Kurosawa Hospital

In Japan, the number of autopsies has steadily decreased. Therefore, postmortem imaging methods have positioned as valuable supplemental or complementary tools in autopsy procedures. We clinicians are increasingly faced with the need to infer cause of death from postmortem imaging findings. We report computed tomography (CT) and magnetic resonance imaging (MRI) findings of a 41-year-old man who committed suicide by hanging. CT revealed fractures of the left superior horn of the thyroid cartilage. Head MRI showed high signal intensity in the basal ganglia on the T1-weighted image and high-intensity rims along the cerebral cortex on the diffusion-weighted image; however, these were considered normal postmortem changes. There were no significant findings in the heart, major blood vessels, or abdominal organs. The contents of the stomach were minimal, and no tablets or other evidence suggestive of drug overdose were identified. Traumatic changes were not observed. Based on the scene and his circumstances, it was speculated that he died by hanging and an autopsy was not performed. This case highlights the importance of understanding normal postmortem brain imaging changes to estimate the true cause of death.

再発脳動脈瘤に対する直達手術は，さまざまな要因により治療が難しくなる．今回，過去7年間に直達手術により再治療を行った再発脳動脈瘤16例を対象とし，治療戦略と成績について後方視的検討を行った．

The continence self-management programme fee (CSPF) for hospitalized patients was revised in 2020 to include those receiving consistent care on an out-patient basis. We extracted candidate patients for CSPF on an out-patient basis (out-patient candidates hereafter) from those for whom-CSPF had been calculated during hospitalization at our hospital, and defined those who had undergone a medical examination related to continence care as out-patient calculation candidates. Of the 956 patients for whom CSPF had been calculated during hospitalization, 482 patients (50%) were out-patient candidates ; 275 (54%) and 169 (33%) of whom were seen in the urology and neurosurgery departments, respectively. Of the 482 out-patient candidates, 238 (49%) were out-patient calculation candidates ; 197 (83%) and 14 (6%) of whom were seen in the urology and neurosurgery departments, respectively. Forty-two and 41 of the calculation candidates were cases of benign prostatic hyperplasia and bladder cancer, respectively. The CSPF was actually processed 93 times for 78 of the 482 out-patient candidates (16%). There were various obstacles in the current system of calculating the fees to realize consistent care from hospitalization to out-patient care.

Abnormal foot movements seen in hemiplegic patients include drop foot and clubfoot. This study aimed to detect and evaluate abnormal foot movements during early stance phase of hemiplegic patients using inertial sensors. Two inclination angles associated with abnormal foot movement were calculated from acceleration and angular velocity obtained from inertial sensors, and reference range of healthy subjects was created by defining a two-dimensional plane with these two angles. In addition, the angle distribution was divided into 3 groups based on the stride length, and the reference range was created for each group. Measured data of paralyzed side of a hemiplegic subject was suggested to be abnormal foot movements by comparing to the reference range. Therefore, the reference ranges of healthy subject for different stride lengths are expected to be useful for the detection and evaluation of abnormal movements of hemiplegic subjects.

自己血管による内シャント（arteriovenous fistula： AVF）は本邦における慢性透析用バスキュラーアクセスの中で最も多い．AVF造設術は一定の割合で不成功例を認めるが，本邦において大規模RCTは行われておらず，AVFの初期開存に影響を与える因子の詳細な解析は行われていない．今回AVF造設術を施行した症例群をレトロスペクティブに解析し，初期開存に影響を及ぼす因子を解析した．対象とした119例の内，シャント閉塞をきたした症例は15例（12.6％）であり，初期開存に影響を与える因子として有意差を認めた項目は深部静脈血栓症（deep vein thrombosis： DVT）の既往のみであった．過去の論文にて開存率に影響を与える因子とされている，性別，年齢，糖尿病の既往などの因子よりも，血栓素因の有無がAVF初期開存に重要な影響を与える可能性が示唆された．

To date, research has not determined the optimal procedure for adjuvant androgen deprivation therapy (ADT) in patients with locally advanced prostate cancer (PCa) treated for 6months with neoadjuvant ADT and external-beam radiation therapy (EBRT). A multicenter, randomized, phase 3 trial enrolled 303 patients with locally advanced PCa between 2001 and 2006. Participants were treated with neoadjuvant ADT for 6months. Then, 280 patients whose prostate-specific antigen levels were less than pretreatment levels and less than 10ng/mL were randomized. All 280 participants were treated with 72Gy of EBRT in combination with adjuvant ADT for 8months. Thereafter, participants were assigned to long-term ADT (5years in all; arm 1) or intermittent ADT (arm 2). The primary endpoint was modified biochemical relapse-free survival (bRFS) with respect to nonmetastatic castration-resistant prostate cancer (nmCRPC) progression, clinical relapse, or any cause of death. The median follow-up time after randomization was 8.2years. Among the 136 and 144 men assigned to trial arms 1 and 2, respectively, 24 and 30 progressed to nmCRPC or clinical relapse, and 5 and 6 died of PCa. The 5-year modified bRFS rates were 84.8% and 82.8% in trial arms 1 and 2, respectively (hazard ratio, 1.132; 95% confidence interval, 0.744-1.722). Although modified bRFS data did not demonstrate noninferiority for arm 2, intermittent adjuvant ADT after EBRT with 14months of neoadjuvant and short-term adjuvant ADT is a promising treatment strategy, especially in a population of responders after 6months of ADT for locally advanced PCa.

This study aimed to first elucidate prostate-specific antigen (PSA) kinetics in prostate cancer patients treated with carbon ion radiotherapy (CIRT). From 2010 to 2015, 131 patients with prostate adenocarcinoma treated with CIRT (57.6 Gy relative biological effectiveness (RBE) in 16 fractions) alone were recruited. PSA was measured at 1, 2, 3, 6, 9, 12, 15, 18, 21, 24, 30, 36, 42, 48, 54, and 60 months post-CIRT. PSA bounce was defined as PSA increase over a cutoff followed by spontaneous decrease to or below the pre-bounce nadir. PSA failure was determined using the Phoenix criteria (nadir + 2.0 ng/mL). As a result, non-failure-associated temporary increase in PSA exhibited two distinct patterns, namely a classical bounce and a surge at one month. PSA bounce of ≥0.2 ng/mL was observed in 55.7% of the patients. Bounce amplitude was <2.0 ng/mL in 97.6% of cases. Bounce occurred significantly earlier than PSA failure. Younger age was a significant predictor of bounce occurrence. Bounce positivity was a significant predictor of favorable 5-year PSA failure-free survival. Meanwhile, a PSA surge of ≥0.2 ng/mL was observed in 67.9% of patients. Surge amplitude was significantly larger than bounce amplitude. Larger prostate volume was a significant predictor of PSA surge occurrence. PSA surge positivity did not significantly predict PSA failure. In summary, PSA bounce was distinguishable from PSA failure with regard to timing of occurrence and amplitude (earlier and lower for bounce, respectively). These data are useful for post-CIRT surveillance of prostate cancer patients.