American Astronomical Society Acta Medica Okayama 0067-0049 283 2 2026 The Simons Observatory: Detector Polarization Angle Calibration Using a Sparse Wire Grid with Initial Datasets of the Small-aperture Telescopes 78 EN Hironobu Nakata Department of Physics, Faculty of Science, Kyoto University Shunsuke Adachi Okayama University, Department of Physics Kyohei Yamada Joseph Henry Laboratories of Physics, Jadwin Hall, Princeton University Michael Randall Joseph Henry Laboratories of Physics, Jadwin Hall, Princeton University Yutaro Kasai Department of Physics, Faculty of Science, Kyoto University Kam Arnold Joseph Henry Laboratories of Physics, Jadwin Hall, Princeton University Bryce Bixler Department of Physics, University of California San Diego Yuji Chinone QUP (WPI), KEK Kevin T. Crowley Joseph Henry Laboratories of Physics, Jadwin Hall, Princeton University Nadia Dachlythra Department of Physics, University of Milano-Bicocca Samuel Day-Weiss Joseph Henry Laboratories of Physics, Jadwin Hall, Princeton University Nicholas Galitzki Department of Physics, University of Texas at Austin Serena Giardiello School of Physics and Astronomy, Cardiff University Bradley R. Johnson University of Virginia, Department of Astronomy Brian Keating Department of Physics, University of California San Diego Brian J. Koopman Wright Laboratory, Department of Physics, Yale University Akito Kusaka Kavli IPMU (WPI), UTIAS, The University of Tokyo Jack Lashner Wright Laboratory, Department of Physics, Yale University Federico Nati Department of Physics, University of Milano-Bicocca Lyman Page Joseph Henry Laboratories of Physics, Jadwin Hall, Princeton University Daichi Sasaki Department of Physics, The University of Tokyo Yoshinori Sueno Joseph Henry Laboratories of Physics, Jadwin Hall, Princeton University Junya Suzuki Department of Physics, Faculty of Science, Kyoto University Osamu Tajima Department of Physics, Faculty of Science, Kyoto University Tran Tsan Physics Division, Lawrence Berkeley National Laboratory Improved measurements of B-modes in the cosmic microwave background can be obtained through accurate calibration of the orientation of detector antennas as projected onto the sky. Miscalibration of the detector polarization angle leads to a leakage of E-modes into B-modes, which can bias the detection of the latter. To achieve a σ(r) of 0.003, the Simons Observatory small-aperture telescopes are required to calibrate the global polarization angle on the sky with an accuracy ≲0.°1. We demonstrate a fully remote-controllable calibration system using a “sparse wire grid,” which injects a rotatable linear polarized signal across the telescope’s focal plane. This calibration system is installed and operational on one of the small-aperture telescopes at its observing site at the Parque Astronómico in the Atacama desert in Chile. We developed a pipeline for the detector polarization angle calibration, and demonstrate it using initial data for 93 and 145 GHz frequency bands. The observed distribution of detector polarization angles is in agreement with the instrument design. Statistical uncertainties for the relatively calibrated polarization angles are 0.°02 and 0.°03 at 93 and 145 GHz, respectively. Systematic uncertainty was evaluated to be 0.°08 at the hardware development and fabrication stage. Their sum in quadrature is less than 0.°1. No potential conflict of interest relevant to this article was reported.

MDPI AG Acta Medica Okayama 2073-4360 18 7 2026 Effect of Universal Adhesives on Resin Cement–Fiber Post–Core Materials 810 EN Masao Irie Department of Biomaterials, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Masahiro Okada Department of Dental Biomaterials, Graduate School of Dentistry, Tohoku University Yukinori Maruo Department of Prosthodontics, Okayama University Kenraro Akiyama Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Kumiko Yoshihara Health Research Institute, National Institute of Advanced Industrial Science and Technology Akimasa Tsujimoto Department of Operative Dentistry, School of Dentistry, Aichi Gakuin University Takuya Matsumoto Department of Biomaterials, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University This study evaluated eleven resin cements used as core build-up materials by examining the following properties: (a) push-out force between root dentin and the fiber post; (b) pull-out force between the fiber post and the core build-up material; (c) shear bond strength of the resin cement to root dentin; (d) flexural strength of the resin cement; and (e) flexural modulus of elasticity of the resin cement. The purpose of this investigation was to clarify the relationships between recently available universal adhesives, core build-up materials, resin cements, and fiber posts. All experiments were performed at two evaluation periods: after 1 day of water storage (Base) and after 20,000 thermocycles (TC 20k). For the push-out test, simulated post spaces were prepared in single-rooted human premolars. The specimens were sectioned perpendicular to the long axis into 2 mm-thick slices and then subjected to push-out testing to assess the bond strength of the dentin–resin cement–fiber post complex. No significant differences in bonding performance were found between Base and TC 20k. These findings suggest that universal adhesives used for pretreatment of multiple substrates in fiber post cementation can provide not only strong but also durable adhesion over time. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers (IEEE) Acta Medica Okayama 2169-3536 14 2026 A Self-Adaptive Framework for Deploying Machine Learning Systems Without Ground-Truth Data at Runtime 30309 30326 EN Kento Furukawa Graduate School of Information Science and Technology, Osaka University Hiroyuki Nakagawa Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Tatsuhiro Tsuchiya Graduate School of Information Science and Technology, Osaka University In recent years, the practical application of machine learning technology has rapidly progressed, accelerating its adoption across various fields. In this context, studies into the effective operation of machine learning systems in real-world environments have become essential. In actual operational settings, the distribution of input data often changes over time, leading to a significant decline in the predictive performance of models. Additionally, the lack of ground-truth data for test data during operation can sometimes make adaptation through retraining difficult. This study proposes a framework that autonomously adapts to changes in input data distribution, even in environments where ground-truth data for test data is unavailable during operation. This framework analyzes the distribution of input data and selects the appropriate predictive model based on the state of the distribution. To ensure optimal model selection, the framework employs two complementary approaches: 1) dynamically switching between multiple pre-trained models with different feature sets according to environmental changes and 2) building ensemble models based on the distribution of the test data. These approaches enable the framework to autonomously adapt to shifts in data distribution, even in operational settings where ground-truth data is unavailable. Evaluation experiments using both simulated and real-world data assessed the predictive performance of the proposed method through metrics such as R2, RMSE, and MAE. Compared to conventional single model predictions, the proposed method consistently demonstrated higher accuracy. These results indicate that the proposed approach effectively adapts to data distribution shifts in operational environments where ground-truth data is unavailable. No potential conflict of interest relevant to this article was reported.

John Wiley & Sons Ltd. Acta Medica Okayama 2314-6133 2025 2025 Comparing the Activity of Peripheral Blood Mononuclear Cells Frozen Under Electromagnetic Field Freezing and Standard Slow-Freezing 9884345 EN Takehiro Matsubara Okayama University Hospital Biobank Mina Takagi Faculty of Health Sciences, Okayama University Medical School Takahiro Uwabo Department of Biorepository Research and Networking, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Junichi Soh Department of Thoracic Surgery, Osaka Metropolitan University Graduate School of Medicine Shinichi Toyooka Okayama University Hospital Biobank Mizuki Morita Okayama University Hospital Biobank Peripheral blood mononuclear cells (PBMCs) are cells obtained from the blood that are used not only in clinical tests but also in various research applications. The slow-freezing (SLF) method, currently the standard for PBMC cryopreservation, involves extended storage at －80°C before transfer to liquid nitrogen. Delays in this transfer, such as overnight or weekend holds, risk a gradual decline in cell viability. Additionally, variability in freezing duration can lead to inconsistent cell quality, emphasizing the need for an alternative freezing method that allows for more timely transfer to liquid nitrogen. This study is aimed at clarifying whether the method of using a freezer with an applied electromagnetic field (EMF) is superior to the currently used standard SLF method for PBMC cryopreservation. A comparison of the number of viable cells, cell viability, and cell activity showed that the EMF method was equivalent to the SLF method. However, the shortest time required for freezing was significantly shorter with the EMF method than the SLF method (0.25 vs. 3 h), allowing for earlier transfer of PBMC to liquid nitrogen. This demonstrates that the EMF method offers an advantage in operational efficiency, particularly for facilities that routinely process and store PBMCs, such as biobanks and other storage-focused departments. No potential conflict of interest relevant to this article was reported.

岡山大学大学院社会文化科学研究科 Acta Medica Okayama 1881-1671 61 2026 環境支出は企業リスクを軽減するのか？日本企業の実証分析 155 174 EN YUSRA NAZIR 10.18926/70283 　This study examines how environmental conservation costs (ECC) affects firm risk, using changes in leverage ratios and earnings volatility as stand-ins for risk. This study evaluates the direct impact of ECC and its relationship to profitability (ROA) using panel data of Japanese companies from 2010 to 2022 and Pooled OLS regression models. The results demonstrate the risk-mitigating function of sustainability investments by showing that, although independent ECC have little direct significance, their interaction with firm profitability dramatically lowers earnings volatility and leverage instability. These findings underscore the economic value of environmental strategies, suggesting that incorporating profitability considerations into sustainability practices enhances operational stability and reduces risk exposure. To help policymakers, investors, and corporate managers strike a balance between sustainability and financial performance, this study contributes to the growing body of research on the relationship between the environment and finance. No potential conflict of interest relevant to this article was reported.

岡山大学経済学会 Acta Medica Okayama 2433-4146 57 3 2026 Environmental Conservation Costs and Operational Efficiency: Evidence from Japanese Manufacturing Firms 93 109 EN Yusra Nazir Doctoral student at Graduate school of humanities and social sciences, Okayama University Tatsumasa Tennojiya Faculty of humanities and social sciences, Okayama University 10.18926/OER/70264 　This study investigates whether environmental conservation costs (ECC) support the operational effectiveness and financial stability of Japanese manufacturing firms. Using a balanced panel of 128 non-financial companies listed on the Tokyo Stock Exchange from 2010 to 2022, we manually collected firm-level ECC data based on the Ministry of the Environment, Japan's guidelines from sustainability reports and matched them with financial data from Compustat Global/S&P Capital IQ. Applying pooled ordinary least squares regression with firm-level clustered standard errors and winsorized variables, we examine two aspects of performance as measures of operating efficiency and profitability: asset turnover and profit margin. The results show that ECC is positively associated with asset turnover and profit margin, and that the effect is stronger in more profitable companies, substantiating the Resource-Based View that green practices generate competitiveness. These findings contribute to sustainability finance research by going beyond perceptual measures of environmental, social, and governance ratings, and measuring actual firm-level spending on environmental activities, thereby providing more nuanced insights into how environmental practices translate into actual financial performance. This study offers clear managerial and policy implications by showing that transparent environmental conservation costs improve disclosure quality and serve as a measure of improved efficiency and profitability. No potential conflict of interest relevant to this article was reported.

岡山大学経済学会 Acta Medica Okayama 2433-4146 57 3 2026 地域間での情報交流に関するネットワーク分析：高梁川流域圏での調査による 11 40 EN Ryohei Nakamura Natsumi Yokota 10.18926/OER/70262 　本稿では，岡山県の「高梁川流域連携中枢都市圏」で2014年から開催されている「高梁川流域経済成長戦略会議」における参加主体間の情報交流についてのネットワーク分析を行った。高梁川流域連携中枢都市圏（高梁川流域圏）とは，岡山県高梁川周辺に位置する現在の新見市，高梁市，総社市，早島町，倉敷市，矢掛町，井原市，浅口市，里庄町，笠岡市の10自治体が参加している連携中枢都市圏である。高梁川流域圏におけるネットワーク分析に際しては，同圏域内で展開されている事業を８つに分類し，それぞれの事業に関する参加主体間の情報交流についてアンケート調査を行った。ネットワーク指標については事業ごとに次数中心性と媒介中心性の中心性指標を，また事業別に密度，推移性，相互性を算出した。事業別にみると，観光事業についての情報交流が最も密なネットワーク構造をしており，ネットワークの視点では観光事業が高梁川流域圏内で最も勢力的に行われている事業といえる。また全事業において特定の行政主体や商工会議所をはじめとする地域経済団体等の中心性指標が全体的に大きな値をとっており，ネットワークにおいて情報交流のハブや情報の集中・分散主体として機能していることが明らかになった。分析結果を踏まえ，ネットワークの視点から高梁川流域圏の今度の地域振興について２点提言した。１つは事業によって情報交流のハブや情報の集中・分散主体を主体間で分担することによって，すべての事業で密なネットワークを築くことを目指すことである。もう１つは高梁川流域圏の情報交流ネットワークに全く参加していない主体をなくすことで，全体的に密なネットワークを目指すことである。 No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 1435-2451 411 1 2025 The impact of liver transection depth on surgical difficulty in robotic versus laparoscopic limited liver resection (TAKUMI-5) 22 EN Tomokazu Fuji Department of Gastroenterological Surgery, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Kosei Takagi Department of Gastroenterological Surgery, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Kazuya Yasui Department of Gastroenterological Surgery, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Atene Ito Department of Gastroenterological Surgery, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Takeyoshi Nishiyama Department of Gastroenterological Surgery, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Yasuo Nagai Department of Gastroenterological Surgery, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Shohei Yokoyama Department of Gastroenterological Surgery, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Purpose Although robotic liver resection (RLR) has gained popularity worldwide, limited liver resection remains the mainstay of RLR. This study aimed to investigate the effect of parameters, including liver transection depth (LTD), on surgical difficulty in limited RLR compared with limited laparoscopic liver resection (LLR). Methods This retrospective study included 105 patients who underwent limited RLR (n = 56) or LLR (n = 49) at our institution between January 2018 and December 2024. After comparing outcomes of RLR and LLR, multivariate analyses were performed to examine effect of LTD on surgical difficulty (defined as prolonged operative time). Moreover, outcomes stratified by LTD cut-off values were compared between the groups. Results Median LTD was similar between groups (RLR vs. LLR: 2.6 vs. 2.6 cm, P = 0.77). LTD was significantly correlated with operative time for both procedures (RLR, R² = 0.07, P = 0.042; LLR, R² = 0.08, P = 0.046). Multivariate analyses demonstrated that LLR (odds ratio, 6.9; P < 0.001) and LTD (odds ratio, 2.0; P = 0.004) were significant risk factors of surgical difficulty. Among patients with deeper LTD (> 2.5 cm), the RLR group had significantly shorter operative time (145 vs. 231 min, P < 0.001), less blood loss (nil vs. 100 mL, P = 0.006), and a higher rate of textbook outcomes (76.7% vs. 42.3%, P = 0.01). Conclusion This study investigated impact of LTD on surgical outcomes in patients who underwent limited RLR compared to those who underwent limited LLR. LTD may be a useful parameter for estimating surgical difficulty in limited RLR. Moreover, robotic surgery may be favorable for deeper and limited liver resections. No potential conflict of interest relevant to this article was reported.

Wiley Acta Medica Okayama 1462-8910 27 10 2025 D3 lymph node dissection in colon cancer patients aged 90 years and over: Is it justified? A multi‐institutional retrospective study e70269 EN Fuminori Teraishi Department of Gastroenterological Surgery, Okayama University Hospital Satoe Takanaga Department of Gastroenterological Surgery, Okayama University Hospital Ryo Inada Department of Surgery, Kochi Health Sciences Center Toshiharu Mitsuhashi Center for Innovative Clinical Medicine, Medical Development Field, Okayama University Toshiaki Toshima Department of Surgery, Kagawa Rosai Hospital Tsuyoshi Ohtani Department of Surgery, Saiseikai Okayama Hospital Ryosuke Yoshida Department of Surgery, Okayama Rosai Hospital Ryohei Shoji Department of Gastroenterological Surgery, Okayama University Hospital Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Hospital Setouchi Colorectal Neoplasm Registration study group collaborators Aim: The oncological benefit of D3 lymph node dissection (D3 LND) for colon cancer in patients aged ≥90 years remains unclear. This study aimed to evaluate the impact of D3 LND on outcomes in this specific, vulnerable population. Method: This retrospective cohort study evaluated 166 patients aged ≥90 years with pathological Stages II–III colon cancer undergoing non-D3 or D3 LND from a multicentre database (2011–2022). Postoperative complications, overall survival and cancer-specific survival were compared between LND groups using propensity score-weighted analyses. Results: D3 LND group had significantly more females and laparoscopic procedures. Operation time was longer, and blood loss was lower in the D3 LND group. Postoperative complications and severe complications were significantly fewer, and postoperative hospital stay was shorter in the D3 LND group. The number of harvested lymph nodes and distal margin was significantly higher in the D3 group. While unadjusted analysis showed better overall survival with D3 LND (p < 0.001), adjusted cancer-specific survival showed no significant difference (p = 0.10). Adjusted mortality risk was significantly higher in the non-D3 group (p = 0.001). Conclusion: In nonagenarian colon cancer patients, D3 LND is safe and feasible without increasing complications, but lacks survival benefit. Careful consideration is warranted, and high-quality D2 LND must be consistently ensured when limited surgery is chosen. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 1435-2451 411 1 2025 Surgical outcomes and patient selection in nonagenarians with colon cancer: a comparative multi-institutional study of laparoscopic and open approaches 21 EN Ryohei Shoji Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Fuminori Teraishi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Satoe Takanaga Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiharu Mitsuhashi Center for Innovative Clinical Medicine, Okayama University Hospital Ryo Inada Department of Surgery, Kochi Health Sciences Center Toshiaki Toshima Department of Surgery, Kagawa Rosai Hospital Tsuyoshi Ohtani Department of Surgery, Saiseikai Okayama Hospital Ryosuke Yoshida Department of Surgery, Okayama Rosai Hospital Naoto Hori Department of Surgery, Tottori Municipal Hospital Kaoru Shigemitsu Department of Surgery, Tsuyama Chuo Hospital Sumiharu Yamamoto Department of Surgery, Okayama City Hospital Tetsushi Kubota Department of Surgery, Kobe Red Cross Hospital Yuka Okano Department of Surgery, Onomichi City Hospital Tetsuji Nobuhisa Department of Surgery, Himeji Red Cross Hospital Fumitaka Taniguchi Department of Surgery, National Hospital Organization Iwakuni Clinical Center Wataru Ishikawa Department of Surgery, Fukuyama City Hospital Tatsuo Matsuda Department of Surgery, Matsuda Hospital Tatsuo Umeoka Department of Surgery, Matsuyama City Hospital Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Setouchi Colorectal Neoplasm Registration study group collaborators Purpose The appropriate surgical approach for colon cancer (CC) in nonagenarian patients remains a subject of clinical debate. This study aimed to compare the short-term outcomes of laparoscopic (Lap) versus open (Open) surgery in patients aged ≥ 90 years with resectable colon cancer. Methods This multi-institutional retrospective cohort study included oldest-old patientswith pathological Stage II/III CC who underwent elective surgery at 15 hospitals between 2011 and 2022. Patients with rectal cancer, Stage 0/I/IV disease, or emergency surgery were excluded. To address selection bias, inverse-probability-weighted regression adjustment and stabilized inverse probability of treatment weighting (sIPTW) were applied. The primary outcome was postoperative complications; secondary outcomes included overall survival (OS). Results Median age was 92 years in both groups. Before adjustment, the Lap group had a higher proportion of female patients (p = 0.038) and lower ASA scores (p = 0.01). Laparoscopic surgery was associated with a significantly longer operative time (220 vs. 171 min, p = 0.046) but less intraoperative blood loss (10 vs. 78 mL, p < 0.01). Postoperative complication rates were comparable (Lap: 31.8%, Open: 33.8%), while the Lap group had a significantly shorter hospital stay (13 vs. 17 days, p < 0.01). D3 lymph node dissection was more frequently performed in the Lap group (p < 0.01). After sIPTW, overall survival did not differ significantly between groups (p = 0.61). Conclusion Both laparoscopic and open surgery are feasible options for selected nonagenarians with colon cancer. Laparoscopic surgery may offer benefits in terms of reduced blood loss and shorter hospitalization, despite longer operative times. Careful patient selection considering frailty and comorbidities is essential in determining the most appropriate surgical approach. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 2038-131X 2025 Early C-reactive protein as a predictive biomarker for postoperative complications following robot-assisted surgery for rectal cancer EN Fuminori Teraishi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ryusei Takahashi Department of Surgery, NHO Fukuyama Medical Center Hiroki Okabayashi Department of Surgery, NHO Fukuyama Medical Center Masashi Utsumi Department of Surgery, NHO Fukuyama Medical Center Hideaki Miyaso Department of Surgery, NHO Fukuyama Medical Center Ryohei Shoji Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiharu Mitsuhashi Center for Innovative Clinical Medicine, Okayama University Hospital Masaru Inagaki Department of Surgery, NHO Fukuyama Medical Center This retrospective cohort study aimed to assess the predictive value of early postoperative C-reactive protein (CRP) levels for complications following robot-assisted rectal surgery (RARS) for rectal cancer. We analyzed data from 117 consecutive patients who underwent elective RARS at Okayama University Hospital between September 2020 and January 2025. Serum CRP levels were routinely measured preoperatively and on postoperative days (POD) 1 and 4. The primary outcome was the occurrence of any postoperative complication within 30 days, classified according to the Clavien–Dindo grading system. Postoperative complications were observed in 26 patients, representing 22.2% of the cohort. Univariate analysis revealed that several factors were significantly associated with complications, including older age, higher ASA score, neoadjuvant therapy, stoma creation, prolonged operative time, and elevated CRP levels on POD1 and POD4. Notably, multivariate logistic regression analysis identified POD1 CRP as a robust independent predictor of overall postoperative complications (adjusted odds ratio 0.77, 95% confidence interval (CI) [0.63–0.93], p < 0.01). In the ROC analysis, the AUC was 0.735 (bootstrap bias-corrected 95% CI 0.544–0.848). The optimal cutoff value of POD1 CRP was 5.63 mg/dl, at which Youden’s index, yielding a sensitivity of 0.615 and specificity of 0.868. In conclusion, early postoperative measurement of CRP on POD1 serves as a valuable and independent biomarker for predicting complications following RARS for rectal cancer. Incorporating POD1 CRP into postoperative surveillance may facilitate the early identification of high-risk patients, thereby facilitating timely interventions and ultimately improving surgical outcomes in this patient population. No potential conflict of interest relevant to this article was reported.

The Japanese Society for Neuroendovascular Therapy Acta Medica Okayama 1882-4072 19 1 2025 The Qualification Examination for Specialists and Instructors in the Japanese Society of Neuroendovascular Therapy: History and Current Status sr.2024-0099 EN Shinichi Yoshimura Department of Neurosurgery, Hyogo Medical University Kenji Sugiu Department of Neurological Surgery, Okayama University Graduate School of Medicine Masaru Hirohata Department of Neurosurgery, Kurume Medical University Yukiko Enomoto Department of Neurosurgery, Gifu University Graduate School of Medicine Hirotoshi Imamura Department of Neurosurgery, National Cerebral and Cardiovascular Center Wataro Tsuruta Department of Endovascular Neurosurgery, Toranomon Hospital Toshiyuki Fujinaka Department of Neurosurgery, National Hospital Organization Osaka National Hospital Hitoshi Hasegawa Department of Neurosurgery, Brain Research Institute, Niigata University Toshio Higashi Department of Neurosurgery, Fukuoka University Chikushi Hospital Takashi Izumi Department of Neurosurgery, Nagoya University of Graduate School of Medicine Hiro Kiyosue Department of Diagnostic Radiology, Kumamoto University Faculty of Life Sciences Yasushi Matsumoto Division of Development and Discovery of Interventional Therapy, Tohoku University Hospital Hidenori Oishi Oishi Neurosurgery Clinic, and Department of Neurosurgery, The Jikei University School of Medicine Tetsu Satow Department of Neurosurgery/Stroke Center, Kindai University Hospital Michihiro Tanaka Department of Neurosurgery and Neuroendovascular Surgery, Kameda Neurocenter, Kameda Medical Center Tomoyuki Tsumoto Department of Neurosurgery, Showa University Fujigaoka Hospital Hiroshi Yamagami Division of Stroke Prevention and Treatment, Institute of Medicine, University of Tsukuba Akira Ishii Department of Neurosurgery, Juntendo University Faculty of Medicine Yuji Matsumaru Department of Neurosurgery, Institute of Medicine, University of Tsukuba Shigeru Miyachi Department of Neurological Surgery, Aichi Medical Univeristy Neuroendovascular therapy is a key treatment for cerebrovascular disorders, driven by advancements in devices and techniques. The Japanese Society for Neuroendovascular Therapy (JSNET) established a certification system in 1997 to ensure operator competence and minimize complications, with the first examination in 2002. JSNET offers 2 main certifications: specialist and instructor. Specialists perform basic procedures, while instructors lead in practice, education, and research. In 2020, the mechanical thrombectomy practitioner qualification was added to promote mechanical thrombectomy. Applicants must have a JSNET membership, relevant certifications, training, and documented experience. The certification process includes rigorous written and practical examinations that now employ non-fluoroscopic models. Certification renewal every 5 years requires conference participation and a continuing education program. Public awareness and integration into stroke center designations have grown. Over 2200 specialists, including more than 500 instructors, have been certified, significantly advancing neuroendovascular therapy in Japan. JSNET aims to continue improving certification and education to maintain high standards. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 2045-2322 16 1 2026 Calcium ions play a critical role in calcification of Corynebacterium matruchotii 4591 EN Naoko Ohara Department of Operative Dentistry, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Midori Ogawa Department of Microbiology, School of Medicine, University of Occupational and Environmental Health Katsuki Takebe Department of Dental Pharmacology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Ikue Tosa Department of Oral Microbiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Serina Ono Department of Operative Dentistry, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Mitsumasa Saito Department of Microbiology, School of Medicine, University of Occupational and Environmental Health Naoya Ohara Department of Oral Microbiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Dental calculus is a hardened deposit composed of calcium phosphate precipitated within dental plaque. While the involvement of dental calculus in the progression of periodontal disease is well established, many aspects of its formation process remain poorly understood. In this study, we focused on Corynebacterium matruchotii, a key bacterium involved in dental calculus formation, and investigated the role of calcium ions in calcification, as well as the associated internal and external changes in the bacterium through long-term observation. In the absence of calcium ions, no intracellular calcification was observed, and the lipid bilayer with the formation of holes in bacterial body was evident. In contrast, in the presence of calcium ions, lipid bilayer remained intact, and intracellular needle- and plate- like crystals were formed. Furthermore, calcified C. matruchotii showed increased flocculation compared to non-calcified C. matruchotii. These results indicate that the influx of calcium ions is essential for intracellular calcification. Calcium ions entry appears to reinforce the integrity of the lipid bilayer, providing a stable intracellular environment conductive to calcification. Moreover, calcified C. matruchotii may contribute to the nucleation of dental calculus by forming aggregates composed of both bacterial components and calcified material. No potential conflict of interest relevant to this article was reported.

MDPI AG Acta Medica Okayama 1999-4923 18 1 2026 Streamlined Radiosynthesis of [18F]Fluproxadine (AF78): An Unprotected Guanidine Precursor Enables Efficient One-Step, Automation-Ready Labeling for Clinical Use 123 EN Xinyu Chen Nuclear Medicine, Faculty of Medicine, University of Augsburg Kaito Ohta Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Hiroyuki Kimura Agency for Health, Safety and Environment, Kyoto University Yusuke Yagi Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Takanori Sasaki Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Naoko Nose Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Masaru Akehi Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Tomohiko Yamane Department of Molecular Imaging Research, Kobe City Medical Center General Hospital Rudolf A. Werner Department of Nuclear Medicine, LMU Hospital, and German Cancer Consortium (DKTK), Partner Site Munich, Ludwig-Maximilians-University of Munich Takahiro Higuchi Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Background/Objectives: [18F]Fluproxadine (formerly [18F]AF78) is a PET radiotracer targeting the norepinephrine transporter (NET) with potential applications in cardiac, neurological, and oncological imaging. Its guanidine moiety, while essential for NET binding, presents major radiosynthetic challenges due to high basicity and the harsh deprotection conditions required for protected precursors. Previous methods relied on multistep procedures, strong acids, and complex purification, limiting clinical translation. This study aimed to develop a practical one-step radiosynthesis suitable for routine and automated production. Methods: A direct SN2-type nucleophilic [18F]fluorination was performed using an unprotected guanidine precursor to eliminate deprotection steps. Reaction parameters, including the base system, solvent composition, precursor concentration, and temperature, were optimized under conventional and microwave heating. Radiochemical conversion (RCC) and operational robustness were evaluated, and purification strategies were assessed for automation compatibility. Results: Direct [18F]fluorination using the unprotected precursor reduced the total synthesis time to 60–70 min. Optimal conditions employed a tert-butanol/acetonitrile (4:1) solvent system with K2CO3/Kryptofix222, affording RCC up to 33% under conventional heating. Microwave irradiation further improved efficiency, achieving RCC of up to 64% within 1.5 min at 140 °C. The method showed broad tolerance to variations in the base molar ratio and precursor concentration and enabled isocratic HPLC purification. Conclusions: This one-step radiosynthesis overcomes longstanding challenges in [18F]fluproxadine production by eliminating harsh deprotection and enabling high-yield, automation-ready synthesis, thereby improving clinical feasibility. No potential conflict of interest relevant to this article was reported.

Royal Society of Chemistry (RSC) Acta Medica Okayama 2041-6520 17 9 2026 Gaseous CO2 electrolysis: latest advances in electrode and electrolyzer technologies toward abating CO2 emissions 4363 EN Kazuhide Kamiya Research Center for Solar Energy Chemistry, Graduate School of Engineering Science, The University of Osaka Sora Nakasone Research Center for Solar Energy Chemistry, Graduate School of Engineering Science, The University of Osaka Ryo Kurihara Research Center for Solar Energy Chemistry, Graduate School of Engineering Science, The University of Osaka Asato Inoue Research Center for Solar Energy Chemistry, Graduate School of Engineering Science, The University of Osaka Hazuki Irie Research Center for Solar Energy Chemistry, Graduate School of Engineering Science, The University of Osaka Shoko Nakahata Research Center for Solar Energy Chemistry, Graduate School of Engineering Science, The University of Osaka Yuta Nishina Research Institute for Interdisciplinary Science, Okayama University Satoshi Taniguchi Research Institute for Chemical Process Technology, National Institute of Advanced Industrial Science and Technology (AIST), Central 5 Thuy T. H. Nguyen Research Institute for Chemical Process Technology, National Institute of Advanced Industrial Science and Technology (AIST), Central 5 Sho Kataoka Research Institute for Chemical Process Technology, National Institute of Advanced Industrial Science and Technology (AIST), Central 5 The conversion of CO2 into multicarbon (C2+) products via electrochemical reduction is considered a key technology for the sustainable production of fuels and chemicals. The performance of high-rate gaseous CO2 electrolysis is governed by interrelated factors such as the electrocatalysts, electrodes, electrolytes, and cell architectures. Despite the intensive focus on catalyst research, systematic studies addressing the other components remain scarce, leaving critical gaps in our understanding toward achieving higher performance in CO2 electrolysis systems. The nanoscale design of catalyst surface electronic structures and the macroscale design of electrodes and electrolyzer architectures both influence the overall activity of the electrochemical system. In designing macroscale components, it is necessary to establish benchmarks based on a comprehensive evaluation of CO2 emissions for the entire electrolysis process, because these parameters are directly linked to output metrics such as current density and cell voltage under practical operating conditions. This review summarizes recent advances in electrodes and electrolyzers, and through life-cycle assessment (LCA), evaluates key performance indicators (KPIs) for achieving negative emissions and assesses the current technology readiness of CO2 electrolysis. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 1068-9265 32 12 2025 Mesenteric Route Superior Mesenteric Artery First Approach in Robot-Assisted Pancreatoduodenectomy 8903 8905 EN Kosei Takagi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Atene Ito Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Tomokazu Fuji Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kazuya Yasui Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Takeyoshi Nishiyama Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Tsubasa Yanagihara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Background. The superior mesenteric artery (SMA) approach is crucial for the successful implementation of robot-assisted pancreatoduodenectomy (RPD). Herein, we present a novel technique, the mesenteric route SMA-first approach, for RPD. Patients and Methods. A 20-year-old woman with a 50 mm intraductal papillary mucinous neoplasm underwent RPD. As the tumor was large and located close to the mesenteric vessels, we developed the mesenteric route SMA-first approach. Results. Following the mesenteric Kocher maneuver, the mesenteric route SMA-first approach was applied. With appropriate retraction of the pancreatic head, dissection around the mesenteric vessels was performed and their branches were divided. The uncinate process dissection (PL, ph II) was performed via the mesenteric route. This approach facilitated dorsal dissection, particularly around the large tumor. After dissection of the hepatoduodenal ligament, the remaining pancreatic nerve plexus (PL ph I) was dissected. Finally, the pancreas was divided on the superior mesenteric vein, and the specimen was resected. Operative time was 390 min with minimal blood loss. Conclusions. The mesenteric route SMA-first approach enables uncinate process dissection via the mesenteric route. This technique may be a safe and feasible option for selected patients, such as nonobese individuals with a large pancreatic head tumor near major vessels. No potential conflict of interest relevant to this article was reported.

Ovid Technologies (Wolters Kluwer Health) Acta Medica Okayama 2210-2612 133 2025 Robotic pancreatoduodenectomy for a giant duodenal leiomyoma: A case report and literature review 111546 EN Susumu Doita Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kosei Takagi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Motohiko Yamada Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kazuya Yasui Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Tomokazu Fuji Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Introduction: Duodenal leiomyomas are rare mesenchymal tumors. To date, several studies have reported on the safety and feasibility of surgical intervention for duodenal leiomyomas. However, minimally invasive surgery has rarely been performed in cases with duodenal leiomyomas. Herein, we present a case of a giant duodenal leiomyoma successfully treated with robotic pancreatoduodenectomy (RPD). Presentation of case: A 74-year-old man was referred to our hospital with a 6.5 cm duodenal tumor accompanied by gastrointestinal bleeding. The tumor was located in the second portion of the duodenum. Considering the tumor size and location, RPD was performed. Using the mesenteric Kocker maneuver, the posterior side of the duodenum was safely dissected, and the tumor was resected. The operative time was 373 min, with an estimated blood loss of 10 mL. The patient was followed up for 7 months with no recurrence. Discussion: To the best of our knowledge, this is the first to highlight the clinicopathological findings of a patient with duodenal leiomyoma undergoing RPD. To date, there have been 19 cases, including our case, reporting surgically treated duodenal leiomyoma. Treatment strategies should be decided depending on tumor characteristics, including the size, location, and histology of the tumor. Conclusion: We present a rare case of a giant duodenal leiomyoma that was successfully treated with RPD. Minimally invasive surgery can be safe and an alternative for the treatment of large duodenal tumors. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 1435-2451 410 1 2025 Robotic distal pancreatectomy using two-surgeon technique (TAKUMI-4): a technical note and initial outcomes 171 EN Kosei Takagi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Tomokazu Fuji Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kazuya Yasui Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Purpose With the increasing use of minimally invasive distal pancreatectomy, the use of robotic distal pancreatectomy (RDP) is also increasing worldwide. Standardized surgical protocols are essential for safe implementation of RDP. In this study, we present our surgical protocol and initial outcomes of RDP using “two-surgeon technique”. Methods Our standard RDP protocol included a two-surgeon technique for cooperation, rationality, and education. Short-term outcomes of RDP were also investigated. This retrospective study included 77 consecutive patients who underwent RDP at our institution between April 2021 and January 2025. Results The median operative time, estimated blood loss, and postoperative hospital stay were 214 min (interquartile range [IQR], 176–253), 10 mL (IQR, 0–50), and 9 days (IQR, 8–10), respectively. A textbook outcome was achieved in 84.4% of patients. Moreover, superior outcomes of RDP (n = 77) compared with those of laparoscopic distal pancreatectomy (n = 62) were confirmed in this study. Conclusion Using the two-surgeon technique, we successfully standardized and introduced the RDP program. The two-surgeon technique can contribute to the safe introduction of RDP and expansion of the program. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 0930-2794 39 5 2025 Impact of visceral fat area on surgical difficulty during robotic distal pancreatectomy (TAKUMI-2) 3137 3145 EN Kosei Takagi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Motohiko Yamada Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Tomokazu Fuji Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kazuya Yasui Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Takeyoshi Nishiyama Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yasuo Nagai Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Noriyuki Kanehira Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Background: Difficulty scoring systems (DSS) have been developed to quantify the surgical complexity of laparoscopic distal pancreatectomy (LDP). However, few studies have validated these systems in the context of robotic distal pancreatectomy (RDP). Moreover, the impact of body composition on RDP outcomes remains unexplored. This study aimed to investigate the risk factors of surgical difficulty in RDP, including body composition. Methods: This retrospective study included 72 consecutive patients who underwent RDP at our institution between April 2021 and October 2024. Using a modified DSS for LDP, patients were divided into three difficulty index groups. The association between the difficulty index and outcomes was investigated. Multivariate analyses were performed to identify risk factors associated with surgical difficulty (prolonged operative time) in RDP. Results: Patients were classified into three difficulty index groups: low (n = 28), intermediate (n = 25), and high (n = 19). Operative time was significantly associated with the surgical index (P = 0.01). Moreover, visceral fat area (VFA) was significantly correlated with operative time (r2 = 0.10, P = 0.008). The multivariate analyses found that VFA (≥ 100 cm2) (odds ratio [OR] 5.03, 95% confidence interval [CI] 1.32–22.4, P = 0.02), malignancy (OR 4.92, 95% CI 1.50–18.9, P = 0.01), and pancreatic resection on the portal vein (OR 4.14, 95% CI 1.24–15.9, P = 0.02) were significant risk factors associated with surgical difficulty. Conclusion: VFA could be a novel and useful factor for assessing the surgical difficulty associated with RDP. No potential conflict of interest relevant to this article was reported.

Wiley Acta Medica Okayama 1758-5902 18 1 2025 Metachronous Pancreatic Metastasis of Myxoid Liposarcoma Successfully Treated With Robotic Spleen‐Preserving Distal Pancreatectomy With Splenic Vessels Resections: A Case Report e70069 EN Yumi Sota Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kosei Takagi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Motohiko Yamada Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Tomokazu Fuji Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kazuya Yasui Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Takeyoshi Nishiyama Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yasuo Nagai Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Noriyuki Kanehira Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Akari Masunaga Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Pancreatic metastasis of myxoid liposarcoma (MLS) after primary resection is extremely rare. Herein, we present a case of metachronous pancreatic metastasis of MLS that was successfully treated with robotic spleen-preserving distal pancreatectomy (SPDP) using the Warshaw technique. A 60-year-old woman underwent radical resection of a 25-cm MLS in the right thigh after receiving neoadjuvant radiotherapy. The patient developed a 6-cm solitary pancreatic metastasis of the MLS 2 years later. Because no other distant metastases were detected, robotic SPDP (Warshaw technique) was performed. The operative time was 140 min with minimal blood loss. Follow-up at 3 months showed no recurrence. To our knowledge, this is the first report of a case of metachronous pancreatic metastasis of MLS successfully treated with robotic SPDP. Curative resection using minimally invasive surgery should be performed for solitary pancreatic metastases from MLS. No potential conflict of interest relevant to this article was reported.

MDPI AG Acta Medica Okayama 2077-0383 15 5 2026 Effect of Surgical Procedures for Rheumatoid Forefoot Deformities on Radiographic Foot Length and Width Variations 1877 EN Masahiro Horita Department of Orthopaedic Surgery, Faculty of Medical Development Field, Okayama University Yohei Kiso Department of Orthopaedic Surgery, Kurashiki Sweet Hospital Yoshihisa Nasu Department of Orthopaedic Surgery, Okayama City Hospital Ryuichi Nakahara Department of Musculoskeletal Health Promotion, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Kenta Saiga Department of Sports Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Toshifumi Ozaki Department of Orthopaedic Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Keiichiro Nishida Locomotive Pain Center, Faculty of Medical Development Field, Okayama University Background: The number of patients with rheumatoid arthritis (RA) undergoing forefoot arthroplasty has increased to better control the disease. Despite patients frequently expressing concerns regarding postoperative foot appearance and footwear-related expectations, no study has investigated postoperative changes in foot length and width in patients with RA. The aim of this study was to evaluate the effect of surgical procedures for rheumatoid forefoot deformities on variations in radiologically determined foot length and width. Methods: In total, 72 feet of 50 women and 3 men (average age: 66.7 years) underwent joint-preserving arthroplasty (n = 33) and arthrodesis of the first metatarsophalangeal joint with shortening osteotomy of the lesser metatarsals or resection arthroplasty of the lesser metatarsal heads (n = 39); procedures were carried out in our institute from August 2013 to February 2020. The mean disease duration was 23.5 years, and the average follow-up period was 17.5 months. Pre- and postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA) of the first and second metatarsals (M1M2A), and IMA of the first and fifth metatarsals (M1M5A) were measured on weightbearing radiographs as well as foot length and width. We also evaluated the correlation between changes in radiographic parameters and variations in radiologically determined foot length and width. Results: Radiologically determined foot width changed significantly from 10.1 cm to 9.7 cm (p < 0.01), while no significant difference was found between pre- and postoperative radiologically determined foot length. HVA, M1M2A, and M1M5A were significantly improved after the surgery (p < 0.01, p < 0.01, and p < 0.01, respectively). A significant negative correlation was found between the variation in radiologically determined foot length and changes in HVA (r = －0.29, p = 0.02) and M1M5A (r = －0.23, p < 0.05), while a significant positive correlation was found between the variation in the foot width and changes in HVA (r = 0.34, p < 0.01), M1M2A (r = 0.55, p < 0.01), and M1M5A (r = 0.45, p < 0.01). There were no significant differences between operative procedures regarding variation in radiologically determined foot length and width. Conclusions: Surgical procedure for rheumatoid forefoot deformity improved radiographic parameters and reduced radiographic foot width while maintaining foot length. No potential conflict of interest relevant to this article was reported.

Elsevier BV Acta Medica Okayama 1991-7902 21 1 2026 Piezo1-mediated mechanotransduction in cementocytes via protein kinase B and p38 mitogen-activated protein kinase signaling 57 66 EN Kaixin Xiong Department of Stomatology, Chengdu Integrated TCM and Western Medicine Hospital (Chengdu First People’s Hospital) Yukihiko Sakisaka Division of Periodontology and Endodontology, Tohoku University Graduate School of Dentistry Taichi Tenkumo Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry Eiji Nemoto Division of Periodontology and Endodontology, Tohoku University Graduate School of Dentistry Kentaro Maruyama Division of Periodontology and Endodontology, Tohoku University Graduate School of Dentistry Faisal Muhammad Division of Periodontology and Endodontology, Tohoku University Graduate School of Dentistry Shigeki Suzuki Department of Operative Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroyuki Tada Division of Oral Microbiology and Immunology, Tohoku University Graduate School of Dentistry Satoru Yamada Division of Periodontology and Endodontology, Tohoku University Graduate School of Dentistry Background/purpose: Cementocytes, terminally differentiated cells embedded within cellular cementum, are morphologically similar to osteocytes; however, their mechanosensory function remains poorly understood. This study aimed to investigate whether Piezo1, a mechanosensitive ion channel, contributes to the regulation of osteo/cementogenic gene expression in murine cementocyte-like IDG-CM6 cells. Materials and methods: IDG-CM6 cells were subjected to cyclic stretch or treated with Piezo1-specific agonist Yoda1 or antagonist GsMTx4. Expression levels of osteo/cementogenic genes (Wnt1, Sost, Opg) and protein levels were analyzed. The involvement of intracellular signaling pathways was assessed using pharmacological inhibitors targeting mitogen-activated protein kinase and protein kinase B (PKB/AKT) pathways. Results: Cyclic stretch upregulated Wnt1 and Opg, and downregulated Sost expression, without altering Piezo1 expression, suggesting an enhanced osteo/cementogenic potential. These effects were abolished by GsMTx4 and closely mimicked by Yoda1 stimulation. The Yoda1-induced gene expression changes were transient and diminished after withdrawal. Inhibitor experiments confirmed that Piezo1-mediated gene expression is modulated primarily through the AKT and p38 signaling pathways. Phosphorylation of AKT and p38 was rapidly induced by cyclic stretch. Conclusion: Our findings demonstrate that Piezo1 functions as a mechanosensor in cementocytes, modulating the expression of osteo/cementogenic genes via the AKT and p38 pathways. This study provides new insight into the molecular mechanisms of cementocyte mechanotransduction and may inform strategies for periodontal regeneration and orthodontic treatment. No potential conflict of interest relevant to this article was reported.

