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Response teams, via the rapid response system (RRS), are activated when a patient's condition deteriorates; respiratory, neurological, or cardiac diseases are precursors to unexpected in-hospital cardiac arrest or death. In December 2019, our hospital introduced the RRS to reduce serious adverse events. Herein, we report a case where RRS was initiated twice for a patient who developed septic shock due to cervical necrotizing fasciitis and non-occlusive mesenteric ischemia (NOMI) after the septic shock. In August 2021, a male in his 70 s developed facial swelling, difficulty opening his mouth, and difficulty with oral intake. We observed necrotic skin on the face, soft tissue swelling in the neck, and hypotension. The RRS was initiated, and the patient was immediately admitted to the intensive care unit (ICU) where he was diagnosed with septic shock and necrotizing fasciitis of the neck. The patient underwent surgical necrotic lesion debridement and incisional drainage under general anesthesia. After weaning from shock, owing to his hypotensive and hemorrhagic status, the RRS was requested again. The patient was re-admitted to the ICU and diagnosed with NOMI. His general condition improved, and he was discharged on day 47. [ABSTRACT FROM AUTHOR]

The adaptive cardiac resynchronization therapy (aCRT) algorithm enables synchronized left ventricular pacing (sLVP) to achieve fusion with intrinsic right ventricular activation. Although sLVP presents benefits over biventricular pacing, the adequate sLVP rate for better clinical outcomes remains unclear. We aimed to assess the association between sLVP rates and clinical outcomes. Our study cohort included 271 consecutive patients, who underwent CRT implantation between April 2016 and August 2021. We evaluated 63 patients on whom we applied the aCRT algorithm [48 men, mean age: 64 ± 14 years; median follow-up period: 316 days (interquartile range: 212–809 days)]. At the 6-month follow-up after CRT implantation, the frequency of CRT responders was 71 % (n = 45). The sLVP rate was significantly higher in responders than in non-responders (75 ± 30 % vs. 47 ± 40 %, p = 0.003). Receiver operating characteristics curve analysis revealed that the optimal cut-off value during the sLVP rate was 59.4 % for the prediction of CRT responders (area under the curve, 0.70; sensitivity, 80 %; specificity, 61 %; positive predictive value, 84 %; and negative predictive value, 55 %). Kaplan–Meier analysis demonstrated that the higher-sLVP group (sLVP ≧59.4 %, n = 43) had a better prognosis (cardiac death and heart failure hospitalization) than the lower-sLVP group (sLVP <59.4 %, n = 20) (log-rank p < 0.001). Multivariate Cox hazard analysis revealed that a higher sLVP rate was associated with a good prognosis (p < 0.001). sLVP was associated with CRT response, and a higher sLVP rate (≧59.4 %) was important for good prognosis in patients with aCRT. [Display omitted] • Synchronized left ventricular pacing (sLVP) rate was associated with improved cardiac function after cardiac resynchronization therapy (CRT) implantation • High sLVP rates were associated with better clinical outcomes • High sLVP rates were associated with a lower risk of cardiac death • sLVP ≧59.4 % was a significant predictor of CRT responders and better clinical outcomes [ABSTRACT FROM AUTHOR]

Osteoma is a benign neoplasm composed of mature bone and is limited almost exclusively to the craniofacial bones. Osteoma of the coronoid process is very rare. We encountered a 35-year-old woman who noticed right cheek pain when opening her mouth. She was referred to our hospital in August 2021 for the further evaluation and treatment of radio-opacity of the right mandibular coronoid process. She had no relevant medical history, family history, or history of oral parafunction. Initial extra- and intraoral clinical examinations revealed no definite swelling and no limitation of joint motion. However, the maximum unassisted mouth opening was 37 mm, and she experienced pain in the medial mandibular ramus at mouth opening. After this discomfort she had been pain-free for 15 years. Panoramic radiography revealed mushroom-shaped radiopacity on the right-side mandibular coronoid process which had increased in size compared to 15 years earlier. Computed tomography showed a bone-like lesion on the right mandibular coronoid process measuring 28 × 18 × 15 mm, with lesion-shaped right skull base bone resorption. The clinical diagnosis was a benign osseous neoplasm of the coronoid process (right side). The lesion was excised intraorally under general anesthesia; the pathological diagnosis was compact bone osteoma. The postoperative course was uneventful. The patient was then able to open her mouth to 40 mm and her right cheek pain at mouth-opening had disappeared. There has been no recurrence as of 2 years post-surgery. [ABSTRACT FROM AUTHOR]

Various treatment approaches for atrial fibrillation (AF) have demonstrated improved health status, yet the significance of these therapeutic interventions in individual patients remains unclear. This study aimed to evaluate health status changes in patients with early AF, focusing on those who experience clinically significant deterioration after treatment initiation. We analyzed data from a multicenter, prospective registry of newly diagnosed patients with AF. One-year changes in health status across different treatment strategies were assessed by the Atrial Fibrillation Effect on QualiTy-of-life Overall Summary (AFEQT-OS) score. Clinically relevant deterioration and improvement in health status were defined as ≥5-point decrease and increase in AFEQT-OS score, respectively; no change was −5 to 5 points. Overall, 1960 patients with AF were evaluated. Mean AFEQT-OS scores at baseline and 1-year follow-up were 76.7 ± 17.7 and 85.4 ± 14.8, respectively. Although most patients (53.9%) experienced clinically important improvement, a considerable proportion had no change (28.7%) or deterioration (17.4%) in their health status. Proportions of patients with no change or deterioration varied by treatment strategy: 59.9%, 53.9%, and 32.0% in rate control, antiarrhythmic drug, and catheter ablation groups, respectively. The multivariable model identified older age, female sex, heart failure, coronary artery disease, and higher baseline AFEQT-OS score as independent predictors of worsening health status, regardless of treatment strategy. Many patients with early AF experience worsening or no change in health status irrespective of treatment strategy. Standardizing patients' health status assessment, especially for patients with comorbidities, may aid in patients' selection and their outcomes. [Display omitted] [ABSTRACT FROM AUTHOR]

To explore the appropriate dissection extent for cN1 oral cancer and to summarize neck treatment outcomes. The cases of a series of oral squamous cell carcinoma (OSCC) patients with cN1, who underwent radical resection of the primary site and neck dissection (I-V) as the initial treatment at our institution. The distribution of pathological cervical lymph node metastases was analyzed, and the overall survival (OS), disease- specific survival (DSS) and regional control rate were estimated by the Kaplan–Meier method. Pathological positive cervical lymph nodes were seen in 19 of the 57 patients. Eleven patients had one positive lymph node (pN1), whereas eight patients had multiple positive lymph nodes (pN2b). The most distal cervical metastasis was at level Ⅰ or Ⅱ in 17 cases, at level Ⅲ in one case, and at level IV in one case. There was no patient with cervical metastasis at level Ⅴ. The 5-year OS was 79.9%, the 5-year DSS was 85.3%, and the 5-year regional control rate was 87.5%. In conclusion, of the 57 patients diagnosed as cN1 oral cancer, there was no patient with cervical metastasis at level Ⅴ, suggesting that level V dissection can be omitted. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis aimed to compare the effectiveness of selective neck dissection (SND) and comprehensive neck dissection (CND) in patients with oral squamous cell carcinoma N1 (Level I). Randomized controlled trials and prospective and retrospective non-randomized clinical studies were selected and evaluated for the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The statistical analysis was performed using Review Manager 5.4 software. We included one observational study. The analysis revealed no difference in survival rates (overall survival, disease-specific survival, and regional control) between SND and CND for oral squamous cell carcinoma N1 (level I) cases. In the included study, the risk of bias was high, total sample size was small, and certainty of evidence was rated as "very low.". This systematic review and analysis suggested no difference in effectiveness between SND and CND; however, a high certainty of evidence could not be determined. Such evidence needs to be established through future systematic reviews, including randomized controlled trials with larger sample sizes. [ABSTRACT FROM AUTHOR]

