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Background: Previous experimental studies have suggested many possible anti-cancer mechanisms for green tea, but epidemiological evidence for the effect of green tea consumption on gastric cancer risk is conflicting. Objective: To examine the association between green tea consumption and gastric cancer. Methods: We analysed original data from six cohort studies that measured green tea consumption using validated questionnaires at baseline. Hazard ratios (HRs) in the individual studies were calculated, with adjustment for a common set of variables, and combined using a random-effects model. Results: During 2 285 968 person-years of follow-up for a total of 219 080 subjects, 3577 cases of gastric cancer were identified. Compared with those drinking <1 cup/day, no significant risk reduction for gastric cancer was observed with increased green tea consumption in men, even in stratified analyses by smoking status and subsite. In women, however, a significantly decreased risk was observed for those with consumption of ≥ 05 cups/day (multivariate-adjusted pooled HR = 0.79, 95% confidence interval (CI) = 0.65 to 0.96). This decrease was also significant for the distal subsite (HR = 0.70, 95% CI = 0.50 to 0.96). In contrast, a lack of association for proximal gastric cancer was consistently seen in both men and women. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the associations between long-term weight change after age 20 and overall mortality and cause-specific mortality in the general Asian population. Methods: From 1990 to 2005, the Japan Public Health Center (JPHC)-based prospective study conducted a follow-up of 42 242 men and 46 177 women aged 40-69 years with no history of cardiovascular disease (CVD) or cancer. Sex-specific multivariable-adjusted hazard ratios for cause-specific mortality were computed in accordance with weight change categories from age 20, as assessed by a self-administered questionnaire, and clustered by the JPHC communities and age groups, using Cox's proportional hazard model. Results: During the 12.9-year follow-up, there were 6494 deaths, including 2888 from cancer, 1011 from CVD and 2595 from other causes. In all, weight loss ⩾5 kg since age 20 increased hazard ratios for all-cause mortality in men (1.44, 95% CI 1.32 to 1.56) and women (1.33, 95% CI 1.17 to 1.52) compared with maintenance of a stable weight, and elevated risk was also found within each age group. The risk of weight loss was higher for individuals in the younger age group. Weight loss predicted cancer and CVD mortality only for men ⩾50 years of age. The increased risk was observed regardless of whether the individual was ill, a smoker or overweight at baseline or at age 20. There was an inverse association between weight gain and mortality risk. Conclusion: Weight loss strongly predicted all-cause, cancer and CVD mortality, primarily for men. An unfavourable effect of weight gain was small at the population level. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The aim of this study was to investigate left ventricular (LV) function reserve in hypertrophic cardiomyopathy (HCM) patients with and without cardiac troponin gene mutations before transition to the dilated phase. METHODS: LV ejection fraction (EF) was continuously evaluated in 52 patients with non-obstructive HCM during supine ergometer exercise using radionuclide ventricular function monitoring with a cadmium telluride detector (VEST). On the basis of genetic analysis, patients were divided into two groups: 10 with cardiac troponin gene mutations (group A) and 42 without these gene mutations (group B). RESULTS: Exercise duration, peak exercise load, and heart rate during exercise did not differ between the two groups. The differences from baseline to peak exercise of the LV end-diastolic volume decreased similarly in the two groups. In contrast, the difference of the LV end-systolic volume in group A increased significantly compared with group B (17.7% (SD 12.7%) vs 3.4% (SD 13.2%); p=0.0031). Consequently, the difference of LVEF in group A decreased significantly in contrast with group B (-14.1% (SD 11.1%) vs -1.2% (SD 11.7%); p=0.0025). Additionally, the changes in LVEF and stroke volume decreased significantly more in group A than in group B (-22.2% (SD 18.6%) vs -1.1% (SD 17.8%); p=0.0017 and -12.9% (SD 21.7%) vs 12.3% (SD 24.4%); p=0.0042, respectively). CONCLUSIONS: These results suggest that HCM patients with cardiac troponin gene mutations may display exercise-induced LV systolic dysfunction more frequently than HCM patients without this abnormality. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the long axis function of both ventricles during the early neonatal period by using pulsed wave Doppler tissue (PWDT) echocardiography. DESIGN: PWDT echocardiography was recorded from the lateral sites of the mitral and tricuspid annuluses and the tip of interventricular septum in 130 neonates within 24 hours after birth (day 0 group), in 135 neonates 1-7 days after birth (day 1-7 group), and in 131 healthy children (children group). RESULTS: Peak systolic motion velocity (Sw) of the three ventricular walls positively correlated with the number of days after birth (p < 0.005). Compared with the children group, in neonates Sw in the right ventricle and peak early diastolic motion velocity (Ew) and peak atrial systolic motion velocity in the interventricular septum were lower than in the remaining two walls (p < 0.0005, p < 0.0001, and p< 0.0001, respectively). Although peak mitral and tricuspid flow velocities during early diastole (E) correlated with the number of hours after birth in the day 0 group, there was no significant change in the Ew of either ventricle. The E:Ew ratio of both ventricles was significantly higher in both neonate groups than in the children group (p < 0.001). The E:Ew ratio of the left ventricle was higher in the day 0 group than in the day 1-7 group (p < 0.005). CONCLUSIONS: The two ventricles differ in their normal PWDT echocardiographic values and in the parameter change after birth during the early neonatal period, which may reflect differences in ventricular adaptation after birth. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relation between QT variables and disproportion of left ventricular wall hypertrophy in patients with hypertrophic cardiomyopathy. Design: Retrospective analysis of the results of echocardiography and electrocardiography. Setting: University hospital (tertiary referral centre). Patients: 70 patients with hypertrophic cardiomyopathy were divided into four groups according to the distribution of left ventricular wall hypertrophy on cross sectional echocardiography: group A-hypertrophy confined to the interventricular septum; group B-hypertrophy confined to the interventricular septum and left ventricular anterior wall; group C-hypertrophy confined to the interventricular septum, left ventricular anterior wall, and lateral free wall; group D-hypertrophy involving all portions of the left ventricle. Main outcome measures: QT intervals and QT dispersion in precordial six lead ECGs. Results: There were no significant differences in the maximum left ventricular wall thickness among the four groups, and maximum and minimum QTc intervals also did not differ. QTc dispersion was increased significantly in groups A and B compared with groups C and D. Dispersions of the interval from the J point to the end of the T wave (JTc dispersions) in groups A and B were also increased significantly compared with groups C and D. By linear regression analysis, QTc and JTc dispersions correlated with the ratio of the interventricular septal thickness to left ventricular posterior wall thickness (p = 0.0152 and p = 0.0075, respectively). Conclusions: QT dispersion may be affected by not only electrical inhomogeneity but also by morphological inhomogeneity of the left ventricle in patients with hypertrophic cardiomyopathy. [ABSTRACT FROM AUTHOR]