MDPI AG Acta Medica Okayama 2079-7737 15 5 2026 Alpha-Ketoglutarate Drives an Osteogenic and Extracellular Matrix Gene Program in Periodontal Ligament Fibroblasts via Selective Reduction of H3K27me3 372 EN Ryu Hasegawa Department of Periodontology and Endodontology, Tohoku University Graduate School of Dentistry Shigeki Suzuki Department of Operative Dentistry, Okayama University Graduate School, Medicine, Dentistry and Pharmaceutical Sciences Rahmad Rifqi Fahreza Department of Periodontology and Endodontology, Tohoku University Graduate School of Dentistry Shin-Ho Tsai Department of Operative Dentistry, Okayama University Graduate School, Medicine, Dentistry and Pharmaceutical Sciences Yoshino Daidouji Department of Periodontology and Endodontology, Tohoku University Graduate School of Dentistry Masato Omori Department of Periodontology and Endodontology, Tohoku University Graduate School of Dentistry Tetsuhiro Kajikawa Department of Periodontology and Endodontology, Tohoku University Graduate School of Dentistry Satoru Yamada Department of Periodontology and Endodontology, Tohoku University Graduate School of Dentistry Periodontal disease damages the tissues that support teeth and can ultimately lead to tooth loss, yet effective treatments to regenerate these tissues are still limited. Recent studies have shown that substances produced during normal cellular metabolism can influence how genes are regulated, but their role in periodontal regeneration has not been fully clarified. In this study, we investigated whether alpha-ketoglutarate, a naturally occurring metabolite involved in energy production, could promote periodontal tissue regeneration. We found that alpha-ketoglutarate enhanced bone-related and extracellular matrix-related gene expression in human periodontal ligament cells by reducing a repressive gene-regulatory signal that normally suppresses these genes. Importantly, alpha-ketoglutarate did not broadly alter chromatin accessibility, indicating that its effects were mediated through selective gene regulation. Furthermore, oral administration of alpha-ketoglutarate promoted alveolar bone regeneration and collagen-rich tissue formation in a mouse model of periodontal disease. Because alpha-ketoglutarate is a naturally occurring molecule in the body, these findings suggest that metabolite-based regulation of gene activity may represent a promising and safe approach for periodontal tissue regeneration. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 80 1 2026 The Preoperative Anterior Pelvic Plane Angle Predicts Cup Anteversion Changes at 1 Year after Total Hip Arthroplasty 31 37 EN Kyota Ishibashi Department of Orthopedic Surgery, Hachinohe City Hospital Hirotaka Oishi Department of Orthopedic Surgery, Hachinohe City Hospital Ryo Araki Department of Orthopedic Surgery, Hachinohe City Hospital Kosuke Kawamura Department of Orthopedic Surgery, Hachinohe City Hospital Isamu Sasaki Department of Orthopedic Surgery, Hachinohe City Hospital Eiji Sasaki Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine Hikaru Kamada Department of Orthopedic Surgery, Hachinohe City Hospital Masakazu Kogawa Department of Orthopedic Surgery, Hachinohe City Hospital Sunao Tanaka Department of Orthopedic Surgery, Hachinohe City Hospital Takuya Numasawa Department of Orthopedic Surgery, Hachinohe City Hospital Yasuyuki Ishibashi Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine Original Article 10.18926/AMO/70070 We investigated global alignment changes following total hip arthroplasty (THA) and predictive alignment parameters for increased cup anteversion (CA) by retrospectively analyzing the primary THA data of 75 patients treated at our hospital (49 women, 26 men; age 65.1±5.7 years, BMI 28.3±3.4 kg/m2). Global alignment parameters, i.e., the anterior pelvic plane angle (APPa) and proximal femoral shaft angle (PFSa) and other alignment parameters were measured. CA was evaluated based on the patients’ standing coronal radiographs. ΔCA was defined as the difference in CA from 2 weeks before to 1 year after each THA. We classified the cases as stable (S) (CA < 10°; n=63) and pelvic retroversion (R) (CA ≥ 10°; n=12) groups. Associations between ΔCA and alignment parameters were evaluated by linear regression and a receiver operating characteristic (ROC) analysis. A significant decrease in the PFSa occurred between the 2-week and 1-year post-THA timepoints (7.8±4.3° vs. 4.2±3.6°, p<0.001), with no notable change in other alignment parameters. At 1-year post-THA, the CA of 12 (16%) patients had increased to 4.5±4.4°. Only the preoperative APPa was positively associated with ΔCA (β=0.165, p=0.020). The ROC analysis revealed that the optimal cut-off value for increased CA in the APPa is 2.1° (area under the curve, 0.700; p=0.020; odds ratio, 4.80). The APPa change predicted increased CA, which emphasizes the importance of the use of preoperative standing radiography for identifying the optimal cup positioning for post-THA changes in CA. No potential conflict of interest relevant to this article was reported.

The Japanese Society of Interventional Radiology Acta Medica Okayama 2432-0935 10 2025 Is Saline Sealing of Needle Tract Effective to Prevent Pneumothorax after Computed Tomography-guided Lung Biopsy? e2025-0068 EN Soichiro Okamoto Department of Radiology, Okayama University Hospital Yusuke Matsui Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Koji Tomita Department of Radiology, Okayama University Hospital Kazuaki Munetomo Department of Radiology, Okayama University Hospital Noriyuki Umakoshi Department of Radiology, Okayama University Hospital Toshiharu Mitsuhashi Center for Innovative Clinical Medicine, Medical Development Field, Okayama University Toshihiro Iguchi Department of Radiological Technology, Faculty of Health Sciences, Okayama University Takao Hiraki Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Purpose: To evaluate the efficacy of needle tract sealing using normal saline instillation for decreasing the risk of pneumothorax after computed tomography-guided lung biopsy. Material and Methods: This retrospective, single-institution study included 391 computed tomography-guided lung biopsies performed by 12 operators between January 2022 and October 2024. After exclusion, 298 biopsies were analyzed by comparing the saline seal (n = 138) and control (n = 160) groups. A 17/18-gauge or 19/20-gauge coaxial biopsy system was used, and tract sealing was performed by instilling 1-5 mL of normal saline during the withdrawal of the introducer needle in the saline seal group; tract sealing was not performed in the control group. After 1:1 propensity score matching was performed to balance baseline characteristics, the incidences of pneumothorax and chest tube placement were compared between the two groups using Fisher's exact test. Results: After propensity score matching, 108 pairs (mean lesion size: 17 mm) were well balanced. The incidence of pneumothorax did not differ significantly between the control and saline seal groups (50.0% vs. 60.2%, respectively; p = 0.171). Similarly, the incidence of chest tube placement was not significantly different between the two groups (7.4% vs. 13.0%, respectively; p = 0.260). Conclusions: According to the propensity score-matched analysis, normal saline instillation for tract sealing did not significantly reduce the incidence of pneumothorax or chest tube placement. In our cohort, which had a high prevalence of small lesions, saline sealing alone may be insufficient to reduce post-biopsy pneumothorax risk. Hence, combined strategies require further investigation. No potential conflict of interest relevant to this article was reported.

Elsevier BV Acta Medica Okayama 0732-8893 113 4 2025 Time to positivity for differentiating blood culture contamination: A 20-hour cutoff for major contaminants 117030 EN Yohei Manabe Department of Pharmacy, Okayama University Hospital Hideharu Hagiya Department of Infectious Diseases, Okayama University Hospital Shinnosuke Fukushima Department of Infectious Diseases, Okayama University Hospital Kenta Nakamoto Department of Infectious Diseases, Okayama University Hospital Kohei Oguni Department of Infectious Diseases, Okayama University Hospital Hidemasa Akazawa Department of Infectious Diseases, Okayama University Hospital Yasushi Fujita Department of Nursing, Okayama University Hospital Takashi Kiguchi Department of Nursing, Okayama University Hospital Koji Iio Microbiology Division, Clinical Laboratory, Okayama University Hospital Background: Blood culture remains the gold standard for diagnosing bacteremia; however, contamination inevitably occurs in 2-3% of cases, requiring differentiation between true bacteremia and contamination. Although time to positivity (TTP) aids in this clinical decision, with detection after 24 hours generally indicating contamination, technological advances in blood culture systems may have shortened this threshold interval. Methods: This study retrospectively analyzed blood culture data in our hospital from April 2023 to January 2025 to determine the optimal TTP cutoff. Patients with positive blood cultures for major contaminating bacteria were included. Cases were classified as true bacteremia or contamination based on a comprehensive chart review conducted by the antimicrobial stewardship audit, and TTP was compared between the groups. Sensitivity, specificity, and Youden index at various TTP cutoffs were utilized to determine the optimal threshold using the receiver operating characteristic curve analysis. Results: Seventy-one patients were enrolled, with 34 cases classified as true bacteremia and 37 as contamination. Identified bacteria included coagulase-negative staphylococci (70.4%), viridans group streptococci (18.3%), and others (11.3%). The median TTP was significantly shorter in the true bacteremia group compared with the contamination group (18.6 vs.25.8 hours, p < 0.001). In the contamination group, 43.2% of the cases demonstrated positive growth within 24 hours. Based on sensitivity, specificity, and Youden index, the optimal threshold was estimated to be 20 hours. A subgroup analysis of the CNS-only cohort yielded concordant results. Conclusion: This study suggests that a 20-hour TTP threshold could help effectively differentiate true bacteremia from contamination in current clinical settings. No potential conflict of interest relevant to this article was reported.

Japanese Association of Rehabilitation Medicine Acta Medica Okayama 2432-1354 10 2025 Reliability and Validity of the Japanese Perme ICU Mobility Score: An Initial Psychometric Evaluation 20250037 EN Sho Katayama Department of Rehabilitation Medicine, Okayama University Hospital Tomohiro Ikeda Department of Rehabilitation Medicine, Okayama University Hospital Nobuto Nakanishi Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University Hajime Katsukawa Department of Scientific Research, Japanese Society for Early Mobilization Ricardo Kenji Nawa Department of Critical Care Medicine, Hospital Israelita Albert Einstein Christiane Perme Department of Rehabilitation Services, Houston Methodist Hospital Toshifumi Ozaki Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Masanori Hamada Department of Rehabilitation Medicine, Okayama University Hospital Ikumi Sato Academic Field of Health Science, Okayama University Satoshi Hirohata Academic Field of Health Science, Okayama University Objectives : The Perme ICU Mobility Score is widely used to assess functional status, but no version of this assessment tool has been validated for use in Japan. This study aimed to translate the Perme Score into Japanese and evaluate its reliability and validity. Methods : Following forward–backward translation, the Japanese Perme Score was tested at ICU discharge. Inter-rater reliability was examined using weighted kappa coefficient. Construct validity was assessed through correlations with the Medical Research Council Sum Score (MRC-SS), Functional Status Score for the ICU (FSS-ICU), and ICU Mobility Scale (IMS). Predictive validity for activities of daily living (ADL) independence (Barthel Index ≥ 85) and discharge destination was evaluated using Receiver operating characteristic (ROC) analysis. Floor and ceiling effects were also analyzed. Results : In 69 patients, the Japanese Perme Score showed high inter-rater reliability (κ=0.83). It showed moderate correlation with FSS-ICU (rho=0.61) and IMS (rho=0.73), and it showed weak correlation with MRC-SS (rho=0.36). Predictive validity for ADL independence and home discharge yielded AUCs of 0.76 and 0.73, respectively. A ceiling effect was noted in 10% of cases, with no floor effect. Conclusions: The Japanese Perme Score is a reliable, valid instrument for evaluating physical function at ICU discharge. No potential conflict of interest relevant to this article was reported.

Japanese Society of Internal Medicine Acta Medica Okayama 0918-2918 63 13 2024 Activated CD4+ T Cell Proportion in the Peripheral Blood Correlates with the Duration of Cytokine Release Syndrome and Predicts Clinical Outcome after Chimeric Antigen Receptor T Cell Therapy 1863 1872 EN Wataru Kitamura Department of Hematology and Oncology, Okayama University Hospital Noboru Asada Department of Hematology and Oncology, Okayama University Hospital Shuntaro Ikegawa Department of Hematology and Oncology, Okayama University Hospital, Japan Hideaki Fujiwara Department of Hematology and Oncology, Okayama University Hospital Chihiro Kamoi Department of Hematology and Oncology, Okayama University Hospital Daisuke Ennishi Center for Comprehensive Genomic Medicine, Okayama University Hospital Hisakazu Nishimori Department of Hematology and Oncology, Okayama University Hospital Keiko Fujii Division of Clinical Laboratory, Okayama University Hospital Nobuharu Fujii Division of Blood Transfusion, Okayama University Hospital Ken-ichi Matsuoka Department of Hematology and Oncology, Okayama University Hospital Yoshinobu Maeda Department of Hematology and Oncology, Okayama University Hospital Objective Chimeric antigen receptor (CAR) T cell therapy is an emerging and effective therapy for relapsed or refractory diffuse large B cell lymphoma (R/R DLBCL). The characteristic toxicities of CAR T cell therapy include cytokine release syndrome (CRS) and prolonged cytopenia. We investigated the factors associated with these complications after CAR T cell therapy by analyzing lymphocyte subsets following CAR T cell infusion. Methods We retrospectively analyzed peripheral blood samples on days 7, 14, and 28 after tisagenlecleucel (tisa-cel) infusion by flow cytometry at our institution between June 2020 and September 2022. Patients Thirty-five patients with R/R DLBCL who received tisa-cel therapy were included. Results A flow cytometry-based analysis of blood samples from these patients revealed that the proportion of CD4+CD25+CD127+ T cells (hereafter referred to as "activated CD4+ T cells" ) among the total CD4+ T cells on day 7 after tisa-cel infusion correlated with the duration of CRS (r=0.79, p<0.01). In addition, a prognostic analysis of the overall survival (OS) using time-dependent receiver operating characteristic curves indicated a significantly more favorable OS and progression-free survival of patients with a proportion of activated CD4+ T cells among the total CD4+ T cells <0.73 (p=0.01, and p<0.01, respectively). Conclusion These results suggest that the proportion of activated CD4+ T cells on day 7 after tisa-cel infusion correlates with the CRS duration and predicts clinical outcomes after CAR T cell therapy. Further studies with a larger number of patients are required to validate these observations. No potential conflict of interest relevant to this article was reported.

Wiley Acta Medica Okayama 1748-3735 21 1 2025 Japanese Adult Day Service Nurses' Bathing Decisions for Persons Requiring Long‐Term Care: A Focused Ethnography e70052 EN Kanako Miyoshi Graduate School of Health Sciences, Okayama University Keiko Mori Graduate School of Health Sciences, Okayama University Introduction: Adult day services in Japan operate under the Long-Term Care Insurance Law, and care is provided mainly by caregivers. However, because doctors are often not on site, nurses manage the health of the person requiring long-term care. Adult day services provide bathing and functional training; however, although Japanese-style bathing relieves fatigue and brings a sense of well-being, it also entails the risk of bathing accidents for those in need of care. To continue living at home, those in need of care who have difficulty bathing at home must be provided with safe bathing during adult day services and supported in returning home safely. Nurses are responsible for accurately assessing the health status of users and implementing safe bathing. This study aimed to identify how nurses working in adult day services make bathing decisions for home-dwelling persons requiring long-term care. Method: Qualitative manifest and latent content analyses were performed using a focused ethnography. Findings: Six themes were identified: ‘gather information to compare with baseline’, ‘make observations based on information from others to understand the big picture’, ‘give persons time to get in shape’, ‘consideration of life at home’, ‘determining the need for medical institutions’ and ‘devise ways to communicate to promote collaboration’. Conclusions: Adult day service nurses' decisions about whether to bathe persons requiring care are characterised by their emphasis on information from others, consideration of the home living conditions of persons requiring care and their wishes regarding bathing. In addition, based on their observations, they determine the need for cooperation with medical institutions and communicate this information to family members and multiple professions. No potential conflict of interest relevant to this article was reported.

Elsevier BV Acta Medica Okayama 2210-2612 134 2025 Robotic posterior radical antegrade modular pancreatosplenectomy for left-sided pancreatic cancer using the ligament of Treitz first approach: A case report and technical note 111782 EN Kosei Takagi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Tomokazu Fuji Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kazuya Yasui Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kazuyuki Matsumoto Department of Gastroenterology, Okayama University Hospital Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Introduction: Radical antegrade modular pancreatosplenectomy (RAMPS) is the standardized open surgical technique for treating left-sided pancreatic cancer. However, studies reporting the surgical approaches for robotic RAMPS are limited. Here, we present a robotic posterior RAMPS using the ligament of Treitz first approach. Presentation of case: A 46-year-old male patient with initially unresectable pancreatic body cancer underwent robotic posterior RAMPS as a conversion surgery after 1-year of chemotherapy with modified FOLFIRINOX. Discussion: Following evaluation of resectability, the ligament of Treitz first approach was applied. The transverse colon was lifted cranially, and the left renal vein was exposed after dissection around the ligament of Treitz. The left adrenal vein was divided, and the left adrenal gland was resected with special caution to avoid injury to the left renal artery. Retroperitoneal dissection was performed with lymphadenectomy around the superior mesenteric and celiac arteries using the ligament of Treitz first approach. After repositioning the transverse colon, the gastrocolic and gastrosplenic ligaments were dissected. Following the division of the pancreas and splenic vessels, the retroperitoneal dissection line was connected with those of the ligament of Treitz first approach. The operative time was 303 min, and the estimated blood loss was 150 mL. Conclusion: The ligament of Treitz first approach may be an option for robotic RAMPS for left-sided pancreatic cancer. Surgeons should select the best approach for performing robotic RAMPS. No potential conflict of interest relevant to this article was reported.

Elsevier BV Acta Medica Okayama 1349-0079 68 1 2026 Evaluation of Mycobacterium-derived plasmids for application in oral Actinomyces species 100718 EN Sakiko Ohara Department of Oral Microbiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yijuan Sheng Department of Oral Microbiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuki Nishiya Department of Oral Microbiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ikue Tosa Department of Oral Microbiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Katsuki Takebe Department of Dental Pharmacology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yuki Arimura Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroshi Mese Department of Dentistry and Oral Surgery, Fukuyama City Hospital Naoko Ohara Department of Operative Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Naoya Ohara Department of Oral Microbiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Objectives: Genetic manipulation tools are essential for elucidating the pathogenic mechanisms of microorganisms. Several species of Actinomyces, including A. israelii, are present in the oral cavity and they are the causative agents of actinomycosis. However, efficient gene-editing tools for these species have not yet been developed. In this study, the aim was to evaluate the introduction of foreign genes into Actinomyces using plasmids derived from Mycobacterium, which belong to the same class as Actinomycetes. Methods: A truncated derivative of pYT923, pYT923S, which contains the replication origin of the M. scrofulaceum plasmid pMSC262 was constructed and introduced into A. israelii by electrotransformation. Results: pYT923S was successfully introduced into A. israelii. The transformation efficiency of A. israelii was approximately 7–66 CFU/μg of DNA, and all transformed colonies harbored pYT923S. The plasmid recovered from A. israelii replicated in Escherichia coli. Conclusions: pYT923S was introduced into and maintained within A. israelii. Therefore, the pYT923S vector represents a useful genetic tool for Actinomyces and it is expected to facilitate future studies on the biology and pathogenicity of Actinomyces. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 0944-1174 60 5 2025 Diagnostic accuracy and cut-off values of serum leucine-rich alpha-2 glycoprotein for Crohn’s disease activity in the small bowel 573 582 EN Muneyori Okita Department of Biostatistics, Nagoya University Graduate School of Medicine Kento Takenaka Department of Gastroenterology and Hepatology, Institute of Science Tokyo Fumihito Hirai Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine Shinya Ashizuka Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine Hideki Iijima Osaka International Medical & Science Center, Osaka Keisatsu Hospital Shigeki Bamba Department of Fundamental Nursing, Shiga University of Medical Science Toshimitsu Fujii Department of Gastroenterology and Hepatology, Institute of Science Tokyo Kenji Watanabe Department of Internal Medicine for Inflammatory Bowel Disease, Toyama University Yosuke Shimodaira Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine Hisashi Shiga Division of Gastroenterology, Tohoku University Graduate School of Medicine Sakiko Hiraoka Department of Gastroenterology and Hepatology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Toshihiro Inokuchi Research Center for Intestinal Health Science, Okayama University Takeshi Yamamura Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine Ryo Emoto Department of Biostatistics, Nagoya University Graduate School of Medicine Shigeyuki Matsui Department of Biostatistics, Nagoya University Graduate School of Medicine Background Small bowel (SB) lesions in Crohn’s disease (CD) are often asymptomatic despite being highly active. Fecal calprotectin (FC) is the most widely used biomarker of CD activity, but its drawbacks include a large intra-individual sample variability and the burden of collecting stool samples. Meanwhile, serum leucine-rich alpha-2 glycoprotein (LRG) has recently attracted attention as a biomarker that can address the limitations of FC. This study determined the diagnostic accuracy of LRG and its cut-off values for diagnosing CD activity in SB. Methods This was a retrospective, multi-center study of CD patients undergoing retrograde balloon-assisted endoscopy. For ileal- and ileocolonic-type patients with a colon SES-CD score of 0, we estimated the receiver operating characteristic curve of LRG and determined the cut-off value to achieve a target sensitivity level of 80%. Results Among 285 patients with SB lesions, LRG had an area under the curve (AUC) of 0.72 (95% CI 0.67–0.78) with a sensitivity of 80.2% and specificity of 47.2% for a cut-off value of 10.5 when diagnosing endoscopic remission (modified SES-CD ≤ 3), while it had an AUC of 0.72 (95% CI 0.65–0.78) with a sensitivity of 81.2% and specificity of 46.2% for a cut-off value of 10.1 when diagnosing complete ulcer healing (modified SES-CD ≤ 1). Conclusion LRG was effective for diagnosing CD activity in SB, specifically with cut-off values of 10.5 and 10.1 for endoscopic remission and complete ulcer healing, respectively. A future prospective validation study will assess its clinical utility. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 2168-8184 17 6 2025 Clinical Outcomes and Biomechanical Evaluation of the Cement-Catching Screw Technique for Osteoporotic Vertebral Fractures e85955 EN Hisakazu Shitozawa Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Haruo Misawa Department of Orthopaedic Surgery, Ryusou Orthopaedic Hospital Yoshiaki Oda Department of Orthopaedic Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Ryoji Joko Department of Orthopaedic Surgery, Japanese Red Cross Okayama Hospital Masaya Takahashi Department of Orthopaedic Surgery, Japanese Red Cross Okayama Hospital Koji Uotani Department of Orthopaedic Surgery, Okayama University Hospital Yasuyuki Shiozaki Department of Orthopaedic surgery, Mitoyo General Hospital Tomoko Tetsunaga Department of Orthopaedic Surgery, Okayama University Hospital Kensuke Shinohara Department of Sports Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Ryo Nakamichi Department of Orthopaedic Surgery, Okayama University Hospital Masataka Ueda Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ryo Takatori Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazutaka Yamashita Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshifumi Ozaki Department of Orthopaedic Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Objectives: We developed a cement-catching screw (CCS) technique for pedicle screw insertion into hardened cement, connecting anterior and posterior vertebral elements during balloon kyphoplasty (BKP) for osteoporotic vertebral fractures (OVFs). This study reports the CCS technique, clinical outcomes, and biomechanical properties. Methods: This retrospective study included 59 patients (20 men, 39 women; mean age, 77.4 ± 8.7 years) who underwent BKP with one-above-one-below posterior fixation for OVFs between 2020 and 2023. Patients were divided into CCS (－) (without intermediate screws, n = 28) and CCS (+) (with intermediate CCSs, n = 31) groups. Clinical and radiographic outcomes, including activities of daily living, vertebral wedge angle (VWA), surgical level Cobb angle (CA), anterior vertebral body height (AVBH), screw loosening, pullout, and adjacent vertebral fractures, were evaluated preoperatively, postoperatively, and at the final follow-up (≥6 months). Biomechanical pullout strength was assessed at different insertion depths (5, 10, and 15 mm) using polymethylmethacrylate cement. Results: No significant differences were observed between groups in age, sex, follow-up duration, or blood loss; however, the operation time was significantly longer in the CCS (+) group than in the CCS (－) group (P < 0.0001). Radiographic outcomes showed no significant differences in the VWA, CA, AVBH, adjacent vertebral fracture rates, and reoperation rates. However, the incidence of adjacent pedicle screws loosening and pullout was significantly higher in the CCS (－) group than in the CCS (+) group (P = 0.046 and 0.0084, respectively). The correction loss of the CA was significantly lower in the CCS (+) group (CCS (－), 5.6° ± 4.8°; CCS (+), 3.5° ± 4.8°, P = 0.023). The biomechanical test revealed pullout strengths of 683 ± 164, 2231 ± 208, and 3477 ± 393 N for insertion depths of 5, 10, and 15 mm, respectively, with significant increases by depth (P = 0.003 and 0.009). Conclusions: The CCS technique improves anterior-posterior vertebral body stability, enhances fixation strength, and contributes to better surgical outcomes in OVFs treatment. No potential conflict of interest relevant to this article was reported.

MDPI AG Acta Medica Okayama 2072-6694 17 19 2025 Utility of Same-Modality, Cross-Domain Transfer Learning for Malignant Bone Tumor Detection on Radiographs: A Multi-Faceted Performance Comparison with a Scratch-Trained Model 3144 EN Joe Hasei Department of Medical Informatics and Clinical Support Technology Development, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Ryuichi Nakahara Science of Functional Recovery and Reconstruction, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yujiro Otsuka Department of Radiology, Juntendo University School of Medicine Koichi Takeuchi Graduate School of Environmental, Life Natural Science and Technology, Okayama University Yusuke Nakamura Plusman LCC Kunihiro Ikuta Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University Shuhei Osaki Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital Hironari Tamiya Department of Musculoskeletal Oncology Service, Osaka International Cancer Institute, Shinji Miwa Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University Shusa Ohshika Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine Shunji Nishimura Department of Orthopaedic Surgery, Kindai University Hospital Naoaki Kahara Department of Orthopedic Surgery, Mizushima Central Hospital Aki Yoshida Science of Functional Recovery and Reconstruction, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Hiroya Kondo Science of Functional Recovery and Reconstruction, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Tomohiro Fujiwara Science of Functional Recovery and Reconstruction, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Toshiyuki Kunisada Science of Functional Recovery and Reconstruction, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Toshifumi Ozaki Science of Functional Recovery and Reconstruction, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Background/Objectives: Developing high-performance artificial intelligence (AI) models for rare diseases like malignant bone tumors is limited by scarce annotated data. This study evaluates same-modality cross-domain transfer learning by comparing an AI model pretrained on chest radiographs with a model trained from scratch for detecting malignant bone tumors on knee radiographs. Methods: Two YOLOv5-based detectors differed only in initialization (transfer vs. scratch). Both were trained/validated on institutional data and tested on an independent external set of 743 radiographs (268 malignant, 475 normal). The primary outcome was AUC; prespecified operating points were high-sensitivity (≥0.90), high-specificity (≥0.90), and Youden-optimal. Secondary analyses included PR/F1, calibration (Brier, slope), and decision curve analysis (DCA). Results: AUC was similar (YOLO-TL 0.954 [95% CI 0.937–0.970] vs. YOLO-SC 0.961 [0.948–0.973]; DeLong p = 0.53). At the high-sensitivity point (both sensitivity = 0.903), YOLO-TL achieved higher specificity (0.903 vs. 0.867; McNemar p = 0.037) and PPV (0.840 vs. 0.793; bootstrap p = 0.030), reducing ~17 false positives among 475 negatives. At the high-specificity point (~0.902–0.903 for both), YOLO-TL showed higher sensitivity (0.798 vs. 0.764; p = 0.0077). At the Youden-optimal point, sensitivity favored YOLO-TL (0.914 vs. 0.892; p = 0.041) with a non-significant specificity difference. Conclusions: Transfer learning may not improve overall AUC but can enhance practical performance at clinically crucial thresholds. By maintaining high detection rates while reducing false positives, the transfer learning model offers superior clinical utility. Same-modality cross-domain transfer learning is an efficient strategy for developing robust AI systems for rare diseases, supporting tools more readily acceptable in real-world screening workflows. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 2168-8184 17 4 2025 Subcutaneous and Periorbital Emphysema Following a Dental Procedure e83089 EN Takafumi Obara Department of Emergency, Critical Care and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences Okayama University Tsuyoshi Nojima Department of Emergency, Critical Care and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences Okayama University Kazuki Nakatsuji Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Hospital Takashi Hongo Department of Emergency, Critical Care and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences Okayama University Tetsuya Yumoto Department of Emergency, Critical Care and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences Okayama University Atsunori Nakao Department of Emergency, Critical Care and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences Okayama University Subcutaneous emphysema following dental procedures is rare. We present the case of a young, healthy woman who was transferred from a dental clinic to our emergency department due to sudden swelling of the left orbit immediately after a dental procedure involving the use of the dental air and water syringe. The diagnosis of subcutaneous facial emphysema was made based on the patient's history, physical examination, and computed tomography imaging. The patient received prophylactic amoxicillin, and the lesion resolved completely in one week. Prompt clinical suspicion and a thorough evaluation of the signs and symptoms, including a detailed clinical history, are crucial for diagnosing subcutaneous emphysema following a dental procedure. No potential conflict of interest relevant to this article was reported.

American Society of Hematology Acta Medica Okayama 2473-9529 9 18 2025 Refinement of day 28 treatment response criteria for acute GVHD: a collaboration study of the JSTCT and MAGIC 4640 4653 EN Yu Akahoshi Division of Hematology/Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai Yoshihiro Inamoto Department of Blood and Marrow Transplantation and Cellular Therapy, Fujita Health University School of Medicine Nikolaos Spyrou Division of Hematology/Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai Hideki Nakasone Division of Hematology, Jichi Medical University Saitama Medical Center Marcio A. Diniz Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai Noboru Asada Department of Hematology and Oncology, Okayama University Hospital Francis Ayuk Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf Hannah K. Choe Division of Hematology, Blood and Marrow Transplantation Program, The Ohio State University Comprehensive Cancer Center Noriko Doki Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital Tetsuya Eto Department of Hematology, Hamanomachi Hospital Aaron M. Etra Division of Hematology/Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai Elizabeth O. Hexner Department of Medicine and Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania Nobuhiro Hiramoto Department of Hematology, Kobe City Medical Center General Hospital William J. Hogan Division of Hematology, Mayo Clinic Ernst Holler Department of Hematology and Oncology, Internal Medicine III, University of Regensburg Keisuke Kataoka Division of Molecular Oncology, National Cancer Center Research Institute Toshiro Kawakita Department of Hematology, National Hospital Organization Kumamoto Medical Center Masatsugu Tanaka Department of Hematology, Kanagawa Cancer Center Takashi Tanaka Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital Naoyuki Uchida Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital Ingrid Vasova Department of Internal Medicine 5, Hematology and Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg and University Hospital Erlangen Satoshi Yoshihara Department of Hematology, Hyogo Medical University Hospital Fumihiko Ishimaru Technical Department, Japanese Red Cross Blood Service Headquarters Takahiro Fukuda Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital Yi-Bin Chen Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital Junya Kanda Department of Hematology, Graduate School of Medicine, Kyoto University Ryotaro Nakamura Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Yoshiko Atsuta Japanese Data Center for Hematopoietic Cell Transplantation James L. M. Ferrara Division of Hematology/Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai Yoshinobu Kanda Division of Hematology, Jichi Medical University Saitama Medical Center John E. Levine Division of Hematology/Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai Takanori Teshima Department of Hematology, Hokkaido University Faculty of Medicine and Graduate School of Medicine Overall response (OR) that combines complete (CR) and partial responses (PR) is the conventional end point for acute graft-versus-host disease (GVHD) trials. Because PR includes heterogeneous clinical presentations, reclassifying PR could produce a better end point. Patients in the primary treatment cohort from the Japanese Society for Transplantation and Cellular Therapy (JSTCT) were randomly divided into training and validation sets. In the training set, a classification and regression tree algorithm generated day 28 refined response (RR) criteria based on symptoms at treatment and day 28. We then evaluated RR for primary and second-line treatments, using the area under the receiver operating characteristic curve (AUC) and negative predictive value (NPV) for 6-month nonrelapse mortality as performance measures. RR considered patients with grade 0/1 at day 28 without additional treatment as responders. RR for primary treatment produced higher AUCs than OR with small improvement of NPVs in both validation sets: JSTCT (AUC, 0.73 vs 0.69 [P < .001]; NPV, 92.0% vs 89.6% [P < .001]) and the Mount Sinai Acute GVHD International Consortium (MAGIC; AUC, 0.71 vs 0.68 [P = .032]; NPV, 90.9% vs 89.8% [P = .009]). RR for second-line treatment produced similar AUCs but much higher NPVs than OR in both validation sets of JSTCT (AUC, 0.64 vs 0.63 [P = .775]; NPV, 74.5% vs 66.0% [P < .001]) and MAGIC (AUC, 0.67 vs 0.64 [P = .105]; NPV, 86.8% vs 76.1% [P = .004]). Classifying persistent but mild skin symptoms as responses and residual lower gastrointestinal GVHD as nonresponses were major drivers in improving the prognostic performance of RR. Our externally validated day 28 RR would serve as a better end point than conventional criteria in future first- and second-line treatment trials. No potential conflict of interest relevant to this article was reported.

Elsevier BV Acta Medica Okayama 0301-679X 214 2026 The influence of lubricant additives and surface roughness and hardness of material on the damage behavior of gears 111341 EN Takuya Ohno Faculty of Environmental, Life, Natural Science and Technology, Okayama University Tadashi Shiota Faculty of Environmental, Life, Natural Science and Technology, Okayama University Masahiro Fujii Faculty of Environmental, Life, Natural Science and Technology, Okayama University This study investigates the influence of lubricant additives, surface roughness, and material hardness on gear damage behavior under boundary lubrication conditions. We conducted both the Short-term Test and the Standard Test using an FZG gear test machine to evaluate how lubricant additives and gear surface roughness influence damage progression when the surface roughness exceeds the oil-film thickness. Acid phosphate ester effectively suppressed micropitting through surface smoothing but led to severe damage such as pitting and scuffing during prolonged use. In contrast, sulfurized fatty oil promoted mild wear, delaying catastrophic failures and extending gear life. Higher surface roughness accelerated wear, while increased hardness reduced deformation but it expanded damage areas. The study found that initial surface roughness and its progress during load stages strongly correlate with gear durability. Measurement of arithmetic mean roughness after sufficient running-in under actual load conditions proved useful for predicting long-term performance. These findings highlight the importance of selecting lubricant formulations tailored to specific gear operating environments and damage modes. Understanding the interplay between lubrication chemistry and material properties enables the design of more durable gear systems. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 1439-0108 2025 Coupling effects of biochar and sediment microbial fuel cells on CH4 and CO2 emissions from straw-amended paddy soil EN Adhena Tesfau Bekele Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Morihiro Maeda Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Nozomi Nakahara Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Ayumi Hashiguchi Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Hiroaki Somura Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Satoshi Akao Faculty of Science and Engineering, Doshisha University Chiyu Nakano Department of Comprehensive Technical Solutions, Okayama University Yuta Nishina Research Institute for Interdisciplinary Science, Okayama University Purpose The independent incorporation of biochar and sediment microbial fuel cells (SMFCs) into paddy soil has been shown to reduce methane (CH4) emissions. However, the application of rice straw into paddy soil enhances the availability of labile carbon that stimulates methanogen growth, counteracting the mitigation effects of both methods. This study, therefore, aimed to investigate the effect of coupling biochar and SMFC on CH4 and CO2 emissions from straw-amended paddy soil. Materials and methods Single chamber SMFC setups constructed using acrylic columns (height, 25 cm; inner diameter, 9 cm) with six treatments were established using soil amended with 0% (0BC), 1% (1BC), and 2% (2BC) biochar: with and without SMFC conditions. Stainless steel mesh (15 × 3 cm) and graphite felt (6 × 5 cm) were used as anode and cathode materials, respectively. Results Cumulative emission of CH4 in the 0BC treatment with SMFC was 39% less than in that without SMFC. Biochar addition and SMFC operation together further reduced CH4 emission by 57% and 60% in 1BC and 2BC treatments, respectively, compared to that in the 0BC treatment without SMFC operation. The relative abundance of microbial communities indicated methane-oxidizing bacteria were enriched in the presence of biochar and hydrogenotrophic Methanoregula were suppressed by SMFC operation. This suggested that SMFC mainly inhibited CH4 production by outcompeting hydrogenotrophic archaea. Conclusion The use of biochar made from leftover rice straw has an interactive effect on SMFC operation and both methods can be used to reduce CH4 emission from straw-amended paddy soil. No potential conflict of interest relevant to this article was reported.

Elsevier BV Acta Medica Okayama 0952-1976 150 2025 Surrogate-assisted motion planning and layout design of robotic cellular manufacturing systems 110530 EN Tomoya Kawabe Graduate School of Environmental, Life and Natural Science and Technology, Okayama University Tatsushi Nishi Graduate School of Environmental, Life and Natural Science and Technology, Okayama University Ziang Liu Graduate School of Environmental, Life and Natural Science and Technology, Okayama University Tomofumi Fujiwara Graduate School of Environmental, Life and Natural Science and Technology, Okayama University A surrogate-assisted multi-objective evolutionary algorithm is proposed for simultaneous optimization of robot motion planning and layout design in robotic cellular manufacturing systems. A sequence-pair is used to represent the layout of components in a robotic cell to avoid overlapping in the evolutionary computation. The robot motion planning with Rapidly exploring Random Trees Star (RRT*) is applied to compute the total operation time of a robot arm for each layout. Non-dominated Sorting Genetic Algorithm II (NSGA-II) is used to minimize the total required layout area and the operation time for a robot arm. The proposed surrogate model can estimate the robot’s operation time with 98% of accuracy without explicit computations of the motion planning algorithm. The experimental results with a physical 6 Degree of Freedom (DOF) manipulator show that the total computation time is approximately 1/400, significantly shorter than the conventional methods. No potential conflict of interest relevant to this article was reported.

Japan Society on Water Environment Acta Medica Okayama 1348-2165 23 5 2025 Biochar-amended Sediment Microbial Fuel Cells for Water Quality Improvement in Intensive and Extensive Pond Drainages in Central Vietnam 234 249 EN Uyen Tu Nguyen Graduate School of Environmental and Life Science, Okayama University Morihiro Maeda Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Hiroaki Somura Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Nozomi Nakahara Department of Comprehensive Technical Solutions, Okayama University Gamamada Liyanage Erandi Priyangika Perera Graduate School of Environmental and Life Science, Okayama University Chiyu Nakano Graduate School of Environmental and Life Science, Okayama University Huu Tien Le Department of Education, Science and Technology Quang Tri Branch, Hue University Yuta Nishina Research Institute for Interdisciplinary Science, Okayama University The use of nutrient-rich feed in shrimp farming in Central Vietnam has led to high nitrogen (N) and phosphorus (P) contents in the pond sediment. The objectives of the study were to assess the effectiveness of biochar-sediment microbial fuel cells (BC-SMFCs) in suppressing P and N release from two types of sediment in intensive (Int) and extensive (Ext) pond drainages in Central Vietnam. Single chamber SMFCs were set up and operated under open or closed-circuit (no SMFC or SMFC) conditions. Coconut shell biochar (BC) was amended to sediments at 1%. For Int-sediment, total phosphorus (TP) release was reduced by no BC-SMFCs through co-precipitation with Fe. On the other hand, BC-SMFCs did not suppress TP release because P was released from BC and organic matter decomposition was enhanced in the sediment. Application of BC enhanced organic N mineralization in the sediment. Nitrification and denitrification occurred in the overlying water, reducing mineral N concentrations. For Ext-sediment, BC addition and SMFC conditions did not affect TP and total nitrogen (TN) release because of low initial organic matter content, and less reductive condition. Our study suggested that the effect of SMFCs was masked by BC which released more P from Int-sediment to the water. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 79 5 2025 Advantages of Single-Position Surgery over Posterior Fusion for Single-Level Degenerative Lumbar Diseases 359 368 EN Tomohiko Hirose Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital Hisanori Ikuma Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital Kazutoshi Otsuka Otsuka Orthopedic Clinic Keisuke Kawasaki Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital Original Article 10.18926/AMO/69437 Single-position surgery with lateral lumbar interbody fusion (LLIF) and percutaneous pedicle screws (PPSs) is gaining attention for its reduced invasiveness. We developed SPAPS, a technique allowing two surgeons to perform anterior LLIF and posterior PPS insertion simultaneously in a single lateral decubitus position. This retrospective study compared SPAPS (SPAPS-LLIF, Group SL) and minimally invasive posterior/transforaminal lumbar interbody fusion (MIS-PLIF/TLIF, Group PT) in patients treated between 2016 and 2019 with a two-year follow-up. Operative time, estimated blood loss (EBL), length of hospital stay (LOS), JOABPEQ and VAS scores, segmental lordotic angle, lumbar lordotic angle, segmental Cobb’s angle, PPS misplacement, PPS loosening, fusion status, and muscle cross-sectional areas were compared. Fifty-two patients were analyzed (Group SL: 25; Group PT: 27). SPAPS significantly reduced operative time (118.0 vs. 165.3 min, p <0.01) and estimated blood loss (8.6 vs. 164.1 mL, p<0.01). While clinical outcomes and hospital stay were comparable, Group SL had significantly lower PPS loosening (0% vs. 13%, p<0.01) and non-union rates (0% vs. 22.2%, p=0.02). Multifidus muscle atrophy was also less in Group SL (－14.3 vs. －121.5 mm2, p<0.01). SPAPS demonstrated advantages in reducing surgical invasiveness without compromising clinical efficacy, offering a promising alternative to conventional posterior fusion surgery. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers (IEEE) Acta Medica Okayama 1932-4537 22 5 2025 Topology-Driven Configuration of Emulation Networks With Deterministic Templating 3933 3946 EN Satoru Kobayashi Faculty of Environmental, Life, Natural Science and Technology, Okayama University Ryusei Shiiba Department of Informatics, School of Multidisciplinary Sciences, The Graduate University of Advanced Studies, Sokendai Shinsuke Miwa StarBED Technology Center, Testbed Research, Development and Operations Laboratory, National Institute of Information and Communications Technology Toshiyuki Miyachi Strategic Planning Department, Strategic Planning Office, National Institute of Information and Communications Technology Kensuke Fukuda Department of Informatics, School of Multidisciplinary Sciences, The Graduate University of Advanced Studies, Sokendai Network emulation is an important component of a digital twin for verifying network behavior without impacting on the service systems. Although we need to repeatedly change network topologies and configuration settings as a part of trial and error for verification, it is not easy to reflect the change without failures because the change affects multiple devices, even if it is as simple as adding a device. We present topology-driven configuration, an idea to separate network topology and generalized configuration to make it easy to change them. Based on this idea, we aim to realize a scalable, simple, and effective configuration platform for emulation networks. We design a configuration generation method using simple and deterministic config templates with a new network parameter data model, and implement it as dot2net. We evaluate three perspectives, scalability, simplicity, and efficacy, of the proposed method using dot2net through measurement and user experiments on existing test network scenarios. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 1943-3921 87 6 2025 Implicit effect of visual long-term memory for nonverbal objects on recognition judgment 1841 1851 EN Tomoe Masuoka Faculty of Nursing, Japanese Red Cross Hiroshima College of Nursing Megumi Nishiyama Department of Criminal Psychology, University of Human Environments Yuna Tsurusaki Faculty of Education, Okayama University Takafumi Terasawa Faculty of Education, Okayama University This study uses an indirect recognition procedure to examine whether prior exposure to nonverbal visual objects affects recognition judgments in later, unrelated recognition tests. We also examined the effect of matching operations between study and test on recognition judgments. The experiment consisted of two sessions. The first session was an incidental learning task: Each object was presented twice, and participants were asked to count the number of corners of the presented object. In the second session after 3 weeks, participants performed the same task as in the first session and then performed an unexpected recognition test. In this test, participants were asked to identify whether the presented object had appeared in the second session. To unify the operation between study and test, some participants were required to count the number of corners of the presented object before the recognition judgment. The results revealed that recognition performance for the objects that appeared in the first session was significantly different from that of objects that had not appeared, even when participants were not asked to recall the episode of the first session when performing the recognition test. Although the results of the effect of the matching operation suggested a negative effect on recognition, the results were unclear. This finding indicates that representations for nonverbal objects are preserved for at least 3 weeks. This also highlights the need to consider the implicit effect of a brief prior experience on recognition judgments. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 1342-1751 29 5 2025 Development and validation of an algorithm for identifying patients undergoing dialysis from patients with advanced chronic kidney disease 650 661 EN Takahiro Imaizumi Department of Nephrology, Nagoya University Graduate School of Medicine Takashi Yokota Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital Kouta Funakoshi Kyusyu University Hospital Kazushi Yasuda Department of Nephrology, Nagoya University Graduate School of Medicine Akiko Hattori Department of Nephrology, Nagoya University Graduate School of Medicine Akemi Morohashi Department of Advanced Medicine, Nagoya University Hospital Tatsumi Kusakabe Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital Masumi Shojima Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University Sayoko Nagamine Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University Toshiaki Nakano Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University Yong Huang Division of Medical Informatics, Okayama University Hospital Hiroshi Morinaga Department of Comprehensive Therapy for Chronic Kidney Disease, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Miki Ohta Clinical Research Promotion Center, The University of Tokyo Hospital Satomi Nagashima Department of Healthcare Information Management, The University of Tokyo Hospital Ryusuke Inoue Medical Information Technology Center, Tohoku University Hospital Naoki Nakamura Medical Information Technology Center, Tohoku University Hospital Hideki Ota Medical Information Technology Center, Tohoku University Hospital Tatsuya Maruyama Clinical Research Promotion Center, The University of Tokyo Hospital Hideo Gobara Division of Medical Informatics, Okayama University Hospital Akira Endoh Department of Medical Informatics, Hokkaido University Hospital Masahiko Ando Department of Nephrology, Nagoya University Graduate School of Medicine Yoshimune Shiratori Medical IT Center, Nagoya University Hospital Shoichi Maruyama Department of Nephrology, Nagoya University Graduate School of Medicine Background Identifying patients on dialysis among those with an estimated glomerular filtration rate (eGFR) < 15 mL/min/1.73 m2 remains challenging. To facilitate clinical research in advanced chronic kidney disease (CKD) using electronic health records, we aimed to develop algorithms to identify dialysis patients using laboratory data obtained in routine practice. Methods We collected clinical data of patients with an eGFR < 15 mL/min/1.73 m2 from six clinical research core hospitals across Japan: four hospitals for the derivation cohort and two for the validation cohort. The candidate factors for the classification models were identified using logistic regression with stepwise backward selection. To ensure transplant patients were not included in the non-dialysis population, we excluded individuals with the disease code Z94.0. Results We collected data from 1142 patients, with 640 (56%) currently undergoing hemodialysis or peritoneal dialysis (PD), including 426 of 763 patients in the derivation cohort and 214 of 379 patients in the validation cohort. The prescription of PD solutions perfectly identified patients undergoing dialysis. After excluding patients prescribed PD solutions, seven laboratory parameters were included in the algorithm. The areas under the receiver operation characteristic curve were 0.95 and 0.98 and the positive and negative predictive values were 90.9% and 91.4% in the derivation cohort and 96.2% and 94.6% in the validation cohort, respectively. The calibrations were almost linear. Conclusions We identified patients on dialysis among those with an eGFR < 15 ml/min/1.73 m2. This study paves the way for database research in nephrology, especially for patients with non-dialysis-dependent advanced CKD. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 1618-1247 2025 Establishment of a regenerative endodontic procedures model of mature mouse teeth and evaluation of the wound healing process EN Xiuting Wang Department of Periodontology and Endodontology, Tohoku University Graduate School of Dentistry Shigeki Suzuki Department of Operative Dentistry, Okayama University Graduate School, Medicine, Dentistry and Pharmaceutical Sciences Shin-Ho Tsai Department of Operative Dentistry, Okayama University Graduate School, Medicine, Dentistry and Pharmaceutical Sciences Karin Nagasaki Department of Periodontology and Endodontology, Tohoku University Graduate School of Dentistry Rahmad Rifqi Fahreza Department of Periodontology and Endodontology, Tohoku University Graduate School of Dentistry Masato Omori Department of Periodontology and Endodontology, Tohoku University Graduate School of Dentistry Satoru Yamada Department of Periodontology and Endodontology, Tohoku University Graduate School of Dentistry As the pulp regeneration for non-vital teeth is one of the ultimate clinical achievements, regenerative endodontic procedures (REPs) have become the most explored treatment modality. In this technique, periodontal tissue is guided from the apical region into the root canal and pulp chamber to promote attachment. It is well established that immature teeth are effective targets for treatment. However, the indications for this treatment have not yet expanded sufficiently to encompass mature teeth with closed apical apex. In the present study, a mouse model of REPs in mature teeth was established, employing the maxillary first molar mesial root. μCT analyses disclosed that the distance from the occlusal surface to the physiological apex of the maxillary first molar mesial root in mice is 2.14 mm ± 0.08 mm, and the distance from the occlusal surface to the periapical alveolar bone is 2.46 mm ± 0.10 mm. Mesial root canal was treated with several sizes of k-files, and 15# k-file was identified as the most suitable k-file for use (P = 0.0007). During the regenerative process, spindle-shaped fibroblast-like cells, fibrous tissue formation, and mineralized tissue formation were identified on days 14 and 28. This study demonstrated that it is feasible to use the maxillary first molar mesial root as a REPs model for mature teeth and provided a detailed protocol and analysis of the healing process. No potential conflict of interest relevant to this article was reported.