To identify factors influencing the better and worse changes in the Western Ontario Rotator Cuff Index of patients undergoing conservative treatment for supraspinatus tendon tear. The study included 30 patients with supraspinatus tendon tear who underwent conservative treatment. The average duration of intervention was 35.4 days. The Western Ontario Rotator Cuff Index, shoulder range of motion, isometric muscle strength, supraspinatus tendon thickness, thickness of the supraspinatus, infraspinatus, and teres minor muscles, and acromiohumeral interval were assessed before and after the intervention. In the statistical analyses, change in the Western Ontario Rotator Cuff Index was the dependent variable, and the amount of change in each measurement variable before and after the intervention was the independent variable. The average Western Ontario Rotator Cuff Index improved from 1067 at pre-treatment to 997 at post-treatment, but without a significant difference (p = 0.29). A multiple regression analysis revealed that supraspinatus tendon thickness and muscle strength in shoulder external rotation at 90° scaption had a significant effect on the change in the Western Ontario Rotator Cuff Index (R2 = 0.44, p < 0.01). Supraspinatus tendon thickness and muscle strength in shoulder external rotation at 90° scaption were important factors for the Western Ontario Rotator Cuff Index score in the early stages of conservative treatment for patients with supraspinatus tendon tear. CLINICAL RELEVANCE. • The study aimed to identify the factors influencing better and worse clinical outcomes in patients with supraspinatus tear undergoing conservative treatment using multiple regression analysis of changes in physical parameters and medical information before and after the treatment. • The clinical outcomes correlated with supraspinatus tendon thickness and muscle strength in shoulder external rotation at 90° scaption for patients with supraspinatus tear. [ABSTRACT FROM AUTHOR]

Atrial amyloidosis is primarily caused by atrial natriuretic peptide (ANP) amyloid deposition. The main precursor protein causing cardiac amyloidosis is transthyretin (TTR), also known as TTR amyloid cardiomyopathy (ATTR-CM). A 73-year-old man, who presented with external dyspnea, was diagnosed with decompensated heart failure due to atrial fibrillation and severe mitral regurgitation. Left ventricular hypertrophy and elevated levels of high-sensitivity cardiac troponin T indicated cardiac amyloidosis. 99mtechnetium pyrophosphate scintigraphy findings and cardiac magnetic resonance imaging in the absence of monoclonal proteins were consistent with those of ATTR-CM. The patient underwent mitral valve repair, a maze procedure, and left atrial appendage (LAA) excision. While the histological analysis of the sampled left ventricular tissue led to diagnosis of ATTR-CM, the histological analysis revealed the coexistence of ANP and TTR amyloid deposition in the resected LAA. We report a case of ATTR-CM in which TTR and ANP amyloid deposition coexisted in the surgically resected LAA, indicating that both TTR and ANP amyloid correlate with atrial amyloidosis development in ATTR-CM. Atrial natriuretic peptide (ANP) and transthyretin (TTR) amyloids can coexist in the same atrium. Not only TTR amyloids but also ANP amyloids can be correlated with the development of atrial amyloidosis in TTR amyloid cardiomyopathy with subsequent increased risk of atrial fibrillation. [ABSTRACT FROM AUTHOR]

Cardiac resynchronization therapy (CRT) is effective for patients with heart failure with QRS duration (QRSd) ≥150 ms. However, its beneficial effect seems to be limited for those with "mid-range" QRSd (120–149 ms). Recent studies have demonstrated that modifying QRSd to left ventricular end-diastolic volume (LVEDV)—modified QRSd—improves the prediction of clinical outcomes of CRT. The purpose of this study was to investigate the clinical impact of the modified QRSd on the efficacy of CRT in patients with "mid-range" QRSd. We conducted a retrospective, multicenter, observational study, with heart failure hospitalization (HFH) after CRT as the primary endpoint. Modified QRSd is defined as QRSd divided by LVEDV, determined through the Teichholtz method of echocardiography. Among the 506 consecutive patients considered, 119 (mean age 61 ± 15 years; 80% male, QRSd 135 ± 9 ms) with a "mid-range" QRSd who underwent de novo CRT device implantation were included for analysis. During median follow-up of 878 days [interquartile range 381–1663 days], HFH occurred in 45 patients (37%). Fine-Gray analysis revealed modified QRSd was an independent predictor of HFH (hazard ratio [HR] 0.97; 95% confidence interval [CI] 0.96–0.99; P <.01). Receiver operating characteristic curve analysis revealed a cutoff value of 0.65 ms/mL for the modified QRSd in predicting HFH. Patients above the threshold exhibited a significantly lower incidence of HFH than patients below the threshold (HR 0.46; 95% CI 0.25–0.86; P =.01). Modified QRSd can effectively predict the efficacy of CRT in patients with a "mid-range" QRSd. [Display omitted] [ABSTRACT FROM AUTHOR]

To investigate and compare the pathologies and clinical outcomes of patients with traumatic anterior shoulder instability who underwent arthroscopic stabilization at 40 years or older between shoulders with initial dislocation before age 40 years and at 40 years or after. Shoulders that underwent arthroscopic stabilization for recurrent traumatic anterior shoulder instability at 40 years or older with a minimum of 2-year follow-up were included. The subjects were divided into 2 groups according to age at initial dislocation after propensity score matching to reduce potential bias: younger than 40 years (group 1) and 40 years or older (group 2). Radiographic findings, pathologies, clinical outcomes, and complications were compared between the groups. Group 1 included 56 shoulders in 56 patients (26 men and 30 women) with a mean age of 51 years (range, 40-77 years). Group 2 included 28 shoulders in 28 patients (13 men and 15 women) with a mean age of 51 years (range, 40-77 years). Glenoid bone loss was greater in group 1 than in group 2 (P =.004). Rotator cuff tears were more frequently observed in group 2 than in group 1 (P <.001). Both groups showed significant improvement in the West Ontario Shoulder Instability Index score (P <.001 for each) and flexion (P <.001 for each). The recurrence rate was 4% in group 1 and 7% in group 2. Rotator cuff tears are significantly more frequent in recurrent shoulder instability patients with initial dislocation at age 40 or older. Arthroscopic stabilization yielded a low recurrence rate and favorable outcomes with a good return-to-sport rate in patients 40 years or older. Level III, retrospective comparative prognostic trial. [ABSTRACT FROM AUTHOR]

Primary cardiac lymphoma is an extremely rare disease, with the most common being diffuse large B-cell lymphoma (DLBCL). Fibrin-associated diffuse large B-cell lymphoma (FA-DLBCL) has been classified as a rare and unusual type of lymphoma and is included in the category of DLBCL associated with chronic inflammation (DLBCL-CI). In this study, we report a case of FA-DLBCL in the aortic valve and ascending aorta of a 51-year-old-woman. In this rare case of FA-DLBCL in the aortic valve and ascending aorta, we highlight the features of FA-DLBCL and its differences from DLBCL-CI. [ABSTRACT FROM AUTHOR]

An implantable loop recorder (ILR) is now widely used for differential diagnosis of unexplained syncope or recurrent syncope with unknown causes. In the inherited arrhythmia syndromes, ILR may be useful for management of the therapeutic strategies; however, there is no obvious evidence to uncover arrhythmic syncope by ILR in long-QT syndrome (LQTS) patients. Here we experienced a 19-year-old female patient with LQTS type 1 who had recurrent syncope even after beta-blocker therapy but no arrhythmias were documented, and some episodes might be due to non-cardiogenic causes. Implantable cardioverter defibrillator (ICD) therapy was also recommended; however, she could not accept ICD but was implanted with ILR for further continuous monitoring. Two years later, she suffered syncope during a brief run, and ILR recorded an electrocardiogram at that moment. Thus a marked QT interval prolongation as well as T-wave alternance resulting in development of torsades de pointes could be detected. Although ILR is just a diagnostic tool but does not prevent sudden cardiac death, most arrhythmic events in LQTS are transient and sometimes hard to be diagnosed as arrhythmic syncope. ILR may provide direct supportive evidence to select the optimal therapeutic strategy in cases where syncope is difficult to diagnose. Long-QT syndrome (LQTS) patients often suffer recurrent syncope even after beta-blocker therapy, but torsades de pointes (TdP) is not always detected by standard 12‑lead electrocardiogram or Holter monitoring, and some syncope might be non-cardiogenic. In this case, implantable loop recorder (ILR) documented the evidence of QT interval prolongation and beat-by-beat T-wave alternance subsequent TdP. Thus, ILR may provide useful evidence for the optimal treatment strategy in LQTS cases where syncope is difficult to diagnose. [ABSTRACT FROM AUTHOR]

