A 69-year-old woman had dysphagia, hoarseness, and asthma-like symptoms such as cough and wheeze. Inhaled corticosteroids and long-acting β₂ stimulants was not effective. Gastrointestinal endoscopy showed compression of the esophagus wall from outside. Enhanced computed tomography (CT) showed thoracic descending aortic aneurysm compressing esophagus and left lower lobe bronchus. Immediately thoracic endovascular aortic repair (TEVAR) was performed. After surgery, significant improvement of hoarseness and asthma-like attack was obtained at the time of 1 month after surgery. This is the first reported case of TEVAR which improved compression symptoms of both esophagus and bronchus due to thoracic aortic aneurysm in Japan.

A 64-year-old man who had chronic aortic dissecting aneurysm with true lumen obstruction of the abdominal aorta was referred to our hospital for surgery. He underwent total aortic arch replacement with the elephant trunk technique using an aortofemoral artery bypass as a first-stage operation. Reconstruction of the thoracic aortic descending aneurysm using the previous elephant trunk graft in a second-stage operation was feasible. His perioperative course was uneventful and he had no neurologic complications.

STUDY DESIGN: Prospective study. PURPOSE: The main purpose of this study was to clarify the range of magnification errors on digital plain radiographs and to determine if there is a correlation between the body mass index (BMI) of a patient and the magnification error. OVERVIEW OF LITERATURE: Most clinicians currently use digital plain radiography. This new method allows one to access images and measure lengths and angles more easily than with the past technologies. In addition, conventional plain radiography has magnification errors. Although few articles mention magnification errors in regards to digital radiographs, they are known to have the same errors. METHODS: We used plain digital radiography and magnetic resonance imaging (MRI) to acquire images of the cervical spine with the goal of evaluating magnification errors by measuring the anteroposterior vertebral body lengths of C2 and C5. The magnification error (ME) was then calculated: ME=(length on radiograph-length on MRI)/length on MRI x100 (%). The correlation coefficient between the magnification error and BMI was obtained using Pearson's correlation analysis. RESULTS: Average magnification errors in C2 and C5 were approximately 18.5%+/-5.4% (range, 0%-30%) and 20.7%+/-6.3% (range, 1%-32%). There was no positive correlation between BMI and the magnification error. CONCLUSIONS: There were magnification errors on the digital plain radiographs, and they were different in each case. Maximum magnification error differences were 30% (C2) and 31% (C5). Based on these finding, clinicians must pay attention to magnification errors when measuring lengths using digital plain radiography.
Body Mass Index ; Humans ; Magnetic Resonance Imaging* ; Prospective Studies ; Radiographic Image Enhancement ; Radiography ; Spine*

STUDY DESIGN: Prospective cohort study. PURPOSE: To identify differences in time-dependent perioperative changes between the Japanese Orthopaedic Association (JOA) score and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) score in patients with cervical spondylotic myelopathy (CSM) and posterior longitudinal ligament (OPLL) who underwent cervical laminoplasty. OVERVIEW OF LITERATURE: The JOA score does not take into consideration patient satisfaction or quality of life. Accordingly, the JOACMEQ was designed in 2007 as a patient-centered assessment tool. METHODS: We studied 21 patients who underwent cervical laminoplasty. We objectively evaluated the time-dependent changes in JOACMEQ scores and JOA scores for all patients before surgery and at 2 weeks, 3 months, 6 months, and 1 year after surgery. RESULTS: The average total JOA score and the recovery rate improved significantly after surgery in both groups, with a slightly better recovery rate in the OPLL group. Cervical spine function improved significantly in the CSM group but not in the OPLL group. Upper- and lower-extremity functions were more stable in the CSM group than in the OPLL group. The effectiveness rate of the JOACMEQ for measuring quality of life was quite low in both groups. In both groups, the Spearman contingency coefficients were dispersed widely except for upper- and lower-extremity function. CONCLUSIONS: Scores for upper- and lower-extremity function on the JOACMEQ correlated well with JOA scores. Because the JOACMEQ can also assess cervical spine function and quality of life, factors that cannot be assessed by the JOA score alone, the JOACMEQ is a more comprehensive evaluation tool.
Asian Continental Ancestry Group* ; Cohort Studies ; Humans ; Longitudinal Ligaments* ; Ossification of Posterior Longitudinal Ligament ; Patient Satisfaction ; Prospective Studies ; Quality of Life ; Spinal Cord Diseases* ; Spine ; Spondylosis ; Surveys and Questionnaires