Wiley Acta Medica Okayama 2640-4567 2025 Integration of Cholesterol Oxidase‐Based Biosensors on a Smart Contact Lens for Wireless Cholesterol Monitoring from Tears 2500368 EN Yang Cui Graduate school of Information, Production and Systems, Waseda University Lin Zhuo Graduate school of Information, Production and Systems, Waseda University Yuta Nishina Graduate School of Natural Science and Technology, Okayama University Saman Azhari Graduate school of Information, Production and Systems, Waseda University Takeo Miyake Graduate school of Information, Production and Systems, Waseda University Cholesterol plays a critical role in physiological functions, but elevated levels increase the risk of cardiovascular disease. Regular cholesterol monitoring is essential for elderly or obese individuals. Current methods, such as blood tests, are invasive, inconvenient, and require a professional operator. In contrast, tears, as an accessible body fluid, offer a promising alternative for noninvasive monitoring due to their correlation with blood cholesterol levels. Herein, a noninvasive approach for monitoring cholesterol levels in tears using a biosensor integrated into a smart contact lens is reported. The biosensor employs cholesterol oxidases as the biocatalyst, coupled with an osmium-based mediator, to detect cholesterol concentrations ranging from 0.1 mM to 1.2 mM in artificial tears. A key challenge is the extremely low cholesterol concentration in tears, which is addressed using a parity-time (P-T) symmetry-based magnetic resonance coupling system. This system enables wireless signal reading and achieves high sensitivity due to its high-quality (Q) factor, which can achieve a detection limit of 0.061 mM. This portable, high-sensitivity smart contact lens demonstrates significant potential as a wearable device for continuous, noninvasive cholesterol monitoring. The findings contribute to advancing tear-based diagnostic systems and highlight the scientific importance of utilizing tear biomarkers for health monitoring. No potential conflict of interest relevant to this article was reported.

Wiley Acta Medica Okayama 1758-5902 18 1 2025 Clinical Impacts of Minimally Invasive Transperineal Abdominoperineal Resection in Crohn's Disease: A Retrospective Analysis e70149 EN Yoshitaka Kondo Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Nobuhiko Kanaya Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ryohei Shoji Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshihiro Inokuchi Research Center for Intestinal Health Science, Okayama University Sakiko Hiraoka Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yusuke Yoshida Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuki Matsumi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kunitoshi Shigeyasu Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Fuminori Teraishi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shinji Kuroda Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Introduction: Crohn's disease (CD) often leads to complex anorectal complications, posing significant challenges in surgical management. Transperineal abdominoperineal resection (TpAPR) has emerged as a minimally invasive alternative to APR. This study aims to evaluate the safety and efficacy of TpAPR compared to APR in patients with CD. Methods: A retrospective analysis was conducted on 19 CD patients who underwent either minimally invasive TpAPR (n = 11) or APR (n = 8) between 2008 and 2023 from a single institution. The primary outcomes were assessed: intraoperative blood loss, operative time, and surgical site infection (SSI) rates. Results: The minimally invasive TpAPR group exhibited significantly reduced intraoperative blood loss (223 mL vs. 533 mL, p = 0.04) and a lower incidence of SSI rates (36.4% vs. 75%, p = 0.07). Operative time and hospital stay were comparable between groups. Conclusion: Minimally invasive TpAPR demonstrates potential benefits over APR in reducing blood loss and SSI rates in CD patients. Further large-scale studies are warranted to confirm these findings. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 1939-5981 2025 MATERIAL PROPERTIES OF DIE-CASTING DIE AROUND HEAT-CHECKING CREATED BY A HIGH-PRESSURE ALUMINUM ALLOY DIE-CASTING OPERATION EN Mitsuhiro Okayasu Department of Mechanical Systems Engineering, Okayama University Junya Shimazu Department of Mechanical Systems Engineering, Okayama University In this study, the material properties of a nitride die-casting die exhibiting heat-checking after the die-casting process were experimentally investigated using various methods. Based on the obtained results, the authors believe that several possible mechanisms underlying the formation of heat-checking can be identified. The microstructure of the die-casting die near the heat-checking region is characterized by equiaxed grains along the vicinity of the prior γ-grain boundaries, resulting from the lath martensitic formation. Additionally, numerous Cr–Mo–V-based nitride particles, approximately 100 nm in diameter, are precipitated. The surface hardness of the die-casting die, enhanced by nitriding, induces compressive residual stresses and increases adhesive forces. As a result of changes in microstructural characteristics and crack formation, the stress state near the die-casting die is altered, where compressive residual stresses, observed in the die-casting die, are released, leading to the tensile residual stresses. This phenomenon could accelerate the formation of a large number of heat-checking cracks. No potential conflict of interest relevant to this article was reported.

Informa UK Limited Acta Medica Okayama 1468-6996 26 1 2025 Quantitative measurements of transverse thermoelectric generation and cooling performances in SmCo5/Bi0.2Sb1.8Te3-based artificially tilted multilayer module 2535955 EN Masayuki Murata Research Institute for Energy Conservation, National Institute of Advanced Industrial Science and Technology Fuyuki Ando Research Center for Magnetic and Spintronic Materials, National Institute for Materials Science Takamasa Hirai Research Center for Magnetic and Spintronic Materials, National Institute for Materials Science Hiroto Adachi Research Institute for Interdisciplinary Science, Okayama University Ken-ichi Uchida Research Center for Magnetic and Spintronic Materials, National Institute for Materials Science The transverse thermoelectric generation and cooling performances in a thermopile module composed of recently developed SmCo5/Bi0.2Sb1.8Te3 artificially tilted multilayers are evaluated quantitatively. When a large temperature difference of 405°C is applied to the SmCo5/Bi0.2Sb1.8Te3-based module, the open-circuit voltage and output power reach 0.51 V and 0.80 W, respectively. The corresponding maximum power density is 0.16 W/cm2, even if the power is normalized by the device area including areas that do not contribute to the power generation, such as epoxy resin, electrodes, and insulating layers. The maximum energy conversion efficiency for our module in this condition is experimentally determined to be 0.92%. Under the cooling operation, the same module exhibits the maximum temperature difference of 9.0°C and heat flow at the cold side of 1.6 W. Although these values are lower than the ideal thermoelectric performance expected from the material parameters due to the imperfections associated with modularization, the systematic investigations reported here clarify a potential of the SmCo5/Bi0.2Sb1.8Te3 artificially tilted multilayers as thermoelectric generators and cooling devices. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 137 2 2025 脳卒中右片麻痺者における左手書字の上達過程を捉える作業療法士の観察内容 58 64 EN Maki Daito Graduate School of Health Sciences, Okayama University Michiko Morimoto Division of Nursing, Faculty of Health Sciences, Okayama University 　This study explored the observations of occupational therapists regarding the early stages of left-hand writing improvement in patients with right hemiplegic stroke. Semi-structured interviews using interview guides were conducted with 12 occupational therapists, and the qualitative data were analyzed inductively. From 79 descriptive codes, 33 interpretive codes were generated and grouped into 12 subcategories. These were further classified into five main categories : ‘letter neatness,’ ‘tool operability, postural optimization,’ ‘practical utility of writing,’ and ‘autonomy in writing.’ These results revealed that the occupational therapists observed improvements in handwriting from a multifaceted perspective, including not only the patients' motor skills but also psychological and behavioral aspects. The findings of this study capture the contents of occupational therapists' observations regarding the process of the early improvement of left-hand writing, and the insights suggest that, in supporting left-hand writing for stroke patients with right hemiplegia ― among whom it is necessary to grasp changes within a limited intervention period ― these observations are potentially useful for occupational therapists to assess handwriting improvement and provide support, regardless of their years of experience. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 2045-2322 15 1 2025 Coronary cross-sectional area stenosis severity determined using coronary CT highly correlated with coronary functional flow reserve: a pilot study 26737 EN Takuto Koumoto Division of Radiation, Okayama Heart Clinic Shozo Kusachi Okayama University Graduate School of Health Sciences Takumi Tomiya Division of Cardiovascular Intervention, Okayama Heart Clinic Takuya Akagi Division of Cardiovascular Intervention, Okayama Heart Clinic Hiroshi Kawamura Division of Cardiovascular Medicine, Okayama Heart Clinic Satoshi Hirohata Okayama University Graduate School of Health Sciences Hirosuke Yamaji Division of Cardiovascular Medicine, Okayama Heart Clinic Takashi Murakami Division of Cardiovascular Medicine, Okayama Heart Clinic Shigeshi Kamikawa Division of Cardiovascular Intervention, Okayama Heart Clinic Masaaki Murakami Division of Cardiovascular Intervention, Okayama Heart Clinic Fractional flow reserve (FFR) is the gold standard for assessing the physiological significance of coronary stenosis. We examined the potential correlation between digitally measured coronary cross-sectional area stenosis using coronary computed tomography (CT) angiography and FFR. We analyzed data of 32 consecutive patients with stenoses who underwent invasive FFR determination. The cross-sectional area was assessed using 128-slice coronary detector-based spectral CT angiography. Power analysis revealed that the sample size enabled the detection of an area under the receiver operating characteristic (ROC) curve (AUC) of 0.90. FFR ≤ 0.8 and > 0.8 were defined as FFR-positive and FFR-negative, respectively. Intra- and interobserver differences were negligible. Percentage cross-sectional area stenosis was calculated as 100 × (A－B)/A, where A is the cross-sectional area at non-stenotic pre-stenotic segment and B is the cross-sectional area of the most severe stenotic lesion. AUC indicated that percentage cross-sectional area stenosis effectively discriminated between FFR-positive and FFR-negative cases, yielding a sensitivity of 0.882 and specificity of 0.933 at a cutoff of 50% area reduction, with an AUC of 0.976. Lesions with less than 45% cross-sectional area stenosis on coronary CT angiography were not FFR-positive. When ROC analysis was conducted for lesion characteristics, AUC did not significantly improve. In conclusion, the percent coronary cross-sectional area stenosis measured using coronary CT angiography distinguished between FFR-positive and FFR-negative lesions with high accuracy. The severity of coronary cross-sectional area stenosis determined using CT angiography is clinically useful for predicting FFR. No potential conflict of interest relevant to this article was reported.

Elsevier BV Acta Medica Okayama 0360-3199 101 2025 Next frontier in photocatalytic hydrogen production through CdS heterojunctions 173 211 EN Aminul Islam Department of Petroleum and Mining Engineering, Jashore University of Science and Technology Abdul Malek Department of Petroleum and Mining Engineering, Jashore University of Science and Technology Md. Tarekul Islam Department of Leather Engineering, Faculty of Mechanical Engineering, Khulna University of Engineering and Technology Farzana Yeasmin Nipa Department of Petroleum and Mining Engineering, Jashore University of Science and Technology Obayed Raihan Department of Pharmaceutical Sciences, College of Health Sciences and Pharmacy, Chicago State University Hasan Mahmud Bangladesh Energy and Power Research Council (BEPRC) Md. Elias Uddin Department of Leather Engineering, Faculty of Mechanical Engineering, Khulna University of Engineering and Technology Mohd Lokman Ibrahim School of Chemistry and Environment, Faculty of Applied Sciences, Universiti Teknologi MARA G. Abdulkareem-Alsultan Catalysis Science and Technology Research Centre, Faculty of Science, Universiti Putra Malaysia Alam Hossain Mondal USAID - Bangladesh Advancing Development and Growth through Energy (BADGE) Project, Tetra Tech Md. Munjur Hasan Department of Chemistry, Graduate School of Science, Osaka University Md. Shad Salman Institute for Chemical Research, Kyoto University Khadiza Tul Kubra Department of Chemistry, Graduate School of Science, Osaka University Md. Nazmul Hasan Department of Chemistry, School of Science, The University of Tokyo Md. Chanmiya Sheikh Division of Applied Chemistry, Graduate School of Natural Science and Technology, Okayama University Tetsuya Uchida Division of Applied Chemistry, Graduate School of Natural Science and Technology, Okayama University Adiba Islam Rasee Department of Chemistry, Graduate School of Science, Osaka University Ariyan Islam Rehan Department of Chemistry, School of Science, The University of Tokyo Mrs Eti Awual Institute for Chemical Research, Kyoto University Mohammed Sohrab Hossain Department of Chemistry, Graduate School of Science, Osaka University R.M. Waliullah Institute for Chemical Research, Kyoto University Md. Rabiul Awual Western Australian School of Mines: Minerals, Energy and Chemical Engineering, Curtin University Photocatalytic hydrogen (H₂) generation via solar-powered water splitting represents a sustainable solution to the global energy crisis. Cadmium sulfide (CdS) has emerged as a promising semiconductor photocatalyst due to its tunable bandgap, high physicochemical stability, cost-effectiveness, and widespread availability. This review systematically examines recent advancements in CdS-based heterojunctions, categorized into CdS-metal (Schottky), CdS-semiconductor (p-n, Z-scheme, S-scheme), and CdS-carbon heterojunctions. Various strategies employed to enhance photocatalytic efficiency and stability are discussed, including band structure engineering, surface modification, and the incorporation of crosslinked architectures. A critical evaluation of the underlying photocatalytic mechanisms highlights recent efforts to improve charge separation and photostability under operational conditions. This review highlights the challenges and opportunities in advancing CdS-based photocatalysts and provides a direction for future research. The insights presented aim to accelerate the development of efficient and durable CdS-based photocatalysts for sustainable H₂ production. No potential conflict of interest relevant to this article was reported.

Fuji Technology Press Ltd. Acta Medica Okayama 1883-8049 37 1 2025 Fan-Shaped Pneumatic Soft Actuator that Can Operate Bending Motion for Ankle-Joint Rehabilitation Device 43 53 EN So Shimooka Faculty of Environmental, Life, Natural Science and Technology, Okayama University Hirosato Yokoya Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University Masanori Hamada Department of Rehabilitation Medicine, Okayama University Hospital Shun Shiomi Department of Rehabilitation Medicine, Okayama University Hospital Takenori Uehara Department of Orthopaedic Surgery, NHO Okayama Medical Center Takahiro Hirayama Department of Emergency, Critical Care and Disaster Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Tetsushi Kamegawa Faculty of Environmental, Life, Natural Science and Technology, Okayama University Nowadays, owing to declining birthrates and an aging population, patients and the elderly requiring rehabilitation are not getting enough physical activity. In addressing this issue, devices for rehabilitating them have been researched and developed. However, rehabilitation devices are almost exclusively used for patients who can get up, rather than those who are bedridden. In this study, we aim to develop a rehabilitation device that can provide passive exercise for bedridden patients. The ankle joint was selected as the target joint because the patients who have undergone surgery for cerebrovascular disease remain bedridden, and early recovery in the acute stage is highly desirable. We proposed and tested a fan-shaped pneumatic soft actuator (FPSA) that can expand and bend stably at angles when supply pressure is applied as an actuator for a rehabilitation device to encourage patient exercise. However, the previous FPSA’s movement deviates from the arch of the foot owing to increased supply pressure. In the ideal case, FPSA should push the arch of the foot in an arc motion. This study proposes and tests the FPSA that can operate a bending motion to provide passive exercise to the ankle joint using tensile springs and a winding mechanism powered by a servo motor. The proposed FPSA has a significant advantage of exhibiting no hysteresis in its pressure-displacement characteristics. The configuration and static analytical model of the improved FPSA are described. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 1068-9265 32 2 2024 Hemodynamic Assessment Using SPY Laser Fluorescence Imaging During Pancreatoduodenectomy with Common Hepatic Artery Resection 1334 1336 EN Tomokazu Fuji Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kosei Takagi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kazuya Yasui Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Takeyoshi Nishiyama Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Motohiko Yamada Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yasuo Nagai Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Noriyuki Kanehira Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Background. Pancreatectomies combined with arterial resection can be indicated for pancreatic cancer. In a pancreatectomy with arterial resection, intraoperative confirmation of blood flow through reconstructed vessels is crucial. This study highlights the usefulness of SPY laser fluorescence imaging during a pancreatoduodenectomy with common hepatic artery resection (PD-CHAR). Patient and Methods. A 55-year-old man with borderline resectable pancreatic head cancer underwent a PD-CHAR. After confirming tumor resectability, reconstruction of the CHA to the proper hepatic artery was performed. Subsequently, the superior mesenteric vein was reconstructed. Results. SPY laser fluorescence imaging demonstrated arterial blood perfusion to the liver through the reconstructed hepatic artery, followed by perfusion from the portal vein. The operation lasted 493 min, with an estimated blood loss of 400 mL. The postoperative course was uneventful with good arterial blood flow. Conclusion. The SPY Portable Handheld Imager could be valuable for visualizing blood flow in reconstructed vessels and assessing tissue perfusion during a pancreatectomy combined with vascular reconstruction. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 1472-6831 25 1 2025 A cross-sectional interventional study on the effects of periodontal treatment on periodontal inflamed surface area and masticatory efficiency values according to the 2018 periodontal status classification 1094 EN Shinji Matsuda Department of Periodontal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University Hiromichi Yumoto Department of Periodontology and Endodontology, Institute of Biomedical Sciences, Tokushima University Graduate School Yasutaka Komatsu Periodontal Clinic, Medical and Dental Hospital, Niigata University Nanae Dewake Department of Operative Dentistry, Endodontology and Periodontology, School of Dentistry, Matsumoto Dental University Takanori Iwata Department of Periodontology, Tokyo Medical and Dental University Takatoshi Nagano Department of Periodontology, Tsurumi University School of Dental Medicine Toshiya Morozumi Department of Periodontology, Faculty of Dentistry, Kanagawa Dental University Ryoma Goto Department of Periodontology, School of Dentistry, Aichi Gakuin University Satsuki Kato School of Dentistry, Division of Periodontology and Endodontology, Department of Oral Rehabilitation, Health Sciences University of Hokkaido Motozo Yamashita Department of Periodontology and Regenerative Dentistry, Osaka University Graduate School of Dentistry Joichiro Hayashi Division of Periodontology, Department of Oral Biology and Tissue Engineering, Meikai University School of Dentistry, Meikai University School of Dentistry Satoshi Sekino School of Life Dentistry Department of Periodontology, The Nippon Dental University Akiko Yamashita Section of Periodontology, Division of Oral Rehabilitation Faculty of Dental Science, Kyushu University Keiko Yamashita Department of Periodontology, Tokyo Dental College Atsutoshi Yoshimura Department of Periodontology and Endodontology, Nagasaki University Graduate School of Biomedical Sciences Tsutomu Sugaya Department of Periodontology and Endodontology, Faculty of Dental Medicine, Hokkaido University Shogo Takashiba Department of Pathophysiology-Periodontal Science, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yoichiro Taguchi Faculty of Dentistry, Department of Periodontology, Osaka Dental University Eiji Nemoto Department of Periodontology and Endodontology, Tohoku University Graduate School of Dentistry Tomoaki Shintani Center of Oral Clinical Examination, Hiroshima University Hospital Tsuyoshi Miyagawa Clinical Research Center in Hiroshima, Hiroshima University Hospital Hiromi Nishi Department of General Dentistry, Hiroshima University Hospital, Noriyoshi Mizuno Department of Periodontal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University Yukihiro Numabe Department of Periodontology, Tokyo Dental College Hiroyuki Kawaguchi Department of General Dentistry, Hiroshima University Hospital, Background Periodontal inflamed surface area (PISA) and masticatory efficiency have been used to evaluate the relationship between systemic diseases and oral diseases. However, clear standards for PISA values and masticatory efficiency in relation to the severity of periodontitis are lacking. This study aims to evaluate PISA values and masticatory efficiency based on the 2018 periodontal status classification system. Methods In total, 153 healthy participants diagnosed with periodontitis were included in the study. The diagnosis was based on the 2018 periodontal status classification. PISA values and masticatory efficiency were measured at baseline and after initial periodontal therapy. Results PISA demonstrated a higher area under the curve for Stage III (0.815) and Grade B (0.85). At baseline, PISA was showed significant negative correlation with masticatory efficiency (B coefficient [95% CI]: -0.02 [-0.03, -0.006], p < 0.01). Following periodontal therapy, both PISA values and masticatory efficiency showed significant improvements, with median PISA values changing from 856 at baseline to 277.5 after treatment, and mean masticatory efficiency increasing from 153.3 to 166.9. After initial periodontal therapy, PISA values were significantly higher in patients classified as Stage IV and Grade C compared to those with other stages and grades. Age exhibited a significant negative correlation with changes in PISA (B coefficient [95%CI]: -11.8 [-20.3, -3.19]), and change in PISA value was significantly positively related to the increase in masticatory efficiency (B coefficient [95%CI], 0.02 [(0.0002, 0.03]). In patients with periodontitis, changes in periodontitis classification were associated with increased PISA values and decreased masticatory efficiency. Conclusion Periodontal therapy improved PISA and masticatory efficiency values. However, the extent of improvement was less pronounced in patients with higher stages and grades of periodontitis. It is essential to consider the interplay between increased PISA and decreased masticatory efficiency when treating patients with severe periodontitis. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 1432-1068 35 1 2024 Transtibial pullout repair improved short-term clinical outcomes in patients with oblique medial meniscus posterior root tear comparable to radial root tear 30 EN Naohiro Higashihara Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Takayuki Furumatsu Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yuki Okazaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yusuke Yokoyama Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Masanori Tamura Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Koki Kawada Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Tsubasa Hasegawa Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Toshiki Kohara Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Purpose Medial meniscus (MM) posterior root tears (PRT) can lead to excessive knee loading and unsatisfactory clinical outcomes after non-operative treatment or meniscectomy. Although favourable clinical outcomes after MM posterior root (PR) repair have been reported, no study has specifically investigated the outcomes of different types of MMPRT. This study aimed to compare the clinical outcomes of patients with complete radial and oblique MMPRT following MMPR repair. Methods Forty patients who had undergone MMPR repair were retrospectively investigated. Patients with type 2 (20 knees) and 4 MMPRT (20 knees) were included in this study. The MMPRT type was classified according to the LaPrade classification. Plain radiographs, magnetic resonance images, arthroscopic findings, and pre- and postoperative clinical outcomes were evaluated. Results At 1 year postoperatively, clinical outcomes notably improved in patients with type 2 and 4 MMPRT. No significant differences were observed in any of the evaluations between these patients, both before and after the surgery. Conclusion Patients with type 2 and type 4 MMPRT exhibited significantly improved clinical outcomes. MMPR repair is beneficial in treating type 2 and type 4 MMPRT. Level of evidence IV No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 79 4 2025 A Study of Periprosthetic Femoral Stem Fractures in Hip Arthroplasty for Femoral Neck Fracture 253 259 EN Yoshiaki Miyake Department of Orthopaedic Surgery, Japanese Red Cross Okayama Hospital Toru Takagi Department of Orthopaedic Surgery, Japanese Red Cross Okayama Hospital Taizo Konishiike Department of Orthopaedic Surgery, Japanese Red Cross Okayama Hospital Original Article 10.18926/AMO/69150 This study investigated the risk factors for bone fragility and perioperative periprosthetic femoral stem fractures in patients undergoing hip arthroplasty for femoral neck fractures. The records of 215 patients (42 male, 173 female; mean age, 84.4 years) were analyzed to assess correlations among periprosthetic fracture rates and sex, age, body mass index (BMI), Dorr classification, femoral stem fixation type (cemented/cementless), and bone mineral density (BMD) of the contralateral proximal femur. The overall prevalence of perioperative periprosthetic fractures was 4.7%. All patients with periprosthetic fractures were female, and all but one were ≥ 80 years of age. Fracture rates were higher in patients with lower BMI, although this difference was not significant. The fracture rates were 0%, 4.7%, and 7.9% for Dorr types A, B, and C, respectively, and 0% and 5.3% for patients who received cemented and cementless stems, respectively. The findings indicated that female patients, those of advanced age, those with lower BMI, and those with Dorr type C had lower BMDs. Although BMD was significantly lower in patients who received cemented stems compared to those who received cementless stems, no fractures were observed in the former group, suggesting that the use of cemented stems is safe for this high-risk population. No potential conflict of interest relevant to this article was reported.

Informa UK Limited Acta Medica Okayama 1179-1322 17 2025 Predictive Value of Tumor ERCC1 Expression for Treatment Outcomes After Adjuvant Chemotherapy in Patients with Completely Resected Non-Small Cell Lung Cancer 1477 1486 EN Masao Nakata Department of General Thoracic Surgery, Kawasaki Medical School Shinsuke Saisho Department of General Thoracic Surgery, Kawasaki Medical School Junichi Soh Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Norihito Okumura Department of Thoracic Surgery, Kurashiki Central Hospital Hiroshige Nakamura Division of General Thoracic Surgery and Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Tottori University Motohiro Yamashita Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center Shinichi Toyooka Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroshi Date Department of Thoracic Surgery, Kyoto University Graduate School of Medicine Purpose: To evaluate the predictive value of tumor expression of the excision repair cross-complementation group 1 gene (ERCC1) for the treatment outcomes after platinum-based adjuvant chemotherapy in patients with completely resected non-small cell lung cancer (NSCLC). Methods: In this study, we conducted immunohistochemical analysis using a mouse monoclonal anti-ERCC1 antibody (clone 8F1) of operative specimens obtained from 238 patients enrolled in the SLCG0401 study which compared paclitaxel plus carboplatin (CBDCA+PTX) with uracil-tegafur (UFT) as adjuvant chemotherapy for stage IB-IIIA NSCLC. The overall survival (OS) of the patients was compared according to the ERCC1 expression status and adjuvant chemotherapy employed. Results: Of the 238 specimens, 102 (42.9%) showed a positive result for ERCC1 expression. There were no significant differences in the patient characteristics or OS between the tumor ERCC1-positive and -negative patient groups. Among the patients with ERCC1-negative tumors, there was no significant difference in the survival between patient groups treated with CBDCA+PTX and UFT (HR=0.932, 95% CI: 0.52– 1.67, p=0.814). However, among the patients with ERCC1-positive tumors, CBDCA+PTX treatment tended to yield an inferior outcome, in terms of the OS, as compared with UFT treatment (HR=1.852, 95% CI: 0.92– 3.73, p=0.080). Multivariate analysis showed that ERCC1 expression was not an independent predictor of the OS following CBDCA+PTX treatment in completely resected NSCLC patients. Conclusion: In completely resected NSCLC patients with positive tumor ERCC1 expression, adjuvant CBDCA+PTX treatment tended to yield an inferior outcome as compared with UFT treatment in terms of the OS. However, immunohistochemical analysis with the 8F1 antibody cannot be used for clinical decision making at this point. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 2045-2322 15 1 2025 Survival days of patients with metastatic spinal tumors of lung cancer requiring surgery: a prospective multicenter study 24117 EN Takuya Takahashi Department of Orthopedic Surgery, Institute of Science Tokyo Takashi Hirai Department of Orthopedic Surgery, Institute of Science Tokyo Yuki Shiratani Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University Akinobu Suzuki Department of Orthopaedic Surgery, Osaka Metropolitan University Kenichiro Kakutani Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine Satoshi Kato Department of Orthopaedic Surgery Graduate School of Medical Sciences, Kanazawa University Hiroyuki Tominaga Department of Orthopedic Surgery Graduate School of Medical and Dental Sciences, Kagoshima University Hirokazu Inoue Rehabilitation Center, Jichi Medical University Hospital Hirokatsu Sawada Department of Orthopaedic Surgery, Nihon University School of Medicine Norihiko Takegami Department of Orthopaedic Surgery, Mie University Graduate School of Medicine Kazuo Nakanishi Department of Orthopaedic Surgery, Kawasaki Medical School Hideaki Nakajima Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui Masayuki Ishihara Department of Orthopaedic surgery, Kansai Medical University Hospital Tsutomu Oshigiri Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine Toru Funayama Department of Orthopaedic Surgery Institute of Medicine, University of Tsukuba Takuya Iimura Department of Orthopaedic Surgery, Dokkyo Medical University Shinji Tanishima Division of Orthopedic Surgery, Department of Sensory and Motor Organs, School of Medicine, Faculty of Medicine, Tottori University Hiroaki Nakashima Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine Daisuke Yamabe Department of Orthopaedic Surgery, Iwate Medical University Ko Hashimoto Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine Koji Uotani Department of Orthopaedic Surgery, Okayama University Hospital Masahiro Funaba Department of Orthopaedics Surgery, Yamaguchi University Graduate school of Medicine Narihito Nagoshi Department of Orthopaedic Surgery, Keio University Kazu Kobayakawa Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University Toshitaka Yoshii Department of Orthopedic Surgery, Institute of Science Tokyo Kazuyuki Watanabe Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine Toshio Nakamae Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University Takashi Kaito Department of Orthopedic Surgery, Osaka University Graduate School of Medicine Gen Inoue Department of Orthopaedic Surgery, Kitasato University School of Medicine Shiro Imagama Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine Kota Watanabe Department of Orthopaedic Surgery, Keio University Takeo Furuya Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University Surgery for metastatic spinal tumors has improved postoperative activities of daily living. A few studies reported on prognostic factors assessed in large multicenter prospective studies for metastatic spinal tumors of lung cancer origin. This study aimed to determine preoperative prognostic factors in patients undergoing surgery for metastatic spinal tumors associated with lung cancer. This prospective registry study included 74 patients diagnosed and operated with metastatic spine tumors derived from lung cancer in 39 high-volume cancer centers. We examined the postoperative survival period and the preoperative factors related to postoperative survival time. We conducted univariate and multivariate Cox regression analyses to determine preoperative prognostic factors. The mean postoperative survival period was 343 days. Multivariate Cox regression analysis revealed a higher feeding score of vitality index, indications for molecularly targeted therapy, and a higher mobility score of Barthel index as independent factors associated with postoperative survival time in metastatic spinal tumors derived from lung cancer. Patients with indications for molecular-targeted therapy and good vitality exhibited longer survival. These results may help in surgical selection for patients with metastatic spinal tumors derived from lung cancer. No potential conflict of interest relevant to this article was reported.

Springer Nature Singapore Acta Medica Okayama 0302-9743 2025 RKPM: Restricted Kernel Page Mechanism to Mitigate Privilege Escalation Attacks 213 231 EN Hiroki Kuzuno Graduate School of Engineering, Kobe University Toshihiro Yamauchi Faculty of Environmental, Life, Natural Science and Technology, Okayama University Kernel memory corruption attacks against operating systems exploit kernel vulnerabilities to overwrite kernel data. Kernel address space layout randomization makes it difficult to identify kernel data by randomizing their virtual address space. Control flow integrity (CFI) prevents unauthorized kernel code execution by verifying kernel function calls. However, these countermeasures do not prohibit writing to kernel data. If the virtual address of privileged information is specified and CFI is circumvented, the privileged information can be modified by a kernel memory corruption attack. In this paper, we propose a restricted kernel page mechanism (RKPM) to mitigate kernel memory corruption attacks by introducing restricted kernel pages to protect the kernel data specified in the kernel. The RKPM focuses on the fact that kernel memory corruption attacks attempt to read the virtual addresses around the privileged information. The RKPM adopts page table mapping handling and a memory protection key to control the read and write restrictions of the restricted kernel pages. This allows us to mitigate kernel memory corruption attacks by capturing reads to the restricted kernel page before the privileged information is overwritten. As an evaluation of the RKPM, we confirmed that it can mitigate privilege escalation attacks on the latest Linux kernel. We also measured that there was a certain overhead in the kernel performance. This study enhances kernel security by mitigating privilege escalation attacks through the use of software or hardware based restricted kernel pages. No potential conflict of interest relevant to this article was reported.

IEEE Acta Medica Okayama 2024 kdMonitor: Kernel Data Monitor for Detecting Kernel Memory Corruption 66 73 EN Hiroki Kuzuno Graduate School of Engineering, Kobe University Toshihiro Yamauchi Okayama University,Faculty of Environmental, Life, Natural Science and Technology Privilege escalation attacks through memory corruption via kernel vulnerabilities pose significant threats to operating systems. Although the extended Berkley Packet Filter has been employed to trace kernel code execution by inserting interrupts before and after kernel code invocations, it does not track operations before and after kernel data writes, thus hindering effective kernel data monitoring. In this study, we introduce a kernel data monitor (kdMonitor), which is a novel security mechanism designed to detect unauthorized alterations in the monitored kernel data of a dedicated kernel page. The kdMonitor incorporates two distinct methods. The first is periodic monitoring which regularly outputs the monitored kernel data of the dedicated kernel pages. The second is dynamic monitoring, which restricts write access to a dedicated kernel page, supplements any write operations with page faults, and outputs the monitored kernel data of dedicated kernel pages. kdMonitor enables real-time tracking of specified kernel data of the dedicated kernel page residing in the kernel's virtual memory space from the separated machine. Using kdMonitor, we demonstrated its capability to pinpoint tampering with user process privileged information stemming from privilege escalation attacks on the kernel. Through an empirical evaluation, we validated the effectiveness of kdMonitor in detecting privilege escalation attacks by user processes on Linux. Performance assessments revealed that kdMonitor achieved an attack detection time of 0.83 seconds with an overhead of 0.726 %. No potential conflict of interest relevant to this article was reported.

Springer Nature Switzerland Acta Medica Okayama 0302-9743 2023 vkTracer: Vulnerable Kernel Code Tracing to Generate Profile of Kernel Vulnerability 222 234 EN Hiroki Kuzuno Graduate School of Engineering, Kobe University Toshihiro Yamauchi Faculty of Natural Science and Technology, Okayama University Vulnerable kernel codes are a threat to an operating system kernel. An adversary’s user process can forcefully invoke a vulnerable kernel code to cause privilege escalation or denial of service (DoS). Although service providers or security operators have to determine the effect of kernel vulnerabilities on their environment to decide the kernel updating, the list of vulnerable kernel codes are not provided from the common vulnerabilities and exposures (CVE) report. It is difficult to identify the vulnerable kernel codes from the exploitation result of the kernel which indicates the account information or the kernel suspension. To identify the details of kernel vulnerabilities, this study proposes a vulnerable kernel code tracer (vkTracer), which employs an alternative viewpoint using proof-of-concept (PoC) code to create a profile of kernel vulnerability. vkTracer traces the user process of the PoC code and the running kernel to hook the invocation of the vulnerable kernel codes. Moreover, vkTracer extracts the whole kernel component’s information using the running and static kernel image and debug section. The evaluation results indicated that vkTracer could trace PoC code executions (e.g., privilege escalation and DoS), identify vulnerable kernel codes, and generate kernel vulnerability profiles. Furthermore, the implementation of vkTracer revealed that the identification overhead ranged from 5.2683 s to 5.2728 s on the PoC codes and the acceptable system call latency was 3.7197 μs. No potential conflict of interest relevant to this article was reported.

日本エアロゾル学会 Acta Medica Okayama 0912-2834 40 2 2025 水溶性高分子含有スラリー液滴乾燥過程の評価 99 108 EN Koichi Nakaso Faculty of Environmental, Life, Natural Science and Technology, Okayama University Daichi Yamashita Graduate School of Natural Science and Technology, Okayama University Yutaro Aoyama Graduate School of Natural Science and Technology, Okayama University Yasushi Mino Faculty of Environmental, Life, Natural Science and Technology, Okayama University Kuniaki Gotoh Faculty of Environmental, Life, Natural Science and Technology, Okayama University The granulation process of a slurry droplet containing a water-soluble polymer in a spray dryer is investigated. Although there have been many studies on the drying behavior of a single-component slurry droplet, there have been few reports for a multicomponent slurry droplet. This is due to the complexity and difficulty in evaluating the drying behavior of a multicomponent slurry droplet. Therefore, for the production of granules from multicomponent materials by a spray dryer, its operating conditions are usually determined by trial and error. To optimize the practical granule production process, the drying behavior of multicomponent slurry droplets should be studied. In this study, the drying behavior of a silica slurry droplet containing polyvinyl alcohol (PVA) is investigated. The drying behavior of a droplet suspended on the tip of a needle was observed. The effect of the volume fraction of PVA on the drying behavior and the morphology of a dried granule is studied. The effect of drying condition on the granule formation process is also investigated. As a result, the structure of dried granules was strongly influenced by PVA concentration. Segregation of PVA in the dried granules was observed. Based on the results, the drying process diagram is presented. No potential conflict of interest relevant to this article was reported.

Springer International Publishing Acta Medica Okayama 0302-9743 2022 CyNER: Information Extraction from Unstructured Text of CTI Sources with Noncontextual IOCs 85 104 EN Shota Fujii Graduate School of Natural Science and Technology, Okayama University Nobutaka Kawaguchi Research & Development Group, Hitachi, Ltd. Tomohiro Shigemoto Research & Development Group, Hitachi, Ltd. Toshihiro Yamauchi Faculty of Natural Science and Technology, Okayama University Cybersecurity threats have been increasing and growing more sophisticated year by year. In such circumstances, gathering Cyber Threat Intelligence (CTI) and following up with up-to-date threat information is crucial. Structured CTI such as Structured Threat Information eXpression (STIX) is particularly useful because it can automate security operations such as updating FW/IDS rules and analyzing attack trends. However, as most CTIs are written in natural language, manual analysis with domain knowledge is required, which becomes quite time-consuming. In this work, we propose CyNER, a method for automatically structuring CTIs and converting them into STIX format. CyNER extracts named entities in the context of CTI and then extracts the relations between named entities and IOCs in order to convert them into STIX. In addition, by using key phrase extraction, CyNER can extract relations between IOCs that lack contextual information, such as those listed at the bottom of a CTI, and named entities. We describe our design and implementation of CyNER and demonstrate that it can extract named entities with the F-measure of 0.80 and extract relations between named entities and IOCs with the maximum accuracy of 81.6%. Our analysis of structured CTI showed that CyNER can extract IOCs that are not included in existing reputation sites, and that it can automatically extract IOCs that have been exploited for a long time and across multiple attack groups. CyNER is thus expected to contribute to the efficiency of CTI analysis. No potential conflict of interest relevant to this article was reported.

IEEE Acta Medica Okayama 2832-1324 2023 Analyzing Post-injection Attacker Activities in IoT Devices: A Comprehensive Log Analysis Approach 292 297 EN Hervet Victor Okayama University Satoru Kobayashi Faculty of Environmental, Life, Natural Science and Technology, Okayama University Toshihiro Yamauchi Faculty of Environmental, Life, Natural Science and Technology, Okayama University With the continuous proliferation of Internet of Things (IoT) devices, malware threats that specifically target these devices continue to increase. The urgent need for robust security measures is predicated on a comprehensive understanding of the behavioral patterns of IoT malware. However, previous studies have often overlooked the analysis of command sequences in Telnet logs. This study bridges this research gap by examining the post-injection behaviors of attackers. By analyzing a vast dataset comprising more than ten million logs collected from an IoT honeypot, we reveal three distinct post-injection activity patterns, each with unique characteristics. These patterns provide pivotal insights that not only help distinguish between legitimate operations and attempted attacks, but also drive the development of robust cybersecurity measures that effectively deter such behaviors. The nuances discovered in this study contribute significantly to IoT security by enhancing our understanding of malware tactics and informing targeted defense strategies. No potential conflict of interest relevant to this article was reported.

IEEE Acta Medica Okayama 2832-1324 2023 Supporting Multiple OS Types on Estimation of System Call Hook Point by Virtual Machine Monitor 267 273 EN Masaya Sato Okayama Prefectural University Taku Omori Okayama Prefectural University Toshihiro Yamauchi Okayama University Hideo Taniguchi Okayama University Methods to hook system calls issued by a guest operating system (OS) running on a virtual machine using a virtual machine monitor are proposed. The address of the hook point is derived from the guest OS’s source code and established prior to the kernel startup process. Due to changes in system call processing in OS updates and address space layout randomization, the addresses of these hook points cannot always be pre-determined before the kernel startup process. To address this challenge, a method for estimating the system call hook point is proposed in Linux by analyzing the guest OS memory on x86-64 CPUs rather than pre-calculation. Although the method supports Linux, the method can be extended to support other OS types. In this paper, we propose a method to extend the method to support additional OSes. Specifically, we present analysis results and a novel method for estimating hook points on FreeBSD, NetBSD, and OpenBSD. The effectiveness of our proposed method is also demonstrated through evaluation. No potential conflict of interest relevant to this article was reported.

Elsevier BV Acta Medica Okayama 0039-9140 295 2025 Using a microfluidic paper-based analytical device and solid-phase extraction to determine phosphate concentration 128303 EN Kaewta Danchana Department of Chemistry, Okayama University Haruka Namba Department of Chemistry, Okayama University Takashi Kaneta Department of Chemistry, Okayama University Phosphate is an essential nutrient, but in high concentrations it contributes to water pollution. Traditional methods for phosphate measurement, such as absorption spectrophotometry and ion chromatography, require expensive equipment and skilled operators. This study introduces a microfluidic paper-based analytical device (μPAD) that is designed to accomplish field-based, low-concentration phosphate measurements. This μPAD utilizes colorimetric detection based on the molybdenum blue method. Herein, we describe how the conditions were optimized in terms of design and sensitivity by adjusting reagent concentrations, paper thickness, and the time frames for sample introduction, and reaction. The operation consists of simply dipping the μPAD into a sample, capturing images in a home-made photo studio box, and processing the images with ImageJ software to measure RGB intensity. An additional preconcentration step involves solid-phase extraction with an anion exchange resin that achieves a 10-fold enrichment, which enables detection that ranges from 0.05 to 1 mg L－1 with a detection limit of 0.089 mg L－1 and a quantification limit of 0.269 mg L－1. The replicated measurements showed good reproducibility both intraday and interday (five different days) as 4.7 % and 3.0 % of relative standard deviations, respectively. After storage in a refrigerator for as long as 26 days, this μPAD delivered stable and accurate results for real-world samples of natural water, soil, and toothpaste. The results produced using this system correlate well with those produced via spectrophotometry. This μPAD-based method is a cost-effective, portable, rapid, and simple approach that allows relatively unskilled operators to monitor phosphate concentrations in field applications. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 79 3 2025 Investigation of Cup Placement Position in Total Hip Arthroplasty with Cup-side Implant Placement in Computed Tomography Horizontal Sections 177 184 EN Shuro Furuichi Department of Bone and Joint Surgery, Kawasaki Medical School Shigeru Mitani Department of Bone and Joint Surgery, Kawasaki Medical School Hirosuke Endo Department of Bone and Joint Surgery, Kawasaki Medical School Yoshifumi Namba Department of Bone and Joint Surgery, Kawasaki Medical School Toyohiro Kawamoto Department of Bone and Joint Surgery, Kawasaki Medical School Original Article 10.18926/AMO/68725 The position attained in total hip arthroplasty (THA) is ideally in the center of the horizontal plane of the acetabulum. However, central placement is not always possible. We hypothesized that differences in approach result in individual differences in cup positioning; thus, we investigated the cup positions of 217 hips that underwent THA. The acetabulum’s anteroposterior diameter was measured, and the cups placed within 2 mm of the line perpendicular to the center as a central placement (central). Of the 217 hips, 68, 114, and 35 hips were anterior, central, and posterior, respectively. In 21 hips, anteroposterior deviation was noted. Among patients operated using the anterolateral approach, 48, 93, and 30 hips were anterior, central, and posterior, respectively. Among those operated using the posterolateral approach, 16, 20, and 4 hips were anterior, central, and posterior, respectively. The cup position shifted either anteriorly or posteriorly to the acetabulum in approximately half of all hips operated using both approaches and tended to shift anteriorly in the hips operated using the posterolateral approach. During THA surgery, it is important to operate with awareness of the center of the acetabulum. No potential conflict of interest relevant to this article was reported.