Myelodysplastic syndromes (MDS) are neoplastic diseases characterized by thrombocytopenia, morphological dysplasia, inadequate hematopoiesis in the bone marrow, and risk of transformation to acute leukemia. These diseases, when developed as a result of chemo- or radiotherapy for malignant tumors, are called treatment-related MDS (t-MDS). We report a case of t-MDS after chemotherapy for squamous cell carcinoma. The patient was a 56-year-old man with T4aN2bM0 stage IVA squamous cell carcinoma of the mandibular gingiva and underwent resection and reconstruction after triple therapy with paclitaxel, carboplatin, and cetuximab. Since the pathological diagnosis showed no risk factors for recurrence or metastasis, postoperative treatment was not performed, and the patient was followed-up on an outpatient basis. Three years and three months after the completion of treatment, he was diagnosed with t-MDS after close examination due to thrombocytopenia. Induction therapy with azacitidine was started and cord blood transplantation was performed after 5 courses. The patient achieved good implantation, but was diagnosed with recurrence three months after transplantation and died. [ABSTRACT FROM AUTHOR]

• We report the first case of GGE combined with CPVT and RYR2 variant. • RYR2 variant may represent a novel neurocardiac calcium channelopathy. • Epilepsy complications may be considered in patients with CPVT and RYR2 variant. [ABSTRACT FROM AUTHOR]

Superior capsule reconstruction (SCR) was developed to improve shoulder function and alleviate pain in patients with primary irreparable rotator cuff tears. Although suitable clinical results of SCR have been reported, only a few studies have investigated the clinical outcomes of arthroscopic superior capsule reconstruction (ASCR) using tensor fascia at a minimum follow-up period of 2 years after surgery. Among 100 consecutive patients who underwent ASCR since April 2010, this retrospective cohort study included 49 patients with a Hamada classification of ≤3 who were available for at least 2-year follow-up after surgery. The mean follow-up period was 34.5 (24-74) months. We analyzed preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, University of California at Los Angeles (UCLA) shoulder scores, preoperative and postoperative active elevation angles, external and internal rotations with the arms in the anatomical position, manual muscle test (MMT) scores, preoperative and postoperative acromiohumeral distance (AHD), and cuff integrity on postoperative magnetic resonance imaging using the Hasegawa classification. We compared 27 pseudoparalyzed (elevation of <90°) shoulders with 22 nonpseudoparalyzed shoulders. We also evaluated the treatment of patients with subscapularis tendon tears and compared the outcomes of patients with good graft repair and those with graft retear. The JOA score, UCLA score, active elevation angle, internal and external rotation angles, and muscle strength (MMT) significantly improved at the time of investigation preoperatively and 2 years postoperatively. The mean AHD also improved from 5 ± 2.6 mm preoperatively to 9 ± 2.8 mm postoperatively. No significant difference in graft tear rate was observed between pseudoparalyzed shoulder and nonpseudoparalyzed shoulder groups. The subscapularis tendon was torn in 26 of 49 (53%) patients, and all patients underwent repair. The graft repair group showed a significant improvement in JOA scores, UCLA shoulder scores, joint range of motion, MMT, and AHD postoperatively, but not in internal rotation strength. In contrast, the graft tear group did not show any significant improvement. All patients could return to work, except for those performing heavy labor. Complications included graft tear in five patients, postoperative infection in two patients, and progressive postoperative arthropathic changes in one patient. Good clinical results of ASCR were obtained using tensor fascia lata at 2 years after surgery, with few complications and low graft tear rates. [ABSTRACT FROM AUTHOR]

Muscle quantification using chest computed tomography (CT) is a useful prognostic biomarker for coronavirus disease 2019 (COVID-19). However, no studies have evaluated the clinical course through comprehensive assessment of the pectoralis and erector spinae muscles. Therefore, we compared the impact of the areas and densities of these muscles on COVID-19 infection outcome. This multicenter retrospective cohort study was conducted by the COVID-19 Task Force. A total of 1410 patients with COVID-19 were included, and data on the area and density of the pectoralis and erector spinae muscles on chest CT were collected. The impact of each muscle parameter on the clinical outcome of COVID-19 was stratified according to sex. The primary outcome was the percentage of patients with severe disease, including those requiring oxygen supplementation and those who died. Additionally, 167 patients were followed up for changes in muscle parameters at three months and for the clinical characteristics in case of reduced CT density. For both muscles, low density rather than muscle area was associated with COVID-19 severity. Regardless of sex, lower erector spinae muscle density was associated with more severe disease than pectoralis muscle density. The muscles were divided into two groups using the receiver operating characteristic curve of CT density, and the population was classified into four (Group A: high CT density for both muscles, Group B: low CT density for pectoralis and high for erector spinae muscle. Group C: high CT density for pectoralis and low for erector spinae muscle, Group D: low CT density for both muscles). In univariate analysis, Group D patients exhibited worse outcomes than Group A (OR: 2.96, 95% CI: 2.03–4.34 in men; OR: 3.02, 95% CI: 2.66–10.4 in women). Multivariate analysis revealed that men in Group D had a significantly more severe prognosis than those in Group A (OR: 1.82, 95% CI: 1.16–2.87). Moreover, Group D patients tended to have the highest incidence of other complications due to secondary infections and acute kidney injury during the clinical course. Longitudinal analysis of both muscle densities over three months revealed that patients with decreased muscle density over time were more likely to have severe cases than those who did not. Muscle density, rather than muscle area, predicts the clinical outcomes of COVID-19. Integrated assessment of pectoralis and erector spinae muscle densities demonstrated higher accuracy in predicting the clinical course of COVID-19 than individual assessments. [ABSTRACT FROM AUTHOR]

[Display omitted] [ABSTRACT FROM AUTHOR]

Previous research has shown that low birth weight is one of the risk factors for esophageal atresia. However, there remains a paucity of evidence on the timing and the treatment method. Data were collected using a multi-institutional observational study in 11 hospitals that performed surgeries on esophageal atresia babies whose birth weights were ≤1500 g from 2001 to 2020. Of the 46 patients analyzed, median birth weight was 1233 (IQR 1042–1412) g. Within 46 cases, 19 (41%) underwent definitive esophageal anastomosis at the median of age in 8 (IQR 2–101) days. Thirteen out of 19 experienced either closure of tracheoesophageal fistula, gastrostomy, or esophageal banding at the first operation, followed by esophageal anastomosis. Seven infants, including four cases of <1000 g, underwent anastomosis after one month of age to wait for weight gain (variously 2–3000 g). Twenty-one out of 27 infants (78%) who did not receive anastomosis died within one year of age, including 21 (78 %) with major cardiac anomalies and 24 (89%) with severe chromosomal anomalies (trisomy 18). Six survivors in this group, all with trisomy 18, lived with palliative surgical treatments. In our study, the definitive esophageal anastomosis was effective either at the first operation or as a later treatment after gaining weight. Although having severe anomalies, some infants receive palliative surgical treatments, and the next surgery was considered depending on their condition. II. • There has been little agreement on the optimal timing and method for low birth weight esophageal atresia. • 41% underwent definitive esophageal anastomosis with a good prognosis, including 13 receiving staged surgeries. • Patients with major cardiac anomaly or trisomy 18 could live long with anastomosis or palliative surgical treatments. [ABSTRACT FROM AUTHOR]

