Springer Science and Business Media LLCActa Medica Okayama1867-10712026Robots for CT-guided needle insertion: clinical implementation and future perspectivesENYusukeMatsuiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKojiTomitaDepartment of Radiology, Medical Development Field, Okayama UniversityNoriyukiUmakoshiDepartment of Radiology, Medical Development Field, Okayama UniversityKazuakiMunetomoDepartment of Radiology, Medical Development Field, Okayama UniversityYutaKimuraDepartment of Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityFumiyoHigakiDepartment of Radiology, Medical Development Field, Okayama UniversityJunSakuraiCenter for Innovative Clinical Medicine, Medical Development Field, Okayama UniversityToshihiroIguchiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversitySoShimookaFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityTakayukiMatsunoFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityTetsushiKamegawaFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityRobotic systems for computed tomography (CT)-guided needle insertion have been developed to address the limitations of conventional manual needle insertion. Thus far, various robotic systems have been clinically implemented, and accumulating evidence has suggested their clinical utility. The evidence has evolved beyond initial feasibility and early clinical experience to include larger observational and comparative studies. These studies have demonstrated high success rates of robot-assisted needle insertion in various CT-guided interventions, including thermal ablation, biopsy, and preoperative localization. Furthermore, an increasing number of comparative studies have demonstrated the advantages of robot-assisted procedures over conventional manual procedures. These advantages include improved needle insertion accuracy and reduced radiation doses to patients and/or physicians. Although most currently available robotic systems are needle-guiding robots designed to align a needle guide with a predetermined insertion trajectory, we have developed a CT-guided needle insertion robot capable of robotic needle advancement via remote control. Clinical studies have demonstrated the feasibility of robotic needle insertion using this system, as well as needle placement accuracy comparable to that of manual procedures, while eliminating radiation exposure to physicians. The integration of artificial intelligence and the implementation of telerobotic interventions are expected to contribute significantly to the further advancement of robotic systems for CT-guided needle insertion. This narrative review summarizes the current clinical implementations and available evidence for robotic systems for CT-guided needle insertion, including our system, and discusses future perspectives in this field.
No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X8052026Radiogenomic Analysis of Contrast-Enhanced MRI for Predicting Pathogenic BRCA Variants in Ovarian Cancer317325ENHayatoSaitoDepartment of Radiological Technology, Graduate School of Health Sciences, Okayama UniversityRyoheiFukuiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityHanakoSugiharaDepartment of Obstetrics and Gynecology, Okayama UniversityAkihiroTadaOkayama Diagnostic Imaging CenterShojiNagaoDepartment of Obstetrics and Gynecology, Okayama UniversityToshihiroIguchiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityOriginal Article10.18926/AMO/71341This study evaluated the feasibility of predicting pathogenic BRCA1/2 variants in ovarian cancer using radiogenomic analysis of contrast-enhanced MRI. Twenty six patients were analyzed, including 14 with pathogenic BRCA1/2 variants and 12 without. Contrast enhanced MRI was used to generate two dimensional (2D) and three dimensional (3D) tumor segmentations. Radiomic features extracted with PyRadiomics were reduced using least absolute shrinkage and selection operator (LASSO) regression, yielding two selected features. Linear discriminant analysis (LDA) models were trained on 18 patients and tested on 8, with performance assessed using sensitivity, specificity, accuracy, and the area under the receiver operating characteristic (ROC) curve. The DeLong test compared AUCs between segmentation methods. Automated machine learning (AutoML) was performed with a training set of 20 patients and a test set of 6, with multiple performance metrics calculated. LDA achieved approximately 60% accuracy in both 2D and 3D test datasets. AUCs were 0.80 (3D) and 0.77 (2D), with no significant difference (p=0.85). AutoML identified CatBoost_BAG_L2_FULL as the optimal model, achieving accuracy above 80%. MRI-based radiogenomic analysis demonstrated moderate classification performance for identifying pathogenic BRCA1/2 variants in ovarian cancer. These preliminary findings suggest a potential role for noninvasive prediction, warranting further validation in larger cohorts.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X8052026High Accuracy of Pelvic Tilt Measurement Using Three-Dimensional Planning Software: A Validation Study Using Dry Bone Models289298ENYukiKomutaDivision of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Niigata UniversityNorioImaiDivision of Comprehensive Musculoskeletal Medicine, Graduate School of Medical and Dental Sciences, Niigata UniversityDaisukeHommaDivision of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Niigata UniversityKazuhisaFunayamaDivision of Legal Medicine, Graduate School of Medical and Dental Sciences, Niigata UniversityYukiHiranoDivision of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Niigata UniversityYojiHorigomeDivision of Comprehensive Musculoskeletal Medicine, Graduate School of Medical and Dental Sciences, Niigata UniversityIzumiMinatoDepartment of Orthopedic Surgery, Niigata Rinko HospitalHiroyukiKawashimaDivision of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Niigata UniversityOriginal Article10.18926/AMO/71338The “CR Alignment” function was recently introduced in ZedHip®, the hip joint module of ZedView®, to evaluate pelvic tilt in non-supine positions via two-dimensional (2D)‒3D matching using radiographs. However, its ccuracy has not been validated. This study therefore evaluated the accuracy of pelvic tilt measurements using the CR Alignment function in dry pelvic bone specimens. Two cadaveric pelvic bone models were placed in nine orientations (anterior/posterior tilt and left/right rotation). Both radiographic and CT images were acquired in each position. In Study 1, pelvic tilt measured directly from CT images was defined as the “true value.” Three observers used the CR Alignment function to calculate pelvic tilt on radiographs, and measurement errors were determined relative to the true values. In Study 2, measurement errors were compared between matched (same position) and mismatched (different position) imaging. In Study 1, the mean measurement error was 1.28±0.64°. Intra- and interobserver intraclass correlation coefficients were 0.996-0.998 and 0.997, respectively. In Study 2, the mean errors were 1.20±0.88° (matched) and 1.32±1.03° (mismatched). This software exhibited high accuracy and reproducibility in 2D‒3D matching of pelvic tilt, with lower variability under matched acquisition, demonstrating its utility for pre- and postoperative assessment in joint arthroplasty.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X8052026Artificial Intelligence-Assisted Peroral Cholangioscopy for the Diagnosis and Management of Biliary Strictures: Current Evidence and Future Directions271277ENRyosukeSatoDepartment of Gastroenterology and Hepatology, Okayama University HospitalKazuyukiMatsumotoDepartment of Gastroenterology and Hepatology, Okayama University HospitalMotoyukiOtsukaDepartment of Gastroenterology and Hepatology, Okayama University HospitalReview10.18926/AMO/71336Peroral cholangioscopy (POCS) enables direct intraductal visualization and targeted biopsies for indeterminate biliary strictures. However, its diagnostic performance remains operator-dependent and is limited by sampling error. As artificial intelligence (AI) has rapidly advanced in gastrointestinal endoscopy, AI-assisted cholangioscopy has progressed from proof-of-concept image classification to multicenter validation, feature detection, and real-time application. Recent studies using digital single-operator cholangioscopy have reported diagnostic accuracy comparable to that of experts in differentiating malignant from benign strictures, and feature-based approaches can automatically detect tumor vessels and other key visual characteristics. Beyond classification, generative models may enhance mucosal and margin visualization through virtual chromoendoscopy, potentially improving lesion-margin assessment. Furthermore, new models compatible with multiple systems are emerging to address device heterogeneity, which is a key barrier to routine practice. This review summarizes the current evidence on AI-assisted POCS, discusses practical considerations for clinical translation, and highlights future directions, including real-time integration and multimodal decision support.No potential conflict of interest relevant to this article was reported.MDPI AGActa Medica Okayama1422-00672732026Bioinformatic Prediction of Activation States in Molecular Network Pathways of Eukaryotic Initiation Factor 2 (EIF2) Signaling and Coronavirus Pathogenesis1525ENShihoriTanabeDivision of Risk Assessment, Center for Biological Safety and Research, National Institute of Health SciencesSabinaQuaderInnovation Centre of NanoMedicine (iCONM), Kawasaki Institute of Industrial PromotionRyuichiOnoDivision of Cellular and Molecular Toxicology, Center for Biological Safety and Research, National Institute of Health SciencesHiroyoshi Y.TanakaDepartment of Pharmaceutical Biomedicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityHoracioCabralDepartment of Bioengineering, Graduate School of Engineering, The University of TokyoEukaryotic initiation factor 2 (EIF2) signaling plays a crucial role in regulating mRNA translation and initiating eukaryotic protein synthesis. Computational molecular network pathway analysis of the canonical pathways of the coronaviral infection revealed that EIF2 signaling is inactivated when the coronavirus pathogenesis pathway is activated and vice versa. Our computational analyses indicated that the coronavirus pathogenesis pathway and EIF2 signaling had inverse activation states. Computational investigation of upstream or downstream microRNA (miRNA) revealed that EIF2 signaling directly interacted with miRNAs, including let-7, miR-1292-3p (miRNAs with the seed CGCGCCC), miR-15, miR-34, miR-378, miR-493, miR-497, miR-7, miR-8, and MIRLET7. A total of 36 nodes, including 8 molecules (ATF4, BCL2, CCND1, DDIT3, EIF2A, EIF2AK3, EIF4E, and ERK1/2), 1 complex (the ribosomal 40s subunit), and 1 function (apoptosis) in the coronavirus pathogenesis pathway, overlapped with EIF2 signaling. Alterations in EIF2 signaling may play a role in the pathogenesis of coronavirus.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama2168-81841722025Elevated Plasma Progastrin-Releasing Peptide Levels Associated With the Diagnosis of Pulmonary Carcinoid Tumors: A Report of Two Casese79601ENTakashiYamaokaDepartment of Respiratory Medicine, Japanese Red Cross Kobe HospitalKiichiroNinomiyaDepartment of Allergy and Respiratory Medicine, Okayama University HospitalTakuNoumiDepartment of Respiratory Medicine, Japanese Red Cross Kobe HospitalChiakiMatsumotoDepartment of Respiratory Medicine, Japanese Red Cross Kobe HospitalKeisukeSugimotoDepartment of Respiratory Medicine, Japanese Red Cross Kobe HospitalPulmonary carcinoids are the type of thoracic malignant tumors classified as neuroendocrine tumors. Case 1 involved a 59-year-old woman with a nodular shadow in the left upper pulmonary field observed on chest radiography. Chest computed tomography (CT) scan revealed a nodule in the left upper lobe and a soft tissue tumor near the left third rib. Given her elevated plasma progastrin-releasing peptide (ProGRP) level, a CT-guided biopsy was performed, confirming a diagnosis of pulmonary carcinoid with solitary bone metastasis. She subsequently underwent partial resection of the left upper lobe and the rib tumor. Case 2 involved a 67-year-old woman referred to our hospital after a chest CT scan revealed a nodule in the left lingular region. Her plasma ProGRP level was elevated, and a CT-guided biopsy confirmed a diagnosis of pulmonary carcinoid. As no lymph node metastases were detected, she underwent segmental resection of the left upper lobe. In both cases, plasma ProGRP levels decreased following surgical resection. These findings suggest that plasma ProGRP levels may serve as a useful diagnostic marker for pulmonary carcinoids.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1867-10714322024Cranial and spinal computed tomography (CT) angiography with photon-counting detector CT: comparison with angiographic and operative findings143151ENFumiyoHigakiDepartment of Radiology, Okayama University HospitalMasafumiHiramatsuDepartment of Neurological Surgery, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityTakaoYasuharaDepartment of Neurological Surgery, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversitySusumuSasadaDepartment of Neurological Surgery, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityYoshihiroOtaniDepartment of Neurological Surgery, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityJunHarumaDepartment of Neurological Surgery, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityTomohiroInoueDivision of Radiological Technology, Okayama University HospitalYusukeMorimitsuDivision of Radiological Technology, Okayama University HospitalNoriakiAkagiDivision of Radiological Technology, Okayama University HospitalYusukeMatsuiDepartment of Radiology, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityToshihiroIguchiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityThe clinical imaging features of photon-counting detector (PCD) computed tomography (CT) are mainly known as dose reduction, improvement of spatial resolution, and reduction of artifacts compared to energy-integrating detector CT (EID-CT). The utility of cranial and spinal PCD-CT and PCD-CT angiography (CTA) has been previously reported. CTA is a widely used technique for noninvasive evaluation. Cranial CTA is important in brain tumors, especially glioblastoma; it evaluates whether the tumor is highly vascularized prior to an operation and helps in the diagnosis and assessment of bleeding risk. Spinal CTA has an important role in the estimation of feeders and drainers prior to selective angiography in the cases of spinal epidural arteriovenous fistulas and spinal tumors, especially in hemangioblastoma. So far, EID-CTA is commonly performed in an adjunctive role prior to selective angiography; PCD-CTA with high spatial resolution can be an alternative to selective angiography. In the cases of cerebral aneurysms, flow diverters are important tools for the treatment of intracranial aneurysms, and postoperative evaluation with cone beam CT with angiography using diluted contrast media is performed to evaluate stent adhesion and in-stent thrombosis. If CTA can replace selective angiography, it will be less invasive for the patient. In this review, we present representative cases with PCD-CT. We also show how well the cranial and spinal PCD-CTA approaches the accuracy of angiographic and intraoperative findings.No potential conflict of interest relevant to this article was reported.WileyActa Medica Okayama0961-836835102026Conformational stability and domain‐specific structural features of tumor autoantigens regulate autoantibody epitope propensitye70808ENAiMiyamotoGraduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama UniversityRikaYamamotoGraduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama UniversityRyuiSakaguchiGraduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama UniversityRikakoKutsumaGraduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama UniversityTakeruMoriGraduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama UniversityMireiMasuiGraduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama UniversityTomokoHonjoGraduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama UniversityMidoriFutamiDepartment of Bioscience, Faculty of Life Science, Okayama University of ScienceMarikoMoriiGraduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama UniversityHiromiWatanabeDepartment of Respiratory Medicine, Okayama University HospitalTadahiroKuribayashiDepartment of Respiratory Medicine, Okayama University HospitalKadoakiOhashiDepartment of Respiratory Medicine, Okayama University HospitalKatsuyukiKiuraDepartment of Respiratory Medicine, Okayama University HospitalJunichiroFutamiGraduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama UniversityAutoantibodies against tumor-associated autoantigens are clinically valuable biomarkers for cancer diagnosis; however, the structural determinants governing epitope selectivity remain unknown. Here, we investigated whether the intrinsic conformational stability of target autoantigens regulates the epitope propensity of tumor-associated autoantibodies in non-small cell lung cancer. Using a dual-antigen Luminex bead-based assay that presents each autoantigen in both native and S-cationized denatured forms, we directly compared IgG autoantibody reactivity toward conformational and linear epitopes across 11 autoantigens. Intrinsically disordered aggregation-prone autoantigens, including cancer/testis antigens, NY-ESO-1, and XAGE-1b, predominantly elicit linear epitope-directed responses, whereas thermodynamically stable soluble autoantigens generally drive conformational epitope recognition. Intriguingly, for autoantigens harboring both ordered and disordered segments, the immune response is strictly guided by domain-specific biophysics: while p53-specific antibodies preferentially target their flanking disordered regions, the Wilms' tumor protein 1 exceptionally drives conformational recognition directed toward its structured zinc-finger domains. Recombinant solubility in Escherichia coli broadly correlated with epitope class across all 11 autoantigens, confirming that prokaryotic folding efficiency generally reflects intrinsic conformational stability in vivo for autonomously folding monomeric cytosolic proteins. Independent computational validation was provided by the concordance between the experimental solubility ratios and AlphaFold3-derived Rosetta energy unit/solvent-accessible surface area values, demonstrating the convergence of thermodynamic estimates and patient-derived immune data within a unifying biophysical framework. These findings establish that the autoantibody epitope propensity is closely associated with the thermodynamic stability of the target autoantigen and provide a rational basis for tailoring antigen preparation strategies for autoantibody-based cancer diagnosis.No potential conflict of interest relevant to this article was reported.MDPI AGActa Medica Okayama2311-55211192026First-Order Wall-Slip-Induced Departure from Inverse-Cubic Scaling of Levitation-Pressure RMS in a Push–Pull Levitation Stage218ENEisukeUmesakiGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityHirokiSuzukiGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityJunjiSakamotoGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityToshinoriKouchiGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityThis study clarifies how rarefaction-induced wall slip in a thin gas film affects the established inverse-cubic scaling law for the spatial nonuniformity of levitation pressure in a push–pull levitation stage. The levitation force in this stage is generated by the combined action of blowing and suction. The continuum-based stress description is retained, and only the wall boundary condition is changed from the no-slip condition to a first-order slip condition. Three-dimensional incompressible unsteady Stokes simulations in a thin-gap unit-cell model are combined with a lubrication-theory scaling analysis. The effects of levitation height, blowing-velocity distribution, port-radius ratio, and computational-domain width are examined systematically. The results show that wall slip has only a minor influence at relatively large levitation heights. As the levitation height decreases, however, rarefaction-induced slip increases the flow-rate conductance. Consequently, the intensity of the spatial variation in levitation pressure is systematically reduced below that predicted by the no-slip inverse-cubic scaling law. This departure is well described by a correction relation derived from the lubrication approximation and remains robust against changes in the prescribed blowing-velocity distribution and geometric conditions. These findings provide an incompressible baseline for predicting levitation-pressure nonuniformity within the nominal gap-based Knudsen-number range examined here.No potential conflict of interest relevant to this article was reported.Association for Computing Machinery (ACM)Acta Medica Okayama2474-9567932025Presentation Quality Assessment through Audience 3D Facial and Head Direction Using Conventional Cameras115ENGoshiImamuraOkayama UniversityAtsushiNakazawaOkayama UniversityThis paper shows the method for evaluating the quality of presentations using information from the audience's facial and head behavior. Existing studies have focused on assessing presentation skills by analyzing presentation materials and the presenter's verbal and non-verbal cues, however, since a presentation is an interaction between the presenter and the audience, the presentation quality is not only influenced by presenter's information but also audience's information such as their background knowledge. This means that the presenter's output alone is not enough for a comprehensive evaluation of the presentation. To address this, we show a method that utilizes videos of the audience recorded during presentations using two cameras: one capturing from the presenter's point of view and the other from around the presentation screen. The 3D position and direction of the audience's face were detected using face detection techniques, which were then used to predict gaze targets, such as the presenter and the presentation screen. The number of times these targets were looked at during the presentation served as feature values for evaluating presentation quality. Using a dataset of 18 presenters and 32 audience members, this paper shows a significant correlation between subjective ratings and behavioral characteristics. It also demonstrates an algorithm that infers the quality of a presentation from these feature values.No potential conflict of interest relevant to this article was reported.WileyActa Medica Okayama0022-3751604182026Integrative simulation analysis of myocardial ischaemia–reperfusion injury76407662ENTakaoShimayoshiCenter for Artificial Intelligence and Mathematical Data Science, Okayama UniversityAyakoTakeuchiDepartment of Physiology and Biophysics, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversitySatoshiMatsuokaDepartment of Integrative and Systems Physiology, Faculty of Medical Sciences, University of FukuiCardiac ischaemia, reduced coronary blood flow, causes significant damages to the heart, and paradoxically reperfusion, restored flow after ischaemia, often results in more severe injury. Although the mechanisms underlying cardiac ischaemia–reperfusion injury have been intensively investigated, effective therapeutic strategies applicable during reperfusion to mitigate this damage have not been established yet. To obtain more insights into the mechanisms underlying ischaemia–reperfusion injury, and to explore effective methods to relieve reperfusion injury, we developed a comprehensive mathematical model of ventricular myocyte, implementing excitation–contraction (E–C) coupling, cytosolic and mitochondrial pH regulation, pH dependence of major components of E–C coupling and cellular energy metabolism, including mitochondrial oxidative phosphorylation. The mathematical model successfully reproduced experimentally observed findings on cardiac ischaemia–reperfusion injury, such as intracellular and extracellular acidosis, cytosolic Na+ overload, cytosolic Ca2+ overload, mitochondrial dysfunction, action potential shortening and contraction failure. It was found that the reperfusion-induced exacerbation of Na+i, Ca2+i overloads was mainly caused by insufficient production of NADH, which is used in mitochondrial oxidative phosphorylation to synthesize ATP for Na+/K+ pump and sarcoplasmic/endoplasmic reticulum Ca2+ pump (SERCA) to expel accumulated cytosolic Na+ and Ca2+, respectively. It was suggested that the preservation of mitochondrial NADH production, attenuation of ATP consumption via SERCA or contraction for a short period or activation of the Na+/K+ pump during reperfusion mitigates reperfusion injury.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama0969-806X2512027A rule-based calculation approach to derive bone-suppressed chest X-ray images using photon-counting techniques114493ENNatsumiKimotoDepartment of Radiological Science, Faculty of Health Sciences, Junshin Gakuen UniversityRinaNishigamiGraduate School of Medical Sciences, Kanazawa UniversityTakashiAsaharaDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityManaMitaniDivision of Radiology, Medical Support Department, Okayama University HospitalDaikiKobayashiGraduate School of Medical Sciences, Kanazawa UniversityNoriakiAkagiDivision of Radiology, Medical Support Department, Okayama University HospitalToshihiroIguchiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityHiroakiHayashiCollege of Transdisciplinary Sciences for Innovation, Kanazawa UniversityImproving the visibility of lung nodules, which are often hidden by bone shadows and difficult to identify, remains a challenge in chest radiography. This study aims to develop an algorithm for generating novel bone-suppressed images using photon-counting techniques. The core idea of our algorithm is to fit photon interaction cross-sections to X-ray attenuation data measured with photon-counting detectors. Based on further calculations using the derived fitting coefficients, both density (ρ) and amount-of-substance concentration (mol) were determined. The product of these values produced a ρ×mol image exhibiting a clear bone-suppression effect. We conducted a virtual chest imaging simulation using 10 patient datasets acquired via clinical photon-counting computed tomography (PC-CT). The CT images were converted into ρ×mol images following the proposed processing procedure, and two-dimensional chest images were generated through projection. Quantitative evaluations confirmed that the proposed images achieved sufficient bone suppression. Furthermore, commercial software provided by a vendor was used to generate bone-suppressed images from conventional images projected from CT data. A comparable bone-suppression effect on the ribs was observed between the vendor-generated images and our proposed images, while lesion visibility (e.g., lung nodules) was preserved. Additionally, bone-suppression effects in our images were observed in the vertebrae and clavicles located outside the lung fields. Our research demonstrates the value of constructing general X-ray imaging systems using photon-counting detectors.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama2590-1230322026Prediction of tool-path and cycle time errors of CNC machining using a transformer-based deep learning model112872ENKazukiKanekoGraduate School of Environmental, Life, Natural Science and Tech, Okayama UniversityZongzeLiGraduate School of Advanced Science and Engineering, Hiroshima UniversityThe prediction of tool-path and cycle time errors of computer numerical control (CNC) machining is important in manufacturing field. In this study, these errors are considered as sequential data corresponding to the lines of G-code, i.e., the error prediction is a sequence-to-sequence task, and a Transformer-based deep learning model was constructed to predict the tool-path and cycle time errors simultaneously, taking the positional increments and feed rate as the input. The training datasets were created by running a randomly generated G-code on a real CNC machine tool and subsequently tracking the actual errors, where the motion and feed rate are stochastically defined. The model is validated by conducting the error prediction on six sets of G-code. In addition, the comparison with a Bi-LSTM-based deep learning model is conducted. The results show that the prediction accuracy of the Transformer model can achieve the mean prediction accuracies of ±1 μm and ±1 ms in tool-path and cycle time error predictions, respectively. Furthermore, the Transformer model has a smaller prediction uncertainty than the Bi-LSTM model. Compared with conventional methods only analyzing tool-path errors or cycle-time errors, the utilized model has an advantage in its ability to simultaneously predict tool-path errors and cycle time errors.No potential conflict of interest relevant to this article was reported.MDPI AGActa Medica Okayama1660-33972492026A Marine Brevibacillus-Derived Membrane-Lytic Peptide: Molecular Insight and Biophysical Characterization of a Novel AMP, FNL62-AMP309ENNamfaSermkaewSchool of Pharmacy, Walailak UniversityApichartAtipairinSchool of Pharmacy, Walailak UniversitySucheewinKrobthongCenter of Excellence in Natural Products Chemistry (CENP), Department of Chemistry, Faculty of Science, Chulalongkorn UniversityChanatAonbangkhenCenter of Excellence in Natural Products Chemistry (CENP), Department of Chemistry, Faculty of Science, Chulalongkorn UniversityYodyingYingchutrakulNational Center for Genetic Engineering and Biotechnology, National Science and Technology Development AgencyJumpeiUchiyamaDepartment of Infectious Diseases, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityNuttaponSongnakaSchool of Pharmacy, Walailak UniversityThis study characterizes the genomic identity, functional efficacy, and computational biophysics of FNL62-AMP, a novel antimicrobial peptide isolated from a phylogenomically distinct, newly identified Brevibacillus species. Production kinetics revealed a late-exponential phase onset of antibacterial activity with sustained potency against methicillin-resistant Staphylococcus aureus (MRSA). LC-MS/MS analysis identified the peptide sequence as NH2-LLLLFR-COOH. FNL62-AMP demonstrated excellent formulation resilience, retaining full anti-MRSA activity under high thermal stress (80 °C for 6 h) and showing robust resistance to generic trypsin and proteinase K proteolysis. Formulative co-incubation assays demonstrated charge-dependent compatibility, where nonionic Triton X-100 preserved baseline efficacy while ionic surfactants induced antagonism. In vitro time-kill kinetics, scanning electron microscopy, and SYTOX Green assays confirmed rapid, concentration-dependent bactericidal action driven by immediate membrane permeabilization. Molecular dynamics simulations successfully captured the spontaneous self-assembly of 64 FNL62-AMP monomers into a stable macro-aggregate. This consolidation process was quantitatively characterized by a simultaneous contraction in the radius of gyration (Rg), a sharp drop in solvent-accessible surface area (SASA), and a transitional plateau in mean squared displacement (MSD). Ultimately, the high thermal stability, structural resilience, and predictable surfactant compatibility of FNL62-AMP propose ways to be developed for lead optimization and druggability.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama2198-40341212026Development of a preoperative accuracy prediction model using machine learning for implant placement in static-guided surgery: retrospective observational study44ENTakuyaMinoDepartment of Removable Prosthodontics and Occlusion, School of Dentistry, Osaka Dental UniversityYurinaMatsuokaDepartment of Semiconductor, Computer Science and Applied Mathematics, Graduate School of Science and Technology, Kumamoto UniversityKen’ichiMorookaDivision of Biomedical Engineering, Faculty of Advanced Science and Technology, Kumamoto UniversityKanaTokumotoDepartment of Oral and Maxillofacial Surgery, School of Medicine, Hyogo Medical UniversityHiroakiShimizuShimizu Dental ClinicYokoKurosakiDepartment of Removable Prosthodontics and Occlusion, School of Dentistry, Osaka Dental UniversityAyaKimura-OnoCenter for Innovative Clinical Medicine, Okayama University HospitalHiromitsuKishimotoDepartment of Oral and Maxillofacial Surgery, School of Medicine, Hyogo Medical UniversityTakuoKubokiDepartment of Oral Rehabilitation and Regenerative Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesKenjiMaekawaDepartment of Removable Prosthodontics and Occlusion, School of Dentistry, Osaka Dental UniversityPurpose This study aimed to develop a machine learning model capable of preoperatively predicting three-dimensional implant placement errors at the implant apex in static-guided surgery and to identify the clinical features associated with placement accuracy.<br>
Methods Clinical data partially derived from a previous observational study were analyzed. In total, 181 patients and 480 implants placed using fully static-guided surgery were included in this study. The outcome variable was defined as three-dimensional implant placement error at the implant apex relative to the preoperative simulation, dichotomized as less than 0.5 mm or ≥ 0.5 mm. Twenty-one clinical and radiographic factors previously suggested to influence the placement accuracy were used as explanatory variables. The feature importance was evaluated using three gradient boosting decision tree models. Furthermore, a stacking model combining multiple classifiers was constructed, and the classification performance was assessed using ten-fold cross-validation.<br>
Results The feature importance analysis identified 12 features associated with implant placement errors. The stacking model demonstrated superior classification performance compared to individual classifiers. The true positive rate was 0.73, false negative rate was 0.27, false positive rate was 0.14, and true negative rate was 0.86.<br>
Conclusions The proposed stacking model correctly classified 86% of cases with implant placement error less than 0.5 mm and 73% of cases with implant placement error of ≥ 0.5 mm. These findings suggest that the proposed model may support the preoperative evaluation of implant placement accuracy in static-guided surgeries.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155813822026自然脱落した子宮原発 DLBCL に対して Pola-R-CHP 療法と CNS 再発予防を行った１例5861ENHikaruOsadaDepartment of Hematology, Japanese Red Cross Okayama HospitalMaikoKimuraDepartment of Hematology, Japanese Red Cross Okayama HospitalManakaMuneishiDepartment of Hematology, Japanese Red Cross Okayama HospitalKozoMurayamaDepartment of Hematology, Japanese Red Cross Okayama HospitalDaigoNiiyaDepartment of Hematology, Japanese Red Cross Okayama HospitalMakotoTakeuchiDepartment of Hematology, Japanese Red Cross Okayama HospitalSoichiroFujiiDepartment of Hematology, Japanese Red Cross Okayama Hospital A 55-year-old woman presented to her local physician with the chief complaint of genital bleeding. A 22×19-mm mass was noted on the patient's cervix, and during the internal examination the mass auto-amputated. The pathological examination of the auto-amputated mass revealed diffuse large B-cell lymphoma (DLBCL). An examination by F-fluorodeoxyglucose-positron emission tomography-computed tomography (FDG-PET-CT) showed FDG uptake at physiological levels in the cervix, with no abnormal uptake in other organs. Cervical tissue was sampled after the spontaneous detachment of the cervical mass, and the biopsy of the cervical mass did not reveal findings suggestive of lymphoma. Six courses of chemotherapy with polatuzumab vedotin, rituximab, cyclophosphamide, doxorubicin, and prednisolone (Pola-R-CHP) plus an intramedually injection of methotrexate, cytarabine, and predonisolone (IT-triple), followed by two courses of high-dose intrathecal methotrexate (HD-MTX) were adiministered, and the patient has remained recurrence-free for the more than 8 months since the completion of this treatment. Primary uterine DLBCL is an extremely rare disease with a high rate of recurrence in the central nervous system and a poor prognosis. Our search of the relevant literature identified very few reports describing the prognoses of cases with spontaneous tumor detachment.No potential conflict of interest relevant to this article was reported.WileyActa Medica Okayama1356-95973152026Transforming Life Science Through Chromosome‐Level Genome Assembliese70145ENTetsuoKonDepartment of Neurosciences and Developmental Biology, University of ViennaKosukeKataokaGraduate School of Engineering, Tokyo University of Agriculture and TechnologyYi‐JyunLuoBiodiversity Research Center, Academia SinicaJohannes NicolausWibisanaGenomics and Regulatory Systems Unit, Okinawa Institute of Science and Technology Graduate UniversityKouheiTogaLaboratory of BioDX, PtBio Co‐Creation Research Center, Genome Editing Innovation Center, Hiroshima UniversityNarumiUnoLaboratory of Bioengineering, School of Life Sciences, Tokyo University of Pharmacy and Life SciencesYukiMondenGraduate School of Environmental, Life, Natural Science, and Technology, Okayama UniversityMayukoHamadaUshimado Marine Institute, Okayama UniversityAdvances in long-read sequencing and Hi–C scaffolding have made chromosome-level genome assembly increasingly accessible to individual laboratories, shifting genome research from large consortium-led projects toward investigator-driven studies across diverse taxa. This transition allows researchers to select organisms based on biological questions rather than the prior availability of genomic resources. In this review, we summarize the core experimental and computational steps for generating, evaluating, and annotating chromosome-level assemblies, and examine how they have advanced research in non-model organisms and genetically complex systems. Representative case studies illustrate four major contributions: resolving structural variation and lineage-specific genome architecture, linking genome organization to phenotypic innovation and plasticity, reconstructing deep chromosome evolution and macrosynteny, and distinguishing homologous and homoeologous chromosomes in polyploid genomes. These examples show that chromosome-level assemblies provide more than complete reference sequences. They establish a continuous genomic coordinate system through which genes, regulatory elements, transposable element insertions, sequence variants, and cellular states can be interpreted within broader chromosomal, population, and evolutionary contexts. We describe this integrative perspective as “glocal biology.” Future progress will require pangenomic, population-scale, and haplotype-resolved resources integrated with multi-omics and functional analyses. Collectively, chromosome-level genomics is reshaping life science by embedding molecular functions within chromosomal and evolutionary contexts.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama2452-302X10102025Inhibition of Scarb1 on Endothelial Cells Attenuates Pressure Overload-Induced Heart Failure Progression101308ENToshiomiKatsukiDepartment of Cardiology, Keio University School of MedicineDaiKusumotoDepartment of Cardiology, Keio University School of MedicineYoheiAkibaDepartment of Cardiology, Keio University School of MedicineMaiKimuraDepartment of Cardiology, Keio University School of MedicineJinKomuroDepartment of Cardiology, Keio University School of MedicineTakahiroNakamuraDepartment of Cardiology, Keio University School of MedicineHisayukiHashimotoDepartment of Cardiology, Keio University School of MedicineThukaaKoukaDepartment of Cardiology, Keio University School of MedicineKazuhisaSugaiInstitute for Integrated Sports Medicine, School of Medicine, Keio UniversityYoshinoriKatsumataDepartment of Cardiology, Keio University School of MedicineMasakiMiyasakaDepartment of Computational Biology and Medical Sciences, the University of TokyoYutakaSuzukiDepartment of Computational Biology and Medical Sciences, the University of TokyoJunkoKuramotoDepartment of Pathology, Keio University School of MedicineYoshiakiKubotaDepartment of Anatomy, Keio University School of MedicineKeiichiFukudaDepartment of Cardiology, Keio University School of MedicineShinsukeYuasaDepartment of Cardiovascular Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityMasakiIedaDepartment of Cardiology, Keio University School of MedicineInappropriate endothelial cell (EC) interactions contribute to heart failure; however, their precise mechanisms remain poorly understood. This study investigated EC-fibroblast interactions mediated by Scarb1 using single-cell RNA-sequencing analysis in a mouse heart failure model. ECs exhibited inflammatory and fibrotic gene expression, with Scarb1-mediated fibroblast-EC interactions driving disease progression. EC-specific Scarb1 knockout and systemic SCARB1 inhibition attenuated heart failure progression. In vitro and spatial omics analyses confirmed the role of SCARB1 in ECs and cell-cell interaction during heart failure progression. These findings highlight SCARB1 as a promising therapeutic target for EC-focused interventions.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X8042026Spinous Process Plate Fixation Alone for an AO Spine Osteoporotic Fracture (OF) 5 Diffuse Idiopathic Skeletal Hyperostosis (DISH)-Associated Thoracolumbar Fracture in a Nonagenarian259264ENSatoruYabunoDepartment of Neurosurgery, Kagawa Rosai HospitalMasatoshiYunokiDepartment of Neurosurgery, Kagawa Rosai HospitalSaoriTakeuchiDepartment of Neurosurgery, Kagawa Rosai HospitalKojiHirashitaDepartment of Neurosurgery, Kagawa Rosai HospitalCase Report10.18926/AMO/71070Diffuse idiopathic skeletal hyperostosis (DISH) predisposes the spine to highly unstable fractures because of long lever-arm biomechanics. Unstable injuries, including AO Spine Osteoporotic Fracture (OF) type 5, are typically treated with long-segment posterior instrumentation; however, pedicle-screw fixation may be infeasible in very elderly patients with severe osteoporosis, critically narrow pedicles, and/or significant comorbidities. A 93-year-old Japanese woman presented with severe back pain without apparent trauma. Computed tomography (CT) revealed a T12 fracture with DISH, classified as OF5. The pedicles were critically narrow (3.7-4.1 mm), and dual-energy X-ray absorptiometry confirmed severe osteoporosis. Because conventional pedicle-screw fixation was considered technically unsafe and excessively invasive, limited posterior stabilization was performed using a single spinous process plate spanning T10-L1. The operative time was 48 min and the estimated blood loss was 10 ml. Immediate postoperative CT confirmed appropriate implant positioning and maintained alignment. At the 1-year follow-up, CT demonstrated solid bony union with preserved alignment and no implant failure; the patient had remained pain-free and ambulatory. This case demonstrates that spinous process-plate fixation can be a minimally invasive salvage option for carefully selected very-elderly patients with DISH when pedicle-screw instrumentation is not feasible.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X8042026Video-Assisted Thoracoscopic Resection of an Upper Mediastinal Ectopic Parathyroid Adenoma241246ENYutaHasegawaDepartment of Surgery, National Defense Medical College HospitalHironoriTsujimotoDepartment of Surgery, National Defense Medical College HospitalNaoyukiUehataDepartment of Surgery, National Defense Medical College HospitalRisaKariyaDepartment of Surgery, National Defense Medical College HospitalAsumaIdeDepartment of Surgery, National Defense Medical College HospitalTakafumiSuzukiDepartment of Surgery, National Defense Medical College HospitalSeiichiroFujishimaDepartment of Surgery, National Defense Medical College HospitalKeitaKouzuDepartment of Surgery, National Defense Medical College HospitalYoshihisaYaguchiDepartment of Surgery, National Defense Medical College HospitalKosukeMiyaiDepartment of Laboratory Medicine, National Defense Medical College HospitalAyumuKuriharaDepartment of Laboratory Medicine, National Defense Medical College HospitalShoOgataDepartment of Laboratory Medicine, National Defense Medical College HospitalSusumuMatsukumaDepartment of Laboratory Medicine, National Defense Medical College HospitalHidekiUenoDepartment of Surgery, National Defense Medical College HospitalCase Report/10.18926/AMO/71067Primary hyperparathyroidism (pHPT) is typically caused by a parathyroid adenoma, although some cases arise from ectopic glands. Accurate preoperative localization is essential for guiding surgical strategy, particularly for mediastinal lesions. We report successful video-assisted thoracoscopic surgery (VATS) for an upper mediastinal parathyroid adenoma. A 68-year-old woman was referred for hypercalcemia during evaluation for recurrent ureteral stones. Laboratory tests revealed elevated serum calcium (13.2 mg/dl) and intact parathyroid hormone (iPTH) levels (266 pg/ml). Contrast-enhanced computed tomography, magnetic resonance imaging, and 99mTc-methoxyisobutylisonitrile scintigraphy identified a 20-mm mass adjacent to the right esophageal wall. VATS was performed due to the tumor’s mediastinal location. The lesion was resected with intraoperative nerve monitoring (IONM) to avoid recurrent laryngeal nerve damage. Postoperatively, iPTH and calcium levels rapidly normalized. Transient hypocalcemia and mild hoarseness occurred but resolved with calcium supplementation and conservative management. Pathological examination confirmed a parathyroid adenoma without malignancy. VATS offers a safe and minimally invasive approach for upper mediastinal parathyroid adenomas. IONM and vigilant calcium management are crucial for minimizing these complications. This case highlights the importance of comprehensive imaging, surgical planning, and postoperative care in managing upper mediastinal pHPT.No potential conflict of interest relevant to this article was reported.WileyActa Medica Okayama1526-99142772026Potential of quantitative X‐ray imaging from photon‐counting CT: A novel analysis based on effective atomic number and physical densitye70673ENTakashiAsaharaDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityRinaNishigamiGraduate School of Medical Sciences, Kanazawa UniversityNatsumiKimotoDepartment of Radiological Science, Faculty of Health Sciences, Junshin Gakuen UniversityManaMitaniDivision of Radiological Technology, Medical Support Department, Okayama University HospitalYusukeMorimitsuDivision of Radiological Technology, Medical Support Department, Okayama University HospitalNoriakiAkagiDivision of Radiological Technology, Medical Support Department, Okayama University HospitalFumiyoHigakiDepartment of Radiology, Medical Development Field, Okayama UniversityToshihiroIguchiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityHiroakiHayashiCollege of Transdisciplinary Sciences for Innovation Kanazawa University Kanazawa Ishikawa JapanBackground: Conventional CT assessment of lung lesions is based mainly on morphological features. CT values represent relative X-ray attenuation that does not directly reflect tissue composition and/or physical density. Quantitative imaging using photon-counting CT (PC-CT) has the potential to provide quantitative parameters, such as effective atomic number (Zeff) and effective physical density (ρeff).<br>
Purpose: The purpose is to develop and demonstrate the potential of an algorithm that generates both the Zeff and ρeff images, derived directly from virtual monoenergetic images (VMIs) acquired with a clinical PC-CT system.<br>
Methods: The ρeff image was generated by fitting a database of mass attenuation coefficients (μ/ρ) to the measured linear attenuation coefficients (μ), which were obtained from two VMIs at 70 and 100 keV. As an effective material, Zeff information was also determined and fed back into the ρeff calculation. An in-house low-density phantom was scanned for quantitative evaluation of ρeff. In addition, to demonstrate the applicability of our procedure to actual clinical imaging, representative chest PC-CT images from patients were analyzed.<br>
Results: In experiments using low-density phantoms, the CT values did not necessarily correlate with Zeff values, but they showed a very good correlation with the ρeff values. The ρeff values calculated using our procedure correlated well with the correct values of ρ. A relative root mean square error of ρeff calculation was 5.5%. Furthermore, we found that in pulmonary diagnosis, image contrast information from ρeff makes it easier to identify and distinguish lesions compared to that from Zeff.<br>
Conclusions: The proposed procedure directly generated Zeff and ρeff images from PC-CT data and enabled quantitative interpretation of CT value in terms of elemental composition and physical density. In this study, the feasibility of generating Zeff and ρeff images was demonstrated.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama1746-80941272026Outcome-aware and interpretable subtyping of chronic kidney disease: an analysis of the FROM-J study111090ENTianyiShiDepartment of Computer Science, University of TsukubaXiucaiYeDepartment of Computer Science, University of TsukubaWenyuXiDepartment of Computer Science, University of TsukubaAkiraImakuraDepartment of Computer Science, University of TsukubaKaoriMaseDepartment of Nephrology, Faculty of Medicine, University of TsukubaRyoyaTsunodaDepartment of Nephrology, Faculty of Medicine, University of TsukubaChieSaitoDepartment of Nephrology, Faculty of Medicine, University of TsukubaAkihikoKatoBlood Purification Unit, Hamamatsu University School of MedicineJunWadaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShoichiMaruyamaDepartment of Nephrology, Nagoya University Graduate School of MedicineTakashiWadaDepartment of Nephrology and Rheumatology, Kanazawa UniversityIchieiNaritaDivision of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental SciencesKunihiroYamagataDepartment of Nephrology, Faculty of Medicine, University of TsukubaTetsuyaSakuraiDepartment of Computer Science, University of TsukubaChronic kidney disease (CKD) affects approximately 10% of the global population and exhibits substantial heterogeneity in disease progression and clinical outcomes. Despite ongoing efforts to develop new therapeutic strategies, the number of patients progressing to end-stage kidney disease (ESKD) and the incidence of cardiovascular disease (CVD) continue to rise. Although severity classification systems for CKD are well established and refined, they remain insufficient to capture prognostically relevant patient subtypes. In this study, we developed an outcome-aware and interpretable clustering framework for CKD subtyping using data from the FROM-J cohort with prognostic follow-up. A supervised XGBoost model was first trained to predict a ≥ 30% decline in estimated glomerular filtration rate (eGFR), a surrogate marker of CKD progression. SHAP (SHapley Additive exPlanations) values derived from this model were then used to quantify outcome-relevant feature contributions. Based on these feature attributions, a similarity graph was constructed, and spectral clustering was performed to identify patient subtypes driven by prognostic relevance. The proposed framework identified four CKD subtypes with distinct baseline clinical characteristics and significantly different risks of renal replacement therapy (RRT) and cardiovascular disease (CVD) events. Serum albumin, blood urea nitrogen (BUN), and smoking status consistently emerged as key features defining subtype structure and prognosis. Robust risk stratification was preserved even when clustering was restricted to these three routinely measured variables. Overall, our findings demonstrate that integrating outcome-driven feature attribution into clustering enables interpretable and clinically relevant CKD subtyping, providing a practical approach for characterizing disease heterogeneity and supporting risk stratification and personalized management.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama2949-678082026Immersion is not enough: Design quality as the key determinant of perceived effectiveness and usage intention in educational virtual reality100152ENAchmadSamsudinUniversitas Pendidikan IndonesiaMuhammadZahranOkayama UniversityEkiNugrahaUniversitas Pendidikan IndonesiaHadiNasbeyUniversitas Negeri JakartaMustafaSozbilirAtatürk UniversityNor Farahwahidah AbdulRahmanUniversiti Teknologi MalaysiaTakashiIrieOkayama UniversityImmersive technologies such as Virtual Reality (VR) are increasingly used to support conceptual understanding in science education, yet perceived learning benefits depend on the quality of system design rather than immersion alone. This study investigates how four design-quality dimensions—Visual and Technological Design (VT), Aesthetic Quality (AQ), Curriculum Alignment (CA), and Digital Feasibility (DF)—influence learners' Perceived Effectiveness (PE) and Intention to Use (IU) the VARIASI VR simulation, which visualizes particle behavior across phase states of matter. Using an explanatory sequential mixed-methods design, quantitative data from 60 participants were analyzed using PLS-SEM, followed by reflexive thematic analysis of open-ended responses. Results show that VT, AQ, CA, and DF each significantly predict PE, demonstrating that learners' perception of effectiveness depends on the coordinated alignment of conceptual clarity, emotional resonance, and system reliability. However, none of these dimensions directly predicted IU, and the PE → IU relationship was positive but marginal, reflecting learners’ need for procedural guidance and comfort to sustain voluntary adoption. Qualitative findings reveal that while VR enhanced conceptual clarity and engagement, continued use depended on familiarity, scaffolding, and physical comfort. The study highlights that effective VR-based science learning experiences emerge when immersive environments are not only well-designed but pedagogically framed to support confidence and sustained use.No potential conflict of interest relevant to this article was reported.Frontiers Media SAActa Medica Okayama2296-4185142026High horizontal force and lateral force transmission induced by the twist of the Achilles tendon1874501ENShotaEnomotoGraduate School of Education, Okayama UniversityKohtaItoArtificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology (AIST)The Achilles tendon—the largest and strongest of the many tendons in the human body—consists of subtendons arising from each head of the triceps surae. These subtendons run helically and intertwine to form a twisted three-dimensional structure. More than a century has passed since the twisted structure of the Achilles tendon was first described, and numerous studies have investigated its functional morphology. However, it remains unclear how the presence or degree of twist affects the mechanical function of the lower limbs. Here, using finite element models of the Achilles tendon with and without twist, we show that the presence and degree of twist can modulate the forces transmitted from muscle to skeleton in a complex manner. In contrast to the model without twist, the twisted models clearly exhibit anterolaterally directed horizontal forces at the distal end under a simple proximal tensile load. The lateral and anterior components reach approximately 101 N and 63 N, respectively. Furthermore, the twisted structure induces inter-subtendon force transmission, and the magnitude of the transmitted force increases with increasing degree of twist. These results indicate that the uniaxial contractile force generated by the triceps surae is transformed into triaxial forces by the twisted Achilles tendon and is redistributed in a complex three-dimensional manner through inter-subtendon interactions.No potential conflict of interest relevant to this article was reported.WileyActa Medica Okayama2090-6447202612026Carcinoma ex Pleomorphic Adenoma With an Epithelial‐Myoepithelial Carcinoma Component in the Submandibular Gland: A Case ReportENTomohiroYasuharaDepartment of Oral and Maxillofacial Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityMasanoriMasuiDepartment of Oral and Maxillofacial Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityYukiKunisadaDepartment of Oral and Maxillofacial Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityHiroakiTakakuraDepartment of Oral and Maxillofacial Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityEijiIwataDepartment of Oral and Maxillofacial Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKoichiKadoyaDepartment of Oral and Maxillofacial Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKokiUmemoriDepartment of Oral and Maxillofacial Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityNorieYoshiokaDepartment of Oral and Maxillofacial Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKeisukeNakanoDepartment of Oral Pathology and Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversitySoichiroIbaragiDepartment of Oral and Maxillofacial Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityBackground: Carcinoma ex pleomorphic adenoma (CXPA) is an uncommon malignant salivary gland tumor arising from pleomorphic adenoma, whereas epithelial-myoepithelial carcinoma (EMC) is a rare low-grade salivary gland malignancy. CXPA with an EMC component in the submandibular gland is uncommon.<br>
