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Purpose: To evaluate the impact of optimized trigger threshold on 40-keV pancreatic phase images acquired with a dual-energy CT (DECT) protocol., Methods: A cohort of 69 consecutive participants (median age, 72 years) undergoing a pancreatic protocol DECT examination between September to December 2021 were prospectively randomized into two protocols: conventional trigger threshold of 100 HU (Group A, n = 34) and optimized trigger threshold of 30 HU (Group B, n = 35). Pancreatic phase image acquisition was performed with fixed delay of 20 s from the trigger threshold. Two radiologists assessed the 40-keV pancreatic phase images for scan timing adequacy using a binary scale (adequate or inadequate). The proportions of these classifications were compared in the two groups using the Fisher's test., Results: The median times to achieve the aortic attenuation of 30 HU and 100 HU were 16.3 s and 22.3 s in Group A, respectively, and was 17.8 s for 30 HU in Group B. The median time difference from 30 HU to 100 HU was 4.5 s in Group A. The scan timing adequacies of pancreatic phase images were classified as adequate (50.0% and 74.3%) or inadequate (50.0% and 25.7%) in Group A and Group B (P = 0.049)., Conclusion: An optimized trigger threshold of 30 HU allows consistent acquisition of adequate pancreatic phase images compared to the conventional trigger threshold of 100 HU for pancreatic protocol DECT at 40-keV which might lead to improved pancreatic lesion conspicuity., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

It is well known that dogs are capable of following human verbal instructions. However, very little is known about the equivalent ability in cats. In this study, we used a switched stimuli task to examine whether cats rapidly form picture-word association, which is a fundamental ability for word learning. We presented cats with two meaningless picture-word combinations, in the habituation phase. Then, on half of the trials we switched the combination (switched condition), but the other half of the trials remained as before (non-switched condition). If cats rapidly form picture-word association, they were expected to look at the monitor for longer in the switched condition, reflecting detection of the change. We used human speech as stimuli in Exp.1, and mechanical sounds (electronic sounds) in Exp.2. Cats expressed detection of the switched combination in Exp.1, where human speech and objects were paired. However, in Exp.2 where non-social sounds and objects were paired, there was no statistical difference between switched and non-switched conditions, although there was a main effect of condition when the data from the two experiments were pooled. These results demonstrate that cats can rapidly form picture-word association. Further research should investigate whether domestication has played a role in this ability., (© 2024. The Author(s).)

Introduction: Late adolescence is a crucial period during which individuals connect with new communities. Furthermore, their mental health has lasting effects on their overall well-being. Involvement with family and the local community plays a significant role in shaping adolescents' personalities and well-being. Additionally, pets, such as dogs and cats, function as social catalysts and increase interactions with family and the local community. We hypothesized that pet ownership would increase involvement with family and the local community and thereby impact adolescents' personalities and well-being., Methods: Therefore, this study investigated whether owning dogs or cats was related to well-being through increased involvement with family and local community members in late adolescence. Data were collected via a questionnaire administered to high school and university students. The questionnaire included questions on basic information about adolescents and their families, pet ownership experience, family and local community involvement, well-being, cultural estrangement inventory, and general trust., Results: Structural equation modeling revealed that adolescent women who owned dogs or cats had higher well-being and general trust through their involvement with their families. Although previous research reported that men who had experienced pet ownership in childhood were more sociable in old age, the effect of pet ownership on men was not observed in this study., Discussion: During late adolescence, when individuals experience many connections with new communities, the effects of pets may temporarily decrease. Therefore, future cohort studies should examine the effects of pets on each age group., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Koyasu, Ogasawara, Kikusui and Nagasawa.)

Physical and mental effects stemming from COVID-19 have impacted not only people's lives but also the lives of their pets, which in recent years are often seen as members of the family. This study aimed to explore the impact of the COVID-19 pandemic in Japan on pets and their owners. Participants reported changes in physical activity and mental health, as well as working conditions and frequency of interaction with pets, before and after behavioural restrictions due to the COVID-19 pandemic. We also asked about their pets' behaviours using the Feline Behavioural Assessment and Research Questionnaire (Fe-BARQ) and the Canine Behavioural Assessment and Research Questionnaire (C-BARQ). This study showed that most cat and dog owners spent more time at home due to the COVID-19 behavioural restrictions and that the frequency of contact interaction with their pets increased. However, this study showed higher stress-related behaviours (e.g., cats: excessive grooming; dogs: aggression towards owners) among pets whose owners increased contact interaction. Furthermore, owners' low mental health was correlated with high stress-related behaviours (e.g., touch sensitivity) in pets. The results of this study indicate that the lockdown caused by the COVID-19 pandemic in Japan may have affected not only the lives of owners but also the interaction between owners and their pets, and consequently their pets' behaviours. Therefore, there is also concern that changes in lifestyle patterns caused by pandemics could form a negative feedback loop between the health status of both owners and their pets.

Individual differences in the sociality of cats are influenced by inherited and environmental factors. We recently revealed that hormones can make a difference in intraspecies social behavior. It remains unclear whether cat behavior toward humans is modulated by hormones. Therefore, we analyzed the relationship between cat behavior and their basal hormone concentrations after spending time together with human experimenters. In addition, we analyzed the relationship between cat behavior and the timing of when the individual cats began living with a human because the sociality of cats could be dependent on their developmental experiences. The results showed that male cats that began living with humans earlier had more contact with an experimenter. In addition, individual male cats with low testosterone levels were more likely to interact with an experimenter. These findings of this pilot study suggest that the sociality of male cats toward humans is affected by testosterone and the age at which they begin to live with humans.

Domestic cats (Felis silvestris catus) can live in high densities, although most feline species are solitary and exclusively territorial animals; it is possible that certain behavioral strategies enable this phenomenon. These behaviors are regulated by hormones and the gut microbiome, which, in turn, is influenced by domestication. Therefore, we investigated the relationships between the sociality, hormone concentrations, and gut microbiome of domestic cats by conducting three sets of experiments for each group of five cats and analyzing their behavior, hormone concentrations (cortisol, oxytocin, and testosterone), and their gut microbiomes. We observed that individuals with high cortisol and testosterone concentrations established less contact with others, and individuals with high oxytocin concentrations did not exhibit affiliative behaviors as much as expected. Additionally, the higher the frequency of contact among the individuals, the greater the similarity in gut microbiome; gut microbial composition was also related to behavioral patterns and cortisol secretion. Notably, individuals with low cortisol and testosterone concentrations were highly tolerant, making high-density living easy. Oxytocin usually functions in an affiliative manner within groups, but our results suggest that even if typically solitary and territorial animals live in high densities, their oxytocin functions are opposite to those of typically group-living animals., Competing Interests: The authors have declared that no competing interests exist.