Despite high primary response rates with cisplatin-based combination chemotherapy, the overall survival rate for advanced ovarian cancers remains dismal. We designed a new systematic treatment approach with a combination chemotherapy consisting of cisplatin, doxorubicin and cyclophosphamide (cyclic PAC chemotherapy), with the aim of improving survival rates with minimal disturbance of quality of life. Cyclic PAC chemotherapy is a three-step chemotherapy with three courses of the PAC regimen in each step. A total of nine courses with a 3-month drug-free period between each step were administered over a 15-month period to patients with clinical stage IC-IV ovarian cancer who had undergone cytoreductive surgery. Forty-eight patients with stage IC-IV disease (34 patients with stage III and IV disease) were treated with cyclic PAC chemotherapy. Thirty-four patients with stage IC-IV disease (23 patients with stage III and IV disease) were treated by a brief course of PAC chemotherapy. Long-term survival and toxicity were evaluated for both treatment groups. Cyclic PAC chemotherapy improved the overall outcome of patients (66.6% 3-year and 56.5% 5-year survival rates) compared to brief PAC (41.2% 3-year and 23.5% 5-year survival rates) (P < 0.01). The outcome of patients with stage III-IV ovarian cancer of the cyclic PAC group (52.6% 3-year and 37.2% 5-year survival rates) was also superior to that of the brief PAC group (21.7% 3-year and 8.7% 5-year survival rates). Generally, the treatment was well tolerated. The toxicity was similar in both groups, although myelosuppresion and neurotoxicity were rather prominent in the cyclic PAC group. Cyclic PAC chemotherapy may lead to improved survival in advanced ovarian cancer, and merits further investigation in a randomized study. [ABSTRACT FROM AUTHOR]

