Tokyo Teishin Hospital

The dose of bendamustine used to treat previously untreated follicular lymphoma (FL) is sometimes reduced based on various clinical considerations, but the impact of such dose reductions on outcomes is unclear. We retrospectively analyzed 92 untreated FL patients treated with bendamustine at seven institutions in Japan. Dose reduction was defined as receiving less than 90% of the planned total dose of 1080 mg/m2 over six cycles. Patients with disease progression observed at ≤ 180 days of treatment initiation were defined as primary bendamustine-refractory (PBR). The 3-year overall survival (OS) and progression-free survival (PFS) were 87.1% and 71.8%, respectively. Seven patients were classified as PBR, six of whom received bendamustine at full dose without dose reduction, and they had significantly worse OS with 3-year OS of 38.1%. We excluded the PBR cases from subsequent analyses of the dose intensity's prognostic significance. The dose-reduction group had a significantly lower CR rate (93.0% vs. 74.4%, p = 0.032). Similarly, the 3-year PFS was significantly worse in the dose-reduction group (86.8% vs. 68.1%, p = 0.005). In univariate and multivariate analyses, dose reduction was associated with inferior PFS. In an analysis limited to patients who completed all six courses, the CR rate was comparable between the two groups, but 3-year PFS was significantly worse in the dose-reduction group (86.8% vs. 68.7%, p = 0.041). Furthermore, even among patients who achieved CR, the 3-year PFS tended to be poorer in the dose-reduction group (85.7% vs. 72.7%, p = 0.062). These findings suggest that PBR cases are resistant to bendamustine itself regardless of the dose intensity. In contrast, among responders including those who achieved CR, dose reduction was associated with poorer PFS, indicating that maintaining treatment intensity is important for improving prognosis in the treatment of bendamustine-responsive FL patients.

Background:The meniscus-bone angle (MBA), defined as the angle formed by the lateral meniscus with respect to the lateral tibial slope, has recently been identified as an intrinsic factor associated with primary anterior cruciate ligament (ACL) injuries. However, no studies have investigated the influence of MBA and other intrinsic factors excluding the influence of extrinsic factors, especially the level of sports activity.Purpose/Hypothesis:The purpose was to evaluate the intrinsic factors of primary ACL injury while controlling for the effect of sports activity level. It was hypothesized that the MBA would be a significant factor associated with ACL deficiency, irrespective of the sports activity level.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 143 knees in 139 patients with ACL injuries (group A) and matched controls (matched by age, sex, and Tegner Activity Scale score), 143 knees in 143 patients without ACL injuries (group N), were evaluated. Patient height, body weight, body mass index, lateral posterior tibial slope angle (LPTSA), medial posterior tibial slope angle (MPTSA), MBA of the lateral meniscus, and relative posterior inclination angle (RPIA; MBA – LPTSA) were evaluated between the 2 groups.Results:The MBA (group A: 22.3°± 4.5°; group N: 29.1°± 3.7°) and RPIA (group A: 15.0°± 6.1°; group N: 24.1°± 4.1°) were significantly (P < .001) smaller in group A, whereas LPTSA (group A: 7.3°± 3.4°; group N: 5.0°± 2.7°) and MPTSA (group A: 7.1°± 3.0°; group N: 5.6°± 2.4°) were significantly (P < .001) larger. Logistic regression analysis with ACL injury as the dependent variable showed significant differences in MBA (OR, 0.645; 95% CI, 0.579-0.718; P < .01) and LPTSA (OR, 1.3; 95% CI, 1.14-1.48; P < .001) between the 2 groups. The receiver operating characteristic curves for the MBA showed a sensitivity of 76.2% and a specificity of 83.9% with the cutoff value of 25.2° (area under the curve, 0.88).Conclusion:A low MBA with a cutoff value of 25.2° was the most significant independent factor associated with primary ACL injury when controlling for differences in sports activity level.

