University of Tsukuba Hospital

Human papillomavirus (HPV) causes not only cervical cancer in women, but also other HPV-related cancers in both men and women. Currently, Japan runs a national immunisation programme for girls only, while some municipalities started to give subsidy for vaccinations for boys. Considerations of HPV vaccination being a nationally gender-neutral programme is a current topic in health policy arena that raises a question whether such an extension is justifiable in terms of cost-effectiveness. Cost-effectiveness analyses were conducted to evaluate the efficiency of extending HPV vaccination programme to boys. A decision tree model with Markov model was developed accounting for anal, oropharyngeal, and cervical cancers. The target cohort was 12-year-old boys and girls. It was assumed that boys would receive 3 doses 4-valent (B4v) or 2 dose 9-valent vaccine (B9v) and girls would receive two doses 9-valent vaccine (G9v). Incremental cost-effectiveness ratio (ICER) of B4vG9v vs. G9v and B9vG9v vs. G9v were estimated from payers' perspective. Transition probabilities, utility weights to estimate effectiveness in terms of quality-adjusted life year (QALY), and disease treatment costs were either estimated or extracted from the literature. Costs per vaccination was assumed at JPY12,000/US$80 and JPY20,000/US$133 for 4v and 9v vaccine, respectively. Annual discount rate for both costs and effectiveness were set at 3%. While both gender-neutral vaccination programmes reduced disease treatment costs, the reduction was not able to offset vaccination costs. ICERs of B4vG9v programmes ranged from JPY15,954,845 ~ JPY17,116,194/US$106,366 ~ US$114,108 per QALY gained; of B9vG9v programmes from JPY14,606,709 ~ JPY16,022,742/US$97,378 ~ US$106,818 per QALY gained, depending on the vaccine uptake rates. ICERs were all larger than the willingness-to-pay criterion (WTP = JPY5,000,000/US$33,333 per QALY gained) for vaccine. Regardless of the vaccine used, we found that extending HPV vaccination programme to boys was not cost-effective. • Cost-effectiveness of extending HPV vaccination programmes to boys in Japan was evaluated. • Boys were assumed to get 4- or 9-valent vaccine, while girls receive only 9-valent. • Markov model was developed accounting for anal, oropharyngeal, and cervical cancers. • Extending HPV vaccination to boys was not cost-effective, regardless of vaccine type.

To evaluate the efficacy of a self-supervised learning Vision Transformer (ViT) for classification of the nucleus, cortex, and posterior capsule cataract severity utilizing anterior segment optical coherence tomography (AS-OCT) images. Artificial intelligence (AI) model training. Overall, 1,693 eyes were imaged using AS-OCT, with 1,023 classified according to the Lens Opacities Classification System III for supervised training at the Department of Ophthalmology, University of Tsukuba Hospital, Japan. Five AI models were compared: ResNet18, ViT with/without ImageNet pre-training, and Self-Supervised ViT (SS-ViT) constructed using AS-OCT images from 670 eyes. These models were evaluated across five classification tasks: nuclear cataract 2-class (N1 vs. N2≥), 3-class (N1, N2-N3, N4≥), and 6-class classifications; and 2-class classifications for both cortical (C1 vs. C2≥) and posterior subcapsular cataracts (P1 vs. P2≥). Performance was measured using Area Under the Precision-Recall Curve (AUPRC). In the nuclear cataract 2-class classification, ResNet18, ViT, and SS-ViT, which were pre-trained on ImageNet, demonstrated the highest AUPRC of 0.999. For the nuclear cataract 3-class classification, SS-ViT exhibited the highest AUPRC of 0.939. In the 6-class classification of nuclear cataract, SS-ViT attained the highest value with an AUPRC of 0.788. In the 2-class classification of cortical cataract, SS-ViT demonstrated the highest performance with an AUPRC of 0.774, while in the 2-class classification of posterior subcapsular cataract, SS-ViT exhibited the most favorable performance with an AUPRC of 0.506. Our findings demonstrate the effectiveness of a self-supervised ViT model for severity classification of nuclear, cortical, and posterior subcapsular cataracts on AS-OCT.