Elsevier Acta Medica Okayama 2772-963X 4 5 2025 Prognostic Value of Pericoronary Fat Attenuation Index on Computed Tomography for Hospitalization for Heart Failure 101685 EN Mitsutaka Nakashima Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toru Miyoshi Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takahiro Nishihara Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takashi Miki Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kentaro Ejiri Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shohei Hara Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoichi Takaya Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Rie Nakayama Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Keishi Ichikawa Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazuhiro Osawa Department of General Internal Medicine 3, Kawasaki Medical School General Medicine Centre Shinsuke Yuasa Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences BACKGROUND Pericoronary fat attenuation index (FAI) assessed on computed tomography is associated with the inflammation of the pericoronary artery. OBJECTIVES This study aimed to investigate whether pericoronary FAI predicts hospitalization for heart failure with preserved ejection fraction (HFpEF). METHODS This retrospective single-center study included 1,196 consecutive patients who underwent clinically indicated coronary computed tomography angiography (CCTA) and transthoracic echocardiography. We assessed the FAI of proximal 40-mm segments for each major epicardial coronary vessel. The primary outcome was the incidence of hospitalization for HFpEF. Patients were divided into groups based on the optimal cutoff value for predicting hospitalization for HFpEF by receiver operating characteristic curve analysis. RESULTS During a median follow-up of 4.3 years, 29 hospitalizations for HFpEF occurred. Multivariable Cox regression analysis revealed that a left anterior descending artery (LAD)-FAI >=-63.4 HU and a left circumflex artery-FAI >=-61.6 HU were significantly associated with hospitalization for HF after adjustment for age and sex (HR: 4.8; 95% CI: 2.1-10.8 and HR: 4.5; 95% CI: 2.1-9.4, respectively). The addition of LAD-FAI >-63.4 HU to a model incorporating other risk factors, including hypertension, estimated glomerular filtration rate <60 mL/min/1.73 m2, and significant stenosis on CCTA, increased the C-statistic for predicting hospitalization for HFpEF from 0.646 to 0.750 (P = 0.010). CONCLUSIONS LAD-and left circumflex artery-FAI can predict hospitalization for HFpEF in patients undergoing clinically indicated CCTA. Pericoronary inflammation may be useful for identifying patients at high risk of developing HFpEF. No potential conflict of interest relevant to this article was reported.

Optica Publishing Group Acta Medica Okayama 1094-4087 33 8 2025 Demonstration of enhanced Raman scattering in high-Q silicon nanocavities operating below the silicon band-gap wavelength 18515 18529 EN Yu Shimomura Department of Physics and Electronics, Osaka Metropolitan University Takashi Asano Department of Electronic Science and Engineering, Kyoto University Ayumi Ishihara Department of Physics and Electronics, Osaka Metropolitan University Susumu Noda Department of Electronic Science and Engineering, Kyoto University Yasushi Takahashi Graduate School of Environmental, Life, Natural Science and Technology, Okayama University We experimentally determined the quality factor (Q) and the intensity of the Raman scattered light for different silicon photonic-crystal nanocavities operating at wavelengths shorter than the silicon band-gap wavelength. Despite the relatively large absorption of silicon in this wavelength region, we observed Q values greater than 10,000 for cavities with a resonance wavelength of 1.05 mu m, and Q values greater than 30,000 for cavities with a resonance wavelength of 1.10 mu m. Additionally, we measured the Raman scattering spectra of cavities with resonance wavelengths of 1.10 mu m and 1.21 mu m. On average, the generation efficiency of the Raman scattered light in a 1.10-mu m nanocavity is 6.5 times higher than that in a 1.21-mu m nanocavity. These findings suggest that silicon nanocavities operating below the silicon band-gap wavelength could be useful in the development of silicon-based light sources. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 79 2 2025 Safe Resection of Esophageal Cancer with a Non-Recurrent Inferior Laryngeal Nerve Associated with an Aberrant Right Subclavian Artery Using Intraoperative Nerve Monitoring 139 144 EN Yasushige Takeda Department of Gastroenterological Surgery, Okayama University Hospital Kazuhiro Noma Department of Gastroenterological Surgery, Okayama University Hospital Naoaki Maeda Department of Gastroenterological Surgery, Okayama University Hospital Yohei Mizusawa Department of Gastroenterological Surgery, Okayama University Hospital Hijiri Matsumoto Department of Gastroenterological Surgery, Okayama University Hospital Yuhei Kondo Department of Gastroenterological Surgery, Okayama University Hospital Tomoyoshi Kunitomo Department of Gastroenterological Surgery, Okayama University Hospital Yukinori Tanoue Department of Gastroenterological Surgery, Okayama University Hospital Masashi Hashimoto Department of Gastroenterological Surgery, Okayama University Hospital Shunsuke Tanabe Department of Gastroenterological Surgery, Okayama University Hospital Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Hospital Case Report 10.18926/AMO/68654 In thoracic esophageal cancer, lymph node dissection around the recurrent laryngeal nerve is crucial but poses a risk of nerve palsy, affecting postoperative quality of life. In cases with an aberrant right subclavian artery (ARSA), the right recurrent laryngeal nerve is absent, and the non-recurrent inferior laryngeal nerve (NRILN) enters the larynx directly from the vagus nerve in the cervical region. Identifying the course of the NRILN is vital to avoid injury. A case of esophageal cancer with an ARSA, in which the course of the NRILN was preserved using the Nerve Integrity Monitoring (NIM) system during surgery, is described. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 79 2 2025 Effectiveness of Postoperative Irradiation in Patients with cN0 Early Breast Cancer Treated with Sentinel Lymph Node Surgery 101 107 EN Hiroshi Isozaki Department of Surgery, Oomoto Hospital Sasau Matsumoto Department of Surgery, Oomoto Hospital Takehiro Takama Department of Surgery, Oomoto Hospital Yuka Isozaki Department of Surgery, Oomoto Hospital Original Article 10.18926/AMO/68648 To evaluate the effectiveness of postoperative irradiation (POI) for patients with cN0 early breast cancer, we retrospectively analyzed the cases of 650 consecutive breast cancer patients who underwent sentinel lymph node (SLN)-guided surgery (2005-2022) at our hospital. In this cohort, 53% (278/521) of the patients who underwent breast conservative surgery (BCS) and 96% (124/129) of those treated with mastectomy did not receive POI. The patients who underwent BCS were treated with POI using opposing tangential field irradiation. A false negative (FN) SLN was retrospectively defined as a negative metastasis in SLN plus positive recurrence in the axillary lymph nodes. Recurrence was detected in 83 patients. A logistic regression analysis revealed that the nuclear grade (odds ratio [OR] 1.69), POI (OR 0.41), and postoperative hormone therapy (OR 0.40) were each significantly related to recurrence. The 26.1% (12/46) FN rate of the non-POI patients decreased to 5.8% (1/17) compared to those treated with POI. The rate of axillary recurrence was significantly lower in the POI group (0.4%) versus the non-POI group (2.7%) (p=0.0355). The rate of locoregional recurrence was also significantly lower in the POI group (2.0%) versus the non-POI group (13.4%) (p<0.0001). No significant difference was observed in the rate of distant recurrence between the POI (4.0%) and non-POI (3.3%) (p=0.831) groups. These results indicated that the postoperative opposing tangential field irradiation of conserved breast tissue inhibited recurrence in the axillary lymph nodes. No potential conflict of interest relevant to this article was reported.

BMC Acta Medica Okayama 1477-7819 23 1 2025 Surgical protocol of robotic liver resection using a two-surgeon technique (TAKUMI-3): a technical note and initial outcomes 124 EN Kosei Takagi Department of Gastroenterological Surgery, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Tomokazu Fuji Department of Gastroenterological Surgery, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Kazuya Yasui Department of Gastroenterological Surgery, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Yuzo Umeda Department of Hepatobiliary Pancreatic Surgery, Ehime University Graduate School of Medicine Motohiko Yamada Department of Gastroenterological Surgery, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Takeyoshi Nishiyama Department of Gastroenterological Surgery, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Yasuo Nagai Department of Gastroenterological Surgery, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Noriyuki Kanehira Department of Gastroenterological Surgery, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Background Internationally, evidence supporting robotic liver resection (RLR) has gradually increased in recent years. However, a standardized protocol for RLR remains lacking. This study describes a surgical protocol and the initial outcomes of RLR in a high-volume center for robotic hepatopancreatobiliary surgery in Japan. Methods Patients were placed in the reverse Trendelenburg position, with a supine position for anterolateral tumors and left lateral position for posterosuperior tumors. Our standard RLR protocol involved a two-surgeon technique. Liver parenchymal transection was performed by an assistant using the clamp crush technique with a console, with or without a laparoscopic Cavitron ultrasonic surgical aspirator (CUSA). Surgical techniques, including the tips, tricks, and pitfalls of RLR, are also demonstrated. Results We performed 113 RLR at our institution for common primary diseases, including hepatocellular carcinoma (n = 52, 46.0%) and metastatic tumors (n = 48, 42.5%) between July 2022 and December 2024. The median operative time and estimated blood loss were 156 min (interquartile range [IQR], 121-209 min) and 20 mL (IQR, 0-100 mL), respectively. During liver parenchymal transection, a laparoscopic CUSA was used in 59 patients (52.2%), and a water-jet scalpel was used in 12 patients (10.6%). The incidence of mortality, major complications, and bile leakage was 0%, 6.2%, and 2.7%, respectively. The median hospital stay was 7 days (IQR, 6-9 days). Conclusions We successfully introduced an RLR program using the two-surgeon technique. Safe implementation of RLR can be achieved upon completion of the training program and thorough understanding of the surgical protocols. No potential conflict of interest relevant to this article was reported.

Elsevier BV Acta Medica Okayama 0168-0102 213 2025 The potential mechanism maintaining transactive response DNA binding protein 43 kDa in the mouse stroke model 128 137 EN Yuting Bian Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yusuke Fukui Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Ricardo Satoshi Ota-Elliott Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Xinran Hu Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Hongming Sun Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Zhihong Bian Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yun Zhai Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Haibo Yu Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Xiao Hu Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Hangping An Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Hongzhi Liu Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Ryuta Morihara Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Hiroyuki Ishiura Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Toru Yamashita Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University The disruption of transactive response DNA binding protein 43 kDa (TDP-43) shuttling leads to the depletion of nuclear localization and the cytoplasmic accumulation of TDP-43. We aimed to evaluate the mechanism underlying the behavior of TDP-43 in ischemic stroke. Adult male C57BL/6 J mice were subjected to 30 or 60 min of transient middle cerebral artery occlusion (tMCAO), and examined at 1, 6, and 24 h post reperfusion. Immunostaining was used to evaluate the expression of TDP-43, G3BP1, HDAC6, and RAD23B. The total and cytoplasmic number of TDP-43–positive cells increased compared with sham operation group and peaked at 6 h post reperfusion after tMCAO. The elevated expression of G3BP1 protein peaked at 6 h after reperfusion and decreased at 24 h after reperfusion in ischemic mice brains. We also observed an increase of expression level of HDAC6 and the number of RAD23B-positive cells increased after tMCAO. RAD23B was colocalized with TDP-43 24 h after tMCAO. We proposed that the formation of stress granules might be involved in the mislocalization of TDP-43, based on an evaluation of G3BP1 and HDAC6. Subsequently, RAD23B, may also contribute to the downstream degradation of mislocalized TDP-43 in mice tMCAO model. No potential conflict of interest relevant to this article was reported.

Springer Nature Acta Medica Okayama 2234-2451 37 1 2025 The preoperative flexion tear gap affects postoperative meniscus stability after pullout repair for medial meniscus posterior root tear 16 EN Masanori Tamura Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Takayuki Furumatsu Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Takahiro Kitayama Department of Radiology, Okayama University Hospital Yusuke Yokoyama Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yuki Okazaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Koki Kawada Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Background We investigated whether the preoperative flexion tear gap (FTG) observed in open magnetic resonance imaging (MRI) affects meniscus stability after medial meniscus (MM) posterior root (MMPR) repairs. Furthermore, time-correlated MRI findings from MMPR tear occurrence were evaluated. Methods This retrospective observational study included 54 patients (mean age, 64.6 years; 13 males and 41 females) who underwent pullout repair for radial degenerative MMPR tear. Meniscus stability (scored 0-4 points) was assessed using a semi-quantitative arthroscopic scoring system during second-look arthroscopy 1 year postoperatively. The FTG was evaluated on preoperative axial MRI at 90 degrees knee flexion. Other MRI measurements included MM extrusion (MME) at 10 degrees knee flexion, MM posterior extrusion (MMPE) at 90 degrees knee flexion, and MM posteromedial extrusion (MMpmE) at 90 degrees knee flexion preoperatively and 1 year postoperatively. The correlation between the arthroscopic stability score and MRI findings was investigated. A receiver-operating characteristic curve was calculated to predict a good meniscus healing score (3-4 points). The correlation between the FTG and patient demographics, including time from injury to MRI, was analyzed. Results At 1 year postoperatively, MME increased by 1.1 mm, while MMpmE and MMPE decreased by 0.4 mm and 1.0 mm, respectively. The meniscus stability score was negatively correlated with the preoperative FTG (r = -0.61, p < 0.01). The time from injury to MRI was significantly correlated with the preoperative FTG. The receiver-operating characteristic curve identified an FTG cut-off value of 8.7 mm for predicting good postoperative stability, with sensitivity and specificity of 67% and 85%, respectively. Conclusions FTG evaluated with open MRI at 90 degrees knee flexion was associated with time from injury and affected meniscus stability following pullout repair. MMPR tears should be treated in the early phase to increase meniscus healing stability. No potential conflict of interest relevant to this article was reported.

Department of Mathematics, Faculty of Science, Okayama University Acta Medica Okayama 0030-1566 67 1 2025 Inseparable Gauss maps and dormant opers 1 28 EN Yasuhiro Wakabayashi Graduate School of Information Science and Technology, Osaka University The present paper aims to generalize a result by H. Kaji on Gauss maps in positive characteristic and establish an interaction with the study of dormant opers and Frobenius-projective structures. We prove a correspondence between dormant opers on a smooth projective variety and closed immersions into a projective space with purely inseparable Gauss map. By using this, we determine the subfields of the function field of a smooth curve in positive characteristic induced by Gauss maps. Moreover, this correspondence gives us a Frobenius-projective structure on a Fermat hypersurface. No potential conflict of interest relevant to this article was reported.

Medknow Publications Acta Medica Okayama 0971-6203 50 1 2025 Investigating the Effects of Reconstruction Conditions on Image Quality and Radiomic Analysis in Photon-counting Computed Tomography 100 107 EN Miyu Ohata Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Ryohei Fukui Department of Radiological Technology, Faculty of Health Sciences, Okayama University Yusuke Morimitsu Division of Radiological Technology, Okayama University Hospital Daichi Kobayashi Division of Radiological Technology, Okayama University Hospital Takatsugu Yamauchi Division of Radiological Technology, Okayama University Hospital Noriaki Akagi Division of Radiological Technology, Okayama University Hospital Mitsugi Honda Division of Radiological Technology, Okayama University Hospital Aiko Hayashi Department of Radiology, Hiroshima University Hospital Koshi Hasegawa Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Katsuhiro Kida Department of Radiological Technology, Faculty of Health Sciences, Okayama University Sachiko Goto Department of Radiological Technology, Faculty of Health Sciences, Okayama University Takao Hiraki Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical, Okayama University Introduction:Photon-counting computed tomography (CT) is equipped with an adaptive iterative reconstruction method called quantum iterative reconstruction (QIR), which allows the intensity to be changed during image reconstruction. It is known that the reconstruction conditions of CT images affect the analysis results when performing radiomic analysis. The aim of this study is to investigate the effect of QIR intensity on image quality and radiomic analysis of renal cell carcinoma (RCC). Materials and Methods:The QIR intensities were selected as off, 2 and 4. The image quality evaluation items considered were task-based transfer function (TTF), noise power spectrum (NPS), and low-contrast object specific contrast-to-noise ratio (CNRLO). The influence on radiomic analysis was assessed using the discrimination accuracy of clear cell RCC. Results:For image quality evaluation, TTF and NPS values were lower and CNRLO values were higher with increasing QIR intensity; for radiomic analysis, sensitivity, specificity, and accuracy were higher with increasing QIR intensity. Principal component analysis and receiver operating characteristics analysis also showed higher values with increasing QIR intensity. Conclusion:It was confirmed that the intensity of the QIR intensity affects both the image quality and the radiomic analysis. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 1999-5903 17 3 2025 Facial Privacy Protection with Dynamic Multi-User Access Control for Online Photo Platforms 124 EN Andri Santoso Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Samsul Huda Green Innovation Center, Okayama University Yuta Kodera Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Yasuyuki Nogami Graduate School of Environmental, Life, Natural Science and Technology, Okayama University In the digital age, sharing moments through photos has become a daily habit. However, every face captured in these photos is vulnerable to unauthorized identification and potential misuse through AI-powered synthetic content generation. Previously, we introduced SnapSafe, a secure system for enabling selective image privacy focusing on facial regions for single-party scenarios. Recognizing that group photos with multiple subjects are a more common scenario, we extend SnapSafe to support multi-user facial privacy protection with dynamic access control designed for online photo platforms. Our approach introduces key splitting for access control, an owner-centric permission system for granting and revoking access to facial regions, and a request-based mechanism allowing subjects to initiate access permissions. These features ensure that facial regions remain protected while maintaining the visibility of non-facial content for general viewing. To ensure reproducibility and isolation, we implemented our solution using Docker containers. Our experimental assessment covered diverse scenarios, categorized as "Single", "Small", "Medium", and "Large", based on the number of faces in the photos. The results demonstrate the system's effectiveness across all test scenarios, consistently performing face encryption operations in under 350 ms and achieving average face decryption times below 286 ms across various group sizes. The key-splitting operations maintained a 100% success rate across all group configurations, while revocation operations were executed efficiently with server processing times remaining under 16 ms. These results validate the system's capability in managing facial privacy while maintaining practical usability in online photo sharing contexts. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 1661-6596 26 6 2025 Involvement of a Novel Variant of FGFR1 Detected in an Adult Patient with Kallmann Syndrome in Regulation of Gonadal Steroidogenesis 2713 EN Yoshiaki Soejima Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuki Otsuka Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Marina Kawaguchi Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kohei Oguni Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Koichiro Yamamoto Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasuhiro Nakano Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Miho Yasuda Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazuki Tokumasu Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Keigo Ueda Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kosei Hasegawa Department of Pediatrics, Okayama University Hospital Nahoko Iwata Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Fumio Otsuka Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Fibroblast growth factor receptor 1 (FGFR1), also known as KAL2, is a tyrosine kinase receptor, and variants of FGFR1 have been detected in patients with Kallmann syndrome (KS), which is a congenital developmental disorder characterized by central hypogonadism and anosmia. Herein, we report an adult case of KS with a novel variant of FGFR1. A middle-aged male was referred for a compression fracture of a lumbar vertebra. It was shown that he had severe osteoporosis, anosmia, gynecomastia, and a past history of operations for cryptorchidism. Endocrine workup using pituitary and gonadal stimulation tests revealed the presence of both primary and central hypogonadism. Genetic testing revealed a novel variant of FGFR1 (c.2197_2199dup, p.Met733dup). To identify the pathogenicity of the novel variant and the clinical significance for the gonads, we investigated the effects of the FGFR1 variant on the downstream signaling of FGFR1 and gonadal steroidogenesis by using human steroidogenic granulosa cells. It was revealed that the transfection of the variant gene significantly impaired FGFR1 signaling, detected through the downregulation of SPRY2, compared with that of the case of the forced expression of wild-type FGFR1, and that the existence of the variant gene apparently altered the expression of key steroidogenic factors, including StAR and aromatase, in the gonad. The results suggested that the novel variant of FGFR1 detected in the patient with KS was linked to the impairment of FGFR1 signaling, as well as the alteration of gonadal steroidogenesis, leading to the pathogenesis of latent primary hypogonadism. No potential conflict of interest relevant to this article was reported.

SAGE Publications Acta Medica Okayama 1756-2848 18 2025 Clipping closure length is a crucial factor for delayed bleeding after endoscopic papillectomy: a retrospective multicenter cohort study EN Yuki Fujii Department of Gastroenterology and Hepatology, Okayama University Hospital Kazuyuki Matsumoto Department of Gastroenterology and Hepatology, Okayama University Hospital Kiyoaki Ochi Department of Gastroenterology, Fukuyama City Hospital Hitomi Himei Department of Gastroenterology, Hiroshima City Hiroshima Citizens Hospital Ichiro Sakakihara Department of Gastroenterology, Kagawa Prefectural Central Hospital Eijiro Ueta Department of Gastroenterology, National Hospital Organization, Iwakuni Clinical Center Tatsuya Toyokawa Department of Gastroenterology, National Hospital Organization, Fukuyama Medical Center Ryo Harada Department of Gastroenterology, Japanese Red Cross Okayama Hospital Taiji Ogawa Department of Gastroenterology, Tsuyama Chuo Hospital Takeshi Tomoda Department of Gastroenterology, Okayama City Hospital Hironari Kato Department of Gastroenterology, Okayama City Hospital Ryosuke Sato Department of Gastroenterology and Hepatology, Okayama University Hospital Taisuke Obata Department of Gastroenterology and Hepatology, Okayama University Hospital Akihiro Matsumi Department of Gastroenterology and Hepatology, Okayama University Hospital Kazuya Miyamoto Department of Gastroenterology and Hepatology, Okayama University Hospital Daisuke Uchida Department of Gastroenterology and Hepatology, Okayama University Hospital Shigeru Horiguchi Department of Gastroenterology and Hepatology, Okayama University Hospital Koichiro Tsutsumi Department of Gastroenterology and Hepatology, Okayama University Hospital Motoyuki Otsuka Department of Gastroenterology and Hepatology, Okayama University Hospital Background: Bleeding is a serious and frequent adverse event that occurs during and after endoscopic papillectomy (EP). Previous studies have highlighted the effectiveness of preventive clipping closure of the resection site in preventing post-EP bleeding. However, the optimal length of closure remained unclear. Objectives: We aimed to clarify the optimal clipping length at the post-EP resection site to prevent delayed bleeding. Design: This study was a multicenter retrospective cohort study. ] Methods: We retrospectively analyzed patients who were consecutively admitted to nine high-volume centers for EP between November 2003 and October 2023. The primary outcome was the frequency of delayed bleeding based on the closure length. The optimal closure length rate of the resected site to prevent delayed bleeding was determined using a receiver operating characteristic curve. Secondary outcomes were the incidence, treatment outcomes, and risk factors for post-EP delayed bleeding. Results: A total of 130 patients who underwent EP were analyzed. Delayed bleeding was observed in 22 (17%) patients, occurring more frequently in cases without clipping closure than in those with clipping closure (28% (13/47) vs 11% (9/83); p = 0.014). Among 83 patients who underwent clipping closure, delayed bleeding occurred more frequently with a closure length rate <65% than in those with a closure rate >= 65% (25% (5/20) vs 6% (4/63); p = 0.019). Multivariate analysis showed that a closure rate <65% was the risk factor for delayed bleeding (odds ratio, 6.3; 95% confidence interval, 1.2-33; p = 0.030) in cases with clipping. Conclusion: Clipping closure was effective in preventing delayed bleeding, and closure length rate >= 65% of the resected site significantly reduced post-EP delayed bleeding. No potential conflict of interest relevant to this article was reported.

Nature Portfolio Acta Medica Okayama 2045-2322 15 1 2025 Age-specific assessment of initial hemoglobin levels and shock index for predicting life-saving interventions in pediatric blunt liver and spleen injuries 8502 EN Tetsuya Yumoto Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Takafumi Obara Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Takashi Hongo Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Atsuyoshi Iida Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Kohei Tsukahara Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Morihiro Katsura Department of Surgery, Okinawa Chubu Hospital Yutaka Kondo Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital Hideto Yasuda Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center Shigeki Kushimoto Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine Takashi Yorifuji Department of Epidemiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Hiromichi Naito Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Atsunori Nakao Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University SHIPPs Study Group This study aimed to evaluate the effectiveness of combining initial hemoglobin levels with the shock index for predicting the need for life-saving interventions (LSI) in pediatric patients with blunt liver and spleen injuries (BLSI), specifically tailored to different age groups. This was a multicenter retrospective cohort study of pediatric patients with BLSI in Japan. The area under the receiver operating characteristic curve (AUROC) were used to assess predictive accuracy. The study included 1,370 patients. LSI was required in 59 of 247 (23.9%) aged 1 to 6 years, 100 of 402 (24.9%) aged 7 to 12 years, and 125 of 297 (42.1%) patients aged 13 to 16 years. Within each specific age group, the predictability was categorized as fair and appeared higher than that of the entire cohort or when using either parameter alone. Notably, in the 1 to 6-year age group, the combined values showed the highest predictability, which was statistically superior to the shock index alone (AUROC of 0.770 vs. 0.671, P = 0.025). Tailoring initial hemoglobin levels and shock index to specific age groups enhances predictability of LSI in pediatric BLSI, showing a fair level of predictive accuracy. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 79 1 2025 A Rare Case of Compression Neuritis due to Intraorbital Arteriovenous Fistula (IOAVF) Mimicking Retrobulbar Optic Neuritis 59 64 EN Shun Minakawa Department of Ophthalmology, Japanese Red Cross Society Himeji Hospital Masayuki Hirano Department of Ophthalmology, Japanese Red Cross Society Himeji Hospital Kazuya Takahashi Department of Neurosurgery, Japanese Red Cross Society Himeji Hospital Yuta Imamura Department of Ophthalmology, Japanese Red Cross Society Himeji Hospital Takashi Watanabe Department of Ophthalmology, Japanese Red Cross Society Himeji Hospital Case Report 10.18926/AMO/68363 Intraorbital arteriovenous fistulas (IOAVFs) are rare vascular abnormalities. We describe a case of an IOAVF featuring a direct shunt between the accessory meningeal artery and the superior ophthalmic artery. A 55-year-old woman presented with a 1-month history of visual impairment in her right eye, and magnetic resonance imaging (MRI) revealed optic neuritis-like findings. Steroid pulse therapy temporarily resolved visual impairment. However, 1 month later, she experienced decreased visual acuity, ocular conjunctival hyperemia, edema, and a pulsatile murmur. Contrast-enhanced MRI and digital subtraction angiography revealed compression optic neuropathy due to an IOAVF. Following successful treatment with transarterial embolization, her symptoms disappeared. No potential conflict of interest relevant to this article was reported.

Springer Nature Acta Medica Okayama 2731-4383 5 1 2025 Voice analysis and deep learning for detecting mental disorders in pregnant women: a cross-sectional study 12 EN Hikaru Ooba Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Jota Maki Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hisashi Masuyama Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Introduction Perinatal mental disorders are prevalent, affecting 10-20% of pregnant women, and can negatively impact both maternal and neonatal outcomes. Traditional screening tools, such as the Edinburgh Postnatal Depression Scale (EPDS), present limitations due to subjectivity and time constraints in clinical settings. Recent advances in voice analysis and machine learning have shown potential for providing more objective screening methods. This study aimed to develop a deep learning model that analyzes the voices of pregnant women to screen for mental disorders, thereby offering an alternative to the traditional tools. Methods A cross-sectional study was conducted among 204 pregnant women, from whom voice samples were collected during their one-month postpartum checkup. The audio data were preprocessed into 5000 ms intervals, converted into mel-spectrograms, and augmented using TrivialAugment and context-rich minority oversampling. The EfficientFormer V2-L model, pretrained on ImageNet, was employed with transfer learning for classification. The hyperparameters were optimized using Optuna, and an ensemble learning approach was used for the final predictions. The model's performance was compared to that of the EPDS in terms of sensitivity, specificity, and other diagnostic metrics. Results Of the 172 participants analyzed (149 without mental disorders and 23 with mental disorders), the voice-based model demonstrated a sensitivity of 1.00 and a recall of 0.82, outperforming the EPDS in these areas. However, the EPDS exhibited higher specificity (0.97) and precision (0.84). No significant difference was observed in the area under the receiver operating characteristic curve between the two methods (p = 0.759). Discussion The voice-based model showed higher sensitivity and recall, suggesting that it may be more effective in identifying at-risk individuals than the EPDS. Machine learning and voice analysis are promising objective screening methods for mental disorders during pregnancy, potentially improving early detection. Conclusion We developed a lightweight machine learning model to analyze pregnant women's voices for screening various mental disorders, achieving high sensitivity and demonstrating the potential of voice analysis as an effective and objective tool in perinatal mental health care. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 79 1 2025 Gastrectomy Causes an Imbalance in the Trunk Muscles 9 19 EN Nanami Ikeya Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Atsushi Okita Department of Surgery, Okayama City Hospital Shinsuke Hashida Department of Surgery, Okayama City Hospital Sumiharu Yamamoto Department of Surgery, Okayama City Hospital Hirokuni Ikeda Department of Surgery, Okayama City Hospital Kazunori Tsukuda Department of Surgery, Okayama City Hospital Shinichi Toyooka Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/68354 Muscle loss negatively affects gastrectomy prognosis. However, muscle loss is recognized as a systemic change, and individual muscle function is often overlooked. We investigated changes in the muscle volume of individual muscles after gastrectomy to identify clues for prognostic factors and optimal rehabilitation programs. Patients who underwent R0 gastrectomy for Stage I gastric cancer at our hospital from 2015 to 2021 were retrospectively selected to minimize the effects of malignancy and chemotherapy. Trunk muscle volume was measured by computed tomography to analyze body composition changes. Statistical analysis was performed to identify risk factors related to body composition changes. We compared the preoperative and 6-month postoperative conditions of 59 patients after gastrectomy. There was no difference in the psoas major muscle, a conventional surrogate marker of sarcopenia. There were significant decreases in the erector spinae (p=0.01) and lateral abdominal (p=0.01) muscles, and a significant increase in the rectus abdominis muscle (p=0.02). No significant correlation was found between these muscle changes and nutritional status. Body composition imbalance may serve as a new indicator of the general condition of patients after gastrectomy. Rehabilitation to correct this imbalance may improve prognosis after gastrectomy. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 2072-6694 17 1 2024 The Three-Class Annotation Method Improves the AI Detection of Early-Stage Osteosarcoma on Plain Radiographs: A Novel Approach for Rare Cancer Diagnosis 29 EN Joe Hasei Department of Medical Information and Assistive Technology Development, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Ryuichi Nakahara Science of Functional Recovery and Reconstruction, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yujiro Otsuka Department of Radiology, Juntendo University School of Medicine Yusuke Nakamura Plusman LCC Kunihiro Ikuta Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University Shuhei Osaki Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital Tamiya Hironari Department of Musculoskeletal Oncology Service, Osaka International Cancer Institute Shinji Miwa Department of Orthopedic Surgery, Kanazawa University Graduate School of Medical Sciences Shusa Ohshika Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine Shunji Nishimura Department of Orthopaedic Surgery, Kindai University Hospital Naoaki Kahara Department of Orthopedic Surgery, Mizushima Central Hospital Aki Yoshida Science of Functional Recovery and Reconstruction, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Tomohiro Fujiwara Science of Functional Recovery and Reconstruction, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Eiji Nakata Science of Functional Recovery and Reconstruction, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Toshiyuki Kunisada Science of Functional Recovery and Reconstruction, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Toshifumi Ozaki Science of Functional Recovery and Reconstruction, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Background/Objectives: Developing high-performance artificial intelligence (AI) models for rare diseases is challenging owing to limited data availability. This study aimed to evaluate whether a novel three-class annotation method for preparing training data could enhance AI model performance in detecting osteosarcoma on plain radiographs compared to conventional single-class annotation. Methods: We developed two annotation methods for the same dataset of 468 osteosarcoma X-rays and 378 normal radiographs: a conventional single-class annotation (1C model) and a novel three-class annotation method (3C model) that separately labeled intramedullary, cortical, and extramedullary tumor components. Both models used identical U-Net-based architectures, differing only in their annotation approaches. Performance was evaluated using an independent validation dataset. Results: Although both models achieved high diagnostic accuracy (AUC: 0.99 vs. 0.98), the 3C model demonstrated superior operational characteristics. At a standardized cutoff value of 0.2, the 3C model maintained balanced performance (sensitivity: 93.28%, specificity: 92.21%), whereas the 1C model showed compromised specificity (83.58%) despite high sensitivity (98.88%). Notably, at the 25th percentile threshold, both models showed identical false-negative rates despite significantly different cutoff values (3C: 0.661 vs. 1C: 0.985), indicating the ability of the 3C model to maintain diagnostic accuracy at substantially lower thresholds. Conclusions: This study demonstrated that anatomically informed three-class annotation can enhance AI model performance for rare disease detection without requiring additional training data. The improved stability at lower thresholds suggests that thoughtful annotation strategies can optimize the AI model training, particularly in contexts where training data are limited. No potential conflict of interest relevant to this article was reported.

Wiley Acta Medica Okayama 0947-6539 31 14 2025 Graphene Oxide as a Self‐Carbocatalyst to Facilitate the Ring‐Opening Polymerization of Glycidol for Efficient Polyglycerol Grafting e202404400 EN Yajuan Zou Research Institute for Interdisciplinary Science, Okayama University Kentaro Ohkura Graduate School of Natural Science and Technology, Okayama University Israel Ortiz‐Anaya Research Institute for Interdisciplinary Science, Okayama University Ryota Kimura Graduate School of Natural Science and Technology, Okayama University Alberto Bianco Research Institute for Interdisciplinary Science, Okayama University Yuta Nishina Research Institute for Interdisciplinary Science, Okayama University Grafting carbon-based nanomaterials (CNMs) with polyglycerol (PG) improves their application potentials in biomedicine and electronics. Although “grafting from” method offers advantages over “grafting to” one in terms of operability and versatility, little is known about the reaction process of glycidol with the surface groups onto CNMs. By using graphene oxide (GO) as a multi-functional model material, we examined the reactivity of the surface groups on GO toward glycidol molecules via a set of model reactions. We reveal that carboxyl groups spontaneously react with the epoxide ring with no need of catalyst, while GO catalyzes the reactions of hydroxyl groups with the epoxide of glycidol. In addition, the hydroxyl group of glycidol can open the epoxide in the basal plane of GO. The subsequent polymerization of PG is supposed to propagate at the primary and/or the secondary hydroxyl groups, generating a ramified PG macromolecule with random branch-on-branch topology. In addition, ketones, benzyl esters and aromatic ethers are found not to react with glycidol even in the presence of GO, while the aldehydes are easily oxidized into carboxyl groups under ambient condition, behaving then as the carboxyl groups. Our findings pose the foundation for understanding the polymerization mechanism of PG on CNMs. No potential conflict of interest relevant to this article was reported.

AIP Publishing Acta Medica Okayama 0021-9606 159 19 2023 Efficiency and energy balance for substitution of CH4 in clathrate hydrates with CO2 under multiple-phase coexisting conditions 194504 EN Hideki Tanaka Research Institute for Interdisciplinary Science, Okayama University Masakazu Matsumoto Research Institute for Interdisciplinary Science, Okayama University Takuma Yagasaki Division of Chemical Engineering, Graduate School of Engineering Science, Osaka University Many experimental and theoretical studies on CH4–CO2 hydrates have been performed aiming at the extraction of CH4 as a relatively clean energy resource and concurrent sequestration of CO2. However, vague or insufficient characterization of the environmental conditions prevents us from a comprehensive understanding of even equilibrium properties of CH4–CO2 hydrates for this substitution. We propose possible reaction schemes for the substitution, paying special attention to the coexisting phases, the aqueous and/or the fluid, where CO2 is supplied from and CH4 is transferred to. We address the two schemes for the substitution operating in three-phase and two-phase coexistence. Advantages and efficiencies of extracting CH4 in the individual scheme are estimated from the chemical potentials of all the components in all the phases involved in the substitution on the basis of a statistical mechanical theory developed recently. It is found that although substitution is feasible in the three-phase coexistence, its working window in temperature–pressure space is much narrower compared to the two-phase coexistence condition. Despite that the substitution normally generates only a small amount of heat, a large endothermic substitution is suggested in the medium pressure range, caused by the vaporization of liquid CO2 due to mixing with a small amount of the released CH4. This study provides the first theoretical framework toward the practical use of hydrates replacing CH4 with CO2 and serves as a basis for quantitative planning. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 0941-1291 2024 Optimization of workflow processes for sustainable paternal involvement: case study of an academic “daddy surgeon” in Japan EN Nobuhiko Kanaya Department of Gastroenterological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Shinji Kuroda Department of Gastroenterological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Yoshitaka Kondo Department of Gastroenterological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Yuko Takehara Department of Surgery, Okayama Saiseikai General Hospital Yoshihiko Kakiuchi Department of Gastroenterological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Hitoshi Minagi Department of Gastroenterological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Masaki Sakamoto Department of Gastroenterological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Shunsuke Kagawa Department of Gastroenterological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Hitomi Kataoka Integrated Clinical Education Center, Kyoto University Hospital Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine Work–life balance is often discussed in Japan. Yet surgeons find it challenging to take paternity leave because of their demanding surgical duties and a strong sense of responsibility. One Japanese male surgeon had his first paternity experience as a research fellow in the US. When he returned to Japan, he resumed his surgical training and started a research project to become an academic surgeon. When he and his wife were expecting their second child, they discussed his paternity participation before the delivery and decided on a sustainable paternity participation plan. By coordinating his responsibilities with his co-workers, he limited his attendance at work to daytime hours only for 1 month to manage paternity duties. This adjustment did not affect the number of main and assistant operations conducted that month and effective optimization of workflow processes decreased the extra workload for other team members. His experience suggests that the optimization of workflow processes can enhance personal life, including paternity participation. (150/150). No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 6 2024 Closure of Ventricular Septal Rupture through a Left Thoracotomy in a Patient with a History of Esophageal Reconstruction 449 452 EN Gentaro Kato Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital Tatsuya Ogawa Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital Tomohiro Hayashida Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital Shuji Shimizu Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University Hospital Shu Yamamoto Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital Takeshi Shichijo Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital Case Report 10.18926/AMO/67870 A 73-year-old man who had undergone esophagectomy and retrosternal gastric tube reconstruction for esophageal cancer 8 years prior was transferred to our hospital for the treatment of an acute myocardial infarction. Emergent percutaneous coronary intervention for the left anterior descending artery (#7) was successfully performed. However, echocardiography revealed a ventricular septal rupture (25×27 mm). Seventeen days after admission, the rupture was successfully treated with a double-patch closure via a left anterolateral thoracotomy to avoid a surgical injury to his retrosternal gastric tube. Determining the best surgical approach to the heart is important for safe cardiac surgery in patients after esophageal reconstruction. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 6 2024 Risk Factors for Gangrenous Cholecystitis and the Outcomes of Early Cholecystectomy: A Retrospective Study of a Single-Center City General Hospital 439 447 EN Mampei Yamashita Department of Surgery, Sasebo City General Hospital Takayuki Tanaka Department of Surgery, Sasebo City General Hospital Yorihisa Sumida Department of Surgery, Sasebo City General Hospital Shoto Yamazaki Department of Surgery, Sasebo City General Hospital Yuki Hara Department of Surgery, Sasebo City General Hospital Akiko Fukuda Department of Surgery, Sasebo City General Hospital Makoto Hisanaga Department of Surgery, Sasebo City General Hospital Koki Wakata Department of Surgery, Sasebo City General Hospital Masato Araki Department of Surgery, Sasebo City General Hospital Susumu Eguchi Department of Surgery, Nagasaki University Graduate School of Biomedical Science Original Article 10.18926/AMO/67869 Gangrenous cholecystitis (GC) is classified as moderate acute cholecystitis according to the Tokyo Guidelines from 2018 (TG18). We evaluated the risk factors for GC and the outcomes of early cholecystectomy. A total of 136 patients who underwent emergency cholecystectomy for acute cholecystitis were retrospectively analyzed; 58 of these patients (42.6%) were diagnosed with GC (GC group) based on our retrospective pathologic diagnosis. We comparatively evaluated the patient backgrounds and surgical outcomes between the GC group and non-GC group. The GC group was significantly older and included more hypertensive patients than the non-GC group. The GC group was prescribed more antibiotics as initial treatment than the non-GC group, and they had more days between onset and surgery. The preoperative white blood cell count and C-reactive protein values were significantly higher in the GC group than in the non-GC group, and these values were predictive factors for GC. Cholecystectomy required a longer operation time and caused greater blood loss in the GC group. The GC group also had longer hospitalization times than the non-GC group; however, no significant differences were observed in terms of postoperative complications. In conclusion, gangrenous changes should be assessed when diagnosing cholecystitis, and appropriate treatment, such as surgery or drainage, should be undertaken. No potential conflict of interest relevant to this article was reported.

Japan Prosthodontic Society Acta Medica Okayama 1883-1958 68 1 2023 Tooth morphology fusion technique is more accurate than conventional technique in transferring morphology of provisional to definitive screw-retained, implant-supported crown: A preliminary intervention study 139 146 EN Takuya Mino Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Yoko Kurosaki Department of Oral Rehabilitation and Implantology, Okayama University Hospital Kana Tokumoto Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Koji Izumi SHIKEN Corporation Hiroshi Mitsumune SHIKEN Corporation Kenji Maekawa Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Akihiro Ueda Dental Technician Laboratory, Okayama University Hospital Tomohito Nakano Dental Technician Laboratory, Okayama University Hospital Junichi Sejima Dental Technician Laboratory, Okayama University Hospital Aya Kimura-Ono Department of Oral Rehabilitation and Implantology, Okayama University Hospital Takuo Kuboki Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Purpose: To compare the accuracy of the tooth morphology fusion (TMF) digital technique and customized impression transfer coping (conventional) technique when transferring the morphology of a provisional crown to a definitive screw-retained implant-supported crown. Methods: Six cases of partial edentulism (one anterior and five posterior) treated with oral implant placement in our clinic for the loss of three or fewer teeth in the maxilla or mandible between April 2017 and September 2018 were included. After implant placement and re-entry surgery, provisional restorations were made and adjusted to obtain the ideal morphology. Two definitive restorations were constructed by transferring the complete morphology of the provisional restorations, including the subgingival contour, using the TMF digital and conventional techniques. Three sets of surface morphological data were obtained using a desktop scanner. The three-dimensional total discrepancy volume (TDV) between the provisional restoration (reference) and the two definitive restorations was digitally measured by overlapping the surface data of the stone cast using the Boolean operation. Each TDV ratio (%) was calculated by dividing the TDV by the volume of provisional restoration. The median TDV ratios for TMF and conventional techniques were compared using the Wilcoxon signed-rank test. Results: The median TDV ratio between provisional and definitive restorations constructed using the TMF digital technique (8.05%) was significantly lower than that obtained using the conventional technique (13.56%, P < 0.05). Conclusions: In this preliminary intervention study, the TMF digital technique was more accurate than the conventional technique for the transfer of morphology from provisional to definitive prosthesis. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 2234-2451 35 1 2023 Meniscus extrusion is a predisposing factor for determining arthroscopic treatments in partial medial meniscus posterior root tears 8 EN Takayuki Furumatsu Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Keisuke Kintaka Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Naohiro Higashihara Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Masanori Tamura Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Koki Kawada Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Haowei Xue Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Background Patients with partial medial meniscus posterior root tears (MMPRTs) sometimes require arthroscopic pullout repair because of their intolerable/repeated knee pains and continuous disturbance in gait during activities of daily living. However, the predisposing factors for future knee surgery in patients with partial MMPRTs remain unclear. We compared the findings of magnetic resonance imaging (MRI) between patients who underwent pullout repair and nonoperative management following partial MMPRTs. Methods Twenty-five patients who required arthroscopic repair for partial MMPRTs and 23 patients who were managed nonoperatively were evaluated during a mean follow-up period of 27.1 months. Sex, age, height, body weight, body mass index, duration from onset to initial MRI, MRI findings, and medial meniscus (MM) extrusion were compared between the two groups. Linear regression analysis was used to assess the correlation between MM extrusion and duration from onset to MRI examination. Results No significant differences were observed between the pullout repair and nonoperative management groups in terms of patient demographics and the positive ratio of MRI-based root tear signs. However, absolute MM extrusion in the pullout repair group (3.49 ± 0.82 mm) was larger than that in the nonoperative management group (2.48 ± 0.60 mm, P < 0.001). Extrusion of the MM (> 3 mm) was detected more frequently in the pullout repair group than in the nonoperative management group (P < 0.001). The odds ratio in the pullout repair and MM extrusion > 3 mm cases was 9.662. Linear regression analysis revealed a fair correlation between the duration from onset to MRI and MM extrusion only in the pullout repair group (0.462 mm/month increase in MM extrusion). Conclusions This study demonstrated that more severe MM extrusions were observed in the pullout repair group than in the nonoperative management group. Major extrusion (> 3 mm) was also observed more in the pullout repair group than in the nonoperative group. Assessing MM extrusion and its severity can help determine a valid treatment for patients with partial MMPRTs. Level of evidence IV, Retrospective comparative study. No potential conflict of interest relevant to this article was reported.

