Gunma Chuo Hospital

We aimed to examine the psychometric properties of the second version of the Brief Evaluation of Psychosis Symptom Domains (BE-PSD-V2.0) and its correspondence with the Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression-Severity scale (CGI-S) scores. This cross-sectional study was conducted at 18 institutes in Japan. We performed correlational analyses to test the convergent and divergent validity of the BE-PSD-V2.0. Inter-rater reliability was assessed using intraclass correlation coefficients (ICCs). The equipercentile equating method was employed to examine the linking of the BE-PSD-V2.0 with the PANSS and the CGI-S. A total of 353 patients with schizophrenia spectrum disorders were included. Spearman's rank correlation coefficients between the BE-PSD-V2.0 item scores and their corresponding PANSS factor scores ranged from 0.64 to 0.86, indicating sufficient convergent validity. These specific correlation coefficients were consistently the highest among all item-to-factor comparisons, indicating sufficient divergent validity. In 34 patients, ICCs for the BE-PSD-V2.0 itemand total scores ranged from 0.60 to 0.94, showing sufficient inter-rater reliability. Conversion tables were established between the BE-PSD-V2.0 total score and the PANSS total score, between the BE-PSD-V2.0 total score and the CGI-S score, and between the BE-PSD-V2.0 item scores and their corresponding PANSS factor scores. A correspondence between symptomatic remission criteria using the PANSS and BE-PSD-V2.0 was confirmed. The BE-PSD-V2.0 possesses sufficient psychometric properties and corresponds to the PANSS and CGI-S. It is a sound and reliable brief rating scale for assessing symptoms in schizophrenia spectrum disorders, and its established conversion correspondences facilitate score interpretation within existing clinical paradigms for both clinical practice and research.

Introduction: Moderate-to-severe ulcerative colitis (UC) is commonly treated with oral corticosteroids. However, in cases of oral corticosteroid failure, no clear consensus exists on whether to transition to intravenous corticosteroids (IVCS) or initiate advanced therapies. The aim of this study was to evaluate whether responsiveness to oral corticosteroids is associated with differences in the efficacy of IVCS. Methods: This multicenter cohort study (conducted at 10 facilities) included patients with moderate-to-severe UC who were transitioned to IVCS after failure of oral corticosteroid therapy. The patients were categorized into the partial responder and nonresponder groups based on their response to oral corticosteroids, as measured by improvements in their PRO-2 scores. The primary outcome was clinical remission at day 30, defined as a total PRO-2 score ≤1 with a rectal bleeding subscore of 0. Logistic regression was used to estimate the odds ratio (OR) of achieving clinical remission. Results: A total of 123 patients with UC were included, with 41 and 82 patients in the partial responder and nonresponder groups, respectively. Clinical remission at day 30 was achieved in 41.4% of the partial responders and 18.3% of the nonresponders (multivariable-adjusted OR, 0.35 [95% CI: 0.15–0.83]; p = 0.017). The nonresponder group had a higher risk of requiring advanced therapies within 90 days than the partial responder group (multivariable-adjusted OR, 2.48 [95% CI: 1.09–5.66]; p = 0.030). Conclusions: In patients with UC and oral corticosteroid failure, responsiveness to oral corticosteroids may be associated with differences in IVCS efficacy.

ABSTRACTObjectivesConventional antispasmodics used during endoscopic retrograde cholangiopancreatography (ERCP), such as hyoscine butylbromide and glucagon, are often contraindicated in elderly patients with comorbidities. This trial aimed to assess the efficacy of lidocaine for inhibiting duodenal peristalsis during ERCP.MethodsThis multicenter randomized controlled trial enrolled 40 elderly patients (aged 65–89 years) who were scheduled to undergo ERCP. Patients were randomly assigned to the lidocaine group or the control group using a computer‐generated sequence with stratification by age and sex. The lidocaine group (n = 19) received 2% lidocaine jelly mixed with saline, while the control group (n = 21) received a placebo jelly mixed with saline. The primary endpoint was inhibition of duodenal peristalsis. Secondary endpoints included the required time from drug spraying to cessation of duodenal peristalsis, stop duration time (DT) from cessation of peristalsis until peristalsis recovery, and adverse events.ResultsEighteen patients from the lidocaine group and 19 patients from the control group were analyzed for the primary outcome. The inhibition rate of duodenal peristalsis was significantly higher in the lidocaine group (94.4%) than in the control group (52.6%) (p = 0.008). The required time was significantly shorter in the lidocaine group than in the control group (p < 0.001). No significant difference was observed in the stop DT (p = 0.862); no adverse events occurred in either group.ConclusionsIn our limited cohort, lidocaine inhibited duodenal peristalsis during ERCP without adverse events, suggesting its potential as a safe and practical option (jRCT No. 031190059).