Case Report: A 65-year-old man presented with a painless, firm mass in the left submandibular region and weakness of the left lower lip. Computed tomography and magnetic resonance imaging demonstrated an irregular submandibular mass, and FDG-PET/CT showed increased uptake (maximum standardized uptake value, 9.2). Core biopsy suggested pleomorphic adenoma; however, the clinical and radiological findings strongly indicated malignancy. Incisional biopsy was therefore performed under general anesthesia, with a plan to proceed to definitive treatment if malignancy was confirmed. Intraoperative histopathological examination revealed a malignant salivary gland tumor, and tumor resection with neck dissection was completed during the same procedure. Histopathological examination showed invasive CXPA with an EMC component, accompanied by extracapsular invasion exceeding 6 mm, perineural invasion, and extension into adjacent muscle (pT3N0). Although surgical margins were negative, pulmonary metastases developed 12 months after surgery, followed by suspected pleural dissemination and spinal canal extension. The patient declined further aggressive treatment and died of the disease 48 months after surgery.<br>
Conclusion: This case highlights the importance of integrating clinical, radiological, and pathological findings for accurate diagnosis of salivary gland tumors, particularly when biopsy results are inconsistent with clinical suspicion.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama0914-50878752026Cardio-ankle vascular index as a screening tool for coronary artery disease in patients with metabolic dysfunction-associated steatotic liver disease429433ENMitsutakaNakashimaDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToruMiyoshiDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYutaUekiDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakahiroNishiharaDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakashiMikiDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShoheiHaraDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKeishiIchikawaDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKazuhiroOsawaDepartment of General Internal Medicine 3, Kawasaki Medical School General Medicine CentreShinsukeYuasaDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesBackground: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common hepatic disorder that significantly increases cardiovascular risk. However, no established screening method exists for detecting subclinical coronary artery disease (CAD) in this high-risk population. The cardio-ankle vascular index (CAVI), a blood pressure–independent measure of arterial stiffness, may offer a non-invasive tool for early detection of coronary atherosclerosis.<br>
Methods: We retrospectively analyzed 295 patients with MASLD who underwent both CAVI measurement and coronary computed tomography angiography at a single center. Significant CAD was defined as ≥50 % luminal stenosis. Receiver operating characteristic (ROC) analysis was used to evaluate diagnostic performance. Multivariable logistic regression was performed to identify independent associations between elevated CAVI and CAD. The incremental predictive value of CAVI was assessed using net reclassification improvement (NRI).<br>
Results: Of the 295 patients, 110 (37.3 %) had significant CAD. Patients with CAD had significantly higher CAVI values (9.0 vs. 8.7, p = 0.007). The area under the ROC curve for CAVI predicting CAD was 0.614. A CAVI cut-off of 8.6 provided a sensitivity of 66.4 % and a specificity of 56.8 %. CAVI ≥8.0 was independently associated with CAD (OR 3.44, 95 % CI: 1.06–11.2, p = 0.040). Adding CAVI to a conventional risk model improved risk reclassification (NRI 0.4236, p < 0.001), although the C-statistic change was not significant (from 0.724 to 0.725, p = 0.835).<br>
Conclusions: CAVI is independently associated with significant coronary stenosis in MASLD patients and may serve as a non-invasive screening tool to enhance cardiovascular risk stratification. Its moderate diagnostic accuracy suggests utility as a component of a multifactorial risk assessment strategy.No potential conflict of interest relevant to this article was reported.American Society of Tropical Medicine and HygieneActa Medica Okayama0002-963711432026A Case of Heavy Paragonimiasis Involving a Multi-Organ Presentation with Hypereosinophilia and Hepatic Migration486489ENHidemasaAkazawaDepartment of Infectious Diseases, Okayama University HospitalHideharuHagiyaDepartment of Infectious Diseases, Okayama University HospitalShinnosukeFukushimaDepartment of Infectious Diseases, Okayama University HospitalKentaNakamotoDepartment of Infectious Diseases, Okayama University HospitalKoheiOguniDepartment of Infectious Diseases, Okayama University HospitalYoheiManabeDepartment of Pharmacy, Okayama University HospitalMioKokubo-TanakaDivision of Parasitology, Department of Infectious Diseases, Faculty of Medicine, University of MiyazakiHaruhikoMaruyamaDivision of Parasitology, Department of Infectious Diseases, Faculty of Medicine, University of MiyazakiFumioOtsukaDepartment of General Medicine, Okayama University HospitalParagonimiasis is a parasitic disease caused by the genus Paragonimus, typically transmitted through the ingestion of raw or undercooked freshwater crabs. Although pulmonary involvement is typical, ectopic migration to subcutaneous or hepatic sites is rare and poses diagnostic challenges. A case of paragonimiasis in a 29-year-old Cambodian woman residing in Japan who presented with painless subcutaneous nodules on the chest and abdomen is reported in the current study. She had consumed raw crab 4 months before presentation. Laboratory findings revealed marked eosinophilia (21,000/µL) and elevated immunoglobulin E (5,049 IU/mL). Computed tomography scans revealed pleural effusion, club-shaped pulmonary consolidation, funicular hypodense lesions in the liver, and subcutaneous lesions. Stool and sputum test results were negative for parasite eggs; however, a microplate ELISA indicated a Paragonimus westermani infection. The patient responded well to 3 consecutive days of praziquantel (75 mg/kg/day) and was discharged a week later. This case highlights the importance of considering paragonimiasis in patients with unexplained subcutaneous nodules and eosinophilia, especially when supported by dietary risk factors.No potential conflict of interest relevant to this article was reported.WileyActa Medica Okayama2090-6447202612026A Rare Case of Hyperplastic Dental Follicle Presenting With an Unusually Large Radiolucent Area2879891ENSatoshiOtsukiDepartment of Oral and Maxillofacial Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityYukiKunisadaDepartment of Oral and Maxillofacial Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKoichiKadoyaDepartment of Oral and Maxillofacial Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityChizuruKobayashiDepartment of Oral and Maxillofacial Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKeisukeNakanoDepartment of Oral Pathology and Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityToshiyukiKawazuDepartment of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversitySoichiroIbaragiDepartment of Oral and Maxillofacial Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityHyperplastic dental follicle (HDF) is a rare odontogenic hamartomatous lesion typically associated with unerupted teeth in children and adolescents and is often found incidentally on radiographic imaging. HDF usually presents as a pericoronal radiolucency of 2–3 mm in diameter and is commonly difficult to distinguish from dentigerous cysts on radiographs. We report an unusual case of HDF in an 11-year-old male who was referred for evaluation of delayed eruption of the left maxillary canine. Panoramic radiography and cone-beam computed tomography (CBCT) revealed a remarkably large radiolucent area, with a maximum dimension of 25.3 mm. The initial clinical diagnosis was a dentigerous cyst; however, incisional biopsy revealed solid tissue characteristics, and histopathological examination confirmed HDF, with no evidence of cystic lining, neoplastic transformation, or inflammation. Following the patient′s and parents′ preference for complete removal, resection of the lesion together with extraction of the impacted canine was performed under general anesthesia. At the 6-month follow-up, no recurrence was observed and bone regeneration was confirmed on radiographic examination. This case underscores the diagnostic challenge posed by atypical radiographic findings and highlights the necessity of histopathological confirmation. Given the exceptional size and potential for recurrence, long-term follow-up is warranted.No potential conflict of interest relevant to this article was reported.Institute of Electrical and Electronics Engineers (IEEE)Acta Medica Okayama2187-01361412025Study of Signal Separation and Demodulation Techniques Considering IQ Imbalance by Stored Data Batch Signal Processing3033ENYudaiMitaGraduate School of Natural Science and Technology, Okayama UniversityYutaHiraokaGraduate School of Natural Science and Technology, Okayama UniversityTomofumiHikasaGraduate School of Natural Science and Technology, Okayama UniversityShigeruTomisatoGraduate School of Natural Science and Technology, Okayama UniversitySatoshiDennoGraduate School of Natural Science and Technology, Okayama UniversityKazuhiroUeharaGraduate School of Natural Science and Technology, Okayama UniversityWith the arrival of the IoT era, the problem of interference has become even more serious, and the challenge is to establish techniques for separating and demodulating collide signals. To achieve this, we are conducting research on stored data batch signal processing technology using short-time Fourier transform (STFT). In this paper, we used a feature quantity demodulation method proposed as a method for stored data batch signal processing to evaluate the effect of IQ imbalance, which is a factor in signal degradation in the transmitter, on signal separation and demodulation performance. Furthermore, we proposed a receiver configuration that estimates the amount of degradation due to IQ imbalance from the extracted feature quantities and compensates for the signal degradation. Computer simulation results confirmed that the proposed compensation method can improve signal separation and demodulation performance when degraded by IQ imbalance.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1478-63622712025Performance of the modified 2022 ACR/EULAR giant cell arteritis classification criteria without age restriction for discriminating from Takayasu arteritis19ENTakahikoSugiharaDepartment of Rheumatology, Graduate School of Medical and Dental Sciences, Institute of Science TokyoMasayoshiHarigaiDivision of Rheumatology, Department of Internal Medicine, Tokyo Women’s Medical University School of MedicineHaruhito A.UchidaDepartment of Chronic Kidney Disease and Cardiovascular Disease, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of MedicineHajimeYoshifujiDepartment of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto UniversityYasuhiroMaejimaDepartment of Cardiovascular Medicine, Graduate School of Medical and Dental Sciences, Institute of Science TokyoJunIshizakiDepartment of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Graduate School of MedicineYoshikoWatanabeDepartment of General Medicine, Kawasaki Medical SchoolHiroakiDobashiDivision of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa UniversityYoshinoriKomagataDepartment of Nephrology and Rheumatology, Kyorin University School of MedicineNaotoTamuraDepartment of Internal Medicine and Rheumatology, Juntendo University School of MedicineYoshikazuNakaokaDepartment of Vascular Physiology, National Cerebral and Cardiovascular Center Research InstituteJapan Research Committee of the Ministry of Health, Labour, and Welfare for Intractable Vasculitis (JPVAS)Objective To evaluate the ability to discriminate giant cell arteritis (GCA) from Takayasu arteritis (TAK) according to the modified 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) GCA classification criteria.<br>
Methods Patients enrolled in the Japanese nationwide retrospective registry were evaluated using the criteria with partial modification; wall thickening of descending thoracic-abdominal aorta were mainly diagnosed by contrast-enhanced computed tomography (CT) or magnetic resonance imaging instead of evaluating with positron emission tomography (PET)-CT. The discriminability of the criteria was evaluated using C-statistic (> 0.7: good ability).<br>
Results Newly diagnosed patients with GCA (n = 139) and TAK (n = 129) were assessed, and 23.3% of TAK were aged 50 years or older at onset. The sensitivity of the modified 2022 ACR/EULAR GCA classification criteria with a score ≥ 6 was 82.0%, 68.5%, and 32.1% in all GCA, GCA with large-vessel involvement, and GCA without cranial arteritis, respectively. The specificity of the modified criteria was 96.1% for the 129 TAK as controls. Five patients with late-onset TAK met the modified criteria, and four had cranial signs and symptoms, two had bilateral axillary artery involvement, and four had descending thoracic-abdominal aorta involvement. The discriminability of the criteria was good (C-statistic: 0.986, 95% confidence interval [CI]: 0.976–0.996) and remained good after excluding age (C-statistic: 0.927, 95% CI: 0.894–0.961). The discriminability of a set of large-vessel lesions (bilateral axillary artery and descending thoracic-abdominal aorta) and inflammatory markers was markedly decreased with poor C-statistic value (C-statistic: 0.598, 95% CI: 0.530–0.667). Discriminability was improved after adding polymyalgia rheumatica (PMR) (C-statistic: 0.757, 95% CI: 0.700–0.813) or age (C-statistic: 0.913, 95%CI: 0.874–0.951) to the set of large-vessel lesions. In GCA patients with a score ≤ 5, 52% had bilateral subclavian and/or axillary artery involvement.<br>
Conclusion The modified 2022 ACR/EULAR GCA classification criteria well performed in classifying GCA and TAK without PET-CT in routine clinical practice. A set of items included in the modified GCA classification criteria had good discriminative ability for GCA and TAK, even when age was excluded. However, age restriction or PMR was required to distinguish GCA without cranial lesions from TAK.No potential conflict of interest relevant to this article was reported.American Society for Clinical InvestigationActa Medica Okayama1558-8238136102026Spatial single-cell proteotyping reveals immunotherapy-resistant features within the complex tumor microenvironment of metastatic NSCLCe195021ENKohsukeIsomotoDepartment of Medical Oncology, Kindai University Faculty of MedicineKojiHarataniDepartment of Medical Oncology, Kindai University Faculty of MedicineTakahiroTsujikawaDepartment of Otolaryngology–Head and Neck Surgery, Kyoto Prefectural University of MedicineShutaTomidaCenter for Comprehensive Genomic Medicine, Okayama University HospitalYusukeMakutaniDepartment of Surgery, Kindai University Faculty of MedicineMasayukiTakedaDepartment of Medical Oncology, Kindai University Faculty of MedicineKimioYonesakaDepartment of Medical Oncology, Kindai University Faculty of MedicineKaoruTanakaDepartment of Medical Oncology, Kindai University Faculty of MedicineTsutomuIwasaDepartment of Medical Oncology, Kindai University Faculty of MedicineKazukoSakaiDepartment of Genome Biology, Kindai University Faculty of MedicineKazutoNishioDepartment of Genome Biology, Kindai University Faculty of MedicineAkihikoItoDepartment of Pathology, Kindai University Faculty of MedicineKazuhikoNakagawaDepartment of Medical Oncology, Kindai University Faculty of MedicineHidetoshiHayashiDepartment of Medical Oncology, Kindai University Faculty of MedicineBACKGROUND. Immune checkpoint inhibitors (ICIs) targeting the programmed cell death 1 axis have revolutionized metastatic non–small cell lung cancer (mNSCLC) treatment. However, disease progression remains a concern, and the role of the complex tumor microenvironment (TME) in treatment failure is not fully understood.<br>
METHODS. In this biomarker study involving 103 patients with mNSCLC, including 81 patients who received ICI treatment, we evaluated the association between heterogeneous immune cell subsets and ICI efficacy through single-cell spatial profiling of pretreatment tumor tissue, using a 29-marker multiplex IHC platform built for in-depth dissection of the TME.<br>
RESULTS. Among various types of intratumoral lymphocytes, including Th1, Treg, and NK cells, only CD8+ T cells (tumor-infiltrating lymphocytes [TILs]) were associated with ICI efficacy. Computational tissue segmentation underscored the importance of direct physical interactions between CD8+ TILs and cancer cells for ICI efficacy. TIL phenotyping identified CD39/CD103/Ki-67 positivity as a hallmark of exhausted yet functional tumor-reactive CD8+ TILs. Immunosuppressive tumor-associated macrophages (TAMs) and cancer-associated fibroblasts were independent unfavorable adversaries. High CD73 expression on cancer cells was suggested to confer tolerance to ICI in EGFR/ALK-oncogene+ NSCLC, potentially through M2-TAM accumulation and aberrant angiogenesis.<br>
CONCLUSION. Our study delineates the clinical relevance of heterogeneous immune cell subsets in ICI-treated mNSCLC, aiding the development of targeted therapeutic strategies.No potential conflict of interest relevant to this article was reported.Georg Thieme Verlag KGActa Medica Okayama0013-726X57042024Efficacy and safety of endoscopic ultrasonography-guided ethanol injections of small pancreatic neuroendocrine neoplasms: a prospective multicenter study321329ENKazuyukiMatsumotoGastroenterology and Hepatology, Okayama University HospitalHironariKatoGastroenterology and Hepatology, Okayama University HospitalTakaoItoiGastroenterology and Hepatology, Tokyo Medical UniversityMasayukiKitanoSecond Department of Internal Medicine, Wakayama Medical UniversityKazuoHaraGastroenterology, Aichi Cancer Center HospitalMasakiKuwataniGastroenterology and Hepatology, Hokkaido University HospitalMamoruTakenakaGastroenterology and Hepatology, Kindai University Faculty of Medicine Graduate School of Medical SciencesReikoAshidaSecond Department of Internal Medicine, Wakayama Medical UniversityShuntaroMukaiGastroenterology and Hepatology, Tokyo Medical UniversityNozomiOkunoGastroenterology, Aichi Cancer Center HospitalKazumichiKawakuboGastroenterology and Hepatology, Hokkaido University HospitalTatsuhiroYamazakiGastroenterology and Hepatology, Okayama University HospitalJunSakuraiCenter for Innovative Clinical Medicine, Okayama University HospitalYukiNakatsukaCenter for Innovative Clinical Medicine, Okayama University HospitalMichihiroYoshidaCenter for Innovative Clinical Medicine, Okayama University HospitalMotoyukiOtsukaGastroenterology and Hepatology, Okayama University HospitalBackground Endoscopic ultrasonography (EUS)-guided ethanol injection (EI) has recently been introduced as one of the management strategies for pancreatic neuroendocrine neoplasms (PNENs); however, its role as a surgical alternative is unclear. We evaluated the efficacy and safety of EUS-EI in treating small PNENs through a prospective multicenter study.<bR>
Methods Patients with grade 1 tumors of ≤15 mm confirmed by pathology were included. The primary end point assessed efficacy and safety, measuring complete ablation using computed tomography at 1 and 6 months, prevention of adverse events (AEs) within 1 month, severe pancreatic fistula at 1 month, and incidence/worsening of diabetes mellitus (DM) at 6 months. The composite end point of EUS-EI was compared with that of historical results of a study based on surgical treatment.<br>
Results 25 patients with PNENs, with a median tumor size of 10.1 mm, were treated using EUS-EI. The composite primary end point was achieved by 76.0% of patients (19/25; 95%CI 54.9%–90.6%), a proportion significantly higher than that of surgical treatment (P = 0.008). Regarding efficacy, 88.0% (22/25) of patients achieved complete ablation at 1 and 6 months (95%CI 68.8%–97.5%). Regarding safety, 96.0% (24/25) of patients had no severe AEs within 1 month (95%CI 79.7%–99.9%). No patients had severe pancreatic fistulas at 1 month, and 84.0% (21/25) had no incidence or exacerbation, or both, of DM at 6 months (95%CI 63.9%–95.5%).<br>
Conclusion EUS-EI is safe and could be a potent treatment option for patients with small PNENs.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama0911-60284042024Central dentinogenic ghost cell tumor of the maxilla: a case report with new imaging findings and review of the literature561568ENSuzukaYoshidaDepartment of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYoheiTakeshitaDepartment of Oral and Maxillofacial Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityToshiyukiKawazuDepartment of Oral and Maxillofacial Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityMikiHisatomiDepartment of Oral and Maxillofacial Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityShunsukeOkadaDepartment of Oral and Maxillofacial Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityMamikoFujikuraDepartment of Oral and Maxillofacial Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKyoichiObataDepartment of Oral and Maxillofacial Surgery, Okayama University HospitalKiyofumiTakabatakeDepartment of Oral Pathology and Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversitySaoriYoshidaPreliminary Examination Room, Okayama University HospitalJunichiAsaumiDepartment of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesA dentinogenic ghost cell tumor (DGCT) is a rare benign odontogenic tumor that commonly shows characteristics of solid proliferation and has a relatively high risk of recurrence after surgical treatment. We herein report a case of a central DGCT that occurred in the maxilla and resulted in bone expansion. This study highlights new imaging findings (particularly magnetic resonance imaging) along with histopathological observations. In addition, we conducted a review of the existing literature on this rare tumor. A 37-year-old man developed swelling around the right cheek. A benign odontogenic tumor such as ameloblastoma was suspected based on the imaging examination findings (including bone expansion and the internal characteristics of the tumor) on panoramic imaging, computed tomography, and magnetic resonance imaging. The lesion was surgically excised from the right maxilla. Postoperative histopathological examination led to a definitive diagnosis of central DGCT. The tumor comprised epithelial neoplastic islands, resembling ameloblastoma, inside tight fibroconnective tissue; masses of ghost cells and formation of dentin were also observed. We had suspected that the minute high-density region around the molars on the imaging examinations represented alveolar bone change; however, it represented dentin formation. This led to difficulty diagnosing the lesion. Although DGCT may present characteristic findings on imaging examinations, its occurrence is infrequent, and in some cases, the findings may include the presence or absence of an impacted tooth without obvious calcification. The present case suggests that we should consider the possibility of an odontogenic tumor with calcification when high-density structures are observed inside the lesion.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1279-851746102024Radiological assessment of the dissection area in supraomohyoid neck dissection16431652ENYoheiTakeshitaDepartment of Oral and Maxillofacial Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityJoeIwanagaClinical Anatomy Research Association in Oral and Maxillofacial SurgeryYoshioOhyamaClinical Anatomy Research Association in Oral and Maxillofacial SurgerySoichiroIbaragiDepartment of Oral and Maxillofacial Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityYukiMatsushitaClinical Anatomy Research Association in Oral and Maxillofacial SurgeryR. ShaneTubbsClinical Anatomy Research Association in Oral and Maxillofacial SurgeryNorioKitagawaClinical Anatomy Research Association in Oral and Maxillofacial SurgeryToshiyukiKawazuMikiHisatomiDepartment of Oral and Maxillofacial Radiology, Okayama University HospitalShunsukeOkadaDepartment of Oral and Maxillofacial Radiology, Okayama University HospitalMamikoFujikuraDepartment of Oral and Maxillofacial Radiology, Okayama University HospitalJunichiAsaumiDepartment of Oral and Maxillofacial Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityPurpose The current supraomohyoid neck dissection (SOHND) is performed above the omohyoid muscle to dissect levels I, II, and III in the levels of cervical lymph nodes. However, the anatomical boundary between levels III and IV is the inferior border of the cricoid cartilage. We investigated the anatomical relationship between the omohyoid muscle and cricoid cartilage using contrast-enhanced CT (CE-CT) images to assess the validity of the current SOHND.<br>
Methods CE-CT images of the head and neck regions in patients were reviewed. The patients were divided into two groups: “malignant tumors” and “others”. The vertebral levels corresponding to the positions of anatomical structures such as the intersection of the omohyoid muscle and internal jugular vein (OM-IJ), and the inferior border of the cricoid cartilage (CC), were recorded.<br>
Results The OM-IJ was located around the seventh cervical to the first thoracic vertebra. There was a significant difference between the malignant tumor and others groups in females (p = 0.036). The CC was located around the sixth to seventh cervical vertebrae. There was a significant sex difference in each group (malignant tumor: p < 0.0001; others: p = 0.008). Both sexes tended to have lower OM-IJ than CC, and females had significantly lower OM-IJ than males.<br>
Conclusion This study provides clear anatomical evidence showing the difference between the SOHND dissection area and levels I, II, and III. It could be considered that in most cases SOHND invades level IV, not just levels I, II, and III, especially in female patients.No potential conflict of interest relevant to this article was reported.Department of Mathematics, Faculty of Science, Okayama UniversityActa Medica Okayama0030-15666812026The Dijkgraaf-Witten invariants from second Chern classes6375ENTakefumiNosakaDepartment of Mathematics, Tokyo Institute of TechnologyGiven a 3-cocycle ψ in the cohomology of a finite group G, we can define the Dijkgraaf-Witten invariant of closed 3-manifolds. In this paper, we focus on the case where ψ is a 3-cocycle systematically transferred from the second Chern class of a complex representation of G, and show some procedures for computing the invariant, and clarify its topological interpretation under some conditions.No potential conflict of interest relevant to this article was reported.Oxford University Press (OUP)Acta Medica Okayama2056-3426122025Optimizing β-TCP with E-rhBMP-2-infused fibrin for vertical bone regeneration in a mouse calvarium modelrbae144ENKunZhaoDepartment of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMitsuakiOnoDepartment of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesXindiMuDepartment of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesZiyiWangDepartment of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShichaoXieDepartment of Biomaterials, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTomokoYonezawaDepartment of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMasahiroOkadaDivision of Dental Biomaterials, Tohoku University Graduate School of DentistryTakuyaMatsumotoDepartment of Biomaterials, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakuoKubokiDepartment of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToshitakaOohashiDepartment of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesEffective reconstruction of large bone defects, particularly in thickness, remains one of the major challenges in orthopedic and dental fields. We previously produced an Escherichia coli-based industrial-scale GMP-grade recombinant human bone morphogenetic protein-2 (E-rhBMP-2) and showed that the combination of E-rhBMP-2 with beta-tricalcium phosphate (β-TCP/E-rhBMP-2) can effectively promote bone reconstruction. However, the limited mechanical strength and poor morphology retention of β-TCP granules are key points that need optimization to obtain more effective grafts and further expand its clinical applications. Therefore, we combined β-TCP/E-rhBMP-2 with fibrin gel to enhance its mechanical properties and usability for vertical bone regeneration. We investigated the mechanical properties and vertical bone regeneration effects of the materials applied, with or without fibrin containing E-rhBMP-2, in a calvarial defect model in mice. Compression tests were conducted to assess the initial stability of the materials. Scanning electron microscopy and Fourier transform infrared spectroscopy were conducted to characterize the presence of fibrin on the scaffold. After 4 and 12 weeks of implantation, micro-computed tomography and histological and immunofluorescent analyses were performed to assess the morphology and volume of the newly formed bone. The fibrin-containing groups had significantly higher initial mechanical strength and higher ability to maintain their morphology in vivo compared to the counterparts without fibrin. However, fibrin gel alone suppressed the bone formation ability of β-TCP/E-rhBMP-2 whereas the presence of high doses of E-rhBMP-2 in fibrin gel resulted in material resorption and enhanced new bone formation. In conclusion, fibrin gel significantly improved the mechanical strength and surgical manageability of the β-TCP/E-rhBMP-2 scaffold, and the addition of E-rhBMP-2 to the fibrin gel further enhanced the vertical bone regeneration and initial structural integrity of the scaffold.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama0969-80432362026An algorithm to calculate physical density of biomedical objects having 3 ≤ Zeff ≤ 20: an application study using clinical photon-counting computed tomography equipment112768ENHiroakiHayashiCollege of Transdisciplinary Sciences for Innovation, Kanazawa UniversityRinaNishigamiGraduate School of Medical Sciences, Kanazawa UniversityTakashiAsaharaDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityNatsumiKimotoDepartment of Radiological Science, Faculty of Health Sciences, Junshin Gakuen UniversityDaikiKobayashiGraduate School of Medical Sciences, Kanazawa UniversityManaMitaniDivision of Radiological Technology, Medical Support Department, Okayama University HospitalNoriakiAkagiDivision of Radiological Technology, Medical Support Department, Okayama University HospitalFumiyoHigakiDepartment of Radiology, Medical Development Field, Okayama UniversityToshihiroIguchiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityRecently, photon-counting computed tomography (PC-CT) devices have become clinically available for X-ray diagnosis, and developments of analysis algorithms to generate various quantitative images have focused attention. This study proposes an algorithm to calculate the effective physical density (ρeff) of biological objects having an effective atomic number (Zeff) of 3–20. In our procedure, ρeff was determined when fitting the interaction cross sections (σs) to the measured linear attenuation coefficients (μs), which were determined from virtual monochromatic images (VMIs). In this process, the Zeff was analyzed in advance, and this information was fed back to the ρeff analysis. A key feature of our procedure is that it does not require calibration processes based on specific substances, which allow us to analyze any substance without making assumptions.<br>
To validate the availability of the proposed algorithm, we conducted an experiment using a clinical PC-CT scanner. A multi-energy CT phantom, a water phantom, an in-house low-density phantom, food samples, and a chest phantom were scanned. The results showed that our procedure can calculate ρeff of water with an uncertainty of 4.5%. The academic significance of the present research results lies in demonstrating that the factors contributing to contrast, previously obtained from CT values, can be physically interpreted using information from Zeff and ρeff. This analysis cannot be performed with conventional single-energy CT scanners and is possible with PC-CT and dual-energy CT scanners. Our novel procedure is expected to provide useful additional information in X-ray diagnosis.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X8032026Determination of the Side Responsible for Bilateral Pneumothorax due to Pleural Communication225228ENKenSuzawaDepartment of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHaruchikaYamamotoDepartment of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKumiNakajimaDepartment of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShinTanakaDepartment of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHidejiroTorigoeDepartment of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKazuhikoShienDepartment of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKentarohMiyoshiDepartment of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMikioOkazakiDepartment of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesSeiichiroSugimotoDepartment of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShinichiToyookaDepartment of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesCase Report10.18926/AMO/70859Simultaneous bilateral spontaneous pneumothorax associated with pleuro-pleural communication is a rare but potentially life-threatening condition, most commonly occurring after major thoracic surgery. We report the case of an 81-year-old man with severe emphysema and a history of esophagectomy who presented with sudden-onset dyspnea. Chest computed tomography revealed bilateral pneumothorax with pleuro-pleural communication. Although bilateral chest tube drainage was performed, the primary side of air leakage could not be identified preoperatively. After induction of general anesthesia, a double-lumen endotracheal tube clamping test identified the right pleural cavity as the source of air leakage, thereby enabling appropriate thoracoscopic surgery.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X8032026Common Bile Duct Stone Formed Around an Ingested Fish Bone219223ENKaitaroHigashiDepartment of Gastroenterological Surgery, Kochi Health Sciences CenterMotoyasuTabuchiDepartment of Gastroenterological Surgery, Kochi Health Sciences CenterShinyaSakamotoDepartment of Gastroenterological Surgery, Kochi Health Sciences CenterShutaTamuraDepartment of Gastroenterological Surgery, Kochi Health Sciences CenterSunaoUemuraDepartment of Gastroenterological Surgery, Kochi Health Sciences CenterTeppeiTokumaruDepartment of Gastroenterological Surgery, Kochi Health Sciences CenterTakehiroOkabayashiDepartment of Gastroenterological Surgery, Kochi Health Sciences CenterCase Report/10.18926/AMO/70858An 86-year-old man presented with epigastric pain. He had previously undergone distal gastrectomy with Roux-en-Y reconstruction. Computed tomography (CT) revealed a 32×17 mm common bile duct (CBD) stone with an internal 20 mm linear hyperdense component. Endoscopic removal was unsuccessful due to the size and impaction of the stone. Open choledochotomy retrieved multiple stones and a calcified fish bone, which was confirmed by infrared spectroscopy using the potassium bromide (KBr) wafer method. Although fish bone ingestion is relatively common, this case highlights that such foreign bodies can occasionally serve as a nidus for CBD stone formation, leading to unexpected and clinically significant pathologies. When CT demonstrates a linear high-attenuation intraductal structure, clinicians should suspect a bone fragment and follow a stepwise approach, considering early surgical intervention when endoscopic extraction is unsuccessful or likely to be challenging.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X8032026Evaluation of Bone Mineral Density and Bone Structure in the Cervical and Thoracic Spine203212ENShingoAoyamaDepartment of Orthopedic Surgery, Kindai University HospitalTerumasaIkedaDepartment of Orthopedic Surgery, Kindai University HospitalNobuhitoNangoRatoc System Engineering Co., Ltd.KojiGotoDepartment of Orthopedic Surgery, Kindai University HospitalOriginal Article/10.18926/AMO/70856Dropped head syndrome, which has been increasingly reported in recent years, requires correction of cervical kyphosis and may require long-range fixation extending from the cervical to the thoracic spine. Assessing vertebral bone structure may be important for preventing instrumentation failure in the upper thoracic spine, which is a potential complication of surgery. In this study, we evaluated volumetric bone mineral density, trabecular bone porosity, and cortical calcification in the cervical and upper thoracic spine using three-dimensional (3D) trabecular structure measurement software. The study included 79 patients with cervical spine disorders who underwent various surgical procedures and preoperative imaging, including dual-energy X-ray absorptiometry and computed tomography (CT) scans from C3 to Th3. Quantitative analysis using specialized software assessed volumetric bone mineral density and trabecular and cortical bone parameters, and statistical analyses were performed to examine correlations between imaging metrics and indicators of bone fragility. Two-dimensional CT evaluation revealed different trends between cancellous and cortical bone in the cervical and thoracic spine, suggesting that detailed 3D evaluation may also be important.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X8032026HIP COMPASS®: A Mechanical Intraoperative Navigation Guide Associated with Improved Revision-Free Implant Survivorship after Ceramic-on-Ceramic Total Hip Arthroplasty at Minimum 10-Year Follow-up195202ENYoshiakiTeiDivision of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental SciencesNorioImaiDivision of Comprehensive Musculoskeletal Medicine, Niigata University Graduate School of Medical and Dental SciencesKeishiKimuraDivision of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental SciencesYukiHiranoDivision of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental SciencesYojiHorigomeDivision of Comprehensive Musculoskeletal Medicine, Niigata University Graduate School of Medical and Dental SciencesKenSudaDivision of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental SciencesHiroyukiKawashimaDivision of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental SciencesOriginal Article/10.18926/AMO/70855HIP COMPASS® has demonstrated improved accuracy in intraoperative support for the acetabular component insertion angle. We assessed long-term revision-free implant survivorship following total hip arthroplasty (THA) using HIP COMPASS, with ≥10 years of follow-up. We retrospectively analyzed 210 hips of 186 patients who underwent cementless THA with ceramic-on-ceramic bearing couples, with or without HIP COMPASS. The mean follow-up duration was 10.8 years in the HIp COMPASS group and 12.7 years in the control group. Overall, 86.0% and 78.2% of cups were placed within Lewinnek’s safe zone with and without HIP COMPASS, respectively. Variability in radiographic inclination and anteversion was greater in the control group than in the HIP COMPASS group. Dislocation rates were 3.2% in the control group and 1.2% in the HIP COMPASS group, with no significant difference between groups. The control group had a significantly higher revision rate than the HIP COMPASS group (7.3% vs. 1.2%). Use of HIP COMPASS was associated with improved long-term revision-free implant survivorship over ≥ 10 years and more consistent acetabular component positioning at an appropriate insertion angle, which may contribute to stable initial fixation.No potential conflict of interest relevant to this article was reported.MDPI AGActa Medica Okayama1422-006727112026Genomic Basis of Lifestyle Divergence in Rice-Associated Burkholderia: From Pathogenesis to Plant Growth Promotion4730ENAndrews DansoOforiState Key Laboratory of Crop Gene Exploration and Utilization in Southwest China, Sichuan Agricultural UniversityZohrehNasimiState Key Laboratory of Crop Gene Exploration and Utilization in Southwest China, Sichuan Agricultural UniversityFrank KwekucherAckahDepartment of Crop Science, School of Agriculture and Natural Sciences, University of Cape CoastMuhammad IrfanAhmedState Key Laboratory of Crop Gene Exploration and Utilization in Southwest China, Sichuan Agricultural UniversityYaotingYanState Key Laboratory of Crop Gene Exploration and Utilization in Southwest China, Sichuan Agricultural UniversityWangLiState Key Laboratory of Crop Gene Exploration and Utilization in Southwest China, Sichuan Agricultural UniversityAbdul GhaniKandroState Key Laboratory of Crop Gene Exploration and Utilization in Southwest China, Sichuan Agricultural UniversityKazunoriOkadaAgro-Biotechnology Research Center, The University of TokyoKeiichiMochidaBioproductivity Informatics Research Team, RIKEN Center for Sustainable Resource ScienceYoshiteruNoutoshiGraduate School of Environmental and Life Science, Okayama UniversityAipingZhengState Key Laboratory of Crop Gene Exploration and Utilization in Southwest China, Sichuan Agricultural UniversityThe genus Burkholderia encompasses both plant pathogenic and beneficial species, yet the genomic determinants underlying this lifestyle divergence remain poorly understood. Using 16S rRNA sequencing of 100 rice cultivars, our companion study demonstrated that resistant varieties are enriched in beneficial Burkholderiaceae, leading to the isolation of three phenotypically contrasting strains. Here, we present comparative genomic analyses of non-pathogenic biocontrol strain Burkholderia vietnamiensis J14EpLeaf2 and pathogenic strains Burkholderia gladioli A1EpSeed5 and Burkholderia cepacia J14Eple. Pathogenic strains possess significantly larger genomes (8.36–8.46 Mb) enriched in mobile genetic elements compared to the streamlined 6.95 Mb genome of B. vietnamiensis. CAZyme analysis revealed broader repertoires of glycoside hydrolases and polysaccharide lyases in pathogens, consistent with enhanced plant cell wall degradation. B. gladioli possesses a complete T3SS and expanded T6SS with 301 predicted effectors, while B. cepacia lacks structural T3SS genes but harbors 271 candidate effectors predicted to be secreted via alternative secretion pathways, compared to 180 in B. vietnamiensis. Notably, B. cepacia harbors cystic fibrosis-associated markers (cable pili, ZmpA/ZmpB), raising significant biosafety concerns that preclude its agricultural application. LC-MS validated IAA, ornibactin, and AHL production in B. vietnamiensis, supporting its plant growth-promoting and biocontrol functions. Computational PPI networks predicted distinct interaction landscapes requiring experimental validation. This study provides a genomic framework for distinguishing pathogenic from beneficial Burkholderia and supports B. vietnamiensis as a safe biocontrol agent while cautioning against B. cepacia J14Eple.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1068-92653372026Association of Preoperative Inspiratory Muscle Weakness and Respiratory Sarcopenia with Postoperative Pneumonia Following Esophagectomy: A Multicenter Retrospective Cohort Study62966305ENKazukiOkuraDepartment of Rehabilitation Medicine, Akita University HospitalTomohiroIkedaDepartment of Rehabilitation Medicine, Okayama University HospitalHirokiSatoDepartment of Rehabilitation, Kawasaki University of Medical WelfareShoKatayamaDepartment of Rehabilitation Medicine, Okayama University HospitalYusukeTakahashiDepartment of Rehabilitation Medicine, Akita University HospitalYushiNagakiDepartment of Esophageal Surgery, Akita University HospitalAkiyukiWakitaDepartment of Esophageal Surgery, Akita University HospitalNaoakiMaedaDepartment of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityShunsukeTanabeDepartment of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityYoshinoriFujiwaraDepartment of Digestive Surgery, Kawasaki Medical SchoolKazuhiroNomaDepartment of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityYusukeSatoDepartment of Esophageal Surgery, Akita University HospitalYujiKasukawaDepartment of Rehabilitation Medicine, Akita University HospitalNaohisaMiyakoshiDepartment of Rehabilitation Medicine, Akita University HospitalBackground Esophagectomy is associated with a high rate of postoperative pneumonia, which significantly impacts patient outcomes, including survival and quality of life. While some modifiable risk factors have been identified, the specific role of preoperative respiratory muscle function remains to be fully elucidated. Therefore, this study was designed to investigate the association of preoperative inspiratory muscle weakness (IMW) and respiratory sarcopenia (RS) with postoperative pneumonia in patients with esophageal cancer who underwent esophagectomy.<br>
Methods Patients with esophageal cancer who underwent esophagectomy between July 2021 and June 2023 were enrolled in this multicenter, retrospective, cohort study. The primary outcome was postoperative pneumonia, while preoperative IMW and RS were the main exposures. Respiratory sarcopenia was defined as the presence of both IMW and low skeletal muscle mass, which is assessed by using bioelectrical impedance analysis. Associations were analyzed by using G-computation within a Bayesian framework.<br>
Results A total of 213 patients were enrolled in this study. Postoperative pneumonia occurred in 42 patients (19.7%). Preoperative IMW was strongly associated with an increased risk of pneumonia, with a mean risk difference (RD) of 18.1% (95% credible interval [CrI] 5–33.6). The posterior probability that the RD exceeds 5% was > 98%. Respiratory sarcopenia also showed a potential association, although with greater uncertainty (mean RD, 11.2%; 95% CrI − 3.8 to 27.9). The posterior probability that the RD exceeds 5% was 76.7%.<br>
Conclusions Preoperative IMW is a notable risk factor for postoperative pneumonia following esophagectomy. While a potential link with RS was found, its role remains uncertain and requires further investigation.No potential conflict of interest relevant to this article was reported.WileyActa Medica Okayama0012-1592684-52026Computer‐Aided Sperm Analysis Protocol for Evaluating Sperm Motility in Japanese Medakae70061ENMiwaKuroyanagiDepartment of Advanced Aquaculture Science, Faculty of Marine Bioscience and Technology, Fukui Prefectural UniversitySatoshiAnsaiUshimado Marine Institute, Faculty of Science, Okayama UniversityKeigoOkamotoLaboratory of Aquatic Molecular Developmental Biology, Graduate School of Bioresource and Bioenvironmental Sciences, Kyushu UniversityAiKatoInteruniversity Bio-Backup Project Center, National Institute for Basic Biology (NIBB)ToukoYamazakiLaboratory of Bioresources, National Institutes of Natural SciencesYasuhiroKameiOptics and Bioimaging Facility, NIBBEijiWatanabeBasic Biology Program, Graduate University for Advanced Studies (SOKENDAI)KiyoshiNaruseLaboratory of Bioresources, National Institutes of Natural SciencesYukikoOginoLaboratory of Aquatic Molecular Developmental Biology, Graduate School of Bioresource and Bioenvironmental Sciences, Kyushu UniversityChanges in sperm motility can serve as an early indicator of reproductive effects caused by environmental chemicals or genetic perturbations. However, sperm motility is highly sensitive to external factors such as osmolarity, ionic composition, and the timing of measurement after activation, making it challenging to obtain consistent and reproducible measurements. Here, we present a standardized protocol for assessing sperm motility in Japanese medaka (Oryzias latipes) using a sperm motility analysis system (SMAS), an application for computer-aided sperm motility analysis (CASA). This protocol details the procedures for sperm collection, activation, and quantitative motility assessment, with particular focus on changes in the percentage of motile sperm post activation and the effects of sperm cryopreservation. We demonstrate time-dependent declines in sperm motility and velocity, and highlight the importance of early post-activation measurements to accurately capture peak motility. Notably, cryopreservation significantly accelerated the decline in sperm motility rate without affecting the initial proportion of motile sperm. To enable reliable comparisons among experimental groups, we recommend standardizing the initiation time after sperm activation by using CASA, and show that measurements should be initiated within 1 min after activation to obtain consistent and reliable data. This standardized SMAS-based protocol provides a robust and reproducible framework for sperm motility analysis in medaka and will be valuable not only for studies in reproductive biology, toxicology, and environmental risk assessment but also for applied research, such as breeding of aquacultural fishes.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama0916-70054322026Machine learning prediction of the Madden–Julian oscillation using reservoir computing25ENTamakiSuematsuRIKEN Center for Computational ScienceKengoNakaiGraduate School of Environmental Life, Natural Science and Technology, Okayama UniversityTsuyoshiYonedaGraduate School of Economics, Hitotsubashi UniversityDaisukeTakasukaDepartment of Geophysics, Tohoku UniversityTakuyaJinnoGraduate School of Science, The University of TokyoYoshitakaSaikiGraduate School of Business Administration, Hitotsubashi UniversityHiroakiMiuraGraduate School of Science, The University of TokyoThe prediction of the Madden–Julian Oscillation (MJO), a massive tropical weather event with global socio-economic impacts, has been infamously difficult with physics-based weather prediction models. We employ the reservoir computing, a brain-inspired machine-learning technique, to construct a machine learning model that forecasts the real-time multivariate MJO index (RMM), a macroscopic variable that represents the state of the MJO. The training data was refined by development of a novel real-time band-pass filter that extracts the recurrency of MJO signals only from the past raw atmospheric data, and by selection of a suitable time-delay coordinate of the RMM that enhances the recurrency of the input data. The constructed model demonstrated the skill to forecast the time sequence of the RMM for a month from pre-developmental stages of the MJO. Examination of best-performing cases suggested that RMM sequences may be predicted for over two months in some cases. These results imply that inherent predictability limit of the MJO is longer than that has been estimated from physics-based weather prediction models.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1867-10712026A novel robot for CT-guided bone needle insertion with a rotational drilling and force-feedback speed control mechanism: preliminary evaluation in swineENYusukeMatsuiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityYutaKimuraDepartment of Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTakanoriSasakiCollaborative Research Center for OMIC, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityRyutaroMatsuuraDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityKojiTomitaDepartment of Radiology, Medical Development Field, Okayama UniversityNoriyukiUmakoshiDepartment of Radiology, Medical Development Field, Okayama UniversitySoichiroOkamotoDepartment of Radiology, Medical Development Field, Okayama UniversityKazuakiMunetomoDepartment of Radiology, Medical Development Field, Okayama UniversityFumiyoHigakiDepartment of Radiology, Medical Development Field, Okayama UniversityJunSakuraiCenter for Innovative Clinical Medicine, Okayama University HospitalToshihiroIguchiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityAtsushiNakazawaFaculty of Interdisciplinary Science and Engineering in Health Systems, Okayama UniversityKiyoshiMatsumiyaDepartment of Medical Technology, Faculty of Life Science, Okayama University of ScienceTakayukiMatsunoFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityTetsushiKamegawaFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityPurpose To evaluate the feasibility and accuracy of computed tomography (CT)-guided needle insertion into swine bones by using a novel robotic system capable of rotational drilling.<br>