BMC Acta Medica Okayama 1471-2482 24 1 2024 The required experience of open pancreaticoduodenectomy before becoming a specialist in hepatobiliary and pancreatic surgeons: a multicenter, cohort study of 334 open pancreaticoduodenectomies 366 EN Tomokazu Fuji Department of Gastroenterological Surgery Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yuzo Umeda Department of Gastroenterological Surgery Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kosei Takagi Department of Gastroenterological Surgery Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Masayoshi Hioki Department of Surgery, Fukuyama City Hospital Ryuichi Yoshida Department of surgery, Hiroshima Citizens Hiroshima Citizens Hospital Yoshikatsu Endo Department of Surgery, Japanese Red Cross Society Himeji Hospital Kazuya Yasui Department of Gastroenterological Surgery Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Daisuke Nobuoka Department of Gastroenterological Surgery, Kagawa Prefectural Central Hospital Toshiharu Mitsuhashi Center for Innovative Clinical Medicine, Okayama University Hospital Toshiyoshi Fujiwara Department of Gastroenterological Surgery Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Background Open pancreaticoduodenectomy (OPD) is an essential surgical procedure for expert hepato-biliary-pancreatic (HBP) surgeons. However, there is no standard for how many surgeries must be performed by a surgeon in training before they are considered to have enough experience to ensure surgical safety. Methods Cumulative Sum (CUSUM) analysis was performed using the surgical data of OPDs performed during the training period of board-certified expert surgeons of the Japanese Society of Hepato-Biliary-Pancreatic Surgery. Results Fourteen HBP surgeons participated in this study and performed 334 OPDs during their training period. The median (interquartile range) values for operative time, blood loss, and length of hospital stay were 455 (397-519) minutes, 450 (234--716) ml, and 28 (21-38) days, respectively. CUSUM analysis showed inflection points at 20 surgeries performed for operative time. After 20 procedures, operative time was significantly shorter (461 min vs. 425 min, p = 0.021) and blood loss was significantly lower (470 ml vs. 340 ml, p = 0.038). No significant differences between within 20 and after 21 procedures were found in the complication rate (53% vs. 48%, p = 0.424) and rate of in-hospital deaths (1.5% vs.1.4%. p = 0.945). Up to 20 surgeries, PDAC and another malignant tumor had longer operative time than benign/low malignant diseases (486 min vs. 472 min vs. 429 min, p < 0.001), and higher blood loss (500 ml vs. 502 ml vs. 355 ml, p < 0.001). Mortality rate was higher at PDAC cases (5% vs. 0% vs. 0%, p = 0.01). After the 21 procedures, these outcomes were improved and no differences in by primary disease were observed. Multivariable analysis showed that within 20 surgeries were independent risk factors of longer operative time (HR2.6, p = 0.013) and higher blood loss (HR2.0, p = 0.049). Conclusions To stabilize the surgical outcome of OPD for malignant disease, at least 20 surgeries should be performed at a certified institution during surgeon training. Trial registrationClinical trial number: Not applicable. No potential conflict of interest relevant to this article was reported.

Elsevier BV Acta Medica Okayama 0305-0548 169 2024 The parallel stack loading problem of minimizing the exact number of relocations 106712 EN Shunji Tanaka Faculty of Environmental, Life and Natural Science and Technology, Okayama University Mohamed ElWakil Department of Production Engineering and Mechanical Design, Faculty of Engineering, Tanta University Amr Eltawil Department of Industrial and Manufacturing Engineering, Egypt Japan University of Science and Technology This study addresses the parallel stack loading problem, a general optimization problem arising in storage facilities such as container yards, slab yards, and warehouses. In this problem, we load incoming items into parallel stacks in the loading phase to minimize the number of relocations in the subsequent retrieval phase. Because of difficulties in treating the nested problem structure originating from the mutual dependence of the two phases, the existing studies approximately minimized the number of relocations using surrogate objective functions. In contrast, this study considers the parallel stack loading problem aiming to minimize the exact number of relocations. We first provide an integer programming formulation and next develop a nested branch-and-bound algorithm. In a computational study, we verify the effectiveness of the proposed branch-and-bound algorithm and evaluate the known surrogate objective functions based on the exact minimization. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 2078-2489 15 10 2024 A Study of Exergame System Using Hand Gestures for Wrist Flexibility Improvement for Tenosynovitis Prevention 622 EN Yanqi Xiao Department of Information and Communication Systems, Okayama University Nobuo Funabiki Department of Information and Communication Systems, Okayama University Irin Tri Anggraini Department of Information and Communication Systems, Okayama University Cheng-Liang Shih Department of Information and Communication Systems, Okayama University Chih-Peng Fan Department of Information and Communication Systems, Okayama University Currently, as an increasing number of people have been addicted to using cellular phones, smartphone tenosynovitis has become common from long-term use of fingers for their operations. Hand exercise while playing video games, which is called exergame, can be a good solution to provide enjoyable daily exercise opportunities for its prevention, particularly, for young people. In this paper, we implemented a simple exergame system with a hand gesture recognition program made in Python using the Mediapipe library. We designed three sets of hand gestures to control the key operations to play the games as different exercises useful for tenosynovitis prevention. For evaluations, we prepared five video games running on a web browser and asked 10 students from Okayama and Hiroshima Universities, Japan, to play them and answer 10 questions in the questionnaire. Their playing results and System Usability Scale (SUS) scores confirmed the usability of the proposal, although we improved one gesture set to reduce its complexity. Moreover, by measuring the angles for maximum wrist movements, we found that the wrist flexibility was improved by playing the games, which verifies the effectiveness of the proposal. No potential conflict of interest relevant to this article was reported.

Japan Society of Hydrology and Water Resources Acta Medica Okayama 1882-3416 18 4 2024 Evaluation and selection of a set of CMIP6 GCMs for water resource modeling in the poorly gauged complex terrain of the Tana River basin in Kenya 87 94 EN Daniel Mwendwa Wambua Graduate School of Environmental and Life Science, Okayama University Hiroaki Somura Graduate School of Environmental and Life Science, Okayama University Toshitsugu Moroizumi Graduate School of Environmental and Life Science, Okayama University The Tana River basin is among the least monitored in terms of meteorological data in Kenya. The Kenya Meteorological Department (KMD) provided data on a ten-day timescale, which is not adequate for water resource evaluation. To bridge this data gap, there is a growing need to leverage General Circulation Models (GCMs) and global datasets to assess current and future water resources in this basin. This study focused on evaluating the performance of 19 CMIP6 GCMs concerning precipitation (pr), maximum temperature (tasmax), and minimum temperature (tasmin) for the complex terrain of the Tana River basin. This involved a rigorous process of disaggregating the data provided by the KMD into a daily timescale for downscaling. The GCMs’ historical output was prepared using the Climate Data Operator (CDO) in Cygwin. The Kling Gupta Efficiency (KGE) was computed for each variable at three stations: Nyeri (upstream), Kitui (midstream), and Bura (downstream). The KGE results were validated using Taylor statistics. Five GCMs, CMCC-ESM2, MPI-ESM1-2-HR, ACCESS-CM2, NorESM2-MM, and GFDL-ESM4, performed best with a multivariable Multi-station KGE statistic of 0.455–0.511. The outputs from these selected GCMs were subsequently downscaled for later use in assessing the water resources and crop water demand in the basin. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 2077-0383 13 19 2024 The Liver Transection Area Is a Novel Predictor for Surgical Difficulty in Laparoscopic Liver Resection 5686 EN Motohiko Yamada Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kosei Takagi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Tomokazu Fuji Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kazuya Yasui Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Jiro Kimura Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Takeyoshi Nishiyama Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yasuo Nagai Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Noriyuki Kanehira Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Background: A difficulty scoring system was developed to estimate the surgical outcomes of laparoscopic liver surgery (LLS); however, the effect of the liver transection area (LTA) on LLS outcomes have not been previously examined. Therefore, this study investigated the predictive significance of the LTA for LLS. Methods: This retrospective study included 106 patients who underwent LLS in our hospital between January 2012 and December 2023. The association of the LTA with the surgical difficulty level and operative time was investigated. Multivariate analyses were performed to identify factors predicting surgical difficulty in LLS. Results: The median LTA and operative time were 62.5 (IQR, 36.0–91.8) cm2 and 250 (IQR, 195–310) minutes, respectively. The LTA was significantly associated with surgical difficulty as evaluated using the IWATE Criteria. Moreover, the LTA significantly correlated with operative time (r2 = 0.19, p < 0.001). The multivariable analyses found that the LTA (≥59 cm2) (odds ratio [OR], 6.07; 95% confidence interval [CI], 2.38–16.6; p < 0.001) and the type of LLS (≥segmentectomy) (OR, 3.79; 95% CI, 1.35–11.4; p = 0.01) were significant factors associated with surgical difficulty. Conclusions: The LTA is a useful parameter that reflects the difficulty of LLS. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 5 2024 Occult Nesidioblastosis Detected by 111In-Pentetreotide Single-Photon Emission Computed Tomography 423 428 EN Shinya Sakamoto Department of Gastroenteorlogical Surgery, Kochi Health Sciences Center Motoyasu Tabuchi Department of Gastroenteorlogical Surgery, Kochi Health Sciences Center Rika Yoshimatsu Department of Radiology, Kochi Health Sciences Center Ai Hishida Department of Endocrinology and Metabolism, Kochi Health Sciences Center Manabu Matsumoto Department of Diagnostic Pathology, Kochi Health Sciences Center Jun Iwata Department of Diagnostic Pathology, Kochi Health Sciences Center Takehiro Okabayashi Department of Gastroenteorlogical Surgery, Kochi Health Sciences Center Case Report 10.18926/AMO/67667 Nesidioblastosis, also known as persistent hyperinsulinemic hypoglycemia, is usually observed in children and infants, although more recently adult-onset nesidioblastosis has also been described. We present a case of nesidioblastosis in a 78-year-old man that was detected by 111In-pentetreotide single photon emission computed tomography (SPECT/CT). The patient was transferred to our hospital’s emergency department in a hypoglycemic coma. Dynamic enhanced CT could detect no lesion in the pancreas, but an 111In-pentetreotide SPECT/CT scan performed after a similar episode four weeks later showed increased focal uptake at the head of the pancreas. The results of a selective arterial calcium injection test were negative. After careful consideration and discussion among colleagues, surgical intervention was selected, and a pancreaticoduodenectomy was performed. On histology, there were elevated numbers of Langerhans islets in the pancreatic head, and the islets themselves appeared enlarged. Hypertrophic β-cells comprised the majority, but α-cells, δ-cells and pancreatic polypeptide were also detected in the islets. Based on the histopathological results and repeated hyperinsulinemic hypoglycemic crises, the patient was finally diagnosed with adult-onset nesidioblastosis. He had no hypoglycemic symptoms during outpatient follow-up examination. Since 111In-pentetreotide SPECT/CT may be able to detect nesidioblastosis, clinicians should consider this relatively new-modality examination when encountering such cases. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 4 2024 Surgical Treatment of an Abdominal Aortic Aneurysm in a Patient with a Liver Abscess 345 347 EN Gentaro Kato Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital Yuto Narumiya Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital Michihiro Okuyama Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital Shuji Shimizu Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University Hospital Kenji Sangawa Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital Shu Yamamoto Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital Case Report 10.18926/AMO/67553 The presence of an intraperitoneal source of infection, e.g., a liver abscess, can be an obstacle to performing an abdominal aortic surgery with a midline laparotomy because graft infection is one of the most critical complications of aortic surgery. We report the successful Y-grafting of a pararenal abdominal aortic aneurysm through a retroperitoneal approach in a 67-year-old male undergoing liver abscess drainage. The retroperitoneal approach to the abdominal aorta may be useful for abdominal aortic surgery in patients with a localized intraperitoneal infection. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 4 2024 Pneumocephalus with Inverted Papilloma in the Frontoethmoidal Sinus: Case Report and Literature Review 337 343 EN Seiichiro Makihara Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshihiro Otani Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kensuke Uraguchi Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Sawako Ono Department of Pathology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Aiko Shimizu Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ryosuke Ikemachi Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yosuke Okazaki Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tomoyuki Ota Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroshi Matsumoto Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shotaro Miyamoto Department of Otolaryngology-Head & Neck Surgery, Kagawa Rosai Hospital Munechika Tsumura Department of Otolaryngology-Head & Neck Surgery, Kagawa Rosai Hospital Seiya Hayashi Department of Neurosurgery, Kagawa Rosai Hospital Michiari Umakoshi Department of Neurosurgery, Kagawa Rosai Hospital Koji Hirashita Department of Neurosurgery, Kagawa Rosai Hospital Mizuo Ando Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/67550 Here, we describe the unique case of a pneumocephalus originating from an inverted papilloma (IP) in the frontoethmoidal sinus. A 71-year-old man with diabetes presented with headaches and altered consciousness. Imaging revealed the pneumocephalus together with bone destruction in the left frontal sinus. He underwent simultaneous endoscopic endonasal and transcranial surgery using an ORBEYE exoscope. Pathological diagnosis of the tumor confirmed IP. Post-surgery, the pneumocephalus was significantly resolved and the squamous cell carcinoma antigen level, which had been elevated, decreased. This case underscores the importance of a multidisciplinary approach and innovative surgical methods in treating complex sinonasal pathologies. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers (IEEE) Acta Medica Okayama 0093-9994 60 3 2024 Designing and Prototyping an Axial-Flux Machine Using Ferrite PM and Round Wire for Traction Applications: Comparison With a Radial-Flux Machine Using Nd-Fe-B PM and Rectangular Wire 3934 3949 EN Ren Tsunata Division of Industrial Innovation Sciences Graduate School of Natural Science and Technology, Okayama University Kosuke Izumiya Division of Industrial Innovation Sciences Graduate School of Natural Science and Technology, Okayama University Masatsugu Takemoto Division of Industrial Innovation Sciences Graduate School of Natural Science and Technology, Okayama University Jun Imai Division of Industrial Innovation Sciences Graduate School of Natural Science and Technology, Okayama University Tatsuya Saito Sumitomo Electric Industries Ltd. Tomoyuki Ueno Sumitomo Electric Industries Ltd. This paper proposes a novel axial-flux permanent magnet machine (AFPM) employing ferrite permanent magnets (PMs) and round copper wire. The proposed AFPM adopts a novel rotor structure and uses tooth-tips with a suitable trapezoidal shape. These structures compensate for the low magnetomotive force of the round copper wire and ferrite PMs, achieving high performance at low cost. Additionally, compared with an off-the-shelf radial-flux permanent magnet machine (RFPM) using Nd-sintered PMs and rectangular copper wire, the proposed AFPM achieves the same output power and higher efficiency, despite using ferrite PMs and the round copper wire. Finally, a prototype of the proposed AFPM was manufactured and evaluated experimentally. The prototype achieved a high efficiency of over 95% across a wide operating area while maintaining required maximum torque, suggesting its potential for traction applications. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 0167-6806 208 2024 Comparison of proportions and prognostic impact of pathological complete response between evaluations of representative specimen and total specimen in primary breast cancer after neoadjuvant chemoradiotherapy: an ancillary study of JCOG0306 145- 154 EN Tadahiko Shien Department of Breast and Endocrine Surgery, Okayama University Hospital Hitoshi Tsuda Department of Basic Pathology, National Defense Medical College Keita Sasaki JCOG Data Center/Operations Office, National Cancer Center Hospital Junki Mizusawa JCOG Data Center/Operations Office, National Cancer Center Hospital Futoshi Akiyama Department of Pathology, Cancer Institute Hospital Masafumi Kurosumi Department of Diagnostic Pathology, Kameda Kyobashi Clinic Masataka Sawaki Department of Breast Oncology, Aichi Cancer Center Hospital Nobuko Tamura Department of Breast Surgery, Toranomon Hospital Kiyo Tanaka Department of Breast Surgery, Toranomon Hospital Takahiro Kogawa Department of Breast Medical Oncology, Cancer Institute Hospital Mina Takahashi Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center Naoki Hayashi Department of Breast Surgery Oncology, St Lukes International Hospital Hirofumi Mukai Department of Breast and Medical Oncology, National Cancer Center Hospital East Norikazu Masuda Department of Surgery, Breast Oncology, National Hospital Organization Osaka National Hospital Fumikata Hara Department of Breast Medical Oncology, Cancer Institute Hospital Hiroji Iwata Department of Breast Oncology, Aichi Cancer Center Hospital Background In JCOG0306 trial, a phase II study to examine the efficacy of neoadjuvant chemotherapy followed by radiation therapy (NAC-RT) to primary breast cancer, pathological complete response (pCR) was evaluated from specimens of the representative cross-section including the tumor center that had been accurately marked [representative specimen (RS) method]. In this ancillary study, we examined if the RS method was comparable to the conventional total specimen (TS) method, which is widely employed in Japan, to identify the pCR group showing excellent prognosis. Methods We obtained long-term follow-up data of 103 patients enrolled in JCOG0306 trial. As histological therapeutic effect, pCR (ypT0 and ypT0/is) and quasi-pCR [QpCR, ypT0/is plus Grade 2b (only a few remaining invasive cancer cells)] were evaluated with RS and TS methods. Concordance of pCR between these two methods and associations of the pCR with prognosis were examined. Results ypT0, ypT0/is, and QpCR were observed in 28 (27.2%), 39 (37.9%), and 45 (43.7%) patients with RS method, whereas these were 20 (19.4%), 25 (24.3%) and 40 (38.9%) with TS method, respectively. Between RS and TS methods, concordance proportions of ypT0 and ypTis were 92.2% and 86.4%, respectively. Risk of recurrence of ypT0/is group was lower than that of non-ypT0/is group (HR 0.408, 95% CI [0.175–0.946], P = 0.037) and risk of death of ypT0/is group was lower than that of non-ypT0/is group (HR 0.251, 95% CI [0.073–0.857], P = 0.027). The ypT0 and ypT0/is groups with RS method showed excellent prognosis similarly with those with TS method, and RS method was able to differentiate the OS and RFS between pCR and non-pCR than TS method significantly even if pCR was classified ypT0 or ypT0/is. With TS method, QpCR criteria stratified patients into the better and worse prognosis groupsmore clearly than pCR criteria of ypT0 or ypT0/is. Conclusions RS method was comparable to TS method for the evaluation of pCR in the patients who received NAC-RT to primary breast cancer provided the tumor center was accurately marked. As pCR criteria with RS method, ypT0/is appeared more appropriate than ypT0. No potential conflict of interest relevant to this article was reported.

Elsevier Acta Medica Okayama 2405-8440 10 11 2024 Bacterial DNA and serum IgG antibody titer assays for assessing infection of human-pathogenic and dog-pathogenic Porphyromonas species in dogs e31872 EN Masako Tai-Tokuzen Department of Periodontics and Endodontics, Division of Dentistry, Okayama University Hospital Takashi Ito Center for Innovative Clinical Medicine, Okayama University Hospital Kazuya Tamura Department of Pathophysiology-Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Haruko Hirayama Department of Animal Resources, Advanced Science Research Center, Okayama University Hirohito Ogawa Department of Virology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Shin Nakamura Center for Collaborative Research, Department of Oral Science and Translational Research, Nova Southeastern University Keisuke Okubo Department of Periodontics and Endodontics, Division of Dentistry, Okayama University Hospital Kazuhiro Omori Department of Pathophysiology-Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tadashi Yamamoto Department of Comprehensive Dentistry, The Center for Graduate Medical Education (Dental Division), Okayama University Hospital Katsumi Mominoki Department of Animal Resources, Advanced Science Research Center, Okayama University Shogo Takashiba Department of Pathophysiology-Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Periodontal disease is highly prevalent in both humans and dogs. Although there have been reports of cross-infection of periodontopathic bacteria, methods for assessing it have yet to be established. The actual status of cross-infection remains to be seen. The purpose of this study was to evaluate the utility of bacterial DNA and serum immunoglobulin G (IgG) antibody titer assays to assess infection of human-pathogenic and dog-pathogenic Porphyromonas species in dogs. Four experimental beagles were used for establishing methods. Sixty-six companion dogs at veterinary clinics visiting for treatment and prophylaxis of periodontal disease were used and divided into healthy, gingivitis, and periodontitis groups. Periodontal pathogens such as Porphyromonas gingivalis and Porphyromonas gulae were investigated as target bacteria. DNA levels of both bacteria were measured using species-specific primers designed for real-time polymerase chain reaction (PCR). Serum IgG titers of both bacteria were measured by enzyme-linked immunosorbent assay (ELISA). PCR primers were confirmed to have high sensitivity and specificity. However, there was no relationship between the amount of bacterial DNA and the severity of the periodontal disease. In addition, dogs with periodontitis had higher IgG titers against both bacteria compared to dogs in the healthy and gingivitis groups; there was cross-reactivity between the two bacteria. Receiver operating characteristic (ROC) analysis of IgG titers against both bacteria showed high sensitivity (>90 %) and specificity (>75 %). Since both bacteria were distinguished by DNA assays, the combination of these assays may be useful in the evaluation of cross-infection. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 3 2024 Palliative Gamma Knife Radiosurgery for a Small Part of a Large Vestibular Schwannoma in an Elderly Patient 301 306 EN Kiyoshi Nakazaki Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital Satoshi Hirai Department of Neurosurgery, Kawasaki Medical School Tomohito Hishikawa Department of Neurosurgery, Kawasaki Medical School Case Report 10.18926/AMO/67207 We report a case of a large vestibular schwannoma in an 80-year-old female patient that shrank after palliative Gamma Knife radiosurgery (GKS). Neurological symptoms included hearing deterioration and facial palsy. The tumor volume was 21.9 mL. Craniotomy was considered high-risk, and conventional GKS was risky, owing to the risk of transient enlargement. Therefore, GKS was performed on only a portion of the tumor. The marginal dose (12 Gy) volume was 3.8 mL (17.4%). The tumor began to shrink after transient enlargement. Sixty months later, the tumor volume was only 3.1 mL, and the patient was able to maintain independent activities of daily living without salvage treatment. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 3 2024 A Multidisciplinary Approach to Hip Fractures: Evaluating Outcomes on Mortality and Secondary Hip Fractures 237 243 EN Osamu Muraoka Department of Orthopedic Surgery, Niigata Prefectural Tokamachi Hospital Norio Imai Division of Comprehensive Musculoskeletal Medicine, Niigata University Graduate School of Medical and Dental Sciences Tatsuya Kuraishi Department of Orthopedic Surgery, Niigata Prefectural Tokamachi Hospital Makoto Imai Department of Orthopedic Surgery, Niigata Prefectural Tokamachi Hospital Takashi Fukuhara Department of Orthopedic Surgery, Niigata Prefectural Tokamachi Hospital Toshifumi Yoshimine Department of Internal Medicine, Niigata Prefectural Tokamachi Hospital Original Article 10.18926/AMO/67198 Fracture liaison services (FLS) have been introduced in Japan and several other countries to reduce medical complications and secondary fractures. We aimed to evaluate the effects of the implementation of an FLS approach on patient outcomes during hospitalization at our hospital and over a 2-year follow-up post-injury. This retrospective cohort study included patients ≥ 60 years admitted to our hospital for hip fragility fractures between October 1, 2016, and July 31, 2020. Patient groups were defined as those treated before (control group, n=238) and after (FLS group, n=196) establishment of the FLS protocol at our institution. The two groups were compared in terms of time to surgery, length of hospital stay, and the incidence of complications after admission, including secondary hip fracture and mortality rates. The follow-up period was 24 months. FLS focuses on early surgery within 48 h of injury and assessing osteoporosis treatment before injury to guide post-discharge anti-osteoporosis medication. FLS reduced the length of hospital stay (p<0.001) and the prevalence of complications after admission (p<0.001), particularly cardiovascular disease, and it increased adherence to anti-osteoporosis medication. These FLS effects resulted in lower secondary hip fracture and mortality rates at 12 and 24 months post-injury. FLS for fragility hip fractures can improve patient outcomes during hospitalization and over a 2-year follow-up period. No potential conflict of interest relevant to this article was reported.

Elsevier Acta Medica Okayama 2210-2612 118 2024 The effectiveness of palliative middle meningeal artery embolization prior to craniotomy for large acute epidural hematoma: A case report 109704 EN Yuichi Hirata Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yu Takahashi Department of Neurological Surgery, Kagawa Prefectural Central Hospital Satoshi Kuramoto Department of Neurological Surgery, Kagawa Prefectural Central Hospital Shingo Nishihiro Department of Neurological Surgery, Kagawa Prefectural Central Hospital Yasuhiro Ono Department of Neurological Surgery, Kagawa Prefectural Central Hospital Tomotsugu Ichikawa Department of Neurological Surgery, Kagawa Prefectural Central Hospital Introduction and importance: Acute epidural hematoma is typically managed with craniotomy. However, there are a few reports on transcatheter arterial embolization (TAE) as an adjunctive therapy. Case presentation: A 70-year-old female with no obvious history of trauma was transported to our hospital. Computed tomography scan revealed an epidural hematoma of approximately 80 ml with a midline shift of 5 mm. We decided to perform an emergency craniotomy. However, the operating room (OR) was already occupied by a scheduled surgery and it would take 30 min to an hour to prepare it. We opted to wait for our OR, considering that, even if the patient was transferred to another hospital, it would take time for the craniotomy to commence. Clinical discussion: We performed TAE for the middle meningeal artery (MMA) as a palliative measure to prevent hematoma enlargement. The MMA was selectively embolized with 20 % n-butyl-2-cyanoacrylate (NBCA), resulting in no hematoma enlargement or observed complications. The criteria for endovascular treatment of acute epidural hematoma are not yet well-established. This case demonstrates the potential role of endovascular treatment for large acute epidural hematomas in carefully selected patients. Conclusion: If there is a time gap before craniotomy, TAE could be considered a viable option for large acute epidural hematomas as a palliative intervention before craniotomy. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 0941-1291 54 11 2024 Effective division of the intersegmental plane using a robotic stapler in robotic pulmonary segmentectomy 1319 1328 EN Mikio Okazaki Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Ken Suzawa Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Kazuhiko Shien Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Kohei Hashimoto Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Shin Tanaka Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Kentaroh Miyoshi Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Hiromasa Yamamoto Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Seiichiro Sugimoto Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Shinichi Toyooka Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Purposes Robot-assisted thoracoscopic (RATS) segmentectomy is becoming increasingly common because of the expanded indications for segmentectomy and the widespread adoption of robotic surgery. The precise division of the intersegmental plane is necessary to ensure oncologic margins from the tumor and to preserve the lung function. In this study, we present a strategy for accurately dividing the intersegmental plane using a robotic stapler and review the surgical outcomes. Methods RATS portal segmentectomy was performed using the Da Vinci Xi system and the intersegmental plane was dissected using a robotic stapler. We evaluated the perioperative outcomes in 92 patients who underwent RATS portal segmentectomy between May 2020 and January 2023. These results were compared with those of 82 patients who underwent complete video-assisted thoracoscopic surgery (CVATS) during the same period. Results The operative and console times were 162 and 97 min, respectively. No intraoperative complications occurred, and postoperative complications were observed in four cases (4.3%). The operative time, blood loss, postoperative complications, and maximum incision size were significantly lower in the RATS group than in the CVATS group. However, RATS requires a significantly higher number of staplers than CVATS. Conclusions The division of the intersegmental plane using a robotic stapler in RATS portal segmentectomy was, therefore, found to be safe and effective. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 1435-2451 408 1 2023 Innovative suture technique for robotic hepaticojejunostomy: double-layer interrupted sutures 284 EN Kosei Takagi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yuzo Umeda Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Ryuichi Yoshida Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Tomokazu Fuji Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kazuya Yasui Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Takahito Yagi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Purpose Biliary reconstruction remains a technically demanding and complicated procedure in minimally invasive hepatopancreatobiliary surgeries. No optimal hepaticojejunostomy (HJ) technique has been demonstrated to be superior for preventing biliary complications. This study aimed to investigate the feasibility of our unique technique of posterior double-layer interrupted sutures in robotic HJ. Methods We performed a retrospective analysis of a prospectively collected database. Forty-two patients who underwent robotic pancreatoduodenectomy using this technique between September 2020 and November 2022 at our center were reviewed. In the posterior double-layer interrupted technique, sutures were placed to bite the bile duct, posterior seromuscular layer of the jejunum, and full thickness of the jejunum. Results The median operative time was 410 (interquartile range [IQR], 388–478) min, and the median HJ time was 30 (IQR, 28–39) min. The median bile duct diameter was 7 (IQR, 6–10) mm. Of the 42 patients, one patient (2.4%) had grade B bile leakage. During the median follow-up of 12.6 months, one patient (2.4%) with bile leakage developed anastomotic stenosis. Perioperative mortality was not observed. A surgical video showing the posterior double-layer interrupted sutures in the robotic HJ is included. Conclusions Posterior double-layer interrupted sutures in robotic HJ provided a simple and feasible method for biliary reconstruction with a low risk of biliary complications. No potential conflict of interest relevant to this article was reported.

Oxford University Press (OUP) Acta Medica Okayama 1873-734X 63 3 2023 Surgical outcome of ipsilateral anatomical resection for lung cancer after pulmonary lobectomy ezad048 EN Mikio Okazaki Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Ken Suzawa Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Kazuhiko Shien Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Hiromasa Yamamoto Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Kota Araki Okayama University Thoracic Surgery Study Group (OUTSSG) Mototsugu Watanabe Okayama University Thoracic Surgery Study Group (OUTSSG) Masanori Okada Okayama University Thoracic Surgery Study Group (OUTSSG) Yuho Maki Okayama University Thoracic Surgery Study Group (OUTSSG) Tsuyoshi Ueno Okayama University Thoracic Surgery Study Group (OUTSSG) Shinji Otani Okayama University Thoracic Surgery Study Group (OUTSSG) Ryujiro Sugimoto Okayama University Thoracic Surgery Study Group (OUTSSG) Hitoshi Nishikawa Okayama University Thoracic Surgery Study Group (OUTSSG) Riki Okita Okayama University Thoracic Surgery Study Group (OUTSSG) Makio Hayama Okayama University Thoracic Surgery Study Group (OUTSSG) Hiroyuki Tao Okayama University Thoracic Surgery Study Group (OUTSSG) Toshiya Fujiwara Okayama University Thoracic Surgery Study Group (OUTSSG) Hidetoshi Inokawa Okayama University Thoracic Surgery Study Group (OUTSSG) Yuji Hirami Okayama University Thoracic Surgery Study Group (OUTSSG) Yoshifumi Sano Okayama University Thoracic Surgery Study Group (OUTSSG) Motohiro Yamashita Okayama University Thoracic Surgery Study Group (OUTSSG) Osamu Kawamata Okayama University Thoracic Surgery Study Group (OUTSSG) Motoki Matsuura Okayama University Thoracic Surgery Study Group (OUTSSG) Shinichi Toyooka Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University OBJECTIVES: Ipsilateral reoperation after pulmonary lobectomy is often challenging because of adhesions from the previous operation. We retrospectively examined the surgical outcome and prognosis of ipsilateral anatomical resection for lung cancer after pulmonary lobectomy using a multicentre database. METHODS: We evaluated the perioperative outcomes and overall survival of 51 patients who underwent pulmonary lobectomy followed by ipsilateral anatomical resection for lung cancer between January 2012 and December 2018. In addition, patients with stage I non-small-cell lung cancer (NSCLC) were compared with 3411 patients with stage I lung cancer who underwent pulmonary resection without a prior ipsilateral lobectomy. RESULTS: Ipsilateral anatomical resections included 10 completion pneumonectomies, 19 pulmonary lobectomies and 22 pulmonary segmentectomies. Operative time was 312.2 ± 134.5 min, and intraoperative bleeding was 522.2 ± 797.5 ml. Intraoperative and postoperative complications occurred in 9 and 15 patients, respectively. However, the 5-year overall survival rate after anatomical resection followed by ipsilateral lobectomy was 83.5%. Furthermore, in patients with c-stage I NSCLC, anatomical resection followed by ipsilateral lobectomy was not associated with worse survival than anatomical resection without prior ipsilateral lobectomy. CONCLUSIONS: Anatomical resection following ipsilateral lobectomy is associated with a high frequency of intraoperative and postoperative complications. However, the 5-year overall survival in patients with c-stage I NSCLC who underwent ipsilateral anatomical resection after pulmonary lobectomy is comparable to that in patients who underwent anatomical resection without prior pulmonary lobectomy. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 0910-8327 38 9 2023 Prognostic value of the liver fibrosis marker fibrosis-5 index in patients with severe isolated tricuspid regurgitation: comparison with fibrosis-4 index 1181 1189 EN Mitsutaka Nakashima Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toru Miyoshi Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Machiko Tanakaya Department of Cardiovascular Medicine, National Hospital Organization Iwakuni Clinical Center Takaaki Saito Department of Cardiovascular Medicine, National Hospital Organization Iwakuni Clinical Center Yusuke Katayama Department of Cardiovascular Medicine, National Hospital Organization Iwakuni Clinical Center Satoru Sakuragi Department of Cardiovascular Medicine, National Hospital Organization Iwakuni Clinical Center Yoichi Takaya Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroshi Ito Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences The fibrosis-4 index (FIB4), a liver fibrosis maker, has been shown to be associated with the prognosis in patients with severe isolated tricuspid regurgitation (TR). Recent study showed that the fibrosis-5 index (FIB5), which was calculated by albumin, alkaline phosphatase, aspartate transaminase, alanine aminotransferase and platelet count, had better prognostic value than FIB4 in patients with heart failure. The aim of this study was to evaluate the usefulness of FIB5 index for predicting prognosis in patients with severe isolated TR and compare the prognostic value between the FIB4 and the FIB5 in those patients. This was a dual-center, retrospective study. 113 consecutive outpatients with severe isolated TR (mean age, 65.8 years; 47.8% male) were analyzed. Major adverse cardiovascular events (MACEs) were defined as the composite of cardiovascular death, hospitalization for heart failure, myocardial infarction, and stroke. During a median follow-up of 3.0 years, 41 MACEs occurred. Patients with MACEs had a lower the FIB5 than patients without MACEs. The multivariate Cox analysis revealed that the FIB5 < -4.30 was significantly associated with higher incidence of MACEs after adjusted by confounding factors. Receiver-operating characteristic curve analyses showed that prognostic values did not differ between the FIB5 and the FIB4 in whole patients and in patients aged ≥ 70 years; while, in patients aged < 70 years, the FIB5 had better prognostic value than the FIB4. The FIB5 may be a useful predictor of MACEs in patients with severe isolated TR. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 1867-1071 42 3 2023 Prospective evaluation of core number of biopsy for renal tumor: are multiple cores preferable? 319 325 EN Toshihiro Iguchi Department of Radiology, Okayama University Hospital Yusuke Matsui Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Tomohiro Toji Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Jun Sakurai Center for Innovative Clinical Medicine, Okayama University Hospital Koji Tomita Department of Radiology, Okayama University Hospital Mayu Uka Department of Radiology, Okayama University Hospital Noriyuki Umakoshi Department of Radiology, Okayama University Hospital Takahiro Kawabata Department of Radiology, Okayama University Hospital Kazuaki Munetomo Department of Radiology, Okayama University Hospital Toshiharu Mitsuhashi Center for Innovative Clinical Medicine, Okayama University Hospital Takao Hiraki Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Purpose This single-center, single-arm, prospective, open-label study was conducted to evaluate the optimal number of cores (single or multiple) in renal tumor biopsy. Materials and methods Forty-four biopsies of 44 tumors (mean diameter, 2.7 ± 1.0 cm; range, 1.6–5.0 cm) were included. Biopsy was performed under ultrasound or computed tomography fluoroscopy guidance using an 18-gauge cutting needle and the co-axial method. Two or more specimens were obtained, which were divided into first and subsequent specimens. “First specimen” and “all specimens” were histologically evaluated (i.e., appropriateness of specimen, histological diagnosis, subtype, and Fuhrman grade of renal cell carcinoma [RCC]) blindly and independently by two board-certified pathologists. Results Multiple specimens were successfully and safely obtained in all the biopsies. All tumors were histologically diagnosed; 40 malignancies included 39 RCCs and 1 solitary fibrous tumor, and 4 benign lesions included 2 angiomyolipomas, 1 oncocytoma, and 1 capillary hemangioma. In all RCCs, the subtype could be determined (32 clear cell RCCs, 4 chromophobe RCCs, and 3 papillary RCCs), and the Furman grade was determined in 38 RCCs. When only the first specimen was evaluated, 22.7% of the specimens were inappropriate for diagnosis, and 34 (77.3%) were histologically diagnosed. The diagnostic yield was significantly lower than that of all specimens (P = 0.0044). Univariate analysis revealed that smaller lesions were a significant predictor of diagnostic failure (P = 0.020). Conclusion Biopsy with multiple cores significantly improved diagnostic yield. Thus, operators should obtain multiple cores during renal tumor biopsy. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 2 2024 p53-Armed Oncolytic Virotherapy Improves Radiosensitivity in Soft-Tissue Sarcoma by Suppressing BCL-xL Expression 151 161 EN Tadashi Komatsubara Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroshi Tazawa Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Joe Hasei Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshinori Omori Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazuhisa Sugiu Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yusuke Mochizuki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Koji Demiya Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Aki Yoshida Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tomohiro Fujiwara Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiyuki Kunisada Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasuo Urata Oncolys BioPharma, Inc. Shunsuke Kagawa Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/66924 Soft-tissue sarcoma (STS) is a heterogeneous group of rare tumors originating predominantly from the embryonic mesoderm. Despite the development of combined modalities including radiotherapy, STSs are often refractory to antitumor modalities, and novel strategies that improve the prognosis of STS patients are needed. We previously demonstrated the therapeutic potential of two telomerase-specific replication-competent oncolytic adenoviruses, OBP-301 and tumor suppressor p53-armed OBP-702, in human STS cells. Here, we demonstrate in vitro and in vivo antitumor effects of OBP-702 in combination with ionizing radiation against human STS cells (HT1080, NMS-2, SYO-1). OBP-702 synergistically promoted the antitumor effect of ionizing radiation in the STS cells by suppressing the expression of B-cell lymphoma-X large (BCL-xL) and enhancing ionizing radiation-induced apoptosis. The in vivo experiments demonstrated that this combination therapy significantly suppressed STS tumors’ growth. Our results suggest that OBP-702 is a promising antitumor reagent for promoting the radiosensitivity of STS tumors. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 2 2024 Impact of Travel Distance on Surgical Outcomes of Patients Surgically Treated for Non-Small Cell Lung Cancer: A Single-Center Study in Ehime, Japan 143 149 EN Hisayuki Shigematsu Department of Thoracic Surgery, NHO Shikoku Cancer Center Natsumi Yamashita Clinical Research Center, NHO Shikoku Cancer Center Hiroshi Suehisa Department of Thoracic Surgery, NHO Shikoku Cancer Center Tsuyoshi Ueno Department of Thoracic Surgery, NHO Shikoku Cancer Center Tsuyoshi Ryuko Department of Thoracic Surgery, NHO Shikoku Cancer Center Takahito Sugihara Department of Thoracic Surgery, NHO Shikoku Cancer Center Shohei Nakashima Department of Thoracic Surgery, NHO Shikoku Cancer Center Yoshifumi Sano Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine Motohiro Yamashita Department of Thoracic Surgery, NHO Shikoku Cancer Center Original Article 10.18926/AMO/66923 Travel burden is a poor prognostic factor for many cancers worldwide because it hinders optimal diagnosis and treatment planning. Currently, the impact of travel burden on survival after surgery for non-small cell lung cancer (NSCLC) in Japan is largely unexplored. We examined the impact of travel distance on the postoperative outcomes of patients with NSCLC in Ehime Prefecture, Japan. The data of 1212 patients who underwent surgical resection for NSCLC were retrospectively reviewed. Patients were divided into quartiles based on the travel distance from their home to the hospital (≤ 13 km, 13-40 km, 40-57 km, and > 57 km) in Ehime Prefecture. We found no significant differences among the quartiles in baseline clinicopathological characteristics, including sex, smoking status, histology, surgical procedure, clinical stage, and pathological stage. Overall survival (OS) and relapse-free survival (RFS) also were not significantly different among the travel distance quartiles. We conclude that travel distance did not impact OS or RFS among patients with NSCLC who underwent surgical resection at our institution. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 2077-0383 13 6 2024 Enhancing Diagnostic Precision: Evaluation of Preprocessing Filters in Simple Diffusion Kurtosis Imaging for Head and Neck Tumors 1783 EN Yuki Nakamitsu Radiological Technology, Graduate School of Health Sciences, Okayama University Masahiro Kuroda Radiological Technology, Graduate School of Health Sciences, Okayama University Yudai Shimizu Department of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Kazuhiro Kuroda Radiological Technology, Graduate School of Health Sciences, Okayama University Yuuki Yoshimura Radiological Technology, Graduate School of Health Sciences, Okayama University Suzuka Yoshida Department of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Yoshihide Nakamura Department of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Yuka Fukumura Department of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Ryo Kamizaki Radiological Technology, Graduate School of Health Sciences, Okayama University Wlla E. Al-Hammad Department of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Masataka Oita Graduate School of Interdisciplinary Sciences and Engineering in Health Systems, Okayama University Yoshinori Tanabe Radiological Technology, Graduate School of Health Sciences, Okayama University Kohei Sugimoto Radiological Technology, Graduate School of Health Sciences, Okayama University Irfan Sugianto Department of Oral Radiology, Faculty of Dentistry, Hasanuddin University Majd Barham Department of Dentistry and Dental Surgery, College of Medicine and Health Sciences, An-Najah National University Nouha Tekiki Department of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Junichi Asaumi Department of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Background: Our initial clinical study using simple diffusion kurtosis imaging (SDI), which simultaneously produces a diffusion kurtosis image (DKI) and an apparent diffusion coefficient map, confirmed the usefulness of SDI for tumor diagnosis. However, the obtained DKI had noticeable variability in the mean kurtosis (MK) values, which is inherent to SDI. We aimed to improve this variability in SDI by preprocessing with three different filters (Gaussian [G], median [M], and nonlocal mean) of the diffusion-weighted images used for SDI. Methods: The usefulness of filter parameters for diagnosis was examined in basic and clinical studies involving 13 patients with head and neck tumors. Results: The filter parameters, which did not change the median MK value, but reduced the variability and significantly homogenized the MK values in tumor and normal tissues in both basic and clinical studies, were identified. In the receiver operating characteristic curve analysis for distinguishing tumors from normal tissues using MK values, the area under curve values significantly improved from 0.627 without filters to 0.641 with G (sigma = 0.5) and 0.638 with M (radius = 0.5). Conclusions: Thus, image pretreatment with G and M for SDI was shown to be useful for improving tumor diagnosis in clinical practice. No potential conflict of interest relevant to this article was reported.

Dove Press Acta Medica Okayama 1178-7074 17 2024 Association of Regular Cervical Cancer Screening with Socioeconomic, COVID-19 Infection and Vaccine Status Among Japanese Population: Cohort Observational Study 541 551 EN Tomohiro Mitoma Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Jota Maki Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Hikaru Ooba Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Chikako Ogawa Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Hisashi Masuyama Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Takahiro Tabuchi Department of Cancer Control Center, Osaka International Cancer Institute Purpose: Among the Organisation for Economic Co-operation and Development countries, Japan has one of the lowest cervical cancer screening coverages. Cancer screening coverage has worsened due to the coronavirus disease of 2019 (COVID-19) pandemic. This study investigated the relationship between socioeconomic background, COVID-19 infection history and vaccine status, and regular cervical cancer screening (CCS) during the two years of the COVID-19 era in Japan. Patients and Methods: We used data from the Japan COVID-19 and Society Internet Survey, a nationwide, Internet-based, selfreport cohort observational study conducted in 2022. The outcome variable was identified by asking whether the participants had undergone CCS within the last two years. Cervical cytology was performed in Japan by brushing the external cervical os. This study used multivariate log-binomial regression models to evaluate inequalities during regular checkups for CCS. Adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs) were estimated to incorporate the socioeconomic background variables. Results: Of the 12,066 participants, 5597 (46.4%) had undergone regular CCS for over two years. The prevalence ratio (PR) of patients who underwent CCS was 0.70 for those in their 20s and 0.78 for those in their 60s, compared to those in their 40s. Socioeconomic inequities were found in the following groups: unemployed/student, unmarried, high school graduate or lower, and household income below 4 million Yen. Our final multivariate analysis revealed that participants who were in their 20s or 60s, had a household income below 4 million Yen, were unmarried, had no annual health check-ups, and were unvaccinated with COVID-19 were at a higher risk of not undergoing CCS. Conclusion: The relationship between socioeconomic inequality and CCS hesitancy is prevalent among younger participants. The CCS coverage in Japan during the COVID-19 pandemic year (2020-2022) was not low compared with the pre-pandemic era. No potential conflict of interest relevant to this article was reported.

岡山大学法学会 Acta Medica Okayama 0386-3050 73 3 2024 戦後特許法執行体制の形成過程 260 201 EN Y. Oizumi No potential conflict of interest relevant to this article was reported.

