University of Fukui Hospital

Cognitive models of attention deficit hyperactivity disorder (ADHD) have traditionally centered on deficits in inhibitory control and motivation. A substantial body of empirical research supports impairments in both domains: children with ADHD exhibit elevated commission error rates, prolonged stop-signal reaction time, and a strong preference for smaller immediate rewards over larger delayed ones. In the first part of this review, we synthesize key findings from behavioral and task-state functional neuroimaging studies that characterize these deficits, highlighting how deficits in inhibitory control and motivation/reward systems manifest across tasks and contexts. We further examine evidence on the interplay between the two systems and how their interaction is altered in children with ADHD. In the second part, we introduce recent advances in cognitive and computational neuroscience that extend classic neurocognitive models by incorporating dynamic perspectives. Specifically, we describe the dynamic dual-control framework, which distinguishes between proactive and reactive inhibitory control, and highlight dynamics of trial-by-trial adaptive response strategy adjustment. We also review emerging computational models that can identify latent brain states and their evolution during task performance, revealing novel neurodynamic mechanisms that may underlie cognitive instability in ADHD. Additionally, we discuss pharmacological studies that shed light on how the inhibitory control and motivation/reward systems are modulated by medication. Finally, we address current limitations and challenges in ADHD research, with a particular focus on task-state functional neuroimaging, and propose future directions for advancing the field. By integrating dynamic modeling approaches with established neurocognitive frameworks, this review aims to deepen our understanding of the brain mechanisms underlying ADHD and to inform the development of more precise and effective interventions.

Abstract Background Surgical decision-making in older adults with spontaneous intracerebral hemorrhage (ICH) is complicated by hematoma consistency, frailty, and anesthesia risks. Endoscopic evacuation under local anesthesia is minimally invasive, but optimal timing and functional assessment remain uncertain. Objective To evaluate the safety and efficacy of consistency-guided endoscopic hematoma evacuation in the subacute phase and determine prognostic factors influencing recovery using the modified Rankin Scale (mRS) and Functional Independence Measure (FIM). Methods We retrospectively analyzed 52 patients aged ≥ 70 years with spontaneous ICH treated between April 2013 and April 2024 and classified hematomas as solid (day 0), firm (days 1–6), soft (days 7–9), and liquefied (day ≥ 10). Endoscopic evacuation was performed in the soft or liquefied phases using a rigid neuroendoscope and transparent sheath with hemostasis achieved using topical Avitene® and saline irrigation. Ninety-day outcomes were assessed using the mRS and FIM, and multivariable regression identified predictors of poor recovery. Results Endoscopic evacuation achieved effective hematoma removal, significantly shorter operative times, and no respiratory complications. Advanced age and lower admission Glasgow Coma Scale score independently predicted poor outcomes. Patients with hematomas ≥ 50 mL showed significantly better outcomes with endoscopic evacuation. The FIM also detected functional gains at ≥ 40 mL that were not captured by the mRS, underscoring its complementary role. Conclusion Consistency-guided subacute endoscopic evacuation under local anesthesia is safe and effective for older adults with ICH, particularly those with large hematomas. Incorporating the FIM with the mRS improves sensitivity for detecting functional recovery and supports broader treatment eligibility.

A 30-year-old previously healthy man presented with fever and headache. HIV tests yielded negative results. Cerebrospinal fluid (CSF) analysis revealed pleocytosis (619/µL), elevated protein (210.3 mg/dL) and adenosine deaminase levels, and decreased glucose levels. A positive CSF culture for tuberculosis confirmed the patient had tuberculous meningitis (TBM). He was treated with methylprednisolone, isoniazid, rifampicin, pyrazinamide, and ethambutol (all highly sensitive). His compliance with medication was good. After six weeks of treatment, he was discharged in stable condition. Eight weeks after onset, he was readmitted with vertigo and right deafness. CSF examination showed worsened pleocytosis (819/µL) and protein levels (4296.1 mg/dL). Contrast-enhanced MRI revealed enhancement of meninges in the brainstem and spinal cord as well as the right vestibulocochlear nerve. No brain abscesses were observed. Based on these findings, a paradoxical reaction (PR) with vestibulocochlear neuritis following antituberculous therapy initiation was suspected. He received oral prednisolone, leading to rapid resolution of vestibulocochlear symptoms within two days. Although cranial nerve enhancement due to PR has been mentioned in the literature, specific imaging demonstrating it is scarce. This case highlights PR as a cause of cranial neuropathy in TBM and provides clear radiological evidence of direct inflammatory spread to the vestibulocochlear nerve, bridging a gap in the current literature.

Background/Objectives: Accurate prediction of severe adverse events (SAEs) is crucial for optimizing supportive care while maintaining treatment intensity in diffuse large B-cell lymphoma (DLBCL). We evaluated the predictive value of the Geriatric Nutritional Risk Index (GNRI) for SAEs in de novo DLBCL and examined potential interactions with treatment regimen and age. Methods: This multicenter retrospective study included 555 adults treated with standard immunochemotherapies. SAEs, defined as grade ≥ 3 non-hematological adverse events or febrile neutropenia, were independently assessed by board-certified hematologists. Results: Multivariable logistic regression identified GNRI as an independent predictor of SAEs (odds ratio 0.982, 95% confidence interval 0.967-0.997). Restricted cubic spline modeling revealed a significant non-linear association between GNRI and SAE risk (p = 0.045). No significant interaction was observed between GNRI and regimen or age (p = 0.894 and 0.217, respectively), a finding consistent across subgroups in forest plot analyses. Conclusions: This study showed that lower diagnostic GNRI was independently associated with higher SAE risk regardless of treatment regimen or age. These findings highlight the potential utility of GNRI as a simple clinical indicator for identifying patients at higher risk of treatment-related toxicity, although they are derived from a retrospective, tertiary-care cohort and require confirmation in external prospective studies.