Materials and methods This was an animal experiment using three swine. A remote-controlled robot equipped with a rotational drilling and force-feedback insertion speed control mechanism was developed for bone needle insertion. Using the robot, CT-guided insertion of a 10-gauge bone access needle was attempted in the lumbar vertebrae, ilia, and femora six times each. Needle insertion accuracy was evaluated using the angle error, which is defined as the difference between the predetermined and post-insertion needle angles on axial and sagittal CT images. The time required for needle insertion was measured. The angle error and time required for needle insertion were compared among the bones using the Kruskal–Wallis test. Adverse events were also evaluated.<br>
Results Robotic bone needle insertion was successful in all attempts. The median axial and sagittal angle errors were 0.21 and 0.21° for the lumbar vertebrae, 0.32 and 0.13° for the ilia, and 0.65 and 0.25° for the femora, respectively. Axial angle errors were significantly different among the bone types (p = 0.038). The time required for needle insertion was 23.6, 21.3, and 59.7 s for the lumbar vertebrae, ilia, and femora, respectively. Time was significantly different among bone types (p = 0.017). No adverse events were observed.<br>
Conclusion CT-guided bone needle insertion using a robot equipped with a rotational drilling and force-feedback insertion speed control mechanism was feasible and accurate in swine.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama2168-81841832026Septic Arthritis of the Temporomandibular Joint Complicated by Dislocatione105091ENHidekaKanemotoDepartment of Oral Surgery, Kochi Health Sciences CenterKyoichiObataDepartment of Oral and Maxillofacial Surgery, Okayama University Graduate School of MedicineYoheiTakeshitaDepartment of Oral and Maxillofacial Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKokiUmemoriDepartment of Oral and Maxillofacial Surgery, Okayama University Graduate School of MedicineSoichiroIbaragiDepartment of Oral and Maxillofacial Surgery, Okayama University Graduate School of MedicineSeptic arthritis of the temporomandibular joint (SATMJ) is a rare but potentially serious condition, and standardized diagnostic and therapeutic strategies have not been established. We present the case of a 70-year-old man who developed acute right temporomandibular joint (TMJ) pain, swelling, mandibular deviation, and inability to achieve mouth closure. Computed tomography and magnetic resonance imaging revealed right TMJ dislocation, joint effusion, degenerative changes, and anterior disc displacement with effusion. Aspiration of the joint yielded neutrophil-predominant purulent fluid, although bacterial cultures were negative. The patient was treated empirically with intravenous ceftriaxone followed by oral clindamycin and amoxicillin, resulting in rapid symptom resolution, and the dislocation spontaneously reduced without surgical intervention. No recurrence was observed during three months of follow-up. This case highlights the diagnostic challenges associated with culture-negative SATMJ, supports the role of early empirical antibiotic therapy, and suggests that chronic joint instability due to habitual dislocation may predispose the TMJ to infection.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1865-13801912026Pseudoaneurysm of the thoracoacromial artery associated with habitual shoulder dislocation: a case report139ENHonokaWadaDepartment of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityAyaHamasakiDepartment of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversitySoichiroOkamotoDepartment of Radiology, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityShunkiYamamotoDepartment of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityTsuyoshiNojimaDepartment of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityTetsuyaYumotoDepartment of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityAtsunoriNakaoDepartment of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityBackground Shoulder dislocation is one of the most common joint dislocations encountered in emergency departments, but vascular complications are rare and often underrecognized. Pseudoaneurysms of the thoracoacromial artery, a branch of the axillary artery, are extremely uncommon and may present with subtle symptoms, delaying diagnosis.<br>
Case presentation An 82-year-old woman with a history of habitual anterior shoulder dislocation presented with a 10-day history of progressive pain and swelling in the left shoulder. She was on edoxaban for atrial fibrillation. Examination revealed localized tenderness and swelling without neurological deficits. Computed tomography angiography showed a 30 × 35 × 35 mm pseudoaneurysm arising from the acromial branch of the thoracoacromial artery. Endovascular embolization was performed using a proximal oxidized regenerated cellulose sheet placement followed by injection of N-butyl cyanoacrylate and Lipiodol due to the risk of coil migration into the joint space. The procedure achieved complete exclusion of the lesion. At three-month follow-up, the patient remained asymptomatic with preserved left upper limb function. Computed tomography angiography demonstrated the pseudoaneurysm remains excluded.<br>
Conclusion Although rare, pseudoaneurysms of the thoracoacromial artery can occur after repeated shoulder dislocation and reduction, especially in elderly patients on anticoagulation therapy. Early recognition through imaging and prompt endovascular intervention can prevent serious vascular and neurological complications.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama0924-42474082026A flexible PVDF-based galloping flow sensor117978ENMitsukiKuroseGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityTakefumiKandaGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityYuyaSatoGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityShuichiWakimotoGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityDaisukeYamaguchiGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityShinjiHiejimaGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityTakejiUedaHydro-VENUS Co., Ltd., Okayama UniversityEffective monitoring of low flow velocities in small rivers and irrigation channels is hindered by the power requirements and maintenance costs of existing technologies. This study proposes a novel flexible piezoelectric polymer flow sensor utilizing galloping vibration to detect flow velocity in the low range (≤ 0.1 m/s). The sensor features a flexible cantilever structure composed of a silicone rubber beam embedded with a polyvinylidene fluoride (PVDF) film and a tip pillar. Unlike conventional devices based on flow-induced vibration, the use of low-stiffness materials enables the induction of self-excited vibration even under weak fluid forces. Computational fluid dynamics (CFD) analysis has been conducted to optimize the tip shape; a D-shaped semicylinder is selected over a cylinder and a square prism because the geometry maximizes the lift force per unit mass, ensuring efficient energy conversion. To predict sensor behavior, a coupled mechanical-fluid-electrical model was developed. Specifically, the model accounts for the static deflection angle caused by fluid drag. Water channel experiments demonstrated that sensors with beam thicknesses under 4 mm successfully generated stable periodic outputs at 0.1 m/s, a regime previously difficult for galloping-based devices. Conversely, thicker beam which has a thickness of 8 mm achieved higher outputs at higher velocities but failed to actuate at low speeds. Furthermore, the study showed a vibration suppression phenomenon in flexible beams at high flow velocities due to excessive static deflection, which was accurately reproduced by the analytical model. These findings establish structural stiffness as the critical design parameter for optimizing the operable velocity range of flow sensors.No potential conflict of interest relevant to this article was reported.WileyActa Medica Okayama2090-6447202612026A Case of Peripheral Odontogenic Myxofibroma Arising in the Palatal Gingiva of the Maxillary Second Premolar Region: A Case ReportENMasanoriMasuiDepartment of Oral and Maxillofacial Surgery , Faculty of Medicine , Dentistry and Pharmaceutical Sciences Okayama UniversityHirokazuYutoriDepartment of Oral and Maxillofacial Surgery , Kagawa Prefectural Central HospitalAiFujimuraDepartment of Oral and Maxillofacial Surgery , Kagawa Prefectural Central HospitalSoichiroIbaragiDepartment of Oral and Maxillofacial Surgery , Faculty of Medicine , Dentistry and Pharmaceutical Sciences Okayama UniversityOdontogenic myxofibroma (OMF) is a rare benign mesenchymal odontogenic tumor characterized by myxoid stroma with a prominent fibrous component. Although it usually arises intraosseously within the jaws, the peripheral variant, peripheral odontogenic myxofibroma (POMF), which occurs in extraosseous soft tissues, is uncommon and may be clinically misdiagnosed as a reactive gingival lesion. We report a case of POMF in a 68-year-old man who was referred for evaluation of a painless, slowly enlarging swelling of the palatal gingiva in the left maxillary second premolar region, which had initially been diagnosed as chronic periodontitis at a local clinic. An intraoral examination revealed an elastic, firm mass with partial erythema on the palatal marginal gingiva. Panoramic radiography showed mild generalized horizontal bone loss without lesion-specific changes, and computed tomography revealed no bone resorption associated with the lesion. Exfoliative cytology was negative for intraepithelial lesions or malignancy. The lesion was excised with a 5-mm clinical margin, including periosteum, and superficial peripheral ostectomy of the adjacent cortical bone was performed. Histopathological examination revealed a myxoid stroma rich in mucinous matrix and collagen fibers, containing sparsely distributed spindle-shaped cells and scattered nests of odontogenic epithelium. Alcian blue staining revealed diffuse positivity, supporting the diagnosis of POMF. No recurrence was observed during a 2-year follow-up period. This case highlights a diagnostic pitfall in the tooth-bearing gingiva and underscores the importance of histopathological confirmation of persistent gingival masses. When imaging shows no apparent bone involvement, and clinical suspicion of malignancy is low, complete excision with an adequate soft-tissue margin and selective, limited bone removal may achieve local control while preserving the adjacent teeth; long-term follow-up remains advisable.No potential conflict of interest relevant to this article was reported.WileyActa Medica Okayama0902-00634062026Risk Factors for Waiting List Mortality in Lung Transplant Candidates With Post‐Hematopoietic Stem Cell Transplantation Non‐Infectious Pulmonary Complicationse70582ENHisaoHigoDepartment of Respiratory Medicine, Okayama University HospitalSatoruSenooDepartment of Respiratory Medicine, Okayama University HospitalSatokoMakimotoDepartment of Radiology, Okayama University HospitalTomohiroNaganoDepartment of Hematology, Okayama University HospitalTakumiKondoDepartment of Hematology, Okayama University HospitalHaruchikaYamamotoDepartment of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShinTanakaDepartment of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKentarohMiyoshiDepartment of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesSeiichiroSugimotoDepartment of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShinichiToyookaDepartment of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYoshinobuMaedaDepartment of Respiratory Medicine, Okayama University HospitalYosukeTogashiDepartment of Respiratory Medicine, Okayama University HospitalNobuakiMiyaharaDepartment of Respiratory Medicine, Okayama University HospitalBackground: Late-onset non-infectious pulmonary complications (LONIPCs) following hematopoietic stem cell transplantation (HSCT) are a known indication for need of lung transplantation. This study aimed to clarify the clinical characteristics of patients with LONIPCs after HSCT who were registered for lung transplantation and reveal the risk factors for waiting list mortality.<br>
Methods: We retrospectively reviewed the clinical data of patients with LONIPCs after allogeneic HSCT who were referred to Okayama University Hospital and registered in the Japan Organ Transplant Network for deceased-donor lung transplantation between 2005 and 2023. Pediatric patients aged <18 years at the time of registration were excluded.<br>
Results: Thirty-four patients were included in this study. Notably, two distinct phenotypic groups were identified: One with a bronchiolitis obliterans pattern on high-resolution computed tomography and a mixed ventilatory defect, and the other with a pleuroparenchymal fibroelastosis pattern and a restrictive ventilatory defect. The median waiting duration for a deceased-donor lung transplant was 662 days, and 16 patients died during the waiting period. The cumulative incidence of waiting list mortality was 20.6% (95% confidence interval [CI], 8.9%–35.6%) at 1 year and 46.1% (95% CI, 27.8%–62.7%) at 3 years. A history of pneumothorax, greater dyspnea on exertion, and higher serum Krebs von den Lungen-6 levels were associated with an increased risk of waiting list mortality.<br>
Conclusion: In patients with LONIPCs after HSCT, a history of pneumothorax may be a marker of a poor prognosis and could serve as a criterion for referral of lung transplantation.No potential conflict of interest relevant to this article was reported.Fuji Technology Press Ltd.Acta Medica Okayama1883-80143032026A Verification of Relationship Between Multiplicatively Weighted Voronoi Diagram and Huff Model: A Case Study on Order Assignment in E-Commerce921930ENTakakiKawamotoFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityTakashiHasuikeDepartment of Industrial and Management Systems Engineering, School of Creative Science and Engineering, Waseda UniversityThis study examines the relationship between a multiplicatively weighted (MW-) Voronoi diagram and the Huff model. A mathematical comparison demonstrates that the models are structurally equivalent when the Huff model is deterministic and the distance decay parameter λ takes a specific value. This theoretical finding was empirically validated using real-world e-commerce order assignment data. The experiments demonstrate the distinct strengths of each model. The Huff model enables the flexible balancing of competing objectives through parameter adjustment, whereas the MW-Voronoi diagram provides geometric clarity in the interpretation of territories. We conclude that the selection of the two models should be guided by the problem objectives, depending on whether probabilistic flexibility or deterministic spatial partitioning is required.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1867-10712026Appropriate dose reduction using photon-counting detector CT for temporal bone imaging: phantom and clinical studies with helical acquisitionENYukaTakahashiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesFumiyoHigakiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYukoNakamuraDepartment of Diagnostic Radiology, Hiroshima UniversityToruHigakiGraduate School of Advanced Science and Engineering, Hiroshima UniversityAkikoSugayaDepartment of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityToshiharuMitsuhashiCenter for Innovative Clinical Medicine, Okayama UniversityTakahiroKitayamaDepartment of Radiology, Medical Development Field, Okayama UniversityYusukeMorimitsuDepartment of Radiological Technology, Okayama University HospitalTomohiroInoueDepartment of Radiological Technology, Okayama University HospitalNoriakiAkagiDepartment of Radiological Technology, Okayama University HospitalYusukeMatsuiDepartment of Radiology, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityToshihiroIguchiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityKazuoAwaiDepartment of Diagnostic Radiology, Hiroshima UniversityTakaoHirakiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesPurpose: To determine the extent of possible dose reduction with photon-counting detector computed tomography (PCD-CT) while maintaining image quality equivalent to that of energy-integrating detector CT (EID-CT) images at standard dose in the temporal bone.<br>
Materials and methods: PCD-CT and EID-CT imaging quality were compared by visual evaluation of clinical temporal bone images and visual scores with Welch’s t-test at standard dose. A head phantom was used to evaluate imaging quality under dose reduction. The detectability index (d’) of the PCD-CT images at various dose levels and the EID-CT images at standard dose was evaluated. Dose reduction limit with PCD-CT used in the subsequent clinical evaluation was determined as the lowest dose with image quality equal to or better than EID-CT. The clinical equivalence of PCD-CT image quality at the determined reduced dose to that with EID-CT at standard dose was evaluated using visual scores. Equivalence was determined if the 95% confidence intervals of differences did not exceed the equivalence margin of ±1.<br>
Results: At standard doses, PCD-CT images demonstrated significantly higher visual scores than EID-CT images (3.73 vs. 2.56 for incudomalleolar joint, 3.75 vs. 2.63 for stapes, 3.54 vs. 2.52 for cochlea, and 3.58 vs. 2.46 for facial nerve canal; all P 0.001). In the phantom study, the d’ value was 0.15 with EID-CT at standard dose and was 0.12 and 0.17 with PCD-CT at 25% and 50% of the standard dose, respectively. Clinically, the mean visual scores of PCD-CT images at 50% of the standard dose were equivalent to EID-CT images at standard dose in all regions (3.58 vs. 3.12 for incudomalleolar joint, 3.46 vs. 3.19 for stapes, 3.50 vs. 3.08 for cochlea, 3.58 vs. 3.27 for facial nerve canal).<br>
Conclusion: PCD-CT may preserve image quality even at 50% of the standard dose in the temporal bone.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1557-1963212026Surface Plasmon Resonances in Silver Nanodendrites : Trunk Length and Branch Connectivity Dependence22472258ENQingyuanMaGraduate School of Informatics and Engineering, The University of Electro-communicationsYukiKishidaGraduate School of Informatics and Engineering, The University of Electro-communicationsNobuyukiTakeyasuGraduate School of Natural Science and Technology, Okayama UniversitySatoruShojiGraduate School of Informatics and Engineering, The University of Electro-communicationsThis study systematically investigates how trunk length and branch connectivity govern surface plasmon resonances in silver nanodendrites in the infrared (IR) region using a computational modeling strategy. We show that a continuous conductive trunk is essential for exciting long-wavelength collective plasmon modes. In a simulated bottom-up construction scheme, the trunk length is gradually increased to conductively connect additional branches to the backbone. Our results reveal that the fundamental δ mode resonance can be deterministically tuned across the mid-infrared spectrum (from 3840 nm to 4360 nm) primarily by controlling the trunk connectivity. As the number of connected branches grows, the lowest-order collective resonance peak exhibits a systematic redshift, and its resonance wavelength scales linearly with the effective dipole length Leff of the electron oscillation path. Concurrently, new higher-order modes emerge as local resonances of the connected substructures. These observations indicate that interrupting the conductive pathway causes a global collective mode to decompose into multiple resonances associated with more weakly coupled subsystems. The established linear scaling relationship provides a highly predictable design rule for this “programmable” connectivity, offering a robust platform for advanced applications such as multi-spectral infrared imaging, selective chemical sensing, and surface-enhanced infrared absorption (SEIRA) spectroscopy, where precise, a priori control over narrow-band infrared resonances is essential.
No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama8756-32822092026PPy-coated wire actuators for micromechanostimulation of cells – identification of immediate-early responsive mechanoregulatory genes in osteoblasts117914ENJiaminChenDepartment of Orthodontics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesAmaia B.Ortega-SantosDepartment of Physics, Chemistry and Biology (IFM), Linköping UniversitySatoruHayanoDepartment of Orthodontics, Okayama University HospitalZiyiWangDepartment of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesJose G.MartinezDepartment of Physics, Chemistry and Biology (IFM), Linköping UniversityEmilio SatoshiHaraDepartment of Advanced International and Information Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesEdwin W.H.JagerDepartment of Physics, Chemistry and Biology (IFM), Linköping UniversityHiroshiKamiokaDepartment of Orthodontics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMechanotransduction, i.e., the conversion of mechanical cues into biochemical signals, is essential for bone development, remodeling, and adaptation. Although mechanical loading is known to regulate osteoblast function and bone homeostasis, dissecting the early and sustained mechanotransductive responses at the microscale remains challenging due to limitations of existing in vitro models. Here, we report the development and application of a mechanostimulation system comprising a polypyrrole (PPy)-based wire actuator that expands and contracts (4 μm in radius) upon electrical actuation and enables precise, localized micromechanical stimulation of a small number of cells within standard culture formats. Using this system, we applied short-term (30 min) cyclic (Cyc30) or static (Stat30), as well as prolonged (120 min) cyclic (Cyc120) stimulations to two osteoblast-like cells (MC3T3-E1 or KUSA-A1). Subsequent transcriptomic profiling and computational network analyses revealed that Cyc30 was not capable of inducing significant changes in mRNA expression, suggesting cellular adaptation to short-term cyclic loading. In contrast, Stat30 induced the upregulation of Fos, Btg2, Egr1, and Fosl1, all known genes associated with mechanotransduction, supporting the validity and reproducibility of our experimental mechanostimulation system. Notably, two long non-coding RNAs (B930036N10Rik and 5430431A17Rik) were identified for the first time as being upregulated in response to Stat30 stimuli. Among the differentially expressed genes (DEGs) upregulated by Cyc120 stimuli, Hmox1, a stress-inducible enzyme known for its roles in maintaining cellular homeostasis and promoting survival, was the only DEG repeatedly observed across the Cyc30/Cyc120 and Stat30/Cyc120 comparisons in both cell types, potentially emerging as a key stress-response gene under prolonged mechanical loading. Collectively, these results establish the PPy-based microactuator as a powerful tool for microscale mechanobiology, and provide molecular insight into immediate-early responsive transcriptional programs underlying osteoblastic mechanoadaptation conserved across different cell types.No potential conflict of interest relevant to this article was reported.WileyActa Medica Okayama2051-33801432026An Atypical Surgical Case of Lung Cancer With Unilateral Absence of the Pulmonary Artery, With Only the Superior Branch Remaininge70554ENKazuhiroOkadaDepartment of Thoracic Surgery, Okayama University HospitalShinTanakaDepartment of Thoracic Surgery, Okayama University HospitalTsuyoshiRyukoDepartment of Thoracic Surgery, Okayama University HospitalYasuakiTomiokaDepartment of Thoracic Surgery, Okayama University HospitalKazuhikoShienDepartment of Thoracic Surgery, Okayama University HospitalKenSuzawaDepartment of Thoracic Surgery, Okayama University HospitalKentarohMiyoshiDepartment of Thoracic Surgery, Okayama University HospitalMikioOkazakiDepartment of Thoracic Surgery, Okayama University HospitalSeiichiroSugimotoDepartment of Thoracic Surgery, Okayama University HospitalShinichiToyookaDepartment of Thoracic Surgery, Okayama University HospitalA 69-year-old woman was referred to our department for an abnormal shadow on chest radiography. Contrast-enhanced computed tomography (CT) revealed a solid nodule in the right lower lobe and defects in the branches of the middle and lower lobes of the pulmonary artery (PA). Furthermore, collateral circulation had developed via the right internal thoracic, bronchial, intercostal, inferior phrenic, and subdiaphragmatic arteries. The solid nodule was diagnosed as adenocarcinoma by CT-guided biopsy. The day before surgery, embolization was performed using interventional radiology (IVR) to mitigate the risk of bleeding during thoracotomy, resulting in minimal intraoperative bleeding during the subsequent right middle and lower lobectomies with lymph node dissection (ND2a-1). UAPA is a rare congenital abnormality characterized by unilateral pulmonary artery agenesis. The presence of recurrent infections, extensive intrathoracic adhesions, and developed collateral circulation may pose challenges during surgical procedures.No potential conflict of interest relevant to this article was reported.Japanese Society for Medical and Biological EngineeringActa Medica Okayama2187-5219152026Automatic Detection of Turning Over in Bed with Protection of Privacy Using Four Low-resolution Thermal Sensors to Support Nursing Care265271ENJyun-JheChouDepartment of Computer Science and Information Engineering, National Taiwan UniversityKammeiRaiDepartment of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesGoMakimotoDepartment of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMizukiMoritaDepartment of Biomedical Informatics, Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama UniversityYoshinobuMaedaDepartment of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesChi-ShengShihGraduate Institute of Networking and Multimedia, National Taiwan UniversityTurning over in bed, especially turning over at night, is a vital human unconscious behavior. Clinically, this movement disperses pressure between the body and bed, thus preventing bedsores. Several devices, such as acceleration and pressure sensors, can count turning overs automatically; however, they often require installation on the patients or in the bed. The simplest and noninvasive method to count turning overs is to record and count on video images, but this method cannot protect privacy. Images obtained using thermal sensors have been used to protect privacy; however, there are no reports of counting turning overs automatically using low-resolution sensors. We developed a novel device equipped with four low-resolution thermal sensors, with each sensor recording only an 8×8-pixel thermal image. The original data can protect patient privacy because the resolution is only ~28.8×28.8 cm per body, which is the lowest resolution compared to previous reports using thermal images. Using four sensors simultaneously enables us to collect sufficient data for automatic identification. We first used the bilinear interpolation method employed in a previous report to count turning overs; however, the results were unsatisfactory because turning overs produced extremely subtle changes in the original data compared with postural changes such as falls. After several attempts, we finally developed a unique identification program that interleaved all data from four sensors and then identified turning overs using residual neural network-18. Using the new system, the accuracy, recall, and precision of counting turning overs in bed improved to approximately 90% with an acceptable computation load in an experiment conducted on volunteers. This study demonstrated the feasibility of our device to count turning overs in clinical settings by the new identification program using four 8×8-pixel thermal images per frame, which have sufficiently low resolution to protect patient privacy.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama2950-32993422026Mitochondrial inhibition enhances the sensitivity of pancreatic ductal adenocarcinoma cells to oncolytic adenovirus201180ENRyoheiShojiDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHiroshiTazawaDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShinjiKurodaDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakeyoshiNishiyamaDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYoshinoriKajiwaraDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMotohikoYamadaDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasuoNagaiDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHiroakiInoueDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesNaoyukiHashimotoDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesSatoruKikuchiDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesRyuichiYoshidaDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYuzoUmedaDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasuoUrataOncolys BioPharma, Inc.ShunsukeKagawaDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToshiyoshiFujiwaraDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesThe metabolism of cancer cells is associated with resistance to anticancer therapies. Pancreatic ductal adenocarcinoma (PDAC) cells exhibit glycolytic and non-glycolytic subtypes. Although oncolytic virotherapy is a novel antitumor modality, the relationship between metabolism and virus sensitivity remains unclear. We demonstrated the cytopathic activity of telomerase-specific, replication-competent oncolytic adenoviruses OBP-301 and p53-armed OBP-702 against PDAC cells. Here, we show the role of metabolism in the virus sensitivity of PDAC cells. The virus sensitivity of human PDAC cells of glycolytic (MIA PaCa-2, PK-45H) and non-glycolytic (PK-59, Capan-2) subtypes was assessed by evaluating replication, glycolysis, and glutamine metabolism through exposure to hypoxia and glucose deprivation or treatment with the mitochondrial metabolism inhibitor CPI-613. Glycolytic PDAC cells were sensitive, and non-glycolytic cells were resistant to oncolytic adenoviruses, which was improved by hypoxia and glucose deprivation or CPI-613 treatment to induce glycolytic activation. OBP-702-mediated p53 activation modulated glutamine metabolism to promote virus sensitivity. In vivo experiments demonstrated the antitumor efficacy of combination therapy with CPI-613 and OBP-702, and the utility of positron emission tomography/computed tomography metabolic parameters for assessing glycolytic activity. Our results suggest that non-glycolytic PDAC cells are refractory to oncolytic adenoviruses. CPI-613 is a promising reagent for overcoming virotherapy resistance in PDAC tumors.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X8022026Complete Transection of the Common Bile Duct Caused by Blunt Abdominal Trauma: A Rare Case Report147152ENShinyaSakamotoDepartment of Gastroenterological Surgery, Kochi Health Sciences CenterMotoyasuTabuchiDepartment of Gastroenterological Surgery, Kochi Health Sciences CenterAkiraHamadaDepartment of Intensive Care Medicine, Kochi Health Sciences CenterRikaYoshimatsuDepartment of Radiology, Kochi Health Sciences CenterYuichiSaisakaDepartment of Emergency and Critical Care Medicine, Kochi Health Sciences CenterManabuMatsumotoDepartment of Diagnostic Pathology, Kochi Health Sciences CenterJunIwataDepartment of Diagnostic Pathology, Kochi Health Sciences CenterTakehiroOkabayashiDepartment of Gastroenterological Surgery, Kochi Health Sciences CenterCase Report/10.18926/AMO/70457Common bile duct (CBD) injury after blunt abdominal trauma is rare and difficult to diagnose. Delayed recognition leads to severe morbidity. A 70-year-old Japanese man was admitted after sustaining blunt abdominal trauma. Ultrasonography revealed intra-abdominal fluid, suggesting bleeding. Contrast-enhanced computed tomography revealed pancreatic head injury, intra-abdominal bleeding, and pseudoaneurysm of the anterior superior pancreatoduodenal artery (ASPDA). Bile duct injury was not evident. The application of transarterial embolization (TAE) controlled the bleeding. Canulation into the pancreatic or biliary duct was not possible during endoscopic retrograde cholangiopancreatography. An emergency laparotomy revealed severe pancreatic head and extrahepatic bile duct injuries. Pancreaticoduodenectomy/Child reconstruction was performed. Complete CBD transection was confirmed. The patient was ultimately discharged without complications. Early recognition, timely surgical management, and intensive care are essential for favorable outcomes in patients who have sustained abdominal trauma.No potential conflict of interest relevant to this article was reported.WileyActa Medica Okayama1434-193X2026Informatics‐Driven and Automated Optimization in Flow Electrochemical Synthesise202501237ENEisukeSatoDepartment of Applied Chemistry, Graduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityAkineTaniDepartment of Applied Chemistry, Graduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityTomohiroNakahamaDepartment of Applied Chemistry, Graduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityKoichiMitsudoDepartment of Applied Chemistry, Graduate School of Environmental, Life, Natural Science and Technology, Okayama UniversitySeijiSugaDepartment of Applied Chemistry, Graduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityElectrochemical synthesis has emerged as a powerful platform for environmentally sustainable chemical transformations. When integrated with flow chemistry, electrosynthetic processes exhibit enhanced scalability, making them suitable for industrial applications. Recently, the integration of electrochemical flow systems with informatics techniques has accelerated the optimization of reaction conditions. Data-driven strategies facilitate rapid exploration of multidimensional parameter spaces, enabling identification of optimal reaction conditions with high efficiency. These advances have enabled the development of automated optimization systems. This review highlights recent progress in combining electrosynthesis, flow chemistry, and computational tools, focusing on representative examples that illustrate efficient optimization protocols and autonomous reaction development. By showcasing these developments, we discuss how the integration of these technologies is driving innovation in electrochemical synthesis.No potential conflict of interest relevant to this article was reported.MDPI AGActa Medica Okayama2410-387X942025Role-Based Efficient Proactive Secret Sharing with User Revocation80ENYixuanHeGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityYutaKoderaGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityYasuyukiNogamiGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversitySamsulHudaInterdisciplinary Education and Research Field, Okayama UniversityProactive secret sharing (PSS), an extension of secret-sharing schemes, safeguards sensitive data in dynamic distributed networks by periodically refreshing shares to counter adversarial attacks. In our previous work, we constructed a non-interactive proactive secret scheme by integrating threshold homomorphic encryption (ThHE) while reducing the communication complexity to 𝑂(𝑛). Not only is refreshing shares important but revoking the shares of users who have left the system is also essential in practical dynamic membership scenarios. However, the previous work was insufficient for supporting explicit user revocation. This study strengthens the description of roles for authorized users and proposes a scheme to achieve non-interactive share refresh and dynamic user management. In each epoch, authorized users are classified into three roles: retain, newly join, and rejoin, and they receive a broadcast of the compact ciphertext encoding both the refresh information and the revocation instructions from the trusted center (dealer). Authorized users independently derive new shares through homomorphic computations, whereas revoked users are unable to generate new shares. Hash functions are used to bind revocation parameters to the cryptographic hashes of valid users in order to guarantee integrity during revocation, allowing for effective verification without compromising non-interactivity. Our new scheme not only extends the revocation structure but also preserves the 𝑂(𝑛) communication complexity.No potential conflict of interest relevant to this article was reported.BON VIEW PUBLISHING PTEActa Medica Okayama2810-9503512025A Study on Zeek IDS Effectiveness for Cybersecurity in Agricultural IoT Networks133142ENSamsulHudaInterdisciplinary Education and Research Field, Okayama UniversityMuhammad BisriMusthafaGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityS. M.ShamimGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityYasuyukiNogamiGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityAs agriculture moves toward Agriculture 4.0, which uses Internet of Things (IoT) devices to collect data in real time and monitor things from a distance, these networks are becoming increasingly vulnerable to cyberattacks. A common method used to protect against these kinds of threats is the use of intrusion detection systems (IDS). However, the agricultural environment is often changing and has limited resources, which makes cybersecurity challenging. Several available IDS tools are not designed to work properly in places with few resources, intermittent access, and unpredictable network conditions. This paper investigates the performance of Zeek, an open-source IDS, in identifying potential threats in agricultural IoT networks. We performed both offline and real-time experiments: offline analysis used pcap files from the Stratosphere Laboratory dataset, and real-time evaluation involved simulated live attack scenarios, focusing on unauthorized access attempts and distributed denial-of-service (DDoS) attacks. Zeek's performance was assessed based on CPU and memory utilization, as well as quality of service (QoS) metrics. From the experimental results, we found that Zeek was quite effective in protecting agricultural IoT networks against typical threats. Memory usage remained stable around 5% during offline analysis and under 20% during active attacks. However, CPU usage was more volatile, peaking at 120% during DDoS events. In terms of QoS, the system maintained a good throughput (1,375 kbits/s) with minimal packet loss (0.000186%). Among the attack types that we tested, brute force attacks, which represent attempts at unauthorized access, had the strongest effect on network performance, increasing delay to 2.159 ms and jitter to 0.793 ms. It seems clear that a heavier traffic load during such attacks can interfere with QoS. On the basis of our observation, we recommend practical deployment strategies for agricultural IoT systems that take these limitations into consideration, aiming to keep networks both secure and efficient under pressure.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama0923-181111912025Big data-driven target identification by machine learning: DRD2 as a therapeutic target for psoriasis917ENTakashiSakaiDepartment of Dermatology, Faculty of Medicine, Oita UniversityRyusukeSawadaDepartment of Pharmacology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOtohaIchinoseDepartment of Bioscience and Bioinformatics, Faculty of Computer Science and Systems Engineering, Kyushu Institute of TechnologyTakeshiTerabayashiDepartment of Pharmacology, Faculty of Medicine, Oita UniversityYutakaHatanoDepartment of Dermatology, Faculty of Medicine, Oita UniversityYoshihiroYamanishiDepartment of Complex Systems Science, Graduate School of Informatics, Nagoya UniversityToshimasaIshizakiDepartment of Pharmacology, Faculty of Medicine, Oita UniversityBackground: The development of medical treatments has traditionally relied on researchers leveraging scientific knowledge to hypothesize disease mechanisms and identify therapeutic agents. However, the depletion of novel therapeutic targets has become a significant challenge, resulting in stagnation within pharmaceutical research.<br>
Objective: To address the scarcity of therapeutic targets, we developed a machine learning (ML)-based system capable of predicting therapeutic target molecules for diseases. To validate its utility, we applied this system to psoriasis, aiming to identify novel treatment strategies.<br>
Methods: Our approach utilized a large clinical database to calculate reporting odds ratios for all drugs associated with the prevention of diseases of interest. We identified target proteins by analyzing large chemical structure databases to discover proteins commonly associated with preventive drug candidates. Experimental validation was conducted by administering a predicted therapeutic candidate in an imiquimod-induced psoriasis mouse model.<br>
Results: The ML-based predictions identified drugs for Parkinson’s disease as potential preventive candidates for psoriasis. Further analysis highlighted dopamine receptor D2 (DRD2) as a therapeutic target. Administration of a DRD2 agonist alleviated psoriasis symptoms in mice, evidenced by the downregulation of mRNA expression in the IL-17 pathway and reduced serum tumor necrosis factor-α levels.<br>
Conclusion: This study demonstrates the utility of a novel ML-based system for identifying therapeutic targets, as shown by its successful application in uncovering the role of DRD2 in psoriasis. Beyond psoriasis, this system offers significant potential for exploring pathological mechanisms and discovering therapeutic targets across various diseases.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama1547-52712292025Aging of the tricuspid valve annulus detected by photon-counting detector computed tomography: Importance of aortic root compression on occurrence of arrhythmiase772e780ENHiroshiMoritaDepartment of Cardiovascular Therapeutics, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesKojiNakagawaDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and DentistrySatoshiNagaseDepartment of General Internal Medicine 3, Kawasaki Medical School General Medical CenterYoshihisaMorimotoDepartment of Cardiovascular Medicine, Fukuyama City HospitalTakuroMasudaDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and DentistryAkiraUeokaDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and DentistrySaoriAsadaDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and DentistryMasakazuMiyamotoDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and DentistryNorihisaTohDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and DentistryToruMiyoshiDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and DentistryNobuhiroNishiiDepartment of Cardiovascular Therapeutics, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesShinsukeYuasaDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and DentistryBackground The aortic root compresses the heart in elderly patients, potentially influencing the conduction system and causing atrial tachyarrhythmias. However, actual anatomic alterations in the right side of the heart because of aortic root compression have not yet been fully evaluated.<br>
Objective This study aimed to elucidate the alterations in the tricuspid valve annulus (TVA) caused by aortic root compression using a 3-dimensional endoscopic view of the heart constructed by photon-counting detector computed tomography, an emerging medical technology.<br>
Methods We analyzed 147 consecutive patients who underwent photon-counting detector computed tomography at our institute after excluding those with diseases that directly influenced the right side of the heart.<br>
Results Aortic root compression caused significant TVA deformation. We defined severe TVA compression as the length of the TVA compressed by the aortic root ≥80% of the major axis of the TVA. Severe compression was more prevalent in elderly patients (age ≥75 years [44%]; P < .01). The distance between the membranous septum and ostium of the coronary sinus was shortened, whereas the cavotricuspid isthmus was elongated in older patients. The regression analysis identified aging as a significant contributor to TVA compression. The short minor and long major axes of the TVA, incidence of atrial tachyarrhythmias (74% vs 45%; P < .01), and atrioventricular conduction disturbances (35% vs 15%; P < .01) were more frequently observed in patients with severe compression.<br>
Conclusion Aortic root compression deforms the TVA and alters the anatomic relationship between the atrioventricular conduction system and the cavotricuspid isthmus. Therefore, aortic root compression may contribute to the occurrence of atrial tachyarrhythmias and conduction disturbances in older patients.No potential conflict of interest relevant to this article was reported.Institute of Electrical and Electronics Engineers (IEEE)Acta Medica Okayama2169-3536142026FEM-Based Design and Characterization of a Millimeter-Scale Piezoelectric Resonance Force Sensor1796017970ENAotoYamazakiDepartment of Mechanical Engineering, Toyohashi University of TechnologyTakumaAkidukiDepartment of Mechanical Engineering, Toyohashi University of TechnologyAtsuoHonnaRiccoh Company Ltd.MichiteruKitazakiDepartment of Computer Science and Engineering, Toyohashi University of TechnologyTomoakiMashimoGraduate School of Natural Science and Technology, Okayama UniversityThis paper presents a millimeter-scale piezoelectric effect-based force sensor that uses the change in its resonant frequency as the detection principle for high sensitivity and a wide measurement range. Such characteristics are suited for robot hand applications that not only detect small forces but also handle large payloads. We develop a methodology to estimate the relationship between applied force and resonant frequency shift by combining classical contact theory and finite element method (FEM) analysis. Although this relationship is non-linear, the designability of sensitivity and measurement range is demonstrated by the simulation. The simulation results based on the method are verified, showing good agreement with the experimental results. The static characteristics, including sensitivity, standard deviation, and resolution, are evaluated using prototype sensors with characteristic lengths ranging from 1 mm to 4 mm. The 4-mm model has a measurement range of 77 mN to 300 N, and the smallest model, which is one of the smallest force sensors suitable for practical implementation, has a measurement range of 9 mN to 20 N.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama1880-65467612026Effects of systemic ventricular assist combined with fenestration in failing Fontan: A theoretical analysis100065ENShujiShimizuDepartment of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University HospitalYasuhiroKotaniDepartment of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University HospitalNaohiroHorioDepartment of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University HospitalEiriKisamoriDepartment of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University HospitalYoshinoriMiyaharaPediatric Heart Disease and Adult Congenital Heart Disease Center, Showa Medical University HospitalKojiUemuraDepartment of Research Promotion and Management, National Cerebral and Cardiovascular CenterToshiakiShishidoDepartment of Research Promotion and Management, National Cerebral and Cardiovascular CenterShingoKasaharaDepartment of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University HospitalBiventricular assist for failing Fontan circulation remains challenging. Because fenestration effectively reduces stressed blood volume and central venous pressure in Fontan patients with increased pulmonary vascular resistance (PVR), systemic ventricular assist device (VAD) combined with fenestration may improve hemodynamics in failing Fontan patients with increased PVR who would require biventricular assist. To validate this hypothesis, we performed a computational hemodynamic simulation of the failing Fontan circulation using a lumped parameter model. We compared hemodynamic variables between the models with and without fenestration while the PVR index was increased sequentially from 3.01 to 6.81 Wood Units m2. Following VAD initiation and stressed blood volume reduction, central venous pressure was maintained at a lower level in the fenestration models. This positive effect was greater in the model with larger fenestration diameter. However, excessive fenestration caused significant desaturation. In failing Fontan circulation with elevated PVR, systemic VAD combined with fenestration significantly improved hemodynamics.No potential conflict of interest relevant to this article was reported.Institute of Electrical and Electronics Engineers (IEEE)Acta Medica Okayama2644-134962026Ultrafast Time-Compressive CMOS Image Sensors Based on Multitap Charge Modulators for Filming Light-In Flight4760ENKeiichiroKagawaResearch Institute of Electronics, Shizuoka UniversityDaisukeHayashiGraduate School of Integrated Science and Technology, Shizuoka UniversityArashiTakakuraFaculty of Engineering, Shizuoka UniversityYutoUmekiGraduate School of Integrated Science and Technology, Shizuoka UniversityMichitakaYoshidaFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityKeitaYasutomiResearch Institute of Electronics, Shizuoka UniversityShojiKawahitoResearch Institute of Electronics, Shizuoka UniversityYoungcheolChaeDepartment of Electrical and Electronic Engineering, Yonsei UniversityHajimeNagaharaD3 Center, The University of OsakaUltrafast time-compressive CMOS image sensors based on multitap charge modulators can capture light-in flight using coded exposure masks on the focal plane. Transient images can then be reconstructed using iterative methods or deep learning models. Although the image sensor is based on indirect time-of-flight (ToF) image sensors, the reconstructed images are equivalent to those captured by direct ToF (D-ToF) image sensors. Important design parameters of the image sensor include the pixel block size and the number of taps of the charge modulator. Several constraints regarding the charge transfer of the multitap charge modulator, the hamming distance between exposure codes at adjacent timings, and the minimal time window duration must be considered when designing exposure codes. The influence of these factors on the fidelity of the reconstructed images is analyzed numerically. The results show that a pixel block size of 4×4 is optimal and that four or more taps are required for light detection and ranging (LiDAR) applications when 32 transient images of light-in flight are reconstructed. To demonstrate LiDAR in a scene with multipath interference, two objects were observed through a weakly diffusive sheet. The temporal resolution, as defined by the clock period of the exposure codes, was 1.65 ns. Multiple reflections were reconstructed using an iterative method (TVAL3) and a deep learning model (ADMM-Net). Although the waveforms of optical pulses reconstructed by TVAL3 are distorted, the amplitudes are more accurate. Conversely, although ADMM-Net reconstructs sharper optical pulses, the amplitudes are inaccurate. To achieve the shorter temporal resolution required for time-resolved diffuse optical tomography (DOT) and fluorescence lifetime imaging (FLIm), the feasibility of heterodyne compression was demonstrated through simulation.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama2168-81841752025Pseudoachalasia Due to Malignant Pleural Mesothelioma Involving the Esophaguse84161ENManamiHondaDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesMasayaIwamuroDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesKazuyaMiyamotoDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesTakehiroTanakaDepartment of Pathology, Okayama University HospitalMotoyukiOtsukaDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesWe report a rare case of pseudoachalasia secondary to malignant pleural mesothelioma involving the esophagus. A 66-year-old man presented with progressive dysphagia, weight loss, and postprandial hiccups. Endoscopic examination showed esophageal dilation with luminal narrowing at the esophagogastric junction, but no mucosal abnormalities. Computed tomography revealed an irregular-shaped mass extending from the peri-esophagogastric junction to the retroperitoneum, accompanied by pleural effusion, right-sided hydronephrosis, and multiple hepatic lesions. Endoscopic ultrasound-guided fine-needle aspiration from the mass lesion through the esophageal lumen revealed epithelioid malignant mesothelioma. This case highlights the importance of considering malignant mesothelioma in the differential diagnosis of pseudoachalasia, particularly when imaging reveals extrinsic esophageal compression without mucosal lesions.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama2168-81841722025Gastric Metastasis of Renal Cell Carcinoma Initially Diagnosed by Esophagogastroduodenoscopye79651ENMasayaIwamuroDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesTomohiroKamioDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesShoichiroHirataDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesTakehiroTanakaDepartment of Pathology, Okayama University HospitalMotoyukiOtsukaDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesHere, we report a rare case of renal cell carcinoma (RCC) initially detected as a gastric metastasis. A 58-year-old man with epigastric discomfort underwent esophagogastroduodenoscopy, which revealed a reddish semi-pedunculated lesion with a whitish coating. Biopsy and imaging confirmed clear cell RCC metastasis. Contrast-enhanced computed tomography (CT) revealed a primary renal tumor with pancreatic and lymph node metastases. Despite chemotherapy treatment, the patient died after 10 months. Gastric metastases from RCC, although rare, should be considered in highly vascular gastric lesions with white coatings. Clinicians must be vigilant for metastatic diseases with atypical gastric findings.No potential conflict of interest relevant to this article was reported.Cambridge University Press (CUP)Acta Medica Okayama1460-3969252026Effects of sagging correction calibration error on radiation therapy equipment using image analysise5ENYasushiFujiiDepartment of Radiology, Chugoku Central Hospital of the Mutual Aid Association of Public School TeachersTakahiroNakayamaDepartment of Radiology, Chugoku Central Hospital of the Mutual Aid Association of Public School TeachersJunkiOshitaDepartment of Radiology, Chugoku Central Hospital of the Mutual Aid Association of Public School TeachersAyakaTsunodaDepartment of Radiology, Graduate School of Health Sciences, Okayama UniversityYusukeSaekiDepartment of Radiological Technology, Kawasaki Medical School HospitalYoshinoriTanabe Faculty of Medicine, Graduate School of Health Sciences, Okayama UniversityPurpose: This study investigates the effect of sagging correction errors on image quality and geometric coordinate accuracy.<br>