PurposeThe purpose of this study was to investigate the relationship among deep optic nerve head (ONH), lamina cribrosa (LC), and peripapillary sclera (pSc) configurations in healthy eyes.MethodsThis prospective cross-sectional study included 205 healthy eyes of 141 subjects. Multivariable linear mixed models identified factors associated with LC curvature index, prelaminar thickness (PLT), pSc angle, and LC depth (LCD). Explanatory variables included age, gender, intraocular pressure, axial length (AXL), visual field sensitivity, disc area, disc ovality, disc torsion, Bruch's membrane opening (BMO)-minimum rim width (MRW), BMO and anterior scleral canal opening (ASCO) area, peripapillary zone area with and without Bruch's membrane (PPZ+BM/–BM), and peripapillary choroidal thickness (pChT). A sub-analysis was conducted by dividing the eyes at the median AXL.ResultsLC curvature was flatter in eyes with large PPZ-BM, long AXL, and shallow LCD (P = 0.002, P = 0.015, and P = 0.042, respectively). Similar factors exhibited consistent effects in longer AXL eyes, whereas different factors, BMO-MRW, ASCO-area, and pSc-angle, were associated in shorter AXL eyes (P = 0.006, P = 0.012, and P = 0.018. respectively). PLT was thinner in eyes with thin BMO-MRW, large ASCO area, and young age (P < 0.001, P < 0.001, and P = 0.009, respectively). The pSc angle was steeper in eyes with long AXL and large PPZ+BM (P < 0.001). LCD was deeper in eyes with thick pChT, thin BMO-MRW, and small ASCO area (P < 0.001, P < 0.001, and P = 0.004, respectively).ConclusionsNovel associations between LC configurations with scleral canal size, PPZ+BM/–BM, and BMO-MRW were found after correction for confounding deep ONH morphologies. Given that these structures are associated with glaucomatous changes, these inter-structure correlations should be considered when distinguishing LC changes between healthy and glaucomatous eyes.

Background/Objectives: The objective of this study is to determine whether the strong acoustic stimuli used in vestibular evoked myogenic potential (VEMP) testing contribute to distortion product otoacoustic emission (DPOAE) level reduction due to noise-induced hearing loss. Methods: The DPOAE levels were measured routinely to evaluate vestibular balance disorders with sensorineural hearing loss and to monitor changes in cochlear function before and after VEMP. The changes in DPOAE levels after VEMP testing in 174 patients (80 males and 94 females; median age, 53 years [interquartile range, 39-67 years; range, 15-85 years]) who were examined in the vertigo outpatient clinic between June 2021 and December 2024 were retrospectively analyzed. Results: The DPOAE levels decreased significantly after VEMP testing at 1.4 kHz, 2 kHz, 2.8 kHz, sum all 1/2 octave, and average 1/2 octave (1-6 kHz). The decrease in DPOAE levels at 6 kHz exhibited a significant negative linear correlation with age (the coefficient of determination: 0.0189, p = 0.01), but not sex or side. Conclusions: The strong sound stimulation used in VEMP testing can decrease DPOAE levels. The frequencies at which DPOAE levels decreased significantly were overtones of the stimulus frequency, suggesting a possible effect of acoustic stimulation. VEMP testing can be an invasive test method and should be performed with detailed consideration of the risks and benefits. The age factor can influence the decrease in DPOAE levels in VEMP testing.

Artificial Intelligence (AI) is a concept whose goal is to imitate human intellectual activity in computers. It emerged in the 1950s and has gone through three booms. We are in the third boom, and it will continue. Medical applications of AI include diagnosing otitis media from images of the eardrum, often outperforming human doctors. Temporal bone CT and MRI analyses also benefit from AI, with segmentation accuracy improved in anatomically significant structures or diagnostic accuracy improved in conditions such as otosclerosis and vestibular schwannoma. In treatment, AI predicts hearing outcomes for sudden sensorineural hearing loss and post-operative hearing outcomes for patients who have undergone tympanoplasty. AI helps patients with hearing aids hear in challenging situations, such as in noisy environments or when multiple people are speaking. It also provides fitting information to help improve hearing with hearing aids. AI also improves cochlear implant mapping and outcome prediction, even in cases of cochlear malformation. Future trends include generative AI, such as ChatGPT, which can provide medical advice and information, although its reliability and application in clinical settings requires further investigation.