Purpose: As the concept of late-onset hypogonadism (LOH) has gained increased attention, the treatment of eugonadal patients with LOH symptom has become a clinical problem. Previous studies have shown the possible benefits of 5-aminolevulinic acid (5-ALA) on the somatic, psychological and sexual functions. We therefore conducted this randomized, double-blind, placebo-controlled study to confirm the efficacy and safety of 5-ALA for LOH symptoms., Materials and Methods: Thirty-two eugonadal subjects with LOH symptoms were randomly divided into a 5-ALA group (n=15) and a placebo group (n=17). Treatment was continued for 8 weeks. The change of the Aging Males' Symptoms (AMS) scale score and several biochemical and endocrinological variables during treatment were compared between the groups., Results: After treatment, the change in the total AMS in the 5-ALA group was significantly greater than that in the placebo group (-7.4±4.7 vs. -4.9±4.9, p=0.029). However, the differences between the groups in the change of the somatic, psychological, and sexual sub-scores of the AMS did not reach the statistical significance, although these changes in the 5-ALA group were greater than those in the placebo group. Furthermore, the change in the biochemical and endocrinological variables in the two groups did not differ to a statistically significant extent. During the 8-week treatment period, no patients discontinued 5-ALA due to treatment-emergent adverse events (TEAEs)., Conclusions: The intake of 5-ALA for 8 weeks was beneficial for eugonadal patients with symptoms of LOH and no severe TEAEs was experienced. 5-ALA should be considered as an option for those patients., Competing Interests: The authors have nothing to disclose., (Copyright © 2022 Korean Society for Sexual Medicine and Andrology.)

Humans communicate with each other through language, which enables us talk about things beyond time and space. Do non-human animals learn to associate human speech with specific objects in everyday life? We examined whether cats matched familiar cats' names and faces (Exp.1) and human family members' names and faces (Exp.2). Cats were presented with a photo of the familiar cat's face on a laptop monitor after hearing the same cat's name or another cat's name called by the subject cat's owner (Exp.1) or an experimenter (Exp.2). Half of the trials were in a congruent condition where the name and face matched, and half were in an incongruent (mismatch) condition. Results of Exp.1 showed that household cats paid attention to the monitor for longer in the incongruent condition, suggesting an expectancy violation effect; however, café cats did not. In Exp.2, cats living in larger human families were found to look at the monitor for increasingly longer durations in the incongruent condition. Furthermore, this tendency was stronger among cats that had lived with their human family for a longer time, although we could not rule out an effect of age. This study provides evidence that cats link a companion's name and corresponding face without explicit training., (© 2022. The Author(s).)

Background: This study aimed to assess the longitudinal health-related quality of life (HRQOL) using the Expanded Prostate Cancer Index Composite (EPIC) and HRQOL change between the nerve-sparing technique in Japanese men treated with robot-assisted radical prostatectomy (RARP)., Methods: A total of 573 patients who received RARP were included in this study. EPIC questionnaire was administered before treatment and up to 36 months after RARP. Clinical recovery was defined as half of the standard deviation of the baseline score for each domain. We divided all patients into recovery group or nonrecovery group. The time from survey to each domain recovery was calculated using the Kaplan-Meier method. We compared the sexual and urinary score change between groups using analysis of variance to confirm the effect of nerve-sparing technique., Results: The median age was 67 years (interquartile range, 62-71 years). The mean score of all urinary domains worsened noticeably after 1 month. All postoperative urinary summary, function, and incontinence scores were significantly lower than preoperative scores up to 3 years post-RARP. Postoperative sexual summary and functional scores were significantly lower than preoperative score at all follow-up times throughout the 36 months. The recovery rate for the urinary incontinence domain was the lowest (44.5%), whereas the recovery rate for the urinary irritative-obstructive domain was the highest (73.7%). In the sexual domain, the bother domain had a higher recovery rate (73.0%) than the functional domain (29.7%). Although the recovery of sexual domains was slower compared with other domains, by 36 months after RARP, almost all values had recovered. Compared with other technique groups, bilateral intrafascial nerve-sparing group showed significantly decreased change in subscale scores before and after RARP in several sexual and urinary domain., Conclusion: The time course and extent of functional and bother domain recovery documented in this study may prove useful for RARP patient selection in Japan., Competing Interests: None of the contributing authors have any conflicts of interest, including specific financial interests, relationships, and affiliations relevant to the subject matter or materials discussed in the article., (© 2022 Asian Pacific Prostate Society. Publishing services by Elsevier B.V.)