BMC Acta Medica Okayama 1471-2474 25 1 2024 The first presentation of a case of nail-patella syndrome newly diagnosed at the onset of rheumatoid arthritis: a case report 139 EN Kazuya Matsumoto Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yoshinori Matsumoto Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Shoichi Nawachi Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yosuke Asano Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yu Katayama Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yoshia Miyawaki Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Takayuki Katsuyama Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Eri Katsuyama Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yoshihisa Nasu Department of Orthopaedic Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Ken-Ei Sada Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Jun Wada Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Background Nail-patella syndrome (NPS) is a rare autosomal dominant disorder that is characterized by dysplasia of the nails, hypoplasia and/or dislocation of the patella and the presence of iliac horns. Using the CARE guidelines, we present the first reported case of NPS that was newly diagnosed at the onset of rheumatoid arthritis (RA). Case presentation A 74-year-old man was admitted to our hospital due to an 8-month history of arthralgia in bilateral wrists, elbows and fingers. He had a past history of glaucoma and left patella dislocation that had been operatively recentered at the age of 15 years. Laboratory data showed elevated levels of serum C-reactive protein and rheumatoid factor and an elevated titer of anti-SS-A antibodies, while estimated glomerular filtration rate (eGFR), titers of other antibodies and the results of a urinary test were normal. An X-ray showed deformity of bilateral radial heads and the right elbow, and magnetic resonance imaging (MRI) of his hands showed synovitis and erosion in the multiple swollen joints of the wrists and fingers. In addition to these typical features of RA, he had bilateral thumb nail dysplasia with mild hypoplasia of bilateral patellae and iliac horns as shown by the X-ray. He was diagnosed as having autosomal dominant disorder NPS co-existing with RA and he was treated with methotrexate in combination with an oral Janus kinase (JAK) inhibitor, leading to induction of remission. Conclusions We have presented a rare case of NPS that was newly diagnosed at the onset of RA. Clinical and radiographic findings of NPS are highlighted in this case report for diagnosing NPS on the basis of typical manifestations. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 78 1 2024 High Fracture Rate of AVANTA Silicone Implant Following Arthroplasty of the Thumb MCP Joint of Rheumatoid Arthritis Patients with Boutonniere Deformities 71 78 EN Daisuke Kaneda Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Keiichiro Nishida Locomotive Pain Center, Okayama University Hospital Yoshihisa Nasu Department of Orthopaedic Surgery, Okayama University Hospital Ryuichi Nakahara Department of Orthopaedic Surgery, Okayama University Hospital Ryozo Harada Department of Orthopaedic Surgery, Kurashiki Sweet Hospital Yoshifumi Hotta Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shuichi Naniwa Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/66673 We retrospectively investigated the mid-term outcomes of arthroplasty using the AVANTA silicone implant for thumb metacarpophalangeal (MCP) joints with boutonniere deformity in patients with rheumatoid arthritis (RA). This study involved 36 thumbs of 33 RA patients with a mean follow-up period of 5.1 years (range, 2.0-13.3). Postoperatively, the mean extension was significantly increased and the mean flexion was significantly decreased (p<0.001, p<0.001, respectively), resulting in the mean arc of range of motion (ROM) shifting in the direction of extension after surgery. Implant fracture was observed in 10 thumbs (28%), and 4 of these (11%) underwent revision surgery. The survivorship with implant fracture and revision surgery as endpoints were 73.4% and 91.8% at 5 years, respectively. The preoperative arc of ROM and the postoperative flexion range of the implant-fracture group were significantly greater than those in the no-implant-fracture group (p=0.039, 0.034, respectively). These results suggest the importance of patient education and careful rehabilitation to prevent excessive flexion. Overall, the AVANTA silicone implant showed a relatively high rate of implant fracture at our institute. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 1424-8220 24 2 2024 Ultrathin Platinum Film Hydrogen Sensors with a Twin-T Type Notch Filter Circuit 548 EN Shoki Wakabayashi Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University Yuki Oh Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University Haruhito Nakayama Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University Jin Wang Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University Toshihiko Kiwa Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University In recent years, hydrogen energy has garnered attention as a potential solution for mitigating greenhouse gas emissions. However, concerns regarding the inherent risk of hydrogen gas leakage and potential explosions have necessitated the development of advanced sensors. Within our research group, we have innovated an ultrathin platinum (Pt) film hydrogen sensor that gauges resistance changes in Pt thin films when exposed to hydrogen gas. Notably, the sensitivity of each sensor is contingent upon the thickness of the Pt film. To address the challenge of detecting hydrogen using multiple sensors, we integrated the ultrathin Pt film as a resistance element within a twin-T type notch filter. This filter exhibits a distinctive reduction in output signals at a specific frequency. The frequency properties of the notch filter dynamically alter with changes in the resistance of the Pt film induced by hydrogen exposure. Consequently, the ultrathin Pt film hydrogen sensor monitors output signal variations around the notch frequency, responding to shifts in frequency properties. This innovative approach enables the electrical control of sensor sensitivity by adjusting the operating frequency in proximity to the notch frequency. Additionally, the simultaneous detection of hydrogen by multiple sensors was successfully achieved by interconnecting sensors with distinct notch frequencies in series. No potential conflict of interest relevant to this article was reported.

Elsevier BV Acta Medica Okayama 0003-4975 117 1 2024 Clinical Features of Patients With Second Primary Lung Cancer After Head and Neck Cancer 181 188 EN Fumiaki Takatsu Department of Thoracic Surgery, Okayama University Hospital Ken Suzawa Department of Thoracic Surgery, Okayama University Hospital Mikio Okazaki Department of Thoracic Surgery, Okayama University Hospital Kazuhiko Shien Department of Thoracic Surgery, Okayama University Hospital Hiromasa Yamamoto Department of Thoracic Surgery, Okayama University Hospital Mototsugu Watanabe Okayama University Thoracic Surgery Study Group Makio Hayama Okayama University Thoracic Surgery Study Group Tsuyoshi Ueno Okayama University Thoracic Surgery Study Group Ryujiro Sugimoto Okayama University Thoracic Surgery Study Group Yuho Maki Okayama University Thoracic Surgery Study Group Toshiya Fujiwara Okayama University Thoracic Surgery Study Group Riki Okita Okayama University Thoracic Surgery Study Group Hidetoshi Inokawa Okayama University Thoracic Surgery Study Group Hiroyuki Tao Okayama University Thoracic Surgery Study Group Yuji Hirami Okayama University Thoracic Surgery Study Group Eisuke Matsuda Okayama University Thoracic Surgery Study Group Kazuhiko Kataoka Okayama University Thoracic Surgery Study Group Motohiro Yamashita Okayama University Thoracic Surgery Study Group Yoshifumi Sano Okayama University Thoracic Surgery Study Group Motoki Matsuura Okayama University Thoracic Surgery Study Group Hisao Mizutani Okayama University Thoracic Surgery Study Group Shinichi Toyooka Department of Thoracic Surgery, Okayama University Hospital Background In survivors of head and neck cancer (HNC), second primary lung cancer (SPLC) often develop as a result of a common risk factor, that is, smoking. A multicenter experience was reviewed to evaluate how the history of a diagnosis of HNC affects the outcomes of patients undergoing pulmonary resection for SPLC. Methods A multicenter retrospective analysis of patients hospitalized between January 2012 and December 2018 was performed. From a cohort of 4521 patients undergoing therapeutic pulmonary resection for primary non-small cell lung cancer, 100 patients with a previous history of HNC (HNC group) were identified. These patients were compared with a control group consisting of 200 patients without an HNC history from the same cohort pair-matched with operating facility, age, sex, and pathologic stage of lung cancer. Results At the time of surgery for SPLC, the HNC group showed malnutrition with a lower prognostic nutritional index compared with the control group (P < .001). The HNC group was determined to have postoperative complications more frequently (P = .02). The 5-year overall survival rates in the HNC and control groups were 59.0% and 83.2%, respectively (P < .001). Statistically, HNC history, lower prognostic nutritional index, squamous cell lung cancer, and TNM stage were identified to be independently associated with poor survival. Conclusions Patients with SPLC after primary HNC often present with malnutrition and are predisposed to postoperative complications and poor survival after pulmonary resection. No potential conflict of interest relevant to this article was reported.

Optica Publishing Group Acta Medica Okayama 1094-4087 31 23 2023 Optical multi-context scrubbing operation on a redundant system 38529 38539 EN Kakeru Ando Graduate School of Natural Science and Technology, Okayama University Minoru Watanabe Faculty of Environmental, Life, Natural Science and Technology, Okayama University Nobuya Watanabe Faculty of Environmental, Life, Natural Science and Technology, Okayama University This paper presents a proposal of the world-first optical multi-context scrubbing operation on a redundant system that can maintain the state of a sequential circuit and the operation continuously without any interruption on a radiation-hardened optically reconfigurable gate array even after a permanent failure suddenly happens on the sequential circuit or a flip-flop by radiation. Up to now, a high-speed optical scrubbing operation has been demonstrated on a radiation-hardened optically reconfigurable gate array. In addition, a multi-context scrubbing operation based on the high-speed optical scrubbing operation has already been demonstrated. Although the multi-context scrubbing operation presents the benefit that it can treat both soft errors and permanent failures caused by radiation simultaneously, the conventional contributions have never presented how to maintain the state of a sequential circuit after a permanent failure occurs on flip-flops. Therefore, in the conventional multi-context scrubbing operation, all the operations must be restarted from the initial condition each time a permanent failure occurs on a programmable gate array. As a result, conventional multi-context scrubbing operations could not be applied for real-time systems. The proposed optical multi-context scrubbing method that can solve the issue has been experimentally evaluated on a radiation-hardened optically reconfigurable gate array. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 2077-0383 12 22 2023 The Effectiveness of Rehabilitation after Open Surgical Release for Trigger Finger: A Prospective, Randomized, Controlled Study 7187 EN Taichi Saito Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ryo Nakamichi Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ryuichi Nakahara Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Keiichiro Nishida Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Background: It is not clear whether rehabilitation after surgery for trigger finger is effective. The aim of this study was to reveal its effectiveness for trigger finger. Methods: This study was a randomized, controlled trial that included patients who underwent operations for trigger fingers. The patients in the rehabilitation group had postoperative occupational therapy (OT) for 3 months, while the patients in the control group were not referred for rehabilitation but received advice for a range of motion exercises. We evaluated the severity of trigger finger, Disability of Arm-Shoulder-Hand (DASH) score, pain-visual analogue scale (VAS), grip strength, whether they gained a full range of motion (ROM), and complications before and after surgery. Results: Finally, 29 and 28 patients were included in the control and rehabilitation groups, respectively. At final follow-up, the DASH score, grip strength, and ROM were significantly improved in the rehabilitation group compared to that preoperatively. At final follow-up, pain was significantly improved in both groups from that preoperatively. There were no significant differences in the results, including the DASH score, grip strength, ROM and pain-VAS between the control and rehabilitation groups at the final follow-up. Subgroup analysis showed that there is a significant difference in the DASH score of patients doing housework or light work and those with a duration of symptoms >12 months between the control and rehabilitation groups at the final follow-up. No potential conflict of interest relevant to this article was reported.

岡山大学文明動態学研究所 Acta Medica Okayama 2436-8326 3 2024 明治期における水利・洪水と千住中組高尾家―見沼代用水を事例に― 79 91 EN Shoji MIMURA National Defense Academy of Japan 特集：災害と文明・地域社会 (Special Issue: Disasters, civilization, and local society) 10.18926/66194 This paper examines the maintenance work of the Minuma Substitute Canal by the Meiji Government and how Noriyoshi Takao who lived at Senjū-nakagumi was involved in it. In the 1880s, when the cost of maintaining the Minuma Substitute Canal was shifted from government expenditures to private ones, the early modern water usage system was on the verge of being converted to a modern one. This meant that the system, which was based on villages or ryō (領), transformed into one based on individuals, especially landowners. The village served as a cost-sharing unit during the Meiji period. Ryō (領) were operated in the downstream water of the Minuma Substitute Canal where there were no critical structures. However, districts (郡) supervised the water usage of ryō, creating a multilayered local community in terms of water usage. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 6 2023 Omental Abscess after Laparoscopic Proximal Gastrectomy Successfully Treated with Percutaneous Drainage 665 669 EN Atsunobu Sakurai Department of Radiology, Okayama University Hospital Mayu Uka Department of Radiology, Okayama University Hospital Toshihiro Iguchi Department of Radiological Technology, Faculty of Health Sciences, Okayama University Koji Tomita Department of Radiology, Okayama University Hospital Yusuke Matsui Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yoshihiko Kakiuchi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Shinji Kuroda Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science Takao Hiraki Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Case Report 10.18926/AMO/66160 We report the case details of a 65-year-old Japanese man with an omental abscess that was discovered 43 days after he underwent a laparoscopic proximal gastrectomy for gastric cancer. His chief complaint was mild abdominal pain that had persisted for several days. The abscess was diagnosed as a rare postoperative complication. We hesitated to perform a reoperation given the invasiveness of general anesthesia and surgery, plus the possibility of postoperative adhesions and because the patient’s general condition was stable and he had only mild abdominal pain. Percutaneous drainage using a 10.2-F catheter was performed with the patient under conscious sedation and computed tomography–fluoroscopy guidance, with no complications. After the procedure, the size of the abscess cavity was remarkably reduced, and 23 days later the catheter was withdrawn. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 6 2023 Comparison between Cases of Total Hip Arthroplasty Followed by Colonna Capsular Arthroplasty and Lorenz Cast Reduction in Patients with Developmental Dysplasia of the Hip 655 663 EN Hirosuke Endo Department of Bone and Joint Surgery, Kawasaki Medical School Kazuki Yamada Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tomonori Tetsunaga Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshifumi Namba Department of Bone and Joint Surgery, Kawasaki Medical School Yoshihisa Sugimoto Department of Bone and Joint Surgery, Kawasaki Medical School Shigeru Mitani Department of Bone and Joint Surgery, Kawasaki Medical School Eiji Nakata Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/66159 Most patients with developmental dysplasia of the hip (DDH) now receive closed-reduction treatment within 6 months after birth. The long-term outcomes of patients with late-detection DDH have remained unclear. We reviewed the clinical records of 18 patients who underwent Colonna capsular arthroplasty (n=8) or closed reduction (n=10) for developmental dysplasia of the hip as infants or young children and underwent total hip arthroplasty approximately in midlife. Both the Colonna capsular arthroplasty and closed reduction groups achieved good clinical results after total hip arthroplasty. However, the operating time was longer and the improvements of hip range of motion and clinical score were significantly worse in the Colonna capsular arthroplasty group than in the closed reduction group. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 6 2023 Effects of Nutritional Support Combined with Neuromuscular Electrical Stimulation on Muscle Strength and Thickness: A Randomized Controlled Trial in Healthy Young Adult Males 635 645 EN Tomohiro Ikeda Department of Rehabilitation Medicine, Okayama University Hospital Kazunori Okamura Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima Masaki Hasegawa Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima Satoshi Tanaka Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima Shusaku Kanai Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima Original Article 10.18926/AMO/66156 In the management of post-injury patients with activity limitations, methods to prevent musculoskeletal disorders and hasten recovery are important. This randomized controlled, single-blinded study was a preliminary investigation of the combined effect of nutritional support with neuromuscular electrical stimulation (NMES) on muscle strength and thickness. Healthy young adult males (median age, 21 years) were enrolled; each of their hands was randomly assigned to one of the following four groups: Placebo, Nutrition, NMES, and Nutrition + NMES. All participants received whey protein or placebo (3x/week for 6 weeks) and NMES training (3x/week for 6 weeks) on the abductor digiti minimi (ADM) muscle of either the left or right hand. ADM muscle strength and thickness were analyzed at baseline and at week 7. We analyzed 38 hands (9 Placebo, 10 Nutrition, 9 NMES, 10 Nutrition + NMES). There was significantly greater muscle strengthening in the Nutrition + NMES group compared to the Placebo group or the NMES group, but no significant difference in gain of muscle thickness. The combined intervention may be effective in improving muscle strength. Future clinical trials targeting various muscles after sports-related injuries are warranted. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 6 2023 Trochanteric Claw Plate Fixation for Greater Trochanteric Fracture or Osteotomy in Total Hip Arthroplasty 619 625 EN Kenichi Oe Department of Orthopaedic Surgery, Kansai Medical University Hirokazu Iida Department of Orthopaedic Surgery, Kansai Medical University Shohei Sogawa Department of Orthopaedic Surgery, Kansai Medical University Fumito Kobayashi Department of Orthopaedic Surgery, Kansai Medical University Tomohisa Nakamura Department of Orthopaedic Surgery, Kansai Medical University Takanori Saito Department of Orthopaedic Surgery, Kansai Medical University Original Article 10.18926/AMO/66154 This study retrospectively evaluated 41 consecutive open reductions and internal fixations following primary or revision total hip arthroplasty, which required trochanteric claw plate fixation for greater trochanteric fracture or osteotomy between January 2008 and December 2020. The mean duration of clinical follow-up was 4.2 years (range, 1-13 years). The patients included 13 men and 28 women, with a mean age of 68 years (range, 32-87 years). The indications for intervention included trochanteric osteotomy, intraoperative fracture, and non-union including postoperative fracture in 6, 9, and 26 cases, respectively. The mean Merle d’Aubigné Clinical Score improved from 9.4 points (range, 5-15 points) pre-operatively, to 14.3 points (range, 9-18 points) at the last follow-up. Bone union occurred in 35 cases (85%), while implant breakage occurred in four cases. At the last follow-up, the mean Merle d’Aubigné Clinical Scores of bone union and non-union were 15.3 and 14.1, respectively (p=0.48). The Kaplan-Meier survival rate, with the endpoint being revision surgery for pain, non-union, dislocation, or implant breakage, at 10 years was 80.0% (95% confidence interval: 62.6-97.4%). Greater trochanteric fixation using a trochanteric claw plate yielded successful results. No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 2023 ベイズ統計を用いた頭部CT検査における検査実施者の造影効果に与える影響に関する研究 EN Kohei SUGIMOTO Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University No potential conflict of interest relevant to this article was reported.

Elsevier Acta Medica Okayama 2213-0071 38 2022 Massive hemoptysis in a post-operative patient with recurrent lung cancer successfully treated by the combination therapy of Endobronchial Watanabe Spigot and bronchial artery embolization 101669 EN Masataka Taoka Department of Allergy and Respiratory Medicine, Okayama University Hospital Go Makimoto Department of Allergy and Respiratory Medicine, Okayama University Hospital Noriyuki Umakoshi Department of Radiology, Okayama University Hospital Kiichiro Ninomiya Department of Allergy and Respiratory Medicine, Okayama University Hospital Hisao Higo Department of Allergy and Respiratory Medicine, Okayama University Hospital Yuka Kato Center for Innovative Clinical Medicine, Okayama University Hospital Masanori Fujii Department of Allergy and Respiratory Medicine, Okayama University Hospital Toshio Kubo Center for Clinical Oncology, Okayama University Hospital Eiki Ichihara Department of Allergy and Respiratory Medicine, Okayama University Hospital Kadoaki Ohashi Department of Allergy and Respiratory Medicine, Okayama University Hospital Katsuyuki Hotta Center for Innovative Clinical Medicine, Okayama University Hospital Masahiro Tabata Center for Clinical Oncology, Okayama University Hospital Yoshinobu Maeda Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Katsuyuki Kiura Department of Allergy and Respiratory Medicine, Okayama University Hospital A 76-year-old woman who was treated with lorlatinib for postoperative recurrent anaplastic lymphoma kinase-positive lung adenocarcinoma visited our hospital with massive hemoptysis. Chest computed tomography showed massive bleeding from the right upper lobe; however, the cause of bleeding was unclear. After bronchial artery embolization (BAE), bronchial occlusion was performed using an Endobronchial Watanabe Spigot (EWS) that was easily placed because BAE had reduced the bleeding volume. Treatment with BAE alone was inadequate; however, additional therapy with EWS after BAE successfully controlled the massive hemoptysis, especially in this patient who underwent lobectomy to prevent respiratory dysfunction. No potential conflict of interest relevant to this article was reported.

IOP Publishing Acta Medica Okayama 0953-2048 35 5 2022 Experiment and numerical simulation of the combined effect of winding, cool-down, and screening current induced stresses in REBCO coils 054001 EN Hiroshi Ueda Graduate School of Natural Science and Technology, Okayama University Hideaki Maeda Japan Science and Technology Agency Yu Suetomi RIKEN Center for Biosystems Dynamics Research Yoshinori Yanagisawa RIKEN Center for Biosystems Dynamics Research This paper overviews the combined effects of winding, cool-down, and screening current-induced stresses in REBCO coils. First, a simulation method to model the circumferential stress modification effect due to the screening-current is overviewed. The simulation includes coil winding, cooling down, and coil charge up to the operating current. Second, we will compare the numerical simulation results with the experimental results. The numerical simulations for a dry coil and an epoxy impregnated coil agree well with the experimental results. Third, the enhanced circumferential stress did not degrade the performance of a dry winding REBCO coil, but the improved increased compressive stress buckled the coil structure. Finally, it is demonstrated that epoxy impregnation has beneficial effects in reducing the stress modification effect. However, the circumferential stress is enormously enhanced at the coil ends, sometimes resulting in degradation of the coil performance. No potential conflict of interest relevant to this article was reported.

Spandidos Publications Acta Medica Okayama 1792-0981 26 5 2023 Evaluation of the accuracy of heart dose prediction by machine learning for selecting patients not requiring deep inspiration breath‑hold radiotherapy after breast cancer surgery 536 EN Ryo Kamizaki Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Masahiro Kuroda Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Wlla Al‑Hammad Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Nouha Tekiki Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hinata Ishizaka Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Kazuhiro Kuroda Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Kohei Sugimoto Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Masataka Oita Graduate School of Interdisciplinary Sciences and Engineering in Health Systems, Okayama University Yoshinori Tanabe Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Majd Barham Department of Dentistry and Dental Surgery, College of Medicine and Health Sciences, An‑Najah National University Irfan Sugianto Department of Oral Radiology, Faculty of Dentistry, Hasanuddin University Yuki Nakamitsu Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Masaki Hirano Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Yuki Muto Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Hiroki Ihara Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Soichi Sugiyama Department of Proton Beam Therapy, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Increased heart dose during postoperative radiotherapy (RT) for left‑sided breast cancer (BC) can cause cardiac injury, which can decrease patient survival. The deep inspiration breath‑hold technique (DIBH) is becoming increasingly common for reducing the mean heart dose (MHD) in patients with left‑sided BC. However, treatment planning and DIBH for RT are laborious, time‑consuming and costly for patients and RT staff. In addition, the proportion of patients with left BC with low MHD is considerably higher among Asian women, mainly due to their smaller breast volume compared with that in Western countries. The present study aimed to determine the optimal machine learning (ML) model for predicting the MHD after RT to pre‑select patients with low MHD who will not require DIBH prior to RT planning. In total, 562 patients with BC who received postoperative RT were randomly divided into the trainval (n=449) and external (n=113) test datasets for ML using Python (version 3.8). Imbalanced data were corrected using synthetic minority oversampling with Gaussian noise. Specifically, right‑left, tumor site, chest wall thickness, irradiation method, body mass index and separation were the six explanatory variables used for ML, with four supervised ML algorithms used. Using the optimal value of hyperparameter tuning with root mean squared error (RMSE) as an indicator for the internal test data, the model yielding the best F2 score evaluation was selected for final validation using the external test data. The predictive ability of MHD for true MHD after RT was the highest among all algorithms for the deep neural network, with a RMSE of 77.4, F2 score of 0.80 and area under the curve‑receiver operating characteristic of 0.88, for a cut‑off value of 300 cGy. The present study suggested that ML can be used to pre‑select female Asian patients with low MHD who do not require DIBH for the postoperative RT of BC. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers Acta Medica Okayama 2169-3536 11 2023 A Proposal of an Axial-Flux Permanent-Magnet Machine Employing SMC Core With Tooth-Tips Constructed by One-Pressing Process: Improving Torque and Manufacturability 109435 109447 EN Ren Tsunata Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Masatsugu Takemoto Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Jun Imai Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Tatsuya Saito Sumitomo Electric Industries Ltd. Tomoyuki Ueno Sumitomo Electric Industries Ltd. This study aims to improve the torque performance and manufacturability of axial-flux permanent magnet (AFPM) machines. Hence, we propose a novel AFPM machine that employs a soft magnetic composite (SMC) core with tooth-tips constructed by a one-pressing process and die. In this paper, the proposed AFPM machine is compared to two conventional AFPM machines using an SMC core. One of them has open-slot structure without tooth-tips. Another model employs an SMC core with tooth-tips pressed by a conventional pressing process that requires multiple operations and dies. As a result of the comparison, the proposed AFPM machine realizes a much higher torque than the two conventional machines. Additionally, the manufacturability of an SMC core with tooth-tips pressed by the proposed method is superior to the conventional one because the proposed structure can be realized by the one-pressing process and die. Furthermore, two prototypes of the proposed AFPM machine and the conventional one with an open-slot structure are fabricated, and then, they are compared by experiments. Consequently, the proposed AFPM machine achieves a 15.7% higher torque than that of the conventional machine using an open-slot structure. Finally, this paper presents an improved design of an AFPM machine with SMC cores using the proposed pressing process. As a result, the proposed AFPM realizes a 20% larger torque than that of a conventional model employing an open-slot structure. No potential conflict of interest relevant to this article was reported.

Elsevier BV Acta Medica Okayama 0960-7404 50 2023 Prognostic nutritional index is a prognostic factor for patients with gastric cancer and esophagogastric junction cancer undergoing proximal gastrectomy with esophagogastrostomy by the double-flap technique: A secondary analysis of the rD-FLAP study 101990 EN Yoshihiko Kakiuchi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shinji Kuroda Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasuhiro Choda Department of Surgery, Hiroshima City Hiroshima Citizens Hospital Shinya Otsuka Department of Surgery, Fukuyama Medical Center Satoshi Ueyama Department of Surgery, Mihara Red Cross Hospital Norimitsu Tanaka Department of Surgery, Kagawa Prefectural Central Hospital Atsushi Muraoka Department of Surgery, Kagawa Rosai Hospital Shinji Hato Department of Surgery, Shikoku Cancer Center Yasuaki Kamikawa Department of Surgery, Matsuda Hospital Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Purpose: Although proximal gastrectomy (PG) is commonly used in patients with upper gastric cancer (GC) and esophagogastric junction (EGJ) cancer, long-term prognostic factors in these patients are poorly understood. The double-flap technique (DFT) is an esophagogastrostomy with anti-reflux mechanism after PG; we previously conducted a multicenter retrospective study (rD-FLAP) to evaluate the short-term outcomes of DFT reconstruction. Here, we evaluated the long-term prognostic factors in patients with upper GC and EGJ cancer. Methods: The study was conducted as a secondary analysis of the rD-FLAP Study, which enrolled patients who underwent PG with DFT reconstruction, irrespective of disease type, between January 1996 and December 2015. Results: A total of 509 GC and EGJ cancer patients were enrolled. Univariate and multivariate analyses of overall survival demonstrated that a preoperative prognostic nutritional index (PNI) < 45 (p < 0.001, hazard ratio [HR]: 3.59, 95% confidential interval [CI]: 1.93–6.67) was an independent poor prognostic factor alongside pathological T factor ([pT] ≥2) (p = 0.010, HR: 2.29, 95% CI: 1.22–4.30) and pathological N factor ([pN] ≥1) (p = 0.001, HR: 3.27, 95% CI: 1.66–6.46). In patients with preoperative PNI ≥45, PNI change (<90%) at 1-year follow-up (p = 0.019, HR: 2.54, 95%CI: 1.16–5.54) was an independent poor prognostic factor, for which operation time (≥300 min) and blood loss (≥200 mL) were independent risk factors. No independent prognostic factors were identified in patients with preoperative PNI <45. Conclusions: PNI is a prognostic factor in upper GC and EGJ cancer patients. Preoperative nutritional enhancement and postoperative nutritional maintenance are important for prognostic improvement in these patients. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers (IEEE) Acta Medica Okayama 0093-9994 59 3 2023 Comparison of Thermal Characteristics in Various Aspect Ratios for Radial-Flux and Axial-Flux Permanent Magnet Machines 3353 3367 EN Ren Tsunata Division of Industrial Innovation Sciences Graduate School of Natural Science and Technology, Okayama University Masatsugu Takemoto Division of Industrial Innovation Sciences Graduate School of Natural Science and Technology, Okayama University Jun Imai Division of Industrial Innovation Sciences Graduate School of Natural Science and Technology, Okayama University Tatsuya Saito Sumitomo Electric Industries Ltd Tomoyuki Ueno Sumitomo Electric Industries Ltd This paper proposes an axial-flux permanent magnet machine (AFPM) that uses a neodymium-bonded permanent magnet (Nd-bonded PM) and a coreless rotor structure and assesses how it performs in industrial applications requiring high efficiency and low cost. The AFPM is able to achieve high efficiency in high-speed regions because its Nd-bonded PM can restrain eddy current loss. Additionally, the AFPM can continuously function at the rated operating point without a cooling system, so the expenses for one can be eliminated. Hence, the AFPM can simultaneously achieve high efficiency and low-cost mass production. In this paper, a comprehensive comparison including the thermal characteristics of the proposed AFPM and a conventional radial-flux permanent magnet machine (RFPM) is shown. Furthermore, this paper also focuses on how the aspect ratio influences the thermal characteristics of both machines. Finally, the effectiveness of the proposed AFPM in industrial applications is assessed using 3D-FEA and experimental results. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 5 2023 Favorable Outcome of Repeated Salvage Surgeries for Rare Metastasis to the Ligamentum Teres Hepatis and the Upper Abdominal Wall in a Stage IV Gastric Cancer Patient 553 559 EN Takahiro Murokawa Department of Gastroenterological Surgery, Kochi Health Sciences Center Shinya Sakamoto Department of Gastroenterological Surgery, Kochi Health Sciences Center Motoyasu Tabuchi Department of Gastroenterological Surgery, Kochi Health Sciences Center Kenta Sui Department of Gastroenterological Surgery, Kochi Health Sciences Center Kazuhide Ozaki Department of Gastroenterological Surgery, Kochi Health Sciences Center Manabu Matsumoto Department of Diagnostic Pathology, Kochi Health Sciences Center Jun Iwata Department of Diagnostic Pathology, Kochi Health Sciences Center Takehiro Okabayashi Department of Gastroenterological Surgery, Kochi Health Sciences Center Hiroshi Yoshida Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Case Report 10.18926/AMO/65979 Gastric cancer with peritoneal metastases is typically a devastating diagnosis. Ligamentum teres hepatis (LTH) metastasis is an extremely rare presentation with only four known cases. Herein, we report salvage surgery of successive metastases to the abdominal wall and LTH in a patient originally presenting with advanced gastric cancer with peritoneal metastasis, leading to long-term survival. A 72-year-old man with advanced gastric cancer underwent curative-intent distal gastrectomy with D2 lymph node dissection for gastric outlet obstruction. During this procedure, three small peritoneal metastases were detected in the lesser omentum, the small mesentery, and the mesocolon; however, intraoperative abdominal lavage cytology was negative. We added cytoreductive surgery for peritoneal metastasis. The pathological diagnosis of the gastric cancer was tubular adenocarcinoma with pT4aN1pM1(PER/P1b)CY0 stage IV (Japanese classification of gastric carcinoma/JCGC 15th), or T4N1M1b stage IV (UICC 7th). Post-operative adjuvant chemotherapy with S-1 (TS-1)+cisplatin (CDDP) was administered for 8 months followed by S-1 monotherapy for 4 months. At 28 months after the initial surgery, a follow-up computed tomography (CT) detected a small mass beneath the upper abdominal wall. The ass showed mild avidity on 18F-fluorodeoxyglucose positron-emission (FDG-PET) CT. Salvage resection was performed for diagnosis and treatment, and pathological findings were consistent with primary gastric cancer metastasis. At 49 months after the initial gastrectomy, a new lesion was detected in the LTH with a similar level of avidity on FDG-PET CT as the abdominal wall metastatic lesion. We performed a second salvage surgery for the LTH tumor, which also showed pathology of gastric cancer metastasis. There has been no recurrence up to 1 year after the LTH surgery. With multidisciplinary treatment the patient has survived almost 5 years after the initial gastrectomy. Curative-intent gastrectomy with cytoreductive surgery followed by adjuvant chemotherapy for advanced gastric cancer with localized peritoneal metastasis might have had a survival benefit in our patient. Successive salvage surgeries for oligometastatic lesions in the abdominal wall and the LTH also yielded favorable outcomes. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 5 2023 Relationship of Intraoperative SpO2 and ETCO2 Values with Postoperative Hypoxemia in Elderly Patients after Non-Cardiac Surgery 537 543 EN Qingqing Song Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yu Pan Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tomoyuki Kanazawa Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroshi Morimatsu Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/65976 Elderly patients are at higher risk of postoperative hypoxemia due to their decreased respiratory function. The aim of this study was to investigate the relationship of intraoperative oxygen saturation (SpO2) and end-expiratory carbon dioxide (ETCO2) values with postoperative hypoxemia in elderly patients. The inclusion criteria were: 1) patients aged≥75 years; 2) underwent general anesthesia in non-cardiac surgery; 3) operative time longer than two hours; and 4) admission to the intensive care unit (ICU) following surgery performed between January and December 2019. Intraoperative SpO2 and ETCO2 values were collected every minute for the first two hours during surgery. The 253 patients were divided into two groups: SpO2≥92% and SpO2<92%. The time-weighted averages of intraoperative SpO2 and ETCO2 were used to compare differences between the two groups. The incidence of postoperative hypoxemia was 22.5%. For similar ventilator settings, patients with postoperative hypoxemia had lower intraoperative SpO2 and higher ETCO2 values. Sex, ASA classification, and intraoperative SpO2 were independent risk factors for postoperative hypoxemia. In conclusion, postoperative SpO2<92% was a frequent occurrence (> 20%) in elderly patients who underwent major non-cardiac surgery. Postoperative hypoxemia was associated with low intraoperative SpO2 and relatively higher ETCO2. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 5 2023 An Assessment Rubric for a Resident Training Program in Surgery: A Single-Institution Experience 451 460 EN Atsushi Okita Department of Surgery, Okayama City Hospital Kazunori Tsukuda Department of Surgery, Okayama City Hospital Hideo Ino Center for Education in Medicine and Health Science, Okayama University Ema Mitsui Department of Surgery, Okayama City Hospital Nanami Ikeya Department of Surgery, Okayama City Hospital Sumiharu Yamamoto Department of Surgery, Okayama City Hospital Nobuji Yokoyama Department of Surgery, Okayama City Hospital Aubra Bulin Discovery Program for Global Learners, Okayama University Original Article 10.18926/AMO/65967 Using a Collaborative Action Research model, our research team established a one-month clinical resident training program for first- and second-year clinical residents. We created and implemented an assessment rubric to assess the residents’ progress toward independent practice in surgery, and thereby, to evaluate the program itself. The program included training in three areas: basic techniques and procedures in the operating room, surgical ward management, and academic activities. The rubric measured the residents’ performance according to three achievement levels: Level 1 (demonstration), Level 2 (active help) and Level 3 (passive help). The program and rubric implementation began in June 2019 and continued until March 2020, when the program outcomes and shortcomings were analyzed. Among nineteen clinical residents, a total of nine clinical residents participated in the study. Most participants reached achievement Level 3 for their performance of basic techniques in the operating room. Finally, we discussed ideas for improvement and drafted plans for an improved rubric to complete the action research cycle. Our research team found the rubric to be a useful tool in evaluating the status of the new clinical resident training program. No potential conflict of interest relevant to this article was reported.

Fuji Technology Press Ltd. Acta Medica Okayama 1883-8049 34 2 2022 Development of a Spiral Shaped Soft Holding Actuator Using Extension Type Flexible Pneumatic Actuators 373 381 EN So Shimooka Graduate School of Natural Science and Technology, Okayama University Tetsuya Akagi Department of Intelligent Mechanical Engineering, Okayama University of Science Shujiro Dohta Department of Intelligent Mechanical Engineering, Okayama University of Science Takashi Shinohara Design and Manufacturing Center, Organization for Research Development and Outreach, Okayama University of Science Takumi Kobayashi Department of Intelligent Mechanical Engineering, Okayama University of Science Recently, several pneumatic soft actuators have been applied to wearable and welfare devices to provide nursing care and physical support for the elderly and disabled. In this study, as a wearable soft actuator for holding body, a spiral shaped soft holding actuator that can wrap a user according to their body shape was proposed and tested. The construction and operating principle of the tested soft actuator with circumferential restraint mechanism using three extension type flexible pneumatic actuators (EFPAs) has been discussed. As a result, it was found that the tested actuator could hold elbows and knees when the joint is in motion. An analytical model of the spiral actuator was also proposed to achieve an optimal design. It can be confirmed that the proposed analytical model can predict the shape of the actuator when various EFPAs are pressurized. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 0019-5413 57 10 2023 Time-Dependent Increase in Medial Meniscus Extrusion Predicts the Need for Meniscal Repair in Patients with Partial Medial Meniscus Posterior Root Tears: A Case–Control Study 1633 1639 EN Koki Kawada Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takayuki Furumatsu Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masanori Tamura Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Haowei Xue Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Naohiro Higashihara Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Keisuke Kintaka Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yusuke Yokoyama Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Purpose　This study aimed to compare medial meniscus extrusion (MME) in patients with partial medial meniscus posterior root tears (MMPRTs) through magnetic resonance imaging (MRI) conducted at two-time points and to determine whether patient characteristics or MME measurements differ in patients who respond to nonoperative treatment compared with those who require surgical treatment. Methods　Thirty-seven patients with partial MMPRTs underwent two MRI scans during nonoperative management or before pull-out repair. Among these, 17 patients received nonoperative management, and 20 underwent pull-out repair. Partial MMPRTs were diagnosed based on the MRI findings. MME measurements were performed on both MRI scans. Statistical and receiver operating curve (ROC) analyses were performed. Results　The duration between the two MRI scans was significantly shorter in the pull-out repair group than in the nonoperative management group. The increase in MME (ΔMME) on MRI scans was significantly greater in the pull-out repair group than in the nonoperative management group. Linear regression analysis revealed a weak correlation between the MRI interval and ΔMME in the nonoperative management group and a moderate correlation in the pull-out repair group. In the ROC construction, the cut-off value for ΔMME that requires surgical intervention was 0.41 mm, with a sensitivity and specificity of 85.0% and 52.9%, respectively. Conclusion　Patients with partial MMPRTs requiring surgical treatment had greater MME progression in a shorter time and a time-dependent increase in MME. Therefore, a ΔMME of ≥ 0.41 mm may be useful in deciding surgical intervention based on MRI retests. Level of evidence　III. No potential conflict of interest relevant to this article was reported.

Cell Press Acta Medica Okayama 2405-8440 9 8 2023 Bayesian statistical modeling to predict observer-specific optimal windowing parameters in magnetic resonance imaging e19038 EN Kohei Sugimoto Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University Masataka Oita Faculty of Interdisciplinary Science and Engineering in Health Systems, Okayama University Masahiro Kuroda Department of Radiological Technology, Faculty of Health Sciences, Okayama University Magnetic resonance (MR) images require a process known as windowing for optimizing the display conditions. However, the conventional windowing process often fails to achieve the preferred display conditions for observers due to various factors. This study proposes a novel framework for predicting the preferred windowing parameters for each observer using Bayesian statistical modeling. MR images obtained from 1000 patients were divided into training and test sets at a 7:3 ratio. The image intensity and windowing parameters were standardized using previously reported methods. Bayesian statistical modeling was utilized to predict the windowing parameters preferred by three MR imaging (MRI) operators. The performance of the proposed framework was evaluated by assessing the mean relative error (MRE), mean absolute error (MAE), and Pearson's correlation coefficient (ρ) of the test set. In addition, the naive method, which presumes that the average value of the windowing parameters for each acquisition sequence and body region in the training set is optimal, was also used for comparison. Three MRI operators and three radiologists conducted visual assessments. The mean MRE, MAE, and ρ values for the window level and width (WL/WW) in the proposed framework were 12.6 and 13.9, 42.9 and 85.4, and 0.98 and 0.98, respectively. These results outperformed those obtained using the naive method. The visual assessments revealed no significant differences between the original and predicted display conditions, indicating that the proposed framework accurately predicts individualized windowing parameters with the additional advantages of robustness and ease of use. Thus, the proposed framework can effectively predict the windowing parameters preferred by each observer. No potential conflict of interest relevant to this article was reported.

Informa UK Limited Acta Medica Okayama 2770-5781 81 1 2022 Improvement of anterior disc displacement on the mandibular deviated side after intraoral vertical ramus osteotomy in a patient with facial asymmetry: a case report 58 67 EN Hirotaka Ueda Department of Orthodontics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Naoki Oka Department of Orthodontics, Okayama University Hospital Tsuyoshi Shimo Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido Akira Sasaki Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takashi Yamashiro Department of Orthodontics and Dentofacial Orthopedics, Osaka University Graduate School of Dentistry Hiroshi Kamioka Department of Orthodontics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Purpose: We present the orthognathic treatment of an adult skeletal Class III patient with facial asymmetry, mandibular rightward deviation, and anterior disc displacement without reduction (ADDwoR) at the right temporomandibular joint (TMJ) by intraoral vertical ramus osteotomy (IVRO). Materials and methods: The patient was a 23-year-old man with complaints of mandibular deviation and crowded lower anterior teeth, resulting in facial asymmetry. The maxillary position was normal with protrusion and rightward deviation of the mandible. There was no cant of the maxilla. He experienced pain in the right TMJ during mastication, and Magnetic resonance imaging (MRI) revealed an ADDwoR on the right side. The patient was diagnosed with Class III malocclusion, skeletal Class III prognathism with mandibular deviation, and ADDwoR on the right side. Orthognathic surgery was proposed for jaw deformity, and IVRO was performed to correct mandibular deviation. Results: One year and 2 months after treatment onset, IVRO was performed with differential setback: 2 mm on the right and 8 mm on the left side of the mandible. The midline of the lower dentition was rotated by 6 mm to coincide with the facial midline. Symptoms of temporomandibular disorders were not observed post-operatively. Active-treatment period was for 31 months. MRI findings showed improvement in anterior disc displacement on the right side during the post-retention. Conclusion: In the case of facial asymmetry with anterior disc displacement on the mandibular deviated side, IVRO was suggested to have a potential effect on the positional relationship between the mandibular head and temporomandibular disc. No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 2005 An operational engineering perspective for supporting process safety in batch plant EN Datu Rizal Asral No potential conflict of interest relevant to this article was reported.

IOP Publishing Ltd Acta Medica Okayama 2041-8205 951 2 2023 Search for Astrophysical Electron Antineutrinos in Super-Kamiokande with 0.01% Gadolinium-loaded Water L27 EN M. Harada Department of Physics, Okayama University We report the first search result for the flux of astrophysical electron antineutrinos for energies O(10) MeV in the gadolinium-loaded Super-Kamiokande (SK) detector. In 2020 June, gadolinium was introduced to the ultrapure water of the SK detector in order to detect neutrons more efficiently. In this new experimental phase, SK-Gd, we can search for electron antineutrinos via inverse beta decay with efficient background rejection thanks to the high efficiency of the neutron tagging technique. In this paper, we report the result for the initial stage of SK-Gd, during 2020 August 26, and 2022 June 1 with a 22.5 x 552 kton center dot day exposure at 0.01% Gd mass concentration. No significant excess over the expected background in the observed events is found for the neutrino energies below 31.3 MeV. Thus, the flux upper limits are placed at the 90% confidence level. The limits and sensitivities are already comparable with the previous SK result with pure water (22.5 x 2970 kton center dot day) owing to the enhanced neutron tagging. Operation with Gd increased to 0.03% started in 2022 June. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers Acta Medica Okayama 2169-3536 11 2023 Design and Analysis of Hybrid-Excitation Variable Flux Memory Motor for Traction Applications: Improving Output Power in High-Speed Area During Six-Step Operation Mode 82024 82036 EN Ren Tsunata Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Keito Yokomichi Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Masatsugu Takemoto Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Jun Imai Graduate School of Environmental, Life, Natural Science and Technology, Okayama University Variable flux motors with adjustable magnetic flux have been gaining attention because of their capability to simultaneously achieve a high torque density and high efficiency. In addition, the output power characteristic, which is related to acceleration performance, in high-speed areas is important in traction applications. However, typical traction motors have lower output power in high-speed areas. In this paper, a Hybrid-Excitation Variable Flux Memory Motor (HE-VFMM) is therefore proposed to enhance output power characteristics under six-step operation mode in high-speed area. The proposed HE-VFMM can perform magnetic flux adjustment with two components: field winding and variable flux permanent magnet (VPM), thus dramatically increasing flux adjustment range. The simulation results show the proposed HE-VFMM achieves 23.7% higher output power at 17,000 rpm than that of an existing traction motor in Prius 4th generation that has the same size while maintaining high efficiency in the frequently used operating area. Additionally, it was found that variable magnetic flux is very effective in enhancing the output power, especially in the high-speed region because the magnetic saturation in the stator core is mitigated by field-weakening control. Consequently, as the rotational speed increases, an increase ratio of the output power caused by the adjustable magnetic flux becomes higher. This paper shows that the proposed HE-VFMM is an effective method for improving the problem of low output power in high-speed regions in traction motors. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 4 2023 Usefulness of Force-Controlled Pelvic Stress Radiograph in the Evaluation and Treatment of Fragility Fractures of the Pelvis in Geriatric Patients: A Pilot Study 407 414 EN Kensuke Hotta Department of Orthopaedic Surgery, Amagi Chuo Hospital Takaomi Kobayashi Department of Orthopaedic Surgery, Karatsu Red Cross Hospital Original Article 10.18926/AMO/65751 This study aimed to investigate the usefulness of force-controlled pelvic stress radiographs in the evaluation and treatment of fragility fractures of the pelvis (FFP) using a functional treatment strategy. We conducted a retrospective study of 55 geriatric patients with FFP who underwent pelvic stress radiographs on admission. The differences in the sacral width, pelvic ring width, and medial femoral head width between the radiographs with and without the Sam Sling II M size were defined as Δ sacral width, Δ pelvic ring width, and Δ medial femoral head width, respectively. We used Pearson’s correlation test to assess the relationship between the degree of radiographic instability and the Johns Hopkins highest level of mobility scale (JH-HLM) at 10-days postadmission. Conventional receiver-operating-characteristic curve analysis was used to identify cases requiring surgery using the best cutoff value for radiographic instability. The JH-HLM was significantly correlated with Δ sacral width (r=－0.401, p=0.017), but not with Δ pelvic ring width (r=－0.298, p=0.080) nor with Δ medial femoral head width (r= －0.261, p=0.128). The best cutoff value of Δ sacral width in identifying surgical cases was 10.7 mm (sensitivity 75.0%, specificity 98.0%). Force-controlled pelvic stress radiographs could be helpful in assessing the need for surgery on admission. No potential conflict of interest relevant to this article was reported.