Conflicting data are available on whether ventricular arrhythmia (VA) or shock therapy increases mortality. Although cardiac resynchronization therapy (CRT) reduces the risk of VA, little is known about the prognostic value of VA among patients with CRT devices. The purpose of this study was to evaluate the implications of VA as a prognostic marker for CRT. We investigated 330 CRT patients within 1 year after CRT device implantation. The primary endpoint was the composite endpoint of all-cause death or hospitalization for heart failure. Forty-three patients had VA events. These patients had a significantly higher risk of the primary endpoint, even among CRT responders (P =.009). Fast VA compared to slow VA was associated with an increased risk of the primary endpoint (hazard ratio [HR] 2.14; 95% confidence interval [CI] 1.06–4.34; P =.035). Shock therapy was not associated with a primary endpoint (shock therapy vs antitachycardia pacing: HR 1.49; 95% CI 0.73–3.03; P =.269). The patients with VA had a lower prevalence of response to CRT (23 [53%] vs 202 [70%]; P =.031) and longer left ventricular paced conduction time (174 ± 23 ms vs 143 ± 36 ms; P =.003) than the patients without VA. VA occurrence within 1 year was related to paced electrical delay and poor response to CRT. VA could be associated with poor prognosis among CRT patients. [Display omitted] [ABSTRACT FROM AUTHOR]

Drowning is a comprehensive and exclusive diagnosis at autopsy. Autopsy findings such as pleural effusion and waterlogged lungs contribute to the diagnosis. Herein, we aim to reveal the practical usefulness and postmortem changes of the maxillary sinus fluid volume to diagnose drowning. We evaluated 52 drowning and 59 nondrowning cases. The maxillary sinus fluid volume was measured using a computed tomography (CT) scan, and pleural effusion volume and lung weight were manually measured at autopsy. The utility of these three indices for diagnosing drowning and its postmortem changes was evaluated. The maxillary sinus fluid volume was significantly higher in drowning cases than in other external causes and cardiovascular death cases. Receiver operating characteristic curve analysis revealed that a total maxillary sinus fluid volume >1.04 mL more usefully indicated drowning (odds ratio, 8.19) than a total pleural effusion volume >175 mL (odds ratio, 7.23) and a total lung weight >829 g (odds ratio, 2.29). The combination of maxillary sinus fluid volume and pleural effusion volume more effectively predicted drowning than one index alone. Moreover, the maxillary sinus fluid volume was less influenced by the postmortem interval than the other two indices up to a week after death. Maxillary sinus fluid volume can be more useful than pleural effusion volume and lung weight with higher sensitivity and odds ratio for diagnosing drowning. Fluid accumulation in both the maxillary sinuses strongly predicts drowning in the postmortem imaging. [ABSTRACT FROM AUTHOR]

Shoulder injuries in baseball players cause excessive shoulder load during pitching and scapular dyskinesis (SD). However, the characteristics of pitching kinetics in the shoulder joint with SD are unclear. This study aimed to investigate the effect of SD on pitching kinetics in the shoulder joint of baseball players. Seventy-two college and independent league baseball players participated in the study. The pitching motion was measured using an 18–camera motion-capture system. SD was classified into four types (I–IV) using the scapular dyskinesis test (SDT). The pitching kinetics data were analyzed. The agreement of SD in this study was 56/72 (77.8%). SD were classified into 31 abnormal group (type I–Ⅲ) and 25 control group (type Ⅳ). Three participants with measurement failure during the pitching motion analysis were excluded from the analysis. The abnormal group showed a larger maximum value of the glenohumeral normalized anterior joint force than the control group. These results suggest that an increase in GH anterior force during pitching causes an excessive increase in external rotation of the GH with an insufficient posterior tilt of the scapula with SD. Therefore, baseball pitching with SD may involve shoulder injuries owing to excessive shoulder load during pitching. • Pitching kinetic were compared in the abnormal and control groups. • Glenohumeral joint (GH) anterior force was larger in the abnormal group. • Scapular dyskinesis test (SDT) can predict an increase of GH anterior force. • Our results can provide fundamental knowledge for throwing injuries mechanics. [ABSTRACT FROM AUTHOR]

Alterations in neurotransmission, vasculogenesis, and osteogenesis pathways that may play pivotal roles in age-related changes in the temporomandibular joint (TMJ) are poorly understood. This study aimed to measure the associations between gene and protein profiles in senescence-accelerated prone 8 (SAMP8) mice. The investigators designed and used 3 groups of 2 mouse models: 1) early aging SAMP8 at 24 weeks of age and control SAMR1 at 12 and 24 weeks (each stage n = 12). The independent variable was investigated using 3 mouse models: an early aging mouse model and a control mouse model (12 and 24 weeks). The primary outcome variables were CGRP, VEGF-A, CD31, LYVE-1, osteocalcin, osteopontin, type I and II collagen, and MMP-2. The secondary outcome variables were histological characteristics. Not applicable. The gene and protein expression profiles of neurotransmitters, vasculogenesis, and osteogenesis were identified by quantitative real-time polymerase chain reaction and dot blot analysis, respectively. The cellular localization of these events was verified by in situ hybridization and immunohistochemistry. Bivariate statistics were computed for each of the outcome variables. Statistical significance was set to a P value <.05. The expression of CGRP mRNA in the bony mandibular condyle (BMC) of SAMP8 mice (SAMP8, 3.3 ± 0.39 vs SAMR1, 0.001 ± 0.0001) was high at 24 weeks of age (24 weeks) (P <.001). Higher numbers of cells positive percentage for CGRP (MF, SAMP8, 28.67 ± 1.60 vs SAMR 1, 6.36 ± 1.10; CMC, 27.5 ± 2.12 vs 9.00 ± 1.21; BMC, 31.31 ± 2.81 vs 7.85 ± 1.14) and VEGF-A (MF, 34.43 ± 2.45 vs 14.01 ± 1.28; MD, 32.69 ± 1.86 vs 8.00 ± 0.91; CMC, 36.60 ± 2.05 vs 14.19 ± 1.25 BMC 36.49 vs 12.59 ± 1.41) antibodies were found in the 24 weeks TMJ (P <.01). The neurotransmitter, vasculogenesis, and osteogenesis pathways are associated with TMJ aging in the SAMP8 mouse model. In the future, the SAMP8 mouse model may prove to be a robust model for identifying molecular and biochemical events underlying the effects of feeding, occlusal changes, and tooth loss in the aging TMJ. [ABSTRACT FROM AUTHOR]

Several guidelines recommend the measurement of N-terminal pro-B-type natriuretic peptide (NT-proBNP) to diagnose heart failure (HF); however, no screening criteria for measuring NT-proBNP in asymptomatic patients exist. We develop/validate a clinical prediction model for elevated NT-proBNP to support clinical outpatient decision-making. In this multicenter cohort study, we used a derivation cohort (24 facilities) from 2017 to 2021 and a validation cohort at one facility from 2020 to 2021. Patients were aged ≥65 years with at least one risk factor of HF. The primary endpoint was NT-proBNP ≥125 pg/mL. The final model was selected using backward stepwise logistic regression analysis. Diagnostic performance was evaluated for sensitivity and specificity, the area under the curve (AUC), and calibration. In total, 1645 patients (derivation cohort, n = 837; validation cohort, n = 808) were included, of whom 378 (23.0 %) had NT-proBNP ≥125 pg/mL. Body mass index, age, systolic blood pressure, estimated glomerular filtration rate, cardiothoracic ratio, and heart disease were used as predictors and aggregated into a BASE-CH score of 0–11 points. Internal validation resulted in an AUC of 0.74 and an external validation AUC of 0.70. Based on available clinical and laboratory variables, we developed and validated a new risk score to predict NT-proBNP ≥125 pg/mL in patients at risk for HF or with pre-HF. [Display omitted] • We developed a clinical prediction model for elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP). • NT-proBNP ≥125 pg/mL can predict those at risk for heart failure (HF) or with pre-HF. • BASE-CH score was used as a predictor for NT-proBNP ≥125 pg/mL. • This risk score may help in the early diagnosis of pre-HF. [ABSTRACT FROM AUTHOR]

