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For thymic epithelial tumors, simple contact with adjacent structures does not necessarily mean invasion. The purpose of our study was to develop a simple noninvasive technique for evaluating organ invasion using routine pretreatment computed tomography (CT).This retrospective study analyzed the pathological reports on 95 mediastinal resections performed between January 2003 and June 2020. Using CT images, the length of the interface between the primary tumor and neighboring structures (arch distance; Adist) and maximum tumor diameter (Dmax) was measured, after which Adist/Dmax (A/D) ratios were calculated. Receiver operating characteristic (ROC) curves were used to analyze the Adist and A/D ratios.An Adist cut-off of 37.5 mm best distinguished between invaded and non-invaded mediastinal great veins based on ROC curves. When Adist 37.5 mm was used for diagnosis of invasion of the brachiocephalic vein (BCV) or superior vena cava (SVC), the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the ROC curve for diagnosis of invasion were 61.9%, 92.5%, 81.25%, 82.2%, 81.97%, and 0.76429, respectively. Moreover, there were significant differences between BCV/SVC Adist 37.5 mm and ≤ 37.5 mm for 10-year relapse-free survival and 10-year overall survival (p 0.01).When diagnosing invasion of the mediastinal great veins based on Adist 37.5 mm, we achieved a higher performance level than the conventional criteria such as irregular interface with an absence of the fat layer. Measurement of Adist is a simple noninvasive technique for evaluating invasion using CT. Key Points • Simple contact between the primary tumor and adjacent structures on CT does not indicate direct invasion. • Using CT images, the length of the interface between the primary tumor and neighboring structures (arch distance; Adist) is a simple noninvasive technique for evaluating invasion. • Adist 37.5 mm can be a supportive tool to identify invaded mediastinal great veins and surgical indications for T3 and T4 invasion by thymic epithelial tumors.

We propose an algorithm that enhances convolutional long short-term memory (ConvLSTM), i.e., Enhanced ConvLSTM, by adding skip connections to spatial and temporal directions and temporal gates to conventional ConvLSTM to suppress gradient vanishing and use information that is older than the previous frame. We also propose a method that uses this algorithm to automatically recognize facial expressions from videos. The proposed facial expression recognition method consists of two Enhanced ConvLSTM streams. We conducted two experiments using eNTERFACE05 database and CK+. First, we conducted an ablation study to investigate the effectiveness of adding spatial and temporal skip connections and temporal gates to ConvLSTM. Ablation studies have shown that adding skip connections to spatial and temporal and temporal gates to conventional ConvLSTM provides the greatest performance gains. Second, we compared the accuracies of the proposed method and state-of-the-art methods. In an experiment comparing the proposed method and state-of-the-art methods, the accuracy of the proposed method was 49.26% on eNTERFACE05 database and 95.72% on CK+. Our proposed method shows superior performance compared to the state-of-the-art methods on eNTERFACE05.

To investigate the effectiveness of postmortem computed tomography in the diagnosis of drowning, focusing on the comparison of fresh water and salt water cases using three-dimensionally (3D) reconstructed data.We examined features of drowning in 25 fresh water drowning cases (FWDCs; 13 men, 12 women; mean age 73.1 years; range 43-95 years), and compared these with 12 salt water drowning cases (SWDCs; 5 men, 7 women; mean age 66.0 years; range 55-77 years). Pulmonary opacities, volume and density (CT number) of accumulated fluid in the paranasal sinuses and central airways, volume of the stomach/stomach contents, and cardiac blood density were examined.In SWDCs, pulmonary ground-glass opacities with wholly thickened interstitium was frequently identified (P = 0.0274). Whereas in FWDCs, a significantly larger volume and lower density of fluid in the paranasal sinuses (P = 0.0195 and P = 0.0104, respectively), lower density of fluid in the central airways (P = 0.0077), lower stomach content density (P = 0.0216), lower density in the left atrium (P = 0.0029), and a difference of density between the atria (P = 0.0247) were observed.A lower density in the left atrium was observed in FWDCs compared to SWDCs. This finding may be helpful in differentiating between FWDCs and SWDCs.