Introduction: It is crucial to predict the effectiveness of advanced therapies before their administration in ulcerative colitis (UC). Only a few studies have revealed predictive histological factors. Here, we sought to determine whether conventional histology of pretreatment endoscopic biopsy specimens can predict the response to integrin inhibitors. Methods: In the present single-center retrospective study, we examined histopathological findings before initiating an integrin inhibitor. Primary response (PR) was defined as a ≥3-point decrease in the partial Mayo score at 14 weeks. Logistic regression was used to identify the factors predictive for a PR. Results: We analyzed 21 biological and Janus kinase inhibitor-naïve patients with UC. The median baseline Mayo score was 7 (IQR, 6–8), and the C-reactive protein was 0.36 (IQR, 0.11–0.74). Histological findings included large lymphoid follicles (LF) in 61.9% (13/21), basal plasma cell infiltration in 52.4% (11/21), and eosinophilic infiltration (EO) in 42.9% (9/21). PR at 14 weeks was achieved in 57.1% (12/21). Among PR patients, LF was present in 91.7% (11/12), BP in 41.7% (5/12), and EO in 25.0% (3/12). PR was observed in 76.9% (10/13) of LF-positive patients vs. 12.5% (1/8) of LF-negative patients (p = 0.01). LF was significantly associated with the response to integrin inhibitors, whereas BP and EO were not. Conclusion: The presence of LF in biopsy specimens predicts the response to integrin inhibitors in patients with UC. Conventional histological examinations may aid in predicting therapeutic responses to advanced therapies.

ABSTRACTA 33‐year‐old man presented with short stature, thin build, hearing impairment, Rieger anomaly, and a history of inguinal hernia. He also exhibited characteristic facies, including a triangular face with a small chin, deeply set eyes, and low‐set ears. He was born with intrauterine growth restriction and developed diabetes during adolescence, requiring high‐dose insulin therapy. For 19 years, an accurate diagnosis was not made. We performed direct sequencing of the insulin receptor gene and exons 11–16 of the PIK3R1 gene, identifying a c.1957A>T mutation (p.Lys653*) in the PIK3R1 gene, which confirmed a diagnosis of SHORT syndrome. Suspecting SHORT syndrome in individuals who exhibit some of its typical symptoms may facilitate an accurate diagnosis and enable effective management of this condition.

BackgroundThe Activities-specific Balance Confidence (ABC) scale lacks sufficient psychometric evidence for use in patients with subacute stroke.ObjectiveTo investigate the floor and ceiling effects, construct validity, responsiveness, and the minimal important change (MIC) of the ABC scale in patients with subacute stroke.MethodsThe cases of patients with subacute stroke (n = 62) were analyzed for floor/ceiling effects and construct validity at baseline; those of 39 of the patients were analyzed for responsiveness and MIC at baseline and after 4 weeks. Outcome measures included the ABC scale, Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go test (TUG), comfortable walking speed (CWS), and maximal walking speed (MWS) measured at both baseline and 4-week follow-up. The MIC was calculated using a ≥ 4-point improvement on the Mini-BESTest as the anchor.ResultsThe ABC scale's total score did not exhibit any floor or ceiling effects. The ABC scale was correlated with the Mini-BESTest (ρ = 0.74), TUG (ρ = -0.56), CWS (ρ = 0.60), and MWS (ρ = 0.64). The correlation of change score between the ABC scale and Mini-BESTest was ρ = 0.39. The MIC for the ABC scale was 15.6% (95%CI: 10.4%-21.1%).ConclusionsThe ABC scale may help assess self-efficacy in patients with subacute stroke.