岡山大学経済学会 Acta Medica Okayama 2433-4146 55 1 2023 中央銀行デジタル通貨（Central Bank Digital Currency）に対する一考 15 34 EN Nobutaka Honda Satoshi Mimura 10.18926/OER/65683 　本稿では，まず，中央銀行が発行する現代の中央銀行券の性質や発行・流通について省察を行ない，次に，中央銀行券がデジタル通貨に置き換わる可能性について，中央銀行が，本来，果たすべき現金通貨として中央銀行券の機能や役割，また，外国為替決済を含め，グローバルな商品やサービス取引における通貨のデジタル化が進む中で，その機能や役割を十分に果たしえるか否かについて検討した。 　その論点は，「デジタル通貨」はあくまでも消費活動の際に発生する価値を交換する際に使用される機能＝手段の一つであり，現金や預金を代替するものとして捉えるものなのか，それとも，消費活動が生成されるまでの全ての過程において個々の場面で発生する価値を交換する媒介手段として，全く新しい機能として捉えるのかによって，機能と役割も含め，実現するまでの道のりは違ってくる。 　想定される中央銀行デジタル通貨（Central Bank Digital Currency，以下CBDCと言う）の機能要件を考慮しつつ，投資対効果の極大化を実現するには，全く新しい決済システムの根幹として「デジタル通貨」の機能面・運用面を確立するものではなく，民間事業者が進めている様々なデジタル化機能を補完するという立ち位置を加味し，現在進められている事業モデルの中に，「中央銀行券」の代替として「デジタル通貨」としてその役割を組み込むことで，時間とコストを抑えつつ，万民が利用可能な「決済システムの中核機能」として実現できる可能性は高いものと思慮する。 　本稿では，民間事業者の取り組みを検証しながら，日本国民にとっても有益となる仕組みの一つとしての「デジタル通貨」の運用方法を考えたい。 No potential conflict of interest relevant to this article was reported.

Springer Acta Medica Okayama 2198-7793 9 1 2023 Safe and curative modified two-stage operation for T4 esophageal cancer after definitive chemoradiotherapy: a case report 119 EN Tasuku Matsumoto Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazuhiro Noma Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Naoaki Maeda Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takuya Kato Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kazuya Moriwake Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kento Kawasaki Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masashi Hashimoto Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shunsuke Tanabe Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yasuhiro Shirakawa Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Background　The prognosis of esophageal cancer (EC) with organ invasion is extremely poor. In these cases, definitive chemoradiotherapy (CRT) followed by salvage surgery can be planned; however, the issue of high morbidity and mortality rates persists. Herein, we report the long-term survival of a patient with EC and T4 invasion who underwent a modified two-stage operation after definitive CRT. Case presentation　A 60-year-old male presented with type 2 upper thoracic EC with tracheal invasion. First, definitive CRT was performed, which resulted in tumor shrinkage and improvement in the tracheal invasion. However, an esophagotracheal fistula subsequently developed, and the patient was treated with fasting and antibiotics. Although the fistula recovered, severe esophageal stenoses made oral intake impossible. To improve quality of life and cure the EC, a modified two-stage operation was planned. In the first surgery, an esophageal bypass was performed using a gastric tube with cervical and abdominal lymph node dissections. After confirming improved nutritional status and absence of distant metastasis, the second surgery was performed with subtotal esophagectomy, mediastinal lymph node dissection, and tracheobronchial coverage of the fistula. The patient discharged without major complications after radical resection and has been recurrence-free for 5 years since the start of treatment. Conclusion　A standard curative strategy could be difficult for EC with T4 invasion due to differences in the invaded organs, presence of complications, and patient condition. Therefore, patient-tailored treatment plans are needed, including a modified two-stage operation. No potential conflict of interest relevant to this article was reported.

Wiley Acta Medica Okayama 0041-1132 63 7 2023 Efficient granulocyte collection method using high concentrations of medium molecular weight hydroxyethyl starch 1344 1353 EN Takumi Kondo Division of Transfusion, Okayama University Hospital Keiko Fujii Division of Clinical Laboratory, Okayama University Hospital Nobuharu Fujii Division of Transfusion, Okayama University Hospital Yuichi Sumii Division of Transfusion, Okayama University Hospital Tomohiro Urata Division of Transfusion, Okayama University Hospital Maiko Kimura Division of Transfusion, Okayama University Hospital Masayuki Matsuda Division of Transfusion, Okayama University Hospital Shuntaro Ikegawa Division of Transfusion, Okayama University Hospital Kana Washio Department of Pediatrics/Pediatric Hematology and Oncology, Okayama University Hospital Hideaki Fujiwara Department of Hematology and Oncology, Okayama University Hospital Noboru Asada Department of Hematology and Oncology, Okayama University Hospital Daisuke Ennishi Department of Hematology and Oncology, Okayama University Hospital Hisakazu Nishimori Department of Hematology and Oncology, Okayama University Hospital Ken‐ichi Matsuoka Department of Hematology and Oncology, Okayama University Hospital Fumio Otsuka Division of Clinical Laboratory, Okayama University Hospital Yoshinobu Maeda Department of Hematology and Oncology, Okayama University Hospital Background: Granulocyte transfusion therapy is a rational therapeutic option for patients with prolonged, severe neutropenia. Although high molecular weight hydroxyethyl starch (hHES) facilitates the separation of red blood cells during granulocyte collection, renal dysfunction has been noted as a potential side effect. HES130/0.4 (Voluven®) is a medium molecular weight HES (mHES) with superior safety profiles compared to hHES. Although HES130/0.4 is reportedly effective in the collection of granulocytes, we lack studies comparing the efficiency of granulocyte collection using HES130/0.4 and hHES. Study Design and Methods: We retrospectively collected the data from 60 consecutive apheresis procedures performed on 40 healthy donors at the Okayama University Hospital between July 2013 and December 2021. All procedures were performed using the Spectra Optia system. Based on the HES130/0.4 concentration in the separation chamber, granulocyte collection methods using HES130/0.4 were classified into m0.46, m0.44, m0.37, and m0.8 groups. We used HES130/0.4 and hHES groups to compare the various sample collection methods. Results: The median granulocyte collection efficiency (CE) was approximately 24.0% and 28.1% in the m0.8 and hHES groups, respectively, which were significantly higher than those in the m0.46, m0.44, and m0.37 groups. One month following granulocyte collection with HES130/0.4, no significant changes were observed in serum creatinine levels compared to those before the donation. Conclusion: Therefore, we propose a granulocyte collection approach employing HES130/0.4, which is comparable to the use of hHES in terms of the granulocyte CE. A high concentration of HES130/0.4 in the separation chamber was considered crucial for granulocyte collection. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 0341-2695 47 10 2023 Epidemiological features of acute medial meniscus posterior root tears 2537 2545 EN Yusuke Kamatsuki Department of Orthopaedic Surgery, Okayama University Hospital Takayuki Furumatsu Department of Orthopaedic Surgery, Okayama University Hospital Takaaki Hiranaka Department of Orthopaedic Surgery, Okayama University Hospital Yuki Okazaki Department of Orthopaedic Surgery, Okayama University Hospital Keisuke Kintaka Department of Orthopaedic Surgery, Okayama University Hospital Yuya Kodama Department of Orthopaedic Surgery, Okayama University Hospital Shinichi Miyazawa Department of Orthopaedic Surgery, Okayama University Hospital Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Hospital Purpose　Untreated or overlooked medial meniscus posterior root tears (MMPRTs) induce sequential knee joint degradation. We evaluated epidemiological features of acute MMPRT for its early detection and accurate diagnosis. Methods　Among 330 MMPRT patients from 2018 to 2020, those who underwent arthroscopic pullout repairs were enrolled. Patients who underwent non-operative treatment or knee arthroplasty, those with a cruciate ligament-deficient knee or advanced osteoarthritis of the knee, and those with insufficient data were excluded. Finally, we retrospectively evaluated data from 234 MMPRTs (female: 79.9%, complete tears: 92.7%, mean age: 65 years). Welch’s t-test and Chi-squared test were used for pairwise comparisons. Spearman’s rank correlation analysis was performed between age at surgery and body mass index (BMI). Multivariable logistic regression analysis with stepwise backward elimination was applied to the values as risk factors for painful popping events. Results　In both sexes, there were significant differences in height, weight, and BMI. In all patients, there was a significant negative correlation between BMI and age (ρ = － 0.36, p < 0.001). The BMI cutoff value of 27.7 kg/m2 had a 79.2% sensitivity and a 76.9% specificity for detecting MMPRT patients aged < 50 years. A painful popping event was confirmed in 187 knees (79.9%), and the frequency was significantly reduced in partial tears as compared to complete tears (odds ratio: 0.080, p < 0.001). Conclusion　Higher BMI was associated with a significantly younger age of MMPRT onset. Partial MMPRTs had a low frequency of painful popping events (43.8%). No potential conflict of interest relevant to this article was reported.

Elsevier BV Acta Medica Okayama 0022-5223 165 2 2023 Modified single-patch repair for atrioventricular septal defects results in good functional outcomes in the absence of deep ventricular septal defects 411 421 EN Yasuyuki Kobayashi Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University Hospital Shingo Kasahara Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University Hospital Shunji Sano Pediatric Cardiothoracic Surgery, University of California Yasuhiro Kotani Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University Hospital Objectives We compared 2-patch repair (TP) with modified single-patch repair (MSP) for complete atrioventricular septal defects and evaluated their effect on the left atrioventricular valve (LAVV) competence. We also identified risk factors for unfavorable functional outcomes. Methods This retrospective study included 118 patients with complete atrioventricular septal defects who underwent intracardiac repair from 1998 to 2020 (MSP: 69; TP: 49). The median follow-up period was 10.4 years. The functional outcome of freedom from moderate or greater LAVV regurgitation (LAVVR) was estimated using the Kaplan–Meier method. Results The hospital mortality was 1.7% (2/118) and late mortality was 0.8% (1/118). Eight patients required LAVV-related reoperation (MSP: 4; TP: 4) and none required left ventricular outflow tract-related reoperation. In the MSP group without LAVV anomaly, the receiver operating characteristic curve analysis revealed that the ventricular septal defect (VSD) depth was strongly associated with moderate or greater postoperative LAVVR, with the best cutoff at 10.9 mm. When stratified according to the combination of intracardiac repair type and VSD depth, the MSP-deep VSD (VSD depth >11 mm) group showed the worst LAVV competence among the 4 groups (P = .002). According to multivariate analysis, weight <4.0 kg, LAVV anomaly, and moderate or greater preoperative LAVVR were independent risk factors for moderate or greater postoperative LAVVR, whereas MSP was not a risk factor. Conclusions Postoperative LAVVR remains an obstacle to improved functional outcomes. MSP provides LAVV competence similar to TP unless deep VSD is present. The surgical approach should be selected on the basis of anatomical variations, specifically VSD depth. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 3 2023 Associations between Comorbidities and Acute Exacerbation of Interstitial Lung Disease after Primary Lung Cancer Surgery 301 309 EN Takahide Kato Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine Seigo Miyoshi Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine Chizuru Hamada Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine Yoshifumi Sano Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine Naoyuki Nogami Department of Community Medicine, Pulmonology and Cardiology, Ehime University Graduate School of Medicine Osamu Yamaguchi Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine Naohiko Hamaguchi Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine Original Article 10.18926/AMO/65495 Acute exacerbation (AE) of interstitial lung disease (ILD) is a severe complication of lung resection in lung cancer patients with ILD (LC-ILD). This study aimed to assess the predictive value of comorbidities other than ILD for postoperative AE in patients with LC-ILD. We retrospectively evaluated 68 patients with LC-ILD who had undergone lung resection. We classified them into two groups: those who had developed postoperative AE within 30 days after resection and those who had not. We analyzed patient characteristics, high-resolution computed tomography findings, clinical data, pulmonary function, and intraoperative data. The incidence of postoperative AEs was 11.8%. In univariate analysis, performance status (PS), honeycombing, forced vital capacity (FVC), and high hemoglobin A1c (HbA1c) levels without comorbidities were significantly associated with postoperative AE. Patients were divided into two groups according to cutoff levels of those four variables as determined by receiver operating characteristic curves, revealing that the rates of patients without postoperative AE differed significantly between groups. The present results suggested that preoperative comorbidities other than ILD were not risk factors for postoperative AE in patients with LC-ILD. However, a high preoperative HbA1c level, poor PS, low FVC, and honeycombing may be associated with postoperative AE of LC-ILD. No potential conflict of interest relevant to this article was reported.

Elsevier Acta Medica Okayama 2405-8440 9 4 2023 Diagnostic value of circulating microRNA-21 in chronic lung allograft dysfunction after bilateral cadaveric and living-donor lobar lung transplantation e14903 EN Toshio Shiotani Organ Transplant Center, Okayama University Hospital Seiichiro Sugimoto Organ Transplant Center, Okayama University Hospital Yasuaki Tomioka Organ Transplant Center, Okayama University Hospital Haruchika Yamamoto Department of General Thoracic Surgery, Okayama University Hospital Shin Tanaka Organ Transplant Center, Okayama University Hospital Kentaroh Miyoshi Department of General Thoracic Surgery, Okayama University Hospital Ken Suzawa Department of General Thoracic Surgery, Okayama University Hospital Kazuhiko Shien Department of General Thoracic Surgery, Okayama University Hospital Hiromasa Yamamoto Department of General Thoracic Surgery, Okayama University Hospital Mikio Okazaki Department of General Thoracic Surgery, Okayama University Hospital Shinichi Toyooka Department of General Thoracic Surgery, Okayama University Hospital Background: MicroRNAs (miRNAs) involved in the pathogenesis of pulmonary fibrosis have been shown to be associated with the development of chronic lung allograft dysfunction (CLAD) after lung transplantation (LT). We investigated the role of circulating miRNAs in the diagnosis of CLAD after bilateral LT, including cadaveric LT (CLT) and living-donor lobar LT (LDLLT). Methods: The subjects of this retrospective study were 37 recipients of bilateral CLT (n = 23) and LDLLT (n = 14), and they were divided into a non-CLAD group (n = 24) and a CLAD group (n = 13). The plasma miRNA levels of the two groups were compared, and correlations between their miRNAs levels and percent baseline forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and total lung capacity (TLC) values were calculated from one year before to one year after the diagnosis of CLAD. Results: The plasma levels of both miR-21 and miR-155 at the time of the diagnosis of CLAD were significantly higher in the CLAD group than in the non-CLAD group (miR-21, P = 0.0013; miR155, P = 0.042). The miR-21 levels were significantly correlated with the percent baseline FEV1, FVC, and TLC value of one year before and at the time of diagnosis of CLAD (P < 0.05). A receiver operating characteristic curve analysis of the performance of miR-21 levels in the diagnosis of CLAD yielded an area under the curve of 0.89. Conclusion: Circulating miR-21 appears to be of potential value in diagnosing CLAD after bilateral LT. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 1438-4957 25 4 2023 Sequential flotation of 4 components in silicon-based waste solar cells 2407 2416 EN Mami Mizukawa Department of Material and Energy Science, Graduate School of Environmental and Life Science, Okayama University Noriko Nishimura Department of Material and Energy Science, Graduate School of Environmental and Life Science, Okayama University Md. Azhar Uddin Department of Material and Energy Science, Graduate School of Environmental and Life Science, Okayama University Yoshiei Kato Department of Material and Energy Science, Graduate School of Environmental and Life Science, Okayama University Yu-ichi Uchida Department of Applied Chemistry, Faculty of Fundamental Engineering, Nippon Institute of Technology Si, Al, Cu, and Ag particles’ mixture which mainly composes pulverized silicon-based waste solar cells were individually separated by the batch flotation experiments with high recovery and content, and then a general flow chart of the sequential flotation procedure of n-component was postulated including 2-, 3-, and 4-components. The n-component mixture was separated to 1: n-1 or i: j (i + j = n) by a flotation procedure and n-1 times operation was necessary to divide into the individual component. The first flotation process to separate Al into the froth layer was carried out with a collector of SDS solution after dipping Si, Al, Cu, and Ag mixture into the SDS solution. Si was separated in the froth by the second flotation with a collector of a commercial neutral detergent after Al etching by HCl, and Si, Cu and Ag mixture dipped in the detergent. The Cu and Ag mixture was calcinated at 673 or 773 K and dipped into the detergent, and the third flotation with the collector of the detergent led to Cu in the froth and Ag in the sediment. The 4-component mixture was successfully separated into each component by the 3-consecutive flotation processes. No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 2023 Research on Sophistication and Improving Efficiency of Practical Security Operations EN Shota FUJII Graduate School of Natural Science and Technology, Okayama university No potential conflict of interest relevant to this article was reported.

Oxford University Press Acta Medica Okayama 2514-2119 7 5 2023 A successful bridge to recovery with Impella 5.0 and subsequent hybrid cardiac resynchronization therapy in systemic right ventricle failure: a case report ytad214 EN Keiichiro Iwasaki Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Nobuhiro Nishii Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Satoshi Akagi Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Hiroshi Ito Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Background　Impella 5.0 is currently used as a temporary mechanical circulatory support device in cardiogenic shock (CS). However, Impella 5.0 implantation for the systemic right ventricle (sRV) has not been well documented. Case summary　A 50-year-old man with atrial switch for dextro-transposition of the great arteries was transferred to our hospital for the treatment of embolic acute myocardial infarction of the left main trunk lesion with CS. To stabilize haemodynamics, we implanted Impella 5.0 via the left subclavian artery in the sRV. After optimal medical therapy initiation and gradual weaning of Impella 5.0, Impella 5.0 was successfully explanted. An electrocardiogram was obtained, which showed complete right branch block with a QRS duration of 172 ms. Acute invasive haemodynamic evaluation of cardiac resynchronization therapy (CRT) pacing showed that dP/dt increased from 497 to 605 mmHg/s (21.7% improvement), and hybrid cardiac resynchronization therapy defibrillator (CRTD) with a sRV epicardial lead was subsequently implanted. The patient was discharged without inotropic support. Discussion　Coronary artery embolism is a rare but serious complication of dextro-transposition of the great arteries after atrial switch operations. Impella 5.0 implantation is a feasible bridge strategy for refractory CS due to sRV failure. Although CRT implantation in patients with sRV is controversial, an acute invasive haemodynamic evaluation can help assess its potential benefits. No potential conflict of interest relevant to this article was reported.

EDP Sciences Acta Medica Okayama 0399-0559 56 4 2022 Collaborative bargaining solution in tandem supply chain through cooperative game theoretical approach 2581 2593 EN Ikuo Arizono Okayama University, Yasuhiko Takemoto Kindai University There are many studies about negotiation procedures for contract problems in supply chains. Several recent papers have considered a new negotiation procedure for a repurchase contract problem in a supply chain consisting of a manufacturer and a retailer. There, usually, are some wholesalers between a manufacturer and a retailer. Therefore, a supply chain including some wholesalers in addition to a manufacturer and a retailer should be considered. In this study, we call the supply chain in which three or more members are arranged in series the tandem supply chain. We, firstly, address a negotiation problem for a contract about wholesale and repurchase prices in the tandem supply chain in which three members, that is, a manufacturer, a wholesaler and a retailer are arranged in series. The whole contract in the tandem supply chain is composed of two contracts dependent mutually, i.e., the contract between the manufacturer and wholesaler and the contract between the wholesaler and retailer. The collaborative bargaining solution in the tandem supply chain consisting of three members is discussed. This paper, finally, formulates the tandem supply chain including several wholesalers. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 0021-5155 67 4 2023 A factor for predicting simultaneous internal limiting membrane peeling during epiretinal membrane removal: swept-source optical coherence tomography-based evaluation of epiretinal membrane adhesion to the retina 410 416 EN Ryo Matoba Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yuki Kanzaki Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Shuhei Kimura Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Mio M. Hosokawa Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yusuke Shiode Tetsuro Morita Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yuki Morizane Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Purpose　To investigate preoperative factors associated with simultaneous internal limiting membrane (ILM) peeling during epiretinal membrane (ERM) removal. Study design　Observational cross-sectional study. Methods　We retrospectively reviewed 60 eyes with idiopathic ERM that underwent vitrectomy. The gap between the ERM and ILM was visualized using en face optical coherence tomography. The depth and width of the ERM–ILM gap at the initiation site of ERM removal were measured, and the relationship between preoperative factors including these parameters and simultaneous ILM peeling during ERM removal was investigated. Results　The ILM was simultaneously peeled during ERM removal in 30 eyes, but not in the other 30 eyes. Age was significantly higher (P = 0.017) and the width of the ERM–ILM gap was significantly smaller (P < 0.001) in the simultaneous ILM peeling (+) group than in the simultaneous ILM peeling (–) group. Multivariate logistic regression analysis confirmed the width of the ERM–ILM gap as a significant negative predictor for simultaneous ILM peeling (odds ratio, 0.992; 95% confidence interval, 0.986–0.997; P = 0.003). Receiver operating characteristic curve analysis of the width of the ERM–ILM gap revealed that the optimal cutoff for predicting simultaneous ILM peeling was 187.1 µm. Conclusion　The small width of the ERM–ILM gap at the initiation site of ERM removal was significantly associated with simultaneous ILM peeling, indicating that the adhesion strength between the ERM and ILM at the initial ERM grasping site determines whether simultaneous ILM peeling will occur during ERM removal. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 0925-8558 32 1 2023 Against verb-stranding VP-ellipsis in Japanese: reply to Funakoshi (2016) 1 28 EN Hidekazu Tanaka Faculty of Letters, Okayama University Japanese has a deletion operation, called argument ellipsis, that targets arguments (Oku in A theory of selection and reconstruction in the minimalist program, 1998). The operation does not apply to adjuncts, and thus, adjuncts are unelidable. Funakoshi (J East Asian Linguist 25(2):113–42, 2016), following in the footsteps of Otani and Whitman (Linguist Inquiry 22:345–58, 1991), argues that adjuncts can be elided when V-stranding VP-deletion applies. This article refutes Funakoshi’s proposal. Under rigorous control, adjuncts are generally unelidable even when the context strongly favors the adjunct inclusive interpretation, showing that the language lacks VP-deletion. It is also shown that, for a small number of speakers who permit the adjunct inclusive interpretation, the interpretation is sensitive to island constraints. The observation is attributed to covert right dislocation (Tanaka in J Linguist 37:551–79, 2001), marginally available for such speakers. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 134 3 2022 ステロイド使用中の高齢者に生じたCOVID-19院内再燃症例 171 175 EN Koji Fujita Department of General Internal Medicine and Infectious Diseases, Tsuyama Chuo Hospital Kazuki Ocho Department of Internal Medicine, Ishikawa Hospital 　During a pandemic like the novel coronavirus infection 2019 (COVID-19), the availability of inpatient beds is always a major issue. Thus, it is extremely important to release patients from isolation efficiently in order to maintain stable bed operations. However, in clinical practice, patients may develop fever again, before or after the timing specified by the Ministry of Health, Labor and Welfare (MHLW) for lifting isolation, and hence it may be difficult to determine whether the fever is due to a delay in recovery or due to relapse. The diagnosis of relapse is based primarily on the recurrence of symptoms consistent with COVID-19 and a positive PCR result, but few reports have focused on comparing the patterns of variation in two or more blood test findings over the course of the disease. In the present study, we study a case of relapse in an elderly patient on immunosuppressive drugs. 　Understanding the unique patterns of variability between baseline blood test values and acute infection test values in each individual patient may serve as an adjunctive tool to help diagnose COVID-19 relapse. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 2 2023 Locally Advanced Rectal Cancer Invading the Gluteus Maximus Muscle Completely Responded to Total Neoadjuvant Therapy 209 213 EN Masaki Sakamoto Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Fuminori Teraishi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shunsuke Kagawa Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/65152 A 70-year-old male with anal pain and fever was diagnosed with rectal cancer perforation and abscess in the right gluteus maximus (GM) muscle. He underwent a transverse colon colostomy followed by preoperative capecitabine+oxaliplatin. Some local control was achieved but a residual abscess was observed in the right GM muscle. To secure circumferential resection margin by tumor reduction, he received chemoradiotherapy as total neoadjuvant therapy (TNT) and underwent laparoscopic abdominoperineal resection, D3 lymph node dissection, combined coccyx resection, and partial resection of the right GM muscle. The skin defect and pelvic dead space were filled with a right lateral vastus lateral great muscle flap. Histopathologically, the resected specimen showed no tumor cells in the primary tumor or lymph nodes, indicating a pathological complete response (pCR). This case suggests that TNT might improve the R0 resection and pCR rates and overall survival. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 2 2023 Complications of Percutaneous Cryoablation for Renal Tumors and Methods for Avoiding Them 121 129 EN Toshihiro Iguchi Department of Radiology, Okayama University Hospital Yusuke Matsui Department of Radiology, Okayama University Hospital Koji Tomita Department of Radiology, Okayama University Hospital Mayu Uka Department of Radiology, Okayama University Hospital Noriyuki Umakoshi Department of Radiology, Okayama University Hospital Takahiro Kawabata Department of Radiology, Okayama University Hospital Kazuaki Munetomo Department of Radiology, Okayama University Hospital Shoma Nagata Department of Radiology, Okayama University Hospital Motoo Araki Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Takao Hiraki Department of Radiology, Okayama University Hospital Review 10.18926/AMO/65141 Percutaneous cryoablation of renal tumors is widely used because of its high efficacy and safety. This high safety can be attributed, at least in part, to the visibility of the ablated area as an “ice ball”. This therapy has fewer complications (incidence, 0-7.2%) and is less invasive than surgery. Minor bleeding is inevitable in most kidney-related procedures, and indeed the most common complication of this therapy is bleeding (hematoma and hematuria). However, patients require treatment such as transfusion or transarterial embolization in only 0-4% of bleeding cases. Various other complications such as ureteral or collecting system injury, bowel injury, nerve injury, skin injury, infection, pneumothorax, and tract seeding also occur, but they are usually minor and asymptomatic. However, operators should know and avoid the various complications associated with this therapy. This study aimed to summarize the complications of percutaneous cryoablation for renal tumors and provide some techniques for achieving safe procedures. No potential conflict of interest relevant to this article was reported.

岡山大学教師教育開発センター Acta Medica Okayama 2186-1323 13 2023 多文化共生を視点とした外国にルーツをもつ子どもへの支援の試み ―言葉と文化の学習を中心とした取り組みを事例として― 275 284 EN Xinyi Xie Graduate School of Humanities and Social Sciences Toshinori Kuwabara Faculty of Education, Okayama University 10.18926/CTED/65078 　本稿では，多文化共生社会の構築を目指して，筆者（謝）が取り組んでいる外国にルーツを持つ子どもに対する多文化交流活動の実践を検討し，その意義を解明しようとするものである。具体的には，筆者（謝）が岡山県内で主催している地域教育支援活動団体「週末エウレカ」の実践の取り組みを取り上げ検討する。本実践は，日本語の学習だけではなく，様々な国の文化を学ぶことによって，多文化共生社会の一員としての資質を育成しようとする点に特質がある。活動の中では，日本で学ぶ外国人留学生によって，外国にルーツを持つ子どもに対する教育活動が行われた。本研究では，そのような支援の特徴と課題を明らかにしたい。そして，今後，このような外国人留学生による活動支援団体を，地域においてコミュニティの協力のもとで運営するための示唆を得たい。 No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 2023 A Study of Sustainable Management in Arts and Cultural Activities EN Yosuke Nishita Graduate School of Humanities and Social Sciences, Okayama University Regional development is an urgent issue in Japan, which is facing various challenges including a declining population, an aging society, and the concentration of the population in Tokyo. Artistic and cultural activities are expected to play a role in community revitalization as cultural capital unique to the community. However, art museums and festivals face the problem of being unable to cover their operating expenses with revenue from their enterprise, and support from non-beneficiaries is necessary for sustainable operations, which is a prerequisite for community revitalization. This paper discusses the management issues of arts and cultural activities, particularly museums and art festivals, from a community revitalization perspective. As the number of stakeholders in arts and cultural activities expands, management must take on the role of organically linking the cultural capital of museums and art festivals with education, welfare, tourism, and industry. No potential conflict of interest relevant to this article was reported.

岡山医学会 Acta Medica Okayama 0030-1558 134 1 2022 薬剤師業務とAI 開発 32 34 EN Hirotaka Kanzaki Division of Medical Innovation & Sciences, Department of Pharmacy, Okayama University Hospital Takuto Sako H & H Connect Co., Ltd Takao Kimura Kimura Information Technology Co., Ltd No potential conflict of interest relevant to this article was reported.

Springer Acta Medica Okayama 2363-9024 9 1 2023 Anesthetic management of a patient with Osler-Weber-Rendu syndrome with multiple pulmonary arteriovenous malformations and pheochromocytoma for femoral artificial bone replacement: a case report 6 EN Toshiharu Hiyoshi Department of Anesthesiology and Resuscitology, Okayama University Hospital Kazuyoshi Shimizu Department of Anesthesiology and Resuscitology, Okayama University Hospital Satoshi Kimura Department of Anesthesiology and Resuscitology, Okayama University Hospital Toshiki Naritani Department of Anesthesiology and Resuscitology, Okayama University Hospital Hiroshi Morimatsu Department of Anesthesiology and Resuscitology, Okayama University Hospital Background Osler-Weber-Rendu syndrome is characterized by mucocutaneous telangiectasia and arteriovenous malformations in organs. Anesthesia for patients with Osler-Weber-Rendu syndrome is challenging due to complications and physiological changes. Case presentation The case was a 49-year-old female with Osler-Weber-Rendu syndrome, multiple pulmonary arteriovenous malformations and pheochromocytoma who presented for femoral bone head fracture with metastatic adenocarcinoma. The patient was scheduled to undergo bone tumor resection and artificial bone replacement, being positioned laterally with a planned operation duration of 5 h. Anesthesia was managed with spinal and epidural anesthesia, combined with sedation by sevoflurane using a supraglottic airway (SGA) device under spontaneous breathing. Her intraoperative and postoperative courses were uneventful. Conclusion Neuraxial anesthesia combined with general anesthesia using an SGA device to maintain spontaneous ventilation in order to minimize the risk of rupture of pulmonary arteriovenous malformations could be an option. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 1 2023 Treatment of Severe Open Bite Malocclusion with Four-Piece Segmental Horseshoe Le Fort I Osteotomy 97 104 EN Mitsuhiro Hoshijima Department of Orthodontics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Naoki Oka Department of Orthodontics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tatsushi Matsumura Department of Oral and Maxillofacial Surgery, Wakayama Medical University Seiji Iida Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroshi Kamioka Department of Orthodontics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/64369 Appropriate operations in severe anterior open bite (AOB) cases are extremely complicated to perform because of the multiple surgical procedures involved, the difficulty of predicting posttreatment aesthetics, and the high relapse rate. We herein report a 16-year-old girl with skeletal Class II, severe AOB malocclusion, and crowding with short roots, and aesthetic and functional problems. Four-piece segmental Le Fort I osteotomy with horseshoe osteotomy was performed for maxillary intrusion, and bilateral sagittal split ramus osteotomy (SSRO) and genioplasty were performed for mandibular advancement. The malocclusion and skeletal deformity were significantly improved by the surgical orthodontic treatment. Functional and aesthetic occlusion with an improved facial profile was established, and no further root shortening was observed. Acceptable occlusion and dentition were maintained after a two-year retention period. This strategy of surgical orthodontic treatment with a complicated operative procedure might be effective for correcting certain severe AOB malocclusion cases. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 77 1 2023 Image Quality Assessment of Deep Learning Image Reconstruction in Torso Computed Tomography Using Tube Current Modulation 45 55 EN Kazuhiro Takeuchi Department of Radiology, Kagawa University Hospital Yasuhiro Ide Department of Radiology, Kagawa University Hospital Yuichiro Mori Department of Radiology, Kagawa University Hospital Yusuke Uehara Department of Radiology, Kagawa University Hospital Hiroshi Sukeishi Department of Radiology, Kagawa University Hospital Sachiko Goto Department of Radiological Technology, Graduate School of Health Sciences, Okayama University Original Article 10.18926/AMO/64361 Novel deep learning image reconstruction (DLIR) reportedly changes the image quality characteristics based on object contrast and image noise. In clinical practice, computed tomography image noise is usually controlled by tube current modulation (TCM) to accommodate changes in object size. This study aimed to evaluate the image quality characteristics of DLIR for different object sizes when the in-plane noise was controlled by TCM. Images acquisition was performed on a GE Revolution CT system to investigate the impact of the DLIR algorithm compared to the standard reconstructions of filtered-back projection (FBP) and hybrid iterative reconstruction (hybrid-IR). The image quality assessment was performed using phantom images, and an observer study was conducted using clinical cases. The image quality assessment confirmed the excellent noise- reduction performance of DLIR, despite variations due to phantom size. Similarly, in the observer study, DLIR received high evaluations regardless of the body parts imaged. We evaluated a novel DLIR algorithm by replicating clinical behaviors. Consequently, DLIR exhibited higher image quality than those of FBP and hybrid-IR in both phantom and observer studies, albeit the value depended on the reconstruction strength, and proved itself capable of providing stable image quality in clinical use. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 0341-2695 2023 Medial joint space narrowing progresses after pullout repair of medial meniscus posterior root tear EN Koki Kawada Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science Takayuki Furumatsu Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science Masanori Tamura Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science Haowei Xue Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science Naohiro Higashihara Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science Keisuke Kintaka Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science Yusuke Yokoyama Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science Purpose The extent to which arthropathic changes progress after medial meniscus posterior root tear (MMPRT) repair remains controversial. This retrospective study assessed medial joint space (MJS) narrowing progression after pullout of repair for MMPRT and identified the correlating factors. Methods We included 56 patients who underwent pullout of repair for MMPRT. The MJS of the bilateral knees was assessed with radiography using the fixed-flexion view. A second-look arthroscopy was performed one year post-operatively for all patients. The baseline characteristics, clinical scores, Kellgren-Lawrence (KL) grade, and medial meniscus extrusion (MME) were identified. Statistical comparisons and correlation analyses were conducted. Results The MJS narrowing width was significantly larger in MMPRT knees than in contralateral knees (0.51 +/- 0.85 mm vs. 0.09 +/- 0.49 mm, p < 0.001). KL grade progression was observed in 23.2% (13/56) of patients. There was a significant difference between pre- and post-operative MME values, indicating MME progression (p < 0.001). Each clinical score showed significant improvement one year post-operatively (p < 0.001). Positive correlations were found between MJS narrowing and pre-operative MJS (coefficient = 0.510, p < 0.001), rate of change in MJS (coefficient = 0.929, p < 0.001), and increase in MME (Delta MME) (coefficient = 0.506, p < 0.001). Conclusion Knees that underwent pullout of repair for MMPRT showed progression of MJS narrowing by 0.51 mm at one year post-operatively, although clinical scores markedly improved. Correlating factors for MJS narrowing were pre-operative MJS, rate of change in MJS, and Delta MME. Preventing MME progression is essential for preventing arthropathic changes. No potential conflict of interest relevant to this article was reported.

Institute of Electrical and Electronics Engineers (IEEE) Acta Medica Okayama 2169-3536 11 2022 Novel Rotor Structure Employing Large Flux Barrier and Disproportional Airgap for Enhancing Efficiency of IPMSM Adopting Concentrated Winding Structure 2848 2862 EN Xianji Tao Graduate School of Information and Technology, Hokkaido University Masatsugu Takemoto Graduate School of Natural Science and Technology, Okayama University Ren Tsunata Graduate School of Natural Science and Technology, Okayama University Satoshi Ogasawara Graduate School of Information and Technology, Hokkaido University Interior permanent magnetic synchronous motors (IPMSMs) adopting concentrated windings have been widely used in industrial applications. To reduce operating costs, it is an important issue to enhance the efficiency of an IPMSM as much as possible while maintaining manufacturing costs. In general, an IPMSM used for an industrial application always operates in a specific operating area according to the required load. Therefore, this paper has two purposes. The first purpose is to propose a novel rotor structure which can enhance efficiency at the target wide-speed middle-torque operating area without additional manufacturing costs. The second purpose is to clarify the design method for a suitable rotor structure depending on its target operating area. Reducing losses is the key to enhancing efficiency. This paper first examines the effects of adopting large flux barriers and a disproportional airgap on copper and iron losses, and clarifies their merits and respective high-efficiency operating areas. Furthermore, to take advantage of the two rotor structures, a novel rotor structure which employs both large flux barriers and a disproportional airgap has been proposed. 2D-FEM (Finite-Element Method) is used for discussion first, and a prototype machine is manufactured to verify the 2D-FEM results. Both 2D-FEM and experimental results show that the proposed rotor structure can enhance the efficiency of an IPMSM most effectively at the target operating area. Moreover, for a low-speed high-torque operating area, adopting only large flux barriers is most suitable. And for a high-speed low-torque operating area, adopting only a disproportional airgap is most suitable. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 2077-0383 12 2 2023 Surgical Techniques of Gastrojejunostomy in Robotic Pancreatoduodenectomy: Robot-Sewn versus Stapled Gastrojejunostomy Anastomosis 732 EN Kosei Takagi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Yuzo Umeda Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Ryuichi Yoshida Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Tomokazu Fuji Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Kazuya Yasui Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Jiro Kimura Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Nanako Hata Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Takahito Yagi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Toshiyoshi Fujiwara Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Background: Delayed gastric emptying (DGE) is a major complication of pancreatoduodenectomy (PD). Several efforts have been made to decrease the incidence of DGE. However, the optimal anastomotic method for gastro/duodenojejunostomy (GJ) remains debatable. Moreover, few studies have reported the impact of GJ surgical techniques on outcomes following robotic pancreatoduodenectomy (RPD). This study aimed to investigate the surgical outcomes of robot-sewn and stapled GJ anastomoses in RPD. Methods: Forty patients who underwent RPD at the Okayama University Hospital between September 2020 and October 2022 were included. The outcomes between robot-sewn and stapled anastomoses were compared. Results: The mean [standard deviation (SD)] operative and GJ time were 428 (63.5) and 34.0 (15.0) minutes, respectively. Postoperative outcomes included an overall incidence of DGE of 15.0%, and the mean postoperative hospital stays were 11.6 (5.3) days in length. The stapled group (n = 21) had significantly shorter GJ time than the robot-sewn group (n = 19) (22.7 min versus 46.5 min, p < 0.001). Moreover, stapled GJ cases were significantly associated with a lower incidence of DGE (0% versus 21%, p = 0.01). Although not significant, the stapled group tended to have shorter postoperative hospital stays (9.9 days versus 13.5 days, p = 0.08). Conclusions: Our findings suggest that stapled GJ anastomosis might decrease anastomotic GJ time and incidence of DGE after RPD. Surgeons should select a suitable method for GJ anastomosis based on their experiences with RPD. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 0341-2695 47 10 2022 Concomitant posterior anchoring further reduces posterior meniscal extrusion during pullout repair of medial meniscus posterior root tears: a retrospective study 2391 2400 EN Haowei Xue Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama University Takayuki Furumatsu Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama University Takaaki Hiranaka Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama University Keisuke Kintaka Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama University Naohiro Higashihara Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama University Masanori Tamura Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama University Ximing Zhang Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama University Toshifumi Ozaki Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama University Purpose Transtibial pullout repair improves the clinical outcomes of medial meniscus (MM) posterior root tears (PRTs); however, reducing MM extrusion remains challenging. Thus, the purpose of this study was to examine the role of additional posterior anchoring (PA) during pullout repair in reducing the severity of MM extrusion compared to pullout repair alone. Methods Patients who underwent pullout repair with two-cinch stitches (TCS) only or TCS combined with PA (TCSPA)-deployment of an additional suture anchor in the posteromedial corner of MM-were included retrospectively. MM medial and posterior extrusion (MMME and MMPE), MM extrusion and remaining volume (MMEV and MMRV), and corresponding ratios were evaluated pre-operatively and three months post-operatively using a three-dimensional meniscal model at 10 degrees and 90 degrees of knee flexion and compared within and between groups. Results A total of 15 and 16 patients treated with TCS and TCS-PA, respectively, were enrolled. At 90 degrees knee flexion, both techniques significantly reduced MMPE (TCS: 4.2 +/- 0.7 mm to 3.5 +/- 0.6 mm, p < 0.05; TCS-PA: 3.7 +/- 0.8 mm to 2.8 +/- 0.7 mm, p < 0.05) at three months post-operatively. TCS-PA reduced MMPE more significantly than TCS alone (p < 0.05). Only TCS-PA significantly improved the MMEV and MMRV ratios (39.6 +/- 8.9% to 28.1 +/- 6.0%, p < 0.05 and 60.4 +/- 8.9% to 71.9 +/- 6.0%, p < 0.05, respectively). Significance was not found in all other comparisons. Conclusions Both techniques improved MMPE at knee flexion at the three month follow-up, with TCS-PA providing significantly superior results. Our findings support the evidence that the application of PA may be an effective surgical option for alleviating persistent MMPE. No potential conflict of interest relevant to this article was reported.

Springer Science and Business Media LLC Acta Medica Okayama 0942-2056 31 6 2022 The clinical and radiographic outcomes of type 2 medial meniscus posterior root tears following transtibial pullout repair 2323 2330 EN Takaaki Hiranaka Department of Orthopaedic Surgery, Okayama University Hospital Takayuki Furumatsu Department of Orthopaedic Surgery, Okayama University Hospital Yusuke Yokoyama Department of Orthopaedic Surgery, Okayama University Hospital Keisuke Kintaka Department of Orthopaedic Surgery, Okayama University Hospital Naohiro Higashihara Department of Orthopaedic Surgery, Okayama University Hospital Masanori Tamura Department of Orthopaedic Surgery, Okayama University Hospital Koki Kawada Department of Orthopaedic Surgery, Okayama University Hospital Haowei Xue Department of Orthopaedic Surgery, Okayama University Hospital Masanori Hamada Department of Orthopaedic Surgery, Okayama University Hospital Toshifumi Ozaki Department of Orthopaedic Surgery, Okayama University Hospital Purpose The aim of this study was to compare the clinical outcomes of different subtypes of type 2 medial meniscus posterior root tears following transtibial pullout repair. Methods In total, 147 patients (mean age: 66.2 +/- 8.3 years) who were diagnosed with type 2 medial meniscus posterior root tears and underwent transtibial pullout repair were included. Patients were divided into 2A (n = 31), 2B (n = 90), and 2C (n = 26) groups according to tear type. Clinical outcomes were assessed pre-operatively and at second-look arthroscopy using the Knee injury and Osteoarthritis Outcome Score. The meniscal healing status was evaluated at second-look arthroscopy. Medial meniscus extrusion was calculated using magnetic resonance imaging pre-operatively and at second-look arthroscopy. Results No significant differences in pre-operative or post-operative clinical scores were observed between each subtype, although clinical scores improved post-operatively for each subtype. Significant differences were noted in the anteroposterior width of the bridging tissues at second-look arthroscopy (2A, 7.1 +/- 1.2; 2B, 6.2 +/- 1.7; and 2C, 6.2 +/- 1.7 mm; p = 0.045); type 2A tears were the widest. There was a significant difference in post-operative medial meniscus extrusion (2A, 3.2 +/- 0.9; 2B, 4.0 +/- 1.2; and 2C, 4.0 +/- 1.4 mm; p = 0.004) and its progression (2A, 0.7 +/- 0.6; 2B, 1.2 +/- 0.8; and 2C, 1.2 +/- 0.8 mm; p= 0.008), and type 2A tears were the shortest. Conclusion Although there was no significant difference in the post-operative clinical scores among different type 2 tears in the short term, type 2A tears showed better healing and medial meniscus extrusion progression prevention, thus indicating the usefulness of classifying tear type in estimating post-operative outcomes. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 1999-4893 15 12 2022 A Proposal of Printed Table Digitization Algorithm with Image Processing 471 EN Chenrui Shi Department of Information and Communication Systems, Graduate School of Natural Science and Technology, Okayama University Nobuo Funabiki Department of Information and Communication Systems, Graduate School of Natural Science and Technology, Okayama University Yuanzhi Huo Department of Information and Communication Systems, Graduate School of Natural Science and Technology, Okayama University Mustika Mentari Department of Information Technology, State Polytechnic of Malang Kohei Suga Astrolab Takashi Toshida Astrolab Nowadays, digital transformation (DX) is the key concept to change and improve the operations in governments, companies, and schools. Therefore, any data should be digitized for processing by computers. Unfortunately, a lot of data and information are printed and handled on paper, although they may originally come from digital sources. Data on paper can be digitized using an optical character recognition (OCR) software. However, if the paper contains a table, it becomes difficult because of the separated characters by rows and columns there. It is necessary to solve the research question of "how to convert a printed table on paper into an Excel table while keeping the relationships between the cells?" In this paper, we propose a printed table digitization algorithm using image processing techniques and OCR software for it. First, the target paper is scanned into an image file. Second, each table is divided into a collection of cells where the topology information is obtained. Third, the characters in each cell are digitized by OCR software. Finally, the digitalized data are arranged in an Excel file using the topology information. We implement the algorithm on Python using OpenCV for the image processing library and Tesseract for the OCR software. For evaluations, we applied the proposal to 19 scanned and 17 screenshotted table images. The results show that for any image, the Excel file is generated with the correct structure, and some characters are misrecognized by OCR software. The improvement will be in future works. No potential conflict of interest relevant to this article was reported.