Objectives: The aim was to investigate triage methods for suspected transient ischemic attacks (TIAs) with focal or nonfocal symptoms., Materials and Methods: In total, 350 patients with suspected TIAs were enrolled and followed for one year. Potential high-risk factors for TIAs, such as atrial fibrillation, carotid artery stenosis, crescendo TIA, and ABCD2 score ≥ 4, were evaluated. Patients were classified into 3 groups according to the initial neurological symptoms: focal, nonfocal, and mixed (both focal and nonfocal) groups. Stroke-free survival rates were compared via Kaplan-Meier analysis., Results: Diffusion-weighted MRI (DWI) was performed for 89.8% of the patients within 7 days, and the frequency of acute brain infarction on DWI was significantly lower in the nonfocal group (focal, 24.1%; nonfocal, 7.2%; mixed, 22.2%; P < .01). There was no significant difference in the one-year event-free survival rates across the groups. Significantly higher stroke risk was observed in patients with one or more high-risk categories or the ABCD2 score (≥ 4) in the focal group (P = .021 and .26, respectively), whereas no significant difference was observed in the other groups. Across all symptom groups, significantly higher stroke risk was observed in patients showing acute infarcts on DWI evaluated within 7 days., Conclusions: Both high-risk categorization (≥ 1 potential high-risk factors) and ABCD2 score (≥ 4) alone were useful tools for identifying higher stroke risk in patients with focal symptom but not with nonfocal symptoms in isolation. Further studies are warranted in triage methods for TIA with nonfocal in isolation in conjunction with DWI., Competing Interests: Declaration of Competing Interest The authors have reported their conflict of interest to the Japan Stroke Society, and there is no conflict of interest that should be disclosed for the publication of this paper., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: In hepatocellular carcinoma (HCC), detection and treatment prior to growth beyond 2 cm are important as a larger tumor size is more frequently associated with microvascular invasion and/or satellites. In the surveillance of very small HCC nodules (≤ 2 cm in maximum diameter, Barcelona clinical stage 0), we demonstrated that the tumor markers alpha-fetoprotein and PIVKA-Ⅱ are not so useful. Therefore, we must survey with imaging modalities. The superiority of magnetic resonance imaging (MRI) over ultrasound (US) to detect HCC was confirmed in many studies. Although enhanced MRI is now performed to accurately diagnose HCC, in conventional clinical practice for HCC surveillance in liver diseases, unenhanced MRI is widely performed throughout the world. While, MRI has made marked improvements in recent years., Aim: To make a comparison of unenhanced MRI and US in detecting very small HCC that was examined in the last ten years in patients in whom MRI and US examinations were performed nearly simultaneously., Methods: In 394 patients with very small HCC nodules, those who underwent MRI and US at nearly the same time (on the same day whenever possible or at least within 14 days of one another) at the first diagnosis of HCC were selected. The detection rate of HCC with unenhanced MRI was investigated and compared with that of unenhanced US., Results: The sensitivity of unenhanced MRI for detecting very small HCC was 95.1% (97/102, 95% confidence interval: 90.9-99.3) and that of unenhanced US was 69.6% (71/102, 95% confidence interval: 60.7-78.5). The sensitivity of unenhanced MRI for detecting very small HCC was significantly higher than that of unenhanced US ( P < 0.001). Regarding the location of HCC in the liver in patients in whom detection by US was unsuccessful, S 7-8 was identified in 51.7%., Conclusion: Currently, unenhanced MRI is a very useful tool for the surveillance of very small HCC in conventional clinical follow-up practice., Competing Interests: Conflict-of-interest statement: There are no conflicts of interest to disclose., (©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Intravesical bacillus Calmette-Guérin (BCG) instillation is a standard treatment for non-muscle-invasive bladder cancer (NMIBC); however, not all patients benefit from BCG therapy. Currently, no surrogate marker exists to predict BCG efficacy, and thereby, identify patients who will benefit from this treatment., Objective: To evaluate the utility of urine Mycobacterium tuberculosis complex polymerase chain reaction (MTC-PCR) assay as a predictive marker for recurrence and progression following BCG therapy., Design Setting and Participants: A prospective analysis was carried out for of intermediate- or high-risk NMIBC patients who received BCG instillation for the first time. Urine samples, for MTC-PCR assay, were collected at baseline and annually for up to 10 yr after the last BCG instillation, including induction and maintenance therapy. The first postoperative sample for MTC-PCR was taken at 1 yr from the last instillation., Outcome Measurements and Statistical Analysis: A survival analysis was performed using the Kaplan-Meier method, and risk factors for recurrence and progression after BCG treatment were assessed using Cox regression analysis., Results and Limitations: During follow-up (median: 57 mo), 468/521 samples (89.8%) were MTC-PCR positive, and 108/123 patients (87.8%) exhibited MTC-PCR positivity at least once. Five-year recurrence- and progression-free survival in patients who were not MTC-PCR positive was significantly lower than in patients who were MTC-PCR positive at least once ( p  <  0.001). Using multivariable Cox regression analysis, MTC-PCR positivity at least once was a significant prognostic factor for recurrence (hazard ratio [HR]: 36.782, p  <  0.001) and progression (HR: 47.209, p  <  0.001)., Conclusions: Patients who were not MTC-PCR positive, even once after BCG therapy, were extremely likely to exhibit recurrence and progression. Urine MTC-PCR may be an extremely useful, noninvasive surrogate marker to predict recurrence and progression following BCG therapy., Patient Summary: Urine Mycobacterium tuberculosis complex polymerase chain reaction may be a novel biomarker capable of identifying patients at risk of recurrence and progression after bacillus Calmette-Guérin (BCG) immunotherapy., (© 2021 The Author(s).)

Dogs ( Canis familiaris ) and cats ( Felis silvestris catus ) have been domesticated through different processes. Dogs were the first domesticated animals, cooperating with humans by hunting and guarding. In contrast, cats were domesticated as predators of rodents and lived near human habitations when humans began to settle and farm. Although the domestication of dogs followed a different path from that of cats, and they have ancestors of a different nature, both have been broadly integrated into-and profoundly impacted-human society. The coexistence between dogs/cats and humans is based on non-verbal communication. This review focuses on "gaze," which is an important signal for humans and describes the communicative function of dogs' and cats' eye-gaze behavior with humans. We discuss how the function of the gaze goes beyond communication to mutual emotional connection, namely "bond" formation. Finally, we present a research approach to multimodal interactions between dogs/cats and humans that participate in communication and bond formation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Koyasu, Kikusui, Takagi and Nagasawa.)

Purpose: Spinal column procedures require an accurate understanding of neural pathways relative to the anatomic structure. Since Bogduk's report in 1982, it has been known that the human lumbar posterior ramus of the spinal nerve (PRSN) comprise not two but three primary branches at least in some lumbar segments. The purpose of the current study was to examine the existence of the three primary branches in the thoracic and lumbar segments., Methods: In this study, we investigated the anatomy of the human PRSN in the thoracic and lumbar segments. Ventral dissection was performed in eight cadavers to determine the anatomy of the PRSN between T1 and L5., Results: At the distal end of a given PRSN, the PRSN divided into three primary branches-medial, intermediate and lateral-in 196 out of 272 segments in the thoracic and lumbar regions in eight cadavers. The medial branch supplied the spinalis compartment, and reached the skin. The lateral branch supplied the iliocostalis muscle compartment, and reached skin. The intermediate branch supplied the longissimus muscle and the area between the medial and the lateral branch, which was a seemingly shorter branch., Conclusion: The triplication of the primary branch of the PRSN is considered not uncommon. The third branch should be recognized in the literature and in textbooks.