Methods: This study utilised the Elekta radiotherapy system, ball bearing (BB), Catphan phantom and MultiMet-WL phantom. Ten distinct flex maps (FMs) were acquired by positioning the BB at the accuracy isocentre and introducing shifts of 0.2, 0.4 and 0.6 mm in the left, table and up directions, respectively. Cone-beam computed tomography images of the Catphan phantom were acquired using 10 FMs. The images were analysed for modulation transfer function (MTF) values and geometric coordinates. Additionally, the Winston–Lutz (W-L) test was conducted under reference couch positions and with a 0.3 mm couch shift.<br>
Results: For the Catphan phantom analysis, the standard deviations of MTF10% across FMs were 0.19. The centre-of-gravity coordinates of the insert exhibited shifts of approximately 0.2, 0.4 and 0.6 mm when comparing reference images to those acquired with the shifted FMs. The results of the W-L test with a 0.3 mm couch shift showed radiation isocentre deviations exceeding 1 mm compared to the reference couch positions.<br>
Conclusions: Minor sagging correction calibration errors did not remarkably impact image quality; however, they altered the geometric coordinates of the image isocentre. These calibration errors decreased the accuracy of off-isocentre positioning.No potential conflict of interest relevant to this article was reported.MDPI AGActa Medica Okayama1999-48931922026A Slide Annotation System with Multimodal Analysis for Video Presentation Review110ENAmma LiesvarastrantaHazDepartment of Information and Communication Systems, Okayama UniversityKomang CandraBrataDepartment of Information and Communication Systems, Okayama UniversityNobuoFunabikiDepartment of Information and Communication Systems, Okayama UniversityHtoo Htoo SandiKyawDepartment of Information and Communication Systems, Okayama UniversityEvianita DewiFajriantiHuman Centric Multimedia Research Laboratory, Department of Informatic and Computer Engineering, Politeknik Elektronika Negeri SurabayaSritrustaSukaridhotoHuman Centric Multimedia Research Laboratory, Department of Informatic and Computer Engineering, Politeknik Elektronika Negeri SurabayaWith the rapid growth of online presentations, there has been an increasing need for efficient review of recorded materials. In typical presentations, speakers verbally elaborate on each slide, providing details not captured in the slides themselves. Automatically extracting and embedding these verbal explanations at their corresponding slide locations can greatly enhance the review process for audiences. This paper presents a Slide Annotation System that employs a robust hybrid two-stage detector to identify slide boundaries, extracts slide text through Optical Character Recognition (OCR), transcribes narration, and employs a multimodal Large Language Model (LLM) to generate concise, context-aware annotations that are added to their corresponding slide locations. For evaluations, the technical performance was validated on five recorded presentations, while the user experience was assessed by 37 participants. The results showed that the system achieved a macro-average 𝐹1 score of 0.879 (𝑆𝐷=0.024, 95% 𝐶𝐼[0.849,0.909]) for slide segmentation and 90.0% accuracy (95% 𝐶𝐼[74.4%,96.5%]) for annotation alignment. Subjective evaluations revealed high annotation validity and usefulness as rated by presenters, and a high System Usability Scale (SUS) score of 80.5 (𝑆𝐷=6.7, 95% 𝐶𝐼[78.3,82.7]). Qualitative feedback further confirmed that the system effectively streamlined the review process, enabling users to locate key information more efficiently than standard video playback. These findings demonstrate the strong potential of the proposed system as an effective automated annotation system.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X8012026The Preoperative Anterior Pelvic Plane Angle Predicts Cup Anteversion Changes at 1 Year after Total Hip Arthroplasty3137ENKyotaIshibashiDepartment of Orthopedic Surgery, Hachinohe City HospitalHirotakaOishiDepartment of Orthopedic Surgery, Hachinohe City HospitalRyoArakiDepartment of Orthopedic Surgery, Hachinohe City HospitalKosukeKawamuraDepartment of Orthopedic Surgery, Hachinohe City HospitalIsamuSasakiDepartment of Orthopedic Surgery, Hachinohe City HospitalEijiSasakiDepartment of Orthopedic Surgery, Hirosaki University Graduate School of MedicineHikaruKamadaDepartment of Orthopedic Surgery, Hachinohe City HospitalMasakazuKogawaDepartment of Orthopedic Surgery, Hachinohe City HospitalSunaoTanakaDepartment of Orthopedic Surgery, Hachinohe City HospitalTakuyaNumasawaDepartment of Orthopedic Surgery, Hachinohe City HospitalYasuyukiIshibashiDepartment of Orthopedic Surgery, Hirosaki University Graduate School of MedicineOriginal Article/10.18926/AMO/70070We 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.Okayama University Medical SchoolActa Medica Okayama0386-300X8012026Usefulness of D-dimer Assay to Confirm the Course of Overt Venous Thromboembolism (VTE) in Cancer Patients17ENHidenaruYamaokaDepartment of Cardiovascular Medicine, IMS Tokyo Katsushika General HospitalMasashiYoshidaDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToshihiroSarashinaSeisukai Kuroda ClinicSatoshiAkagiDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToruMiyoshiDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMitsuruMunemasaDepartment of Cardiovascular Medicine, Okayama Rosai HospitalKazufumiNakamuraDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHiroshiItoDepartment of General Internal Medicine 3, Kawasaki Medical School General Medical CenterShinsukeYuasaDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOriginal Article10.18926/AMO/70067Venous thromboembolism (VTE) is a serious complication in patients with cancer. In this population, the presence of thrombi is often assessed at cancer diagnosis by measuring D-dimer levels, which have high sensitivity but low specificity for identifying VTE at this clinical time point. However, the usefulness of D-dimer measurement during anticoagulation therapy has not been fully established, despite its widespread use. In this retrospective observational study, we investigated whether D-dimer measurement during anticoagulation therapy in cancer patients could predict overt VTE at follow-up. The study included patients who underwent D-dimer testing and contrast-enhanced computed tomography between 30 and 100 days after initiation of anticoagulation therapy. Eighty-two patients were included: 60 with cancer and 22 without. The diagnostic performance of D-dimer for overt VTE was as follows: sensitivity, 85.7%; specificity, 87.2%; positive predictive value, 78.3%; and negative predictive value, 89.2%. These findings suggest that D-dimer measurement at follow-up has high sensitivity and specificity for overt VTE in cancer patients and may aid in assessing thrombotic status. Clinically, if anticoagulation therapy is continued until D-dimer levels become negative, the absence of overt VTE could be inferred without additional invasive testing.No potential conflict of interest relevant to this article was reported.The Japanese Society of Interventional RadiologyActa Medica Okayama2432-0935102025Is Saline Sealing of Needle Tract Effective to Prevent Pneumothorax after Computed Tomography-guided Lung Biopsy?e2025-0068ENSoichiroOkamotoDepartment of Radiology, Okayama University HospitalYusukeMatsuiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKojiTomitaDepartment of Radiology, Okayama University HospitalKazuakiMunetomoDepartment of Radiology, Okayama University HospitalNoriyukiUmakoshiDepartment of Radiology, Okayama University HospitalToshiharuMitsuhashiCenter for Innovative Clinical Medicine, Medical Development Field, Okayama UniversityToshihiroIguchiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityPurpose: To evaluate the efficacy of needle tract sealing using normal saline instillation for decreasing the risk of pneumothorax after computed tomography-guided lung biopsy.<br>
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.<br>
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).<br>
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 BVActa Medica Okayama2211-12474512026Immunopeptidomics combined with full-length transcriptomics uncovers diverse neoantigens116781ENTakamasaIshinoDepartment of Tumor Microenvironment, Okayama University, Graduate School of Medicine Dentistry and Pharmaceutical SciencesTomofumiWatanabeDepartment of Tumor Microenvironment, Okayama University, Graduate School of Medicine Dentistry and Pharmaceutical SciencesSerinaTokitaDivision of Cancer Immunology, Graduate School of Medical and Dental Sciences, Niigata UniversityYoukiUedaDepartment of Tumor Microenvironment, Okayama University, Graduate School of Medicine Dentistry and Pharmaceutical SciencesKatsushigeKawaseDivision of Cell Therapy, Chiba Cancer Center Research InstituteYukaTakanoDepartment of Tumor Microenvironment, Okayama University, Graduate School of Medicine Dentistry and Pharmaceutical SciencesYin MinThuDepartment of Tumor Microenvironment, Okayama University, Graduate School of Medicine Dentistry and Pharmaceutical SciencesYutaSuzukiDepartment of Computational Biology and Medical Sciences, The University of TokyoChieOwaDepartment of Computational Biology and Medical Sciences, The University of TokyoTakashiInozumeDepartment of Dermatology, Chiba University Graduate School of MedicineWenhaoZhouDepartment of Tumor Microenvironment, Okayama University, Graduate School of Medicine Dentistry and Pharmaceutical SciencesJojiNagasakiDepartment of Tumor Microenvironment, Okayama University, Graduate School of Medicine Dentistry and Pharmaceutical SciencesVitalyKochinDepartment of Immunology, Nagoya University Graduate School of MedicineToshihideUenoDivision of Cellular Signaling, National Cancer Center Research InstituteShinyaKojimaDivision of Cellular Signaling, National Cancer Center Research InstituteAkikoHonobe-TabuchiDepartment of Dermatology, University of YamanashiTatsuyoshiKawamuraDepartment of Dermatology, University of YamanashiTakehiroOhnumaDepartment of Dermatology, Kumamoto Kenhoku HospitalTakamitsuMatsuzawaDepartment of Dermatology, Chiba University Graduate School of MedicineYuKawaharaDepartment of Dermatology, Chiba University Graduate School of MedicineKazuoYamashitaKOTAI Biotechnologies, IncJasonLinDivision of Cell Therapy, Chiba Cancer Center Research InstituteJunKosekiDivision of Systems Biology, Nagoya University Graduate School of MedicineHiroyoshiNishikawaDepartment of Immunology, Nagoya University Graduate School of MedicineMotooArakiDepartment of Urology, Okayama University, Graduate School of Medicine Dentistry and Pharmaceutical SciencesNaoyaKatoDepartment of Gastroenterology, Graduate School of Medicine, Chiba UniversityTeppeiShimamuraDivision of Systems Biology, Nagoya University Graduate School of MedicineShinichiMorishitaDepartment of Computational Biology and Medical Sciences, The University of TokyoYutakaSuzukiDepartment of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of TokyoHiroyukiManoDivision of Cellular Signaling, National Cancer Center Research InstituteToshihikoTorigoeTakayukiKanasekiDivision of Cancer Immunology, Graduate School of Medical and Dental Sciences, Niigata UniversityMasahitoKawazuDivision of Cell Therapy, Chiba Cancer Center Research InstituteYosukeTogashiDepartment of Tumor Microenvironment, Okayama University, Graduate School of Medicine Dentistry and Pharmaceutical SciencesNeoantigens are crucial for antitumor immunity and immune checkpoint inhibitor (ICI) efficacy by triggering strong immune responses. However, conventional methods for identifying neoantigens, such as whole-exon sequencing and short-read RNA sequencing (RNA-seq), appear to be insufficient, and the tumor mutational burden cannot sufficiently predict ICI efficacy. In this study, we employed a proteogenomic approach using long-read RNA-seq with Pacific Biosciences Single-Molecule Real-Time Sequencing technology to analyze full-length transcripts in combination with the human leukocyte antigen ligandome. As a result, many neoantigen candidates were identified, which were unregistered in a comprehensive database, including those from non-coding regions. Additionally, we validated the responses of specific T cell receptors (TCRs) to these candidates and identified several pairs of TCRs and neoantigens. These findings highlight the presence of more diverse neoantigens than expected that cannot be identified by conventional methods.No potential conflict of interest relevant to this article was reported.Royal Society of Chemistry (RSC)Acta Medica Okayama2050-750X2026Multi-step mechanisms of early phospholipid hydrolysis and mineralisation unveiled through combined quantum chemical calculations and experimental analysisENKeisukeShibataDepartment of Materials Science, Waseda UniversityTakahumiShiotaniDepartment of Resources and Environmental Engineering, Waseda UniversityYunhaoChenDepartment of Materials Science, Waseda UniversityReinaKuriharaDepartment of Resources and Environmental Engineering, Waseda UniversityKatsunoriYamaguchiDepartment of Resources and Environmental Engineering, Waseda UniversityEmilio SatoshiHaraDepartment of Advanced International and Information Dentistry, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical SciencesNílsonKunioshiDepartment of Materials Science, Waseda UniversityPhospholipids play key roles in bone formation, with phosphatidylserine (PS) reportedly inducing more rapid mineralisation than phosphatidylcholine (PC); however, the underlying mechanisms remains unclear. This study investigated PS and PC mineralisation using experimental methods and computational chemistry. The stationary points in the potential energy surfaces of the reactions were preliminarily found using a neural network potential (PreFerred Potential in Matlantis) capable of predicting the interaction energies for arbitrary combinations of atoms, and then refined through density functional theory calculations (Gaussian16, at the B3LYP/6-31G(d,p) level of theory). When hydrolysis reactions were assumed to be the initial step in the mineralisation of phospholipids, the results were consistent with empirical analysis. PS was found to be more easily hydrolised than PC, primarily owing to the presence of a labile proton in the NH3+ group of serine that facilitates proton transfer, enhancing hydrolysis of PS at lower energy thresholds. Specifically, when a single phospholipid was considered, three distinct hydrolysis routes were identified: between serine (or choline) and phosphate, between glycerol and phosphate, and between an aliphatic carbon chain and the glycerol backbone. In particular, the initial steps of hydrolysis involved the formation of a pentavalent phosphate intermediate. When calculations were performed with two adjacent phospholipid molecules, the loosely bound proton (H+) in the NH3+ group could be readily transferred either to the P–O bond linking serine to the phosphate group; or to the P–O bond connecting the phosphate to glycerol in a neighboring PS6 molecule. These findings reveal the important roles of serine NH3+ in facilitating hydrolysis of PS, and provide insights for designing novel molecules to accelerate bone regeneration.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama2590-1230292026Unified 2D polygon-based CAM framework integrating tool path generation, machinability evaluation, and cutting-force simulation108948ENKazukiKanekoFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityHirotoTakayasuGraduate School of Science and Engineering, Ibaraki UniversityAtsuyaSuzukiMechanical Systems Engineering Program, Okayama UniversityHiroyukiKodamaFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityThis study proposes a unified two-dimensional (2D) polygon-based computer-aided manufacturing (CAM) framework that enables tool path generation, machinability evaluation, material removal simulation, and cutting-force prediction within a single computational environment. The proposed method represents three-dimensional geometries as aggregates of orthogonal 2D polygon sets, obtained by slicing the model in the xy-, yz-, and zx-parallel planes and superposing the three polygonal datasets. A novel convolutional offsetting algorithm is developed to perform three-dimensional inflation and shrinkage by incorporating adjacent cross-sectional relationships, thereby achieving accurate 3D offsets independent of the slicing orientation. The inflated 2D polygons are directly utilized to generate contour and scanning tool paths, and sequential inflation–shrinkage analysis enables visualization of unmachinable regions for tool accessibility evaluation. Furthermore, the framework integrates an instantaneous cutting force model that accurately predicts the cutting force waveform by detecting intersections between the cutting edge points and 2D polygon aggregations. The system is experimentally validated via ball-end milling. The results demonstrate that tool paths can be generated in under one minute using only a CPU. Furthermore, the simulated cutting forces closely align with experimental measurements. These findings demonstrate that the proposed 2D polygon-based framework provides an efficient and extensible foundation for integrating mechanical simulation and tool-path generation.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama1341-321X31122025Whole-genome sequencing and in vitro characterization of a disseminated ST398 Staphylococcus aureus infection: A case report102845ENYosukeSazumiDepartment of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShinnosukeFukushimaDepartment of Bacteriology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHideharuHagiyaDepartment of Infectious Diseases, Okayama University HospitalAtsushiKatoDepartment of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesAtsuhitoSuyamaDepartment of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKoheiOguniDepartment of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKazuyoshiGotohDepartment of Medical Laboratory Science, Okayama University Graduate School of Health SciencesShokoKutsunoAntimicrobial Resistance Research Center, National Institute of Infectious Diseases, Japan Institute for Health SecurityJunzoHisatsuneAntimicrobial Resistance Research Center, National Institute of Infectious Diseases, Japan Institute for Health SecurityMotoyukiSugaiAntimicrobial Resistance Research Center, National Institute of Infectious Diseases, Japan Institute for Health SecurityShumaTsujiDepartment of Bacteriology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKojiIioMicrobiology Division, Clinical Laboratory, Okayama University HospitalFumioOtsukaDepartment of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesStaphylococcus aureus potentially causes systemic infections such as disseminated abscesses and bloodstream infections, leading to high mortality rates. We herein describe a case of disseminated muscle abscesses caused by sequence type (ST) 398 methicillin-sensitive S. aureus (MSSA), along with in vitro investigation results for potential pathogenic factors. A 67-year-old healthy woman was admitted to our hospital with complaints of systemic body pain. Blood cultures identified MSSA and contrast-enhanced computed tomography revealed multiple muscle abscesses extending from her neck to her soles. She received antibiotic treatment with intravenous cephazolin and underwent repeated surgical drainage, and was finally discharged. Notably, the MSSA strain exclusively affected her muscle tissues, prompting us to perform genetic analysis to uncover the underlying reason. Short-read genome analysis revealed the isolate to be ST398, harboring chp and scn genes known for immune evasion from human immunity. However, no other known pathogenic factors were identified despite rigorous assays for biofilm formation, surface and cell wall proteins, protease production, and hyaluronidase activity. ST398 S. aureus is commonly isolated from livestock, and her prior experience of being flooded could be related to the disease onset. The present case underscores the possibility of severe ST398 MSSA infections in humans, even in the absence of direct animal exposure.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama1341-321X31122025Clinical and molecular characteristics of urinary catheter-associated Pseudomonas aeruginosa prostatic infection: A case series of four postoperative nosocomial infections102853ENShinnosukeFukushimaDepartment of Bacteriology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakayukiSanoLaboratory of Veterinary Public Health, School of Veterinary Medicine and Animal Sciences, Kitasato UniversityTakashigeKashimotoLaboratory of Veterinary Public Health, School of Veterinary Medicine and Animal Sciences, Kitasato UniversityHideharuHagiyaDepartment of Infectious Diseases, Okayama University HospitalPseudomonas aeruginosa is a causative pathogen of nosocomial catheter-associated urinary tract infections (CAUTI), but prostate involvement, including prostatitis and prostatic abscess, is rare. The clinical characteristics of P. aeruginosa-associated CAUTI with prostatic lesions, as well as the contribution of genetic backgrounds remain unclear. We describe four cases of urinary catheter-associated prostatic infection caused by P. aeruginosa following postoperative catheterization. All patients developed fever within 10 days after surgery, and three of the four patients developed bacteremia. Three patients were diagnosed with prostatic abscess by contrast-enhanced computed tomography or magnetic resonance imaging, while one case presented with prostatitis without abscess formation. Prostate-specific antigen levels were elevated over 20 ng/mL in all three measured cases. All patients were treated successfully with prolonged antibiotic therapy (28–39 days) without surgical drainage. Notably, all three abscess cases were successfully managed with fluoroquinolone-based combination therapy, highlighting its potential role in the management of prostatic abscesses. Three of four isolates were submitted for molecular investigations. All isolates harbored exoT and exoY, whereas exoU was absent. Biofilm-associated genes were detected in two cases, but not in the remaining case. Our findings suggested that P. aeruginosa strains carrying T3SS genes (exoT and exoY) potentially develop prostatic infections, independent of biofilm-associated genes. Host and iatrogenic factors, such as catheter manipulation, may play more critical roles in the development of prostatic pathology than strain-specific determinants. Assessment of prostate-specific antigen levels and early imaging may facilitate appropriate diagnosis and effective management when P. aeruginosa is detected as a cause of CAUTI.No potential conflict of interest relevant to this article was reported.MDPI AGActa Medica Okayama2313-433X1212025FluoNeRF: Fluorescent Novel-View Synthesis Under Novel Light Source Colors and Spectra16ENLinShiDepartment of Artificial Intelligence, Kyushu Institute of TechnologyKengoMatsufujiDepartment of Artificial Intelligence, Kyushu Institute of TechnologyMichitakaYoshidaDepartment of Computer Science, Okayama UniversityRyoKawaharaGraduate School of Informatics, Kyoto UniversityTakahiroOkabeDepartment of Computer Science, Okayama UniversitySynthesizing photo-realistic images of a scene from arbitrary viewpoints and under arbitrary lighting environments is one of the important research topics in computer vision and graphics. In this paper, we propose a method for synthesizing photo-realistic images of a scene with fluorescent objects from novel viewpoints and under novel lighting colors and spectra. In general, fluorescent materials absorb light with certain wavelengths and then emit light with longer wavelengths than the absorbed ones, in contrast to reflective materials, which preserve wavelengths of light. Therefore, we cannot reproduce the colors of fluorescent objects under arbitrary lighting colors by combining conventional view synthesis techniques with the white balance adjustment of the RGB channels. Accordingly, we extend the novel-view synthesis based on the neural radiance fields by incorporating the superposition principle of light; our proposed method captures a sparse set of images of a scene from varying viewpoints and under varying lighting colors or spectra with active lighting systems such as a color display or a multi-spectral light stage and then synthesizes photo-realistic images of the scene without explicitly modeling its geometric and photometric models. We conducted a number of experiments using real images captured with an LCD and confirmed that our method works better than the existing methods. Moreover, we showed that the extension of our method using more than three primary colors with a light stage enables us to reproduce the colors of fluorescent objects under common light sources.No potential conflict of interest relevant to this article was reported.Tech Science PressActa Medica Okayama1546-22268522025A Spectrum Allocation and Security-Sensitive Task Offloading Algorithm in MEC Using DVS34373455ENXianweiLiSchool of Computer and Information Engineering, Bengbu UniversityBoWeiFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityXiaoyingYangSchool of Information Engineering, Suzhou UniversityAmrTolbaComputer Science and Engineering Department, College of Applied Studies, King Saud UniversityZijianZengInstitute of Computer Science and Digital Innovation, UCSI UniversityOsamaAlfarrajComputer Science and Engineering Department, College of Applied Studies, King Saud UniversityWith the advancements of the next-generation communication networking and Internet of Things (IoT) technologies, a variety of computation-intensive applications (e.g., autonomous driving and face recognition) have emerged. The execution of these IoT applications demands a lot of computing resources. Nevertheless, terminal devices (TDs) usually do not have sufficient computing resources to process these applications. Offloading IoT applications to be processed by mobile edge computing (MEC) servers with more computing resources provides a promising way to address this issue. While a significant number of works have studied task offloading, only a few of them have considered the security issue. This study investigates the problem of spectrum allocation and security-sensitive task offloading in an MEC system. Dynamic voltage scaling (DVS) technology is applied by TDs to reduce energy consumption and computing time. To guarantee data security during task offloading, we use AES cryptographic technique. The studied problem is formulated as an optimization problem and solved by our proposed efficient offloading scheme. The simulation results show that the proposed scheme can reduce system cost while guaranteeing data security.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama0969-806X2372025Impact of different X-ray tube positions on actual dose measurements during CT examinations -An effect of patient physique-113001ENHiroakiHayashiCollege of Transdisciplinary Sciences for Innovation, Kanazawa UniversityTatsuyaMaedaGraduate School of Medical Sciences, Kanazawa UniversityKazukiTakegamiDepartment of Radiological Technology, Yamaguchi University HospitalSotaGotoFaculty of Health Sciences, Kobe Tokiwa UniversityTakashiAsaharaDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityNatsumiKimotoDepartment of Radiological Science, Faculty of Health Sciences, Junshin Gakuen UniversityRinaNishigamiGraduate School of Medical Sciences, Kanazawa UniversityDaikiKobayashiGraduate School of Medical Sciences, Kanazawa UniversityYukiKanazawaFaculty of Life Science, Kumamoto UniversityKazutaYamashitaDepartment of Orthopedics, School of Medicine, Tokushima UniversityTakeshiKonishiMEDITEC JAPAN Co., Ltd.MotochikaMakiMEDITEC JAPAN Co., Ltd.Dose management of patients is very important during X-ray Computed Tomography (CT) examinations, but because the patient's surface dose is inhomogeneous, it is difficult to measure the most probable value using a small passive-type dosimeter, lent to the patient. To solve this problem, our research group developed a precise dose analysis procedure in which a systematic uncertainty related to the X-ray incident direction (θin) is reduced. θin information was analyzed from CT images. However, the applicability of our procedure to actual patients with various physiques has not been examined. This study aims to propose a dose analysis procedure that can be applied to patients with various physiques, and to show its impact on dose measurement. Clinical data of 198 patients with Body Mass Index (BMI) values between 15 and 40 kg/m2 (mean value: 23.1 ± 3.8 kg/m2) who underwent chest CT scans were analyzed after dividing them into three groups based on BMI values. The absorbed dose was measured with a small-type Optically Stimulated Luminescence (OSL) dosimeter. To derive correction factors related to θin, the dependence of the actually-measured dose values of various patients on θin was analyzed. The correction coefficients were determined independently for the three groups classified by BMI values. By correcting the effect of θin, the systematic uncertainty element could be reduced, resulting in 30 % reduction of the uncertainty. Furthermore, it was found that our analysis procedure makes it possible to visualize outliers. In comparison with the expected dose values based on Computed Tomography Dose Index (CTDI) values, most of the data fell within the range of ±1.34 mGy (=1σ). However, 7 % of the data showed large deviations larger than 2σ. In conclusion, our research group has developed a procedure for measuring patient surface doses that can be applied to patients having various physiques, in which the effects of X-ray incident direction were accurately corrected. The procedure could be one solution to the problems with actual dose measurements during CT examinations, and will be useful for dose management based on the small-type dosimeter.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama2452-199X572026Robust adhesion between solid-state hydroxyapatite and bone tissue through surface demineralization632645ENShichaoXieDepartment of Biomaterials, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityMasahiroOkadaDivision of Biomaterials Science and Engineering, Graduate School of Dentistry, Tohoku UniversityHaruyukiAoyagiDepartment of Biomaterials, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityAkihisaOtakaDepartment of Biomaterials, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityXiaofengYangDepartment of Biomaterials, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTakayoshiNakanoDivision of Materials and Manufacturing Science, Graduate School of Engineering, The University of OsakaTakuyaMatsumotoDepartment of Biomaterials, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityObjective: Current bone adhesives typically lack adequate mechanical strength, long-term stability, or biocompatibility. To address these limitations, we designed a new adhesion strategy using a solid-state hydroxyapatite (HAp) adhesive in combination with bone surface demineralization.<br>
Methods: Solid-state HAp adhesives were synthesized via wet chemical precipitation and heat treatment. Cortical bone specimens were partially demineralized with phosphoric acid (H3PO4) or ethylenediaminetetraacetic acid (EDTA), and characterized using scanning electron microscopy (SEM) and attenuated total reflectance–Fourier transform infrared spectroscopy (ATR-FTIR). Shear adhesion strength of HAp to demineralized bone was measured over time. In vivo fixation was assessed in rats using micro-computed tomography and histology. Statistical analysis used Tukey-Kramer tests after normality and variance checks.<br>
Results: Although the HAp adhesive failed to adhere to non-demineralized bone, effective adhesion was achieved on the surface-demineralized bone tissue. Shear adhesion strength was significantly higher in EDTA-treated samples (238.4 kPa at 10 h) compared to H3PO4-treated samples (102.9 kPa at 1 h), with performance correlating with demineralization depth. ATR-FTIR and SEM analyses revealed that EDTA preserved collagen's triple-helix structure and free water content, both enhancing adhesion. Animal experiments confirmed stable fixation of HAp adhesive to demineralized bone tissue.<br>
Conclusions: Surface demineralization enabled strong adhesion of the solid-state HAp adhesive to bone by exposing collagen swollen with water. Adhesion strength was influenced by structural changes in the demineralized layer, and the adhesive provided stable in vivo fixation, supporting its potential for bone-anchored biomedical applications.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7962025MRI Images of a Case of Adenocarcinoma, Human Papillomavirus-Independent, Mesonephric Type, of the Uterine Cervix463468ENYudaiAsanoDepartment of Radiology, Okayama University HospitalChikaNishiharaDepartment of Radiology, Okayama University HospitalTakahiroKitayamaDepartment of Radiology, Okayama University HospitalNanakoOkawaDepartment of Radiology, Okayama University HospitalSatokoMakimotoDepartment of Radiology, Okayama University HospitalFumiyoHigakiDepartment of Radiology, Okayama University HospitalKatsuhideKojimaDepartment of Radiology, Okayama University HospitalHanakoSugiharaDepartment of Obstetrics and Gynecology, Okayama University HospitalNaoyukiIdaDepartment of Obstetrics and Gynecology, Okayama University HospitalHiroyukiYanaiDepartment of Pathology, Okayama University HospitalTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityCase Report/10.18926/AMO/69850We present a case of a woman in her 70s who was diagnosed with mesonephric adenocarcinoma of the uterine cervix, following biopsy and surgery. Preoperative MRI revealed a 7-cm, well-defined circumferential cervical mass with left lateral wall predominance, bulging into the uterine cavity and vagina. The lesion showed intermediate signal intensity on T2-weighted images, diffusion restriction, and early contrast enhancement weaker than that of the myometrium, followed by washout on contrast-enhanced imaging. The circumferential growth pattern with the lateral wall predominance and its imaging characteristics may suggest this rare entity be routinely included in the differential diagnosis of cervical cancers.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama0264-12752602025An entangled material made from fiber aerosol deposition method115195ENHongwuYuFaculty of Environmental, Life, Natural Science and Technology, University of OkayamaNaoshiIkedaFaculty of Environmental, Life, Natural Science and Technology, University of OkayamaMasakazuMoriRyukoku UniversityJunKanoFaculty of Environmental, Life, Natural Science and Technology, University of OkayamaJae-HyukParkSchool of Advanced Materials Science & Engineering, Sungkyunkwan UniversityJunAkedoNational Institute of Advanced Industrial Science and TechnologyThis study demonstrates the successful application of Aerosol Deposition (AD) technology to short carbon fibers (length < 1 mm), enabling the rapid, three-dimensional (3D) fabrication of objects with vertical growth rates up to 0.3 mm/s, a significant improvement over conventional additive manufacturing. Through a series of experiments using this novel Fiber Aerosol Deposition (FAD) technology, three fiber lengths (47, 85, and 111 μm) and four substrate materials (carbon, polypropylene, polyethylene, and acrylonitrile butadiene styrene (ABS)) were investigated. Our findings indicate that both carbon substrate entanglement and fiber length critically influence deposition efficiency. Scanning electron microscopy (SEM) and X-ray computed tomography (CT) analyses reveal that during formation, longer fibers (>100 μm) initially create a cage-like framework, which is subsequently filled by shorter fibers. Density measurements and fiber distribution analysis confirmed that structures predominantly composed of shorter fibers exhibit higher packing densities, consistent with their role as filler material. These results collectively suggest that the FAD method’s formation mechanism relies on frictional entanglement rather than the room-temperature impact consolidation (RTIC) effect characteristic of traditional AD. This breakthrough presents a promising new technique for forming short fibers into functional 3D architectures, with potential applications extending to proteins, polymer fibers, and biomaterial fibers.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama1547-527122122025Virtual endoscopic imaging of the heart using photon-counting detector computed tomography for electrophysiologists31993207ENHiroshiMoritaDepartment of Cardiovascular Therapeutics, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesSaoriAsadaDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and DentistryMasakazuMiyamotoDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and DentistryKojiNakagawaDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and DentistrySatoshiNagaseDepartment of General Internal Medicine 3, Kawasaki Medical School General Medical CenterYoshimasaMorimotoDepartment of Cardiovascular Medicine, Fukuyama City HospitalSatoshiKawadaDepartment of Cardiovascular Medicine, Kochi Health Science CenterTadashiWadaDepartment of Cardiology, National Hospital Organization Iwakuni Clinical CenterTakuroMasudaDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and DentistryAkiraUeokaDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and DentistryNorihisaTohDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and DentistryToruMiyoshiDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and DentistryNobuhiroNishiiDepartment of Cardiovascular Therapeutics, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesShinsukeYuasaDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and DentistryNo potential conflict of interest relevant to this article was reported.Oxford University Press (OUP)Acta Medica Okayama2042-88122025122025Endoscopic surgery for distal femoral physeal bar resection with computed tomography-assisted navigation: a case reportrjaf972ENYasutakaMasadaDepartment of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTomonoriTetsunagaDepartment of Musculoskeletal Health Promotion, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKazukiYamadaDepartment of Medical Materials for Musculoskeletal Reconstruction, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTomohiroInoueDepartment of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesRyuichiroOkudaDepartment of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTetsuyaYamamotoDepartment of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShinMatsumotoDepartment of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTomokoTetsunagaDepartment of Sports Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityYusukeYokoyamaDepartment of Advanced Rehabilitation Medicine for the Musculoskeletal System, Okayama UniversityYukiOkazakiCenter for Education in Medicine and Health Sciences, Okayama UniversityToshifumiOzakiDepartment of Orthopaedic Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityThe formation of physeal bars, or bony bridges, following growth plate injuries can cause complications such as angular deformities or discrepancies in leg length. The management strategies for these depend on factors such as the bar’s location, extent, and residual growth potential. Herein, we describe the case of a 14-year-old male with a valgus knee deformity caused by a distal femoral physeal bar. The patient underwent endoscopic resection of the bar, assisted by computed tomography-based navigation and intraoperative O-arm imaging. This minimally invasive technique facilitated safe and accurate removal of the lesion with less risk of complications such as cortical perforation or injury to adjacent neurovascular structures compared to traditional approaches. The patient experienced favorable postoperative outcomes, including restored knee range of motion and full symptom resolution. This approach demonstrates the clinical value of integrating endoscopy with advanced navigation systems during the surgical treatment of physeal bars.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama1350-44871912026Experimental approach of internal dose map visualization during helical CT examinations: importance of X-ray incident direction analysis and central internal dose estimation107586ENHiroakiHayashiCollege of Transdisciplinary Sciences for Innovation, Kanazawa UniversityKazukiTakegamiDepartment of Radiological Technology, Yamaguchi University HospitalRinaNishigamiGraduate School of Medical Sciences, Kanazawa UniversityDaikiKobayashiGraduate School of Medical Sciences, Kanazawa UniversitySotaGotoFaculty of Health Sciences, Kobe Tokiwa UniversityTakashiAsaharaDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityNatsumiKimotoDepartment of Radiological Science, Faculty of Health Sciences, Junshin Gakuen UniversityMasakiTakemitsuDepartment of Radiological Technology, Yamaguchi University HospitalRinIshiiCollege of Transdisciplinary Sciences for Innovation, Kanazawa UniversityShinichiMorimotoMeditec Japan Co., Ltd.MotochikaMakiMeditec Japan Co., Ltd.During computed tomography (CT) examination, radiation exposures should be appropriately managed taking into considering the effects of bowtie filter, the heel effect and over-beaming effect. Furthermore, the analysis of an X-ray incident direction is important. The purpose of this study is to develop a procedure to obtain two-dimensional (2D) internal dose distributions based on actual measurements of surface dose distribution and central internal dose data. Experiments were conducted using a clinical CT scanner and four cylindrical polyacetal resin (POM) phantoms having diameters of 15–30 cm. The entrance surface doses and the central internal dose were measured by placing the optically stimulated luminescence (OSL) dosimeters on the surface and inner part of the phantom, respectively, during helical CT scans. The X-ray incident direction at the slice containing the dosimeter was estimated based on the noise distribution analysis of the CT image. Then, circumferential surface dose distributions were determined as a function of the X-ray incident direction. Based on these experimental data, we succeeded in visualizing the 2D dose distributions. The obtained dose distribution was inhomogeneous, clearly reflecting the influence of factors such as the heel effect. The uncertainty due to our methodology was estimated to be from 4.3 % to 7.4 %. Our methodology needs central internal dose data, and the absence of this data introduced additional systematic uncertainties of +6.9 % to −11.4 %. In conclusion, correcting for the effect of the X-ray incident directions for entrance surface dose and adding the central inner dose data can improve the reliability of the internal dose distribution.No potential conflict of interest relevant to this article was reported.IEEEActa Medica Okayama2158-40012025A Linear Search Algorithm for Resource Allocation in Frequency Domain Non-Orthogonal Multiple AccessENSatoshiDennoFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityYutoOhbaFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityYafeiHouFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityThis paper proposes a linear search algorithm for resource allocation in frequency domain non-orthogonal multiple access based on the low-density signature (LDS). Although the proposed linear search enables the non-orthogonal multiple access to achieve superior transmission performance, the proposed linear search makes the resource allocation implemented with lower and fixed computational complexity. The performance of the non-orthogonal access based on the proposed linear search is evaluated by computer simulation. The proposed linear search algorithm makes the non-orthogonal multiple access achieve a gain of about 6 dB at the BER of 10–5 when the overloading ratio is set to 2. The complexity of the non-orthogonal access based on the proposed linear search algorithm is approximately half as much as that of the conventional low complexity resource allocation when the overloading ratio is 2, if the complexity is evaluated in terms of the number of additions.No potential conflict of interest relevant to this article was reported.Oxford University Press (OUP)Acta Medica Okayama2730-6151512025Proliferation of a bloom-forming phytoplankton via uptake of polyphosphate-accumulating bacteria under phosphate-limiting conditionsycaf192ENSeiyaFukuyamaInstitute of Plant Science and Resources, Okayama UniversityFumikoUsamiInstitute of Plant Science and Resources, Okayama UniversityRyuichiHirotaGraduate School of Integrated Sciences for Life, Hiroshima UniversityAyanoSatohGraduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University ShizukaOharaGraduate School of Integrated Sciences for Life, Hiroshima UniversityKenKondoResearch Institute of Environment, Agriculture and Fisheries , Osaka PrefectureYukiGomibuchiDepartment of Physics and Information Technology, Faculty of Computer Science and Systems Engineering, Kyushu Institute of TechnologyTakuoYasunagaDepartment of Physics and Information Technology, Faculty of Computer Science and Systems Engineering, Kyushu Institute of TechnologyToshimitsuOndukaHatsukaichi Branch, Fisheries Technology Institute , Fisheries Research and Education AgencyAkioKurodaGraduate School of Integrated Sciences for Life, Hiroshima UniversityKazuhikoKoikeGraduate School of Integrated Sciences for Life, Hiroshima UniversityShokoUekiInstitute of Plant Science and Resources, Okayama UniversityHarmful algal blooms negatively impact the ecosystem and fisheries in affected areas. Eutrophication is a major factor contributing to bloom occurrence, and phosphorus is particularly important in limiting the growth of bloom-forming algae. Although algae efficiently utilize orthophosphate (Pi) as a phosphorous source over other molecular forms, Pi is often limited in the marine environment. While uptake and utilization of soluble inorganic and organic phosphorous by bloom-forming algae has been extensively studied, the details of geochemical and biological phosphorous cycling remain to be elucidated. Here, we report for the first time that the bloom-forming alga Heterosigma akashiwo can phagocytose bacteria and grow under phosphate-depleted conditions. The addition of Vibrio comitans to Pi-depleted H. akashiwo enabled the alga propagate to high cell densities, whereas other bacterial strains had only a minor effect. Importantly, V. comitans accumulates polyphosphate—a linear polymer of Pi—at high levels. The extent of algal proliferation induced by the addition of Vibrio species and polyphosphate-accumulating Escherichia coli correlated strongly with their polyphosphate content, indicating that bacterial polyphosphate served as an alternative PO43− source for H. akashiwo. The direct uptake of polyphosphate-accumulating bacteria through algal phagocytosis may represent a novel biological phosphorous-cycling pathway in marine ecosystems. The role of polyphosphate-accumulating marine bacteria as a hidden phosphorous source required for bloom formation warrants further investigation.No potential conflict of interest relevant to this article was reported.WileyActa Medica Okayama1616-301X2025A Biologically-Architected Wear and Damage-Resistant Nanoparticle Coating From the Radular Teeth of Cryptochiton stellerie21664ENTaifengWangDepartment of Materials Science and Engineering, University of CaliforniaYuChenLyles School of Civil and Construction Engineering, Purdue UniversityEzraSarmientoDepartment of Materials Science and Engineering, University of CaliforniaTaigeHaoMaterials and Manufacturing Technologies Program, University of CaliforniaAtsushiArakakiDivision of Biotechnology and Life Science, Institute of Engineering, Tokyo University of Agriculture and Technology MichikoNemotoGraduate School of Environmental and Life Science, Okayama UniversityPabloZavattieriLyles School of Civil and Construction Engineering, Purdue UniversityDavidKisailusDepartment of Materials Science and Engineering, University of CaliforniaNature utilizes simple building blocks to construct mechanically robust materials that demonstrate superior performance under extreme conditions. These exquisite structures result from the controlled synthesis and hierarchical assembly of nanoscale organic and mineral components that have provided critical evolutionary advantages to ensure survival. One such example is the ultrahard radular teeth found in mollusks, which are used to scrape against rock to feed on algae. Here, it is reported that the leading edges of these teeth consist of a wear-resistant coating that is comprised of densely packed ≈65 nm magnetic nanoparticles integrated within an organic matrix of chitin and protein. These mesocrystalline magnetite-based structures are assembled from smaller, highly aligned nanocrystals with inter/intracrystalline organics introduced during the crystallization process. Nanomechanical testing reveals that this multi-scale, nano-architected coating has a combination of increased hardness and a slight decrease in modulus versus geologic magnetite provides the surface of the chiton tooth with superior abrasion resistance. The mesocrystalline structures fracture at primary domain interfaces, corroborated by computational models, providing significant toughening to the tooth under extreme contact stresses. The design features revealed provide insight for the design and fabrication of next-generation advanced wear- and impact-resistant coatings for tooling, machinery, wind turbines, armor, etc.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1865-72572025Avoiding splenectomy in splenic sclerosing angiomatoid nodular transformation through endoscopic ultrasound-guided tissue acquisition: a 36-month follow-up case reportENTakakiOkuyamaDepartment of Internal Medicine, Tsuyama Chuo HospitalKazuyukiMatsumotoDepartment of Gastroenterology and Hepatology, Okayama University HospitalKosakuMorimotoDepartment of Internal Medicine, Tsuyama Chuo HospitalShogoKimuraDepartment of Internal Medicine, Tsuyama Chuo HospitalTakayoshiMiyakeDepartment of Pathology, Tsuyama Chuo HospitalTakuyaSatomiDepartment of Internal Medicine, Tsuyama Chuo HospitalKensukeTakeiDepartment of Internal Medicine, Tsuyama Chuo HospitalShogoInoueDepartment of Internal Medicine, Tsuyama Chuo HospitalRyutaTakenakaDepartment of Internal Medicine, Tsuyama Chuo HospitalA 48-mm splenic mass was incidentally discovered in a 78-year-old man upon computed tomography. Follow-up imaging at 12 months revealed enlargement to 60 mm, prompting endoscopic ultrasound-guided tissue acquisition with a 22-gauge needle. Histopathological analysis confirmed that it was a sclerosing angiomatoid nodular transformation. The patient was asymptomatic and had no hematologic abnormalities; therefore, splenectomy was not performed. After biopsy, the lesion regressed from 60 mm to 46 mm, possibly owing to hematoma formation or vascular disruption, and remained stable during 36 months of follow-up. Although splenectomy has been performed in most reported cases of sclerosing angiomatoid nodular transformation because of diagnostic uncertainty, a few recent reports have demonstrated that sclerosing angiomatoid nodular transformation can be diagnosed by endoscopic ultrasound-guided tissue acquisition, thereby avoiding splenectomy. This case highlights the diagnostic utility of endoscopic ultrasound-guided tissue acquisition and supports spleen-preserving management for biopsy-proven sclerosing angiomatoid nodular transformation.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama0020-13835682025Risk factors for extensor pollicis longus tendon rupture following non-displaced distal radius fractures112454ENTaichiSaitoDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesTomokiFurutaniDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesRyoNakamichiDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesRyuichiNakaharaDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesHidenoriKondoDepartment of Orthopaedic Surgery, Kagawa Rosai HospitalYasunoriShimamuraDepartment of Orthopaedic Surgery, Kousei HospitalJunyaImataniDepartment of Orthopaedic Surgery, Saiseikai General HospitalToshifumiOzakiDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesIntroduction: Distal radius fractures (DRFs) are common, with an increasing incidence, particularly among the elderly. Rupture of the extensor pollicis longus (EPL) tendon, essential for thumb extension, is a notable complication, especially in non-displaced DRFs. Several mechanisms, such as local adhesion, ischemic atrophy, and tendon laceration, are associated with EPL tendon rupture. This multicenter retrospective study aims to identify risk factors for EPL tendon rupture in non-displaced DRFs.<br>