To clarify the location of the popliteal artery (PA) is relative to the tibial osteotomy plane in patients with medial and lateral unicompartmental knee osteoarthritis (KOA) undergoing UKA. Preoperative MRI and postoperative radiographs obtained from 50 patients with unicompartmental KOA who underwent fixed-bearing UKA were analyzed. The amount of tibial resection was determined from the surgical records, and a line was drawn parallel to the tibial posterior tilt angle on the sagittal MR image to create a virtual tibial cut line. The tibial resection width measured from the anteroposterior image of the postoperative radiograph was projected onto the transverse plane containing the intersection between the virtual tibial cut line and the posterior tibial cortex, after which a line was drawn parallel to the medial or lateral intercondylar ridge. We then determined whether the PA was within an extension of the osteotomy area. The shortest distance (Distance 1) between the posterior tibial cortex and the PA within the osteotomy area was measured. In addition, the shortest distance between the line extending the osteotomy posteriorly and the PA was measured (Distance 2). The medial UKA (group M) and lateral UKA (group L) group comprised 41 and 9 cases. The percentage of PA located behind the osteotomy plane was significantly higher in group L than in group M [6/9 knees (66.7%) vs. 2/41 knees (4.9%); P<0.001]. The distance 1 was 12.6 (4.3) mm in group M and 7.9 (3.7) mm in group L (P=0.004). The distance2 was 11.1 (4.9)mm in group M and 2.6 (3.5)mm in group L (P<0.001). During lateral UKA, the PA was often located behind the tibial osteotomy plane and close to the posterior tibial cortex. Nearly 5% of medial UKAs, the artery was located behind the osteotomy plane. Retrospective comparative LEVEL III study.

Background: Detection of meniscal ramp lesions concomitant with anterior cruciate ligament (ACL) injury using conventional magnetic resonance imaging (MRI) has low sensitivity, and these lesions are currently difficult to diagnose preoperatively. Purpose/Hypothesis: The purpose of this study was to assess the accuracy of MRI in detecting the presence of meniscal ramp lesions in the 120° flexed-knee position compared with that in the near–extended-knee position. It was hypothesized that the diagnostic performance of MRI in the 120° flexed-knee position would be better than that in the extended-knee position. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: This retrospective study of prospectively collected data between February 2019 and January 2024 included 154 consecutive patients undergoing ACL reconstruction. All patients underwent 3-T MRI examination in the near extended- and 120° flexed-knee positions preoperatively. The presence and Thaunat classification of ramp lesions were separately detected on each MRI scan and confirmed via arthroscopy during ACL reconstruction. Diagnostic sensitivity, specificity, and conditional relative odds ratios for detecting ramp lesions and the classification accuracy were compared between 2 MRI modalities. The accuracies of these MRI scans in acute and chronic cases were also evaluated. Results: This study included 154 patients (79 male and 75 female; mean age, 29.0 ± 14.2 years). A total of 62 ramp lesions (40.3%) were observed on arthroscopy. The sensitivity and specificity of MRI in near extension were 69.4% and 77.2%, respectively, and those in flexion were 91.9% and 94.6%, respectively, with significant superiority in MRI at knee flexion (P = .003 and P < .001, respectively). The conditional relative odds ratio between the MRI examinations at these 2 positions was 10.3 (95% CI, 4.82-21.8). The classification accuracy of MRI in flexion was significantly higher than that of MRI in near extension (accuracy, 49 vs 11; P < .001). The diagnostic accuracy of MRI in the 120° flexed-knee position was significantly higher than that in the near–extended-knee position in the acute cases (P < .05); however, no significant differences were observed in the chronic cases. Conclusion: The diagnostic accuracy of MRI in the 120° flexed-knee position for detecting and classifying meniscal ramp lesions was superior to that of MRI in the near–extended-knee position.

ABSTRACTBackground and ObjectivesThis study evaluated the effectiveness of a pocket‐sized ultrasound device in preoperative planning for lymphaticovenular anastomosis (LVA) to enhance lymphedema treatment outcomes.MethodsA retrospective analysis was performed on 24 patients who underwent LVA for secondary upper extremity lymphedema between June 2020 and August 2022. Patients were categorized into two groups: the ultrasound group, which used a pocket‐sized device (Vscan Air), for preoperative vein identification, and a control group that did not. Preoperative lymphatic mapping was performed using indocyanine green lymphography, and suitable veins for anastomosis were identified using ultrasound. Upper extremity lymphedema index and incision length were compared.ResultsParticipants in the ultrasound group had a shorter average incision length (2.85 ± 0.48 cm) than those in the control group (3.23 ± 0.78 cm, p = 0.038), indicating a more targeted and minimally invasive approach. Although volume reduction rates were not significantly different, the pocket ultrasound device facilitated more precise vein selection, enhancing surgical planning.ConclusionPocket‐sized ultrasound devices provide a cost‐effective and practical solution for vein identification during LVA, particularly in resource‐limited settings. While high‐frequency ultrasound offers superior resolution, portable devices could become standard tools for lymphatic surgery with continued technological advancement.