BackgroundSmall-cell lung cancer (SCLC) is an aggressive malignancy with a poor prognosis. Despite the initial chemosensitivity, survival for extensive-disease (ED) SCLC remains limited. Immune checkpoint inhibitors (ICIs) in combination with chemotherapy have recently been redefined as the standard of care. We evaluated the efficacy of ICI combination therapy in clinical trials translated into real-world clinical practice for patients with ED-SCLC.MethodsThis retrospective cohort study analyzed data from the Tokushukai REAl World Data Project. Patients with ED-SCLC who received first-line platinum-based chemotherapy between April 2010 and March 2022 were included in this study. Overall survival (OS) was estimated using the Kaplan–Meier method, and associations with clinical variables were analyzed using Cox proportional hazards regression.ResultsAmong 590 patients (median age, 71 years; range, 40–90 years), 197 (33.4%) were aged ≥ 75 years. Following ICI approval in Japan in August 2019, 206 patients received first-line treatment, of whom 96 received ICI combination therapy. ICI-treated patients had significantly improved OS compared to chemotherapy alone (median 13.0 vs. 9.7 months; p = 0.011), with a pronounced benefit in those aged < 75 years (15.0 vs. 10.0 months; p = 0.022) but not in those aged ≥ 75 years (8.9 vs. 8.6 months; p = 0.647). The inverse probability of treatment weighting (IPTW) method resulted in an HR of 0.666 (95% confidence interval [CI] 0.483–0.919) in the overall cohort of patients. ICI combination therapy was an independent factor for improved OS (HR, 0.589; 95% CI, 0.447–0.776).ConclusionsICI combination therapy improved survival in real-world patients with ED-SCLC, aligning with the results of pivotal clinical trials. However, their limited efficacy in older adults underscores the need for tailored treatment strategies.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12885-025-14701-z.

BackgroundThe clinical utility of electron density (ED), obtained by non-contrast dual-energy computed tomography, has been demonstrated for the diagnosis of brain tumors and bone lesions; however, the clinical utility of ED in the liver has not been adequately reported. This study aimed to compare ED between hepatocellular carcinomas (HCCs), liver metastases, hepatic hemangiomas, and hepatic cysts and assess the differential diagnostic performance of ED between malignant tumors and benign lesions.MethodsEighty-nine patients (53 men and 36 women; mean age, 67.2±13.2 years) were included. EDs were measured for 24 HCCs, 19 liver metastases, 28 hepatic hemangiomas, and 18 hepatic cysts. The relative ED (rED), normalized by the ED of the background liver parenchyma, was calculated. The ED and rED of the focal hepatic lesions (FHLs) were statistically analyzed. Receiver operating characteristic curve analysis was used to evaluate the diagnostic performance of ED and rED in differentiating malignant tumors from benign lesions.ResultsThe ED and rED were higher in malignant tumors than in benign lesions. Significant differences in ED were observed among all lesions (P<0.05) except liver metastases and hepatic hemangiomas. Significant differences in rED were observed among all lesions (P<0.05) except HCCs and liver metastases. The area under the curve of rED for distinguishing between malignant tumors and benign lesions was significantly larger than that of ED (0.88 vs. 0.80, P<0.05).ConclusionsED aids in the differential diagnosis of FHLs. The use of rED further improves diagnostic performance.

We present a case of invasive pneumococcal disease (IPD) complicated by both iliopsoas abscess and pyogenic vertebral osteomyelitis caused by serotype 35F Streptococcus pneumoniae in a 64-year-old man with a history of splenectomy who was unvaccinated. The patient experienced difficulty moving, severe back pain, vomiting, and high fever. Advanced imaging techniques, including T2-weighted lumbar MRI and diffusion-weighted whole-body imaging with background body signal suppression (DWIBS), revealed hyperintensities in the left iliopsoas muscle and L4-L5 vertebral bodies, facilitating diagnosis. Blood cultures confirmed the presence of serotype 35F S. pneumoniae, a non-vaccine type associated with an increased risk of invasive disease and mortality. The patient was successfully treated with targeted antibiotics and disc lavage, resulting in symptom resolution. To our knowledge, this is the first reported case of serotype 35F S. pneumoniae causing both iliopsoas abscess and vertebral osteomyelitis, making it a noteworthy contribution to medical literature. Notably, DWIBS proved to be a valuable adjunct diagnostic tool, highlighting its potential for visually accessible, comprehensive screening of inflammation and abscesses throughout the body. We believe that DWIBS is particularly useful when bacteria capable of inducing lesions in multiple organs, such as S. pneumoniae or Staphylococcus aureus, are isolated from blood cultures. Although DWIBS is still emerging in infectious disease diagnostics, this case underscores its promising role in detecting abscesses and inflammatory lesions.