Forty-one patients with endodermal sinus tumors of the ovary (EST) (23: pure EST, nine: EST with dysgerminoma; and nine: EST with immature teratoma) were treated with cytoreductive surgery, with or without subsequent adjuvant chemotherapy including VAC or PVB. Clinical staging of these patients showed 23 in stage I, six in stage II and 12 in stage III and IV. The outcome was good in the patients with stage I or II disease, with 5- and 10-year survival rates of around 80%. In contrast, all except two patients with stage III or IV disease died within 2 years. Aggressive surgery did not change the outcome of patients with stage I disease. In addition, postoperative chemotherapy was necessary, but the choice of vincristine, actinomycin-D and cyclophosphamide (VAC) or cis-platin, vinblastine and bleomycin (PVB) did not make any difference. Based on the results of the present study, VAC or PVB chemotherapy, after cytoreductive surgery, is essential for cure and conservative surgery followed by VAC or PVB regimen should be recommended for young patients. [ABSTRACT FROM AUTHOR]

To determine the intrahepatic production of tumour necrosis factor alpha (TNF alpha) in chronic liver disease three monoclonal antibodies were used against TNF alpha in immunohistochemical studies of liver tissue sections from patients with chronic liver disease. All three monoclonal antibodies stained infiltrating mononuclear cells. Monoclonal antibody II 7C2 also stained the cytoplasm or nucleus, or both, of a varied number of hepatocytes from nine patients with chronic hepatitis B virus infection, suggesting that the antigenic epitope related to hepatitis B core antigen (HBcAg) crossreacted with II7C2. The other two monoclonal antibodies, III2F3 and IV3E5, stained significantly larger numbers of mononuclear cells in cases of chronic active hepatitis B than in chronic persistent hepatitis B, or hepatitis B related liver cirrhosis. III2F3 stained significantly larger numbers of mononuclear cells in non-A, non-B chronic active hepatitis than in chronic persistent hepatitis B or hepatitis B related liver cirrhosis. These results indicate that TNF alpha is produced and secreted by infiltrating mononuclear cells in focal inflammatory areas of the liver, and suggest that TNF alpha may have a role in the inflammatory activity of chronic liver disease. [ABSTRACT FROM PUBLISHER]

To evaluate the role of the expression of hepatitis B core antigen (HBcAg) in liver cell damage the immunoperoxidase staining pattern of cryostat liver biopsy specimens from 16 chronic carriers of hepatitis B surface antigen (HBsAg) was investigated using three different kinds of anti-HBc antibodies. Polyclonal antibody prepared from recombinant HBcAg seemed to be more sensitive in detecting HBcAg than did monoclonal antibody from the same antigen. The topographical distribution of HBcAg detected by these two antibodies was similar, showing a close correlation to the histological activity of disease. Furthermore, the predominant localisation of cytoplasmic HBcAg usually reflected an active and severe ongoing hepatitis. On the other hand, monoclonal antibody prepared from purified Dane particles resulted in the prominent cytoplasmic staining for HBcAg regardless of histological severity of the hepatitis. The quantitative expression and topographical distribution of HBcAg depended on the type of anti-HBc antibodies used. [ABSTRACT FROM PUBLISHER]