Materials and methods: The study reviewed 20 cases of EPL tendon rupture and 52 control cases from 2005 to 2022, excluding those who underwent surgery or had incomplete computed tomography (CT) data. We investigated age, sex, location of fracture line, and the morphology of Lister’s tubercle as variables. Logistic regression and decision tree analyses were employed to determine the risk factors for EPL tendon rupture based on these variables.<br>
Results: Fracture lines distal to Lister’s tubercle and specific shapes of Lister’s tubercle, characterized by shallow peak height and a higher radial peak than the ulnar peak, increased the risk of EPL tendon rupture. Decision tree analysis confirmed them as major risk factors. There was a significant difference in the predicted probability rate of tendon rupture between the case with these factors and those without them (P < 0.001). Conversely, the location and size of Lister’s tubercle did not affect the incidence of EPL tendon rupture.<br>
Conclusion: The location of fracture line and the shape of Lister’s tubercle are key factors influencing EPL tendon rupture in non-displaced DRFs. Understanding these factors can help orthopedic surgeons predict and prevent EPL tendon ruptures, improving patient outcomes following these fractures.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1434-391614512025Changes in the anatomical positions of the femoral nerve and artery in the lateral and supine positions: a multicenter retrospective study373ENRyuichiroOkudaDepartment of Orthopaedic Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of MedicineTomonoriTetsunagaDepartment of Musculoskeletal Health Promotion, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKazukiYamadaDepartment of Medical Materials for Musculoskeletal Reconstruction, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTomokoTetsunagaDepartment of Sports Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTakashiKouraDepartment of Orthopaedic Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of MedicineTomohiroInoueDepartment of Orthopaedic Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of MedicineYasutakaMasadaDepartment of Orthopaedic Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of MedicineTetsuyaYamamotoDepartment of Orthopaedic Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of MedicineShinMatsumotoDepartment of Orthopaedic Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of MedicineHisanoriIkumaDepartment of Orthopaedic Surgery, Kagawa Prefectural Central HospitalTadashiKomatsubaraDepartment of Orthopaedic Surgery, Okayama Rosai HospitalYukiOkazakiDepartment of Orthopaedic Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of MedicineToshifumiOzakiDepartment of Orthopaedic Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityIntroduction Femoral nerve palsy and femoral artery injury are serious complications of total hip arthroplasty. However, few studies have compared the anatomical positions of these structures in different patient positions. This study aimed to compare the anatomical positions of the femoral nerve and artery in the lateral and supine positions.<br>
Materials and methods This multicenter retrospective study included 111 patients who underwent lateral and supine computed tomography (CT) from 2016 to 2023. CT images were reconstructed in the anterior pelvic plane. The horizontal distance from the anterior margin of the acetabulum to the femoral nerve (Distance N) and femoral artery (Distance A) was measured. The difference in Distance N between the two positions (ΔLateral–supine Distance N) was calculated by subtracting the supine value from the lateral value.<br>
Results The average Distance N was 26.5 ± 5.1 mm in the lateral position and 21.1 ± 4.4 mm in the supine position, with the nerve located significantly closer to the acetabulum in the supine position (P < 0.001). Similarly, the average Distance A was 26.8 ± 5.4 mm in the lateral position and 20.4 ± 4.9 mm in the supine position (P < 0.001). Multiple regression analysis showed that Distance N in the lateral position was significantly shorter in female patients and those with low body weight. In addition, low body weight correlated with a smaller ΔLateral–supine Distance N.<br>
Conclusions The femoral nerve and artery are located closer to the anterior margin of the acetabulum in the supine position than in the lateral position. Low body weight was an independent predictor of shorter Distance N in both positions and a smaller ΔLateral–supine Distance N. These findings underscore the importance of considering patient positioning during total hip arthroplasty, particularly in patients with low body weight, to reduce neurovascular risks.No potential conflict of interest relevant to this article was reported.MDPI AGActa Medica Okayama1648-91446162025Accuracy Verification of a Computed Tomography-Based Navigation System for Total Hip Arthroplasty in Severe Hip Dysplasia: A Simulation Study Using 3D-Printed Bone Models of Crowe Types II, III, and IV973ENRyuichiroOkudaDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTomonoriTetsunagaDepartment of Musculoskeletal Health Promotion, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKazukiYamadaDepartment of Orthopaedic Surgery, Okayama University HospitalTomokoTetsunagaDepartment of Sports Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTakashiKouraDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTomohiroInoueDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasutakaMasadaDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYukiOkazakiDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToshifumiOzakiDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesBackground and Objective: The use of computed tomography (CT)-based navigation systems has been shown to improve surgical accuracy in total hip arthroplasty. However, there is limited literature available about the application of CT-based navigation systems in severe hip dysplasia. This study aimed to evaluate the accuracy of a CT-based navigation system in patients with severe hip dysplasia using three-dimensional (3D)-printed bone models. Methods: 3D-printed bone models were generated from CT data of patients with severe hip dysplasia (Crowe type II, 10 hips; type III, 10 hips; and type IV, 10 hips). The accuracy of automatic segmentation, success rate, point-matching accuracy across different registration methods, and deviation values at reference points after registration were assessed. Results: For the combined cohort of Crowe II, III, and IV cases (n = 30), the Dice Similarity Coefficient and Jaccard Index were 0.99 ± 0.01 and 0.98 ± 0.02, respectively. These values indicate a high level of segmentation accuracy. The “Matching with true and false acetabulum + iliac crest” method achieved a 100% success rate across all groups, with mean deviations of 0.08 ± 0.28 mm in the Crowe II group, 0.12 ± 0.33 mm in the Crowe III group, and 0.14 ± 0.50 mm in the Crowe IV group (p = 0.572). In the Crowe IV group, the anterior superior iliac spine deviation was significantly lower using the “Matching with true and false acetabulum + iliac crest” method compared to the “Matching with true and false acetabulum” method (0.28 ± 0.49 mm vs. 3.29 ± 2.56 mm, p < 0.05). Conclusions: This study demonstrated the high accuracy of automatic AI-based segmentation, with a Dice Similarity Coefficient of 0.99 ± 0.01 and a Jaccard Index of 0.98 ± 0.02 in the combined cohort of Crowe type II, III, and IV cases (n = 30). The matching success rate was 100%, with additional points on the iliac crest, which improved matching accuracy and reduced deviations, depending on the case.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama2168-81841742025Subcutaneous and Periorbital Emphysema Following a Dental Proceduree83089ENTakafumiObaraDepartment of Emergency, Critical Care and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences Okayama UniversityTsuyoshiNojimaDepartment of Emergency, Critical Care and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences Okayama UniversityKazukiNakatsujiDepartment of Oral and Maxillofacial Reconstructive Surgery, Okayama University HospitalTakashiHongoDepartment of Emergency, Critical Care and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences Okayama UniversityTetsuyaYumotoDepartment of Emergency, Critical Care and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences Okayama UniversityAtsunoriNakaoDepartment of Emergency, Critical Care and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences Okayama UniversitySubcutaneous 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.Japan Medical AssociationActa Medica Okayama2433-3298822025Successful Transplantation of Multiple Organs from Donor after Helium Asphyxiation: First Case Report in Japan650653ENShuntaJinnoDepartment of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityTakashiHongoDepartment of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityTakafumiObaraDepartment of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityTsuyoshiNojimaDepartment of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityKoheiTsukaharaDepartment of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityTetsuyaYumotoDepartment of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityHiromichiNaitoDepartment of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityAtsunoriNakaoDepartment of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityHelium inhalation has increased, but most cases are either minor injuries or deaths; there have not yet been any reported cases of brain death leading to organ donation. We report a patient who attempted helium inhalation and was declared brain dead and became an organ donor without complications. To the best of our knowledge, this is the first reported case of deceased organ donation following helium asphyxiation in Japan. The patient in cardiac arrest was found with a helium-filled vinyl bag sealed around the neck. During emergency medical transport to the hospital, a spontaneous return of circulation was obtained after 31 minutes of cardiopulmonary resuscitation. Upon hospital arrival, the physical examination revealed dilated pupils with no response to light. Electrocardiography showed widespread ST-segment depression and ST-segment elevation in augmented Vector Right, as well as elevated cardiac enzymes and decreased myocardial contractility. Head computed tomography revealed diffuse cerebral edema and loss of the gray-white matter boundary without signs of air embolism in the cerebral and coronary arteries. Despite comprehensive post-cardiac arrest care with recovery of organ function, brain death was confirmed on day 4 after hospitalization. The family consented to organ donation on the 11th day of hospitalization. The heart, lungs, liver, and two kidneys were successfully transplanted and all organs functioned. All organ grafts were functioning well at the 3-month follow-up. Our case demonstrates that brain death caused by helium inhalation is not a contraindication to organ donation.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama2590-1230272025Voxel-based method for predicting workpiece chipping in end milling of unsintered pure iron-powder compact106656ENHirotoTakayasuGraduate School of Science and Engineering, Ibaraki UniversityKazukiKanekoGraduate School of Environmental and Life Science, Okayama UniversityJunShimizuGraduate School of Science and Engineering, Ibaraki UniversityThe miniaturization and high-torque requirements of electric motors in automotive and industrial applications have increased the adoption of axial-gap motors that employ unsintered pure iron-powder compacts. However, machining these brittle materials, particularly through end milling, typically results in significant workpiece chipping, which impedes cost-effective prototyping and small-lot production. Conventional chipping-prediction approaches, such as finite-element analysis and critical uncut chip-thickness methods, are limited by their computational costs and prediction accuracy, respectively. This study proposes a novel method for predicting chipping regions in the end milling of pure iron-powder compacts via voxel-based cutting-force simulation. The chipping risk at each voxel was evaluated based on the magnitude and direction of the simulated cutting force and local workpiece rigidity. Chipping was predicted when the risk index exceeded the threshold value. Cutting experiments were conducted to validate the proposed method, which shows good agreement between the predicted and observed chipping regions under various milling conditions. The results indicate that the proposed method can efficiently and accurately predict the chipping regions, thus outperforming conventional approaches in terms of computational cost. Although parameter tuning and threshold calibration were performed experimentally, the voxel-based framework enables practical prediction and analysis of transient machining phenomena. Future investigations shall focus on expanding the method to a wider range of machining conditions and integrating material-property considerations for further generalization. This approach offers a practical tool for optimizing machining parameters to minimize chipping and enhance the manufacturability of brittle powder compacts.No potential conflict of interest relevant to this article was reported.WileyActa Medica Okayama2470-92391032025Decreased homovanillic acid and 5‐hydroxyindoleacetic acid levels in the cerebrospinal fluid of patients with Dravet syndrome with parkinsonism965970ENRyoSugiyamaDepartment of Child Neurology, National Center Hospital, National Center of Neurology and PsychiatryTakashiSaitoDepartment of Child Neurology, National Center Hospital, National Center of Neurology and PsychiatryAtsukoKatsumotoDepartment of Neurology, National Center Hospital, National Center of Neurology and PsychiatryShotaYonenoDepartment of Child Neurology, National Center Hospital, National Center of Neurology and PsychiatryTomoyukiAkiyamaDepartment of Pediatric Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University HospitalHirofumiKomakiDepartment of Child Neurology, National Center Hospital, National Center of Neurology and PsychiatryDravet syndrome (DS) is an early onset, developmental, and epileptic encephalopathy characterized by drug-resistant seizures and multiple comorbidities. It has been reported that in adulthood, it may be accompanied by parkinsonism, but the pathogenesis of this condition remains unclear. We performed dopamine transporter single-photon emission computed tomography (DAT SPECT) and measured monoamine metabolite levels in the cerebrospinal fluid (CSF) in two adult patients with DS who developed parkinsonism around the age of 30 years. DAT SPECT showed no abnormalities in either patient, whereas CSF tests revealed significant decreases in the levels of homovanillic and 5-hydroxyindoleacetic acids. One patient with severe symptoms was treated with levodopa–carbidopa, which improved parkinsonism manifestations. The other patient initiated treatment with a low dose and has been continuing the treatment without any reported side effects. In conclusion, CSF testing can detect a decrease in dopamine synthesis and may be useful in monitoring the efficacy of levodopa treatment in patients with DS and parkinsonism.<br>
Plain Language Summary: Dravet syndrome (DS) is an early onset, developmental, and epileptic encephalopathy. DS can lead to the development of parkinsonism in adulthood, a clinical syndrome characterized by tremor, slowed movements, and rigidity. Although parkinsonism is a significant issue for patients, its underlying pathology has not yet been elucidated. In this study, we confirmed that the levels of monoamine metabolites in the CSF were low in two patients, potentially shedding light on the pathology involved.No potential conflict of interest relevant to this article was reported.The Japanese Society of Interventional RadiologyActa Medica Okayama2432-0935102025Optimal Virtual-target Definition for Detecting Feeding Arteries of Renal Cell Carcinoma Using Automated Feeder-detection Softwaree2025-0034ENSoichiroOkamotoDepartment of Radiology, Medical Development Field, Okayama UniversityYusukeMatsuiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTakahiroKawabataDepartment of Radiology, Tsuyama Chuo HospitalKojiTomitaDepartment of Radiology, Medical Development Field, Okayama UniversityKazuakiMunetomoDepartment of Radiology, Medical Development Field, Okayama UniversityNoriyukiUmakoshiDepartment of Radiology, Medical Development Field, Okayama UniversityFumiyoHigakiDepartment of Radiology, Medical Development Field, Okayama UniversityToshihiroIguchiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityPurpose: To determine the optimal virtual-target definition for detecting renal cell carcinoma feeders using transarterial computed tomography angiography with automated feeder-detection software.<br>
Material and Methods: This retrospective study included 17 patients with 17 renal cell carcinomas who underwent transarterial ethiodized-oil marking before cryoablation. Tumor feeders were automatically detected on transarterial renal computed tomography angiography images using the automated feeder-detection software with three virtual-target definitions: small (ellipsoidal area maximized within the tumor contour), medium (ellipsoidal area covering the entire tumor with a minimal peripheral margin), and large (ellipsoidal area including the tumor and a 5-mm peripheral margin). The detected feeders were classified as true or false positives according to the findings of selective renal arteriography, by consensus of two interventional radiologists. Feeder-detection sensitivity and the mean number of false-positive feeders per tumor were calculated for each virtual-target definition.<br>
Results: For 17 tumors, 25 feeding arteries were identified on the arteriography. The feeder-detection sensitivity of the software was 80.0% (20/25), 88.0% (22/25), and 48.0% (12/25) for small, medium, and large virtual targets, respectively. The mean ± standard deviation number of false-positive feeders per tumor was 0.82 ± 1.3, 1.41 ± 1.1, and 2.82 ± 1.6 when using small, medium, and large virtual-target definitions, respectively.<br>
Conclusions: The detection rate of renal cell carcinoma feeders with the automated feeder-detection software varies according to the virtual-target definition. Using a medium virtual target, covering the entire tumor with a minimal peripheral margin, may provide the highest sensitivity and an acceptable number of false-positive feeders.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1618-12472025Impact of CT-assessed sarcopenia on the severity of odontogenic deep neck infections: a retrospective cohort studyENShogoKikutaDental and Oral Medical Center, Kurume University School of MedicineEijiIwataDepartment of Oral and Maxillofacial Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of MedicineYoheiTakeshitaDepartment of Oral and Maxillofacial Radiology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of MedicineChizuruKobayashiDepartment of Oral and Maxillofacial Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of MedicineHirokiKimuraDepartment of Oral and Maxillofacial Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of MedicineYukiKinisadaDepartment of Oral and Maxillofacial Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of MedicineAkiraTachibanaDepartment of Oral and Maxillofacial Surgery, Kakogawa Central City HospitalJingoKusukawaDental and Oral Medical Center, Kurume University School of MedicineMasayaAkashiDepartment of Oral and Maxillofacial Surgery, Kobe University Graduate School of MedicineSoichiroIbaragiDepartment of Oral and Maxillofacial Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of MedicineSarcopenia is increasingly recognized as a key predictor of adverse health outcomes. This study aimed to evaluate the impact of computed tomography-assessed sarcopenia (CT–SP) on the clinical severity and hospitalization duration of odontogenic deep neck infections (DNIs). Total of 119 patients admitted for odontogenic DNI treatment were included. Patients were divided into two groups by DNI clinical severity (severe or mild) and the patients' characteristics, including CT–SP based on skeletal muscle index (SMI), were compared between two groups. Multivariable logistic regression analysis was performed to identify independent risk factors for severe DNI. The correlation between SMI and hospitalization duration was assessed using Spearman’s rank correlation coefficient. Of the 119 patients, 60 (50.4%) presented with severe DNIs, including deep neck abscesses and necrotizing soft tissue infections. After adjusting for potential confounders, multivariable analysis identified CT–SP as the sole independent risk factor associated with severe DNI (Odds Ratio = 3.04; 95% Confidence Interval, 1.20–7.71; p = 0.019). Furthermore, SMI demonstrated a significant, weak negative correlation with the hospitalization duration (r = − 0.331, p < 0.001). CT–SP is a powerful, independent risk factor associated with severity in patients with odontogenic DNIs. This finding underscores the critical role of systemic host factors in the clinical course of maxillofacial infections and highlights the potential of opportunistic CT screening as a factor to consider in risk stratification in this vulnerable population.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama2363-90241112025Venous air embolism induced by burr hole drilling before dural incision in craniotomy: two case reports59ENYoheiMotoiDepartment of Anesthesiology and Resuscitology, Okayama University HospitalShujiOkaharaDepartment of Anesthesiology and Resuscitology, Okayama University HospitalMakikoTaniDepartment of Anesthesiology and Resuscitology, Okayama University HospitalNobushigeTsuboiDepartment of Neurosurgery, Okayama Red Cross HospitalHiroshiMorimatsuDepartment of Anesthesiology and Resuscitology, Okayama University HospitalBackground: Venous air embolism (VAE) is a rare but potentially fatal complication in neurosurgery typically caused by injury to dura mater, especially venous sinuses, during craniotomy. We report two cases of VAE that occurred before dural incision.<br>
Case presentation: Both patients underwent craniotomy under general anesthesia in a head-up position. Hemodynamic and respiratory deterioration occurred during or immediately after burr hole drilling with abnormal vital signs and transesophageal echocardiography findings, raising suspicion for VAE. Immediate management, including surgical field protection and cardiopulmonary support, stabilized the patients’ conditions. The procedure was subsequently discontinued in case 1 and modified to limited resection in case 2. Postoperative computed tomography revealed intracranial venous air within the internal jugular vein, cavernous sinus, and diploic veins.<br>
Conclusion: These cases highlight that VAE can occur even before dural incision. Vigilant intraoperative monitoring and prompt intervention are essential for preventing potentially fatal outcomes.No potential conflict of interest relevant to this article was reported.Public Library of Science (PLoS)Acta Medica Okayama1932-620320102025Relationship between obesity indices and cognitive function in Japanese men: A cross-sectional studye0332595ENSatoshiMatsunoDepartment of Psychiatry, Shiga University of Medical ScienceYujiOzekiDepartment of Psychiatry, Shiga University of Medical ScienceSayakaKadowakiNCD Epidemiology Research Center, Shiga University of Medical ScienceSayukiToriiNCD Epidemiology Research Center, Shiga University of Medical ScienceKeikoKondoNCD Epidemiology Research Center, Shiga University of Medical ScienceNaokoMiyagawaDepartment of Preventive Medicine and Public Health, Keio University School of MedicineAzusaShimaDepartment of Clinical Nursing, Shiga University of Medical ScienceMizukiOhashiNCD Epidemiology Research Center, Shiga University of Medical ScienceItsukoMiyazawaDepartment of Medicine, Shiga University of Medical ScienceHiroyoshiSegawaNCD Epidemiology Research Center, Shiga University of Medical ScienceTakashiHisamatsuDepartment of Public Health, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesAyaKadotaNCD Epidemiology Research Center, Shiga University of Medical ScienceKatsuyukiMiuraNCD Epidemiology Research Center, Shiga University of Medical ScienceWe aimed to investigate the associations among various obesity indices, including visceral (VAT) and subcutaneous adipose tissue (SAT), and cognitive function in community-dwelling Japanese men. This population-based cross-sectional study used data of 853 men who participated in the follow-up examinations of the Shiga Epidemiological Study of Subclinical Atherosclerosis. Among them, we analyzed data of 776 men who completed the Cognitive Abilities Screening Instrument (CASI) and had abdominal VAT and SAT areas measured using computed tomography. The VAT-to-SAT ratio (VSR) was calculated; participants were categorized into VSR quartiles. Using analysis of covariance, we computed crude and adjusted means of the CASI total and domain scores across VSR quartiles, adjusting for potential confounders. No significant differences were observed in total CASI scores among body mass index, VAT, or SAT quartiles. However, in the multivariable-adjusted model, participants in the lowest VSR quartile (Q1) had significantly lower CASI total scores than those in the third quartile (Q3) (Q1: 89.5, Q3: 90.9). Low VSR was independently associated with lower cognitive function in a community-based sample of middle-aged and older Japanese men. In summary, VSR may be associated with cognitive function in Japanese men, highlighting the importance of fat distribution in cognitive health and highlighting VSR as a useful indicator.No potential conflict of interest relevant to this article was reported.Japan Neurosurgical SocietyActa Medica Okayama2188-4226122025Endovascular Thrombectomy for Large Vessel Occlusion in a Patient on Venoarterial Extracorporeal Membrane Oxygenation: A Case Report445451ENYukiEBISUDANIDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMasafumiHIRAMATSUDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKeiichiroIWASAKIDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKenjiSUGIUDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesJunHARUMADepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesRyuKIMURADepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMasatoKAWAKAMIDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYutaSOTOMEDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakahiroNISHIHARADepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShinsukeYUASADepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShotaTANAKADepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesExtracorporeal membrane oxygenation is utilized in the treatment of severe acute cardiac failure and respiratory failure. While it provides the advantage of oxygenating blood through extracorporeal circulation, it also carries risks of intracranial ischemic and hemorrhagic complications due to the continuous presence of artificial materials within the body. We encountered a case in which venoarterial extracorporeal membrane oxygenation was initiated for fulminant myocarditis, and the patient subsequently developed a large vessel occlusion. The diagnosis was confirmed using perfusion computed tomography. A visible thrombus was observed on the arterial cannula of the extracorporeal membrane oxygenation circuit, and the large vessel occlusion was determined to have been caused by thromboembolism. An immediate extracorporeal membrane oxygenation circuit exchange was performed, followed by endovascular thrombectomy. The patient experienced no perioperative complications and achieved a favorable neurological outcome. Endovascular thrombectomy in extracorporeal membrane oxygenation patients requires careful perioperative management and should be promptly performed in eligible cases of thromboembolic events. Furthermore, because patients on extracorporeal membrane oxygenation are often sedated and under intensive systemic management, regular neurological assessments and intracranial monitoring are essential for the early detection of intracranial pathologies.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama0266-352X1782025End-to-end time-dependent probabilistic assessment of landslide hazards using hybrid deep learning simulator106920ENMengluHuangDepartment of Civil and Environmental Engineering, Okayama UniversityShin-ichiNishimuraDepartment of Civil and Environmental Engineering, Okayama UniversityToshifumiShibataDepartment of Civil and Environmental Engineering, Okayama UniversityZe ZhouWangMarie Skłodowska-Curie Fellow, Department of Engineering, University of CambridgeEarly warning detection of landslide hazards often requires real-time or near real-time predictions, which can be challenging due to the presence of multiple geo-uncertainties and time-variant external environmental loadings. The propagation of these uncertainties at the system level for understanding the spatiotemporal behavior of slopes often requires time-consuming numerical calculations, significantly hindering the establishment of an early warning system. This paper presents a hybrid deep learning simulator, which fuses parallel convolutional neural networks (CNNs) and long short-term memory (LSTM) networks through attention mechanisms, termed PCLA-Net, to facilitate time-dependent probabilistic assessment of landslide hazards. PCLA-Net features two novelties. First, it is capable of simultaneously handling both temporal and spatial information. CNNs specialize in interpreting spatial data, while LSTM excels in handling time-variant data. Coupled with two attention mechanisms, the two modules are combined to probabilistically predict the spatiotemporal behavior of slopes. Second, PCLA-Net realizes end-to-end predictions. In this paper, the Liangshuijing landslide in the Three Gorges Reservoir area of China is used to illustrate PCLA-Net. It is first validated followed by a comparison with existing techniques to demonstrate its improved predictive capabilities. The proposed PCLA-Net simulator can achieve the same level of accuracy with at least 50% reduction in computation resources.No potential conflict of interest relevant to this article was reported.WileyActa Medica Okayama1532-06263727-282025Algebraic Connectivity Maximizing Regular Graphs: Special Case Analysis and Depth‐First Searche70357ENMasashiKurahashiGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityNajdSalaaniPolytech Sorbonne, Sorbonne UniversityTsuyoshiMigitaFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityNorikazuTakahashiFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityThe algebraic connectivity is an indicator of how well connected a graph is. It also characterizes the convergence speed of some dynamic processes over networks. In this paper, taking into account that homogeneous networks are modeled as regular graphs, we tackle the following problem: given a pair (𝑛, 𝑘) of positive integers such that 𝑘 is less than 𝑛 and kn is an even number, find a 𝑘-regular graph with 𝑛 vertices that have the maximum algebraic connectivity. We first consider some special cases and derive solutions through theoretical analysis. We next present depth-first search algorithms for solving the problem, which reduce the search space by making use of some known properties of the regular graph and the algebraic connectivity.We also show the results of execution of the proposed algorithms for the values of 𝑛 up to 12.No potential conflict of interest relevant to this article was reported.Springer Nature SingaporeActa Medica Okayama1865-09292025Evaluation of a Startup Program Identification for Efficient and Accurate IoT Security Investigations417431ENYutaShimamotoGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityJiratchayaPhinyodomSchool of Engineering, Okayama UniversityRyotaYoshimotoGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityHiroyukiUekawaNTT Social Informatics LaboratoriesMitsuakiAkiyamaNTT Social Informatics LaboratoriesToshihiroYamauchiFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityNot all file in firmware are executed while using Internet of Things (IoT) devices and hundreds to approximately a thousand executable and linkable format files exist in one firmware. Therefore, security investigations without prioritization may lead to investigate programs that are not executed while using IoT devices first. This has resulted in inefficient security investigations. To perform efficient security investigations, we proposed a method that can identify programs executed during the startup process. However, only two firmware were used for the evaluation which can only evaluate one of the two startup sequences in the OpenWrt-based firmware. In addition, security investigations to validate whether the proposed method addresses the problem of inefficient security investigations were limited to OpenWrt-based firmware. In this study, we use more firmware data for evaluation and validation. We use nine firmware not used in previous studies including startup methods that have not previously been used for evaluation. In addition, we increase the number of firmware used for validation to 225. The evaluation results demonstrate that the proposed method can identify with only few false positives. The validation demonstrates that efficiency can be improved and prioritizing investigations by considering the proposed method result is worthwhile.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama0916-70052025Refinement of interval approximations for fully commutative quiversENYasuakiHiraokaKyoto UniversityKenNakashimaShimane UniversityIppeiObayashiOkayama UniversityChenguangXuKyoto UniversityA central challenge in the theory of multiparameter persistence modules lies in defining effective descriptors for representations of infinite or wild type. In this work, we propose a novel framework for analyzing interval approximations of fully commutative quivers, which offers a tunable trade-off between approximation resolution and computational complexity. Our approach is evaluated on commutative ladder modules of both finite and infinite type. For finite-type cases, we establish an efficient method for computing indecomposable decompositions using solely one-parameter persistent homology. For infinite-type cases, we introduce a new invariant that captures persistence in the second parameter by connecting standard persistence diagrams through interval approximations. Furthermore, we present several models for constructing commutative ladder filtrations, providing new insights into the behavior of random filtrations and demonstrating the utility of our framework in topological analysis of material structures.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama2168-818417102025Primary Lacrimal Sac Diffuse Large B-cell Lymphoma Treated With Local Radiotherapy Alone: A Case With No Relapse After 21 Years of Follow-Upe95411ENToshihikoMatsuoHealthcare Science, Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama UniversityTakehiroTanakaPathology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityMitsuhiroTakemotoRadiotherapy, Himeji Red Cross HospitalPrimary lacrimal sac lymphoma is rare and diagnosed as diffuse large B-cell lymphoma in a predominant histopathological type. Systemic chemotherapy would be the standard of care, but local radiotherapy may be a treatment option toward a localized lesion. The present patient is a 54-year-old otherwise healthy woman with a right lacrimal sac mass, which was proven by excisional biopsy to be diffuse large B-cell lymphoma. Since she did not have any other systemic lesions on gallium scintigraphy and neck-to-abdominal computed tomography scans, which were the standard procedure at that time, she underwent local radiotherapy at 40 Gy. Two years later, at the age of 56 years, she developed radiation retinopathy with macular edema in the right eye and had spotty laser photocoagulation in the nasal half of the fundus. At the age of 57 years, she developed radiation cataract and underwent cataract surgery with intraocular lens implantation in the right eye. At the age of 58 years, the macular edema in the right eye became worse and remained active, resulting in poor visual acuity of 0.1. She thus underwent 25-gauge vitrectomy in the right eye to peel off the adhering posterior vitreous surface, together with the internal limiting membrane, as the standard procedure at that time. The visual acuity in the right eye was elevated to 0.6. She maintained the visual acuity afterward and had no relapse of lymphoma in 21 years from the diagnosis of primary right lacrimal sac diffuse large B-cell lymphoma. Local radiotherapy would still be a treatment option for localized lymphoma lesions such as primary lacrimal sac lymphoma.No potential conflict of interest relevant to this article was reported.Springer Nature SwitzerlandActa Medica Okayama0302-97432025Effects of Visual Stimuli on Perceived Sound Volume in Virtual Reality Spaces286299ENYukiMatsudaOkayama UniversityTomaKobayashiNara Institute of Science and TechnologyHirokiWatanabeFuture University HakodateKeiichiYasumotoNara Institute of Science and TechnologyWith the proliferation of affordable and high-performance virtual reality (VR) devices, VR content such as games and the metaverse is becoming increasingly widespread. In VR environments, users experience various sensory stimuli, primarily through visual and auditory cues. However, subjective perception of these stimuli varies based on user context. Existing studies have shown that auditory perception can be influenced by visual stimuli, however, most of them have focused on congruent audiovisual stimuli, leaving the effects of non-congruent pairings unexplored. This study investigates how visual stimuli, specifically color and crowdedness, influence perceived sound volume in VR. In the experiment that participants experienced VR environments with different room colors while listening to test tones, the results showed that warm colors led to higher perceived volume at low sound levels. Also, in the experiment that participants viewed VR scenes with varying crowd densities while hearing announcements, less crowded environments resulted in higher perceived sound volume. These findings suggest that visual context impacts auditory perception, providing insights for optimizing hearable devices and enhancing VR auditory experiences.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama0952-19761502025Surrogate-assisted motion planning and layout design of robotic cellular manufacturing systems110530ENTomoyaKawabeGraduate School of Environmental, Life and Natural Science and Technology, Okayama UniversityTatsushiNishiGraduate School of Environmental, Life and Natural Science and Technology, Okayama UniversityZiangLiuGraduate School of Environmental, Life and Natural Science and Technology, Okayama UniversityTomofumiFujiwaraGraduate School of Environmental, Life and Natural Science and Technology, Okayama UniversityA 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.Okayama University Medical SchoolActa Medica Okayama0386-300X7952025Immunoglobulin G4-related Disease Mimicking Portal Vein Tumor Thrombus381385ENAtsunobuSakuraiDepartment of Radiology, NHO Iwakuni Clinical CenterTakayukiYabukiDepartment of Radiology, NHO Iwakuni Clinical CenterHidekiAokiDepartment of Gastroenterological Surgery, NHO Iwakuni Clinical CenterAkikoIsekiDepartment of Pathology, NHO Iwakuni Clinical CenterCase Report10.18926/AMO/69439We report the case of a 72-year-old Japanese man with an incidental portal vein mass that was surgically resected and diagnosed as immunoglobulin G4 (IgG4)-related disease. The mass was discovered during an atrial fibrillation examination. The patient had a history of gastric cancer and was also diagnosed with rectal cancer, raising concerns about metastasis. Due to technical challenges, a biopsy was not feasible. Imaging findings suggested portal vein tumor thrombosis, complicating the diagnosis. This case highlights a rare presentation of IgG4-related disease mimicking portal vein tumor thrombus.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7952025Blood Pressure and Heart Rate Patterns Identified by Unsupervised Machine Learning and Their Associations with Subclinical Cerebral and Renal Damage in a Japanese Community: The Masuda Study369379ENTakashiHisamatsuDepartment of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMinakoKinutaDepartment of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesSosukeMunetomoDepartment of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMariFukudaDepartment of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKatsuhideKojimaDepartment of Radiology, Okayama University HospitalKaoriTaniguchiDepartment of Environmental Medicine and Public Health, Izumo, Shimane University Faculty of MedicineNorikoNakahataDepartment of Health and Nutrition, The University of Shimane Faculty of Nursing and NutritionHideyukiKandaDepartment of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOriginal Article10.18926/AMO/69438We applied unsupervised machine learning to analyze blood pressure (BP) and resting heart rate (HR) patterns measured during a 1-year period to assess their cross-sectional relationships with subclinical cerebral and renal target damage. Dimension reduction via uniform manifold approximation and projection, followed by K-means++ clustering, was used to categorize 362 community-dwelling participants (mean age, 56.2 years; 54.9% women) into three groups: Low BP and Low HR (Lo-BP/Lo-HR), High BP and High HR (Hi-BP/Hi-HR), and Low BP and High HR (Lo-BP/Hi-HR). Cerebral vessel lesions were defined as the presence of at least one of the following magnetic resonance imaging findings: lacunar infarcts, white matter hyperintensities, cerebral microbleeds, or intracranial artery stenosis. A high urinary albumin-to-creatinine ratio (UACR) was defined as the top 10% (≥ 12 mg/g) of the mean value from ≥2 measurements. Poisson regression with robust error variance, adjusted for demographics, lifestyle, and medical history, showed that the Hi-BP/Hi-HR group had relative risks of 3.62 (95% confidence interval, 1.75-7.46) for cerebral vessel lesions and 3.58 (1.33-9.67) for high UACR, and the Lo-BP/Hi-HR group had a relative risk of 3.09 (1.12-8.57) for high UACR, compared with the Lo-BP/Lo-HR group. These findings demonstrate the utility of an unsupervised, data-driven approach for identifying physiological patterns associated with subclinical target organ damage.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7952025Advantages of Single-Position Surgery over Posterior Fusion for Single-Level Degenerative Lumbar Diseases359368ENTomohikoHiroseDepartment of Orthopedic Surgery, Kagawa Prefectural Central HospitalHisanoriIkumaDepartment of Orthopedic Surgery, Kagawa Prefectural Central HospitalKazutoshiOtsukaOtsuka Orthopedic ClinicKeisukeKawasakiDepartment of Orthopedic Surgery, Kagawa Prefectural Central HospitalOriginal Article10.18926/AMO/69437Single-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.International Institute of Anticancer ResearchActa Medica Okayama0258-851X3952025Accuracy of Contrast-enhanced CT in Diagnosing Small-sized cT3a Renal Cell Carcinoma and Analysis of Factors Predicting Downstaging to pT127872793ENKENSUKEBEKKUDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesKASUMIYOSHINAGADepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesSHOTAINOUEDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesYOSUKEMITSUIDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesTOMOAKIYAMANOIDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesTATSUSHIKAWADADepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesYUSUKETOMINAGADepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesTAKUYASADAHIRADepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesSATOSHIKATAYAMADepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesTAKEHIROIWATADepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesSHINGONISHIMURADepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesKOHEIEDAMURADepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesTOMOKOKOBAYASHIDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesMOTOOARAKIDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesBackground/Aim: This study assessed the accuracy of preoperative contrast-enhanced computed tomography (CECT) scans in staging small-sized, locally advanced (cT3a) renal cell carcinoma (RCC) and identified predictors of pathological downstaging following surgery.<br>
Patients and Methods: Seventy-six patients who underwent radical nephrectomy for cT3aN0M0 RCC with tumors ≤7 cm were analyzed. Preoperative CECT evaluated features such as venous, peritumoral, or renal sinus fat, and urinary tract invasion, predictive values, and concordance index between radiological and pathological findings were calculated for these categories. The study also examined the impact of clinicopathologic factors on downstaging.<br>
Results: Of 76 patients with cT3 RCC, 37% were down-staged to pT1. Down-staged cases had a higher proportion of male patients and non-clear cell carcinoma (86% vs. 58%, 32% vs. 6%; p=0.02, p=0.007, respectively). Multiple cT3a factors were less common in down-staged cases (4% vs. 23%, p=0.04). Non-clear cell carcinoma was significantly associated with downstaging compared to clear cell carcinoma (75% vs. 30%, p=0.006). Multivariate analysis confirmed non-clear cell carcinoma as an independent predictor (odds ratio=8.2, p=0.01). For venous invasion, CECT sensitivity and positive predictive value were high (73.5% and 83.3%, respectively) and the degree of agreement was substantial (κ=0.62).<br>
Conclusion: The accuracy of preoperative CECT was acceptable for detecting venous invasion. The downstaging to pT1 occurred in 37% of cT3a RCC cases in the final pathology, with non-clear cell carcinoma being a significant predictor.<br>No potential conflict of interest relevant to this article was reported.MDPI AGActa Medica Okayama2073-431X14102025A Guided Self-Study Platform of Integrating Documentation, Code, Visual Output, and Exercise for Flutter Cross-Platform Mobile Programming417ENSafira AdineKinariDepartment of Information and Communication Systems, Okayama UniversityNobuoFunabikiDepartment of Information and Communication Systems, Okayama UniversitySoe ThandarAungDepartment of Information and Communication Systems, Okayama UniversityHtoo Htoo SandiKyawDepartment of Information and Communication Systems, Okayama UniversityNowadays, Flutter with the Dart programming language has become widely popular in mobile developments, allowing developers to build multi-platform applications using one codebase. An increasing number of companies are adopting these technologies to create scalable and maintainable mobile applications. Despite this increasing relevance, university curricula often lack structured resources for Flutter/Dart, limiting opportunities for students to learn it in academic environments. To address this gap, we previously developed the Flutter Programming Learning Assistance System (FPLAS), which supports self-learning through interactive problems focused on code comprehension through code-based exercises and visual interfaces. However, it was observed that many students completed the exercises without fully understanding even basic concepts, if they already had some knowledge of object-oriented programming (OOP). As a result, they may not be able to design and implement Flutter/Dart codes independently, highlighting a mismatch between the system’s outcomes and intended learning goals. In this paper, we propose a guided self-study approach of integrating documentation, code, visual output, and exercise in FPLAS. Two existing problem types, namely, Grammar Understanding Problems (GUP) and Element Fill-in-Blank Problems (EFP), are combined together with documentation, code, and output into a new format called Integrated Introductory Problems (INTs). For evaluations, we generated 16 INT instances and conducted two rounds of evaluations. The first round with 23 master students in Okayama University, Japan, showed high correct answer rates but low usability ratings. After revising the documentation and the system design, the second round with 25 fourth-year undergraduate students in the same university demonstrated high usability and consistent performances, which confirms the effectiveness of the proposal.No potential conflict of interest relevant to this article was reported.MDPI AGActa Medica Okayama2078-24891672025A Fundamental Statistics Self-Learning Method with Python Programming for Data Science Implementations607ENPrismahardi AjiRiyantokoDepartment of Information and Communication Systems, Okayama UniversityNobuoFunabikiDepartment of Information and Communication Systems, Okayama UniversityKomang CandraBrataDepartment of Information and Communication Systems, Okayama UniversityMustikaMentariDepartment of Information and Communication Systems, Okayama UniversityAviolla TerzaDamalianaDepartment of Data Science, Universitas Pembangunan Nasional Veteran Jawa TimurDwi ArmanPrasetyaDepartment of Data Science, Universitas Pembangunan Nasional Veteran Jawa TimurThe increasing demand for data-driven decision making to maintain the innovations and competitiveness of organizations highlights the need for data science educations across academia and industry. At its core is a solid understanding of statistics, which is necessary for conducting a thorough analysis of data and deriving valuable insights. Unfortunately, conventional statistics learning often lacks practice in real-world applications using computer programs, causing a separation between conceptual knowledge of statistics equations and their hands-on skills. Integrating statistics learning into Python programming can convey an effective solution for this problem, where it has become essential in data science implementations, with extensive and versatile libraries. In this paper, we present a self-learning method for fundamental statistics through Python programming for data science studies. Unlike conventional approaches, our method integrates three types of interactive problems—element fill-in-blank problem (EFP), grammar-concept understanding problem (GUP), and value trace problem (VTP)—in the Programming Learning Assistant System (PLAS). This combination allows students to write code, understand concepts, and trace the output value while obtaining instant feedback so that they can improve retention, knowledge, and practical skills in learning statistics using Python programming. For evaluations, we generated 22 instances using source codes for fundamental statistics topics, and assigned them to 40 first-year undergraduate students at UPN Veteran Jawa Timur, Indonesia. Statistics analytical methods were utilized to analyze the student learning performances. The results show that a significant correlation (𝜌<0.05) exists between the students who solved our proposal and those who did not. The results confirm that it can effectively assist students in learning fundamental statistics self-learning using Python programming for data science implementations.No potential conflict of interest relevant to this article was reported.MDPI AGActa Medica Okayama2079-929214112025An Automatic Code Generation Tool Using Generative Artificial Intelligence for Element Fill-in-the-Blank Problems in a Java Programming Learning Assistant System2261ENZihaoZhuDepartment of Information and Communication Systems, Okayama UniversityNobuoFunabikiDepartment of Information and Communication Systems, Okayama UniversityMustikaMentariDepartment of Information and Communication Systems, Okayama UniversitySoe ThandarAungDepartment of Information and Communication Systems, Okayama UniversityWen-ChungKaoDepartment of Electrical Engineering, National Taiwan Normal UniversityYi-FangLeeDepartment of Industrial Education, National Taiwan Normal UniversityPresently, Java is a fundamental object-oriented programming language that can be mastered by any student in information technology or computer science. To assist both teachers and students, we developed the Java Programming Learning Assistant System (JPLAS). It offers several types of practice problems with different levels and learning goals for step-by-step self-study, where any answer is automatically marked in the system. One challenge for teachers that is addressed with JPLAS is the generation of proper exercise problems that meet learning requirements. We implemented programs for generating new problems from given source codes, as collecting and evaluating suitable codes remains time-consuming. In this paper, we present an automatic code generation tool using generative AI to solve this challenge. Prompt engineering is used to help generate an appropriate source code, and the quality is controlled by optimizing the prompt based on the outputs. For applications in JPLAS, we implement a web application system to automatically generate an element fill-in-the-blank problem (EFP) in JPLAS. For evaluation, we select the element fill-in-the-blank problem (EFP) as the target type in JPLAS and generate several instances using this tool. The results confirm the validity and effectiveness of the proposed method.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1875-83122025Computed tomography versus aortography for transcatheter patent ductus arteriosus closure in adultsENTakashiMikiDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of MedicineToruMiyoshiDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of MedicineTeijiAkagiDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of MedicineMitsutakaNakashimaDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of MedicineRieNakayamaDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of MedicineYoichiTakayaDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of MedicineKojiNakagawaDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of MedicineNorihisaTohDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of MedicineShinsukeYuasaDepartment of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of MedicineAccurate sizing of the patent ductus arteriosus (PDA) is essential for successful transcatheter closure. While aortography is the standard imaging modality, computed tomography (CT) may offer superior anatomical visualization. This study aimed to compare the accuracy and procedural outcomes of preprocedural CT versus aortography alone in adult patients undergoing transcatheter PDA closure. We retrospectively analyzed 54 adult patients who underwent PDA closure using the Amplatzer™ Duct Occluder between 2009 and 2024. Nineteen patients were treated based on aortography alone and 35 based on preprocedural CT. We compared procedural characteristics and outcomes, including device size exchange and procedure time. A simulation study was also conducted in which two blinded implanters independently predicted occluder size based on CT and aortography, with actual implanted device size used as the reference. The CT group had significantly larger PDA sizes and implanted device sizes. Device replacement was required in three patients in the aortography group but none in the CT group. Procedure time was shorter in the CT group (60 ± 9 vs. 70 ± 14 min, p = 0.003). Simulation results showed that CT more accurately predicted the actual implanted device size (85% vs. 63%, p = 0.008). PDA size at the pulmonary artery end was significantly underestimated by aortography. Preprocedural CT improved procedural efficiency and device selection accuracy in adult PDA closure. These findings suggest that CT imaging may enhance planning and safety in transcatheter PDA interventions.No potential conflict of interest relevant to this article was reported.MDPI AGActa Medica Okayama2504-446X992025Application of LMM-Derived Prompt-Based AIGC in Low-Altitude Drone-Based Concrete Crack Monitoring660ENShijunPanShenzhen Institute for Advanced Study, UESTC, University of Electronic Science and Technology of ChinaZhunFanShenzhen Institute for Advanced Study, UESTC, University of Electronic Science and Technology of ChinaKeisukeYoshidaGraduate School of Environmental and Life Science, Okayama UniversityShujiaQinShenzhen Academy of RoboticsTakashiKojimaTOKEN C.E.E. Consultants Co., Ltd.SatoshiNishiyamaGraduate School of Environmental and Life Science, Okayama UniversityIn recent years, large multimodal models (LMMs), such as ChatGPT 4o and DeepSeek R1—artificial intelligence systems capable of multimodal (e.g., image and text) human–computer interaction—have gained traction in industrial and civil engineering applications. Concurrently, insufficient real-world drone-view data (specifically close-distance, high-resolution imagery) for civil engineering scenarios has heightened the importance of artificially generated content (AIGC) or synthetic data as supplementary inputs. AIGC is typically produced via text-to-image generative models (e.g., Stable Diffusion, DALL-E) guided by user-defined prompts. This study leverages LMMs to interpret key parameters for drone-based image generation (e.g., color, texture, scene composition, photographic style) and applies prompt engineering to systematize these parameters. The resulting LMM-generated prompts were used to synthesize training data for a You Only Look Once version 8 segmentation model (YOLOv8-seg). To address the need for detailed crack-distribution mapping in low-altitude drone-based monitoring, the trained YOLOv8-seg model was evaluated on close-distance crack benchmark datasets. The experimental results confirm that LMM-prompted AIGC is a viable supplement for low-altitude drone crack monitoring, achieving >80% classification accuracy (images with/without cracks) at a confidence threshold of 0.5.No potential conflict of interest relevant to this article was reported.Ovid Technologies (Wolters Kluwer Health)Acta Medica Okayama1536-02102025Applicability of Effective Atomic Number (Z eff) Image Analysis of Coronary Plaques Measured With Photon- Counting Computed TomographyENTakashiAsaharaDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityManaMitaniMedical Support Department, Division of Radiology, Okayama University HospitalNatsumiKimotoDepartment of Radiological Science, Faculty of Health Sciences, Junshin Gakuen UniversityRinaNishigamiGraduate School of Medical Sciences, Kanazawa UniversityKazukiTakegamiDepartment of Radiological Technology, Yamaguchi University HospitalYusukeMorimitsuMedical Support Department, Division of Radiology, Okayama University HospitalNoriakiAkagiMedical Support Department, Division of Radiology, Okayama University HospitalToruMiyoshiDepartment of Cardiovascular Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityYukiKanazawaFaculty of Life Science, Kumamoto UniversityToshihiroIguchiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityHiroakiHayashiCollege of Transdisciplinary Sciences for Innovation, Kanazawa UniversityObjective: Coronary computed tomography (CT) allows the assessment of cardiovascular risk by imaging calcified plaques in coronary arteries. Because photon-counting CT (PC-CT) can analyze the effective atomic number (Zeff) of the subject, it is expected to be applied to the analysis of plaque components. The purpose of this study was to investigate the applicability of plaque analysis based on Zeff images with continuous gradation.<br>