Nature Portfolio Acta Medica Okayama 2045-2322 12 1 2022 Defect-free and crystallinity-preserving ductile deformation in semiconducting Ag2S 19458 EN Masaaki Misawa Faculty of Natural Science and Technology, Okayama University Hinata Hokyo Department of Physics, Kumamoto University Shogo Fukushima Department of Physics, Kumamoto University Kohei Shimamura Department of Physics, Kumamoto University Akihide Koura Department of Physics, Kumamoto University Fuyuki Shimojo Department of Physics, Kumamoto University Rajiv K. Kalia Collaboratory for Advanced Computing and Simulations, Department of Physics and Astronomy, Department of Computer Science, Department of Chemical Engineering and Materials Science, and Department of Biological Science, University of Southern California Aiichiro Nakano Collaboratory for Advanced Computing and Simulations, Department of Physics and Astronomy, Department of Computer Science, Department of Chemical Engineering and Materials Science, and Department of Biological Science, University of Southern California Priya Vashishta Collaboratory for Advanced Computing and Simulations, Department of Physics and Astronomy, Department of Computer Science, Department of Chemical Engineering and Materials Science, and Department of Biological Science, University of Southern California Typical ductile materials are metals, which deform by the motion of defects like dislocations in association with non-directional metallic bonds. Unfortunately, this textbook mechanism does not operate in most inorganic semiconductors at ambient temperature, thus severely limiting the development of much-needed flexible electronic devices. We found a shear-deformation mechanism in a recently discovered ductile semiconductor, monoclinic-silver sulfide (Ag2S), which is defect-free, omni-directional, and preserving perfect crystallinity. Our first-principles molecular dynamics simulations elucidate the ductile deformation mechanism in monoclinic-Ag2S under six types of shear systems. Planer mass movement of sulfur atoms plays an important role for the remarkable structural recovery of sulfur-sublattice. This in turn arises from a distinctively high symmetry of the anion-sublattice in Ag2S, which is not seen in other brittle silver chalcogenides. Such mechanistic and lattice-symmetric understanding provides a guideline for designing even higher-performance ductile inorganic semiconductors. No potential conflict of interest relevant to this article was reported.

Public Library Science Acta Medica Okayama 1932-6203 17 7 2022 Is attention branch network effective in classifying dental implants from panoramic radiograph images by deep learning? e0269016 EN Shintaro Sukegawa Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Kazumasa Yoshii Department of Intelligence Science and Engineering, Graduate School of Natural Science and Technology, Gifu University Takeshi Hara Department of Electrical, Electronic and Computer Engineering, Faculty of Engineering, Gifu University Futa Tanaka Department of Electrical, Electronic and Computer Engineering, Faculty of Engineering, Gifu University Katsusuke Yamashita Polytechnic Center Kagawa Tutaro Kagaya Department of Intelligence Science and Engineering, Graduate School of Natural Science and Technology, Gifu University Keisuke Nakano Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Kiyofumi Takabatake Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Hotaka Kawai Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Hitoshi Nagatsuka Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yoshihiko Furuki Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital Attention mechanism, which is a means of determining which part of the forced data is emphasized, has attracted attention in various fields of deep learning in recent years. The purpose of this study was to evaluate the performance of the attention branch network (ABN) for implant classification using convolutional neural networks (CNNs). The data consisted of 10191 dental implant images from 13 implant brands that cropped the site, including dental implants as pretreatment, from digital panoramic radiographs of patients who underwent surgery at Kagawa Prefectural Central Hospital between 2005 and 2021. ResNet 18, 50, and 152 were evaluated as CNN models that were compared with and without the ABN. We used accuracy, precision, recall, specificity, F1 score, and area under the receiver operating characteristics curve as performance metrics. We also performed statistical and effect size evaluations of the 30-time performance metrics of the simple CNNs and the ABN model. ResNet18 with ABN significantly improved the dental implant classification performance for all the performance metrics. Effect sizes were equivalent to "Huge" for all performance metrics. In contrast, the classification performance of ResNet50 and 152 deteriorated by adding the attention mechanism. ResNet18 showed considerably high compatibility with the ABN model in dental implant classification (AUC = 0.9993) despite the small number of parameters. The limitation of this study is that only ResNet was verified as a CNN; further studies are required for other CNN models. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 6 2022 Salvage Surgery for Symptomatic Recurrence of Retro-Odontoid Pseudotumor after a C1 Laminectomy 749 754 EN Masanari Takami Department of Orthopaedic Surgery, Wakayama Medical University Yasutsugu Yukawa Department of Orthopaedic Surgery, Wakayama Medical University Yusuke Noda Department of Orthopaedic Surgery, Wakayama Rosai Hospital Munehito Yoshida Department of Orthopaedic Surgery, Wakayama Medical University Hiroshi Yamada Department of Orthopaedic Surgery, Wakayama Medical University Case Report 10.18926/AMO/64127 We provide the first report of successful salvage surgery for a post-C1 laminectomy symptomatic recurrence of a retro-odontoid pseudotumor (ROP) that caused myelopathy. The 72-year-old Japanese woman presented with an ROP causing symptomatic cervical myelopathy. With ultrasonography support, we performed the enucleation of the ROP via a transdural approach and fusion surgery for the recurrence of the mass. At the final observation 2-year post-surgery, MRI demonstrated the mass’s regression and spinal cord decompression, and the patient’s symptoms had improved. Our strategy is an effective option for a symptomatic recurrence of ROP. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 6 2022 Posterolateral Floating Technique for the Thoracic Ossification of the Posterior Longitudinal Ligament with Navigation: A Technical Note 743 748 EN Masato Tanaka Department of Orthopaedic Surgery, Okayama Rosai Hospital Hardik Suthar Department of Orthopaedic Surgery, Okayama Rosai Hospital Dhvanit Desai Department of Orthopaedic Surgery, Okayama Rosai Hospital Taro Yamauchi Department of Orthopaedic Surgery, Okayama Rosai Hospital Shinya Arataki Department of Orthopaedic Surgery, Okayama Rosai Hospital Yoshihiro Fujiwara Department of Orthopaedic Surgery, Okayama Rosai Hospital Koji Uotani Department of Orthopaedic Surgery, Okayama Rosai Hospital Yoshiaki Oda Department of Orthopaedic Surgery, Okayama Rosai Hospital Haruo Misawa Department of Orthopaedic Surgery, Okayama University Hospital Case Report 10.18926/AMO/64126 We describe a floating technique via a posterolateral approach with intraoperative O-arm navigation to facilitate decompression of the spinal cord in thoracic myelopathy due to severe ossification of the posterior longitudinal ligament (OPLL). A 62-year-old man with myelopathy due to thoracic OPLL had left-leg muscle weakness, urinary disturbance, and spastic gait. Bilateral leg pain and gait disturbance had persisted for 2 years. He was successfully treated by the posterolateral OPLL floating procedure and posterior pedicle fixation under O-arm navigation. At a 2-year follow-up, manual muscle testing results and sensory function of the left leg had recovered fully. His cervical Japanese Orthopedic Association score had improved from 5/12 to 11/12. The novel intraoperative O-arm navigation-guided posterolateral floating procedure for thoracic OPLL is effective for achieving precise decompression and strong fixation with a posterior approach only and can provide an excellent result for severe thoracic OPLL without the risk of adverse events from intraoperative radiation. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 6 2022 A Case of Paraplegia Treated with Cerebrospinal Fluid Drainage and Permissive Hypertension after Graft Replacement of the Ascending Aorta and the Total Aortic Arch for Acute Aortic Dissection Stanford Type A 737 742 EN Masakazu Yamaoka Department of Anesthesiology, Japanese Red Cross Society Himeji Hospital Yumi Yamamoto Department of Anesthesiology and Critical Care Medicine, Hiroshima Citizens Hospital Eriko Minami Department of Anesthesiology, Japanese Red Cross Society Himeji Hospital Case Report 10.18926/AMO/64125 Paraplegia after an operation for acute aortic dissection Stanford type A (AADA) is fairly uncommon, and there is no consensus about optimal treatment. We present a case in which cerebrospinal fluid drainage (CSFD) and permissive hypertension were used for treatment of paraplegia. When the patient showed complete bilateral paraplegia after operation for AADA, we immediately began CSFD and maintained mean arterial blood pressure at over 90 mmHg. His neurological deficit gradually recovered, and he was eventually able to walk without support. The combination of CSFD and permissive hypertension could be a first-line emergent treatment for postoperative paraplegia after AADA surgery. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 6 2022 A Rare Case of Idiopathic Spinal Cord Herniation Treated by DuraGen® Collagen Matrix Graft 731 736 EN Maho Kamamura Department of Radiology, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Fumiyo Higaki Department of Radiology, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Susumu Sasada Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Toshi Matsushita Division of Radiological Technology, Okayama University Hospital Takao Yasuhara Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Isao Date Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Takao Hiraki Department of Radiology, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/64124 We report a rare case of idiopathic spinal cord herniation (ISCH) with a history of cerebrospinal fluid (CSF) leakage. ISCH is a protrusion of the spinal cord through a dural defect. Thin constructive interference in steady-state (CISS) images clearly demonstrated the herniated cord in the present case. The myelopathy worsened and the patient underwent surgery for reduction of herniated spinal cord; the dural defect was filled by placing collagen matrix graft (DuraGen®) between the inner and outer dural layers. The patient’s symptoms have improved without relapse for 8 months since surgery. This method may be a good surgical option for cases of spinal cord herniation. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 6 2022 Intraoperative Hypothermia Is Not Associated with Surgical Site Infections after Total Hip or Knee Arthroplasty 651 660 EN Bright Osman Abugri Department of Anesthesiology and Resuscitology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takashi Matsusaki Department of Anesthesiology and Resuscitology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Wanxu Ren Department of Anesthesiology and Resuscitology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroshi Morimatsu Department of Anesthesiology and Resuscitology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/64115 Maintaining perioperative normothermia decreases the post-surgery surgical site infection (SSI) rate. We investigated whether SSI is associated with intraoperative hypothermia in total hip (THA) and total knee (TKA) arthroplasties by retrospectively analyzing 297 THA and TKA cases. The patients’ intraoperative core body temperature (BT) was measured by bladder catheter or forehead sensor. We evaluated the associations between SSI and intraoperative BT and other variables and patient characteristics. Fifty-six patients (18.8%) had hypothermia (BT <36°C); 43 developed SSI (14.5%); only five had hypothermia (11.6%). Intraoperative hypothermia and SSI were not significantly associated. The SSI group had more men (34.9% vs. 18.1%) and THA patients (77.4%), a longer mean surgical duration (174.3 vs. 143.5 mins), and a higher average BT (36.4°C vs. 36.2°C) than the no-SSI group. The SSI patients had a higher intraoperative BT. A multivariable analysis revealed that SSI was associated with male sex (OR 2.3, 95%CI: 1.031-4.921, p=0.042), longer surgery (OR, 1.01, 95%CI: 1.003-1.017, p=0.004), THA (OR 3.6, 95%CI: 1.258-10.085, p=0.017), and intraoperative BT >36.0°C (OR 3.6, 95%CI: 1.367-9.475, p=0.009). Intraoperative hypothermia was not associated with SSI in adults who underwent THA or TKA. These results suggest that hypothermia might not be the problem for SSI. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 6 2022 MiR-338-3p Is a Biomarker in Neonatal Acute Respiratory Distress Syndrome (ARDS) and Has Roles in the Inflammatory Response of ARDS Cell Models 635 643 EN Cuicui Zhang Pediatric Intensive Care Unit, Xingtai People’s Hospital Yanan Ji Pediatric Intensive Care Unit, Xingtai People’s Hospital Qin Wang Pediatric Intensive Care Unit, Xingtai People’s Hospital Lianying Ruan Pediatric Intensive Care Unit, Xingtai People’s Hospital Original Article 10.18926/AMO/64113 To investigate the association between serum miR-338-3p levels and neonatal acute respiratory distress syndrome (ARDS) and its mechanism. The relative miR-338-3p expression in serum was detected by quantitative real-time RT-PCR. Interleukin-1beta (IL-1β), IL-6, and tumor necrosis factor-alpha (TNF-α) levels were detected by ELISAs. A receiver operating characteristic (ROC) curve analysis of serum miR-338-3p evaluated the diagnosis of miR-338-3p in neonatal ARDS. Pearson’s correlation analysis evaluated the correlation between serum miR-338-3p and neonatal ARDS clinical factors. Flow cytometry evaluated apoptosis, and a CCK-8 assay assessed cell viability. A luciferase assay evaluated the miR-338-3p/AKT3 relationship. The miR- 338-3p expression was decreased in neonatal ARDS patients and in lipopolysaccharide (LPS)-treated cells. The ROC curve showed the accuracy of miR-338-3p for evaluating neonatal ARDS patients. The correlation analysis demonstrated that miR-338-3p was related to PRISM-III, PaO2/FiO2, oxygenation index, IL-1β, IL-6, and TNF-α in neonatal ARDS patients. MiR-338-3p overexpression inhibited the secretion of inflammatory components, stifled cell apoptosis, and LPS-induced advanced cell viability. The double-luciferase reporter gene experiment confirmed that miR-338-3p negatively regulates AKT3 mRNA expression. Serum miR-338-3p levels were related to the diagnosis and severity of neonatal ARDS, which may be attributed to its regulatory effect on inflammatory response in ARDS. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 6 2022 Artificial Intelligence-based Detection of Epileptic Discharges from Pediatric Scalp Electroencephalograms: A Pilot Study 617 624 EN Katsuhiro Kobayashi Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takashi Shibata Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroki Tsuchiya Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Tomoyuki Akiyama Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/64111 We developed an artificial intelligence (AI) technique to identify epileptic discharges (spikes) in pediatric scalp electroencephalograms (EEGs). We built a convolutional neural network (CNN) model to automatically classify steep potential images into spikes and background activity. For the CNN model’ training and validation, we examined 100 children with spikes in EEGs and another 100 without spikes. A different group of 20 children with spikes and 20 without spikes were the actual test subjects. All subjects were ≥ 3 to < 18 years old. The accuracy, sensitivity, and specificity of the analysis were >0.97 when referential and combination EEG montages were used, and < 0.97 with a bipolar montage. The correct classification of background activity in individual patients was significantly better with a referential montage than with a bipolar montage (p=0.0107). Receiver operating characteristic curves yielded an area under the curve > 0.99, indicating high performance of the classification method. EEG patterns that interfered with correct classification included vertex sharp transients, sleep spindles, alpha rhythm, and low-amplitude ill-formed spikes in a run. Our results demonstrate that AI is a promising tool for automatically interpreting pediatric EEGs. Some avenues for improving the technique were also indicated by our findings. No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 2022 Study on transistor application of new phenacene-type molecules: characterization of molecules, device fabrication and operation properties EN Yanting ZHANG Graduate School of Natural Science and Technology, Okayama university No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 5 2022 Genital Feminizing Surgery without Vaginoplasty as a Safe, Aesthetic, and Cost-Effective Option for Gender-Affirming Surgery for Transwomen 597 603 EN Shiho Watanabe Department of Plastic and Reconstructive Surgery, Okayama University Hospital Toshiyuki Watanabe Department of Plastic and Reconstructive Surgery, Okayama University Hospital Kiyoshi Yamada Department of Plastic Surgery, Kousei Hospital Yuzaburo Namba Department of Gender center, Okayama University Hospital Yoshihiro Kimata Department of Plastic and Reconstructive Surgery, Okayama University Hospital Case Report 10.18926/AMO/64042 Gender affirming surgery (GAS) has important impacts for people with gender incongruence (GI), both physically and socially. As the societal acceptance of gender diversity spreads, the number of individuals with GI who wish to be identified as the gender of their choice is increasing. Indeed, many elderly people who have lived a long time with GI now wish to undergo GAS, but face greater surgical risks due to greater burdens of underlying medical conditions. Generally, vaginoplasty is performed for transwomen; however, this surgery is time-consuming and involves heavy bleeding, and thus, should be avoided in elderly people. A less invasive technique is needed. In this article, we describe a new, less invasive genital feminizing surgical technique for transwomen with reports from two clinical cases. We present this novel technique as a safe, aesthetic, and cost-effective option for gender-affirming surgery for transwomen. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 5 2022 Effects of Model-Based Iterative Reconstruction in Low-Dose Paranasal Computed Tomography: A Comparison with Filtered Back Projection and Hybrid Iterative Reconstruction 511 517 EN Hayato Tomita Department of Radiology, St. Marianna University School of Medicine Kenji Kuramochi Department of Radiology, St. Marianna University School of Medicine Atsuko Fujikawa Department of Radiology, St. Marianna University School of Medicine Hirotaka Ikeda Department of Radiology, Fujita Health University School of Medicine Midori Komita Department of Radiology, St. Marianna University School of Medicine Yoshiko Kurihara Department of Radiology, Machida Municipal Hospital Yasuyuki Kobayashi Department of Advanced Biomedical Imaging Informatics, St. Marianna University School of Medicine Hidefumi Mimura Department of Radiology, St. Marianna University School of Medicine Original Article 10.18926/AMO/64031 Iterative reconstruction (IR) improves image quality compared with filtered back projection (FBP). This study investigated the usefulness of model-based IR (forward-projected model-based iterative reconstruction solution [FIRST]) in comparison with FBP and hybrid IR (adaptive iterative dose reduction three-dimensional processing [AIDR 3D]) in low-dose paranasal CT. Twenty-four patients with paranasal sinusitis who underwent standard-dose CT (120 kV) and low-dose CT (100 kV) scanning before and after medical treatment were enrolled. Standard-dose CT scans were reconstructed with FBP (FBP120), and low-dose CT scans with FBP (FBP100), AIDR 3D, and FIRST. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in three anatomical structures and effective doses were compared using Mann–Whitney U test. Two radiologists independently evaluated the visibility of 16 anatomical structures, overall image quality, and artifacts. Effective doses in lowdose CT were significantly reduced compared with those in standard-dose CT (0.24 vs 0.43 mSv, p<0.001). FIRST achieved significantly higher SNR (p<0.01, respectively) and CNR (p<0.001, respectively) of evaluated structures and significant improvement in overall image quality (p<0.001), artifacts (p<0.001), and visibility related to muscles (p<0.05) compared to FBP120, FBP100, and AIDR 3D. FIRST allowed radiation-dose reduction, while maintaining objective and subjective image quality in low-dose paranasal CT. No potential conflict of interest relevant to this article was reported.

IEEE-INST ELECTRICAL ELECTRONICS ENGINEERS INC Acta Medica Okayama 2169-3536 10 2022 Effectiveness of Tactile Warning and Voice Command for Enhancing Safety of Drivers 93854 93866 EN Atsuo Murata Department of Intelligent Mechanical Systems, Graduate School of Natural Science and Technology, Okayama University Toshihisa Doi Department of Living Environment Design, Graduate School of Human Life and Ecology, Osaka Metropolitan University Waldemar Karwowski Engineering and Management Systems, University of Central Florida (Life Senior Member, IEEE) Safety is impaired when drivers are required to perform main driving task (tracking of own car, distance maintenance between own car and a leading car, and response to target objects) and secondary task simultaneously, for example, responding to target cars on the road while operating in-vehicle equipment. A two-factor (presence or absence of tactile warning by input modality (no secondary task, voice command for a secondary task, and manual input for a secondary task)) within-subject design of ten licensed males was used to investigate how to compensate for safety impairments (decreased performance of a main and a secondary task such as increased tracking error during driving or increased reaction time to target cars on the road). We investigated whether the use of tactile warnings transmitted via left and right thighs for detecting road objects and voice command to operate in-vehicle equipment could compensate for safety impairments such as the increased reaction time to target cars on the road, the increase of detection error of target cars, or increased tracking error in driving. The accuracy and speed of responses to target cars encountered during driving were reduced when a driver was asked to perform the main and the secondary task simultaneously compared to situations performing only the main driving task (tracking, distance maintenance, and response to target cars). The availability of a tactile warning system for road objects compensated for these diminished performance measures, including slower response times and the increased detection error of target cars. Likewise, voice command contributed to enhanced performance of the main driving task such as decrease of tracking error. No potential conflict of interest relevant to this article was reported.

Nature Portfolio Acta Medica Okayama 2045-2322 12 1 2022 Deep learning model for analyzing the relationship between mandibular third molar and inferior alveolar nerve in panoramic radiography 16925 EN Shintaro Sukegawa Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Futa Tanaka Department of Electrical, Electronic and Computer Engineering, Faculty of Engineering, Gifu University Takeshi Hara Department of Electrical, Electronic and Computer Engineering, Faculty of Engineering, Gifu University Kazumasa Yoshii Department of Electrical, Electronic and Computer Engineering, Faculty of Engineering, Gifu University Katsusuke Yamashita Polytechnic Center Kagawa Keisuke Nakano Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Kiyofumi Takabatake Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Hotaka Kawai Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Hitoshi Nagatsuka Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yoshihiko Furuki Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital In this study, the accuracy of the positional relationship of the contact between the inferior alveolar canal and mandibular third molar was evaluated using deep learning. In contact analysis, we investigated the diagnostic performance of the presence or absence of contact between the mandibular third molar and inferior alveolar canal. We also evaluated the diagnostic performance of bone continuity diagnosed based on computed tomography as a continuity analysis. A dataset of 1279 images of mandibular third molars from digital radiographs taken at the Department of Oral and Maxillofacial Surgery at a general hospital (2014-2021) was used for the validation. The deep learning models were ResNet50 and ResNet50v2, with stochastic gradient descent and sharpness-aware minimization (SAM) as optimizers. The performance metrics were accuracy, precision, recall, specificity, F1 score, and area under the receiver operating characteristic curve (AUC). The results indicated that ResNet50v2 using SAM performed excellently in the contact and continuity analyses. The accuracy and AUC were 0.860 and 0.890 for the contact analyses and 0.766 and 0.843 for the continuity analyses. In the contact analysis, SAM and the deep learning model performed effectively. However, in the continuity analysis, none of the deep learning models demonstrated significant classification performance. No potential conflict of interest relevant to this article was reported.

Hasanuddin University and Asian Rural Sociology Association Acta Medica Okayama 2548-3269 5 1 2021 Energizing Communities Through Partnerships With E 63 77 EN Yasuko Honda Graduate School of Environmental and Life Science, Okayama University This study aims to specify the contextual conditions that allow for the success of community renewable energy projects, against the background of the expanding use of renewable energy. It analyzes cases where farmers invested in organizations to establish ownership of hydropower plants in the Chugoku region, Japan. Community renewable energy projects derived from local initiatives to provide an alternative energy resource and serve as a catalyst for rural development. However, the costs of small hydropower plant construction and the expert knowledge required for their operation could hinder the diffusion of the technology. Population decline and aging in rural communities also constrain the development of community renewable energy projects. This study presents cases that illuminate the conditions enabling these organizations to succeed in securing the necessary resources for the operation of their renewable energy plants. The survey illustrates how studied organizations have opted to collaborate with external actors to construct or refurbish their plants. The findings indicate that as building partnerships with external actors often becomes essential, it is vital to develop a business-minded framework in which both communities and external actors can financially benefit from introducing small hydropower projects. The cases also reveal that in building collaborative relationships, broad disparities exist between communities and external actors in financial power and expert knowledge, which give the latter substantial advantages in negotiations. An additional important claim derived is that, for an effective partnership that enables a successful community renewable energy project, a third party with expert knowledge and the ability to audit partnership-building processes could play a crucial role in securing community initiatives and independence. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 2076-3417 12 19 2022 Machine Learning and Inverse Optimization for Estimation of Weighting Factors in Multi-Objective Production Scheduling Problems 9472 EN Hidetoshi Togo Graduate School of Natural Science and Technology, Okayama University Kohei Asanuma Graduate School of Engineering Science, Osaka University Tatsushi Nishi Graduate School of Natural Science and Technology, Okayama University Ziang Liu Graduate School of Natural Science and Technology, Okayama University In recent years, scheduling optimization has been utilized in production systems. To construct a suitable mathematical model of a production scheduling problem, modeling techniques that can automatically select an appropriate objective function from historical data are necessary. This paper presents two methods to estimate weighting factors of the objective function in the scheduling problem from historical data, given the information of operation time and setup costs. We propose a machine learning-based method, and an inverse optimization-based method using the input/output data of the scheduling problems when the weighting factors of the objective function are unknown. These two methods are applied to a multi-objective parallel machine scheduling problem and a real-world chemical batch plant scheduling problem. The results of the estimation accuracy evaluation show that the proposed methods for estimating the weighting factors of the objective function are effective. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 4 2022 The Association between Preoperative Blood Pressure Elevations and Postoperative Adverse Outcomes after Non-cardiac Surgery: A Single-center Retrospective Observational Study 429 437 EN Yusuke Yamadori Department of Anesthesiology, Faculty of Medicine, Kagawa University Tomohiro Hirao Department of Public Health, Faculty of Medicine, Kagawa University Nlandu R. Ngatu Department of Public Health, Faculty of Medicine, Kagawa University Kanae Kanda Department of Public Health, Faculty of Medicine, Kagawa University Syed Mahfuz Al Hasan Department of Public Health, Faculty of Medicine, Kagawa University Akitsu Murakami Department of Anesthesiology, Faculty of Medicine, Kagawa University Yukinori Mashima Department of Public Health, Faculty of Medicine, Kagawa University Gotaro Shirakami Department of Anesthesiology, Faculty of Medicine, Kagawa University Original Article 10.18926/AMO/63902 Blood pressure (BP) often rises before surgery. This study investigated whether BP elevation immediately before surgery was associated with adverse outcomes. Medical records of 11,732 patients (average age: 61 years; male: 47.4%) who underwent non-cardiac elective inpatient surgery under general anesthesia at Kagawa University Hospital between January 2011 and June 2019 were reviewed. Differences between the first BP values measured on the day before surgery and the first BP values in the operating room were defined as Δ systolic BP (ΔSBP) and Δ diastolic BP (ΔDBP). The relationships between ΔSBP/ΔDBP and 30-day mortality, 30-day readmission, and over-the-standard length of hospital stay (OSLOS) were assessed. OSLOS was defined as a hospital stay longer than mean+2 standard deviations and was calculated using the Japanese Diagnosis Procedure Combination data. In univariate analysis, the differences in ΔSBP and ΔDBP between the OSLOS and standard LOS groups were both 2 mmHg. In multivariate logistic regression analysis, only ΔDBP was associated with OSLOS. The adjusted odds ratio (95% confidence interval) for the largest quartile was 1.31 (1.02-1.69) (p<0.05). ΔDBP was associated with OSLOS; however, there may be little need to worry about large ΔSBPs and ΔDBPs in clinical practice. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 4 2022 Gene Expression Profiling between Patient Groups with High and Low Ki67 Levels after Short-term Preoperative Aromatase Inhibitor Treatment for Breast Cancer 399 408 EN Yukiko Kajiwara Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takayuki Iwamoto Departments of Breast and Endocrine Surgery, Okayama University Hospital Yidan Zhu Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Mariko Kochi Departments of Breast and Endocrine Surgery, Okayama University Hospital Tadahiko Shien Departments of Breast and Endocrine Surgery, Okayama University Hospital Naruto Taira Departments of Breast and Endocrine Surgery, Okayama University Hospital Hiroyoshi Doihara Departments of Breast and Endocrine Surgery, Okayama University Hospital Shinichi Toyooka Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Original Article 10.18926/AMO/63894 According to a recent report, a low Ki67 level after short-term preoperative hormone therapy (post-Ki67) might suggest a more favorable prognosis compared with a high post-Ki67 level in patients with hormone receptorpositive/human epidermal growth factor 2-negative (HR+/HER2－) breast cancer with high levels of Ki67. This study aimed to evaluate the pre-treatment genetic differences between these two patient groups. Forty-five luminal B-like patients were stratified into two groups, namely, a group with high (H→H) and one with low (H→L) Ki67 levels after short-term preoperative aromatase inhibitor (AI) treatment. We compared pre-treatmentgene expression profiles between the two groups. In gene level analysis, there was no significant difference between the two groups by the class comparison test. In pathway analysis, five metabolism-related gene sets were significantly upregulated in the H→L group (p≤0.05). In the search for novel targets, five genes (PARP, BRCA2, FLT4, CDK6, and PDCD1LG2) showed significantly higher expression in the H→H group (p≤0.05). Several metabolism-related pathways were associated with sensitivity to AI. In the future, it will be necessary to seek out new therapeutic strategies for the poor prognostic group with high post-Ki67. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 2072-666X 13 8 2022 Optimization of Microchannels and Application of Basic Activation Functions of Deep Neural Network for Accuracy Analysis of Microfluidic Parameter Data 1352 EN Feroz Ahmed Graduate School of Interdisciplinary Science and Engineering in Health Systems, Department of Medical Bioengineering, Okayama University Masashi Shimizu Graduate School of Interdisciplinary Science and Engineering in Health Systems, Department of Medical Bioengineering, Okayama University Jin Wang Graduate School of Interdisciplinary Science and Engineering in Health Systems, Department of Medical Bioengineering, Okayama University Kenji Sakai Graduate School of Interdisciplinary Science and Engineering in Health Systems, Department of Medical Bioengineering, Okayama University Toshihiko Kiwa Graduate School of Interdisciplinary Science and Engineering in Health Systems, Department of Medical Bioengineering, Okayama University The fabrication of microflow channels with high accuracy in terms of the optimization of the proposed designs, minimization of surface roughness, and flow control of microfluidic parameters is challenging when evaluating the performance of microfluidic systems. The use of conventional input devices, such as peristaltic pumps and digital pressure pumps, to evaluate the flow control of such parameters cannot confirm a wide range of data analysis with higher accuracy because of their operational drawbacks. In this study, we optimized the circular and rectangular-shaped microflow channels of a 100 mu m microfluidic chip using a three-dimensional simulation tool, and analyzed concentration profiles of different regions of the microflow channels. Then, we applied a deep learning (DL) algorithm for the dense layers of the rectified linear unit (ReLU), Leaky ReLU, and Swish activation functions to train and test 1600 experimental and interpolation of data samples which obtained from the microfluidic chip. Moreover, using the same DL algorithm, we configured three models for each of these three functions by changing the internal middle layers of these models. As a result, we obtained a total of 9 average accuracy values of ReLU, Leaky ReLU, and Swish functions for a defined threshold value of 6 x 10(-5) using the trial-and-error method. We applied single-to-five-fold cross-validation technique of deep neural network to avoid overfitting and reduce noises from data-set to evaluate better average accuracy of data of microfluidic parameters. No potential conflict of interest relevant to this article was reported.

Springer Acta Medica Okayama 2198-7793 8 1 2022 A case of esophageal atresia with the bronchial-like lower esophagus which originates from the left lower lobe bronchus 156 EN Terutaka Tanimoto Department of Pediatric Surgery, Okayama University Hospital Takuo Noda Department of Pediatric Surgery, Okayama University Hospital Reisuke Imaji Department of Pediatric Surgery, Hiroshima City Hiroshima Citizens Hospital Hiroshi Nouso Department of Pediatric Surgery, Okayama University Hospital Background Esophageal atresia with or without a trachea-esophageal fistula occurs due to the failure of separation or incomplete development of the foregut. Therefore, esophageal atresia is often associated with various forms of tracheobronchial anomalies. We report an extremely rare case of esophageal atresia. Case presentation A female infant was born at 37 weeks of gestation and weighed 2596 g. A diagnosis of esophageal atresia and total anomalous pulmonary vein return type III were confirmed. The infant had respiratory distress that required tracheal intubation and ventilatory support soon after birth. Temporary banding of the gastroesophageal junction and gastrostomy were performed on the second day of life. However, her respiratory condition deteriorated due to atelectasis of the left lung and compensatory hyperinflation of the right lung. Preoperative examinations showed the unilobe and atelectatic left lung. The trachea was trifurcated in three directions, and the branch that was expected to be the left main bronchus was blind-ended. The dorsal branch was cartilaginous and bifurcated into the left lower lobe bronchus and lower esophagus approximately 1 cm distal from the tracheal trifurcation. The cartilaginous tissue continued to the lower esophagus. The diagnosis of esophageal atresia with the lower esophagus which originated from the left lower lobe bronchus was made. Esophageal atresia repair was performed when the patient was 4 months of age. The esophagus was dissected distally to the bifurcation of the left lower lobe bronchus via right thoracotomy. The lower esophagus was bronchial-like in appearance, transitioning to the normal esophageal wall approximately 7 mm distal to the transected edge. The cartilage tissue was completely resected during surgery, and a primary end-to-end anastomosis of the esophagus was successfully performed. Histopathological findings revealed that the extracted specimen was surrounded by tracheal cartilage and that the inner surface was covered by stratified squamous epithelium that originated from the esophagus. Conclusions In cases of esophageal atresia with an atypical clinical presentation, there may be unique structural abnormalities of the foregut. We emphasize the importance of a preoperative surgical planning since an inadequate operation can lead to fatal complications. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 2227-9032 10 7 2022 The Effectiveness of Pre-Operative Screening Tests in Determining Viral Infections in Patients Undergoing Oral and Maxillofacial Surgery 1348 EN Shintaro Sukegawa Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yuka Sukegawa Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Kazuaki Hasegawa Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Sawako Ono Department of Pathology, Kagawa Prefectural Central Hospital Tomoya Nakamura Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital Ai Fujimura Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital Ayaka Fujisawa Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital Keisuke Nakano Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Kiyofumi Takabatake Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Hotaka Kawai Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yumika Mukainaka Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Hitoshi Nagatsuka Department of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Yoshihiko Furuki Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital We analyzed the rate of patients with hepatitis B virus (HBV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV) infection diagnosed by pre-operative screening and estimated its cost. We retrospectively analyzed patients who underwent elective surgery at our maxillofacial surgery department between April 2014 and March 2022. We compared the number of patients with each infection identified by pre-operative screening and a pre-operative questionnaire. We also compared the prevalence of infections with varying age, sex, and oral diseases, and calculated the cost of screening per positive result. The prevalence of HBV, HCV, and HIV was 0.39% (62/15,842), 0.76% (153/15,839), and 0.07% (10/12,745), respectively. The self-reported rates were as follows: HBV, 63.4% (26/41); HCV, 50.4% (62/123); HIV, 87.5% (7/8). Differences in sex were statistically significant for all infectious diseases; age significantly affected HBV and HCV rates. There was no association between the odds ratio of oral disease and viral infections. The cost per positive result was $1873.8, $905.8, and $11,895.3 for HBV, HCV, and HIV, respectively. Although self-assessment using questionnaires is partially effective, it has inadequate screening accuracy. Formulating an auxiliary diagnosis of infectious diseases with oral diseases was challenging. The cost determined was useful for hepatitis, but not HIV. No potential conflict of interest relevant to this article was reported.

BMC Acta Medica Okayama 1471-2253 22 1 2022 Histidine-rich glycoprotein as a novel predictive biomarker of postoperative complications in intensive care unit patients: a prospective observational study 232 EN Masahiko Oiwa Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Kosuke Kuroda Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Naoya Kawanoue Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiroshi Morimatsu Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Background Decrease in histidine-rich glycoprotein (HRG) was reported as a cause of dysregulation of the coagulation-fibrinolysis and immune systems, leading to multi-organ failure, and it may be a biomarker for sepsis, ventilator-associated pneumonia, preeclampsia, and coronavirus disease 2019. However, the usefulness of HRG in perioperative management remains unclear. This study aimed to assess the usefulness of HRG as a biomarker for predicting postoperative complications. Methods This was a single-center, prospective, observational study of 150 adult patients who were admitted to the intensive care unit after surgery. Postoperative complications were defined as those having a grade II or higher in the Clavien-Dindo classification, occurring within 7 days after surgery. The primary outcome was HRG levels in the patients with and without postoperative complications. The secondary outcome was the ability of HRG, white blood cell, C-reactive protein, procalcitonin, and presepsin to predict postoperative complications. Data are presented as number and median (interquartile range). Results The incidence of postoperative complications was 40%. The HRG levels on postoperative day 1 were significantly lower in patients who developed postoperative complications (n = 60; 21.50 [18.12-25.74] mu g/mL) than in those who did not develop postoperative complications (n = 90; 25.46 [21.05-31.63] mu g/mL). The Harrell C-index scores for postoperative complications were HRG, 0.65; white blood cell, 0.50; C-reactive protein, 0.59; procalcitonin, 0.73; and presepsin, 0.73. HRG was independent predictor of postoperative complications when adjusted for age, the presence of preoperative cardiovascular comorbidities, American Society of Anesthesiologists Physical Status Classification, operative time, and the volume of intraoperative bleeding (adjusted hazard ratio = 0.94; 95% confidence interval, 0.90-0.99). Conclusions The HRG levels on postoperative day 1 could predict postoperative complications. Hence, HRG may be a useful biomarker for predicting postoperative complications. No potential conflict of interest relevant to this article was reported.

MDPI Acta Medica Okayama 1467-3037 44 6 2022 Characterization of Gastric Tissue-Resident T Cells in Autoimmune and Helicobacter pylori-Associated Gastritis 2443 2452 EN Daisuke Kametaka Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Masaya Iwamuro Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takahide Takahashi Division of Medical Support, Okayama University Hospital Araki Hirabata Division of Medical Support, Okayama University Hospital Kenta Hamada Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshiyasu Kono Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Hiromitsu Kanzaki Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Seiji Kawano Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Takehiro Tanaka Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Fumio Otsuka Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yoshiro Kawahara Department of Practical Gastrointestinal Endoscopy, Okayama University Hospital Hiroyuki Okada Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Data regarding the in-depth surface marker profiles of gastric tissue-resident lymphocytes in autoimmune and Helicobacter pylori-associated gastritis are lacking. In this study, we investigated potential differences in lymphocyte composition between these profiles. We enrolled patients with autoimmune (n = 14), active (current infection of H. pylori in the stomach; n = 10), and inactive gastritis (post-eradication of H. pylori; n = 20). Lymphocytes were isolated from the greater curvature of the stomach and lesser curvature of the body and analyzed using flow cytometry. The CD8(+)/CD3(+) and CD4(+)/CD3(+) ratios differed between the samples. Body CD4(+)/antrum CD4(+), which is calculated by dividing the CD4(+)/CD3(+) ratio in the body by that in the antrum, was significantly higher in autoimmune gastritis (3.54 +/- 3.13) than in active (1.47 +/- 0.41) and inactive gastritis (1.42 +/- 0.77). Antrum CD8(+)/CD4(+) in autoimmune gastritis (7.86 +/- 7.23) was also higher than that in active (1.49 +/- 0.58) and inactive gastritis (2.84 +/- 2.17). The area under the receiver operating characteristic curve of antrum CD8(+)/CD4(+) was 0.842, and the corresponding optimal cutoff point was 4.0, with a sensitivity of 71.4% and a specificity of 93.3%. We propose that an antrum CD8(+)/CD4(+) ratio > 4.0 is a potential diagnostic marker for autoimmune gastritis. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 3 2022 Bilateral Blunt Ocular Trauma Caused by an Exercise Resistance Band during Muscle Building Exercise for Swimming 349 354 EN Kanazu Ariyasu Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shuhei Kimura Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Ryo Matoba Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Mio Morizane Hosokawa Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yusuke Shiode Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Shinichiro Doi Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuki Kanzaki Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Yuki Morizane Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Case Report 10.18926/AMO/63747 An 18-year-old male high school student presented to our clinic with bilateral blunt ocular trauma caused by an exercise resistance band (ERB) during a muscle-building exercise. Best-corrected decimal visual acuities (BCVAs) for right and left eyes were light perception and 0.15, respectively. The right eye was operated 10 days after injury for persistent vitreous hemorrhage, and the left eye 5 months later because of macular hole onset. After 36 months, the right eye showed extensive retinal degeneration (BCVA 0.04), and the left eye macular hole closure (BCVA 1.2). ERBs should be used cautiously as they can cause serious ocular trauma. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 3 2022 Successful Treatment of Atypical Femoral Fracture with Bowed Femur Using Contralateral Intramedullary Nail Combined with Early Daily Teriparatide 333 338 EN Manabu Akagawa Department of Orthopedic Surgery, Omagari Kosei Medical Center Naohisa Miyakoshi Department of Orthopedic Surgery, Akita University Graduate School of Medicine Hiroyuki Tsuchie Department of Orthopedic Surgery, Akita University Graduate School of Medicine Yuji Kasukawa Department of Orthopedic Surgery, Akita University Graduate School of Medicine Takashi Kawaragi Department of Orthopedic Surgery, Omagari Kosei Medical Center Itsuki Nagahata Department of Orthopedic Surgery, Omagari Kosei Medical Center Masazumi Suzuki Department of Orthopedic Surgery, Omagari Kosei Medical Center Takayuki Yoshikawa Department of Orthopedic Surgery, Omagari Kosei Medical Center Toshiki Abe Department of Orthopedic Surgery, Omagari Kosei Medical Center Yoichi Shimada Department of Orthopedic Surgery, Akita University Graduate School of Medicine Case Report 10.18926/AMO/63744 We report a case of atypical femoral fracture achieving early fracture union with combination therapy comprising contralateral nail and immediate teriparatide injection. Fracture union of atypical fractures is often delayed due to bowing deformity and bone metabolic disorders. Combination treatment that takes both problems into consideration represents a useful treatment option for atypical femoral fracture. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 3 2022 Hip Fractures after Intramedullary Nailing Fixation for Atypical Femoral Fractures: Three Cases 317 321 EN Norio Yamamoto Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital Tomoo Inoue Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital Mochizuki Yusuke Department of Orthopaedic Surgery, Kaneda Hospital Noda Tomoyuki Department of Orthopaedic Surgery and Traumatology, Kawasaki Medical School, General Medical Center Kawasaki Keisuke Department of Orthopedic Surgery, Kagawa Prefectural Central Hospital Ozaki Toshifumi Department of Orthopaedic Surgery, Okayama University Hospital Case Report 10.18926/AMO/63741 Secondary hip fractures (SHFs) rarely occur after intramedullary nailing (IMN) fixation without femoral neck fixation for atypical femoral fractures (AFFs). We report three cases of older Japanese women who sustained SHFs presumably caused by osteoporosis and peri-implant stress concentration around the femoral neck after undergoing IMN without femoral neck fixation for AFF. All cases were fixed with malalignment. In AFF patients, postoperative changes due to postoperative femoral bone malalignment may affect the peri-implant mechanical environment around the femoral neck, which can result in insufficiency fractures. At the first AFF surgery, we recommend femoral neck fixation after adequate reduction is achieved. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 76 3 2022 Factors Associated with Surgical Field Bacterial Detection during Total Hip Arthroplasty 291 295 EN Yoshiaki Miyake Department of Bone and Joint Surgery, Kawasaki Medical School Shigeru Mitani Department of Bone and Joint Surgery, Kawasaki Medical School Yoshifumi Namba Department of Bone and Joint Surgery, Kawasaki Medical School Norifumi Umehara Department of Bone and Joint Surgery, Kawasaki Medical School Toyohiro Kawamoto Department of Bone and Joint Surgery, Kawasaki Medical School Shuro Furuichi Department of Bone and Joint Surgery, Kawasaki Medical School Original Article 10.18926/AMO/63738 Total hip arthroplasty (THA) provides relief from hip pain and improves hip function. However, periprosthetic joint infection (PJI) remains an area of concern. We examined the detection rate of bacteria from surgical fields in wound closure, along with the relationship between bacterial detection rate and type of antiseptic, surgery time, and surgeon experience for 500 patients who underwent THA at our department. The mean age at surgery was 64.3 (± 27.3) years. The bacterial detection rate was 4.6%. None of the cases revealed PJI. No significant association between the detection rate and type of antiseptic used or surgery time was observed. However, for patients treated by surgeons with < 10 years of orthopedic experience, a detection rate of 7.3% was found, while a rate of 1.3% was observed for those treated by surgeons with ≥ 10 years of orthopedic experience. This finding indicated that orthopedic experience of less than 10 years was significantly associated with an increased bacterial detection rate (chi-square test, p=0.002). The detection rate was associated with surgeon experience but not with antiseptic type or surgery time. It is possible that intraoperative handling may increase the number of bacteria in surgical fields in wound closure. No potential conflict of interest relevant to this article was reported.