The relation between the site and severity of coronary artery lesion and infarct size was investigated in 59 patients with acute myocardial infarction. All patients had no prior myocardial infarction and had at least one significant coronary narrowing (greater than or equal to 75%) in one of the major coronary arteries or in the first diagonal branch. Left ventriculography and selective coronary arteriography were performed on average 2.2 months after the onset of infarction to identify the site and severity of coronary narrowing and to assess the extent of the non-contracting segment (akinetic, dyskinetic, or aneurysmal). Thirty-four of 59 patients were studied enzymatically and total CK released was taken as an indication of infarct size. Non-contracting segment and total CK released in group L-I (narrowing proximal to the first diagonal branch) were significantly larger than those in group L-II (a coronary lesion distal to the branch). The data also indicate that the perfusion area of the first diagonal branch is as large as that of the left anterior descending artery below the first diagonal branch. In contrast to left anterior descending artery disease, the involvement of the right ventricular branch did not significantly influence the infarct size. However, infarct size was significantly larger in eight patients with the left ventricular branch of the right coronary artery supplying the predominantly large area of posterior wall of the left ventricle than in nine patients with small left ventricular branches. It was also shown that the severity of coronary narrowing does not correlate with the infarct size in either left anterior descending or right coronary artery disease. [ABSTRACT FROM PUBLISHER]

We evaluated the usefulness and limitations of praecordial ST segment mapping as a clinical means of assessing the size of acute myocardial infarction in 14 patients with anterior myocardial infarction and 13 patients with inferior myocardial infarction. sigma ST, the sum of ST segment elevations, and nST, the number of leads showing ST segment elevation, were obtained from serial electrocardiograms recorded through 39 praecordial leads. The infarct size and period of the evolution of myocardial infarction were estimated respectively from the total creatine kinase (CK) released and the serial changes of the CK releasing rate. sigma ST and nST obtained at the time when the CK release had ceased correlated closely with the total CK released. Peak sigma ST and nST, and values 48 hours after the onset of myocardial infarction, also correlated well with the total CK released; but those on admission or 12 hours after the onset correlated poorly. These results suggest that sigma ST and nST at the end of evolution of myocardial infarction or 48 hours after the onset may be two useful indices for the assessment of infarct size in patients with either anterior or inferior myocardial infarction. [ABSTRACT FROM PUBLISHER]

We have observed rotational excursion, comprising anteroposterior and right to left movement of the heart, and cardiac twist around the long axis in 2 patients with massive pericardial effusion, using a phased-array echocardiograph recently developed in this country. Sagittal real-time cross-sections showed only the anteroposterior swing motion, but horizontal cross-sections revealed a counterclockwise rotational excursion and cardiac twist during this rotational excursion. The rotational excursion consisted of a rapid and almost straight movement right and posteriorly in systole, and a slow arcing excursion left and anteriorly in diastole. The speed of this movement was not uniform. The heart disclosed dominant counterclockwise twisting motions in mid to late systole and in late diastole, synchronous with atrial contraction. These movements were described relative to an external system of co-ordinates. Controls, consisting of a normal healthy subject, and cases with mitral stenosis, mitral regurgitation, and hypertrophic cardiomyopathy, did not show any rotational excursion. In the latter 2 diseases, cardiac twists were observed, but they were less dominant than in cases with massive pericardial effusion. [ABSTRACT FROM PUBLISHER]

Serum m-AST (mitochondrial isoenzyme of AST) activity in patients with acute myocardial infarction was determined quantitatively by a new immunological technique which is sensitive and easily available. All 31 patients with acute myocardial infarction showed abnormally high levels of serum m-AST (more than 5 KU/ml); the mean serum m-AST activity attained its peak (42.0 +/- 4.9 KU/ml) on the first day after the onset of infarction 5 hours later than that of serum t-AST (total AST) activity in 15 patients whose peak m- and t-AST activities were identified clearly. The individual peak m-AST activity correlated with the total CK released (r = 0.83, n = 15), indicating that the release of m-AST also reflects the infarct size. The ratio of serum m-AST/t-AST increased following myocardial infarction and showed the maximal value (average 25.7%) on the third to seventh day after onset. This ratio in the patients with acute myocardial ifarction was also greater than that in patients with liver disease or with heart failure from causes other than acute myocardial infarction. In the patients who had the additional complication of heart failure and/or cardiogenic shock the ratio was also greater than that is the patients without these hazards. These results indicate that the ratio of serum m-AST/t-AST reflects the severity of the myocardial cellular damage in acute myocardial infarction. [ABSTRACT FROM PUBLISHER]