Nearly half the patients identified as having health care facility-onset Clostridioides difficile infections on a hematopoietic cell transplant unit had an alternative clinical explanation for diarrhea, including conditioning regimen toxicity or other medications. Our study supports that targeted diagnostic stewardship interventions should be explored and that additional risk-adjustments considered for facilities with oncology hematopoietic cell transplant wards in the National Healthcare Safety Network LabID Clostridioides difficile infection standardized infection ratio model. • The NHSN definition for HO-CDI lacks clinical review. • Nearly half of HO-CDI cases on HCT unit had an alternative explanation for diarrhea. • Targeted diagnostic stewardship interventions should be explored for HCT patients. • NHSN should consider additional risk adjustment for HCT units for CDI SIR model. [ABSTRACT FROM AUTHOR]

To evaluate range of motion, muscle strength, clinical outcomes, and radiographic results of the extreme medialized procedure on rotator cuff tears that were initially irreparable. From arthroscopic rotator cuff repair cases performed at our institution (June 2017 and August 2020), we retrospectively reviewed cases in which the rotator cuff was (1) unable to be withdrawn to the greater tuberosity, (2) repaired using the extreme medialized procedure, and (3) followed up for a minimum of 2 years. Patients with a history of previous surgery were excluded. Preoperative and postoperative scores were used for clinical evaluation. Imaging evaluation used 2-year postoperative magnetic resonance (MR) images. Sixty-four patients met the criteria; mean age 68.2 ± 7.9 (range 51–82) years; mean follow-up period 26 ± 2 (24-37) months. Tear size: 45 ± 7.1 (30-70) mm in medial to lateral diameters, 40 ± 9.3 (30-60) mm in anteroposterior diameter; suture anchor number: 5.5 ± 1.2 (4-8). The visual analog scale score (50.7 to 11.8), the University of California, Los Angeles, score (12 to 31), constant score (45 to 31), and the American Shoulder and Elbow Surgeons score (53 to 31) at the final follow-up improved compared with preoperative values (all P <.0001). Preoperative and postoperative changes in range of motion also showed improvement in anterior elevation (107° to 151°, P <.0001), abduction (100° to 154°, P <.0001), external rotation (41° to 47°, P =.0238), and internal rotation (L1 to Th10, P <.0001). Muscle strength was also improved in abduction (from 1.9 kg to 5.0 kg, P <.0001) and external rotation (from 3.5 kg to 7.7 kg, P <.0001). MR imaging evaluation revealed 2 cases (3.1%) of retears that fell into type 4 Sugaya classification. Extremely medialized repair of large and massive tears not able to be repaired using conventional techniques led to improved clinical outcomes compared to preoperative conditions. Level IV, therapeutic case series. [ABSTRACT FROM AUTHOR]

High percent ventricular pacing maximizes cardiac resynchronization therapy (CRT) response. An effective CRT algorithm classifies each left ventricular (LV) pace as effective or ineffective on the basis of the detection of QS or QS-r morphology on the electrogram; however, the relationship between percent effective CRT pacing (%e-CRT) and responses is unclear. We aimed to clarify the association between %e-CRT and clinical outcomes. Of the 136 consecutive CRT patients, 49 using the adaptive and effective CRT algorithm with percent ventricular pacing > 90% were evaluated. The primary and secondary outcomes were heart failure (HF) hospitalization and prevalence of CRT responders, defined as patients with an improvement in LV ejection fraction of ≥10% or a reduction in LV end-systolic volume of ≥15% after CRT device implantation, respectively. We divided the patients into the effective group (n = 25) and the less effective group (n = 24) by the median value of %e-CRT (97.4% [93.7%–98.3%]). During the median follow-up period of 507 days (interquartile range 335–730 days), the effective group had a significantly lower risk of HF hospitalization than the less effective group as revealed by Kaplan-Meier analysis (log-rank, P =.016). Univariate analysis revealed %e-CRT ≥ 97.4% (hazard ratio 0.12; 95% confidence interval 0.01–0.95; P =.045) as a predictor of HF hospitalization. The effective group had a higher prevalence of CRT responders than the less effective group (23 [92%] vs 9 [38%]; P <.001). Univariate analysis revealed that %e-CRT ≥ 97.4% (odds ratio 19.20; 95% confidence interval 3.63–101.00; P <.001) was a predictor of CRT response. High %e-CRT is associated with high CRT responder prevalence and low HF hospitalization risk. [Display omitted] [ABSTRACT FROM AUTHOR]

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) plays an important role in patients with massive pulmonary embolism (PE)-related cardiac arrest. A 47-year-old healthy Japanese woman was brought to the emergency department because of shock. The patient suddenly collapsed due to cardiac arrest in an ambulance. The patient was diagnosed with PE on transthoracic echocardiography during cardiopulmonary resuscitation (CPR). Emergency VA-ECMO cannulation was performed percutaneously. Although VA-ECMO support was initiated, the return cannula flow could not be pumped because of the high resistance. Circulation support with VA-ECMO was discontinued. Subsequently, pulmonary angiography under CPR revealed numerous thrombi in the bilateral pulmonary arteries, and aspiration thrombectomy and catheter fragmentation were performed. The patient achieved spontaneous recovery of circulation after successful catheter fragmentation. After the procedure to investigate the cause of VA-ECMO failure, whole-body computed tomography showed a large ovarian tumor and compression of the femoral artery and abdominal aorta. The patient died of multiple organ failure due to hypoxic encephalopathy. Undiagnosed gynecological tumors often cause fulminant PE and may also cause the failure of VA-ECMO due to vascular compression. Alternative cannulation sites and prior thrombolysis should be immediately considered. The complexity of PE management necessitates a well-trained PE response team. Large gynecological tumors may cause pulmonary embolism-related cardiac arrest and consequent failure of venoarterial extracorporeal membrane oxygenation using the femoral artery approach due to vascular compression by the tumor. An adequate strategy should be considered to achieve immediate recovery of spontaneous circulation and circulation support as simultaneous systematic thrombolysis and an alternative central cannulation approach to protect against hypoxic organ damage. The complexity of pulmonary embolism (PE) management necessitates a well-trained PE response team. [ABSTRACT FROM AUTHOR]

Local triamcinolone (TA) injection is widely used to prevent stricture formation after endoscopic submucosal dissection (ESD). However, stricture develops in up to 45% of patients despite this prophylactic measure. We therefore conducted a single-center prospective study to identify predictors of stricture after esophageal ESD and local TA injection. Patients who underwent esophageal ESD and local TA injection and who were comprehensively assessed for lesion- and ESD-related factors were included in the study. Multivariate analyses were conducted to identify the predictors of stricture. A total of 203 patients were included in the analysis. Multivariate analysis identified residual mucosal width ≤5 mm (odds ratio [OR], 29.0; P <.0001) or 6 to 10 mm (OR, 3.7; P =.04), history of chemoradiotherapy (OR, 5.1; P =.045), and tumor in the cervical or upper thoracic esophagus (OR, 3.8; P =.018) as independent predictors of stricture. Based on the ORs of the predictors, patients were stratified into 2 groups according to stricture risk: patients in the high-risk group (residual mucosal width ≤5 mm or 6-10 mm with another predictor) had a stricture rate of 52.5% (31 of 59 cases), and patients in the low-risk group (residual mucosal width ≥11 mm or 6-10 mm without other predictors) had a stricture rate of 6.3% (9 of 144 cases). We identified predictors of stricture after ESD and local TA injection. Local TA injection prevented stricture formation after ESD in low-risk patients but was not sufficient to prevent stricture in high-risk patients. Additional interventions should thus be considered in high-risk patients. (University Hospital Medical Network Clinical Trials Registry number: UMIN 000028894.) [ABSTRACT FROM AUTHOR]