The aim of the present study was to use surgical and histological results to develop a simple noninvasive technique for improving nodal staging using preoperative PET/CT in patients with resectable non-small cell lung cancer (NSCLC). Preoperative PET/CT findings (163 patients) and pathological diagnoses after surgical resection were evaluated. Using PET/CT images, lymph node section area (SA), the maximum standardized uptake value (SUVmax), SA of SUV ≥2.5 and ≥3.0 were drawn freehand and measured using caliper software. Receiver operating characteristic (ROC) curves were then used to analyze those data. Based on ROC analyses, the cut-off values for SA of SUV ≥2.5, SA of SUV ≥3.0, SUV ≥2.5 SA/node SA and SUV ≥3.0 SA/node SA for diagnosis of lymph node metastasis were 200 mm2, 30 mm2, 1.0 and 0.4. SUV ≥2.5 SA/node SA ≥1.0 had the highest negative predictive value, and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of nodal staging were 61.1, 73.4, 36.7, 88.2 and 70.9%. When diagnosing nodal staging based a lymph node SUV ≥2.5 SA/node SA ratio of ≥1.0, it can be an effective criterion for use to determine surgical indications.

Active faults commonly repeat cycles of sudden rupture and subsequent silence of hundreds to tens of thousands of years, but some parts of mature faults exhibit continuous creep accompanied by many small earthquakes. Discovery and detailed examination of creeping faults on land have been in a rapid progress with the advent of space-borne synthetic aperture radar interferometry. In this study, we measured the spatial variation of the creep rate along the Philippine fault on Leyte Island using ALOS/PALSAR data acquired between October 2006 and January 2011. Prominent creep of$$33\pm {11}$$33±11 mm/year was estimated in northern and central parts of the island except for a locked portion around latitude 11.08–11.20$$^\circ$$∘N. We compared the creep rate distribution along the fault with the slip distribution of the 2017$$M_w$$Mw6.5 Ormoc earthquake which occurred in northern Leyte, estimated from the displacements mapped by ALOS-2/PALSAR-2 interferometric data. The estimated slip of the 2017 earthquake amounted up to 2.5 m and to moment magnitude of 6.49, with the dominant rupture area coinciding with the locked portion identified from the interseismic coupling analysis. Teleseismic waveforms of the 2017 earthquake and another event that occurred in 1947 ($$M_s$$Ms6.9) exhibit close resemblance, indicating two ruptures of rather similar locations and magnitudes with a time interval of 70 years.

We evaluated the efficacy and safety of superselective embolization with assistance of colonoscopy for acute colonic hemorrhage.Of 92 cases of acute colonic hemorrhage requiring colonoscopic intervention, 11 (12 %) could not be successfully treated. Of these, 10 patients (9 men, mean age 65.5 years, range 39-75 years) underwent superselective embolization. Hemorrhage was caused by diverticular disease (n = 8), polypectomy (n = 1), and vascular malformation (n = 1). In all 10 cases, the radiopaque clips were placed at the bleeding point via colonoscopy. Microcatheters were used in all procedures, and embolization was performed at the level of the vasa recta leading to or near the clips with Gelfoam particles, microcoils, or both.Immediate hemostasis was achieved in all patients. In 6 of 10 patients (60 %), selective angiograms showed no active extravasation at the time of the procedure and the embolization was performed using clips as a landmark. In the remaining four patients, selective angiograms showed active extravasation from the vasa recta leading to the clips. The mean number of embolized vessels with no active extravasation and with active extravasation was 1.83 (range 1-3) and 1.25 (range 1-2), respectively. The mean duration of clinical follow-up was 11.6 months (range 1-29 months). One patient (10 %) bled from a different site than the treated site a month after embolization, but the bleeding ceased after endoscopic intervention. All the patients (100 %) were evaluated for objective evidence of ischemia by colonoscopy. Four of the 10 patients (40 %) were found endoscopically to have small areas of ischemia involving only the mucosa, but they remained asymptomatic. There was no bowel infarction or stricture.Colonoscopy-assisted superselective embolization may be a safe and useful procedure for acute colonic hemorrhage without active extravasation on angiogram.