The use of the laryngeal mask airway (LMA), which offers the benefits of ease in insertion and prevention of tracheal damage, is associated with a risk of flow leakage. This study analyzed our extensive database to compare leakage associated with the use of LMA and endotracheal tube (ETT). Adult patients who underwent chest wall, abdominal wall, inguinal region, limb, transurethral, or transvaginal surgery and received either LMA or ETT between January 2007 and March 2020 were included. The leak fraction was calculated as (inspiratory tidal volume−expiratory tidal volume)/(inspiratory tidal volume) × 100% every minute during intraoperative stable positive pressure ventilation. The median leak fraction was calculated for each case. The leak fraction in the LMA group demonstrated a left-skewed distribution with a larger proportion of excessive leak fraction. The leak fraction in the LMA group (median, 7.9%; interquartile range, 4.8–11.4%) was significantly lower than that in the ETT group (median, 9.1%; interquartile range: 5.5–12.4%; P < 0.001). This tendency was consistent across subgroups divided by sex, age, type of surgery, and ventilation mode. We propose that LMA provides leakage comparable to or less than ETT in most cases if stable positive pressure ventilation is achieved.

Vitiligo is an autoimmune skin disease with acquired depigmentation. Dietary habits may modulate the pathogenesis of vitiligo. We evaluated dietary habits in adult Japanese patients with nonsegmental vitiligo, and compared their results with those of age- and sex-matched controls. We also examined the relationship between dietary habits and Vitiligo Area Scoring Index (VASI), or vitiligo on different anatomical sites. The intakes of energy, nutrients, and foods in the participants were analyzed using a brief-type self-administered diet history questionnaire. Patients with vitiligo showed higher body mass index (BMI) and lower intakes of manganese, vitamin D, pulses, and confection, compared with controls. Multivariate logistic regression analysis showed that vitiligo was associated with high BMI. VASI was higher in males than in females, and negatively correlated with age or intakes of potatoes and vegetables other than green/yellow vegetables. Linear multivariate regression analysis showed that high VASI was associated with younger age. Multivariate logistic regression analysis showed that moderate to severe vitiligo (VASI ≥ 4.25) was associated with male sex and longer disease duration. Multivariate logistic regression analyses showed the following association with vitiligo on respective anatomical sites: high intake of eggs and dairy products and high VASI on the head or neck, high intake of oils and fats and high VASI on the trunk, high intake of cereals and high VASI on the upper limbs, male sex and high VASI on the lower limbs, and high BMI and high VASI on the hands or feet. In conclusion, the control of obesity might have prophylactic or therapeutic effects on vitiligo.

In 2023, Baishideng Publishing Group (Baishideng) routinely published 47 open-access journals, including 46 English-language journals and 1 Chinese-language journal. Our successes were accomplished through the collective dedicated efforts of Baishideng staffs, Editorial Board Members, and Peer Reviewers. Among these 47 Baishideng journals, 7 are included in the Science Citation Index Expanded (SCIE) and 6 in the Emerging Sources Citation Index (ESCI). With the support of Baishideng authors, company staffs, Editorial Board Members, and Peer Reviewers, the publication work of 2023 is about to be successfully completed. This editorial summarizes the 2023 activities and accomplishments of the 13 SCIE- and ESCI-indexed Baishideng journals, outlines the Baishideng publishing policy changes and additions made this year, and highlights the unique advantages of Baishideng journals.