Purpose: To evaluate the utility of ring-type dedicated breast positron emission tomography (dbPET) for the detection of the residual tumor after neoadjuvant chemotherapy (NAC)., Materials and Methods: This prospective study included 27 women with histologically proven breast cancer over a 37-month period. All patients underwent ring-type dbPET followed by whole-body PET-CT (WBPET) for preoperative tumor evaluation and re-staging after NAC. The maximum standardized uptake value (SUV max ) of the tumor lesion and the degree of confidence for the presence of the residual tumor were compared between pathological complete response (pCR) and non-pCR tumors. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) for the detection of a non-pCR tumor were compared between dbPET and WBPET., Results: On dbPET, SUV max was significantly higher in non-pCR than in pCR tumors (P = 0.030). The sensitivity for the detection of a non-pCR tumor was significantly higher with dbPET than with WBPET (84.2% vs 26.3%, P = 0.001). In the qualitative analysis, the sensitivity for the detection of a non-pCR tumor was also significantly higher with dbPET than with WBPET (57.9% vs 21.1%, P = 0.016)., Conclusion: The dbPET can provide more sensitive detection of residual tumor after NAC than can WBPET.

Purpose: To evaluate the visualization of the right adrenal vein (RAV) on dynamic contrast-enhanced computed tomography (CT) images in patients with primary aldosteronism., Materials and Methods: We evaluated 27 consecutive patients with primary aldosteronism who underwent contrast-enhanced dynamic CT and subsequent adrenal venous sampling. Scan delays were 10-, 20- and 60-s after a bolus-tracking program detected that the threshold of a 100 Hounsfield units (HU) increase in the abdominal aorta had been achieved. RAV visualization for each phase was evaluated by two readers using a four-point scale. The Friedman and McNemar tests were employed to compare the confidence ratings and the RAV visualization rates between the three phase images., Results: The RAV visualization rates were 20.4%, 83.3%, and 63.0%, for the first, second, and third phase, respectively. The RAV visualization rates were 92.6%, 83.3%, 63.0%, and 92.6% for all three phases combined, the first and second phase image combined, the first and third phase image combined, and second and third phase image combined. The combined second and third phase images had the highest RAV visualization rates compared with all other image combinations (P<0.0001)., Conclusion: RAV visualization was significantly improved by combining the second and third phase images., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Purpose: To evaluate the value of view-sharing multi-hepatic arterial-phase (mHAP) imaging for diagnosis of hypervascular hepatocellular carcinoma (HCC)., Materials and Methods: Forty-seven consecutive patients with HCC underwent gadoxetic acid-enhanced magnetic resonance (MR) imaging before angiographic and lipiodol CT. Hepatic arterial-phase images were obtained at 5 consecutive phases with shared central k-space of 25%, followed by portal venous, late (2 and 3min), and hepatobiliary phase imaging. One-hundred-eight HCC nodules (size: 5-88mm, mean size: 18.2mm) confirmed on angiographic CT and lipiodol CT were evaluated for LI-RADS category and compared with single arterial-phase and mHAP findings regarding wash out, capsule, corona enhancement, and image quality., Results: Twenty-four HCCs (22.2%) (size: 6-19mm, mean size: 12.3mm) were categorized as LR-3 based on the single arterial-phase. Capsule appearance (25.9%) and washout (57.4%) were most frequently observed in late phase (2min). Corona enhancement was observed in 73.1% of all HCCs on mHAP. For the 24 HCCs of LR-3, corona enhancement was observed in 75% on mHAP and contributed to upgrade category. No significant difference was found in the frequency of corona enhancement between mHAP and angiographic CT (P=0.11). Image quality was valued as good or excellent in all cases., Conclusion: View-sharing mHAP was feasible without compromising image quality and contributed to the improvement in diagnostic confidence for hypervascular HCC in gadoxetic acid-enhance MR imaging., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Purpose: To evaluate the value of adding single-shot balanced turbo field-echo (b-TFE) sequence to conventional magnetic resonance cholangiopancreatography (MRCP) for the detection of common bile duct (CBD) stone., Methods: One hundred thirty-seven consecutive patients with suspected CBD stone underwent MRCP including single-shot b-TFE sequence. Twenty-five patients were confirmed with CBD stone by endoscopic retrograde cholangiopancreatography or ultrasonography. Two radiologists reviewed two image protocols: protocol A (conventional MRCP protocol: unenhanced T1-, T2-, and respiratory-triggered three-dimensional fat-suppressed single-shot turbo spin-echo MRCP sequence) and protocol B (protocol A plus single-shot b-TFE sequence). The sensitivity, specificity, positive (PPV) and negative predictive value (NPV), and area under the receiver-operating-characteristic (ROC) curve (AUC) for the detection of CBD stone were compared., Results: The sensitivity (72%) and NPV (94%) were the same between the two protocols. However, protocol B was greater in the specificity (99%) and PPV (94%) than protocol A (92% and 67%, respectively) (P = 0.0078 and 0.031, respectively). The AUC was significantly greater for protocol B (0.93) than for protocol A (0.86) (P = 0.026)., Conclusions: Inclusion of single-shot b-TFE sequence to conventional MRCP significantly improved the specificity and PPV for the detection of CBD stone.