Although recent studies have found that chronic kidney disease (CKD) is an independent risk factor for cognitive impairment in population-based cohorts, the mechanisms of cognitive impairment in subjects with CKD are unclear. We examined 503 elderly subjects (mean age: 72.4 years), who were living independently at home without apparent dementia, using MRI. The subject was judged as having frontal lobe dysfunction if the scores on the modified Stroop test were higher than the fifth quintile for each given decade. Serum creatinine values, measured by the enzymatic method, were used for the Japanese equation of estimated glomerular filtration rate (eGFR). Subjects in the frontal lobe dysfunction group tended to have higher blood pressure, lower eGFR and more lacunar infarcts, and were less educated. When possible confounders were entered into the multivariate logistic regression model, the independent predictors of frontal lobe dysfunction were eGFR (odds ratio 0.854; 95% confidence interval (CI) 0.743-0.983 per 10 ml min(-1) per 1.73 m(2)) and the number of lacunar infarction (odds ratio 1.460; 95% CI 1.127-1.892). The mean of the logarithmically transformed Stroop test scores in the eGFR60 ml min(-1) per 1.73 m(2) group was 1.376 (95% CI 1.301-1.451), which was significantly higher than that (1.250) for the eGFR 60-89 ml min(-1) per 1.73 m(2) group (95% CI 1.215-1.285) (P=0.009) and tended to be higher than that (1.264) for the eGFR ≥90 ml min(-1) per 1.73 m(2) group (95% CI 1.188-1.340) (analysis of covariance, adjusted for age). The present study showed that CKD and subclinical lacunar infarction independently contributed to frontal lobe dysfunction in healthy elderly subjects.

The relative motion between the Caribbean and North American plates is accommodated by several active faults around Hispaniola Island1, 2, 3. The Enriquillo–Plantain Garden fault in southern Haiti is one of these structures2, 4. Strain equivalent to a magnitude 7.2 earthquake is estimated to have accumulated along this fault since its last significant activity4. The Haiti earthquake of 12 January 2010 was initially reported to have occurred along this fault5, 6, but more recent studies proposed slips on previously unrecognized, neighbouring faults5, 7, 8. Here we use interferometric synthetic aperture radar data to show that surface deformation caused by the earthquake does not correspond to the present topography. Alluvial fan deltas were uplifted on the north side of the Enriquillo–Plantain Garden fault, whereas mountains located on the south side of the fault subsided, implying that faults other than the Enriquillo–Plantain Garden fault were responsible for the deformation. To determine fault structure, we fit the satellite surface deformation data to a fault model. We show that slip occurred on a fault dipping northward at 42°, with large thrust components. The maximum displacement on the fault was about 4 m at 10–20 km depth, offshore from the Tiburon peninsula. We confirm that the earthquake ruptured a blind thrust fault and show that the fault could not be identified from large-scale present-day topography.

Urinary trypsin inhibitor (UTI), produced in the liver, has been considered to suppress inflammation. The production of UTI may decrease after a hepatectomy and thereby increase the incidence of postoperative inflammation. This study investigated whether the changes in the UTI level affected the postoperative course in patients undergoing a hepatectomy for hepatocellular carcinoma (HCC). The prognostic significance of UTI was also analyzed. The perioperative plasma UTI was measured in 25 HCC patients who underwent hepatic resection, and the correlation between the kinetics of UTI and clinicopathological factors was investigated. The expression of UTI in the resected specimens was examined by immunohistochemistry in 65 patients. Expression of UTI in the cancer cells were then correlated to both the liver pathology and the clinical outcomes in the corresponding patients. The plasma UTI level greatly decreased on the first postoperative day. This decrease significantly correlated with the resected tumor volume (r s = −.530, P = .006), but it had no influence on inflammatory complications. Immunohistochemistry revealed UTI expression in both noncancerous and cancerous lesions. An overexpression of UTI in HCC tissue was found to be an independent prognostic factor for early recurrence (P = .006). Although UTI plasma levels were noted to decrease after the removal of an HCC tumor, this decrease did not lead to an increase in inflammatory complications. However, overexpression of UTI in cancer was found to be a risk factor for tumor recurrence after resection, suggesting that UTI expression may be a useful prognostic marker.

Apathy is defined as a syndrome of primary loss of motivation not attributable to emotional distress, intellectual impairment or consciousness disturbance. The aim of our study was to investigate the effects of vascular risk factors and silent ischemic brain lesions on apathetic behavior of community-dwelling elderly subjects. Brain MRI and other medical examinations were performed on 222 non-demented community-dwelling elderly subjects (96 men and 126 women, average age 70.1 years). The apathy group was defined as the most apathetic quintile determined by Starkstein's apathy scale. Silent infarction, deep white matter lesions (DWMLs) and periventricular hyperintensities were detected in 12.2, 39.2 and 22.5%, respectively. Linear regression analysis (Pearson) revealed that the scores on the apathy scale correlated slightly but significantly with logarithmically transformed scores of the Modified Stroop Test (r=0.135, P=0.045), but not with the Mini-Mental State Examination. The apathy group tended to have more high blood pressure (141.6/82.6 vs. 136.1/79.6 mm Hg), less prevalent hyperlipidemia (18 vs. 35%) and lower serum albumin. Multivariate analysis (the forward stepwise method of logistic analysis) revealed an independent correlation between the apathy and grade of DWMLs (odds ratio 1.826, 95% confidence interval (CI) 1.129-2.953 per grade) or diastolic blood pressure (DBP) (odds ratio 1.055, 95% CI 1.014-1.098 per mm Hg) after adjusting for possible confounders. The mean apathy scale score in the DBP>or=90 mm Hg group was significantly lower (more apathetic) than that in the DBP

