Purpose: This study aimed to investigate changes in target coverage using magnetic resonance–guided online adaptive radiotherapy (MRgoART) for kidney tumors and to evaluate the suitable timing of treatment. Materials and Methods: Among patients treated with 3-fraction MRgoART for kidney cancer, 18 tumors located within 1 cm of the gastrointestinal tract were selected. Stereotactic radiosurgery planning with a prescription dose of 26 Gy was performed using pretreatment simulation and three MRgoART timings with an adapt-to-shape method. The best MRgoART plan was defined as the plan achieving the highest percentage of planning target volume (PTV) coverage of 26 Gy. In clinical scenario simulation, MRgoART plans were evaluated in the order of actual treatment. Waiting for the next timing was done when the PTV coverage of 26 Gy did not achieve 95%–99% or did not increase by 5% or more compared to the pretreatment plan. Results: The median percentages of PTV receiving 26 Gy in pretreatment and the first, second, and third MRgoART were 82% (range, 19%), 63% (range, 7% to 99%), 88% (range, 31% to 99%), and 95% (range, 3% to 99%), respectively. Comparing pretreatment simulation plans with the best MRgoART plans showed a significant difference (p = 0.025). In the clinical scenario simulation, 16 of the 18 planning series, including nine plans with 95%–99% PTV coverage of 26 Gy and seven plans with increased PTV coverage by 5% or more, would be irradiated at a good timing. Conclusion MRgoART revealed dose coverage differences at each MRgoART timing. Waiting for optimal irradiation timing could be an option in case of suboptimal timing.

This review aims to evaluate the safety of remimazolam for intravenous sedation during dental treatment and oral surgery. The protocol was registered in the Open Science Framework (registration DOI: 10.17605/OSF.IO/RFPSZ), and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Literature searches and screenings were conducted using PubMed and the Cochrane database, with additional records manually reviewed from various sources. The selected studies, published in English, investigated the safety of remimazolam for sedation in dental and oral surgery. An initial search identified 20 studies, of which five prospective studies met the inclusion criteria. All included studies used an initial bolus administration of remimazolam. Primary outcomes assessed were the sedation success rate, incidence of adverse effects, onset time, awakening time, recovery time, and postoperative side effects. This scoping review indicates that all studies validated the superiority of remimazolam over other sedatives for dental treatment and oral surgery. The development and research of innovative technologies to reduce dental pain and anxiety presents opportunities for interdisciplinary collaboration and improved patient care in dental practice.Future clinical studies should focus on determining the optimal timing for additional dosing and discontinuation when remimazolam is administered continuously.

This review aims to evaluate the safety of remimazolam for intravenous sedation during dental treatment and oral surgery. The protocol was registered in the Open Science Framework (registration DOI: 10.17605/OSF.IO/RFPSZ), and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Literature searches and screenings were conducted using PubMed and the Cochrane database, with additional records manually reviewed from various sources. The selected studies, published in English, investigated the safety of remimazolam for sedation in dental and oral surgery. An initial search identified 20 studies, of which five prospective studies met the inclusion criteria. All included studies used an initial bolus administration of remimazolam. Primary outcomes assessed were the sedation success rate, incidence of adverse effects, onset time, awakening time, recovery time, and postoperative side effects. This scoping review indicates that all studies validated the superiority of remimazolam over other sedatives for dental treatment and oral surgery. The development and research of innovative technologies to reduce dental pain and anxiety presents opportunities for interdisciplinary collaboration and improved patient care in dental practice.Future clinical studies should focus on determining the optimal timing for additional dosing and discontinuation when remimazolam is administered continuously.

Purpose: This study aimed to investigate changes in target coverage using magnetic resonance–guided online adaptive radiotherapy (MRgoART) for kidney tumors and to evaluate the suitable timing of treatment. Materials and Methods: Among patients treated with 3-fraction MRgoART for kidney cancer, 18 tumors located within 1 cm of the gastrointestinal tract were selected. Stereotactic radiosurgery planning with a prescription dose of 26 Gy was performed using pretreatment simulation and three MRgoART timings with an adapt-to-shape method. The best MRgoART plan was defined as the plan achieving the highest percentage of planning target volume (PTV) coverage of 26 Gy. In clinical scenario simulation, MRgoART plans were evaluated in the order of actual treatment. Waiting for the next timing was done when the PTV coverage of 26 Gy did not achieve 95%–99% or did not increase by 5% or more compared to the pretreatment plan. Results: The median percentages of PTV receiving 26 Gy in pretreatment and the first, second, and third MRgoART were 82% (range, 19%), 63% (range, 7% to 99%), 88% (range, 31% to 99%), and 95% (range, 3% to 99%), respectively. Comparing pretreatment simulation plans with the best MRgoART plans showed a significant difference (p = 0.025). In the clinical scenario simulation, 16 of the 18 planning series, including nine plans with 95%–99% PTV coverage of 26 Gy and seven plans with increased PTV coverage by 5% or more, would be irradiated at a good timing. Conclusion MRgoART revealed dose coverage differences at each MRgoART timing. Waiting for optimal irradiation timing could be an option in case of suboptimal timing.