In our previous report, we described a surgical technique for cochlear implantation in canal wall down (CWD) ears. Specifically, this involved extending the endaural incision superiorly, harvesting a large temporal fascia flap, completely removing the tympanic epithelium, inserting the electrode array, obliterating the middle ear cavity with the temporal fascia flap, and sealing the external auditory canal with a tragal cartilage plug. This report details the safe application of this technique in a patient with severe ear malformation and suspected CHARGE syndrome, supplemented with a brief literature review. The patient was a 28-year-old woman with malformations of the auricle, middle ear, and inner ear, as well as patent ductus arteriosus, amblyopia, and mild intellectual disability.Temporal bone CT revealed significant inferior displacement of the emissary vein, precluding standard electrode insertion via the posterior tympanotomy approach to the round window. We therefore applied our previously reported technique to this malformed ear without prior surgical history. Sequential bilateral implantation was performed. Surgical duration was 96 minutes (right) and 167 minutes (left). Wide bony exposure via CWD facilitated uneventful electrode insertion bilaterally, with minimal bleeding. Postoperative sound-field aided thresholds were favorable at 35dB (right) and 38.3dB (left). Speech discrimination scores were 90% at 60dB (right) and 0% (left). The cochlear implantation technique for CWD ears was safely adapted to this patient with congenital malformation. This approach represents a viable surgical option for cases with severe malformations such as CHARGE syndrome.

To determine whether software-based de-filtering can restore the quantitative accuracy of the bone scan index (BSI) and the number of hot spots (HSn) in whole-body scintigraphy images degraded by the Clarity2D noise-reduction filter. In this IRB-approved retrospective study, 101 adults (mean age ± SD: 67 ± 13 years) who underwent 99mTc-HMDP whole-body scintigraphy on a cadmium-zinc-telluride (CZT) SPECT/CT system were analyzed. For each patient, three planar datasets were obtained: (i) unfiltered images, (ii) 40%-blend Clarity2D-filtered images, and (iii) software de-filtered images reconstructed with a deep learning-based inverse filter in VSBONE BSI v3.0. Quantitative indices (BSI and HSn) and lesion masks were automatically extracted. Agreement with the unfiltered reference was evaluated using Pearson correlation, Bland-Altman analysis (bias ± 95% limits), Dice coefficient, and the Hausdorff distance (p < 0.05). Additionally, lesion detection accuracy was quantified using intersection over union (IoU)-based matching to calculate precision, recall, and F1-score. Clarity2D filtering significantly impaired quantitative concordance (BSI r = 0.23, bias = - 1.55 [-6.20 to 3.10]; HSn r = 0.23, bias = - 14.4 lesions). In contrast, de-filtering restored concordance (BSI r = 0.99, bias = - 0.04 [-0.26 to 0.17]; HSn r = 0.98, bias = - 0.04 lesions) and improved spatial overlap (Dice 0.40 to 0.82) while reducing the median Hausdorff distance from 103 pixels (IQR 85-188) to 39 pixels (IQR 1-40) (all p < 0.001). The de-filtered method demonstrated superior lesion detection accuracy compared to Clarity2D (Precision: 0.77 ± 0.37 vs. 0.19 ± 0.29, Recall: 0.81 ± 0.37 vs. 0.43 ± 0.44, F1-score: 0.78 ± 0.36 vs. 0.23 ± 0.30). Furthermore, de-filtering achieved high inter-case stability (median F1-score: 1.0), whereas Clarity2D showed substantial variability (median F1-score: 0.057). The proposed de-filtering algorithm reliably reverses Clarity2D-induced distortions, enabling accurate BSI and HSn measurements and robust lesion detection without additional radiation or acquisition time. This technique has the potential to broaden the clinical adoption of noise-reduction filters while preserving the integrity of downstream quantitative analyses.

Headaches are common in youth and can impact school and daily life. Data on headaches and care-seeking in Japanese schoolchildren are scarce. We investigated prevalence, impact, and consultation patterns. A school-based online survey was conducted between February and March 2025 among 3,766 students in seven elementary and three junior high schools in Ami-town, Ibaraki-prefecture, Japan. Two questionnaire versions were distributed: one for lower-grade students (grades 1-3) and one for upper-grade students (grades 4-9). The survey included items on headache frequency, triggers, associated symptoms, medication use, and consultation experiences. The prevalence of headaches was 29.1% in lower-grade and 37.6% in upper-grade students. The most common age of onset was 10 years. Students with Headaches that meet most of the diagnostic criteria for episodic migraine experienced more headache days and more school absences compared to students with other headache characteristics. Although nearly half of the students had taken medication, fewer than one-third had consulted a physician. Despite experiencing headaches, only a small number of children sought medical care, which may raise concerns about the potential overuse of over-the-counter medications. Therefore, collaboration between educational and medical institutions is essential to improve early recognition and intervention.

