Surugadai Nihon University Hospital

To characterize choroidal circulation in the vortex veins in central serous chorioretinopathy. Single-center retrospective study. The study included 22 eyes with central serous chorioretinopathy from 22 patients with serous retinal detachment at the macula (18 men and four women, mean age 47.3 years). Ultra-widefield indocyanine green angiography was performed using Optos®California, and images were taken intermittently from the early to the late phase (> 20 min of contrast) to examine late images of the vortex veins. Findings in the affected and contralateral eyes were also compared. In 13 of the 22 eyes, the vortex veins were hypofluorescent in all quadrants and continuous with the vortex ampullae. In five eyes, only the asymmetric dilated vortex vein was hypofluorescent, and in four eyes, the vortex veins were not hypofluorescent. Of the 22 contralateral eyes examined, 20 eyes exhibited identical findings in the vortex veins to those observed in the affected eye. Of the four eyes that did not exhibit hypofluorescence of the vortex veins in the affected eye, two eyes had partial hypofluorescence of some vortex veins in the contralateral eye, showing different findings. In the late phase, some eyes showed hypofluorescence due to the washout of indocyanine green dye in the vortex veins and others did not, suggesting that obstruction of the scleral passage in the choroidal venous outflow is not the main cause of the syndrome.

Abstract A zinc porphyrin bearing 4 1,10-phenanthroline units, ZnPor(phen)₄, forms cofacial dimers upon coordination with Zn²⁺ or Cu⁺ ions. Ultraviolet-visible spectroscopy, electrospray ionization mass spectrometry, and 1H nuclear magnetic resonance ring-current analysis reveal dimers comprising 2 porphyrins linked by 4 tetrahedral M(phen)₂ complexes (M = Zn²⁺, Cu⁺). Compared with a bipyridine analog, the phenanthroline derivative exhibits higher stability, demonstrating that ligand rigidity and stronger metal–ligand binding enhance the robustness of coordination-induced porphyrin assemblies.

PurposeTo evaluate the utility of a magnetic resonance imaging (MRI) projection mapping system (PMS) for determining the resection lines during breast-conserving surgery (BCS) in patients with breast cancer presenting with nonmass enhancement (NME) and identify the clinical or MRI variables associated with close or positive margins.Materials and methodsForty-one patients with breast cancer exhibiting NME were enrolled. In the operating room, a maximum intensity projection image generated from supine MRI was projected onto the breast using a PMS, which employed a structured light method to measure the surface of the breast. Cancer contours delineated on the MRI-PMS, with an additional safety margin, served as the resection lines for cylindrical BCS. Margins were pathologically categorized as negative (> 2 mm), close (≤ 2 mm), or positive. The association between margin status and clinical or MRI variables was analyzed.ResultsSurgical margins were negative in 24 patients (58.5 %), close in 15 (36.6 %), and positive in 2 (4.9 %). There were significant differences in the maximum diameter of nonmass components (NMCs) shown by pathology, that of NME on MRI, and the discrepancy between the two diameters between patients with negative margin and those with close or positive margin (< 0.05 for all). Receiver operating characteristics revealed that threshold of 40 mm for NMEs provided high specificity of 91.7 %.ConclusionThe MRI-PMS led to a low rate of positive margins during BCS in patients with breast cancer with NMEs. Large NMCs and NMEs are associated with positive or close margin.

Asymmetric dilated vortex veins (ADVV) extending continuously to the vortex ampullae seen on Indocyanine green angiography (ICGA) findings, are thought to indicate choroidal venous congestion in central serous chorioretinopathy (CSC). In addition, the sclera is thickened compared to normal eyes, suggesting that obstruction of the scleral passage is the pathophysiological mechanism of CSC. The purpose of this study was to examine the choroidal circulation in and around the vortex vein ampulla. Single-center retrospective study. The subjects were 23 CSC eyes with macular central serous detachment (SRD) undergoing wide-field ICGA with Spectralis®. Choroidal circulation time was defined as the time from the onset of filling in the choroidal artery to the first appearance of dye in the vortex vein ampulla. The choroidal circulation time in the superior and inferior vortex veins were measured separately. The relationship between the ADVV and the choroidal circulation time was investigated. The mean choroidal circulation time was 4.44 seconds for the superior temporal side and 4.33 seconds for the inferior temporal side, with no significant difference (p=0.494). The mean choroidal circulation time was 3.89 seconds on the ADVV side and 4.88 seconds on the non-ADVV side, with a shorter mean circulation time on the ADVV side (p=0.00005). In 21 of 23 eyes, there was a time difference in the filling of the choroidal veins entering the vortex vein ampulla. On the side of the ADVV, no obstruction to the passage of the sclera is thought to have occurred.

Cervical spine injuries in the elderly (defined as individuals aged 65years and older) are increasing, often resulting from falls and minor trauma. Prognosis varies widely, influenced by multiple factors. This study aimed to develop a deep-learning-based predictive model for post-injury outcomes. This study analyzed a nationwide dataset from the Japan Association of Spine Surgeons with Ambition, comprising 1512 elderly patients (aged 65years and older) with cervical spine injuries from 2010 to 2020. Deep learning predictive models were constructed for residence, mobility, and the American Spinal Injury Association Impairment Scale (AIS). The model's performance was compared with that of a traditional statistical analysis. The deep-learning model predicted the residence and AIS outcomes with varying accuracies. The highest accuracy was observed in predicting residence one year post-injury. The model also identified that the AIS score at discharge was significantly predicted by upper extremity trauma, mobility, and elbow extension strength. The deep learning model highlighted factors, such as upper extremity trauma, that were not considered significant in the traditional statistical analysis. Our deep learning-based model offers a novel method for predicting outcomes following cervical spine injuries in the elderly population. The model is highly accurate and provides additional insights into potential prognostic factors. Such models can improve patient care and individualize future interventions.

Abstract Several risk factors for adjacent segment disease (ASD) after posterior lumbar interbody fusion (PLIF) have been reported. However, the reducing the slipped vertebra has not been investigated as a risk factor for ASD. The objective of this study is to identify the risk factors for ASD following single-segment PLIF in patients with L4 spondylolisthesis, with a particular focus on the reduction of vertebral body slippage. Fifty-two patients who underwent PLIF at the L4-L5 level for L4 degenerative spondylolisthesis were investigated. Patients were divided into two groups: the ASD group and the non-ASD group. The ASD group consisted of 12 of the 52 patients (23.1%). %Slip before surgery and at follow-up, Δ%Slip (Δ%Slip = %Slip before surgery - %Slip at follow-up), L4-L5 interbody height, and L4-L5 lordosis angle were evaluated. Stepwise multivariate regression analysis revealed Δ%Slip to be a risk factor for ASD (odds ratio: 1.22, 95% confidence interval: 1.04–1.43, p = 0.015). In the receiver operating characteristic analysis, the cutoff value for Δ%Slip was 7.3% (sensitivity: 75.0%, specificity: 67.5%, area under the curve = 0.725). Our findings suggest that the reduction of L4 slippage may contribute to the development of ASD in patients with L4 spondylolisthesis.