Tokai University Hachioji Hospital

The mechanisms of luminal narrowing after percutaneous coronary intervention (PCI) with directional coronary atherectomy (DCA) and drug-coated balloon (DCB) remains unclear. This study aimed to investigate the pattern and mechanisms of luminal narrowing after DCA/DCB using optical coherence tomography (OCT). Patients who underwent DCA/DCB for de novo lesions and serial OCT imaging at 3, 6, and 18 months were evaluated to determine the pattern of luminal narrowing. Among 40 patients who had follow-up (F/U) OCT at 3 months post-PCI, 33 and 23 patients had F/U at 6 and 18 months, respectively. Thirty-six of the 40 (90.0%) cases exhibited a layered pattern at the 3-month F/U, 31 of 33 (93.9%) at the 6-month F/U, and 22 of 23 (95.7%) at the 18-month F/U. Layer progression was identified in 21 of 33 (63.6%) and 4 of 23 (17.4%) at the 6- and 18-month F/Us, respectively. The patients with layer progression tended to have a higher prevalence of diabetes (16.7% vs 52.4%, p = 0.067), a lower rate of dual-antithrombotic therapy (DATT) use (58.3% vs 19.0%, p = 0.052) between the 3- and 6-month F/Us, and a significantly higher rate of no or low-intensity statin use (0.0% vs 41.7%, p = 0.037) between the 6- and 18-month F/Us. In Conclusion, layer progression and luminal narrowing occurred mainly during the first 6 months after DCA/DCB. Patients with luminal narrowing tended to have a higher prevalence of diabetes, standard DATT duration, and no or low-intensity statin use.

Abstract High‐intensity focused ultrasound (HIFU) has emerged as a widely adopted, minimally invasive treatment for localized prostate cancer (PC). Although originally applied for whole‐gland treatment, recent advancements in imaging and technology have facilitated the adoption of HIFU as a focal therapy modality, targeting clinically significant prostate cancer (CSPC) while preserving surrounding functional structures. Recently, transrectal prostate compression during HIFU has been developed to improve treatment precision by reducing intraoperative prostatic swelling and minimizing target displacement. This method improves the ultrasound propagation path, enhances cavitation, and mitigates the heat‐sink effect by reducing blood flow within the prostate. Clinical outcomes using HIFU with compression in 240 patients demonstrated high biochemical and pathological disease‐free survival rates across low‐, intermediate‐, and high‐risk groups (93.7%/92.2%, 88.5%/91.6%, and 84.8%/86.6%, respectively), with radical treatment‐free survival >94% in all groups. Complication rates were low, with no cases of recto‐urethral fistula reported. The rate of CSPC detection in follow‐up biopsies was significantly lower than in previous studies, suggesting improved local control. These findings support the efficacy and safety of focal HIFU therapy with intraoperative compression as a promising treatment for localized PC.

ObjectivesThe objective of this study was to compare the adhesive strength and flexibility of 3 surgical sealants—synthetic (Hydrofit; Sanyo Chemical Industries, Kyoto, Japan), albumin-based (BioGlue; Artivion, Kennesaw, GA, USA), and fibrin-based (Beriplast; CSL Behring, Tokyo, Japan)—which are commonly used in cardiovascular surgery but unexplored under identical experimental conditions.MethodsAdhesive strength was evaluated using a tensile adhesion test on collagen, polyester, and polytetrafluoroethylene substrates. Flexibility was assessed by measuring the maximum stress and elongation at failure in Hydrofit and BioGlue film samples. Beriplast was excluded as it failed to form films.ResultsHydrofit and BioGlue showed similar collagen–collagen adhesion strengths (p = 0.11), while Beriplast was significantly weaker (p <0.01). Hydrofit outperformed both BioGlue and Beriplast (p <0.01) in collagen–polyester and collagen–expanded polytetrafluoroethylene (ePTFE) adhesions. Hydrofit also demonstrated a significantly higher elongation rate, strength, and maximum stress before rupture than BioGlue.ConclusionsThese surgical sealants possess distinct adhesive and mechanical characteristics. Hydrofit showed stable adhesion across various substrates, with notable flexibility. BioGlue displayed adequate adhesion on collagen surfaces but had restricted flexibility. Beriplast demonstrated reduced adhesion. Although only adhesive strength and flexibility were evaluated, such properties may offer valuable insights into sealant traits contextually. These potentially aid in the selection of appropriate sealants for cardiovascular procedures that require both durable adhesion and tissue compliance. Further in vivo validation is warranted.