The 2007 Noto Hanto earthquake (M w 6.6) is the first major earthquake in inland Japan since the launch of the Japanese ALOS satellite. Interferometric synthetic aperture radar successfully mapped the coseismic displacements from both ascending and descending orbits in and around the earthquake epicentral region. The line-of-sight displacements toward the satellite from the ascending and descending orbits amount to about 50 and 20 cm, respectively. The interferograms as well as the GPS data of the GEONET network are inverted in order to determine the slip distribution on the source fault. The dip and strike angles of the preferred model are 48° and N51°E, respectively, and its fault slip area reaches the seafloor. The dip angle is not well constrained in our tested range between 40° and 60°. The dominant slip area is located just above the hypocenter, at depths between 4 and 10 km. Many aftershocks seem to have occurred on and around the area of dominant slip.

Positron emission tomography with 2-deoxy-2-[(18)F]fluoro-D-glucose (FDG-PET) has been proven useful for differentiating pancreatic ductal cancer from mass-forming chronic pancreatitis. However, there are particular pancreatic tumors having various grades of malignancy such as intraductal papillary mucinous neoplasm (IPMN) or pancreatic neuroendocrine tumor. We examined whether the cut-off value of maximum standardized uptake value (SUVmax) determined by pancreatic ductal cancers is also applicable for other pancreatic tumors. One hundred thirty six patients with pancreatic tumors underwent FDG-PET imaging. We first analyzed the cut-off value to differentiate pancreatic ductal cancers from mass-forming chronic pancreatitis. Secondly, we determined the cut-off value between malignant IPMN and benign IPMN. Thirdly, we computed a cut-off value between malignant pancreatic tumors and benign tumors irrespective of tumor type. The optimal cut-off value to differentiate ductal cancers from mass-forming chronic pancreatitis was 2.5. The optimal cut-off value for differentiating malignant IPMN from benign IPMN was also 2.5, similar to that of reported studies. In all types of pancreatic tumors, the cut-off value was also 2.5. The accuracy for detecting malignancy was 93.4% for all tumors. In the FDG-PET study for pancreatic tumors, an SUVmax of 2.5 would be justified as a cut-off value to differentiate malignant lesions.

The aim of this study was to establish the role played by jejunal veins in hepatopetal flow after biliary-enteric anastomosis and to evaluate the helical CT features of hepatopetal flow through the anastomosis. We retrospectively analyzed helical CT images of the liver in 31 patients with biliary-enteric anastomosis who underwent hepatic angiography with (n=13) or without (n=18) CT arterial portography within 2 weeks of the CT examination during the last 4 years. Arterial portography showed hepatopetal flow through small vessels located (communicating veins) between the elevated jejunal veins and the intrahepatic portal branches in two (9%) of 22 patients with a normal portal system. Helical CT showed focal parenchymal enhancement around the anastomosis in these two patients. All nine patients with extrahepatic portal vein occlusion (100%) had hepatopetal flow through the anastomosis, and four of the nine had decreased portal flow. CT revealed small communicating veins in two of these four patients. In five patients with normal portal perfusion despite extrahepatic portal vein occlusion, CT detected dilated communicating veins and elevated jejunal veins. The presence of communicating veins and/or focal parenchymal enhancement around the anastomosis indicates hepatopetal flow through the elevated jejunal veins.

To investigate the postseismic crustal deformation associated with the Tokachi-oki earthquake (M JMA = 8.0) of 26 September 2003 in Japan Standard Time (JST), off southeastern Hokkaido, Japan, we newly established thirty GPS sites just after the mainshock in the eastern part of Hokkaido. Rapid data analysis for one month after the mainshock clearly indicated postseismic displacements only in the horizontal components. Observed maximum horizontal displacement was 6.6 cm from 28 September to 24 October, 2003. Absence of the vertical suggests that afterslip occurred in and around the coseismic fault rather than at downdip extension. Time series of coordinates are characterized by logarithmic decay functions with 4–11 days relaxation times. This suggests that postseismic deformation was due to afterslip on the fault following the large earthquake.