Purpose: To evaluate the association between gadoxetic-acid-enhanced magnetic resonance (MR) imaging measurements and laboratory and clinical biomarkers of liver function and fibrosis., Materials and Methods: One hundred thirty nine consecutive patients with suspected liver disease or liver tumor underwent gadoxetic-acid-enhanced MR imaging. MR imaging measurements during the hepatobiliary phase included biliary tract structure-to-muscle signal intensity ratio (SIR). These measurements were compared with Child-Pugh classification, end-stage liver disease (MELD) score, and aspartate aminotransferase-to-platelet ratio index (APRI)., Results: The SIRs of cystic duct and common bile duct were significantly correlated with Child-Pugh classification (P=0.012 for cystic duct and P<0.0001 for common bile duct), MELD score (P=0.0016 and P=0.0033), and APRI (P=0.0022 and P=0.0015). The sensitivity, specificity, and area under the receiver-operating-characteristic curve were: (74%, 88%, 0.86) with the SIR of common bile duct for the detection of patients with Child-Pugh class B or C; (100%, 87%, 0.94) with the SIR of cystic duct for MELD score (>10); (65%, 76%, 0.70) with the SIR of common bile duct for APRI (>1.5)., Conclusion: Gadoxetic-acid contrast enhancement of cystic duct and common bile duct could be used as biomarkers to assess liver function., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Purpose: To determine the iodine load per body weight (ILPBW) that is minimally required for the detection of pancreatic adenocarcinoma for 80kVp CT imaging., Material and Methods: Institutional review board approval and written informed consent were obtained. Fifty-seven consecutive patients with histopathologically-proven pancreatic adenocarcinoma were assigned to three groups at random according to iodine load (0.5, 0.4, and 0.3gI/kg) and underwent CT at 80kVp. Enhancement of the pancreas and visualization of the tumor were assessed during the pancreatic parenchymal-phase and compared among the three groups. The relationship between the iodine load and tumor conspicuity was also analyzed., Results: The mean CT number of the pancreas (HUpancreas) was higher in the 0.5gI/kg group (158.8HU) than in the 0.4 (121.7HU) and 0.3 (106.6HU) gI/kg groups (P<0.05). Tumor-to-pancreas contrast (HUtumor-to-pancreas) was also higher in 0.5gI/kg group (88.9HU) than in 0.4 (62.2HU) and 0.3 (54.5HU) gI/kg groups (P<0.05). Linear regression between HUpancreas or HUtumor-to-pancreas and ILPBW were expressed as HUpancreas=23.3+263.9×ILPBW (r=0.74, P<0.0001) and HUtumor-to-pancreas=-1.24+174.3×ILPBW (r=0.56, P<0.0001), respectively. The iodine load estimated to achieve an acceptable HUpancreas (>100HU) and HUtumor-to-pancreas (>50HU) were 0.29 and 0.30gI/kg, respectively., Conclusion: An iodine load of 0.3gI/kg was the least amount required for the detection of pancreatic adenocarcinoma at 80kVp CT., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Japan has the highest number of magnetic resonance imaging units in the world, and citizens can freely choose medical care at any hospital or clinic. We aimed to investigate the triage of patients with suspected transient ischemic attack (TIA) or minor stroke in this unique Japanese healthcare system., Methods: In this cohort study, patients with suspected TIA or minor stroke (National Institutes of Health Stroke Scale score <4) within 7 days after onset were prospectively enrolled and followed for 1 year. The high-risk group was defined as having at least one of the following 5 items at the initial visit: (1) atrial fibrillation, (2) carotid stenosis, (3) crescendo TIA, (4) definite focal brain symptoms, or (5) ABCD2 score of 4 or higher. After the initial assessment, the patients were diagnosed as having acute ischemic cerebrovascular syndrome (AICS) or stroke mimic. AICS was classified into 3 categories including definite, probable, and possible AICS, based on evidence of neurological deficits and brain infarction on the imaging study., Results: A total of 353 patients were enrolled and 89.8% of the patients were examined by diffusion-weighted imaging at the initial visit. Kaplan-Meier analyses demonstrated a statistically significant difference in subsequent stroke risk when the patients were triaged by the ABCD2 score (P = .031), 5-item high-risk categorization (P = .032), or AICS classification (P = .001)., Conclusions: This study demonstrates that hospitals and clinics with imaging facilities play a major role in triage and that the ABCD2 score, 5-item high-risk categorization, and AICS classification are useful as triage tools for patients with suspected TIA or minor stroke., (Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Objectives: To elucidate the epidemiological significance of patients with extra-pulmonary TB., Subjects and Methods: The subjects of this retrospective study were 10,088 TB patients registered in Aichi prefecture between 1989 and 2003. Of these, 8,629 patients had pulmonary TB and 1459 had extra-pulmonary TB. All registration files were reviewed to identify the epidemiological links of patients. When linked patients with an interval of less than 10 years between registrations were found, the earlier registered case was considered the primary or index case, and the other patients were regarded as secondary cases. The index case rate (ICR) for a category of patients was defined as follows: ICR=NI/NA, where NA: number of TB patients in a category A, and NI: number of index cases in category A., Results: The ICR for the 1,459 extra-pulmonary TB patients was 1.1%, which was significantly different from 7.2% for 3332 patients with sputum smear-positive pulmonary TB (p < 0.001), as well as from 2.1% for 2139 patients with sputum smear-negative and bacillus-positive pulmonary TB (p < 0.05). The ICR differences were not significant between extra-pulmonary TB patients and 3,158 patients with bacteriologically negative pulmonary TB (1.2%). Of the 16 index cases with extra-pulmonary TB, the organs in which tuberculosis was found were the pleura in 13 patients, the bone in two, and the hilar nodes in one. The relationship between the 16 index cases and 18 secondary patients were husband-wife in 7 pairs, parent-child in 7 pairs, brother or sister in 2 pairs, and grandparent-grandchild in 2 pairs. The interval of the dates of registration for the index and secondary patients was within one year in 14 pairs or 77.8%., Discussion: The index cases with extra-pulmonary TB can be considered as a good control in the epidemiological study on the ability of TB transmission in patients with pulmonary tuberculosis, so that they can form clusters by chance, or false positive clusters., Conclusion: Our findings suggest that patients with extrapulmonary TB have no ability of TB transmission, nor do patients with bacteriologically negative pulmonary TB.

A 60-year-old man demonstrated a bleeding tendency at enterostomy about 7 months after aortic arch replacement. Abdominal muscle hematoma and pelvic hematoma were also detected. He was diagnosed as having acquired hemophilia A based on prolonged APTT (65.9 sec), reduced FVIII activity (>1%), and the presence of FVIII inhibitor (19.5 BU/ml). Severe anemia was recognized. Recombinant activated factor FVIII (9.6 mg) was administered 25 times, combined with steroid pulse therapy. Usually postoperative acquired hemophilia is recognized in the immediate postoperative period or about 3 months later, while in this case, acquired hemophilia appeared 7 months postoperatively.