Cecal volvulus is a rare but potentially life-threatening cause of colonic obstruction. Emergency surgery is standard but is associated with high morbidity and mortality, especially in high-risk patients. Therefore, non-operative management may be an important alternative in selected cases.A 90-year-old man presented to the emergency department with abdominal distension and pain. He was diagnosed with cecal volvulus without evidence of intestinal necrosis, accompanied by right lower lobe atelectasis and pleural effusion, both attributed to compression of the lung secondary to massive colonic distension. Given the absence of necrosis and the high anesthetic risk associated with advanced age and underlying pulmonary compromise, non-operative management was initiated using a transnasal ileus tube. Successful detorsion was confirmed on day 7 post-insertion, and the patient was discharged. Elective laparoscopic ileocecal resection was performed subsequently to prevent recurrence. Postoperative pneumonia was noted, but no other complications occurred, and the patient was discharged on postoperative day 19. At the 11-month follow-up, the patient remained in good health with no evidence of recurrence.We report a case of cecal volvulus without intestinal necrosis successfully managed by transnasal ileus tube decompression followed by elective laparoscopic ileocecal resection. This approach may be a viable option to avoid emergency surgery in high-risk patients and expands the therapeutic options for elderly individuals.

Introduction:It remains unclear which treatments are effective for addressing mental disorders in patients with acute myocardial infarction (AMI). Therefore, we evaluated the changes over time in anxiety and depression from intensive care units (ICUs) to outpatient departments (OPDs), as well as the post-discharge prevalence of anxiety and depression in AMI patients who underwent percutaneous coronary intervention (PCI) and received treatments based on the ABCDEFGH bundle, including nurse-led continuous follow-up.Methods:This retrospective cohort study involved 29 patients who were hospitalized in the ICU for treatment of AMI. All patients received PCI and treatment based on the ABCDEFGH bundle. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) at three phases: ICU, general ward (GW), and OPD. First, we compared changes in anxiety and depression scores over time using HADS across the three phases. Second, we assessed the prevalence rate of anxiety and depression after hospital discharge based on HADS scores.Results:Of the 29 patients, the mean age was 67 ± 14 years, and 66% were male. For the anxiety subscale (HADS-A), scores improved from ICUs to OPDs (6.4-3.9 points, p = 0.001). For the depression subscale (HADS-D), there were no significant changes between ICU and GW, or between ICU and OPD (5.4-6.7, 5.4-5.2 points, respectively; all not significant). At the OPD stage, 14% of patients were in an anxiety state, and 34% were in a depression state.Conclusions:In AMI patients who received PCI and treatments based on the ABCDEFGH bundle, the depression state remained unchanged from ICUs to OPDs, while the anxiety state improved after hospital discharge. The prevalence of anxiety was 14%, and the prevalence of depression was 34% after hospital discharge.

Recent advances in PET image reconstruction have focused on achieving high image quality and quantitative accuracy. Bayesian penalized likelihood (BPL) algorithms, such as Q.Clear and HYPER Iterative that have been integrated into commercial PET systems offer robust image noise suppression and edge preservation through regularization. In parallel, methods based on deep learning such as SubtlePET, AiCE, uAI® HYPER DLR, and Precision DL have emerged primarily as post-processing techniques. They use trained convolutional neural networks to reduce image noise while preserving lesion contrast. These methods have reduced image acquisition times or reduced radiotracer doses while maintaining diagnostic confidence. uAI® HYPER DPR represents a hybrid approach by embedding deep learning in iterative reconstruction. This review summarizes the technical principles and the clinical performance of BPL and deep learning-based PET reconstruction algorithms, and discusses key considerations such as image quality and quantitative accuracy of PET images. This review should deepen understanding of advanced PET image reconstruction techniques and accelerate their clinical implementation across diverse PET imaging applications.