Bronchopleural fistula (BPF) is a critical complication that may progress to pneumonia and empyema, but optimal treatment remains uncertain. Our purpose was to develop a novel material for bronchial occlusion that can be used to treat BPF by blocking airflow and promoting wound healing. Sponges were prepared in concentrations of 25, 40, and 50 mg/dL of silk-elastin by hydrophobic processing. Five adult Beagle dogs underwent right anterior lobectomy, and 5 underwent left posterior lobectomy. Silk-elastin sponges were placed at bronchial stumps of 8 dogs, and silicone plugs were placed at the stumps of 2 dogs as a control. Postoperative complications were not observed, except in 1 dog in which the silicone plug had been placed and which had massive subcutaneous emphysema at 4 weeks after operation. Histologic examination revealed that stumps were covered with connective tissue and that there was more regeneration of airway epithelium in the silk-elastin sponge group than in the silicone plug group. There were increased numbers of myofibroblasts around the bronchial stump occluded by silk-elastin sponges at 2 weeks after placement, which completely disappeared after 2 months, during which abundant neovascularization occurred. We showed that silk-elastin sponges can manage and promote regeneration of bronchial epithelium. Our results demonstrate that bronchial occlusion with a silk-elastin sponge is a promising option for treatment of BPF. [Display omitted] [ABSTRACT FROM AUTHOR]

• Hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy may improve upper extremity function. • In this case, home-based HANDS therapy was administered to a patient with post-stroke upper extremity paralysis in the chronic phase, and upper limb function was improved. • Home-based rehabilitation encourages the use of the paralyzed upper extremity in daily activities. • The low-frequency HANDS therapy and the use of the affected hand was helpful in improving the function of the paralyzed upper extremity in this case. Although hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy may improve upper extremity functionality in patients with paralysis or paresis due to stroke, it is usually only provided in hospitals as a frequent intervention during the phase of early recovery in stroke. Home-based rehabilitation is limited by frequency and duration of visits. To investigate the effectiveness of low-frequency HANDS therapy using motor function assessment. Case report. We performed HANDS therapy for 1 month on the patient, who was a woman in her 70s with left-sided hemiplegia. It was initiated on day 183 post the onset of stroke. Movement and motor function were evaluated using the Fugl-Meyer Assessment upper-extremity (FMA-UE) motor items and the Motor Activity Log consisting of Amount of Use (MAL-AOU), as well as Quality of Movement (MAL-QOM) scales. This evaluation was performed before starting HANDS therapy and after its conclusion. Following HANDS therapy, there was improvement in the FMA-UE (21 points → 28 points), MAL-AOU (0.17 points → 0.33 points), and MAL-QOM (0.08 points → 0.33 points) scores when compared to the scores before therapy, and the patient was able to use both hands for activities of daily living (ADLs). Low-frequency HANDS therapy combined with encouragement to include the affected hand in ADLs may improve upper extremity function in cases of paralysis. [ABSTRACT FROM AUTHOR]

This paper summarizes current trends in the research and development of e-Mobility and energy coupled simulation to deal with electric vehicle integration into power systems, optimal charging infrastructure design, and regional energy and environmental impact assessments. Small trials and simulations were introduced as a case study. The car probe and floating population data are input into various electric vehicle dynamic models, in which variable vehicle speed and state-of-charge are precisely considered. Then, the synergic impacts on the mobility and energy sides are evaluated through co-simulation of the road traffic and distributed power system models. • Research trends of e-mobility and energy coupled simulation are reviewed. • Achievements of e-mobility trials and dynamic modeling are reported. • An aggregated cross-sectoral architecture of transportation and electricity networks is proposed. [ABSTRACT FROM AUTHOR]

Risk stratification is important in patients with acute heart failure (AHF), and a simple risk score that accurately predicts mortality is needed. The aim of this study is to develop a user-friendly risk-prediction model using a machine-learning method. A machine-learning-based risk model using least absolute shrinkage and selection operator (LASSO) regression was developed by identifying predictors of in-hospital mortality in the derivation cohort (REALITY-AHF), and its performance was externally validated in the validation cohort (NARA-HF) and compared with two pre-existing risk models: the Get With The Guidelines risk score incorporating brain natriuretic peptide and hypochloremia (GWTG-BNP-Cl-RS) and the acute decompensated heart failure national registry risk (ADHERE). In-hospital deaths in the derivation and validation cohorts were 76 (5.1 %) and 61 (4.9 %), respectively. The risk score comprised four variables (systolic blood pressure, blood urea nitrogen, serum chloride, and C-reactive protein) and was developed according to the results of the LASSO regression weighting the coefficient for selected variables using a logistic regression model (4 V-RS). Even though 4 V-RS comprised fewer variables, in the validation cohort, it showed a higher area under the receiver operating characteristic curve (AUC) than the ADHERE risk model (AUC, 0.783 vs. 0.740; p = 0.059) and a significant improvement in net reclassification (0.359; 95 % CI, 0.10–0.67; p = 0.006). 4 V-RS performed similarly to GWTG-BNP-Cl-RS in terms of discrimination (AUC, 0.783 vs. 0.759; p = 0.426) and net reclassification (0.176; 95 % CI, −0.08–0.43; p = 0.178). The 4 V-RS model comprising only four readily available data points at the time of admission performed similarly to the more complex pre-existing risk model in patients with AHF. [Display omitted] • A risk score to predict mortality in acute heart failure was developed. • The newly developed 4 V-RS comprises four readily available variables. • The 4 V-RS performs equally to the more complex pre-existing risk models. [ABSTRACT FROM AUTHOR]

High mortality in patients with acute coronary syndrome (ACS) without standard modifiable cardiovascular risk factors [SMuRFs (e.g. diabetes, hypertension, smoking, and dyslipidemia)] has been reported. However, details regarding their acute presentation and reasons for the excess risk remain unclear. Patient-level data were extracted from a multicenter procedure-based registry (KiCS-PCI). We analyzed consecutive patients with ACS who underwent de novo percutaneous coronary intervention (PCI) between 2009 and 2020. The primary outcome of interest was the in-hospital mortality. Among the 10,523 patients with ACS, 7775 met the inclusion criteria. Patients without SMuRFs who underwent PCI [ n = 529 (6.8 %)] were older [median 71 (IQR: 63–79) vs. 68 (59–76) years, p < 0.001] and more often presented with cardiogenic shock or cardiopulmonary arrest (14.6 % vs. 8.6 %, p < 0.001; 12.7 % vs. 5.3 %, p < 0.001, respectively). In patients with ST-elevation myocardial infarction (STEMI), median door-to-balloon time was significantly longer in SMuRF-less patients (90 min vs 82 min). In-hospital death was significantly higher in SMuRF-less patients [10.2 % vs. 4.1 %, p < 0.001, adjusted odds ratio, 1.81 (95%CI, 1.26–2.59); p = 0.001], whereas the rate of procedural complications showed no significant difference. When stratified by the ACS presentation pattern, the findings were consistent, although the association between SMuRF-less and the increased risk of in-hospital mortality was not statistically significant in patients with non-ST-elevation- (NSTE)-ACS. SMuRF-less ACS patients frequently presented with cardiopulmonary arrest and/or cardiogenic shock, leading to high in-hospital mortality. When stratified by the ACS presentation pattern, the association of SMuRF-less and the increased risk of mortality was more prominent in STEMI patients and it was not statistically significant in NSTE-ACS patients. Almost half of these patients had amendable left main trunk or left anterior descending artery disease and treating clinicians should be aware of this paradox to avoid the delay in treatment. [Display omitted] • SMuRF-less patients accounted for 6% among acute coronary syndrome patients • The prevalence of left main trunk or left anterior descending artery lesion was higher in SMuRF-less patients • SMuRF-less patients were more likely to die than those with SMuRFs • SMuRF-less patients were at risk of cardiac shock or cardiopulmonary arrest [ABSTRACT FROM AUTHOR]