Objectives: This study investigated the associations between gait velocity and kinematic variables in the first half of the gait cycle according to stroke severity. We performed gait analysis in individuals with stroke, focusing on changes in the center-of-gravity (COG) position on the paretic side in the first half of stance phase.Methods: Gait data of 80 individuals (20 each in Brunnstrom recovery stage: III, IV, V and VI) with stroke acquired using a 3D motion analysis system was retrospectively analyzed. Associations of gait velocity with the COG positions in the anteroposterior directions and vertical increases in the first half of stance phase on the paretic side were compared according to stroke severity, using correlation analysis.Results: Gait velocity showed strong positive correlations with step length on the paretic side at initial contact, the rate of vertical increase in the COG during single-leg stance, and the proportion of single-leg stance time in the gait cycle. The associations between velocity and each kinematic variable differed according to stroke severity. Gait velocity was strongly correlated with the rate of vertical increase in the COG during single-leg stance and the proportion of single-leg stance in severe hemiplegia, while a strong correlation was observed with step length on the paretic side in mild hemiplegia.Conclusion: An upward shift of the COG during single-leg stance was an important factor in gait velocity, and the correlation between gait velocity and the rate of vertical increase in the COG during single-leg stance was stronger when hemiplegia was more severe.

We have experienced a surgeon who had a previous left putaminal hemorrhage and presented with higher brain dysfunctions due to a new right frontal lobe infarction. The patient was a right-handed man in his 50s with inattention, constructive disorder, left hemispatial neglect, and executive dysfunction. The lesions were localized not only in the right inferior and middle frontal gyri but also in deep white matter including the right frontal aslant tract and superior longitudinal fasciculus. The patient gradually resumed work early on with multidisciplinary support and returned to work within 3 months after the onset of the disease. In this case, direct attention training, metacognitive strategy training including time pressure management, and visual search training from the acute stage were successful. Even after the completion of cognitive rehabilitation, an improvement in attention and processing speed was confirmed, suggesting that highly personalized cognitive rehabilitation tailored to higher brain dysfunctions have a lasting effect. However, the improvement of higher brain functions and the resumption of work increased self-awareness and anxiety, leading to a decrease in self-efficacy. Cognitive rehabilitation including metacognitive strategy training, together with psychological support, is important for step-by-step return to work.

Rehabilitation for ocular motility disorder and diplopia after acute cerebral infarction has not been established. In the present case, we describe the course of oculomotor rehabilitation in a patient with left-sided gaze palsy and diplopia due to a stroke in the paramedian part of the left pontine tegmentum. The patient was a right-handed man in his 40s. Cerebral infarction occurred after coil embolization with stenting for an unruptured dissecting aneurysm. He presented with eye movement difficulty resulting from conjugate deviation of the eyes to the right at onset. No other motor-sensory abnormalities were present. Processing speed of Wechsler Adult Intelligence Scale-Fourth Edition was decreased. We performed oculomotor rehabilitation from the acute phase, including fixation, smooth pursuit, saccadic and convergent movements. Visual attention tasks such as visual search and cancellation tasks were applied from 10 days after onset. The oculomotor disorders gradually improved and disappeared by 65 days after onset. The responsible lesion was localized in left paramedian pontine reticular formation and abducens nucleus. Medial longitudinal fasciculus was not involved, which was consistent with the clinical oculomotor findings. The neuropsychological assessments showed that processing speed was improved. Based on the neuropsychological assessments and actual vehicle evaluation, our multidisciplinary team determined that the patient should not refrain from automobile driving. The patient returned to work and resumed driving 86 days after onset. The results suggest that visual attention tasks together with basic oculomotor trainings for ocular motility disorder and diplopia are useful for early return to automobile driving and society.