Maizuru Municipal Hospital

To evaluate whether regional treatment settings are associated with differences in the clinical outcomes among older gastric cancer patients undergoing curative gastrectomy. This multicenter retrospective study included 327 patients aged ≥ 80 years who underwent curative gastrectomy for gastric cancer. The patients were classified into urban (n = 118) and rural (n = 209) groups. The baseline characteristics, surgical outcomes, and long-term outcomes were compared. Patients in rural areas had poorer performance statuses, more comorbidities, worse nutritional and inflammatory profiles, and longer distances to the hospital. However, no differences were observed between the urban and rural groups in terms of the surgical approach, postoperative complication rates, or the administration of adjuvant chemotherapy. The 5-year overall survival rates in the rural and urban groups were 66.6% and 59.8%, respectively (p = 0.197). A multivariate Cox regression analysis identified Eastern Cooperative Oncology Group performance status ≥ 2 (hazard ratio: 2.02), carcinoembryonic antigen ≥ 5 ng/mL (hazard ratio: 1.92), pathological stage III (hazard ratio: 3.72), and Clavien-Dindo grade ≥ III complications (hazard ratio: 2.51) as independent predictors of overall survival. The comparable surgical and long-term survival outcomes between patients treated in rural and urban areas suggest that equitable surgical care may be achievable across different geographic settings.

Although several studies have been conducted on dementia disclosure, research on the factors influencing the desire for disclosure remains limited. This study aimed to identify the factors that determine whether patients and caregivers wish to disclose a dementia diagnosis. We conducted a retrospective survey of 804 patients who visited the Dementia Disease Medical Center at the Kyoto Prefectural University of Medicine Hospital. A total of 201 patients were included in this study. We compared survey responses between two groups: those in which the patient wanted the dementia diagnosis disclosed versus those who did not, and those in which the caregiver wanted the diagnosis disclosed versus those who did not. Statistical analyses included the chi-squared test, Fisher's exact test and Mann-Whitney U test. A total of 188 patients (93.5%) wanted to be disclosed about dementia diagnosis, while 151 caregivers (75.1%) wished for the patient's diagnosis to be disclosed. There was a significant difference in hallucinations (as measured by the Neuropsychiatric Inventory 12-item version) between patients who wanted the diagnosis disclosed and those who did not (p < 0.001). Additionally, caregivers who wanted the patient to be informed reported milder symptoms of agitation (p = 0.014) and apathy (p = 0.005) in the patients than did those who did not want the information disclosed. Furthermore, when patients requested a medical examination, caregivers requested that the diagnosis be disclosed to them (p = 0.037). The findings indicate a gap in the awareness of dementia information disclosure between patients and caregivers in Japan. Furthermore, the factors influencing the desire for disclosure appear to differ between patients and caregivers.

PURPOSEMost factors identified in prior studies on meningioma enlargement are qualitative, with limited quantitative evaluation. Predicting future tumor growth from initial imaging of incidentally discovered meningiomas could inform treatment decisions. This study quantitatively evaluates imaging data at diagnosis to identify characteristics associated with tumor enlargement. METHODSWe compared MRI T2 features from the initial imaging of 10 patients in a clearly enlarged group with 10 in a non-enlarged group. Using 3D Slicer and Slicer Radiomics plug-ins, we created a program to set regions of interest (ROIs) in the tumor and calculate various features. Additional ROIs were placed in the outer tumor edge, brain, and white matter contralateral to the tumor. Inter-ROI ratios of features were calculated and compared using PyRadiomics software. We analyzed 107 features across seven classifications: one-dimensional statistics, shape features, Gray Level Co-occurrence Matrix, Gray Level Run Length Matrix, Gray Level Size Zone Matrix, Gray Level Dependence Matrix, and Neighbouring Gray Tone Difference Matrix. A t-test was conducted to identify significant predictors. RESULTSTwenty-four features showed significant differences (p<0.05), including 10 one-dimensional statistics, 1 shape feature, 5 Gray Level Co-occurrence Matrix, 6 Gray Level Run Length Matrix, 1 Gray Level Size Zone Matrix, and 1 Gray Level Dependence Matrix. CONCLUSIONSWe identified potential quantitative predictors of incidentally discovered meningioma growth. Future analysis with a larger sample size will refine these predictors and support the development of a predictive formula and corresponding program.

A 61-year-old man with amyotrophic lateral sclerosis (ALS) on tracheostomy positive pressure ventilation was brought to the emergency room due to decreased consciousness. He was diagnosed with hyperosmolar hyperglycemic nonketotic coma (HHNC) with severe systemic hypotension. He exhibited an adequate response to treatment of continuous intravenous insulin infusion and fluid replacement. On the third day, he developed acute limb ischemia due to extensive occlusion from the left common iliac artery to the femoral artery.

The respiratory instability frequently observed in advanced heart failure (HF) is likely to mirror the clinical status of worsening HF. The present multicenter study was conducted to examine whether the noble respiratory stability index (RSI), a quantitative measure of respiratory instability, reflects the recovery process from HF decompensation. Thirty-six of 44 patients hospitalized for worsening HF completed all-night measurements of RSI both at deterioration and recovery phases. Based on the signs, symptoms, and laboratory data during hospitalization, the Central Adjudication Committee identified 22 convalescent patients and 14 patients with less extent of recovery in a blinded manner without any information on RSI or other respiratory variables. The all-night RSI in the convalescent patients was increased from 27.8±18.4 to 34.6±15.8 (P<0.05). There was no significant improvement of RSI, however, in the remaining patients with little clinical improvement. Of the clinical and laboratory variables, on stepwise linear regression modeling, body weight, peripheral edema, and lung congestion were closely related to the RSI of recovered patients and accounted for 56% of the changes in RSI (coefficient of determination, R2=0.56). All-night RSI, a quantitative measure of respiratory instability, could faithfully reflect congestive signs and clinical status of HF during the recovery process from acute decompensation.

The ontogenetic change in turbiditaxis (i.e. attraction to turbid waters) was examined in the larvae and juveniles of Japanese anchovy Engraulis japonicus by testing three levels of turbidity (0, 20 and 100 ppm of kaolin). Larvae of 12, 20 and 30 mm standard length (LS ) exhibited turbiditaxis to both 20 and 100 ppm of kaolin, whereas 6 mm LS larvae and 45 mm LS juveniles did not exhibit any turbiditaxis. Turbiditaxis might explain the ontogenetic habitat shift from coastal to offshore waters reported for this species.