Background: Moyamoya syndrome is a moyamoya-like cerebrovascular condition associated with an identifiable underlying condition. Although head trauma has historically been considered a possible contributing factor, it is currently excluded from the Japanese diagnostic criteria. We report a rare case of progressive unilateral moyamoya-like vasculopathy that developed on the ipsilateral chronic subdural hematoma (CSDH) following head trauma, with a decade-long imaging follow-up. Anterior circulation basi-parallel anatomical scanning (BPAS) provided unique insights into the progressive vessel narrowing beyond the vascular lumen, suggesting its potential utility in evaluating such rare vasculopathies. Case Presentation: A 40-year-old man developed a left-sided CSDH after head trauma and underwent burr hole drainage. Although his symptoms resolved, serial magnetic resonance angiography (MRA) over the subsequent 10 years revealed progressive stenosis of the left middle cerebral artery (MCA), ultimately culminating in an occlusion-like appearance. BPAS revealed moyamoya-like collateral vessels in the same hemisphere, a significant reduction in the outer diameter of the left MCA, supporting the presence of structural arterial wall changes that were not apparent on conventional MRA. Single-photon emission computed tomography revealed mildly reduced cerebral blood flow on the affected side, with a difference of less than 5% compared to non-affected side. He remained neurologically non-symptomatic, with no history of transient ischemic attacks or overt ischemic stroke. Conclusions: This case highlights a rare clinical course of progressive ipsilateral moyamoya-like vascular changes following head trauma and burr-hole drainage for CSDH, potentially indicating an association between head trauma, CSDH, and subsequent moyamoya-like collateral vessel development, warranting further investigation. The use of the anterior circulation BPAS contributed to the detection of structural arterial changes that were not apparent on conventional MRA, suggesting its potential utility in evaluating such vascular abnormalities.

Surgery is an energy-intensive medical field, and its contribution to the environment is significant. Robotic surgery (RS) may generate a greater carbon footprint than open surgery (OS) or endoscopic surgery (ES). However, the extent of this impact has not been fully evaluated in major cancer surgeries. We focused on surgical materials (classified as Scope 3 in the greenhouse gas protocol) and compared the carbon footprints of RS, ES (laparoscopy or video-assisted thoracoscopy), and OS across four major cancer-related procedures. An approximate process-based life cycle assessment approach was used to calculate the carbon footprint (CO2 equivalent, CO2e). Simulations of replacing single-use trocars and staplers with reusable ones were also evaluated. RS had a higher carbon footprint than ES and OS in all four procedures, and robot-assisted low anterior resection had the highest carbon footprint (27.89kg CO2e) among all 12 procedures. The difference in the carbon footprint between RS and the lowest procedure was 3.29-6.38kg CO2e. The higher carbon footprint of RS was mainly attributable to surgical drapes and personal protective equipment, whereas staplers and energy devices, despite their substantial overall contribution, had a limited impact on the differences between the approaches. When single-use materials are replaced with reusable ones, a 90% reduction is anticipated for trocars (0.55kg CO2e per case) and a 15% reduction for staplers (0.33kg CO2e per case). Robotic approach had the highest carbon footprint in all four cancer surgeries, and alternatives using only reusable products are insufficient to offset the increase. To ensure the sustainability of robotic surgery, all stakeholders must continue to implement environmental initiatives, such as optimizing surgical materials and developing eco-friendly products.

Recently, shock teams have been introduced to optimize cardiogenic shock (CS) care; however, their clinical benefits remain unclear. We conducted a systematic review and meta-analysis to assess whether management by a shock team improves outcomes in patients with CS. This meta-analysis was conducted according to the PRISMA guidelines. Studies comparing adults with CS managed with or without a shock team were identified from the PubMed, Web of Science, and Cochrane Library databases. The primary outcome was short-term mortality (cardiac intensive care unit, in-hospital, or 30-day mortality); the secondary outcome was bleeding. Of the 7 retrospective cohort studies that met the inclusion criteria, 3 without a critical risk of bias were included in the analysis. Shock team management was significantly associated with lower short-term mortality (odds ratio [OR] 0.52; 95% confidence interval [CI] 0.32-0.85; P=0.010) and bleeding complications (OR 0.62; 95% CI 0.43-0.91; P=0.010). Sensitivity analysis using crude data also supported the mortality benefit (OR 0.68; 95% CI 0.54-0.85; P<0.010). However, no randomized trials were included, and the certainty of evidence was rated very low owing to the risk of bias and inconsistency. Shock team management may improve short-term outcomes in patients with CS; however, the level of evidence is very low. Further prospective studies are needed to evaluate optimal shock team composition and roles.