In order to investigate the relation between the release of creatine kinase (CK) in acute myocardial infarction and the evolution of infarction, the appearance functions of CK (release of CK from the heart into the circulation) were calculated by the modified method of Sobel and associates from the serial determinations of serum CK activity in 50 patients with acute myocardial infarction. The relation of the time between the onset of infarction and the peak value of the appearance function to the duration of the evolution of abnormal Q waves in 14 patients with inferior infarction and to the duration of pain in all patients was investigated. The duration of CK release from the heart averaged 37-2+/-2-4 hours and correlated well with the total CK released (R=0.665) which represents the infarct size. The mean per cent of the total CK eventually released by the time of maximum sigmaQ (sum of the amplitude of Q wave in leads II, III, and aVF) was 80-0+/-6-4 per cent and that of CK released while pain persisted was 72-0+/-3-9 per cent. These results strongly suggest that the appearance function of CK reflects the evolution of myocardial infarction. [ABSTRACT FROM PUBLISHER]

The serum creatine kinase (CK), aspartate transaminase (AST), lactic dehydrogenase (LD) and alpha-hydroxybutyric dehydrogenase (HBD) were determined before and 3, 6, 18, and 36 hours after cardiac catheterization and angiocardiography in 56 consecutive patients with ischaemic heart disease. Five of these patients whose serum enzyme levels were higher than normal before the procedure were excluded from the study. Forty-one of the remaining 51 patients had left ventriculography and also selective coronary arteriography. In these 41 patients (groups 1 and 2--see below), the mean serum CK levels increased after the procedure to exceed the upper limit of normal at every study interval. The mean serum AST, LD, and HBD levels generally remained within the normal range at all study intervals, though serum AST increased abnormally in 9 of the 41 patients (22%) and serum LD and HBD each increased above the normal limit in 2 of 41 patients (4.9%). In 24 patients (group 1) whose coronary arteriograms showed insignificant coronary narrowing (less than 75%) in any of the three major coronary arteries, the increase in serum CK was significantly higher than in 17 patients (group 2) with greater than 75% narrowings in at least one of the three major coronary arteries. However, the degree of serum CK elevation observed during the postangiographic period was much lower than that in another group of 30 consecutive patients with acute myocardial infarction. In 10 patients (group 3) who had the same procedure as groups 1 and 2 except without the selective coronary arteriography, the serum enzyme levels showed no noticeable increase after the procedure. The difference in postangiographic serum CK elevation between patients with and without selective coronary arteriography and the difference between group 1 (without significant coronory narrowing) and group 2 (with significant narrowing) strongly suggest that the raised serum CK levels represent some form of myocardial damage caused by the coronary arteriography, which, however, is different at least in degree from that of acute myocardial infarction. [ABSTRACT FROM PUBLISHER]

Presents a letter to the editor on the sexual behaviour and high risk human papillomavirus infections in Japanese women.

A letter to the editor is presented about a patient with a luxation of an encapsulated intraocular lens (IOL) with good visual perception.

The article focuses on the case regarding an exacerbation of ulcerative colitis induced by combination therapy with PEG- interferon and ribavirin. This case involves a man with chronic hepatitis C presented with diarrhea and bloody stools in July 2003. It was found through a biopsy that the lesion confirmed the diagnosis and treatment was initiated with mesalazine. Moreover, a case of ulcerative colitis caused by the combination therapy in PEG-IFN and ribavirin for hepatitis C.

A patient with unilateral upper medial medullary infarction presented with contralateral paralysis of the pharyngeal constrictor muscle in association with lemniscal sensory loss, pyramidal insufficiency, and central facial palsy on the same side. Individual differences in supranuclear control of the pharyngeal muscles may explain this rare occurrence. The combination of these signs is described as a syndrome of upper medial medullary lesion. [ABSTRACT FROM AUTHOR]