The GakuNin LMS operated by the National Institute of Informatics (NII) provides an information security teaching course called "Princess Rin-Rin's security column". Gunma University extensively encourages students, faculty members, and staff to take this course. In this paper, we have classified the participants who took this course at Gunma University in the first semester of 2022 according to their course status and the results of the final test. Hierarchical clustering and K-means clustering, which are unsupervised learning methods, were used for the classification. The course status was classified into eight clusters, and the result of the final test was into four clusters. We have identified the most excellent cluster of the final test by investigating the clusters where the participants complete the final test with fewer attempts and in a shorter period of time. Furthermore, we have identified clusters of course status that include relatively good participants compared to the overall average using the relation between the clusters of course status and the clusters of final tests. [ABSTRACT FROM AUTHOR]

Radiation exposure remains a major concern for electrophysiologists and patients. This study aimed to investigate the effect of altering awareness of radiation exposure during atrial fibrillation ablation using interactive face-to-face (FTF) lectures compared to passive lectures. Patients who underwent their first catheter ablation with radiofrequency energy for atrial fibrillation between January 2014 and December 2020 were included in this study. All operators attended an e-learning lecture on radiation exposure before catheter ablation. The addition of FTF lectures to this lecture was introduced in 2018. The effect on radiation exposure was compared between the pre-FTF and FTF periods by comparing fluoroscopy time and radiation dose. A total of 896 patients [mean age, 66 ± 11 years; 603 men (67 %)] were included in this study. For pre-FTF (n = 345), only pulmonary vein isolation (PVI) was performed in 112 patients and PVI with additional ablation in 233 patients. For FTF lectures (n = 551), PVI-only was performed in 302 patients and PVI with additional ablation in 249 patients. Fluoroscopy time, cumulative air kerma, and cumulative air kerma per time significantly reduced after FTF introduction in both PVI-only group [pre-FTF and FTF; 37 ± 15 min and 16 ± 10 min (p < 0.0001), 477 ± 582 mGy and 108 ± 156 mGy (p < 0.0001), 11 ± 12 mGy/min, and 5 ± 6 mGy/min (p < 0.0001), respectively] and PVI with additional ablation group [pre-FTF and FTF; 48 ± 17 min and 15 ± 13 min (p < 0.0001), 613 ± 483 mGy and 68 ± 96 mGy (p < 0.0001), 12 ± 10 mGy/min, and 4 ± 4 mGy/min (p < 0.0001), respectively]. There were no significant differences in intraoperative complications between the two periods. FTF lectures can reduce radiation exposure. [Display omitted] • Lecturing promotes fluoroscopic exposure reduction during catheter ablation • Procedure time decreased after face-to-face lecture delivery • Face-to-face lectures can reduce radiation exposure without extra complications [ABSTRACT FROM AUTHOR]

The influence of changes in alcohol consumption on newly developed metabolic dysfunction-associated fatty liver disease (MAFLD) is unclear. We investigated the influence of alcohol consumption on newly developed MAFLD in both sexes. This observational cohort study included 4071 patients who underwent more than two health check-ups between 2015 and 2020 over an interval of more than a year. Generalised estimating equations were used for analyses. At baseline, the rates of drinking and MAFLD between men and women were 72.5% versus 41.7% and 42.2% versus 22.1%, respectively. At the most recent stage, the rates of an increase in alcohol consumption for men and women were 13.3% and 8.7%, respectively, and 311/1192 (26.1%) men and 155/1566 (9.9%) women had newly developed MAFLD. The odds ratio (OR) for drinking in patients with newly developed MAFLD was 0.863 (men) (95% confidence interval [CI], 0.676–1.102, p = 0.237) and 1.041 (women) (95% CI, 0.753–1.439, p = 0.808); the OR for women who drank 140–279.9 g/week was 2.135 (95% CI, 1.158–3.939, p < 0.05) and that for all drinking categories among women was >1. Several non-invasive fibrosis scores were significantly associated with the quantity of alcohol consumption in patients with newly developed MAFLD (p < 0.005). Alcohol consumption had no significant protective effect against newly developed MAFLD in both sexes, regardless of quantity. Conversely, alcohol consumption ≥140 g/week was a risk factor for newly developed MAFLD in women. The development of liver fibrosis with increased alcohol intake should be considered in patients with MAFLD. [ABSTRACT FROM AUTHOR]

The immune checkpoint inhibitor (ICI), nivolumab, has revolutionised the treatment of recurrent and metastatic oral cancer. However, the response rate to ICIs remains low, and identifying predictors of nivolumab response is critical. Although the neutrophil-to-lymphocyte ratio (NLR) has been suggested as a predictive marker of nivolumab response in patients with various types of cancer, its utility in oral squamous cell carcinoma (OSCC) has not been elucidated. In this retrospective multicentre cohort study, we evaluated the association between NLR and outcome of nivolumab treatment in 64 patients with OSCC treated between 2017 and 2020. The objective response and disease control rates were 25.1% and 32.9%, respectively. The rates for complete and partial responses were 15.7% (10/64) and 9.4% (6/64), respectively; stable and progressive disease rates were 7.8% (5/64) and 67.1% (43/64), respectively. Complete and partial responses were classified as responders, and stable and progressive diseases were classified as non-responders. The median (range) pre-treatment NLR among responders was 4.3 (2.8–8.0), which decreased to 4.0 (2.6–6.3) after nivolumab treatment, and the median (range) pre-treatment NLR among non-responders was 5.1 (2.7–7.9), which increased to 6.4 (4.0–14.0) with tumour growth. Moreover, overall survival was significantly worse in the group with a higher post-treatment NLR (≥5) than in the group with a lower NLR (<5). Patients with a post-treatment NLR of ≥6 had worse outcomes for salvage chemotherapy following nivolumab treatment. Thus, post-treatment NLR could be a useful marker for predicting the response to nivolumab treatment or salvage chemotherapy in patients with OSCC. [ABSTRACT FROM AUTHOR]

Patient and staff cohorting is part of a bundle approach in the response to multi-drug-resistant organisms, but its effectiveness is not fully clarified. This study compared the risks of acquiring vancomycin-resistant Enterococcus faecium (VREfm) at a hospital during a VREfm outbreak based on contact characteristics in order to better understand the effectiveness of cohorting. Exposure came from contact with patients with VREfm (infectors), including existing patients with VREfm and patients who acquired VREfm during the study period. Contact was defined as length of contact time, degree of sharing space, and care by the same nurses as those caring for infectors between January and March 2018. The outcome was VREfm acquisition as determined through monthly stool or rectal screening cultures. Incidence rates were calculated based on contact patterns, and incidence rate ratios (IRRs) were compared. Among 272 inpatients (4038 patient-days), 43 patients acquired VREfm with the same or similar pulsotype. Incidence rates were 8.45 per 1000 patient-days when susceptible inpatients were on the same ward as an infector but cared for by different nurses (reference), 16.96 when susceptible inpatients were on the same ward as an infector and cared for by the same nurses [IRR 2.01, 95% confidence interval (CI) 0.62–10.28], and 52.91 when susceptible inpatients shared a room with an infector (IRR 6.26, 95% CI 1.61–35.40). Compared with susceptible inpatients in a different room from infectors and not being cared for by the same nurses, the risk of VREfm acquisition could be six times higher for susceptible inpatients who are in the same room as infectors, and could be double for susceptible inpatients cared for by the same nurses as infectors. [ABSTRACT FROM AUTHOR]