Objectives: To elucidate characteristics in generation-to-generation TB transmission from smear positive pulmonary TB patients., Subjects and Methods: The subjects of this retrospective study were 10,088 TB patients registered in Aichi prefecture between 1989 and 2003. Smear-positive pulmonary TB was found in 3,332. All registration files were reviewed to identify epidemiological links of patients. When linked patients with an interval of the dates of registration of less than 10 years were found, the first case was considered as the index case, and the other patients were regarded as secondary patients. All patients were subdivided by every 10 years of age as a generation. All patients were also grouped as young generations aged 0 to 29, middle-aged generations aged 30 to 59, and elder generations aged 60 to 99. A young generations rate (YGR) for a generation of index cases was defined as following; YGR=NY/NA, where NA: Number of whole TB secondary patients transmitted from all index cases belonging to generation A, and NY: Number of secondary patients aged 0-29 in NA. A same generation rate (SGR) for a generation of index cases was defined as following; SGR=NS/NA, where NA: Number of whole TB secondary patients transmitted from all index cases belonging to generation A, and NS: Number of secondary patients belonging to the same generation A in NA., Results: A total of 290 clusters were found with 290 index cases and 411 secondary cases. Of the 290 index cases, the biggest number of patients was 58 for the forties, followed by 43 patients for the twenties and the fifties. Of the 411 secondary patients, the biggest number of patients was 91 for the twenties, followed by 58 patients for the thirties, and 158 patients or 38.4% belonged to the young generations. High YGRs were found in the young and middle-aged generations ranging from 37.5% to 75.0%, while YGRs were low in the elder generations ranging from 15.9% to 26.7%. The difference was significant between the fifties and the sixties (p<0.01). The YGRs were calculated 57.1% for the young generations, 43.5% for the middle-aged generations, and 18.9% for the elder generation. The differences were significant between the young and the middle-aged (p<0.05), as well as between the middle-aged and the elder (p<0.001). The biggest SGR was calculated 42.2% for the twenties. Low SGRs were 18.2% for the forties and 17.5% for the fifties. The differences were significant between the twenties and the forties (p<0.01), as well as between the twenties and the fifties (p<0.01). The secondary patients aged 0 to 29 were counted 158: 123 were transmitted through intra-familial infection and 35 were through extra-familial infection. The major index case generation was the middle-aged generations with 82 or 66.7% secondary patients in the case of intra-familial infection, while it was the young generations with 20 or 57.1% patients in the case of extra-familial infection., Conclusion: These findings suggest that the major sources of TB transmission to young people are smear-positive pulmonary TB patients aged 0 to 59.

Objectives: To elucidate characteristics in clustered secondary TB patients transmitted from culture positive pulmonary TB patients., Subjects and Methods: The subjects of this retrospective study were 10,088 TB patients registered in Aichi Prefecture between 1989 and 2003. Pulmonary TB was found in 8,629 patients, and 1,459 had extra-pulmonary TB. Bacteriological examination revealed sputum smear-positive (SPBP) in 3,332, sputum smear-negative bacillus-culture-positive (SNBP) in 2,139, and smear-negative bacillus-culture-negative (SNBN) in 3,158. All registration files were reviewed to identify epidemiological links of patients. When linked patients with an interval of the dates of registration of less than 10 years were found, the first case was considered as the index case, and the other patients were regarded as secondary cases. A clustered secondary case rate (CSR) for a category of patients was defined as follows; CSR=NCS/NA, where NA: number of TB patients in a category A, and NCS: number of secondary cases in category A. A cluster rate for a category of bacillary pulmonary patients was defined as follows; Cluster rate= (NIC+NCS)/ NA, where NA: number of TB patients in a category A, NIC: number of index cases in category A, and NCS: number of secondary cases in category A., Results: A total of 417 patients were considered as clustered secondary cases, and the CSR was 4.1% in total. The CSRs were 3.5% for the SPBP patients, 3.8% for the SNBP patients, 5.4% for the SNBN patients, and 3.4% for the extra-pulmonary patients. The CSR in SNBN patients was significantly higher than the SPBP patients (p<0.001). The significant differences in the CSRs were found between the SNBN patients and the SNBP patients (p<0.01), as well as between the SNBN patients and the extra-pulmonary patients (p< 0.01). The CSRs were 42.5% in patients aged 0-9, 30.3% in those aged 10-19, 11.2% in those aged 20-29, 7.4% in those aged 30-39, 4.6% in those aged 40-49, 3.2% in those aged 50-59, 2.4% in those aged 60-69, 1.8% in those aged 70-79, 1.3% in those aged 80-89, and 0.6% in those aged 90-99. There were significant differences in the CSRs between those aged 10-19 and those aged 20-29 (p< 0.001), between those aged 20-29 and those aged 30-39 (p<0.05), and between those aged 30-39 and those aged 40-49 (p< 0.05). The male patients showed significantly lower CSR than female patients (2.9% vs 6.3%, p<0.001). The cluster rate for the 5,471 bacillary patients was 8.8%. The cluster rates were significantly different between those patients aged 10-19 and those aged 20-29 (37.1% vs 21.1%, p<0.001), as well as between those aged 40-49 and those aged 50-59 (16.4% vs 8.5%, p<0.001)., Conclusion: These findings suggest that the CSR is closely related with patient's age, gender, and bacillary findings, and that the CSR is significantly high in young, female, and SNBN patients.