Methods: Zeff images were generated from virtual monoenergetic images (VMIs) obtained by PC-CT. Zeff values were derived from the difference between linear attenuation coefficients (μ) at low and high energies using an in-house program. Coronary CT images of 64 plaques in 10 patients were analyzed. The Zeff score, calculated as the sum of Zeff values within the plaque region, was calculated and compared with the conventional Agatston score and mean coronary artery calcium (CAC) score.<br>
Results: The systematic uncertainty of Zeff images was estimated to be ±0.08. The Zeff score of actual patient data showed strong positive correlations with the conventional Agatston and mean CAC scores. The Zeff score uses all voxel data in the plaque area, whereas conventional scores consider only data from voxels with a CT value >130. We found that the conventional scores excluded 39% of the plaque area, and the Zeff score permitted the analysis of low- and high-density plaques.<br>
Conclusions: Zeff imaging was shown to be applicable to plaque analysis that reflects the entire plaque volume. This study demonstrated its technical feasibility as a compositional analysis method using the Zeff image.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama2590-1974272025Development of a technique to identify μm-sized organic matter in asteroidal material: An approach using machine learning100277ENRahulKumarThe Pheasant Memorial Laboratory, Institute for Planetary Materials, Okayama UniversityKatsuraKobayashiThe Pheasant Memorial Laboratory, Institute for Planetary Materials, Okayama UniversityChristianPotiszilThe Pheasant Memorial Laboratory, Institute for Planetary Materials, Okayama UniversityTakKunihiroThe Pheasant Memorial Laboratory, Institute for Planetary Materials, Okayama UniversityAsteroidal materials contain organic matter (OM), which records a number of extraterrestrial environments and thus provides a record of Solar System processes. OM contain essential compounds for the origin of life. To understand the origin and evolution of OM, systematic identification and detailed observation using in-situ techniques is required. While both nm- and μm-sized OM were studied previously, only a small portion of a given sample surface was investigated in each study. Here, a novel workflow was developed and applied to identify and classify μm-sized OM on mm-sized asteroidal materials. The workflow involved image processing and machine learning, enabling a comprehensive and non-biased way of identifying, classifying, and measuring the properties of OM. We found that identifying OM is more accurate by classification with machine learning than by clustering. On the approach of classification with machine learning, five algorithms were tested. The random forest algorithm was selected as it scored the highest in 4 out of 5 accuracy parameters during evaluation. The workflow gave modal OM abundances that were consistent with those identified manually, demonstrating that the workflow can accurately identify 1-15 μm-sized OM. The size distribution of OM was modeled using the power-law distribution, giving slope α values that were consistent with fragmentation processes. The shape of the OM was quantified using circularity and solidity, giving a positive correlation and indicating these properties are closely related. Overall, the workflow enabled identification of many OM quickly and accurately and the obtainment of chemical and petrographic information. Such information can help the selection of OM for further in-situ techniques, and elucidate the origin and evolution of OM preserved in asteroidal materials.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama1078-81743162025Evaluation of a method to predict positioning errors in orthopantomography using cephalography103174ENS.ImajoDivision of Radiology, Medical Support Department, Okayama University HospitalM.HondaDivision of Radiology, Medical Support Department, Okayama University HospitalY.TanabeFaculty of Medicine, Graduate School of Health Sciences, Okayama UniversityIntroduction: Various radiographic examinations are used to diagnose diseases and determine treatment plans, and the quality of radiographic images affects diagnostic accuracy. This study assessed the relationship between orthopantomography and cephalometric analysis in predicting positioning errors before orthopantomography.<br>
Methods: This study evaluated four human head phantom types and included 300 patients aged ≥18 years who underwent orthopantomography. The correlation between the Frankfort horizontal plane and occlusal plane angles in the orthopantomogram was analyzed. The occlusal plane angle at a Frankfort horizontal plane of 0° was estimated using a linear approximation formula. Frankfort horizontal plane and occlusal plane angles were measured on the cephalograms, and their differences were analyzed for correlation with the occlusal plane angle at a Frankfort horizontal plane of 0° in the corresponding orthopantomograms. The cephalogram’s condylar plane–corpus line angle was also compared with orthopantomogram measurements.<br>
Results: Frankfort horizontal and occlusal plane angles demonstrated a strong negative correlation (r < −0.9) in phantom studies and moderate negative correlation (r < −0.4) in clinical orthopantomograms. In the phantoms, the occlusal plane at a Frankfort horizontal of 0° in the orthopantomogram strongly correlated with the difference between the Frankfort horizontal and condylar plane–corpus line angles in the cephalogram.<br>
Conclusion: Adjusting patient positioning based on individual skeletal differences and angles may reduce positioning errors and improve image quality. Cephalogram analysis could help determine an appropriate Frankfort plane angle for each patient when acquiring orthopantomograms.<br>
Implications for practice: Integrating cephalometric analysis into positioning protocols enhances radiographic accuracy, reduces retakes, and improves diagnostic reliability in clinical positioning. This research could improve image quality by identifying reference indicators for orthopantomography by incorporating data from images other than cephalograms, such as computed tomography and magnetic resonance imaging.No potential conflict of interest relevant to this article was reported.WileyActa Medica Okayama0915-56352025Vendor‐Agnostic Vision Transformer‐Based Artificial Intelligence for Peroral Cholangioscopy: Diagnostic Performance in Biliary Strictures Compared With Convolutional Neural Networks and EndoscopistsENRyosukeSatoDepartment of Gastroenterology and Hepatology, Okayama University HospitalKazuyukiMatsumotoDepartment of Gastroenterology and Hepatology, Okayama University HospitalMasahiroTomiyaHealthcare Solutions Division, Ryobi Systems Co., LtdTakayoshiTanimotoHealthcare Solutions Division, Ryobi Systems Co., LtdAkimitsuOhtoHealthcare Solutions Division, Ryobi Systems Co., LtdKentaroOkiDepartment of Gastroenterology and Hepatology, Okayama University HospitalSatoshiKajitaniDepartment of Gastroenterology and Hepatology, Okayama University HospitalTatsuyaKikuchiDepartment of Gastroenterology and Hepatology, Okayama University HospitalAkihiroMatsumiDepartment of Gastroenterology and Hepatology, Okayama University HospitalKazuyaMiyamotoDepartment of Gastroenterology and Hepatology, Okayama University HospitalYukiFujiiDepartment of Gastroenterology and Hepatology, Okayama University HospitalDaisukeUchidaDepartment of Gastroenterology and Hepatology, Okayama University HospitalKoichiroTsutsumiDepartment of Gastroenterology and Hepatology, Okayama University HospitalShigeruHoriguchiDepartment of Gastroenterology and Hepatology, Okayama University HospitalYoshiroKawaharaDepartment of Gastroenterology and Hepatology, Okayama University HospitalMotoyukiOtsukaDepartment of Gastroenterology and Hepatology, Okayama University HospitalObjectives: Accurate diagnosis of biliary strictures remains challenging. This study aimed to develop an artificial intelligence (AI) system for peroral cholangioscopy (POCS) using a Vision Transformer (ViT) architecture and to evaluate its performance compared to different vendor devices, conventional convolutional neural networks (CNNs), and endoscopists.<br>
Methods: We retrospectively analyzed 125 patients with indeterminate biliary strictures who underwent POCS between 2012 and 2024. AI models including the ViT architecture and two established CNN architectures were developed using images from CHF-B260 or B290 (CHF group; Olympus Medical) and SpyScope DS or DS II (Spy group; Boston Scientific) systems via a patient-level, 3-fold cross-validation. For a direct comparison against endoscopists, a balanced 440-image test set, containing an equal number of images from each vendor, was used for a blinded evaluation.<br>
Results: The 3-fold cross-validation on the entire 2062-image dataset yielded a robust accuracy of 83.9% (95% confidence interval (CI), 80.9–86.7) for the ViT model. The model's accuracy was consistent between CHF (82.7%) and Spy (86.8%, p = 0.198) groups, and its performance was comparable to the evaluated conventional CNNs. On the 440-image test set, the ViT's accuracy of 78.4% (95% CI, 72.5–83.8) was comparable to that of expert endoscopists (82.0%, p = 0.148) and non-experts (73.0%, p = 0.066), with no statistically significant differences observed.<br>
Conclusions: The novel ViT-based AI model demonstrated high vendor-agnostic diagnostic accuracy across multiple POCS systems, achieving performance comparable to conventional CNNs and endoscopists evaluated in this study.No potential conflict of interest relevant to this article was reported.IOP PublishingActa Medica Okayama1882-07781892025Fundamentals and advances in transverse thermoelectrics090101ENHirotoAdachiResearch Institute for Interdisciplinary Science, Okayama UniversityFuyukiAndoResearch Center for Magnetic and Spintronic Materials, National Institute for Materials ScienceTakamasaHiraiResearch Center for Magnetic and Spintronic Materials, National Institute for Materials ScienceRajkumarModakResearch Center for Magnetic and Spintronic Materials, National Institute for Materials ScienceMatthew A.GraysonDepartment of Electrical and Computer Engineering, Northwestern UniversityKen-ichiUchidaResearch Center for Magnetic and Spintronic Materials, National Institute for Materials ScienceTransverse thermoelectric effects interconvert charge and heat currents in orthogonal directions due to the breaking of either time-reversal symmetry or structural symmetry, enabling simple and versatile thermal energy harvesting and solid-state cooling/heating within single materials. In comparison to the complex module structures required for the conventional Seebeck and Peltier effects, the transverse thermoelectric effects provide the complete device structures, potentially resolving the fundamental issue of multi-module degradation of thermoelectric conversion performance. This review article provides an overview of all currently known transverse thermoelectric conversion phenomena and principles, as well as their characteristics, and reclassifies them in a unified manner. The performance of the transverse thermoelectric generator, refrigerator, and active cooler is formulated, showing that thermal boundary conditions play an essential role in discussion on their behaviors. Examples of recent application research and material development in transverse thermoelectrics are also introduced, followed by a discussion of future prospects.No potential conflict of interest relevant to this article was reported.Institute of Electrical and Electronics Engineers (IEEE)Acta Medica Okayama2169-3536132025Optimized Ensemble Deep Learning for Real-Time Intrusion Detection on Resource-Constrained Raspberry Pi Devices113544113556ENMuhammad BisriMusthafaGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversitySamsulHudaInterdisciplinary Education and Research Field, Okayama UniversityTuy TanNguyenSchool of Informatics, Computing, and Cyber Systems, Northern Arizona UniversityYutaKoderaGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityYasuyukiNogamiGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityThe rapid growth of Internet of Things (IoT) networks has increased security risks, making it essential to have effective Intrusion Detection Systems (IDS) for real-time threat detection. Deep learning techniques offer promising solutions for such detection due to their superior complex pattern recognition and anomaly detection capabilities in large datasets. This paper proposes an optimized ensemble-based IDS designed specifically for efficient deployment on edge hardware. However, deploying such computationally intensive models on resource-limited edge devices remains a significant challenge due to model size and computational overhead on devices with limited processing capabilities. Building upon our previously developed stacked Long Short-Term Memory (LSTM) model integrated with ANOVA feature selection, we optimize it by integrating dual-stage model compression: pruning and quantization to create a lightweight model suitable for real-time inference on Raspberry Pi devices. To evaluate the system under realistic conditions, we combined with a Kafka-based testbed to simulate dynamic IoT environments with variable traffic loads, delays, and multiple simultaneous attack sources. This enables the assessment of detection performance under varying traffic volumes, latency, and overlapping attack scenarios. The proposed system maintains high detection performance with accuracy of 97.3% across all test scenarios, while efficiently leveraging multi-core processing with peak CPU usage reaching 111.8%. These results demonstrate the system’s practical viability for real-time IoT security at the edge.No potential conflict of interest relevant to this article was reported.Institute of Electrical and Electronics Engineers (IEEE)Acta Medica Okayama2169-3536132025Security in Post-Quantum Era: A Comprehensive Survey on Lattice-Based Algorithms8900389024ENHienNguyenSchool of Informatics, Computing, and Cyber Systems, Northern Arizona UniversitySamsulHudaInterdisciplinary Education and Research Field, Okayama UniversityYasuyukiNogamiGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityTuy TanNguyenSchool of Informatics, Computing, and Cyber Systems, Northern Arizona UniversityLattice-based post-quantum cryptography (PQC) has attracted significant attention as a promising solution to the security challenges posed by quantum computing. Unlike traditional cryptographic algorithms, lattice-based schemes are expected to remain secure even in the presence of quantum attacks, making them essential for securing future data. Despite their strong theoretical foundations, lattice-based schemes face several practical challenges, particularly in optimizing performance and scalability for real-world applications. This survey provides a novel taxonomy that categorizes lattice-based PQC designs, with an emphasis on computational paradigms and security considerations. We systematically evaluate lattice-based PQC implementations across both software platforms, including central processing units and graphics processing units, as well as hardware platforms like field-programmable gate arrays and application-specific integrated circuits, highlighting their strengths and limitations. In addition, we explore the practical applications of lattice-based cryptography in fields such as secure communication, critical infrastructure, privacy-preserving data analytics, artificial intelligence, and trust and authentication systems. By offering a comprehensive overview of the current state of lattice-based PQC, this survey aims to provide valuable insights into the ongoing advancements and future research directions in the field as we transition to a post-quantum era.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama0969-806X2392026Helical X-ray tube trajectory estimation via image noise analysis for enhanced CT dosimetry113260ENTatsuyaMaedaGraduate School of Medical Sciences, Kanazawa UniversityKazukiTakegamiDepartment of Radiological Technology, Yamaguchi University HospitalSotaGotoFaculty of Health Sciences, Kobe Tokiwa UniversityTakashiAsaharaDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityDaikiKobayashiGraduate School of Medical Sciences, Kanazawa UniversityRinaNishigamiGraduate School of Medical Sciences, Kanazawa UniversityNatsumiKimotoDepartment of Radiological Science, Faculty of Health Sciences, Junshin Gakuen UniversityKazutaYamashitaDepartment of Orthopedics, School of Medicine, Tokushima UniversityKosakuHigashinoShikoku Medical Center for Children and AdultsShinichiMorimotoMEDITEC JAPAN Co., Ltd., Yamaguchi Kosan Bld.TakeshiKonishiMEDITEC JAPAN Co., Ltd., Yamaguchi Kosan Bld.MotochikaMakiMEDITEC JAPAN Co., Ltd., Yamaguchi Kosan Bld.HiroakiHayashiCollege of Transdisciplinary Sciences for Innovation, Kanazawa UniversityInformation on the helical trajectory of the X-ray tube is necessary for accurate dose evaluation during computed tomography (CT). We aimed to propose a methodology for analyzing the trajectory of the X-ray tube. The novelty of this paper is that the incident direction of X-rays is estimated from the standard deviation (SD) distribution. The X-ray incident direction for each slice was analyzed using a distribution function of SD values, in which the analysis regions were placed in the air region. Then, the helical trajectory of the CT scan was estimated by fitting a three-dimensional helical function to the analyzed data. The robustness of our algorithm was verified through phantom studies: the analyzed X-ray incident directions were compared with instrumental log data, in which cylindrical polyoxymethylene resin phantoms and a whole-body phantom were scanned. Chest CT scanning was mimicked, in which the field of view (FOV) was set at the lung region. The procedure for analyzing the X-ray incident direction was applicable to cylindrical phantoms regardless of the phantom size. In contrast, in the case of the whole-body phantom, although it was possible to apply our procedure to the chest and abdomen regions, the shoulder slices were inappropriate to analyze. Therefore, the helical trajectory was determined based on chest and abdominal CT images. The accuracy in X-ray incident direction analysis was evaluated to be 7.5°. In conclusion, we have developed an algorithm to estimate a three-dimensional helical trajectory that can be used for dose measurements and simulations.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155813722025令和６年度岡山医学会賞 胸部・循環研究奨励賞（砂田賞）4345ENTakahiroNishiharaDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesNo potential conflict of interest relevant to this article was reported.IEEEActa Medica Okayama2836-37952025Automatically pinpointing original logging functions from log messages for network troubleshootingENGaspardDamoiseau-MalrauxCNRS, LIP6, Sorbonne UniversitéSatoruKobayashiOkayama UniversityKensukeFukudaNII / SokendaiModern large-scale computer networks generate massive amounts of log data due to their increasing size, usage, and complexity. At the same time, as cloud-based businesses continue to grow, the need for services and software dedicated to log analysis is more important than ever. Although very useful, log messages often lack the necessary details for efficient troubleshooting, requiring extensive human analysis of the source code. In this paper, we present a new architecture designed with performance in mind, capable of identifying links between software-generated logs and their logging function calls in the source code (referred to as "origins" of the logs). The system we propose uses static code analysis to generate exact log templates, which are used to match log messages efficiently using a combination of a prefix tree and regular expressions. Our implementation SCOLM can pinpoint the origin of log messages with excellent performance and success rate. SCOLM can parse nearly 1 million log lines per minute on a single thread, with a match rate of 90 to 100% on our datasets. It outperforms the speed of traditional regex-based approaches, reducing the speed by about 98.7% in our experiments. The applications of this system are numerous, including live troubleshooting and statistical event analysis.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama2168-81841782025Craniofacial Fibrous Dysplasia to Affect or Not the Optic Nerve in Long-Term Follow-Up of Three Casese91072ENToshihikoMatsuoDepartment of Ophthalmology, Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama University HospitalTakehiroTanakaDepartment of Pathology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityKiyoshiYamadaDepartment of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityMitsuhiroOkanoDepartment of Otorhinolaryngology, School of Medicine, International University of Health and WelfareFibrous dysplasia of the bone is characterized by immature fibrous bones of trabeculae and fibrovascular proliferation in the medulla. In this study, we report three consecutive patients with craniofacial fibrous dysplasia with or without optic nerve involvement. In Case 1, a 43-year-old man with blurred vision in the right eye at the first visit was well until the age of 54 years, when he came back with symptoms suggestive of paranasal sinusitis. Computed tomography scans disclosed a mucocele in the right sphenoid sinus and thickened bilateral ethmoid, sphenoid, and frontal bones. He underwent an emergency nasal endoscopic surgery to make a drainage opening to the sphenoid and ethmoid sinuses on the right side with incomplete success. The pathology of the resected tissue confirmed fibrous dysplasia. With intravenous antibiotics, he recovered from blepharoptosis, complete ophthalmoplegia, and visual acuity decrease on the right side. He was well until the age of 71 years when he had a self-limiting episode of visual field cloudiness caused by the right sphenoid sinus mucocele. At the age of 75 years, he developed abrupt vision loss to no light perception in the right eye. He underwent an open skull surgery to extirpate the sphenoid mucocele on the right side and died of an unknown cause two years later. In Case 2, a 29-year-old man had a two-week-long headache, and computed tomography scans revealed fibrous dysplasia in the bilateral sphenoid bones. Nasal biopsy at the spheno-ethmoid recess proved a pathological diagnosis of fibrous dysplasia. Goldmann perimetry showed normal visual fields in both eyes. He was followed every year by magnetic resonance imaging to maintain normal visual fields until the latest visit at the age of 41 years. In Case 3, a 12-year-old girl was referred to an ophthalmologist to check her vision. She had been diagnosed with fibrous dysplasia of the left maxillary bone at the age of six years by a dentist. She had a gingival resection on the left maxilla at the age of 15 years and had a left maxillary bone resection at 18 years at another hospital. One month after the resection, Goldmann perimetry showed superior peripheral field depression in the left eye, in contrast with the normal visual field in the right eye. She maintained the visual acuity of 1.5 in both eyes until the last visit at the age of 21 years. In fibrous dysplasia as a rare disease, functional and cosmetic problems, including vision problems, should be considered in a case-based approach.No potential conflict of interest relevant to this article was reported.Japanese Society for Lymphoreticular Tissue ResearchActa Medica Okayama1346-42806442024Computed tomography findings of idiopathic multicentric Castleman disease subtypes292296ENToshihiroIguchiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityAsamiNishikoriDepartment of Molecular Hematopathology, Okayama University Graduate School of Health SciencesYasuharuSatoDepartment of Molecular Hematopathology, Okayama University Graduate School of Health SciencesMidori FilizNishimuraDepartment of Molecular Hematopathology, Okayama University Graduate School of Health SciencesNorikoIwakiDepartment of Hematology, National Cancer Center HospitalKatsuhideKojimaDepartment of Radiology, Okayama University HospitalTakashiAsaharaDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityFumioOtsukaDepartment of General Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityYoshinobuMaedaDepartment of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityThis study retrospectively evaluated the computed tomography (CT) findings of idiopathic multicentric Castleman disease (iMCD) at a single center and compared the CT findings of iMCD-TAFRO with those of iMCD-non-TAFRO. CT images obtained within 30 days before diagnostic confirmation were reviewed for 20 patients with iMCD (8 men and 12 women, mean age 52.8 ± 12.3 years, range 25–74 years). Twelve patients were diagnosed with iMCD-TAFRO, five with iMCD-idiopathic plasmacytic lymphadenopathy, and three with iMCD-not otherwise specified. CT images revealed anasarca and lymphadenopathy in all 20 patients. The iMCD-TAFRO group showed significantly higher frequencies of ascites (100% vs. 37.5%, P = 0.004), gallbladder wall edema (75.0% vs. 12.5%, P = 0.020), periportal collar (91.7% vs. 25.0%, P = 0.004), and anterior mediastinal lesions (non-mass-forming infiltrative lesions) (66.7% vs. 12.5%, P = 0.028). Para-aortic edema tended to be more frequent in patients with the iMCD-TAFRO group (83.3% vs. 37.5%, P = 0.062), while the absence of anterior mediastinal lesions tended to be more frequent in the iMCD-non-TAFRO group (16.7% vs. 62.5%, P = 0.062). These CT findings may have clinical implications for improving the accuracy and speed of iMCD diagnosis and differentiating iMCD-TAFRO from other subtypes.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama2045-23221512025Coronary cross-sectional area stenosis severity determined using coronary CT highly correlated with coronary functional flow reserve: a pilot study26737ENTakutoKoumotoDivision of Radiation, Okayama Heart ClinicShozoKusachiOkayama University Graduate School of Health SciencesTakumiTomiyaDivision of Cardiovascular Intervention, Okayama Heart ClinicTakuyaAkagiDivision of Cardiovascular Intervention, Okayama Heart ClinicHiroshiKawamuraDivision of Cardiovascular Medicine, Okayama Heart ClinicSatoshiHirohataOkayama University Graduate School of Health SciencesHirosukeYamajiDivision of Cardiovascular Medicine, Okayama Heart ClinicTakashiMurakamiDivision of Cardiovascular Medicine, Okayama Heart ClinicShigeshiKamikawaDivision of Cardiovascular Intervention, Okayama Heart ClinicMasaakiMurakamiDivision of Cardiovascular Intervention, Okayama Heart ClinicFractional 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 BVActa Medica Okayama2210-26121262025Rare internal hernia following pancreatoduodenectomy: A case report110673ENTeruyukiTsujiiDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesKoseiTakagiDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesYasuoNagaiDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesKazuyaYasuiDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesTomokazuFujiDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesToshiyoshiFujiwaraDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesIntroduction: Pancreatoduodenectomy (PD) is a complex procedure with a high morbidity rate. Internal hernia following PD is a rare but potentially life-threatening complication. Herein, we describe a rare case of internal hernia after PD.<br>
Presentation of case: A 76-year-old man who underwent subtotal stomach-preserving PD 7 years ago presented with vomiting and abdominal pain. Abdominal computed tomography revealed an internal hernia. Because conservative treatment failed, surgical intervention was performed. Intraoperative findings revealed efferent loop herniation in the space between the afferent loop near the Braun anastomosis and transverse mesocolon. The hernia was repositioned and the mesenteric defect was closed.<br>
Discussion: This is an extremely rare case of an internal hernia that developed 7 years after PD. As conservative management provides a little chance for improvement, precise diagnosis and prompt re-intervention are essential for the management of internal hernia. In this case, the hernial orifice developed in the space between the afferent and efferent loops and the transverse mesocolon. Internal hernia could be a differential diagnosis in patients with ileus after PD.<br>
Conclusion: This study provided a detailed description of an extremely rare case of internal hernia following PD. Therefore, internal hernias should be considered in patients undergoing PD.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7942025A Case of Surgical Treatment for a Large Pulmonary Artery Aneurysm with a Quadricuspid Pulmonary Valve317320ENKeiMoriokaDepartment of Cardiovascular Surgery, Okayama University HospitalYosukeKurokoDepartment of Cardiovascular Surgery, Okayama University HospitalSachikoKadowakiDepartment of Cardiovascular Surgery, Okayama University HospitalJunkoKobayashiDepartment of Cardiovascular Surgery, Okayama University HospitalYasuhiroKotaniDepartment of Cardiovascular Surgery, Okayama University HospitalShingoKasaharaDepartment of Cardiovascular Surgery, Okayama University HospitalCase Report10.18926/AMO/69160A 65-year-old man was referred to our hospital for the annual assessment of the diameter and dilation of a pulmonary artery (PA) aneurysm. He had a small ventricular septal defect (VSD) that had closed naturally. Echocardiography revealed a dilated main PA, mild pulmonary regurgitation and no VSD. Computed tomography confirmed the dilation of the main PA (66.7×47.8 mm), right PA (37.1×32.9 mm), and left PA (36.7×34.0 mm). The patient underwent pulmonary artery replacement using a prosthetic vascular graft. A quadricuspid pulmonary valve was identified intraoperatively. Early surgical intervention could help to prevent rupture and dissection of PA aneurysms.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7942025A Rare Presentation of Pneumonic-Type Adenocarcinoma Hidden behind Empyema305309ENSatoruSenooDepartment of Respiratory Medicine, National Hospital Organization Fukuyama Medical CenterEitoNimanDepartment of General Thoracic Surgery, National Hospital Organization Fukuyama Medical CenterRyokoTsujiDepartment of Respiratory Medicine, National Hospital Organization Fukuyama Medical CenterKoheiTakataDepartment of Respiratory Medicine, National Hospital Organization Fukuyama Medical CenterShunsukeMatsumoriDepartment of Respiratory Medicine, National Hospital Organization Fukuyama Medical CenterFumikaMuranoDepartment of Respiratory Medicine, National Hospital Organization Fukuyama Medical CenterYukaSugisakiDepartment of Respiratory Medicine, National Hospital Organization Fukuyama Medical CenterHirokiOmoriDepartment of Respiratory Medicine, National Hospital Organization Fukuyama Medical CenterAkihikoTaniguchiDepartment of Respiratory Medicine, National Hospital Organization Fukuyama Medical CenterRikaOmoteDepartment of Diagnostic Pathology, National Hospital Organization Fukuyama Medical CenterEikiIchiharaDepartment of Respiratory Medicine, National Hospital Organization Fukuyama Medical CenterKenjiTakahashiDepartment of General Thoracic Surgery, National Hospital Organization Fukuyama Medical CenterToshiakiOkadaDepartment of Respiratory Medicine, National Hospital Organization Fukuyama Medical CenterCase Report10.18926/AMO/69158Pneumonic-type adenocarcinoma (P-ADC) can closely mimic pneumonia. We report a P-ADC initially diagnosed as pneumonia which developed into a pulmonary abscess and empyema. A 50-year-old Japanese male diagnosed with pneumonia, pulmonary abscess, and empyema was administered antibiotics and a chest tube for drainage, which improved his symptoms and blood test results. However, chest computed tomography showed an enlarged infiltrative shadow. The patient underwent bronchoscopy and was diagnosed with an adenocarcinoma. This case highlights the importance of considering P-ADC in differential diagnoses when a pneumonia-like shadow enlarges post-empyema treatment. Diagnostic and clinical tests, e.g., bronchoscopy, should be performed in such cases.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7942025Anterior Uveitis Secondary to an Infected Postoperative Maxillary Cyst283286ENYutaImamuraDepartment of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYusukeShiodeDepartment of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShuheiKimuraDepartment of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMioHosokawaDepartment of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesRyoMatobaDepartment of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYukiKanzakiDepartment of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHiroyaKindoDepartment of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTetsuroMoritaDepartment of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesAyaMuraiDepartment of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMizuoAndoDepartment of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYukiMorizaneDepartment of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesCase Report/10.18926/AMO/69154A 76-year-old man presented with right eyelid swelling and deteriorated vision. Examination revealed anterior uveitis with hypopyon and a visual acuity of 20/2,000 in the right eye, with no abnormalities in the left. Computed tomography revealed enlargement of the right maxillary sinus and internal fluid accumulation, suggesting a postoperative maxillary cyst (POMC). Nasal endoscopic surgery drained the pus by opening the lower wall of the maxillary cyst. Following the procedure, intraocular inflammation resolved, and visual acuity in the right eye improved to 24/20. This is the first reported case of uveitis secondary to POMC.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7942025Femoral and Global Femoral Offset, but not Anteroposterior Offset, to Improve Postoperative Outcomes Following Total Hip Arthroplasty: Considerations Independent of the Contralateral Side269278ENNorioImaiDivision of Comprehensive Musculoskeletal Medicine, Niigata University Graduate School of Medical and Dental SciencesYukiHiranoDivision of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental SciencesDaisukeHommaDivision of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental SciencesYukiEndoDivision of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental SciencesYojiHorigomeDivision of Comprehensive Musculoskeletal Medicine, Niigata University Graduate School of Medical and Dental SciencesHayatoSuzukiDivision of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental SciencesHiroyukiKawashimaDivision of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental SciencesOriginal Article/10.18926/AMO/69152The global femoral offset (the sum of the acetabular and femoral offsets) influences outcomes after total hip arthroplasty (THA). The optimal offset using plain radiographs has been reported, but internal and external rotations of the hip affect the offset value, producing unclear results when the nonsurgical side is not intact. We investigated the relationship between a functional hip score, i.e., the Harris Hip Score (HHS) and its effect on the post-THA anteroposterior and lateral offsets, and we sought to identify the optimal offset value. The cases of 158 patients with hemilateral hip osteoarthritis who underwent THA at a single center were retrospectively analyzed in this cross-sectional study. Three-dimensional pelvic and femoral models generated from computed tomography were used to examine several parameters, and the results revealed a significant binomial correlation among the modified HHS and femoral and global femoral offsets, with maximum values of 21.3 mm and 40 mm/100 cm body height, respectively. Pelvic and femoral parameters were measured and evaluated via alignment with a specific coordinate system. Our findings indicate that preoperative planning using these parameters may improve postoperative hip function, even when the nonoperative side is unsuitable for use as a reference, as in bilateral hip osteoarthritis cases.No potential conflict of interest relevant to this article was reported.WileyActa Medica Okayama2049-41731322024A novel de novo disease-causing variant in ATL1 in a pediatric patient with spastic paraplegia159161ENAyumiNakamuraDepartment of Neurology, Graduate School of Medicine, The University of TokyoHiroyaNaruseDepartment of Neurology, Graduate School of Medicine, The University of TokyoAkihikoMitsutakeDepartment of Neurology, Graduate School of Medicine, The University of TokyoJunMitsuiDepartment of Neurology, Graduate School of Medicine, The University of TokyoShinichiMorishitaDepartment of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of TokyoMieIwakoshiDepartment of Nursing, Faculty of Health Sciences, Kobe Tokiwa UniversityHiroyukiIshiuraDepartment of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShojiTsujiInstitute of Medical Genomics, International University of Health and WelfareTatsushiTodaDepartment of Neurology, Graduate School of Medicine, The University of TokyoNo potential conflict of interest relevant to this article was reported.IOS PressActa Medica Okayama0926-96302025Assessing the Proportion of Clinical Trial Eligibility Criteria Expressible with Standard EHR Data Elements18921893ENRisaOkazakiDepartment of Pharmacy, Okayama University HospitalKunihisaKamikawaCenter for Innovative Clinical Medicine, Okayama University HospitalHidekiUnoCenter for Innovative Clinical Medicine, Okayama University HospitalHirotoOkudaDivision of Clinical Research of New Drugs and Therapeutics, Center for Innovative Clinical Medicine, Okayama University HospitalShihokoNambaDivision of Clinical Research of New Drugs and Therapeutics, Center for Innovative Clinical Medicine, Okayama University HospitalMitsunobuKanoGraduate School of Interdisciplinary Science and Technology in Health Systems, Okayama UniversityMizukiMoritaGraduate School of Interdisciplinary Science and Technology in Health Systems, Okayama UniversityPatient recruitment for clinical trials often requires substantial human effort and experiences delays, leading to increased drug development costs. Leveraging electronic health records (EHRs) may improve the accuracy of estimates of potentially recruitable patients. We evaluated the feasibility of using EHRs by analyzing the proportion of computable eligibility criteria.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1341-96252025Advances in liquid biopsy for bone and soft-tissue sarcomasENYilangWangDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesTomohiroFujiwaraDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesTakanaoKurozumiDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesTeruhikoAndoDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesTakahikoIshimaruDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesHiroyaKondoDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesEijiNakataDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesToshiyukiKunisadaDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesToshifumiOzakiDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesBone and soft-tissue sarcomas are a heterogeneous group of malignant tumors originating from mesenchymal tissues, accounting for approximately 1% of adult solid malignancies and 20% of pediatric solid malignancies. While blood-based tumor markers are available in major types of cancers, evidence demonstrating useful circulating biomarkers is limited in bone and soft-tissue sarcomas. Despite the development of combined modality treatments, a significant proportion of sarcoma patients respond poorly to chemotherapy or radiotherapy, leading to local relapse or distant metastasis. However, imaging methods, such as X-ray, computed tomography, positron emission tomography, magnetic resonance imaging, and scintigraphy, are mostly used to detect or monitor tumor development. Liquid biopsy is an emerging minimally invasive diagnostic technique that detects tumor-derived molecules in body fluids, including circulating tumor cells, circulating tumor DNA (ctDNA), circulating tumor RNA (ctRNA), and circulating extracellular vesicles. This method offers new possibilities for early tumor detection, prognostic evaluation, and therapeutic monitoring and may serve as a benchmark for treatment modification. This review focuses on the current technological advances in liquid biopsy for bone and soft-tissue sarcoma and explores its potential role in guiding personalized treatments. If these modalities could determine resistance to ongoing therapy or the presence of minimal residual disease at the end of the treatment protocol, the obtained data would be important for determining whether to change treatment approaches or add adjuvant therapies.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama1550-41313722025Maternal circadian rhythms during pregnancy dictate metabolic plasticity in offspring395412.e6ENNaYaoDivision of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of MedicineKenichiroKinouchiDivision of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of MedicineManamiKatohDepartment of Cardiovascular Medicine, Graduate School of Medicine, The University of TokyoKousha ChangiziAshtianiDepartment of Computer Science, University of CaliforniaSherifAbdelkarimDepartment of Computer Science, University of CaliforniaHiroyukiMorimotoDepartment of Integrative Anatomy, Nagoya City University Graduate School of Medical SciencesTakutoTorimitsuDivision of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of MedicineTakahideKozumaDivision of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of MedicineAkihideIwaharaDivision of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of MedicineShotaroKosugiDivision of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of MedicineJinKomuroDepartment of Cardiology, Keio University School of MedicineKyosukeKatoDivision of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of MedicineShunTonomuraDivision of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of MedicineToshifumiNakamuraDivision of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of MedicineArataItohDivision of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of MedicineShintaroYamaguchiDivision of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of MedicineJunYoshinoDivision of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of MedicineJunichiroIrieDivision of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of MedicineHisayukiHashimotoDepartment of Cardiology, Keio University School of MedicineShinsukeYuasaDepartment of Cardiovascular Medicine, Academic Field, Dentistry and Pharmaceutical Sciences, Okayama UniversityAkikoSatohDepartment of Integrative Physiology, Institute of Development, Aging and Cancer, Tohoku UniversityYoheiMikamiDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of MedicineShusakuUchidaDepartment of Integrative Anatomy, Nagoya City University Graduate School of Medical SciencesTakatoshiUekiDepartment of Integrative Anatomy, Nagoya City University Graduate School of Medical SciencesSeitaroNomuraDepartment of Cardiovascular Medicine, Graduate School of Medicine, The University of TokyoPierreBaldiDepartment of Computer Science, University of CaliforniaKaoriHayashiDivision of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of MedicineHiroshiItohDivision of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of MedicineTissue-level oscillation is achieved by tissue-intrinsic clocks along with network-dependent signals originating from distal organs and organismal behavior. Yet, it remains unexplored whether maternal circadian rhythms during pregnancy influence fetal rhythms and impact long-term susceptibility to dietary challenges in offspring. Here, we demonstrate that circadian disruption during pregnancy decreased placental and neonatal weight yet retained transcriptional and structural maturation. Intriguingly, diet-induced obesity was exacerbated in parallel with arrhythmic feeding behavior, hypothalamic leptin resistance, and hepatic circadian reprogramming in offspring of chronodisrupted mothers. In utero circadian desynchrony altered the phase-relationship between the mother and fetus and impacted placental efficiency. Temporal feeding restriction in offspring failed to fully prevent obesity, whereas the circadian alignment of caloric restriction with the onset of the active phase virtually ameliorated the phenotype. Thus, maternal circadian rhythms during pregnancy confer adaptive properties to metabolic functions in offspring and provide insights into the developmental origins of health and disease.No potential conflict of interest relevant to this article was reported.Microbiology SocietyActa Medica Okayama0022-131710672025Summary of taxonomy changes ratified by the International Committee on Taxonomy of Viruses (ICTV) from the Animal dsRNA and ssRNA(−) Viruses Subcommittee, 2025002112ENHolly R.HughesCenters for Disease Control and PreventionMatthew J.BallingerBiological Sciences, Mississippi State UniversityYimingBaoNational Genomics Data Center, China National Center for Bioinformation; Beijing Institute of Genomics, Chinese Academy of Sciences; University of Chinese Academy of SciencesNicolasBejermanConsejo Nacional de Investigaciones Científicas y Técnicas (CONICET) and Instituto Nacional de Tecnología Agropecuaria (INTA)Kim R.BlasdellCSIRO Health and BiosecurityThomasBrieseCenter for Infection and Immunity, and Department of Epidemiology, Mailman School of Public Health, Columbia UniversityJuliaBrignoneInstituto Nacional de Enfermedades Virales Humanas Dr. Julio I. Maiztegui. INEVH -ANLISJean PaulCarreraInstituto Conmemorativo Gorgas de Estudios de la SaludLanderDe ConinckDivision of Clinical and Epidemiological Virology, KU LeuvenWilliam Marcielde SouzaDepartment of Microbiology, Immunology and Molecular Genetics, University of KentuckyHumbertoDebatInstituto Nacional de Tecnología Agropecuaria (INTA)Ralf G.DietzgenQAAFI, The University of QueenslandRalfDürrwaldRobert Koch InstitutMertErdinDepartment of Virology, University of HelsinkiAnthony R.FooksAnimal and Plant Health Agency (APHA)Kristian M.ForbesDepartment of Biological Sciences, University of ArkansasJulianaFreitas-AstúaEmbrapa Cassava and FruitsJorge B.GarciaInstituto Nacional de Enfermedades Virales Humanas Dr. Julio I. Maiztegui. INEVH -ANLISJemma L.GeogheganDepartment of Microbiology and Immunology, University of OtagoRebecca M.GrimwoodDepartment of Microbiology and Immunology, University of OtagoMasayukiHorieOsaka International Research Center for Infectious Diseases, Osaka Metropolitan UniversityTimothy H.HyndmanSchool of Veterinary Medicine, Murdoch UniversityReimarJohneGerman Federal Institute for Risk AssessmentJohn D.KlenaViral Special Pathogens Branch, The Centers for Disease Control and PreventionHidekiKondoInstitute of Plant Science and Resources, Okayama UniversityEugene V.KooninComputational Biology Branch, Division of Intramural Research National Library of Medicine, National Institutes of HealthAlexei Y.KostygovUniversity of OstravaMartKrupovicInstitut Pasteur, Université Paris Cité, CNRS UMR6047, Archaeal Virology UnitJens H.KuhnIntegrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of HealthMichaelLetkoPaul G. Allen School for Global Health, Washington State UniversityJun-MinLiInstitute of Plant Virology, Ningbo UniversityYiyunLiuNational Genomics Data Center, China National Center for Bioinformation; Beijing Institute of Genomics, Chinese Academy of Sciences; University of Chinese Academy of SciencesMaria LauraMartinInstituto Nacional de Enfermedades Virales Humanas Dr. Julio I. Maiztegui. INEVH -ANLISNathanielMullDepartment of Natural Sciences, Shawnee State UniversityYaelNazarInstituto Nacional de Enfermedades Virales Humanas Dr. Julio I. Maiztegui. INEVH -ANLISNorbertNowotnyCollege of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai HealthMárcio Roberto TeixeiraNunesUniversidade Federal do ParáArnfinn LoddenØklandPharmaq AnalytiqDennisRubbenstrothInstitute of Diagnostic Virology, Friedrich-Loeffler-InstitutBrandy J.RussellCenters for Disease Control and PreventionEricSchottInstitute of Marine and Environmental Technology, University of Maryland Center for Environmental ScienceStephanieSeifertPaul G. Allen School for Global Health, Washington State UniversityCarinaSenInstituto Nacional de Enfermedades Virales Humanas Dr. Julio I. Maiztegui. INEVH -ANLISElizabethShedroffViral Special Pathogens Branch, The Centers for Disease Control and PreventionTarjaSironenDepartment of Virology, University of HelsinkiTeemuSmuraDepartment of Virology, University of HelsinkiCamila Prestes Dos SantosTavaresIntegrated Group of Aquaculture and Environmental Studies, Federal University of ParanáRobert B.TeshDepartment of Pathology, The University of Texas Medical BranchNatasha L.TilstonDepartment of Microbiology and Immunology, Indiana University School of MedicineNoëlTordoInstitut PasteurNikosVasilakisDepartment of Pathology, The University of Texas Medical BranchPeter J.WalkerUniversity of QueenslandFeiWangWuhan Institute of Virology, Chinese Academy of SciencesAnna E.WhitfieldNorth Carolina State UniversityShannon L.M.WhitmerViral Special Pathogens Branch, The Centers for Disease Control and PreventionYuri I.WolfComputational Biology Branch, Division of Intramural Research National Library of Medicine, National Institutes of HealthHanXiaWuhan Institute of Virology, Chinese Academy of SciencesGong-YinYeInstitute of Insect Sciences, Zhejiang UniversityZhuangxinYeInstitute of Plant Virology, Ningbo UniversityVyacheslavYurchenkoUniversity of OstravaMingliZhaoDepartment of Pathobiology and Population Sciences, Royal Veterinary CollegeRNA viruses are ubiquitous in the environment and are important pathogens of humans, animals and plants. In 2024, the International Committee on Taxonomy of Viruses Animal dsRNA and ssRNA(−) Viruses Subcommittee submitted 18 taxonomic proposals for consideration. These proposals expanded the known virosphere by classifying 9 new genera and 88 species for newly detected virus genomes. Of note, newly established species expand the large family of Rhabdoviridae to 580 species. A new species in the family Arenaviridae includes a virus detected in Antarctic fish with a unique split nucleoprotein ORF. Additionally, four new species were established for historically isolated viruses with previously unsequenced genomes. Furthermore, three species were abolished due to incomplete genome sequence information, and one family was moved from being unassigned in the phylum Negarnaviricota into a subphylum and order. Herein, we summarize the 18 ratified taxonomic proposals and the general features of the current taxonomy, thereby supporting public and animal health responses.No potential conflict of interest relevant to this article was reported.American Chemical Society (ACS)Acta Medica Okayama2575-9108792024Rethinking Thin-Layer Chromatography for Screening Technetium-99m Radiolabeled Polymer Nanoparticles26042611ENKathrinSchorrDepartment of Pharmaceutical Technology, University of RegensburgXinyuChenNuclear Medicine, Faculty of Medicine, University of AugsburgTakanoriSasakiFaculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityAnahi PaulaArias-LozaDepartment of Nuclear Medicine and Comprehensive Heart Failure Center, University Hospital WürzburgJohannesLangDepartment of Pharmaceutical Technology, University of RegensburgTakahiroHiguchiFaculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityAchimGoepferichDepartment of Pharmaceutical Technology, University of RegensburgThin-layer chromatography (TLC) is commonly employed to screen technetium-99m labeled polymer nanoparticle batches for unreduced pertechnetate and radio-colloidal impurities. Although this method is widely accepted, our findings applying radiolabeled PLGA/PLA–PEG nanoparticles underscore its lack of transferability between different settings and its limitations as a standalone quality control tool. While TLC profiles may appear similar for purified and radiocolloid containing nanoparticle formulations, their in vivo behavior can vary significantly, as demonstrated by discrepancies between TLC results and single-photon emission computed tomography (SPECT) and biodistribution data. This highlights the urgent need for a case-by-case evaluation of TLC methods for each specific nanoparticle type. Our study revealed that polymeric nanoparticles cannot be considered analytically uniform entities in the context of TLC analysis, emphasizing the complex interplay between nanoparticle composition, radiolabeling conditions, and subsequent biological behavior.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama2772-3747512025Evaluating Pericoronary Adipose Tissue Attenuation to Predict Cardiovascular Events111ENTakahiroNishiharaDepartment of Cardiovascular Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityToruMiyoshiDepartment of Cardiovascular Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKentaroEjiriDepartment of Cardiovascular Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKazuhiroOsawaDepartment of General Internal Medicine 3, Kawasaki Medical School General Medicine CenterSoichiroFukeDepartment of Cardiovascular Medicine, Japanese Red Cross Okayama HospitalKousukeSeiyamaDepartment of Cardiology, Kagawa Prefectural Central HospitalMasayukiDoiDepartment of Cardiology, Kagawa Prefectural Central HospitalMitsutakaNakashimaDepartment of Cardiovascular Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTakashiMikiDepartment of Cardiovascular Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityShinsukeYuasaDepartment of Cardiovascular Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityBackground: Pericoronary adipose tissue attenuation (PCATA) is a novel imaging biomarker of pericoronary inflammation associated with coronary artery disease. Several studies have reported the usefulness of PCATA among people of European ethnicity; however, data are lacking concerning those of Asian ethnicity.<br>
