A 47-year-old man had severe mitral regurgitation after severe skin eruption, so mitral valve replacement was electively performed 8 months later. A median sternal wound opened spontaneously and had purulent exudate on the 5th postoperative day (5 POD). We had suspicion of bacterial mediastinitis, so we drained the anterior mediastinum and tried antibiotic treatment. However, the microbiological stains and culture were negative, and adipose tissue was extremely melted with pustules around the wound. Considering other diseases without infection, we consulted to a dermatologist and tried highdose steroid therapy as pyoderma gangrenosum (PG) appeared on the 8 POD. Meanwhile, the sternum was left open and apllied a negative pressure dressing applied with Negative Pressure Wound Therapy (NPWT). The wound responded remarkably to steroid therapy, so we closed the sternum on the 10 POD, and sutured the sternal wound on the 19 POD. We tapered off steroids after the suture. PG can be caused by the trauma of surgery, so we have to make a decision on whether to use high dose steroid therapy in the postoperative period. We report this case as one of the differential diseases that the surgeons must know.

Objective: A few cases of an aseptic abscess after thoracic aortic surgery have been reported. However, it sometimes requires surgical treatment because the rapid growth of perigraft fluid collection results in exposure towards the body surface. We discuss the results of our treatment of these cases. Methods: This study was a retrospective analysis. Four of 341 cases who underwent thoracic aortic surgery between April 2013 and March 2020 were included. These cases presented with a bulge of the body surface 10.3 (range, 3-27) months after surgery. Results: Although the fluids looked purulent in all cases, no bacteria were detected. We diagnosed them as aseptic abscess, for which omental implantation was performed. No signs of recurrence have been found in any cases even after 5.4 (range, 1-8.5) years. Conclusions: Omental implantation was effective for controlling aseptic abscess for long-term periods.

Objective: The purposes of this trial were to demonstrate the feasibility and effectiveness of the hybrid of intracavitary and interstitial brachytherapy (HBT) for locally advanced cervical cancer patients in the phase I/II prospective clinical trial. Methods: Patients with FIGO stage IB2-IVA uterine cervical cancer pretreatment width of which was ≥5 cm measured by magnetic resonance imaging were eligible for this clinical trial. The protocol therapy included 30–30.6 Gy in 15–17 fractions of whole pelvic radiotherapy concurrent with weekly CDDP, followed by 24 Gy in 4 fractions of HBT and pelvic radiotherapy with a central shield up to 50–50.4 Gy in 25–28 fractions. The primary endpoint of phase II part was 2-year pelvic progression-free survival (PPFS) rate higher than historical control of 64%. Results: Between October 2015 and October 2019, 73 patients were enrolled in the initial registration and 52 patients proceeded to the secondary registration. With the median follow-up period of 37.3 months (range, 13.9–52.9 months), the 2- PPFS was 80.7% (90% confidence interval [CI]=69.7%–88%). Because the lower range of 90% CI of 2-year PPFS was 69.7%, which was higher than the historical control ICBT data of 64%, therefore, the primary endpoint of this study was met. Conclusion The effectiveness of HBT were demonstrated by a prospective clinical study. Because the dose goal determined in the protocol was lower than 85 Gy, there is room in improvement for local control. A higher dose might have been needed for tumors with poor responses.

A 44-year-old man was injured by concreate boards falling on the left side of his body, and he was transferred to our hospital on suspicion of a blunt traumatic aortic injury. The contrast-enhanced CT axial scan showed the abnormal alignment of the brachiocephalic artery and a mediastinal hematoma. However, a 3D-CT image showed a pseudoaneurysm in the aortic arch between the brachiocephalic and left common carotid arteries. Immediately, partial arch replacement was performed. A 20 mm disruption was detected on the intimal surface of the arch aorta between the brachiocephalic and left common carotid arteries. This case was a very rare condition of blunt traumatic aortic injury.