Background: There have been several histological studies of the Leeds-Keio ligament in anterior cruciate ligament reconstruction, but there have been few of the Leeds-Keio ligament in the extra-articular portion. Aims/Methods: To report the histological and ultrastructural findings of two cases of medial patelofemoral ligament reconstruction using the Leeds-Keio ligament, removed 6.1 years and 8.7 years after implantation. Results: In both cases, the tissue over the Leeds-Keio ligament was a ligament-like tissue. Electron microscopy showed that the diameter of the collagen fibrils in the tissue over the Leeds-Keio ligament was unimodal in the case investigated 6.1 years after implantation but bimodal in the case investigated after 8.7 years. Conclusions: The tissue over the Leeds-Keio ligament may continue to grow with prolonged periods of mechanical stress. [ABSTRACT FROM AUTHOR]

Objectives: APOLLO study, 'efficacy and safety of the deodorAnt Pad against Odour and uLceration for LOcally advanced breast cancer', aimed to assess the safety and efficacy of wearing a deodorant pad in patients with locally advanced breast cancer (LABC) with an ulceration., Methods: Komagome Pads were previously developed by Juntendo University and Kao Corporation. In test A, a conventional pad consisting of gauze, a commercially available diaper, pad, etc and the Komagome Pad were compared over 3 days to assess their efficacy and possible improvements for short-term use. In test B, the Komagome Pad was used continuously for 1 month to evaluate its safety during long-term use., Results: This study included 14 patients in test A and nine in test B. In odour evaluation using sensory testing in test A, nine patients reported more significant efficacy in odour suppression with the Komagome Pad. The odour intensity of the Komagome Pad was lower on the gas chromatography-mass spectrometry. The group with a high level of exudation reported significantly higher satisfaction with the Komagome Pad. In test B, no adverse events were observed., Conclusions: A new deodorant pad for LABC demonstrated high safety and deodorant efficacy., Competing Interests: Competing interests: HI, MI, YT and MS are permanent employees of Kao Corporation. Other authors have no conflict of interest with this article. Kao Corporation was involved in the preparation of this article in terms of odour collection, analysis and statistical interpretation of the data., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The efficacy of endovascular therapy (EVT) in patients with large ischemic core has been reported, but it remains unclear whether IV alteplase (IVT) has beneficial effects in addition to EVT in such patients. We evaluated the efficacy and safety of EVT with or without IVT., Methods: The RESCUE-Japan LIMIT was an open-label, prospective, multicenter, randomized clinical trial to evaluate the efficacy and safety of EVT in stroke patients with large ischemic core, defined as Alberta Stroke Program Early CT Score (ASPECTS) 3-5. This subanalysis evaluated the differences in the effects of EVT with medical care (EVT group) compared with medical care alone (No-EVT group) between those who received IVT (IVT stratum) and those who did not (No-IVT stratum) before EVT., Results: Among 202 enrolled patients, 147 (73%) did not receive IVT. In the No-IVT stratum, the modified Rankin Scale (mRS) score of 0-3 at 90 days was significantly higher in the EVT group than in the No-EVT group (31.1% vs 12.3%, OR 3.21 (95% CI 1.37 to 7.53)). In the IVT stratum, the mRS score of 0-3 was 30.8% in the EVT group and 13.8% in the No-EVT group (OR 2.78 (95% CI 0.72 to 10.7)) (interaction p=0.77). The incidence of symptomatic intracranial hemorrhage was not different between the two groups in the No-IVT stratum (OR 1.20 (95% CI 0.35 to 4.12)), but it was significantly higher in the EVT group than in the No-EVT group in the IVT stratum (11.5% vs 0%, p=0.03)., Conclusions: There was no difference in efficacy of EVT with or without IVT, while IVT before EVT might increase symptomatic intracranial hemorrhage in patients with large ischemic