Kinan Hospital

Primary malignant neoplasms of the epididymis are rare. In this case report, we describe clear cell carcinoma associated with papillary cystadenoma of the epididymis (PCE). A 77-year-old man presented with a painless, enlarged left scrotum. Magnetic resonance imaging (MRI) revealed two different abnormal signals in the left epididymis. A left high inguinal orchiectomy and histopathological examination revealed a benign component consistent with PCE and a malignant component showing solid growth with cell nuclear enlargement, atypical mitotic figures, and invasion into surrounding tissues. The final diagnosis was malignant transformation to clear cell carcinoma of PCE. Although this epididymis tumor may follow an indolent course, the presence of areas with higher proliferative potential suggests surgical excision be recommended as definitive treatment.

Multicenter retrospective cohort study. To evaluate the impact of abscess presence and type on treatment duration and clinical outcomes in patients undergoing minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis. Surgical management is increasingly favored for pyogenic spondylitis. Abscesses, particularly epidural and iliopsoas, have been linked to poorer prognoses, and empyema, though uncommon, tends to be particularly severe. However, the effect of specific abscess types on surgical outcomes remains unclear. This study included 92 patients who underwent minimally invasive posterior fixation across 10 centers between 2014 and 2024. Patients were classified into an abscess group (epidural, iliopsoas, empyema, or other) and a non-abscess group. Clinical outcomes, including total duration of intravenous antibiotics and unplanned additional surgeries, were compared. Subgroup and regression analyses were conducted to assess the impact of specific abscess type. Abscesses were present in 65 patients (71%): epidural (n=51), iliopsoas (n=38), and empyema (n=3), with some overlap. Compared with the non-abscess group (n=27; 29%), there were no significant differences in antibiotic duration or rates of unplanned additional surgery. However, iliopsoas abscess was associated with longer antibiotic duration (8.1 weeks vs. 6.6 weeks, p =0.044), while all empyema cases required additional surgery for poor infection control (p =0.000). Regression analysis identified iliopsoas abscess and age ≥65 years as independent predictors of prolonged antibiotic use, whereas epidural abscess was associated with shorter antibiotic duration. Iliopsoas abscesses were associated with longer antibiotic courses, while empyema was linked to poor infection control and a higher likelihood of additional surgery.

Abstract Background While the thresholds of fractional flow reserve (FFR) and non-pressure hyperaemic ratios (NHPR) for identifying myocardial ischemia (≤0.75 for FFR, ≤0.89 for NHPR) and guiding coronary revascularization (≤0.80 for FFR, ≤0.89 for NHPR) are well established, the values associated with anginal symptoms and impaired exercise capacity in patients with chronic coronary syndrome (CCS) remain unknown. Purpose To identify the FFR and diastolic pressure ratio (dPR) thresholds associated with anginal symptoms and impaired exercise capacity in patients with CCS. Methods This prospective multicentre registry enrolled 208 patients with suspected CCS undergoing coronary angiography with invasive intracoronary pressure measurements at five institutions in our city, Japan. Patients with normal coronary arteries (n=12), coronary anatomies unsuitable for intracoronary pressure assessments (n=21), and one patient who did not undergo intracoronary pressure measurements were excluded, leaving 174 patients for analysis. All patients underwent a 6-minute walk test before cardiac catheterization, meaning that the test results were not influenced by prior knowledge of the severities of their disease. Anginal symptoms and 6-minute walk distance were assessed, with impaired exercise capacity defined as a walk distance below the expected distance based on age, sex, height, and body weight. The Youden index with receiver operating characteristic (ROC) curve analysis was used to determine the FFR and dPR thresholds associated with anginal symptoms and impaired exercise capacity. Results The median age of the patients was 73 [67, 77], and 78% were male. The median 6-minute walk distance was 395 m [325, 447]. Anginal symptoms were reproduced in 40 (23%) patients during the 6-minute walk test, and 39 (22%) had impaired exercise capacity. The median FFR was 0.73 [0.55, 0.85], and the median dPR was 0.85 [0.56, 0.93]. In ROC curve analyses, the area under the curve (AUC) for FFR in identifying anginal symptoms during 6-minute walk test was 0.68 [0.58, 0.79] (P<0.001), while that for dPR was 0.69 [0.59, 0.79] (P<0.001) [Fig.1]. The FFR threshold associated with anginal symptom was 0.53, with a sensitivity of 46% and specificity of 91%, while dPR threshold was 0.63, with a sensitivity of 51% and specificity of 85%. The AUC for FFR in identifying impaired exercise capacity was 0.55 [0.44, 0.66], and that for dPR was 0.56 [0.45, 0.67], indicating that neither FFR nor dPR was significantly associated with impaired exercise capacity (P=0.301 for FFR, P=0.257 for dPR, respectively) [Fig.2]. Conclusion The hemodynamic severity of coronary stenoses, as assessed by FFR and dPR, was associated with anginal symptoms but not with impaired exercise capacity. The FFR and dPR thresholds associated with anginal symptoms were lower than those typically used for ischaemia detection and revascularization decisions.