Objectives: To elucidate TB transmission with multiple secondary patients (MSP) in comparison with a single secondary patient (SSP)., Subjects and Methods: The subjects of this retrospective study were 10,088 TB patients registered in Aichi Prefecture between 1989 and 2003. Pulmonary TB was found in 8,629 patients, and 1,459 had extra-pulmonary TB. Bacteriological examination revealed sputum smear-positive (SPBP) in 3,332, sputum smear-negative bacillus-positive (SNBP) in 2,139, and smear-negative bacillus-negative (SNBN) in 3,158. All registration files were reviewed to identify epidemiological links of patients. When linked patients with an interval of the dates of registration of less than 10 years were found, the first case was considered as the index case, and the other patients were regarded as secondary cases. An index case rate (ICR) for a category of patients was defined as following; ICR=NI/NA, where NA: Number of TB patients in a category A, and NI: Number of index cases in category A. An epidemic source rate (ESR) was used instead of ICR when the index case and the TB patients in a category were smear-positive., Results: A total of 337 patients were considered as index cases. Sixty-nine patients had MSP, while 268 had a SSP. The ICRs for MSP were 1.74% for the SPBP patients, 0.33% for the SNBP patients, 0.06% for the SNBN patients, and 0.14 % for the exrtra-pulmonary TB patients. These ICRs for SSP were 5.43%, 1.73%, 1.14%, and 0.96%, respectively. The ESR differences with MSP were highly significant (p<0.001) between patients aged 0-59 and those aged 60-99 (3.8% vs 0.5%), between patients with cavitary lesion and those with non-cavitary lesion (2.6% vs 0.4%), and between patients with large amount of bacilli and those with small amount of bacilli (2.9% vs 0.9%). These differences were also found in those with SSP., Conclusion: These findings suggest that TB transmission with multiple secondary patients is closely correlated with aging, cavitary lesion, and bacillary amount, and that no characteristic changes were found between index cases with multiple secondary patients and those with a single secondary patient.

Objectives: To elucidate TB transmission from smear-negative bacillus-positive patients., Subjects and Methods: The subjects of this retrospective study were 8,339 TB patients registered in Aichi Prefecture between 1989 and 2003. Of these patients, 7,122 had pulmonary TB and 1,217 had extra-pulmonary TB. Bacteriological examination for the pulmonary patients revealed sputum smear-positive in 2,640, sputum smear-negative bacillus-positive (SNBP) in 1,794, and smear-negative bacillus-negative (SNBN) in 2,688. All registration files were reviewed to identify epidemiological links of patients. When linked patients with an interval of the dates of registration of less than 10 years were found, the initial case was considered as the index case, and the other patients were regarded as secondary cases. An index case rate (ICR) for a category of patients was defined as follows; ICR=NI/NA, where NA: Number of TB patients in a category A, and NI: Number of index cases in category A., Results: A total of 287 patients were considered as index cases, and the ICR was 3.4%. The ICRs were 2.3% for the SNBP patients, 7.5% for the smear-positive patients, 1.2% for the SNBN patients, and 1.1% for the exrtra-pulmonary tuberculosis patients. The SNBP patients had a significantly higher ICR than the SNBN patients (p<0.01), and a significantly lower ICR than the smear-positive patients (p<0.001). In the SNBP patients, the ICRs were 5.0% for those aged 40 to 49 years and 1.6% for those aged 50 to 59, and the difference was statistically significant (p<0.05). All patients were grouped into two groups; younger patients with an age of less than 50 years and elder patients with an age of 50 years or higher. The ICRs showed significant differences between the younger patients and the elder patients as follows: 4.3% vs 1.7% for the SNBP patients (p<0.01), 15.5% vs 5.0% for the smear-positive patients (p<0.001), and 1.9% vs 0.9% for the SNBN patients (p<0.05). The chest X-ray showed cavitary lesion in 453 SNBP patients. The ICRs were 8.7% for 126 cavitary younger SNBP patients, 2.6% for 311 non-cavitary younger SNBP patients, 2.4% for 327 cavitary elder SNBP patients, and 1.5% for 1,030 non-cavitary elder SNBP patients. The ICR for the cavitary younger SNBP patients was significantly higher than those for the other three subgroups (p<0.01 to p<0.001)., Conclusion: These findings suggest that TB transmission from SNBP patients depends on the patient's age and the cavity formation, and that patients aged less than 50 years with cavitary pulmonary TB is the most important target for the epidemiological research.

Objectives: To elucidate TB transmission among nurses., Subjects and Methods: The subjects of this retrospective study were 1,283 TB women aged 20-59 years registered in Aichi Prefecture between 1989 and 2003. All registration files were reviewed to identify their occupation and working places., Results: A total of 80 nurses were found among TB registers. Their age distribution was 45 (56.2%) in 20-29 years, 15 (18.8%) in 30-39 years, 14 (17.5%) in 40-49 years, and 6 (7.5%) in 50-59 years. The proportion of nurses aged 20-29 years decreased from 74.2% in 1989-93 to 24.0 % (p < 0.001) in 1999-2003, while those aged 40-49 years increased from 2.9% to 32.0% (p < 0.01). Regarding working places, 19 (23.8%) were in 4 TB hospitals, 54 (67.4%) in other 35 hospitals, 6 (7.5%) in 6 clinics, and one (1.3%) was in a home. The proportion of nurses in TB hospitals decreased from 31.4% in 1989-1993 to 4.0% (p < 0.05) in 1999-2003. Out of 73 nurses working in hospitals, 58 (79.5%) were working in hospitals with more than 250 beds with an emergency department. TB incidence were 49.1 per 100,000 population among 73 nurses working in hospital, and 14.3 among 6 nurses working in clinic, 39.5 among total 80 nurses, and 13.2 among 1203 women other than nurses. The relative risk was 3.7 for hospital nurses, 1.1 for clinic nurses, and 3.0 for whole 80 nurses., Conclusion: These findings suggest that TB incidence for nurses is 3-fold higher than age-matched women other than nurses, and that hospital nurses are infected with TB more frequently than clinic nurses.