[Objective] In Japan, pediatric acupuncture and moxibustion are practiced mainly in the Kansai region, and the influence of treatment experience by close relatives has been suggested to influence the treatment behavior. On the other hand, the rate of acupuncture and moxibustion treatment in Japan has been declining, and the nuclear family is also increasing.　Based on the above, we decided to conduct an awareness survey of parents regarding their expectations and concerns about pediatric acupuncture in order to understand the issues involved in receiving pediatric acupuncture treatment.[Subjects and Methods] The survey was conducted from May to December 2016 among 50 parents who participated in a self-care workshop for children and their parents held in Tokyo. The survey was a questionnaire, in which the parents' age, gender, relationship with their children, employment status and childcare support status, and age and gender of their children were ascertained.　Massage was also used as a control, and a five-item method was used with acupuncture and massage as independent variables and expectations and anxiety as dependent variables. Expectations consisted of eight items related to symptoms, such as 『childhood neurosis and asthma』, and five items related to general questions, such as 『disease prevention and relaxation』. Wilcoxon signed-rank test was used to compare acupuncture and massage.[Results] Respondents were 35.0 years old (median), 92% were women, 94% were mothers, 98% were nuclear families, 46% were working parents, 44% were housewives/househusbands, 68% had concerns about childcare, and 92% had someone to talk to about childcare.　The children were 1 year (median) and 50% were girls, 48% were boys, and 94% were singletons.　In expectation, the scores for each item were high for both acupuncture and massage (3.0-4.6 points: mean), and there was no significant difference between the two.　For anxiety, acupuncture and moxibustion scored significantly higher than massage in terms of worsening symptoms, hygiene, and effectiveness.[Discussion and Conclusion] The parents of health-conscious children attending the workshop had high expectations for pediatric acupuncture and massage, but were more concerned about worsening symptoms, hygiene, and effectiveness of acupuncture and moxibustion compared to massage.　Based on the above, we believe that acupuncture and moxibustion practitioners updating and complying with information on findings and safety measures and disseminating this information to the public at large will lead to further promotion of the behavior of receiving acupuncture and moxibustion treatment.

Objective: The extended outcomes of the KEYNOTE-024 study demonstrated a favorable 5-year overall survival (OS) rate of 31.9%. The present study investigated the outcomes of pembrolizumab monotherapy for advanced or recurrent non-small cell lung cancer (NSCLC) at our institution.Patient: The long-term outcomes of 102 patients with advanced or recurrent NSCLC treated with pembrolizumab monotherapy between March 2017 and December 2022 were retrospectively assessed.Results: This study included a total of 102 patients [mean age: 72 ± 9.6 years (range: 41–91 years), male/female=77/25; performance status (PS; 0, 1, 2, 3, 4)=49/38/15/0/0; smokers=91 (89%), non-squamous cell carcinoma/squamous cell carcinoma=66/36, PD-L1 tumor proportion score (TPS) ≥50%/1–49%=80/22, positive for EGFR mutation=5, advanced/postoperative recurrence=51/51, treatment line: first/second or later=81/21, treatment courses: median 8 (range: 1–39), objective response rate/disease control rate=44%/55%, immune-related adverse events (irAEs): 47, 5-year OS=34%]. On univariate analysis, PS, PD-L1 TPS, and irAEs were significant prognostic factors. On multivariate analysis, histology, PD-L1 TPS, and irAEs were significant prognostic factors.Conclusion: Pembrolizumab monotherapy demonstrated promising treatment outcomes for advanced or recurrent NSCLC, as evidenced by the significant association of PD-L1 TPS with irAEs and prognosis, suggesting its potential as a beneficial therapeutic option.