Neurofibromatosis type 1 (NF1) is a common autosomal dominant disorder associated with central nervous system gliomas, most frequently optic pathway gliomas; however, oligodendrogliomas in the setting of NF1 are exceedingly rare, with no prior documented cases and no established treatment strategies to date. A 53-year-old female with NF1-associated oligodendroglioma experienced multiple recurrences following surgery, radiotherapy, chemotherapy, and targeted therapy. Upon further disease progression, she was treated with a novel combination of thiotepa, bevacizumab, teniposide, and the mitogen-activated protein kinase kinase 1/2 (MEK1/2) inhibitor tunlametinib. After one treatment cycle, the patient achieved a marked reduction in tumor volume, consistent with a complete response (CR). She subsequently completed eight additional cycles of the regimen and has maintained CR. The treatment was well-tolerated, with manageable grade 3 myelosuppression controlled by supportive care. As of June 2025, the patient has achieved a CR with a progression-free survival of 9 months before experiencing disease recurrence. This rare case of NF1-associated oligodendroglioma was managed with thiotepa, bevacizumab, teniposide, and tunlametinib, highlighting the potential of MEK inhibition in NF1-related gliomas.

We report our findings in a case in which the retinal traction caused by an epiretinal membrane (ERM) was relieved by a spontaneous posterior vitreous detachment (PVD). A 53-year-old woman complained of visual disturbances in both eyes. Her decimal best-corrected visual acuity (BCVA) was 1.2 (about 20/16 in Snellen units) in both eyes with no abnormalities in the anterior chamber, lens, or vitreous. Ophthalmoscopy and optical coherence tomography revealed a Stage 3 ERM in the right eye with a foveal macular thickness (FMT) of 408 μm and an intact posterior hyaloid membrane. The M-chart score was 0° in both the horizontal and vertical directions. She was followed with observation only. Eight months later, the patient returned with a complaint of floaters in the right eye. Her decimal BCVA remained at 1.2 in both eyes with no retinal tears, retinal detachment, or vitreous hemorrhage. However, a PVD was detected with a detachment of the ERM into the vitreous cavity. The FMT had decreased to 389 μm, and the macular traction appeared to be relieved. The detachment of the ERM reduced the retinal traction, and the BCVA was maintained during the 27-month follow-up period. This case shows the long-term stability without decreasing BCVA or recurrence of an ERM. We suggest that the detachment of the ERM was due to the development of a PVD which then led to the release of retinal traction. We recommend that surgery not be performed in cases of idiopathic ERM without a PVD and with good visual acuity and no metamorphopsia. Instead, these cases should be carefully monitored for visual symptoms and a worsening of the traction on the retina.

BackgroundDespite the acknowledged importance of addressing postpartum anxiety alongside postpartum depression, standardized screening tools specifically developed for this purpose remain limited.ObjectiveThis study aimed to validate the anxiety factor of the Edinburgh Postnatal Depression Scale (EPDS) and to determine optimal cutoff scores for screening postpartum anxiety.MethodsEPDS and the State-Trait Anxiety Inventory (STAI) were collected from 100 Japanese women at one month postpartum at Niigata University Medical and Dental Hospital between May 18, 2021, and December 28, 2022, using random convenience and purposive sampling. Confirmatory factor analysis (CFA) was conducted on data from 84 participants to test six previously proposed EPDS factor models, and receiver operating characteristic (ROC) analysis was performed on data from 83 participants to determine area under the curve (AUC) values and cutoff scores. The EPDS anxiety subscales with three items (EPDS-3A) and four items (EPDS-4A) were separately evaluated as predictor variables, with STAI state and trait anxiety as criterion measures. We assessed accuracy, sensitivity, and specificity.ResultsAll models with two-factor and three-factor showed a good fit to the data, with two models with EPDS-3A being superior among other models (comparative fit index = 1.000, root mean square error of approximation = 0.001). ROC analyses indicated good testing accuracy of the EPDS anxiety subscales for detecting both state and trait anxiety. For EPDS-3A, the AUCs were 0.832 (95% CI 0.735–0.930) for state anxiety with an optimal cutoff of ≥3 (sensitivity 79.2%, specificity 79.7%), and 0.912 (95% CI 0.837–0.988) for trait anxiety with an optimal cutoff of ≥4 (sensitivity 82.4%, specificity 84.8%). For EPDS-4A, the AUCs were 0.833 (95% CI 0.736–0.930) for state anxiety with an optimal cutoff of ≥4 (sensitivity 79.2%, specificity 71.2%), and 0.935 (95% CI 0.867–1.000) for trait anxiety with an optimal cutoff of ≥5 (sensitivity 88.2%, specificity 87.9%).ConclusionBoth the EPDS-3A and EPDS-4A demonstrated good model fit and screening accuracy for anxiety at one month postpartum. Integrating anxiety screening into routine postpartum care may improve maternal mental health outcomes. Future studies involving clinical settings and larger cohort studies are recommended to improve external validity.