Objectives: This multicenter study aimed to evaluate the effect of PCATA on prognosis in East Asian patients.<br>
Methods: Between August 2011 and December 2016, 2,172 patients underwent clinically indicated coronary computed tomography angiography (CTA) at 4 hospitals in Japan. Among them, 1,270 patients were analyzed. PCATA was evaluated using coronary CTA to measure pericoronary adipose tissue density surrounding the 3 major coronary arteries. The outcomes were composite cardiovascular events, including cardiovascular death and acute coronary syndrome; 33 cardiovascular events observed during a median follow-up of 6.0 years (Q1-Q3: 3.6-8.2 years).<br>
Results: Right coronary artery (RCA)-PCATA was significantly higher in patients with cardiovascular events than in those without (−63.7 ± 8.9 HU vs −67.4 ± 9.1 HU, respectively; P = 0.021). High RCA-PCATA was significantly associated with cardiovascular events in a model that included the Hisayama risk score and adverse coronary CTA findings (HR: 1.55; 95% CI: 1.07-2.24; P = 0.019).<br>
Conclusions: High RCA-PCATA showed significant association with future cardiovascular events after adjusting conventional risk factors and adverse coronary CTA findings in East Asian patients who underwent clinically indicated coronary CTA.No potential conflict of interest relevant to this article was reported.Japanese Society for Horticultural ScienceActa Medica Okayama2189-01029412025Development of an AI-based Image Analysis System to Calculate the Visit Duration of a Green Blow Fly on a Strawberry Flower6472ENHirokiTaniguchiGraduate School of Environmental and Life Science, Okayama UniversityYukiTsukudaSchool of Agriculture Okayama UniversityKoMotokiGraduate School of Environmental and Life Science, Okayama UniversityTanjuroGotoGraduate School of Environmental and Life Science, Okayama UniversityYuichiYoshidaGraduate School of Environmental and Life Science, Okayama UniversityKen-ichiroYasubaGraduate School of Environmental and Life Science, Okayama UniversityPollinator insects are required to pollinate flowers in the production of some fruits and vegetables, and strawberries fall into this category. However, the function of pollinators has not been clarified by quantitative metrics such as the duration of pollinator visits needed by flowers. Due to the long activity time of pollinators (approximately 10-h), it is not easy to observe the visitation characteristics manually. Therefore, we developed software for evaluating pollinator performance using two types of artificial intelligence (AI), YOLOv4, which is an object detection AI, and VGG16, which is an image classifier AI. In this study, we used Phaenicia sericata Meigen (green blow fly) as the strawberry pollinator. The software program can automatically estimate the visit duration of a fly on a flower from video clips. First, the position of the flower is identified using YOLO, and the identified location is cropped. Next, the cropped image is classified by VGG16 to determine if the fly is on the flower. Finally, the results are saved in CSV and HTML format. The program processed 10 h of video (collected from 07:00 h to 17:00 h) taken under actual growing conditions to estimate the visit durations of flies on flowers. The recognition accuracy was approximately 97%, with an average difference of 550 s. The software was run on a small computer board (the Jetson Nano), indicating that it can easily be used without a complicated AI configuration. This means that the software can be used immediately by distributing pre-configured disk images. When the software was run on the Jetson Nano, it took approximately 11 min to estimate one day of 2-h video. It is therefore clear that the visit duration of a fly on a flower can be estimated much faster than by manually checking videos. Furthermore, this system can estimate the visit durations of pollinators to other flowers by changing the YOLO and VGG16 model files.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama2662-47292025Impact of differences in computed tomography value-electron density/physical density conversion tables on calculate dose in low-density areasENMiaNomuraFaculty of Health Sciences, Department of Radiological Technology, Okayama University Medical School, Okayama UniversityShunsukeGotoGraduate School of Health Sciences, Department of Radiological Technology, Okayama UniversityMizukiYoshiokaFaculty of Health Sciences, Department of Radiological Technology, Okayama University Medical School, Okayama UniversityYuikoKatoFaculty of Health Sciences, Department of Radiological Technology, Okayama University Medical School, Okayama UniversityAyakaTsunodaFaculty of Health Sciences, Department of Radiological Technology, Okayama University Medical School, Okayama UniversityKunioNishiokaDepartment of Radiology, Tokuyama Central HospitalYoshinoriTanabeFaculty of Medicine, Graduate School of Health Sciences, Okayama UniversityIn radiotherapy treatment planning, the extrapolation of computed tomography (CT) values for low-density areas without known materials may differ between CT scanners, resulting in different calculated doses. We evaluated the differences in the percentage depth dose (PDD) calculated using eight CT scanners. Heterogeneous virtual phantoms were created using LN-300 lung and − 900 HU. For the two types of virtual phantoms, the PDD on the central axis was calculated using five energies, two irradiation field sizes, and two calculation algorithms (the anisotropic analytical algorithm and Acuros XB). For the LN-300 lung, the maximum CT value difference between the eight CT scanners was 51 HU for an electron density (ED) of 0.29 and 8.8 HU for an extrapolated ED of 0.05. The LN-300 lung CT values showed little variation in the CT-ED/physical density data among CT scanners. The difference in the point depth for the PDD in the LN-300 lung between the CT scanners was < 0.5% for all energies and calculation algorithms. Using Acuros XB, the PDD at − 900 HU had a maximum difference between facilities of > 5%, and the dose difference corresponding to an LN-300 lung CT value difference of > 20 HU was > 1% at a field size of 2 × 2 cm2. The study findings suggest that the calculated dose of low-density regions without known materials in the CT-ED conversion table introduces a risk of dose differences between facilities because of the calibration of the CT values, even when the same CT-ED phantom radiation treatment planning and treatment devices are used.No potential conflict of interest relevant to this article was reported.Springer Nature SingaporeActa Medica Okayama0302-97432025RKPM: Restricted Kernel Page Mechanism to Mitigate Privilege Escalation Attacks213231ENHirokiKuzunoGraduate School of Engineering, Kobe UniversityToshihiroYamauchiFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityKernel 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.IEEEActa Medica Okayama2024kdMonitor: Kernel Data Monitor for Detecting Kernel Memory Corruption6673ENHirokiKuzunoGraduate School of Engineering, Kobe UniversityToshihiroYamauchiOkayama University,Faculty of Environmental, Life, Natural Science and TechnologyPrivilege 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 SwitzerlandActa Medica Okayama0302-97432023vkTracer: Vulnerable Kernel Code Tracing to Generate Profile of Kernel Vulnerability222234ENHirokiKuzunoGraduate School of Engineering, Kobe UniversityToshihiroYamauchiFaculty of Natural Science and Technology, Okayama UniversityVulnerable 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.岡山大学経済学会Acta Medica Okayama2433-41465712025地域産業連関表における経済波及効果のNew Approach3550ENRyoheiNakamura10.18926/OER/69003 本稿では，まず経済波及効果の考え方について，産業連関表を用いたシミュレーションの結果が，しばしば過大評価になっていることを述べる。その理由として，経済波及効果をもたらす前提条件の考え方にしばしば誤解があることを指摘する。域内の居住者の消費はマネーの移転であり，真の経済効果ではない。波及効果とは，本来，所得が増えた結果の追加消費であって，所得が増えない状況では，代替消費や消費の先取りに過ぎないのである。また，一般にいう経済効果とは，売上高の積み上げであって同じマネーが何でも加算されているものであり，付加価値効果すなわち所得効果とは異なる。付加価値効果は，当初の域外から入ってきたマネー以上にはならない。こういった解釈の誤謬をもたらしているのは，大学での産業連関分析の教育が十分でないことも原因の1つであるが，シンクタンクや公的機関などで提供されている波及効果の計算ツールにも問題がある。そこで本稿では，これまで筆者が提唱してきた波及効果プロセスを見える化するモデルを更に精緻化し，イベントなど外生的インパクトが発生した後の事後的な産業連関表を構築する流れに関して実例を用いて説明を行う。特に自給率の変化の効果については，これまでの競争移入型連関表では効果が過大傾向になる問題点を解消するべく，「部分非競争移入型」の投入構造を提案し，新たな分析方法を提案する。No potential conflict of interest relevant to this article was reported.Royal Society of Chemistry (RSC)Acta Medica Okayama2041-652016262025Collective motions in the primary coordination sphere: a critical functional framework for catalytic activity of the oxygen-evolving complex of photosystem II12024ENHiroshiIsobeTakayoshiSuzukiResearch Institute for Interdisciplinary Science, Okayama UniversityMichihiroSugaResearch Institute for Interdisciplinary Science, Okayama UniversityJian-RenShenResearch Institute for Interdisciplinary Science, Okayama UniversityKizashiYamaguchiCenter for Quantum Information and Quantum Biology, Osaka UniversityPhotosynthetic water oxidation, vital for dioxygen production and light energy conversion, is catalyzed by the oxygen-evolving complex of photosystem II, where the inorganic Mn4CaO5 cluster acts as the catalytic core. In this study, we investigate the functional significance of collective motions of amino acid side chains within the primary coordination sphere of the Mn cluster, focusing on their role in modulating the energetic demands for catalytic transformations in the S3 state. We applied regularized canonical correlation analysis to quantitatively correlate the three-dimensional arrangement of coordinating atoms with catalytic driving forces computed via density functional theory. Our analysis reveals that distinct collective side chain motions profoundly influence the energetic requirements for structural reconfigurations of the Mn cluster, achieved through expansion and contraction of the ligand cavity while fine-tuning its geometry to stabilize key intermediates. Complementary predictions from a neural network-based machine learning model indicate that the coordination sphere exerts a variable energetic impact on the catalytic transformations of the Mn cluster, depending on the S-state environment. Integrated computational analyses suggest that the extended lifetime of the S3YZ˙ state, consistently observed after three flash illuminations, may result from slow, progressive protein dynamics that continuously reshape the energy landscape, thereby shifting the equilibrium positions of rapid, reversible chemical processes over time. Overall, our findings demonstrate that collective motions in the primary coordination sphere constitute an active, dynamic framework essential for the efficient execution of multi-electron catalysis under ambient conditions, while simultaneously achieving a high selectivity with irreversible nature required for effective 3O2 evolution.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama1471-24662512025Co-occurrence of interstitial lung disease and pulmonary embolism as adverse events of adjuvant osimertinib treatment for EGFR mutant non-small cell lung cancer: a case report311ENKentaManabeDepartment of Thoracic Surgery, Okayama University HospitalKazuhikoShienDepartment of Thoracic Surgery, Okayama University HospitalShinichiFurukawaDepartment of Thoracic Surgery, Okayama University HospitalTomoyaSenoDepartment of Thoracic Surgery, Okayama University HospitalKouseiIshimuraDepartment of Thoracic Surgery, Okayama University HospitalShinTanakaDepartment of Thoracic Surgery, Okayama University HospitalKenSuzawaDepartment of Thoracic Surgery, Okayama University HospitalMikioOkazakiDepartment of Thoracic Surgery, Okayama University HospitalSeiichiroSugimotoDepartment of Thoracic Surgery, Okayama University HospitalShinichiToyookaDepartment of Thoracic Surgery, Okayama University HospitalBackground Postoperative osimertinib for EGFR mutant non-small cell lung cancer has become the standard of care. However, its adverse events in clinical practice remain unclear. We report a case of interstitial lung disease and pulmonary embolism occurring simultaneously as adverse events during adjuvant osimertinib treatment.<br>
Case presentation A 74-year-old woman, diagnosed with left lower lobe lung adenocarcinoma harboring an EGFR mutation, underwent a left lower lobectomy with lymph node dissection. During adjuvant osimertinib therapy, the patient developed respiratory distress with hypoxia, leading to the diagnosis of interstitial lung disease. Despite immediate steroid therapy, respiratory distress persisted, the patient developed leg edema. She was diagnosed with deep vein thrombosis and pulmonary embolism via contrast-enhanced computed tomography scan. Following treatment with steroid and anticoagulation, her clinical symptoms improved rapidly, and she showed no recurrence of interstitial lung disease, pulmonary embolism, or lung cancer over the following nine months.<br>
Conclusions We encountered a case of interstitial lung disease and pulmonary embolism occurring simultaneously as adverse events during adjuvant osimertinib treatment. In patients with osimertinib-induced interstitial lung disease, particularly when respiratory symptoms show poor improvement with steroid treatment, the possibility of pulmonary embolism complications should be suspected.No potential conflict of interest relevant to this article was reported.WileyActa Medica Okayama1433-78512025Development of a Vinylated Cyclic Allene: A Fleeting Strained Diene for the Diels–Alder Reactione202510319ENHarukiMizoguchiGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityTakumiObataGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityTaikiHiraiGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityManakaKomatsuGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityAkiraSakakuraGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityFleeting molecules possessing strained multiple bonds are important components in organic synthesis due to their ability to undergo various chemical reactions driven by the release of strain energy. Although the use of strained π-bonds as 2π components, represented by dienophiles in Diels–Alder reactions, has been well studied, “the strained diene (4π component) approach” for molecular construction remains underexplored. Herein, we report the design of a vinyl cyclic allene (1-vinyl-1,2-cyclohexadiene) as a highly reactive strained diene and the development of its Diels–Alder reactions. Experimental and computational studies of vinyl cyclic allenes revealed that this diene system undergoes cycloaddition with dienophiles regio- and stereoselectively under mild reaction conditions. These studies also provide insight into the reactivity and selectivity of the system. The strained diene approach enables the convergent construction of polycyclic molecules through bond disconnections distinct from conventional retrosynthetic analysis, thus offering an efficient strategy for the assembly of functional molecules.No potential conflict of interest relevant to this article was reported.Springer International PublishingActa Medica Okayama0302-97432022CyNER: Information Extraction from Unstructured Text of CTI Sources with Noncontextual IOCs85104ENShotaFujiiGraduate School of Natural Science and Technology, Okayama UniversityNobutakaKawaguchiResearch & Development Group, Hitachi, Ltd.TomohiroShigemotoResearch & Development Group, Hitachi, Ltd.ToshihiroYamauchiFaculty of Natural Science and Technology, Okayama UniversityCybersecurity 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.<br>
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.IEEEActa Medica Okayama2832-13242023Analyzing Post-injection Attacker Activities in IoT Devices: A Comprehensive Log Analysis Approach292297ENHervetVictorOkayama UniversitySatoruKobayashiFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityToshihiroYamauchiFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityWith 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.IEEEActa Medica Okayama2832-13242023Prevention Method for Stack Buffer Overflow Attack in TA Command Calls in OP-TEE274278ENKaitoShibaGraduate School of Natural Science and Technology, Okayama UniversityHirokiKuzunoGraduate School of Engineering, Kobe UniversityToshihiroYamauchiFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityTEE systems provide normal world and secure world. It is impossible to gain access to the secure world directly from the normal world. However, vulnerabilities in the secure world can cause attacks to compromise the secure world. In this study, we investigate the security features applied to trusted applications (TA) in OP-TEE and clarify the lack of protection against stack buffer overflow in TA command calls. We also propose a method for preventing attacks that exploit stack buffer overflows in TA command calls. In addition, the experimental results show that attacks on the vulnerable TAs can be prevented with the proposed method and the overhead can be evaluated.No potential conflict of interest relevant to this article was reported.IEEEActa Medica Okayama2379-18962023Evaluation of Effectiveness of MAC Systems Based on LSM for Protecting IoT Devices161167ENMasatoMikiGraduate School of Natural Science and Technology, Okayama UniversityToshihiroYamauchiFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversitySatoruKobayashiFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityNumerous active attacks targeting Internet of Things (IoT) devices exist. They exploit the latest vulnerabilities discovered in IoT devices. Therefore, Mandatory Access Control (MAC) systems based on Linux Security Modules (LSM), such as SELinux and AppArmor, are effective security features for IoT devices because they can mitigate the impact of attacks even if software vulnerabilities are discovered. However, they are not adopted by most IoT devices. The existing approaches are insufficient for investigating the causes of this problem.In this study, we comprehensively investigated what factors can affect the applicability of MAC systems based on LSM in IoT devices. We focused on how frequently cases can occur where they cannot be adopted, owing to each factor. To increase the comprehensiveness of the factors affecting the adoption of MAC systems in IoT devices, we investigated the kernel version, CPU architecture, and support for BusyBox in addition to the investigation of resources, which conducted in previous studies. We also conducted simulated experiments based on the attack method of Mirai to investigate whether MAC systems can protect against IoT malware. Finally, we discuss the impact of a combination of these factors on MAC system adoption.No potential conflict of interest relevant to this article was reported.IEEEActa Medica Okayama2833-23502023Non Real-Time Data Transmission Performance Analysis of PROFINET for Assuring Data Transmission Quality236244ENTakashiNorimatsuGraduate School of Natural Science and Technology, Okayama UniversityToshihiroYamauchiFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityThe industrial Ethernet PROFINET supports three different data transmission modes: isochronous real-time (IRT), real-time (RT), and non real-time (NRT) transmitting data requiring hard, soft, and no real-time performances, respectively. The data transmission latency in the NRT increased with the amount of data transmission in the IRT, RT, and NRT. Therefore, the quality of data transmission in NRT may degrade as the amount of data transmission in IRT, RT, and NRT increases. In this study, we derived the average data transmission latency in an NRT with data transmission in IRT and RT by applying stochastic processes. This allowed us to maintain the quality of data transmission in the NRT by adjusting the number of devices connected to the network and the number of applications transmitting data in the NRT so that the average latency of data in the NRT does not exceed a certain value.No potential conflict of interest relevant to this article was reported.IEEEActa Medica Okayama2832-13242023Supporting Multiple OS Types on Estimation of System Call Hook Point by Virtual Machine Monitor267273ENMasayaSatoOkayama Prefectural UniversityTakuOmoriOkayama Prefectural UniversityToshihiroYamauchiOkayama UniversityHideoTaniguchiOkayama UniversityMethods 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.Elmer Press, Inc.Acta Medica Okayama1923-41551652025Nephronophthisis and Retinitis Pigmentosa (Senior-Loken Syndrome) After Living-Donor Kidney Transplantation: Twelve-Year Follow-Up in a Young Woman164173ENToshihikoMatsuoGraduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama UniversityYasuhiroOnishiDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityHiroshiMorinagaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityJunWadaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityTakehiroTanakaDepartment of Pathology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityMotooArakiDepartment of Urology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversitySenior-Loken syndrome is a hereditary ciliopathy with recessive trait that manifests as nephronophthisis and retinitis pigmentosa. This report described an 18-year-old woman who was referred to a University Hospital to set up a treatment plan for chronic renal failure of an unknown cause. She had experienced nocturnal polyurea from the age of 12 years and was found to have an elevated level of serum creatinine at 3 mg/dL at the age of 15 years. She underwent renal biopsy at a hometown regional hospital which showed global glomerulosclerosis in six of the 13 glomeruli examined, renal tubular dilation in irregular shape, and marked interstitial fibrosis with lymphocytic infiltration. At the age of 19 years, she received a living-donor kidney transplant from her 46-year-old father as a preemptive therapy. At surgery, biopsy of the father’s donor kidney showed two glomeruli with global sclerosis out of 24 glomeruli examined, in association with minimal interstitial fibrosis and lymphocytic infiltration. She began to have extended-release tacrolimus 4 mg daily and mycophenolate mofetil 1,000 mg daily. According to the standard protocol, she underwent biopsy of the transplanted donor kidney to reveal interstitial fibrosis and lymphocytic infiltration, in addition to no sign of rejection and no glomerular deposition of immunoglobulins and complements, both 4 weeks and 14 months after the kidney transplantation. At the age of 23 years, 4 years after the kidney transplantation, she was, for the first time, diagnosed retinitis pigmentosa, and hence, Senior-Loken syndrome. She was followed up in the stable condition with basal doses of tacrolimus 5 mg daily, mycophenolate mofetil 1,000 mg daily, and prednisolone 5 mg daily up until now in 12 years after the kidney transplantation. The interstitial fibrosis with lymphocytic infiltration in the donor kidney might be a milder presentation of the disease with recessive inheritance.No potential conflict of interest relevant to this article was reported.MDPI AGActa Medica Okayama1424-822025122025Effects of Sampling Frequency on Human Activity Recognition with Machine Learning Aiming at Clinical Applications3780ENTakahiroYamaneDepartment of Biomedical Informatics, Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama UniversityMoekaKimuraFaculty of Health Sciences, Okayama University Medical SchoolMizukiMoritaDepartment of Biomedical Informatics, Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama UniversityHuman activity recognition using wearable accelerometer data can be a useful digital biomarker for severity assessment and the diagnosis of diseases, where the relationship between onset and patient activity is crucial. For long-term monitoring in clinical settings, the volume of data collected over time should be minimized to reduce power consumption, computational load, and communication volume. This study aimed to determine the lowest sampling frequency that maintains recognition accuracy for each activity. Thirty healthy participants wore nine-axis accelerometer sensors at five body locations and performed nine activities. Machine-learning-based activity recognition was conducted using data sampled at 100, 50, 25, 20, 10, and 1 Hz. Data from the non-dominant wrist and chest, which have previously shown high recognition accuracy, were used. Reducing the sampling frequency to 10 Hz did not significantly affect the recognition accuracy for either location. However, lowering the frequency to 1 Hz decreases the accuracy of many activities, particularly brushing teeth. Using data with a 10 Hz sampling frequency can maintain recognition accuracy while decreasing data volume, enabling long-term patient monitoring and device miniaturization for clinical applications.No potential conflict of interest relevant to this article was reported.Japanese Society of Internal MedicineActa Medica Okayama0918-29186452025A Novel De Novo Variant in KCNH5 in a Patient with Refractory Epileptic Encephalopathy759762ENAkihikoMitsutakeDepartment of Neurology, Graduate School of Medicine, The University of TokyoTakashiMatsukawaDepartment of Neurology, Graduate School of Medicine, The University of TokyoTatsuhikoNaitoDepartment of Neurology, Graduate School of Medicine, The University of TokyoHiroyukiIshiuraDepartment of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityJunMitsuiDepartment of Neurology, Graduate School of Medicine, The University of TokyoHiroakiHaradaDepartment of Rheumatology and Allergy, Graduate School of Medicine, The University of TokyoKeishiFujioDepartment of Rheumatology and Allergy, Graduate School of Medicine, The University of TokyoJunFujishiroDepartment of Pediatric Surgery, Graduate School of Medicine, The University of TokyoHarushiMoriDepartment of Radiology, School of Medicine, Jichi Medical UniversityShinichiMorishitaDepartment of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of TokyoShojiTsujiDepartment of Neurology, Graduate School of Medicine, The University of TokyoTatsushiTodaDepartment of Neurology, Graduate School of Medicine, The University of TokyoWe herein report a novel de novo KCNH5 variant in a patient with refractory epileptic encephalopathy. The patient exhibited seizures at 1 year and 7 months old, which gradually worsened, leading to a bedridden status. Brain magnetic resonance imaging (MRI) showed cerebral atrophy and cerebellar hypoplasia. A trio whole-exome sequence analysis identified a de novo heterozygous c.640A>C, p.Lys214Gln variant in KCNH5 that was predicted to be deleterious. Recent studies have linked KCNH5 to various epileptic encephalopathies, with many patients showing normal MRI findings. The present case expands the clinical spectrum of the disease, as it is characterized by severe neurological prognosis, cerebral atrophy, and cerebellar hypoplasia.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama2054-345X1212025In-frame deletion variant of ABCD1 in a sporadic case of adrenoleukodystrophy5ENTakashiMatsukawaDepartment of Neurology, Graduate School of Medicine, The University of TokyoAtsushiSudoDepartment of Neurology, Graduate School of Medicine, The University of TokyoToshiyukiKakumotoDepartment of Neurology, Graduate School of Medicine, The University of TokyoAkihitoHaoDepartment of Neurology, Graduate School of Medicine, The University of TokyoMitsuhiroKainagaDepartment of Neurology, Graduate School of Medicine, The University of TokyoHyangriChangDepartment of Neurology, Graduate School of Medicine, The University of TokyoTatsuoManoDepartment of Neurology, Graduate School of Medicine, The University of TokyoHiroyukiIshiuraDepartment of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesJunMitsuiDepartment of Precision Medicine Neurology, Graduate School of Medicine, The University of TokyoToshihiroHayashiDepartment of Neurology, Graduate School of Medicine, The University of TokyoShinichiMorishitaDepartment of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of TokyoShojiTsujiDepartment of Neurology, Graduate School of Medicine, The University of TokyoTatsushiTodaDepartment of Neurology, Graduate School of Medicine, The University of TokyoAdrenoleukodystrophy (ALD), an X-linked leukodystrophy caused by pathogenic variants in ABCD1, exhibits a broad range of phenotypes from childhood-onset cerebral forms to adult-onset adrenomyeloneuropathy (AMN). We report a rare in-frame ABCD1 deletion c.1469_71delTGG (p.Val490del) in a man with AMN. Although this variant has been interpreted as ‘uncertain significance’ in ClinVar, biochemical analysis along with clinical evaluation confirmed the pathogenicity of this variant, underscoring the importance of functional assessment of in-frame deletions.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7932025A Case of Chromophobe Renal Cell Carcinoma Metastasizing to the Cervical Lymph Nodes after Long-term Follow-up213219ENMakotoWatanabeDepartment of Otolaryngology, Chugoku Rosai HospitalTomoyukiOgawaDepartment of Otolaryngology, Chugoku Rosai HospitalKanaoKobayashiDepartment of Nephrology and Urological Surgery, Chugoku Rosai HospitalNarutakaKatsuyaDepartment of Molecular Pathology, Graduate School of Medical Sciences, Hiroshima UniversityAkiraIshikawaDepartment of Molecular Pathology, Graduate School of Medical Sciences, Hiroshima UniversityTakaoHamamotoDepartment of Otolaryngology and Head and Neck Surgery, Hiroshima University HospitalHiroakiTaharaDepartment of Otolaryngology and Head and Neck Surgery, Hiroshima University HospitalTsutomuUedaDepartment of Otolaryngology and Head and Neck Surgery, Hiroshima University HospitalSachioTakenoDepartment of Otolaryngology and Head and Neck Surgery, Hiroshima University HospitalCase Report/10.18926/AMO/68730Renal cell carcinoma (RCC) can metastasize hematogenously and recur after a long dormancy. Chromophobe RCC metastasized to the cervical lymph nodes 10 years after the primary resection in a woman who underwent nephrectomy for RCC (T1aN0M0 stage I). Metastatic RCC diagnosis was confirmed by aspiration. The lymph node mass was resected, and the tumor cells matched chromophobe RCC metastasis. No adjuvant therapy was administered due to the lack of evidence regarding adjuvant therapy for chromophobe RCC. Long-term surveillance is crucial in RCC because of the possibility of late metastasis. We reviewed the clinical aspects and literature on metastatic cervical RCC.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7932025Investigation of Cup Placement Position in Total Hip Arthroplasty with Cup-side Implant Placement in Computed Tomography Horizontal Sections177184ENShuroFuruichiDepartment of Bone and Joint Surgery, Kawasaki Medical SchoolShigeruMitaniDepartment of Bone and Joint Surgery, Kawasaki Medical SchoolHirosukeEndoDepartment of Bone and Joint Surgery, Kawasaki Medical SchoolYoshifumiNambaDepartment of Bone and Joint Surgery, Kawasaki Medical SchoolToyohiroKawamotoDepartment of Bone and Joint Surgery, Kawasaki Medical SchoolOriginal Article/10.18926/AMO/68725The 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.Mathematical Society of Japan (Project Euclid)Acta Medica Okayama0025-56457722025Period integrals (Givental's I-function) of Calabi–Yau hypersurface in CPN−1 as generating functions of intersection numbers on the moduli space of quasimaps449482ENMasaoJINZENJIDepartment of Mathematics, Okayama UniversityKohkiMATSUZAKAFaculty of Integrated Media, Ikueikan UniversityIn this paper, we derive the generalized hypergeometric functions (period integrals) used in mirror computation of Calabi–Yau hypersurface in CPN−1 as generating functions of intersection numbers on the moduli space of quasimaps from CP1 with 2+1 marked points to CPN−1.No potential conflict of interest relevant to this article was reported.ElsevierActa Medica Okayama2772-963X452025Prognostic Value of Pericoronary Fat Attenuation Index on Computed Tomography for Hospitalization for Heart Failure101685ENMitsutakaNakashimaDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToruMiyoshiDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakahiroNishiharaDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakashiMikiDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKentaroEjiriDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShoheiHaraDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYoichiTakayaDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesRieNakayamaDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKeishiIchikawaDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKazuhiroOsawaDepartment of General Internal Medicine 3, Kawasaki Medical School General Medicine CentreShinsukeYuasaDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesBACKGROUND Pericoronary fat attenuation index (FAI) assessed on computed tomography is associated with the inflammation of the pericoronary artery. <br>
OBJECTIVES This study aimed to investigate whether pericoronary FAI predicts hospitalization for heart failure with preserved ejection fraction (HFpEF). <br>
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. <br>
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). <br>
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.WileyActa Medica Okayama2397-9070942025Frequency and Characteristics of Gastrointestinal Diseases in Patients With Neurofibromatosise70151ENManamiHondaDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMasayaIwamuroDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakehiroTanakaDepartment of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesYasushiYamasakiDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesSeijiKawanoDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesSakikoHiraokaDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYoshiroKawaharaDepartment of Practical Gastrointestinal Endoscopy,Okayama University HospitalMotoyukiOtsukaDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesBackground and Aim: Patients with neurofibromatosis (NF) frequently experience gastrointestinal symptoms, but the specific characteristics of these lesions are not well understood.<br>
Methods: To investigate the prevalence and nature of gastrointestinal diseases in this population, we analyzed the gastrointestinal lesions identified through endoscopic examinations in patients with NF.<br>
Results: We included 225 patients with NF type 1 (NF1) and 15 with NF type 2 (NF2). None of the NF2 patients underwent endoscopy. Among the NF1 patients, 27 received endoscopies, and 13 (59%) had gastrointestinal lesions. These 13 patients were predominantly male (10 males and three females), with a median age of 53 years (range: 19-76 years). The identified lesions included colorectal polyps (n = 6), gastrointestinal stromal tumors ([GIST], n = 4), subepithelial lesions (n = 3), gastric fundic gland polyps (n = 3), diffuse intestinal ganglioneuromatosis (n = 2), esophageal polyps (n = 2), a Schwann cell hamartoma (n = 1), esophageal cancer (n = 1), and a gastric hyperplastic polyp (n = 1). All GISTs and one case of diffuse intestinal ganglioneuromatosis were surgically resected. Interestingly, six out of 13 patients were asymptomatic. Additionally, all patients who required surgery were 40 years of age or older.<br>
Conclusions: These findings suggest that routine endoscopic examinations, along with imaging techniques like computed tomography and magnetic resonance imaging, could be beneficial for the early detection of gastrointestinal lesions in NF1 patients aged 40 and above.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7922025From a Congenital Defect to Cancer: A Case of Squamous Cell Carcinoma in a Neglected Myelomeningocele117121ENAbhishekGautamDepartment of Neurosurgery, Jawaharlal Nehru Medical College, KAHERRahulKenawadekarDepartment of General Surgery, Jawaharlal Nehru Medical College, KAHERVirupaxiHattiholiDepartment of Radiology, Jawaharlal Nehru Medical College, KAHERPraful SureshMasteDepartment of Neurosurgery, Jawaharlal Nehru Medical College, KAHERCase Report/10.18926/AMO/68650Neural tube defects are common congenital anomalies, typically presenting early due to visible swelling and/or neurological deficits. Rarely, cystic swellings are neglected until adulthood, with only 14 cases of malignancy developing in an untreated meningomyelocele reported to date. We describe the case details of a 26-year-old Indian woman with this rare complication. Magnetic resonance imaging revealed a low-lying spinal cord with spinal dysraphism, cord herniation, and a cystic lesion. The biopsy confirmed a well-differentiated squamous cell carcinoma. Malignant transformation in an untreated myelomeningocele is rare, with chronic irritation and infection as proposed causes. Early biopsy and treatment are crucial for its management.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7922025Potential for Radiation Dose Reduction in Temporal Bone CT Imaging Using Photon-Counting Detector CT7580ENFumiyoHigakiDepartment of Radiology, Okayama University HospitalYusukeMorimitsuDepartment of Radiological Technology, Okayama University HospitalToshihiroIguchiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversitySung IlHwangDepartment of Radiology, Seoul National University Bundang HospitalTakahiroKitayamaDepartment of Radiology, Okayama University HospitalYukaTakahashiDepartment of Radiology, Okayama University HospitalMayuUkaDepartment of Radiology, Okayama University HospitalNoriakiAkagiDepartment of Radiological Technology, Okayama University HospitalAkikoSugayaDepartment of Otolaryngology-Head and Neck Surgery, Okayama University HospitalToshiharuMitsuhashiCenter for Innovative Clinical Medicine, Okayama University HospitalYusukeMatsuiDepartment of Radiology, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesTakaoHirakiDepartment of Radiology, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesOriginal Article10.18926/AMO/68645Temporal bone computed tomography (CT) is frequently performed for pediatric patients with ear diseases. Advances in CT technology have improved diagnostic imaging quality, but reduction of radiation exposure remains a goal. We evaluated the potential for radiation dose reduction in temporal bone CT examinations using porcine ear ossicles and a photon-counting detector CT system. Three scans of the bilateral temporal bone were performed on each of three pig cadaver heads. In each of seven successive imaging sessions, the radiation dose was reduced by an additional one-seventh of the recommended dose (RD). Two board-certified radiologists independently scored the resulting images on a scale of 1 to 5 points, where 5 represented the image quality at the RD. Images scoring ≥4.5 points were considered acceptable. Noise was assessed in a 2-cm-diameter region near the ear ossicles, and standard deviation was measured for each of the seven decrements from the RD. As the radiation dose decreased, the noise progressively increased, and visual assessment scores progressively decreased. Acceptable image scores were obtained at six-sevenths (4.9), five-sevenths (4.8), four-sevenths (4.7), and three-sevenths (4.6) of the RD. Thus, acceptable porcine temporal bone CT images were obtained with a radiation dose reduction of approximately 50%.No potential conflict of interest relevant to this article was reported.SpringerActa Medica Okayama1029-84792024122024Elliptic virtual structure constants and generalizations of BCOV-Zinger formula to projective Fano hypersurfaces135ENMasaoJinzenjiDepartment of Mathematics, Okayama UniversityKenKuwataDepartment of General Education, National Institute of Technology, Kagawa CollegeIn this paper, we propose a method for computing genus 1 Gromov-Witten invariants of Calabi-Yau and Fano projective hypersurfaces using the B-model. Our formalism is applicable to both Calabi-Yau and Fano cases. In the Calabi-Yau case, significant cancellation of terms within our formalism occurs, resulting in an alternative representation of the BCOV-Zinger formula for projective Calabi-Yau hypersurfaces.No potential conflict of interest relevant to this article was reported. Medknow PublicationsActa Medica Okayama0971-62035012025Investigating the Effects of Reconstruction Conditions on Image Quality and Radiomic Analysis in Photon-counting Computed Tomography100107ENMiyuOhataDepartment of Radiological Technology, Graduate School of Health Sciences, Okayama UniversityRyoheiFukuiDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityYusukeMorimitsuDivision of Radiological Technology, Okayama University HospitalDaichiKobayashiDivision of Radiological Technology, Okayama University HospitalTakatsuguYamauchiDivision of Radiological Technology, Okayama University HospitalNoriakiAkagiDivision of Radiological Technology, Okayama University HospitalMitsugiHondaDivision of Radiological Technology, Okayama University HospitalAikoHayashiDepartment of Radiology, Hiroshima University HospitalKoshiHasegawaDepartment of Radiological Technology, Graduate School of Health Sciences, Okayama UniversityKatsuhiroKidaDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversitySachikoGotoDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityTakaoHirakiDepartment of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical, Okayama UniversityIntroduction: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).<br>
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.<br>
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.<br>
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.MDPIActa Medica Okayama1999-48931832025A Hair Drawing Evaluation Algorithm for Exactness Assessment Method in Portrait Drawing Learning Assistant System143ENYueZhangDepartment of Information and Communication Systems, Okayama UniversityNobuoFunabikiDepartment of Information and Communication Systems, Okayama UniversityErita CiciliaFebriantiDepartment of Electrical Engineering, Politeknik Elektronika Negeri SurabayaAmangSudarsonoDepartment of Electrical Engineering, Politeknik Elektronika Negeri SurabayaChenchienHsuDepartment of Electrical Engineering, National Taiwan Normal UniversityNowadays, portrait drawing has become increasingly popular as a means of developing artistic skills and nurturing emotional expression. However, it is challenging for novices to start learning it, as they usually lack a solid grasp of proportions and structural foundations of the five senses. To address this problem, we have studied Portrait Drawing Learning Assistant System (PDLAS) for guiding novices by providing auxiliary lines of facial features, generated by utilizing OpenPose and OpenCV libraries. For PDLAS, we have also presented the exactness assessment method to evaluate drawing accuracy using the Normalized Cross-Correlation (NCC) algorithm. It calculates the similarity score between the drawing result and the initial portrait photo. Unfortunately, the current method does not assess the hair drawing, although it occupies a large part of a portrait and often determines its quality. In this paper, we present a hair drawing evaluation algorithm for the exactness assessment method to offer comprehensive feedback to users in PDLAS. To emphasize hair lines, this algorithm extracts the texture of the hair region by computing the eigenvalues and eigenvectors of the hair image. For evaluations, we applied the proposal to drawing results by seven students from Okayama University, Japan and confirmed the validity. In addition, we observed the NCC score improvement in PDLAS by modifying the face parts with low similarity scores from the exactness assessment method.No potential conflict of interest relevant to this article was reported.ElsevierActa Medica Okayama1083-351X30142025Roles of basic amino acid residues in substrate binding and transport of the light-driven anion pump Synechocystis halorhodopsin (SyHR)108334ENMasakiNakamaGraduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTomoyasuNojiDepartment of Applied Chemistry, The University of TokyoKeiichiKojimaGraduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversitySusumuYoshizawaAtmosphere and Ocean Research Institute, The University of TokyoHiroshiIshikitaDepartment of Applied Chemistry, The University of TokyoYukiSudoGraduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityMicrobial rhodopsins are photoreceptive seventransmembrane a-helical proteins, many of which function as ion transporters, primarily for small monovalent ions such as Na+, K+, Cl-, Br-, and I-. Synechocystis halorhodopsin (SyHR), identified from the cyanobacterium Synechocystis sp. PCC 7509, uniquely transports the polyatomic divalent SO42- inward, in addition to monovalent anions (Cl- and Br-). In this study, we conducted alanine-scanning mutagenesis on twelve basic amino acid residues to investigate the anion transport mechanism of SyHR. We quantitatively evaluated the Cl-and SO42- transport activities of the WT SyHR and its mutants. The results showed a strong correlation between the Cl-and SO42- transport activities among them (R = 0.94), suggesting a shared pathway for both anions. Notably, the R71A mutation selectively abolished SO42- transport activity while maintaining Cl- transport, whereas the H167A mutation significantly impaired both Cl-and SO42- transport. Furthermore, spectroscopic analysis revealed that the R71A mutant lost its ability to bind SO42- due to the absence of a positive charge, while the H167A mutant failed to accumulate the O intermediate during the photoreaction cycle (photocycle) due to reduced hydrophilicity. Additionally, computational analysis revealed the SO42- binding modes and clarified the roles of residues involved in its binding around the retinal chromophore. Based on these findings and previous structural information, we propose that the positive charge and hydrophilicity of Arg71 and His167 are crucial for the formation of the characteristic initial and transient anion-binding site of SyHR, enabling its unique ability to bind and transport both Cl-and SO42-.No potential conflict of interest relevant to this article was reported.MDPIActa Medica Okayama2075-44181562025Robustness of Machine Learning Predictions for Determining Whether Deep Inspiration Breath-Hold Is Required in Breast Cancer Radiation Therapy668ENWlla E.Al-HammadDepartment of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityMasahiroKurodaRadiological Technology, Graduate School of Health Sciences, Okayama UniversityJamal, GhaidaAl JamalDepartment of Oral Medicine and Oral Surgery, Faculty of Dentistry, Jordan University of Science and TechnologyMamikoFujikuraDepartment of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityRyoKamizakiRadiological Technology, Graduate School of Health Sciences, Okayama UniversityKazuhiroKurodaRadiological Technology, Graduate School of Health Sciences, Okayama UniversitySuzukaYoshidaDepartment of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityYoshihideNakamuraDepartment of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityMasatakaOitaGraduate School of Interdisciplinary Sciences and Engineering in Health Systems, Okayama UniversityYoshinoriTanabeRadiological Technology, Graduate School of Health Sciences, Okayama UniversityKoheiSugimotoRadiological Technology, Graduate School of Health Sciences, Okayama UniversityIrfanSugiantoDepartment of Oral Radiology, Faculty of Dentistry, Hasanuddin UniversityMajdBarhamDepartment of Dentistry and Dental Surgery, College of Medicine and Health Sciences, An-Najah National UniversityNouhaTekikiDepartment of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityMikiHisatomiDepartment of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityJunichiAsaumiDepartment of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityBackground/Objectives: Deep inspiration breath-hold (DIBH) is a commonly used technique to reduce the mean heart dose (MHD), which is critical for minimizing late cardiac side effects in breast cancer patients undergoing radiation therapy (RT). Although previous studies have explored the potential of machine learning (ML) to predict which patients might benefit from DIBH, none have rigorously assessed ML model performance across various MHD thresholds and parameter settings. This study aims to evaluate the robustness of ML models in predicting the need for DIBH across different clinical scenarios. Methods: Using data from 207 breast cancer patients treated with RT, we developed and tested ML models at three MHD cut-off values (240, 270, and 300 cGy), considering variations in the number of independent variables (three vs. six) and folds in the cross-validation (three, four, and five). Robustness was defined as achieving high F2 scores and low instability in predictive performance. Results: Our findings indicate that the decision tree (DT) model demonstrated consistently high robustness at 240 and 270 cGy, while the random forest model performed optimally at 300 cGy. At 240 cGy, a threshold critical to minimize late cardiac risks, the DT model exhibited stable predictive power, reducing the risk of overestimating DIBH necessity. Conclusions: These results suggest that the DT model, particularly at lower MHD thresholds, may be the most reliable for clinical applications. By providing a tool for targeted DIBH implementation, this model has the potential to enhance patient-specific treatment planning and improve clinical outcomes in RT.No potential conflict of interest relevant to this article was reported.Springer Science and Business Media LLCActa Medica Okayama2168-81841732025A Natural Course From Primary Intraocular Lymphoma to Brain Lymphoma in Four Years According to Patient's Choicee81476ENToshihikoMatsuoDepartment of Ophthalmology, Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama UniversityTakehiroTanakaDepartment of Pathology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityJojiIshidaDepartment of Neurological Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityShotaroKondoDepartment of Internal Medicine, Kurashiki Municipal HospitalKen-ichiMatsuokaDepartment of Hematology and Oncology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityPrimary intraocular lymphoma or vitreoretinal lymphoma is a rare entity of diffuse large B-cell lymphoma that presents vitreous opacity and retinal and choroidal infiltration. Primary central nervous system lymphoma would occur previously, later, or concurrently with respect to primary intraocular lymphoma. This study reported a 72-year-old patient with a pathological diagnosis of primary intraocular lymphoma who developed central nervous system lymphoma four years later in the course of no treatment. She presented with a four-year history of blurred vision in both eyes after cataract surgeries. Three weeks previously, she underwent a vitrectomy in the left eye at a clinic, and measurements of the vitreous fluid showed a high level of interleukin-10 at 5739 pg/mL, in contrast with interleukin-6 at 142 pg/mL. Cytology of the vitreous fluid was class III on the Papanicolaou classification. Head magnetic resonance imaging detected nothing abnormal. She underwent vitrectomy in the right eye as a diagnostic procedure to show large cells in the vitreous which were positive for CD20 and Ki-67 and negative for CD3, leading to a pathological diagnosis of large B-cell lymphoma. Prophylactic chemotherapy with high-dose methotrexate was recommended as a therapeutic option, but she chose observation since she did not have any eye or systemic symptoms. In the follow-up every three months by an oncologist and an ophthalmologist, she did not have any symptoms, and serum levels of soluble interleukin-2 receptor were in the normal range at each visit. She was well for four years until the age of 76 years when she fell and hit her head, and an emergency head computed tomography scan showed a mass in the left occipital lobe. Magnetic resonance imaging demonstrated a well-defined circular mass in the left occipital lobe with a hyperintense signal in the T2-weighted fluid-attenuated inversion recovery (FLAIR) image and diffusion-weighted image. Fluorodeoxyglucose positron emission tomography showed no abnormal uptake systemically, except for the left occipital lesion. She underwent a brain biopsy by craniotomy to pathologically prove diffuse large B-cell lymphoma. She was recommended to receive first-line chemotherapy as the standard treatment but chose observation with no treatment and died of brain lymphoma nine months later. This case happened to illustrate a natural course of primary intraocular lymphoma which proceeded to central nervous system lymphoma four years later.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama1878-87501952025Utility of Surgical Simulation for Tubular Retractor Surgery Using Three-Dimensional Printed Intraventricular Tumor Models: Case Series123743ENRyoOmaeDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesRyuKimuraDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYoshihiroOtaniDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesJunHarumaDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTomoyaSaijoDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesJuntaroFujitaDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShoheiNishigakiDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesRyosukeIkemachiDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShuichiroHiranoDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesJojiIshidaDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKentaroFujiiDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakaoYasuharaDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShotaTanakaDepartment of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesObjective: The utility of the tubular retractor for deep-seated tumors, including intraventricular tumors, has recently been reported. However, the surgical field’s depth and narrowness can lead to blind spots, and it is crucial to prevent damage to the cortex and white matter fibers in eloquent areas. Therefore, preoperative simulation is critical for tubular retractor surgery. In this study, we investigated the benefits of threedimensional (3D)-printed intraventricular tumor models for tubular retractor surgery.<br>