Purpose: To describe the angiographic features of hepatic involvement in hereditary hemorrhagic telangiectasia (HHT), particularly the presence of portovenous shunts. Methods: We reviewed the angiographic findings of seven patients with HHT. The patients comprised three women and four men with a mean age of 51 years. Results: Intrahepatic telangiectasias were found in all seven patients and shunts between three vascular channels were found in six of seven patients. In the four patients who had portovenous shunts combined with arterioportal shunts, the portovenous shunts were large. Three patients had no portovenous shunts. Two of these patients had arteriovenous shunts, and one had no shunt. The mean age (69 years) of the patients with portovenous shunts was older than those without portovenous shunts (26 years). Conclusions: Hepatic vascular lesions in HHT are varied, ranging from telangiectasias to large shunts between three vascular channels. In an advanced stage of involvement, large portovenous shunts are present.

It is important to recognize and understand focal fatty infiltration and pseudolesions of the liver mimicking liver tumors on CT during arterial portography or helical-CT images. These conditions are caused by venous flow outside the main portal vein. Unless this is borne in mind, incorrect diagnosis and management may follow. This article demonstrates the appearance of the parenchymal changes caused by systemic venous flow and location of the systemic veins entering the liver parenchyma.

Activity of large earthquakes in southwestern Japan is simulated with a model that incorporates mechanical interactions between faults, including both interplate and intraplate faults. In this simulation, each fault element is assumed to accumulate stress with a constant slip deficit rate and redistribute its accumulated stress to surrounding faults by making a forward (coseismic) slip when the cumulative stress reaches an assumed threshold. The results from the inversion of geodetic data by Hashimoto and Jackson (1993) were used to specify slip deficit rates for these faults. Each fault in this model is divided into four equal-sized elements, two in the length direction and two in the width direction, so that this model can simulate events as small as M6. A complex pattern of seismicity arises from a 10,000-year run of the simulation. The rate of stress accumulation is not necessarily constant for all faults, which may be attributed to the interaction between faults. It is interesting that fluctuations in the amplitude of stress changes with periods of 1,500 years or longer are seen for some inland faults. A variety of sizes of events occur according to the number of simultaneously rupturing elements. Smaller events in which only one element on a fault ruptures frequently occur, but large events with three or more rupturing elements are rarely seen. This implies that the difference between geodetic and geological/seismological strain rates might be made up by smaller events. Simulations indicate that two models with 1 initial conditions may separate by a factor of about 20∼30 in the state space after hundreds of years. The increase of this distance in the state space slows down or is linear in tome depending on initial conditions.

We interpret the continuous GPS data for the Japanese islands from 1996 to 1999 using the model of Hashimoto and Jackson (1993). In this model crustal deformation is represented by a combination of rigid block motions and deformation due to slip deficits along the fault-bounding blocks. Hashimoto and Jackson used 19 blocks, 104 faults, and geodetic data spanning 100 years. In the present work we assume the same fault and block geometry, and we use only the continuous GPS data. Compared to the previous study, the motions of the major blocks are a bit larger: 107 ± 8 mm/yr for the Pacific plate, 47 ± 2 mm/yr for the Philippine Sea plate, and 24 ± 2 mm/yr for the Izu block, all relative to the Amurian plate. The estimated slip directions on active inland faults are now more consistent with geological estimates. Slip deficit rates exceed 10 mm/yr along the Itoigawa-Shizuoka Tectonic Line, Shinanogawa Seismic Zone, Atotsugawa fault, Hanaori fault, Arima-Takatsuki Tectonic Line, Rokko faults, Median Tectonic Line, and southern boundary of the Beppu-Shimabara graben. Some interplate faults along the Japan and Kurile trenches have slip deficit rates larger than 100 mm/yr, although postseismic deformation from the 1994 Far Off Sanriku earthquake may contaminate these estimates. An interplate fault off Kyushu has a negative slip deficit, possibly due to post-seismic movements from the 1996 events in Hyuganada.

Only a small proportion of cases of this rare neoplasm occur in the skull. We present an unusually extensive tumour in a young man.

We describe a technique for computed tomographic (CT) fluoroscopy-guided celiac artery or superior mesenteric artery (SMA) catheterization for use with CT hepatic arteriography or CT arterial portography, respectively. Patients underwent conventional hepatic angiography to define the anatomy and to place a catheter within the celiac artery or the SMA. Subsequently, the catheter was repositioned in the target vessels under CT fluoroscopy. Our success rate was 94%.