Objectives: To investigate gender difference in index and secondary patients with or without household contact., Subjects and Methods: The subjects of this retrospective study were 3,174 pulmonary TB patients registered in Aichi prefecture between 1989 and 2003. All recorded files were reviewed to identify epidemiologically-related TB patient clusters. In case of epidemiologically-related patients registered within less than 10 years interval, the first registered patients was defined as the index case of the cluster. The other patients in the cluster were defined as secondary cases. Therefore, all pulmonary TB patients were classified to index, secondary, or unclustered cases. An index patient with sputum smear positive was defined as the source of transmission in the cluster. The male/female ratio was calculated separately in the sources and secondary patients with or without household contact., Results: A total of 100 source patients were identified. Of these, 77 were male and 23 were female, and the male/female ratio was 3.3. The secondary patients were 153, of whom 77 were male and 76 were female, and the male/female ratio was 1.0. The difference of the male/female ratio was statistically significant (p<0.001). The male/female ratio in the source patients was 2.5 for 78 clusters with household contact and 21.0 for 22 clusters without household (p<0.05), while the ratio in the secondary patients were 0.8 and 2.2 respectively (p<0.01). Of the 111 secondary patients with household contact, the relations to the source patients were wife-husband in 32, parent-child in 55, brother or sister in 12, grandparent-grandchild in 8, and the others in 4. In the 32 wife-husband transmission, most secondary patients were female (male/female = 9/23) while in other 67 transmissions with household contact, male and female secondary cases were almost same (male/female= 39/40). The male/female ratios in these two settings were significantly different (0.4 vs 1.0, p<0.05). Of the 42 secondary patients without household contact, transmission were occurred in working places in 24, schools in 11, religion circles in 4, hospital in one, and others in 2. The male/female ratio of secondary cases was 7.0 for transmission at working places, and 0.8 for transmission at the other places (p<0.01)., Conclusion: These findings suggest that the male/female ratio of secondary patients with household contact is significantly lower than that of those without household contact.

Objectives: To elucidate the influences of aging on the tuberculosis infection., Subjects and Methods: The subjects of this retrospective study were 1,141 smear positive pulmonary tuberculosis (TB) patients registered in Aichi prefecture between 1989 and 2003. All registration files were reviewed to identify epidemiological links of patients. When linked patients with an interval of the dates of registration of less than 10 years were found, the earliest case was considered as the source case, and the other patients were regarded as secondary cases. An epidemic source rate (ESR) for a category of patients (e.g., age-group, etc.) was defined as following; ESR= NS/NA X 100, where NA: Number of smear-positive pulmonary TB patients in a category A, and NS: Number of source cases in category A., Results: A total of 70 source cases were identifed and the ESR was 6.1%. The ESRs for different age-groups were; 14.3 % for 10-19 years of age (NA = 14), 13.5% for 20-29 years (NA = 74), 14.6% for 30-39 years (NA = 48), 15.0% for 40-49 years (NA = 107), 6.9% for 50-59 years (NA = 145), 3.5% for 60-69 years (NA = 227), 3.8% for 70-79 years (NA = 293), 2.8% for 80-89 years (NA = 212), and 0% for 90-99 years (NA = 21). The ESR were significantly different between those aged 40 to 49 years and those aged 50 to 59 (p<0.05). The ESR was significantly different between those aged 59 years and younger and those aged 60 years or older (11.6% vs 3.3%, p<0.001). The ESR was significantly different between those patients with cavitary lesion and those with noncavitary lesion in the younger groups (14.3% vs 5.2%, p<0.01), as well as in the elder age-groups (4.8% vs 1.7%, p<0.01). The rate in the younger groups was 6.3% for those with lower smear-positivity (Gaffky 1 to 4), compared with 15.3% for those with intermediate smear-positivitiy (Gaffky 5 to 8), and 32.4% for those with higher smear-positivity (Gaffky 9 and 10) (with p<0.01, p<0.05 respectively), while the rates were 3.1%, 3.9%, and 3.4%, respectively in the older groups., Conclusion: These findings suggest that the infectivity is significantly lower in older groups.

Objectives: To elucidate the characteristics of the index and secondary patients in clusters containing multiple TB patients who were examined epidemiologically., Subjects and Methods: The subjects of this retrospective study were 3783 TB patients registered in Aichi between 1989 and 2003. All recorded files were reviewed to identify multiple TB patients in the same transmission group. When multiple patients with a registration interval of less than 10 years were found in the same transmission group, the first patient was considered as the index case, and the other patients were regarded as secondary cases., Results: A total of 106 index patients and 132 secondary patients were found. The index patients occupied 2.8% of the total 3783 registered patients, or 0.9 per 100,000 population. Secondary patients occupied 3.5% and 1.2 per 100,000. Of the 106 clusters, 77.4% consisted of two patients, 15.1% three patients, and 7.5% four or more patients. Smear-positive patients were found in 66.0% of the index patients, 27.3% of the secondary patients, and 30.3% of the 3783 overall patients, and the differences were highly significant between the index and secondary patients, as well as between the index and overall registered patients (p < 0.001). The proportion of the index patients to all registered patients was 6.1% for smear-positive patients, 1.8% for culture-positive patients, and 1.1% for bacilli-negative patients. The differences were highly significant between smear-positive and culture-positive patients, as well as between smear-positive and bacilli-negative patients (p < 0.001)., Conclusion: The findings of this retrospective study suggest that 2.8% of the total registered patients, 6.1% of smear-positive patients, and 0.9 per 100,000 population was the index patients.

Two patients who underwent gamma knife radiosurgery for ruptured cerebral arteriovenous malformations (AVM) developed cystic lesions at 78 and 111 months after undergoing treatment. Both patients presented initially with intracerebral hemorrhage. In one patient, the cystic lesion was discovered during routine follow-up imaging and clinical examination revealed homonymous hemianopsia; the second patient presented with seizure and the lesion was identified more than 9 years after radiosurgery. One patient underwent resection of the nidus and histologic analysis of the resected specimen showed vessels in various stages of obliteration. The present paper discusses the possible mechanism for the delayed development of cystic lesions, and the possibility that radiation-induced vascular changes may continue in a nidus even when angiography shows complete obliteration of the nidus.

Piperacillin sodium (PIPC) is a semisynthetic penicillin displaying high antibacterial activities against Gram-positive and Gram-negative bacteria including Pseudomonas sp., Proteus sp., etc. It acts bactericidally and is stable against beta-lactamases. The usefulness of PIPC in the treatment of infections in mature and premature neonates was investigated and the following results were obtained. The pharmacokinetics (half-life, distribution volume, total body clearance) of PIPC after 50 mg/kg intravenous drip infusion in 10 cases of neonates were examined. Relationship between T1/2 and hours after birth was clearly determined. Adverse effects and abnormality in laboratory test values were not observed. It is considered from the above results that PIPC may be an useful antibacterial agent for the treatment of infections in neonates.