Methods: Nine patients with intraventricular central neurocytoma who underwent tubular retractor surgery at our institution between March 2013 and August 2023 were retrospectively reviewed. Fusion images and 3D-printed intraventricular tumor models were developed from preoperative computed tomography (CT) and magnetic resonance imaging (MRI). The puncture points of the tubular retractor were simulated using fusion images and 3D-printed intraventricular tumor models by 11 neurosurgeons (3 experts in brain tumors, 2 experts in areas other than brain tumors, and 6 residents). The dispersion of puncture points among 8 neurosurgeons (excluding brain tumor experts) was compared in each simulation model.<br>
Results: These cases were categorized into two groups based on the dispersion of puncture points simulated by fusion images. Puncture point dispersion was markedly smaller in all cases when using 3D-printed intraventricular tumor models compared to simulations solely based on fusion images.<br>
Conclusions: In intraventricular tumor surgery using a tubular retractor, 3D-printed intraventricular tumor models proved more beneficial in preoperative simulation compared to fusion images.No potential conflict of interest relevant to this article was reported.MDPIActa Medica Okayama2076-34171552025Deep Reinforcement Learning for Dynamic Pricing and Ordering Policies in Perishable Inventory Management2421ENYusukeNomuraGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityZiangLiuGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityTatsushiNishiGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityPerishable goods have a limited shelf life, and inventory should be discarded once it exceeds its shelf life. Finding optimal inventory management policies is essential since inefficient policies can lead to increased waste and higher costs. While many previous studies assume the perishable inventory is processed following the First In, First Out rule, it does not reflect customer purchasing behavior. In practice, customers' preferences are influenced by the shelf life and price of products. This study optimizes inventory and pricing policies for a perishable inventory management problem considering age-dependent probabilistic demand. However, introducing dynamic pricing significantly increases the complexity of the problem. To tackle this challenge, we propose eliminating irrational actions in dynamic programming without sacrificing optimality. To solve this problem more efficiently, we also implement a deep reinforcement learning algorithm, proximal policy optimization, to solve this problem. The results show that dynamic programming with action reduction achieved an average of 63.1% reduction in computation time compared to vanilla dynamic programming. In most cases, proximal policy optimization achieved an optimality gap of less than 10%. Sensitivity analysis of the demand model revealed a negative correlation between customer sensitivity to shelf lives or prices and total profits.No potential conflict of interest relevant to this article was reported.WileyActa Medica Okayama2692-4609512025Endoscopic ultrasonography-guided removal of a stent that had migrated into the pancreas post-pancreaticojejunostomy: A case reporte70096ENSatoshiKajitaniDepartment of Gastroenterology andHepatology, Okayama University HospitalKazuyukiMatsumotoDepartment of Gastroenterology andHepatology, Okayama University HospitalKentaroOkiDepartment of Gastroenterology andHepatology, Okayama University HospitalAkihiroMatsumiDepartment of Gastroenterology andHepatology, Okayama University HospitalKazuyaMiyamotoDepartment of Gastroenterology andHepatology, Okayama University HospitalYukiFujiiDepartment of Gastroenterology andHepatology, Okayama University HospitalDaisukeUchidaDepartment of Gastroenterology andHepatology, Okayama University HospitalKoichiroTsutsumiDepartment of Gastroenterology andHepatology, Okayama University HospitalShigeruHoriguchiDepartment of Gastroenterology andHepatology, Okayama University HospitalMotoyukiOtsukaDepartment of Gastroenterology andHepatology, Okayama University HospitalA 64-year-old woman had undergone subtotal stomach-preserving pancreaticoduodenectomy for locally advanced pancreatic head cancer. She had an uneventful postoperative course with no recurrence. However, approximately 18 months after surgery, she presented with recurrent abdominal pain. Although contrast-enhanced computed tomography abdominal radiographs showed internal stent migration to the residual pancreas, dilatation of the tail side of the pancreatic duct was observed. The impaired internal stent was considered to be the cause of the abdominal pain. An attempt to remove the stent via balloon-assisted endoscopy was unsuccessful as the pancreaticojejunostomy site could not be reached. Consequently, endoscopic ultrasonography-guided pancreatic duct drainage was performed, and a plastic stent was placed through the jejunal site to the stomach. Two months later, the endosonographically/endoscopic ultrasonography-guided created route was dilated, and an endoscopic introducer was inserted into the pancreatic duct. Biopsy forceps were advanced through the sheath, allowing the successful removal of the stent by direct grasping. The symptoms of the patient improved, and she was discharged without complications.No potential conflict of interest relevant to this article was reported.WileyActa Medica Okayama2769-2558412025A case of invasive pulmonary aspergillosis associated with clozapine-induced agranulocytosise70077ENAkiyoshiYokodeDepartment of Neuropsychiatry, Okayama University HospitalMasakiFujiwaraDepartment of Neuropsychiatry, Okayama University HospitalToshikiTeraoDepartment of Hematology and Oncology, Okayama University HospitalShinjiSakamotoDepartment of Neuropsychiatry, Okayama University HospitalYutoYamadaDepartment of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesRyotaSatoOkayama Psychiatric Medical CenterMomokoMishimaOkayama Psychiatric Medical CenterYujiYadaOkayama Psychiatric Medical CenterKen-IchiMatsuokaDepartment of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical SciencesManabuTakakiDepartment of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesBackground: Clozapine-induced agranulocytosis (CLIA) is a rare but serious complication. Fever associated with CLIA is typically treated with broad-spectrum antimicrobials, but empiric antifungal therapy is rarely used. While bacterial and viral infections have been reported in CLIA cases, no cases of fungal infections complicated by CLIA have been documented. We report the first case of CLIA complicated by invasive pulmonary aspergillosis (IPA) in a patient with schizophrenia. The diagnosis of IPA was made using serum beta-D-glucan, Aspergillus galactomannan antigen tests, and chest computed tomography (CT). <br>
Case presentation: We present a case of a 51-year-old man with schizophrenia who developed CLIA complicated by IPA. The patient, diagnosed with treatment-resistant schizophrenia, was started on clozapine, but 9 months later he presented with fever, cough, leukopenia, and neutropenia. Clozapine was discontinued, and empirical treatments with cefepime and filgrastim were initiated. Serum beta-D-glucan and Aspergillus galactomannan antigen tests were positive, and chest CT showed well-circumscribed nodules, leading to a probable diagnosis of IPA. Antifungal therapy was switched from micafungin to voriconazole according to guidelines. His neutropenia and fever improved, and he was re-transferred to a psychiatric hospital. <br>
Conclusion: CLIA can be complicated by fungal infections. When patients with CLIA present with fever, fungal infections, including IPA, should be considered in the differential diagnosis. Serological tests, including beta-D-glucan and Aspergillus galactomannan, are useful for the diagnosis of IPA as well as the appropriate use of antifungal agents in patients with CLIA.No potential conflict of interest relevant to this article was reported.MDPIActa Medica Okayama2078-24891622025Implementation of Sensor Input Setup Assistance Service Using Generative AI for SEMAR IoT Application Server Platform108ENI. Nyoman DarmaKotamaGraduate School of Natural Science and Technology, Okayama UniversityNobuoFunabikiGraduate School of Natural Science and Technology, Okayama UniversityYohanes Yohanie FridelinPandumanGraduate School of Natural Science and Technology, Okayama UniversityKomang CandraBrataGraduate School of Natural Science and Technology, Okayama UniversityAnak Agung SuryaPradhanaGraduate School of Natural Science and Technology, Okayama UniversityNopriantoGraduate School of Natural Science and Technology, Okayama UniversityI. Gusti Made NgurahDesnanjayaDepartment of Computer System Engineering, Institute of Business and Technology IndonesiaFor rapid deployments of various IoT application systems, we have developed Smart Environmental Monitoring and Analytical in Real-Time (SEMAR) as an integrated server platform. It is equipped with rich functions for collecting, analyzing, and visualizing various data. Unfortunately, the proper configuration of SEMAR with a variety of IoT devices can be complex and challenging for novice users, since it often requires technical expertise. The assistance of Generative AI can be helpful to solve this drawback. In this paper, we present an implementation of a sensor input setup assistance service for SEMAR using prompt engineering techniques and Generative AI. A user needs to define the requirement specifications and environments of the IoT application system for sensor inputs, and give them to the service. Then, the service provides step-by-step guidance on sensor connections, communicating board configurations, network connections, and communication protocols to the user, which can help the user easily set up the configuration to connect the relevant devices to SEMAR. For evaluations, we applied the proposal to the input sensor setup processes of three practical IoT application systems with SEMAR, namely, a smart light, water heater, and room temperature monitoring system. In addition, we applied it to the setup process of an IoT application system for a course for undergraduate students at the Insitut Bisnis dan Teknologi (INSTIKI), Indonesia. The results demonstrate the effectiveness of the proposed service for SEMAR.No potential conflict of interest relevant to this article was reported.MDPIActa Medica Okayama2078-24891622025An Application of SEMAR IoT Application Server Platform to Drone-Based Wall Inspection System Using AI Model91ENYohanes Yohanie FridelinPandumanGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityRadhiatulHusnaGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityNobuoNopriantoGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityNobuoFunabikiGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityShunyaSakamakiGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversitySritrustaSukaridhotoDepartment of Informatics and Computer, Politeknik Elektronika Negeri SurabayaYan WatequlisSyaifudinDepartment of Information Technology, State Polytechnic of MalangAlfiandi AuliaRahmadaniDepartment of Electrical Engineering, State Polytechnic of MalangRecently, artificial intelligence (AI) has been adopted in a number of Internet of Things (IoT) application systems to enhance intelligence. We have developed a ready-made server with rich built-in functions to collect, process, display, analyze, and store data from various IoT devices, the SEMAR (Smart Environmental Monitoring and Analytics in Real-Time) IoT application server platform, in which various AI techniques have been implemented to enhance its capabilities. In this paper, we present an application of SEMAR to a drone-based wall inspection system using an object detection AI model called You Only Look Once (YOLO). This system aims to detect wall cracks at high places using images taken via a camera on a flying drone. An edge computing device is installed to control the drone, sending the taken images through the Kafka system, storing them with the drone flight data, and sending the data to SEMAR. The images are analyzed via YOLO through SEMAR. For evaluations, we implemented the system using Ryze Tello for the drone and Raspberry Pi for the edge, and we evaluated the detection accuracy. The preliminary experiment results confirmed the effectiveness of the proposal.No potential conflict of interest relevant to this article was reported.Medknow PublicationsActa Medica Okayama0971-62034942024Backside Irradiation of Ultraviolet-A for Correcting Nonuniformity Error of Gafchromic XR-QA2 Films563567ENNobuyoshiTankiDepartment of Radiological Technology, Graduate School of Health Sciences, Okayama UniversitySachikoGotoDepartment of Radiological Technology, Faculty of Health Sciences, Okayama UniversityToshizoKatsudaDepartment of Medical Radiation Technology, Shizuoka College of Medicalcare ScienceRumiGotandaDepartment of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical WelfareTatsuhiroGotandaDepartment of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical WelfareTadaoKuwanoDepartment of Radiology, Osaka Center for Cancer and Cardiovascular Diseases PreventionPurpose: Radiochromic film is used for quality assurance and quality control of X-ray equipment in the diagnostic radiology. In addition, three-dimensional dose distribution of computed tomography (CT) is measured. To correct the nonuniformity and uncertainty of radiochromic films for dose measurement of CT, the films are preirradiated ultraviolet (UV)-A rays. There is a difference in the UV protection strength of radiochromic films. A concern exists about the effects of the UV-A irradiation intensity. We thus irradiated with UV-A rays from the backsides of the films to assess if backside irradiation was possible. Materials and Methods: Gafchromic XR-QA2 and RTQA2 were used in this study. The UV-A rays were simultaneously irradiated on the front and backsides of each film for 12 h. The yellow layer of each film was scanned and imaged. The average pixel values ± standard deviations (SDs) were compared. In the statistical analysis, a paired t-test was performed. To compare, the active-layer densities engendered by the UV-A rays. Calibration curve was created with 48 h of preirradiation of UV-A. Results: The mean pixel values ± SD for Gafchromic XR-QA2 on the front and backsides were 130.776 ± 0.812 and 81.015 ± 1.128, respectively. On the other hand, the mean pixel values ± SD for Gafchromic RTQA2 on the front and backsides were 62.299 ± 1.077 and 133.761 ± 1.365, respectively. The statistical results of the paired t-test were significantly different (P < 0.01) between both films. Fitting equation of the calibration curve is shown below. y = -390.47 ± 200 + (443.45 ± 10x80).5068 ± 0.0434. Conclusion: Based on the relationship between the sensitivity of the active layer to UV-A rays and the strength of UV protection on the surface, we concluded that backside irradiation is recommended for Gafchromic XR-QA2, and frontside irradiation is recommended for Gafchromic RTQA2.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7912025Photoinitiators Induce Histamine Production in Human Mast Cells5158ENTaroMiuraDepartment of Clinical Pharmacy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYoichiKawasakiLaboratory of Clinical Pharmacology and Therapeutics, Kagawa School of Pharmaceutical Sciences, Tokushima Bunri UniversityHirofumiHamanoDepartment of Clinical Pharmacy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYoshitoZamamiDepartment of Clinical Pharmacy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToshiakiSendoDepartment of Clinical Pharmacy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOriginal Article/10.18926/AMO/68362Photoinitiators are used in the manufacture of many daily products, and may produce harmful effects due to their cytotoxicity. They have also been detected in human serum. Here, we investigated the histamine-producing effects in HMC-1 cells and the inflammatory cytokine release effects in RAW264 cells for four photoinitiators: 1-hydroxycyclohexyl phenyl ketone; 2-isopropylthioxanthone; methyl 2-benzoylbenzoate; and 2-methyl-4´-(methylthio)-2-morpholinopropiophenone. All four promoted histamine production in HMC-1 cells; however, they did not significantly affect the release of inflammatory cytokines in RAW264 cells. These findings suggest that these four photoinitiators induce inflammatory cytokine-independent histamine production, potentially contributing to histamine-mediated chronic inflammation in vitro.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7912025Could the Trabecular Bone Score Be a Complementary Tool for Evaluating Degenerative Lumbar Vertebrae?3945ENShinichiroTakaoDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKojiUotaniDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHaruoMisawaDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTomokoTetsunagaDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKensukeShinoharaDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKentaroYamaneDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYoshiakiOdaDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHironoriTsujiDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYuyaKajikiDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToshifumiOzakiDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOriginal Article/10.18926/AMO/68360Evaluating vertebral bone mass and quality in the elderly poses challenges due to degenerative changes. This study aims to elucidate the usefulness of the trabecular bone score (TBS) by examining the relationship between bone mineral density (BMD), TBS, and Hounsfield unit (HU) values. A retrospective analysis of 599 vertebrae from 152 patients (mean age 69.0 years; range 44-89; 74 males and 78 females) undergoing dual-energy X-ray absorptiometry (DXA) and CT scans was conducted. Vertebrae were categorized into three grades based on the degree of degeneration. The TBS was calculated from DXA images, and the HU value was measured by placing a region of interest on an axial image of the vertebral mid-body. One-way analysis of variance and Pearson’s correlation tests were employed to investigate the relationship between BMD and TBS or HU values. While lumbar BMD significantly increased (p<0.01) with degenerative changes, TBS and HU values showed no significant differences. The correlations between lumbar BMD and TBS values, and between BMD and HU values, were stronger without degenerative changes than with degenerative changes. Significantly different HU values were observed between the right and left sides of severely degenerated vertebrae. Severe degenerative changes, particularly those associated with sclerosis, may impact HU values. TBS exhibits greater potential than HU values as a complementary tool.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7912025Prediction of Prostate Cancer Grades Using Radiomic Features2130ENYasuhiroYamamotoDepartment of Radiology, Houshasen Daiichi HospitalTakafumiHaraguchiDepartment of Advanced Biomedical Imaging and Informatics, St. Marianna University School of MedicineKaoriMatsudaDepartment of Radiology, Houshasen Daiichi HospitalYoshioOkazakiDepartment of Radiology, Houshasen Daiichi HospitalShinKimotoDepartment of Radiology, Houshasen Daiichi HospitalNozomuTanjiDepartment of Urology, Houshasen Daiichi HospitalAtsushiMatsumotoDepartment of Urology, Houshasen Daiichi HospitalYasuyukiKobayashiDepartment of Medical Information and Communication Technology Research, St. Marianna University School of MedicineHidefumiMimuraDepartment of Radiology, St. Marianna University School of MedicineTakaoHirakiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOriginal Article/10.18926/AMO/68355We developed a machine learning model for predicting prostate cancer (PCa) grades using radiomic features of magnetic resonance imaging. 112 patients diagnosed with PCa based on prostate biopsy between January 2014 and December 2021 were evaluated. Logistic regression was used to construct two prediction models, one using radiomic features and prostate-specific antigen (PSA) values (Radiomics model) and the other Prostate Imaging-Reporting and Data System (PI-RADS) scores and PSA values (PI-RADS model), to differentiate high-grade (Gleason score [GS] ≥ 8) from intermediate or low-grade (GS < 8) PCa. Five imaging features were selected for the Radiomics model using the Gini coefficient. Model performance was evaluated using AUC, sensitivity, and specificity. The models were compared by leave-one-out cross-validation with Ridge regularization. Furthermore, the Radiomics model was evaluated using the holdout method and represented by a nomogram. The AUC of the Radiomics and PI-RADS models differed significantly (0.799, 95% CI: 0.712-0.869; and 0.710, 95% CI: 0.617-0.792, respectively). Using holdout method, the Radiomics model yielded AUC of 0.778 (95% CI: 0.552-0.925), sensitivity of 0.769, and specificity of 0.778. It outperformed the PI-RADS model and could be useful in predicting PCa grades, potentially aiding in determining appropriate treatment approaches in PCa patients.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7912025Gastrectomy Causes an Imbalance in the Trunk Muscles919ENNanamiIkeyaDepartment of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesAtsushiOkitaDepartment of Surgery, Okayama City HospitalShinsukeHashidaDepartment of Surgery, Okayama City HospitalSumiharuYamamotoDepartment of Surgery, Okayama City HospitalHirokuniIkedaDepartment of Surgery, Okayama City HospitalKazunoriTsukudaDepartment of Surgery, Okayama City HospitalShinichiToyookaDepartment of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOriginal Article/10.18926/AMO/68354Muscle 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.Proceedings of the National Academy of SciencesActa Medica Okayama0027-8424121352024Somatic mutations in tumor-infiltrating lymphocytes impact on antitumor immunitye2320189121ENFumiakiMukoharaDepartment of Tumor Microenvironment, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKazumaIwataDepartment of Tumor Microenvironment, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTakamasaIshinoDepartment of Tumor Microenvironment, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTakashiInozumeDepartment of Dermatology, Chiba University Graduate School of MedicineJojiNagasakiDepartment of Tumor Microenvironment, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityYoukiUedaDepartment of Tumor Microenvironment, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKenSuzawaDepartment of General Thoracic Surgery and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama UniversityToshihideUenoDivision of Cellular Signaling, National Cancer Center Research InstituteHidekiIkedaDivision of Cell Therapy, Chiba Cancer Research InstituteKatsushigeKawaseDivision of Cell Therapy, Chiba Cancer Research InstituteYukaSaekiDepartment of Dermatology, Chiba University Graduate School of MedicineShusukeKawashimaDepartment of Dermatology, Chiba University Graduate School of MedicineKazuoYamashitaKOTAI Biotechnologies, Inc.YuKawaharaDepartment of Dermatology, Chiba University Graduate School of MedicineYasuhiroNakamuraDepartment of Skin Oncology/Dermatology, Saitama Medical University International Medical CenterAkikoHonobe-TabuchiDepartment of Dermatology, University of YamanashiHirokoWatanabeDepartment of Tumor Microenvironment, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityHiromichiDansakoDepartment of Tumor Microenvironment, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTatsuyoshiKawamuraDepartment of Dermatology, University of YamanashiYutakaSuzukiDepartment of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, KashiwaHiroakiHondaDepartment of Pathology, Tokyo Women's Medical UniversityHiroyukiManoDivision of Cellular Signaling, National Cancer Center Research InstituteShinichiToyookaDepartment of General Thoracic Surgery and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama UniversityMasahitoKawazuDivision of Cell Therapy, Chiba Cancer Research InstituteYosukeTogashiDepartment of Tumor Microenvironment, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityImmune checkpoint inhibitors (ICIs) exert clinical efficacy against various types of cancers by reinvigorating exhausted CD8+ T cells that can expand and directly attack cancer cells (cancer-specific T cells) among tumor-infiltrating lymphocytes (TILs). Although some reports have identified somatic mutations in TILs, their effect on antitumor immunity remains unclear. In this study, we successfully established 18 cancer-specific T cell clones, which have an exhaustion phenotype, from the TILs of four patients with melanoma. We conducted whole-genome sequencing for these T cell clones and identified various somatic mutations in them with high clonality. Among the somatic mutations, an SH2D2A loss-of-function frameshift mutation and TNFAIP3 deletion could activate T cell effector functions in vitro. Furthermore, we generated CD8+ T cell–specific Tnfaip3 knockout mice and showed that Tnfaip3 function loss in CD8+ T cell increased antitumor immunity, leading to remarkable response to PD-1 blockade in vivo. In addition, we analyzed bulk CD3+ T cells from TILs in additional 12 patients and identified an SH2D2A mutation in one patient through amplicon sequencing. These findings suggest that somatic mutations in TILs can affect antitumor immunity and suggest unique biomarkers and therapeutic targets.No potential conflict of interest relevant to this article was reported.WileyActa Medica Okayama2692-4609512025Efficacy and safety of endoscopic ultrasonography-guided radiofrequency ablation of small pancreatic neuroendocrine neoplasms: A prospective, pilot studye70073ENKazuyukiMatsumotoDepartment of Gastroenterology and Hepatology, Okayama University HospitalDaisukeUchidaDepartment of Gastroenterology and Hepatology, Okayama University HospitalYasutoTakeuchiDepartment of Gastroenterology and Hepatology, Okayama University HospitalHironariKatoDepartment of Gastroenterology and Hepatology, Okayama University HospitalYukiFujiiDepartment of Gastroenterology and Hepatology, Okayama University HospitalKeiHaradaDepartment of Gastroenterology and Hepatology, Okayama University HospitalNaoHattoriDepartment of Gastroenterology and Hepatology, Okayama University HospitalRyosukeSatoDepartment of Gastroenterology and Hepatology, Okayama University HospitalTaisukeObataDepartment of Gastroenterology and Hepatology, Okayama University HospitalAkihiroMatsumiDepartment of Gastroenterology and Hepatology, Okayama University HospitalKazuyaMiyamotoDepartment of Gastroenterology and Hepatology, Okayama University HospitalShigeruHoriguchiDepartment of Gastroenterology and Hepatology, Okayama University HospitalKoichiroTsutsumiDepartment of Gastroenterology and Hepatology, Okayama University HospitalKazuyaYasuiDepartment of Gastroenterological Surgery, Transplant and Surgical Oncology, Okayama University HospitalRyoHaradaDepartment of Gastroenterology, Japanese Red Cross Okayama HospitalMasakuniFujiiDepartment of Internal Medicine, Okayama Saiseikai General HospitalMotoyukiOtsukaDepartment of Gastroenterology and Hepatology, Okayama University HospitalObjectives: Endoscopic ultrasonography (EUS)-guided radiofrequency ablation has recently been introduced as one of the management strategies for small pancreatic neuroendocrine neoplasms (PNENs). However, prospective data on its safety and efficacy remain limited.<br>
Methods: This prospective pilot study was conducted at Okayama University Hospital from May 2023 to December 2024. Patients with grade 1 PNENs <= 15 mm, confirmed by EUS-guided fine-needle aspiration, were included. The primary endpoint was safety (adverse events [AEs] evaluated according to the 2010 guidelines of the American Society for Gastrointestinal Endoscopy. Severe AEs were defined as moderate or higher in American Society for Gastrointestinal Endoscopy grading and grade >= 3. Secondary endpoints included efficacy (complete response on contrast-enhanced computed tomography at 1 and 6 months), treatment details, device failure, diabetes mellitus exacerbation, and overall survival at 6 months.<br>
Results: Five patients with non-functional PNENs (median age: 64 years; median tumor size: 10 mm) were treated. AEs occurred in two patients (40%, 2/5), although none was severe. Both patients developed asymptomatic pseudocysts, one experienced mild pancreatitis, and both resolved with conservative treatment. The complete response rates on contrast-enhanced computed tomography at one and 6 months were 100%. The median procedure time was 16 min without any device failure, and the median hospitalization was 5 days. None of the patients developed new-onset or worsening diabetes mellitus. The 6-month overall survival rate was 100%.<br>
Conclusion: EUS-guided radiofrequency ablation demonstrated a high complete response rate with no severe AEs in this pilot study, suggesting a minimally invasive option for small, low-grade PNENs (jRCTs062230014).No potential conflict of interest relevant to this article was reported.MDPIActa Medica Okayama2079-63741512025Mapping Surface Potential in DNA Aptamer-Neurochemical and Membrane-Ion Interactions on the SOS Substrate Using Terahertz Microscopy46ENKoseiMoritaGraduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama UniversityYutaMitsudaGraduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama UniversitySotaYoshidaGraduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama UniversityToshihikoKiwaGraduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama UniversityJinWangGraduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama UniversityIn this study, we utilized a terahertz chemical microscope (TCM) to map surface potential changes induced by molecular interactions on silicon-on-sapphire (SOS) substrates. By functionalizing the SOS substrate with DNA aptamers and an ion-selective membrane, we successfully detected and visualized aptamer-neurochemical complexes through the terahertz amplitude. Additionally, comparative studies of DNA aptamers in PBS buffer and artificial cerebrospinal fluid (aCSF) were performed by computational structure modeling and terahertz measurements. Beyond neurochemicals, we also investigated calcium ions, measuring their concentrations in PDMS-fabricated micro-wells using minimal sample volumes. Our results highlight the capability of TCM as a powerful, label-free, and sensitive platform for the probing and mapping of surface potential arising from molecular interactions, with broad implications for biomedical diagnostics and research.No potential conflict of interest relevant to this article was reported.MDPIActa Medica Okayama2073-431X1412025An Investigation of Hand Gestures for Controlling Video Games in a Rehabilitation Exergame System25ENRadhiatulHusnaDepartment of Information and Communication Systems, Okayama UniversityKomang CandraBrataDepartment of Information and Communication Systems, Okayama UniversityIrin TriAnggrainiDepartment of Information and Communication Systems, Okayama UniversityNobuoFunabikiDepartment of Information and Communication Systems, Okayama UniversityAlfiandi AuliaRahmadaniDepartment of Electrical Engineering, State Polytechnic of MalangChih-PengFanDepartment of Electrical Engineering, National Chung Hsing UniversityMusculoskeletal disorders (MSDs) can significantly impact individuals' quality of life (QoL), often requiring effective rehabilitation strategies to promote recovery. However, traditional rehabilitation methods can be expensive and may lack engagement, leading to poor adherence to therapy exercise routines. An exergame system can be a solution to this problem. In this paper, we investigate appropriate hand gestures for controlling video games in a rehabilitation exergame system. The Mediapipe Python library is adopted for the real-time recognition of gestures. We choose 10 easy gestures among 32 possible simple gestures. Then, we specify and compare the best and the second-best groups used to control the game. Comprehensive experiments are conducted with 16 students at Andalas University, Indonesia, to find appropriate gestures and evaluate user experiences of the system using the System Usability Scale (SUS) and User Experience Questionnaire (UEQ). The results show that the hand gestures in the best group are more accessible than in the second-best group. The results suggest appropriate hand gestures for game controls and confirm the proposal's validity. In future work, we plan to enhance the exergame system by integrating a diverse set of video games, while expanding its application to a broader and more diverse sample. We will also study other practical applications of the hand gesture control function.No potential conflict of interest relevant to this article was reported.Japanese Society of Internal MedicineActa Medica Okayama0918-29182025Dyspnea with Hemidiaphragm Elevation in a Patient with Giant Cell Arteritis: A Case Report4055-24ENYosukeAsanoDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesYoshinoriMatsumotoDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesNatsukiKubotaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesYuyaTerajimaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesKazuyaMatsumotoDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesKentaShidaharaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesKeiHiroseDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesTakatoNakadoiDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesShoichiNawachiDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesYuKatayamaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesYoshiaMiyawakiDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesEriKatsuyamaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesTakayukiKatsuyamaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesMarikoTakano-NarazakiDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesKen-EiSadaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesJunWadaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical SciencesWe herein report the first case of dyspnea with hemidiaphragm elevation in a 68-year-old woman with active giant cell arteritis (GCA), including successful treatment. Contrast-enhanced computed tomography showed a reduced density of the left ophthalmic artery and the left superficial temporal artery with increased soft tissue compared to the other side, indicating that the GCA had flared up and suggesting that the hemidiaphragm elevation might be caused by vasculitis-associated ischemia of the right phrenic nerve. Hemidiaphragm paralysis due to vasculitis-associated ischemia in patients with GCA needs to be distinguished from local infection, tumors, and hepatomegaly, which are the major causes of hemidiaphragm elevation.No potential conflict of interest relevant to this article was reported.Institute of Electrical and Electronics Engineers (IEEE)Acta Medica Okayama1745-1345E108-B12024Overloaded MIMO Spatial Multiplexing Independent of Antenna Setups113ENSatoshiDennoFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityTakumiSugimotoGraduate School of Natural Science and Technology, Okayama UniversityKokiMatobaGraduate School of Environmental, Life, Natural Science and Technology, Okayama UniversityYafeiHouFaculty of Environmental, Life, Natural Science and Technology, Okayama UniversityThis paper proposes overloaded MIMO spatial multiplexing that can increase the number of spatially multiplexed signal streams despite of the number of antennas on a terminal and that on a receiver. We propose extension of the channel matrix for the spatial multiplexing to achieve the superb multiplexing performance. Precoding based on the extended channel matrix plays a crucial role in carrying out such spatial multiplexing. We consider three types of QR-decomposition techniques for the proposed spatial multiplexing to improve the transmission performance. The transmission performance of the proposed spatial multiplexing is evaluated by computer simulation. The simulation reveals that the proposed overloaded MIMO spatial multiplexing can implement 6 stream-spatial multiplexing in a 2×2 MIMO system, i.e., the overloading ratio of 3.0. The superior transmission performance is achieved by the proposed overloaded MIMO spatial multiplexing with one of the QR-decomposition techniques.No potential conflict of interest relevant to this article was reported.MDPIActa Medica Okayama2079-929213242024An Implementation of Web-Based Answer Platform in the Flutter Programming Learning Assistant System Using Docker Compose4878ENLynn HtetAungDepartment of Information and Communication Systems, Okayama UniversitySoe ThandarAungDepartment of Information and Communication Systems, Okayama UniversityNobuoFunabikiDepartment of Information and Communication Systems, Okayama UniversityHtoo Htoo SandiKyawDepartment of Computer and Information Science, Tokyo University of Agriculture and TechnologyWen-ChungKaoDepartment of Electrical Engineering, National Taiwan Normal UniversityProgramming has gained significant importance worldwide as societies increasingly rely on computer application systems. To support novices in learning various programming languages, we have developed the Programming Learning Assistant System (PLAS). It offers several types of exercise problems with different learning goals and levels for step-by-step self-study. As a personal answer platform in PLAS, we have implemented a web application using Node.js and EJS for Java and Python programming. Recently, the Flutter framework with Dart programming has become popular, enabling developers to build applications for mobile, web, and desktop environments from a single codebase. Thus, we have extended PLAS by implementing the Flutter environment with Visual Studio Code to support it. Additionally, we have developed an image-based user interface (UI) testing tool to verify student source code by comparing its generated UI image with the standard one using the ORB and SIFT algorithms in OpenCV. For efficient distribution to students, we have generated Docker images of the answer platform, Flutter environment, and image-based UI testing tool. In this paper, we present the implementation of a web-based answer platform for the Flutter Programming Learning Assistant System (FPLAS) by integrating three Docker images using Docker Compose. Additionally, to capture UI images automatically, an Nginx web application server is adopted with its Docker image. For evaluations, we asked 10 graduate students at Okayama University, Japan, to install the answer platform on their PCs and solve five exercise problems. All the students successfully completed the problems, which confirms the validity and effectiveness of the proposed system.No potential conflict of interest relevant to this article was reported.WileyActa Medica Okayama2050-09041312025Undetermined Ruptured Low-Grade Appendiceal Mucinous Neoplasm Following High-Energy Blunt Abdominal Trauma Requiring Emergency Laparotomye70071ENIppeiMatsuoDepartment of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityTetsuyaYumotoDepartment of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityAkariTsujiDepartment of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityRyoTanabeDepartment of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityToshihisaMatsumuraDepartment of Digestive Surgery, Japanese Red Cross Okayama HospitalMikotoShimabaraDepartment of Digestive Surgery, Japanese Red Cross Okayama HospitalMasaakiAkaiDepartment of Digestive Surgery, Japanese Red Cross Okayama HospitalShojiTakagiDepartment of Digestive Surgery, Japanese Red Cross Okayama HospitalHiromichiNaitoDepartment of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityAtsunoriNakaoDepartment of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama UniversityBlunt abdominal trauma causing intraperitoneal injury and/or bleeding can be life-threatening, requiring immediate intervention. Diagnosing these cases can be challenging, especially when pre-existing conditions are involved. Low-grade appendiceal mucinous neoplasm (LAMN) is a rare tumor of the appendix that can lead to pseudomyxoma peritonei. Herein, we present a case of ruptured LAMN following blunt abdominal trauma after a high-energy head-on collision, complicating the differentiation from other intraperitoneal injuries. A 42-year-old Japanese female was brought to our hospital following high-energy head-on collision. She presented with stable vital signs, complaining of anterior chest pain and abdominal tenderness without peritoneal irritation. Computed tomography scans indicated multiple fractures in her chest and complex fluid around the Douglas fossa extending to the ileocecal area, with a slightly dilated appendix tip. Despite stable vitals, emergency laparotomy was needed for suspected peritonitis and/or intraperitoneal hemorrhage. Emergency laparotomy revealed yellowish, jelly-like ascites and a ruptured appendiceal tumor. LAMN was suspected, and the appendix was completely resected, with cytoreductive surgery carefully performed. Histopathological examination confirmed the diagnosis of LAMN. Postoperative course was uneventful, and the patient was discharged on Day 13 and referred for further LAMN management. This case report highlights the diagnostic difficulties of LAMN rupture following blunt abdominal trauma, stressing the need to consider rare conditions like LAMN in differential diagnoses of acute abdomen posttrauma.No potential conflict of interest relevant to this article was reported.BMCActa Medica Okayama1880-65467412024Evaluation of the effects of fenestration in Fontan circulation using a lumped parameter model58ENNaohiroHorioDepartment of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShujiShimizuDepartment of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasuhiroKotaniDepartment of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYoshinoriMiyaharaPediatric Heart Disease and Adult Congenital Heart Disease Center, Showa University HospitalShingoKasaharaDepartment of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesFenestration has been reported to enhance Fontan hemodynamics in several cases of Fontan circulation. However, the indication criteria for fenestration remain under discussion. To assess the effectiveness of fenestration in Fontan circulation, we conducted a theoretical analysis using a computational model of the fenestrated Fontan circulation. The cardiac chambers and vascular systems were modeled using the time-varying elastance model and the modified Windkessel model, respectively. When the pulmonary vascular resistance index was 4.01 Wood units m2, fenestration significantly reduced central venous pressure from 18.0 to 16.1 mmHg and decreased stressed blood volume from 610 to 555 ml. However, in the models with reduced ventricular end-systolic elastance, increased ventricular stiffness constant, or heightened systemic vascular resistance, the advantages of fenestration were diminished. Thus, fenestration may effectively improve the hemodynamics of Fontan circulation in patients with elevated pulmonary vascular resistance.No potential conflict of interest relevant to this article was reported.AIP PublishingActa Medica Okayama0021-9606161212024The nature of the hydrophobic interaction varies as the solute size increases from methane’s to C60’s214501ENHidefumiNaitoDepartment of Chemistry, Faculty of Science, Okayama UniversityTomonariSumiDepartment of Chemistry, Faculty of Science, Okayama UniversityKenichiroKogaDepartment of Chemistry, Faculty of Science, Okayama UniversityThe hydrophobic interaction, often combined with the hydrophilic or ionic interactions, makes the behavior of aqueous solutions very rich and plays an important role in biological systems. Theoretical and computer simulation studies have shown that the water-mediated force depends strongly on the size and other chemical properties of the solute, but how it changes with these factors remains unclear. We report here a computer simulation study that illustrates how the hydrophobic pair interaction and the entropic and enthalpic terms change with the solute size when the solute–solvent weak attractive interaction is unchanged with the solute size. The nature of the hydrophobic interaction changes qualitatively as the solute size increases from that of methane to that of fullerene. The potential of mean force between small solutes has several well-defined extrema, including the third minimum, whereas the potential of mean force between large solutes has the deep contact minimum and the large free-energy barrier between the contact and the water-bilayer separated configurations. The difference in the potential of mean force is related to the differences in the water density, energy, and hydrogen bond number distributions in the vicinity of the pairs of hydrophobic solutes.No potential conflict of interest relevant to this article was reported.ElsevierActa Medica Okayama2210-26121262025Laparoscopic resection for oesophageal duplication cyst: A case report110572ENTomohiroHamazakiDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKazuhiroNomaDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKentoKawasakiDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMasashiHashimotoDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShunsukeTanabeDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToshiyoshiFujiwaraDepartment of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesIntroduction: Oesophageal duplication cyst is a congenital malformation and rare tumour, clinically manifesting as dysphagia, epigastric pain, or respiratory distress. Duplicate cysts associated with abscess formation or mediastinal penetration and malignancies have been reported, necessitating surgical resection. <br>
Presentation of case: A 55-year-old woman had chest discomfort for 1 year. Preoperative imaging, including computed tomography (CT), upper gastrointestinal endoscopy, and endoscopic ultrasound, revealed a tumour extending from the anterior wall to the lesser curvature of the near the oesophagogastric junction (OGJ) and a suspected mural nodule within the tumour. Contrast-enhanced CT revealed a cystic nodule on the wall of the lesser curvature of the OGJ, with an unclear boundary between the cystic nodule and the oesophageal wall. Magnetic resonance imaging showed an isointense signal on T1-weighted imaging and hyperintensity on T2weighted imaging. Laparoscopic lower oesophagectomy and proximal gastrectomy with lymph node dissection were performed to the confirm mucinous cyst. Pathological findings revealed a cystic lesion in the muscularis propria of the OGJ filled with mucinous components and lined with multilayered columnar epithelial cells. The cyst was diagnosed as a duplicate without malignancy. <br>
Discussion: Since the border between the cyst and the oesophageal walls was unclear, and the cyst potentially contained a malignant component, instead of cystectomy, lower oesophagectomy and proximal gastrectomy with lymph node dissection were performed with oesophagogastric anastomosis using the double-flap technique, tailored specifically for OGJ cancer. <br>
Conclusions: Oesophageal duplication cysts are rare. Lower oesophagectomy and proximal gastrectomy are selective surgical approaches for cyst duplication at the OGJ.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7862024C-arm Free Unilateral Biportal Endoscopic Discectomy: A Technical Note475483ENHongfeiXiangDepartment of Orthopaedic Surgery, Okayama Rosai HospitalKajetanLatkaDepartment of Orthopaedic Surgery, Okayama Rosai HospitalPrafulMasteDepartment of Orthopaedic Surgery, Okayama Rosai HospitalMasatoTanakaDepartment of Orthopaedic Surgery, Okayama Rosai HospitalChetanKumawatDepartment of Orthopaedic Surgery, Okayama Rosai HospitalShinyaAratakiDepartment of Orthopaedic Surgery, Okayama Rosai HospitalYoshihiroFujiwaraDepartment of Orthopaedic Surgery, Okayama Rosai HospitalTakuyaTaokaDepartment of Orthopaedic Surgery, Okayama Rosai HospitalAkiyoshiMiyamotoDepartment of Orthopaedic Surgery, Okayama Rosai HospitalCase Report/10.18926/AMO/67878This report presents a new unilateral biportal endoscopic (UBE) technique for lumbar disc herniation without C-arm guidance. Lumbar disc herniation requires surgical intervention when conservative methods fail. Shifts towards minimally invasive percutaneous endoscopic lumbar discectomy, including uniportal and biportal approaches, have been hindered by challenges such as steep learning curves and reliance on radiation-intensive C-arm guidance. We here describe the use of standard intraoperative navigation in UBE to reduce radiation exposure and increase surgical accuracy. A 24-year-old man with low back and bilateral leg pain with gait disturbance was referred to our hospital. He had had conservative treatment for 12 months in another hospital before admission, but this proved unsuccessful. On admission he had low back pain (VAS 4/10) and bilateral leg pain (VAS 8/10), muscle weakness of the bilateral legs (manual muscle testing (MMT) grade of the extensor hallucis longus: 4/4), and numbness of the bilateral lower legs. Preoperative lumbar MRI showed L4/5 large central disc herniation. He underwent C-arm free UBE discectomy under the guidance of O-arm navigation. The surgery was successful, with postoperative lumbar MRI showing good decompression of the dural sac and bilateral L5 nerve roots. The MMT grade and sensory function of both legs had recovered fully on final follow-up at one year. The new UBE technique under navigation guidance was shown to be useful for lumbar disc herniation. This innovative technique was safe and accurate for the treatment of lumbar intervertebral disc herniation, and minimized radiation exposure to surgeons.No potential conflict of interest relevant to this article was reported.