The Japanese treatment guidelines recommend treatment of the root of the inferior mesenteric artery (IMA) (#253) to ensure ligation and dissection of the root of the IMA (#253) in descending colon cancer/sigmoid colon cancer deeper than in T2 [muscularis propria (MP)] cancer. However, #253 complete D3 dissection with IMA root ligation has been reported to increase postoperative complications, such as colonic ischemia, and to have a worse prognosis compared to IMA-preserving D3 system dissection. Therefore, we decided to compare complete IMA dissection with ligation and dissection of the IMA root and preserving the left colonic artery (LCA) preserving group. A total of 172 patients with stage II/III primary sigmoid colorectal cancer who had undergone radical curative resection were categorized into two groups: the IMA root ligation group (#253 complete D3 dissection group) and the LCA preservation group (94/78 cases), in which the IMA root was preserved and either lymph node sampling dissection or peripheral ligation of the left colorectal artery bifurcation was performed. The 5-year recurrence-free survival (5Y-RFS) and 5-year overall survival (5Y-OS) rates were compared. The overall 5-year follow-up rate was 70.23%. 5Y-RFS and 5Y-OS were tested, and no significant differences were found. Similarly, there were no significant differences in the background factors. In the laparotomy/hand-assisted laparoscopic surgery (HALS)/laparoscopic surgery procedure, complete IMA ligation tended to be more common in the HALS group, whereas LCA preservation tended to be more prevalent in the laparoscopic surgery group. There were no significant differences in the postoperative complications between the groups. Anastomotic failure occurred in 6/3 patients in the IMA complete ligation/LCA preservation groups; bowel obstruction in 5/4; wound infection in 10/5; posterior hemorrhage in 1/4; dysuria in 5/1; and urinary tract infection (including cystitis) in 2/1. Postoperative cerebral infarction, ureteral injury, and thigh paresthesia were each observed in only one case in the complete ligation group. These results showed no significant differences in the 5Y-OS or 5Y-RFS. There was no significant difference in prognosis between patients with and without lymph node dissection at the root of the IMA. Thus, there was no significant difference in prognosis between the complete IMA ligation and LCA preservation groups, with or without IMA dissection. There were no significant differences in complications in the complete ligation group; however, the number of cases seemed large. These results suggest that preservation of the IMA may be safe and effective for stage II/III lymph node dissection in primary sigmoid colorectal cancer.

Several Ephedra Herb-containing Kampo medicines are common initial treatments for various infections; however, the ephedrine alkaloids in Ephedra Herb can cause side effects by stimulating adrenergic receptors. Accordingly, an ephedrine alkaloids-free Ephedra Herb Extract (EFE) has been developed. This study aimed to evaluate whether EFE can be used effectively and safely in patients with mild coronavirus disease 2019 (COVID-19). We randomized patients with mild COVID-19 to receive EFE equivalent to 6 g of Ephedra Herb per day or a placebo for 14 days. The primary efficacy endpoint was the non-aggravation rate up to Day 15. We allocated 41 and 40 patients to the EFE and placebo groups, respectively. All participants were included in the mITT and safety analysis populations [male ratio, mean age: 31.7%, 42.0 years (EFE); 17.5%, 43.2 years (placebo)]. The non-aggravation rate up to Day 15 for the primary endpoint was 100.0% and 94.6% in the EFE and placebo group, respectively, with no between-group difference. The number of days to the improvement in nausea symptoms was significantly shorter in the EFE group. One patient in the placebo group discontinued the trial due to a side effect. Although EFE demonstrated safety in patients with mild COVID-19, it did not show superior efficacy compared to placebo for symptoms other than nausea.