcare, Boston Scientific, and Fuji Pharma Co., Ltd. Masatoshi Kudo received honoraria and consulting or advisory fees from Bayer AG and Eisai Co., Ltd.; honoraria from Bayer AG, Bristol Myers Squibb, EA Pharma Co., Ltd., Eisai Co., Ltd., and Merck Sharp & Dohme; and research funding from Bayer AG, Daiichi Sankyo Co., Ltd., Chugai Pharmaceutical Co., Ltd., Merck Sharp & Dohme, Otsuka Pharmaceutical Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Ono Pharmaceutical Co., and Taiho Pharmaceutical. Yasuaki Arai received honoraria from Merit Medical Systems, Cosmotec, Fuji Pharma, Canon Medical Systems, Canon Medical Systems Asia Pte. Ltd., Canon Medical Systems Malaysia Sdn. Bhd., Sumitomo Bakelite, Boston Scientific Japan, Boston Scientific Corporation, Japan Lifeline, AstraZeneca plc, Guerbet Japan, Guerbet Asia Pacific, Kyorin Pharmaceutical, Daiichi Sankyo Co., Ltd., and Eisai Co., Ltd. Masatoshi Kudo is the Editor-in-Chief of Liver Cancer, and Kazuomi Ueshima is an Editorial Board Member of Liver Cancer., (Copyright © 2022 by The Author(s). Published by S. Karger AG, Basel.)

Genomic DNA replication requires replisome assembly. We show here the molecular mechanism by which CMG (GAN-MCM-GINS)-like helicase cooperates with the family D DNA polymerase (PolD) in Thermococcus kodakarensis. The archaeal GINS contains two Gins51 subunits, the C-terminal domain of which (Gins51C) interacts with GAN. We discovered that Gins51C also interacts with the N-terminal domain of PolD's DP1 subunit (DP1N) to connect two PolDs in GINS. The two replicases in the replisome should be responsible for leading- and lagging-strand synthesis, respectively. Crystal structure analysis of the DP1N-Gins51C-GAN ternary complex was provided to understand the structural basis of the connection between the helicase and DNA polymerase. Site-directed mutagenesis analysis supported the interaction mode obtained from the crystal structure. Furthermore, the assembly of helicase and replicase identified in this study is also conserved in Eukarya. PolD enhances the parental strand unwinding via stimulation of ATPase activity of the CMG-complex. This is the first evidence of the functional connection between replicase and helicase in Archaea. These results suggest that the direct interaction of PolD with CMG-helicase is critical for synchronizing strand unwinding and nascent strand synthesis and possibly provide a functional machinery for the effective progression of the replication fork., (© The Author(s) 2021. Published by Oxford University Press on behalf of Nucleic Acids Research.)