core., Trial Registration Information: NCT03702413., Competing Interests: Competing interests: SS reports lecturer fees from Medtronic, Kaneka, Stryker, Daiichi Sankyo, Asahi-Intec, Ezai, Bayer, Abbot Medical, Medico’s Hirata and Johnson and Johnson. KU reports lecturer fees from Daiichi Sankyo, Bristol-Myers Squibb, Stryker and Medtronic. SY reports research grants from Stryker, Siemens Healthineers, Bristol-Myers Squibb, Sanofi, Eisai, Daiichi Sankyo, Teijin Pharma, Chugai Pharmaceutical, HEALIOS, Asahi Kasei Medical, Kowa and CSL Behring; lecturer fees from Stryker, Medtronic, Johnson. NS reports research grants from Biomedical Solutions, Medtronic and Terumo; lecturer fees from Asahi-Intec, Biomedical Solutions, Medtronic, TG medical and Terumo; membership on the advisory boards for Johnson. HY discloses research grants from Bristol-Myers Squibb; lecturer fees from Stryker, Medtronic, Terumo, Johnson; membership of the advisory boards for Daiichi Sankyo. KT reports lecture fees from Otsuka, Novartis, Bayer, Daiichi Sankyo, Bristol Myers Squibb and Abbott Medical. YuM reports lecturer fees from Medtronic, Stryker, Terumo, Johnson. YaM reports royalty from Sumitomo Bakelite and lecturer fees from Kaneka, Medico’s Hirata, Fuji Systems, GE Healthcare, Otsuka, Takeda, Century Medical, Terumo, Medtronic and Stryker. KK reports research grants from CSL Behring, EP-CRSU, Amgen Astellas BioPharma, Alexion, Eisai, Kyowa Kirin, Daiichi Sankyo, Teijin, Medtronic, Bristol-Myers Squibb, Bayer, Boehringer-Ingelheim and Helios; lecturer fees from Daiichi Sankyo, Boehringer Ingelheim, Bristol-Myers Squibb, Bayer, Takeda, Medtronic, Otsuka, FP, Alexion, Nippon, Chugai, Kyowa Kirin, Abbott, Shire PLC, Sanofi, CSL Behring, Novartis, Toa Eiyo, Medico’s Hirata and Helios. MI reports lecturer fees from Bayer, Bristol-Myers Squibb, Boehringer Ingelheim and Medico’s Hirata. FS reports manuscript fees from Medicus Shuppan. MN reports lecturer fees from Stryker, Daiichi Sankyo, Biojen, Ezai, Bayer, Otuska, Pfyser, Kowa, Takeda and Abbot Medical. MU reports research grants from Pfizer and Alnylam; lecturer fees from Pfizer, Alnylam, Janssen, CSL Behring, Eisai, Takeda, Daiichi Sankyo, Otsuka, Kyowa Kirin, Chugai, Mitsubishi Tanabe, Alexion, Novartis and Agrenx. TM reports lecturer fees from AstraZeneca, Bristol-Myers Squibb, Daiichi Sankyo, Japan Lifeline, Kowa, Toray and Tsumura; manuscript fees from Bristol-Myers Squibb and Kowa; advisory board for Novartis and Teijin. RI has no conflicts of interest to report., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: We aimed to identify the large ischemic core (LIC) volume ranges in acute ischemic stroke patients that can benefit from mechanical thrombectomy (MT)., Methods: Consecutive patients within 24 hours of onset of anterior circulation ischemic stroke with large vessel occlusion and ischemic core volumes of 70-300 mL were included from our single-center prospective database from March 2014 to December 2019. Subjects were divided into three groups by baseline ischemic core volume (A: 70-100 mL; B: 101-130 mL; C: >130 mL). We compared modified Rankin Scale (mRS) score 0-2 at 3 months and parenchymal hematoma between patients receiving MT and standard medical treatment (SMT), and determined clinically treatable core volume ranges for MT., Results: Of 157 patients (86 women; median age, 81 years; median ischemic core volume, 123 mL), 49 patients underwent MT. In Group A (n=52), MT patients (n=31) showed a higher proportion of mRS 0-2 at 3 months (52% vs 5%, P<0.05) versus SMT, respectively. Group B (n=36) MT patients (n=14) also had a higher proportion of mRS 0-2 at 3 months (29% vs 9%, P=0.13) versus SMT, respectively. In Group C (n=69), only four patients received MT. The 95% confidence intervals for the probability of mRS 0-2 at 3 months in patients with MT (n=49) versus SMT (n=108) intersected at 120-130 mL., Conclusions: Ischemic core volumes between 70 and 100 mL may benefit from MT. The treatable upper core limit is approximately 120 mL in selected patients with LIC of 70-300 mL., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)