PurposeManual alpha angle measurement for diagnosing cam‐type femoroacetabular impingement (FAI) is time‐consuming and variable. We hypothesised that a smartphone‐based artificial intelligence (AI) system would demonstrate a high correlation with the conventional manual method.MethodsWe trained an AI model using 300 of the 45° Dunn view radiographs in a Python‐based environment. The model was implemented using a smartphone application that semi‐automatically extracted the femoral head from radiographs, detected at least four rim points, and calculated the femoral head centre and radius using a least‐squares method. It also identified the narrowest part of the femoral neck, and allowed manual adjustment of the alpha angle deviation. The images were directly captured and transferred without time loss. We evaluated 130 hips of patients with hip pain who underwent 45° Dunn view radiography. The alpha angle was measured using both the AI system and the manual method. Pearson correlation coefficient was used to assess agreement between the two methods. Measurement time and intra‐ and interobserver reliability were assessed using intraclass correlation coefficients (ICC).ResultsPearson correlation coefficient for alpha angle measurement between the two methods was 0.91, indicating a strong correlation. The average alpha angle measured by the AI system (52.7 ± 6.0°) was not significantly different from that of the conventional method (53.9 ± 6.5°, p = 0.12). The AI‐powered system showed intra‐ and interobserver agreement ICCs of 0.96 and 0.93, respectively, demonstrating excellent reliability. The mean measurement time was 5.0 ± 2.4 and 46.7 ± 10.1 s for the AI‐powered system and manual method, respectively, indicating significant time‐saving.ConclusionThe AI‐powered system showed a strong correlation with the manual method and significantly reduced measurement time. This smartphone‐based tool offers a rapid and reliable approach for real‐time assessment of alpha angles and may help standardise the evaluation of cam‐type FAI in clinical practice.Level of EvidenceLevel III, retrospective comparative study.

This study aimed to investigate the effect of hydroxyapatite (HA) augmentation on the maximum lag screw insertion torque (TMax) using extracted human femoral heads. Hemispherical femoral heads extracted from patients who underwent bipolar hip arthroplasty were used. These samples were divided into the HA treatment group (HA group) and the non-HA treatment group (N group). After drilling, HA was inserted into the femoral heads in the HA group. A lag screw was inserted into the femoral head using a dedicated jig in both groups. The bone mineral density of the uninjured contralateral femoral neck (f-BMD), TMax, and the TMax/f-BMD ratio were evaluated. Twenty-seven samples were analyzed in this study: 14 samples in the HA group and 13 samples in the N group. No significant differences were observed in f-BMD and TMax between the two groups (HA: 0.49 ± 0.11 vs. N: 0.48 ± 0.092 g/cm2, p = 0.90; HA: 5.6 ± 1.9 vs. N: 4.3 ± 1.9 N･m, p = 0.78). Considering bone mineral density, the HA group showed a significantly higher TMax/f-BMD ratio than the N group (11.7 ± 3.3 vs. 8.9 ± 3.2 N･m･cm2/g, p = 0.036). Correlation coefficients between f-BMD and TMaxin both groups were moderately strong (r = 0.50 vs. 0.50). Our results suggest that HA augmentation improves lag screw fixation strength in the treatment of osteoporotic intertrochanteric femoral fractures.

Background/AimThis study aimed to assess the effectiveness and safety of 100 U onabotulinumtoxinA (also known as botulinum toxin type A) for overactive bladder (OAB) and urgency urinary incontinence (UUI) in Japanese women.Patients and MethodsThis prospective, nonrandomized study was conducted as a single-center clinical trial in Japan and targeted patients with OAB that did not respond adequately to standard treatments, including anticholinergics and β3-adrenergic receptor agonists. A total of 26 patients received a single intradetrusor injection of onabotulinumtoxinA. The primary endpoint was the change in the number of daily UUI episodes between baseline and week 12. The secondary endpoints were improvements in other OAB symptoms and health-related quality of life (HRQoL). Adverse events were monitored.ResultsPatients who received onabotulinumtoxinA experienced a significant reduction in the mean number of daily UUI episodes between baseline and week 12 (−3.49; p<0.001). Significant improvements in all secondary endpoints except the personal relationships domain of King’s Health Questionnaire were observed. Adverse events, such as urinary tract infection, cystitis, dysuria, and increased postvoid residual urine volume, occurred more frequently with onabotulinumtoxinA. However, the severity of most adverse events was mild or moderate.ConclusionOnabotulinumtoxinA administered at a dose of 100 U was well-tolerated and resulted in significant and clinically meaningful improvements in the OAB symptoms and HRQoL of patients whose OAB could not be adequately managed with other treatments.