[Display omitted] • Precambrian (3268–541 Ma) zircon grains were found in the Devonian sediments. • Bimodal volcanism occurred during the early Carboniferous (346 Ma). • The Hida Gaien belt was located close to NE Gondwana during the early Paleozoic. Devonian–Carboniferous strata in the Hida Gaien belt, Southwest Japan, are characterized by a change in the dominant lithology from clastic rocks and limestones to volcanic rocks. The sandstone compositions and detrital zircon U–Pb ages indicate that the Devonian sedimentary rocks were derived from various basement rocks, including granite and basalt, that were uplifted, exposed, and eroded during the Early–Middle Devonian (398–383 Ma). The source of sediment to these strata changed to basalts and rhyolites in the early Carboniferous (∼346 Ma). Early Carboniferous bimodal volcanic rocks are present in the Hida Gaien and South Kitakami belts, the southeastern margin of the South China block (Hainan), and the Jilin area (NE China) of the eastern Central Asian Orogenic Belt (CAOB). The Cambrian–Silurian zircon grains (540–480 Ma and 460–420 Ma) in the Hida Gaien belt were derived from arc basement of a similar age to the South Kitakami and Kurosegawa belts, the Jiamusi–Khanka–Bureya (NE China and the Russian Far East) and Songliao–Xilinhot (Inner Mongolia) blocks in the eastern CAOB, and the eastern South China and Indochina blocks. The Devonian strata also contain Precambrian zircon grains derived from Mesoarchean basement (∼3000 Ma) and the Grenvillian tectonothermal event (∼1000 Ma), suggesting sediment supply from NE Gondwana (the Thomson and Lachlan orogens of eastern Australia) or related continental remnants. Detrital zircon U–Pb age spectra similar to those of the Devonian strata of the Hida Gaien belt are also observed in Silurian–Devonian metasedimentary rocks in the Jilin area. During the early Paleozoic, the Hida Gaien belt, the eastern margin of the South China block, and the magmatic arcs and microcontinents in the eastern CAOB were located close to NE Gondwana along the western margin of the Paleo-Pacific Ocean. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the association between stage 1 hypertension, defined as systolic blood pressure (BP) of 130-139 mmHg or diastolic BP of 80-89 mmHg, in the first and second trimesters and the risk of adverse pregnancy outcomes.Study Design: We analyzed 79,249 singleton pregnancies from a nationwide birth cohort study. BP in the first and second trimesters was classified into normal, elevated, stage1 hypertension, and stage 2 hypertension. We examined the risk of adverse pregnancy outcomes in each group using multivariable logistic regression analysis. We also investigated the influence of BP changes between the first and second trimesters on adverse pregnancy outcomes.Main Outcome Measures: Overall preterm birth (PTB < 37 weeks), early PTB (<34 weeks), and small for gestational age (SGA).Results: Stage 1 hypertension in the first trimester was associated with increased risks of overall PTB (aOR, 1.23; 95 %CI, 1.08-1.39), early PTB (aOR, 1.38; 95 %CI, 1.07-1.79), and SGA (aOR, 1.19; 95 %CI, 1.04-1.36) compared to normal BP. These risks were more evident in the second trimester; overall PTB (aOR, 1.87; 95 %CI, 1.64-2.14), early PTB (aOR, 2.21; 95 %CI, 1.69-2.87), and SGA (aOR, 1.38; 95 %CI, 1.18-1.62). The risk of PTB was higher among women with an upward BP trajectory between the first and second trimesters.Conclusions: Stage 1 hypertension in the first and second trimesters was associated with increased risks of overall PTB, early PTB, and SGA. Monitoring the BP trajectory for stage 1 hypertension may be useful for identifying high-risk groups. [ABSTRACT FROM AUTHOR]

Recent randomized clinical trials have demonstrated that applying rhythm control during the early stage of atrial fibrillation (AF) may lead to improved clinical outcomes. However, the effects of this modality on health-related quality of life (HRQoL) have not been fully investigated. We aimed to assess the association between the AF stage, determined by the time between AF diagnosis and referral to the cardiology clinic, and HRQoL outcomes. Using an outpatients-based multicenter AF registry (n = 3,313), we analyzed 2,070 patients with AF diagnosed within 5 years. The patients were divided into 2 groups according to AF stage: early and late AF (AF duration ≤1 and >1 year, respectively). All patients had HRQoL information collected at baseline and 1 year after their initial treatment (assessed via the Atrial Fibrillation Effect on Quality-of-Life-overall summary [AFEQT-OS] score, with higher scores reflecting better HRQoL). The change in AFEQT-OS was adjusted for patient characteristics using a generalized linear mixed model. The early AF group (n = 1,644) was older (early, 68.5 ± 11.1, late, 64.4 ± 10.6 years, P <.001) and had more heart failure (early, 19.9%, late, 12.7%, P <.001) than the late AF group (n = 426). At 1 year after treatment, the adjusted changes in AFEQT-OS were similar in patients with rhythm (adjusted difference [SE], early, 8.4 [1.2], late, 7.2 [1.4], P =.15) or rate (early, 4.0 [0.7], late, 2.3 [1.4], P =.16) control, regardless of AF stage. Furthermore, the improvement in HRQoL was similar between early and late AF in patients undergoing catheter ablation (early, 10.2 [2.1], late, 9.8 [2.4], P =.78), whereas a significant difference was observed in those receiving antiarrhythmic drug therapy alone (early, 10.2 [1.4], late, 3.5 [2.2], P <.001). Rhythm control therapy provided clinically meaningful improvements in HRQoL, regardless of AF stage. For patients with impaired HRQoL, AF duration should not be a deterrent to treatment, especially catheter ablation. [ABSTRACT FROM AUTHOR]

A wide range of conditions involving the cecum may be found in patients undergoing imaging work-up for conditions as various as right lower pain, diarrhea, fever, and weight loss. The cecum may be the only area of involvement by a particular disease. However, it may also be affected by a more diffuse process of the gastrointestinal tract or even as part of systemic diseases. Imaging provides an excellent evaluation of the cecal region and its surrounding planes, with an impactful clinical application in multiple scenarios. While typical features in many situations allow establishing a confident diagnosis, there are also challenging entities with overlapping features, making it critical for the radiologist awareness of the whole gamut of these conditions, as well as the ability to correlate imaging findings with other clinical data. Additional challenges to the imaging evaluation include anatomical variations of the cecal position and the absence of proper colonic distention in some cases. This article aims to revisit the spectrum of cross-sectional imaging features of common and uncommon pathologies involving the cecum, ranging from inflammatory and infectious to vascular and neoplastic ones. [ABSTRACT FROM AUTHOR]

• Novel iterative CBCT calculated using machine log file in prostate cancer was analyzed. • HU values were uniform at central position in iterative CBCT, and not in conventional CBCT. • Iterative CBCT was consistent with conventional CBCT in accuracy of dose verification. • This method can potentially be used for adaptive radiation therapy. To evaluate the utility of the use of iterative cone-beam computed tomography (CBCT) for machine log file-based dose verification during volumetric modulated arc therapy (VMAT) for prostate cancer patients. All CBCT acquisition data were used to reconstruct images with the Feldkamp-Davis-Kress algorithm (FDK-CBCT) and the novel iterative algorithm (iCBCT). The Hounsfield unit (HU)-electron density curves for CBCT images were created using the Advanced Electron Density Phantom. The I'mRT and anthropomorphic phantoms were irradiated with VMAT after CBCT registration. Subsequently, fourteen prostate cancer patients received VMAT after CBCT registration. Machine log files and both CBCT images were exported to the PerFRACTION software, and a 3D patient dose was reconstructed. Mean dose for planning target volume (PTV), the bladder, and rectum and the 3D gamma analysis were evaluated. For the phantom studies, the variation of HU values was observed at the central position surrounding the bones in FDK-CBCT. There were almost no changes in the difference of doses at the isocenter between measurement and reconstructed dose for planning CT (pCT), FDK-CBCT, and iCBCT. Mean dose differences of PTV, rectum, and bladder between iCBCT and pCT were approximately 2% lower than those between FDK-CBCT and pCT. For the clinical study, average gamma analysis for 2%/2 mm was 98.22% ± 1.07 and 98.81% ± 1.25% in FDK-CBCT and iCBCT, respectively. A similar machine log file-based dose verification accuracy is obtained for FDK-CBCT and iCBCT during VMAT for prostate cancer patients. [ABSTRACT FROM AUTHOR]