Objective: Human papillomavirus subtypes are predictive indicators of cervical intraepithelial neoplasia (CIN) progression. While colposcopy is also an essential part of cervical cancer prevention, its accuracy and reproducibility are limited because of subjective evaluation. This study aimed to develop an artificial intelligence (AI) algorithm that can accurately detect the optimal lesion associated with prognosis using colposcopic images of CIN2 patients by utilizing objective AI diagnosis. Methods: We identified colposcopic findings associated with the prognosis of patients with CIN2. We developed a convolutional neural network that can automatically detect the rate of high-grade lesions in the uterovaginal area in 12 segments. We finally evaluated the detection accuracy of our AI algorithm compared with the scores by multiple gynecologic oncologists. Results: High-grade lesion occupancy in the uterovaginal area detected by senior colposcopists was significantly correlated with the prognosis of patients with CIN2. The detection rate for high-grade lesions in 12 segments of the uterovaginal area by the AI system was 62.1% for recall, and the overall correct response rate was 89.7%. Moreover, the percentage of high-grade lesions detected by the AI system was significantly correlated with the rate detected by multiple gynecologic senior oncologists (r=0.61). Conclusion Our novel AI algorithm can accurately determine high-grade lesions associated with prognosis on colposcopic images, and these results provide an insight into the additional utility of colposcopy for the management of patients with CIN2.

In accordance with the new model-core-curriculum for medical education, the current status of education about the science of radiation health was surveyed in all medical schools in Japan. Among the four learning points related to the “Biological effects of radiation and radiation hazards” , about half of the schools covered issues on “radiation and human body” and the “effect of medical radiation exposure” in one, or less than one, 60-minutes class, but did not touch on “radiation risk communication” and “radiological disaster medicine” . A significant deviation of human resources was also observed between schools. Learning tools such as presentation files and video content were preferred as education support materials. Therefore, development and distribution of the learning tools, especially in “radiation risk communication” and “radiological disaster medicine” , may be a first step to promoting high-quality education on the science of radiation health risk in each school’s curriculum.

Patients with an aortic root pseudoaneurysm communicating to the right atrium are rare. A 67-year-old woman underwent ascending aorta and total aortic arch replacement for acute type A aortic dissection at our institute 9 years prior to the current presentation. She was transported to our emergency department with complaints of chest pain, palpitations, and cold sensation. A continuous murmur was heard at the right sternal margin. Contrast-enhanced computed tomography (CT) and ultrasonic cardiography showed a huge pseudoaneurysm at the proximal anastomotic site and an aorto-right atrial fistula. Ascending aortic replacement with concomitant direct closure of the fistula was successfully performed. The patient was discharged in good condition on the 14th postoperative day. Careful follow-up with CT is important after acute type A aortic dissection repair.

To develop an osseointegration analyzing system for dental implants, a new analyzing system which can assess the level of osseointegration between an implant and trabecular bone was constructed using digital radiography with morphological filter and node-strut analysis. For assessment of this system, a grayscale test chart that simulates six levels of an osseointegration was created. In addition, digital implant images were made in which the trabecular pattern around the implant was varied over a total of five levels. Implant osseointegration was evaluated on the basis of seven parameters related to the number of nodes (Nd) and terminuses (Tm) of the skeleton bound to the implant (Im) and the skeletal length. The seven parameters were as follows: the number of struts connecting the Im with the Nd and Tm (N.ImNd, N.ImTm), the total number of N.ImNd and N.ImTm (N.Im), the strut length connecting the Im with the Nd and Tm (ImNd, ImTm), and the ratios of the struts connecting the Im with the Nd and Tm (ImNd/TSL, ImTm/TSL), where TSL is the total strut length.Strong correlations (R² = 0.971-1.0) between the theoretical values from the test charts and the measured values were demonstrated. N.ImNd showed the strongest correlation, R² = 0.948, from the digital implant images, followed by N.Im and ImNd, with correlations of R² = 0.86 and R² = 0.84, respectively. This new system for evaluating implant osseointegration by applying morphological processing and node-strut analysis could be useful for computer-assisted diagnosis of digital dental implant images.

To investigate the effects of experimental osteoporosis on the trabecular structure of the mandibular condyle in cynomolgus monkeys by radiological bone morphometry, ovariectomy (OVX) was performed on 10-year-old female cynomolgus monkeys, which were fed a controlled diet for 2 years. Ten sham control groups were fed under the same conditions. Using a microfocus tube and computed radiography, the removed mandibular condyle samples were imaged by standardized magnification radiography. The structural parameters were measured using radiological bone morphometric analysis. The bone mineral density (BMD) was measured by dual energy X-ray absorptiometry. The thickness of the cortical bone was measured using magnified radiographic images. The thickness of the cortical bone and the BMD in the OVX group were significantly lower than in the sham group. In the results of skeletal structure of the mandibular condyle, the trabecular structure of the mandibular condyle was markedly deteriorated in the OVX group. The trabecular structure of the mandibular condyle for the OVX group was significantly decreased, thus it was suggested that osteoporosis is a potential risk factor of osteoarthritis of the temporomandibular joint.