A 64-year-old man with a history of abdominal aortic occlusion was admitted because of anterior chest pain. Angina pectoris with ischemic mitral regurgitation were diagnosed by transthoracic echocardiography and coronary artery angiography. He underwent coronary artery bypass grafting and mitral valve annuloplasty with a 26-mm Physio-ring. Because of difficulty in weaning from cardiopulmonary bypass, he required IABP support which was introduced via the ascending aorta. On the 2nd postoperative day, IABP was discontinued and the sternum was closed. His postoperative course thereafter was uneventful without any neurological complications. Postoperative echocardiogram showed good mitral valve function. He was discharged 16 days after surgery.

Rheumatoid arthritis and interstitial pneumonitis were diagnosed in a 72-year-old man and thoracic computed tomography revealed an aortic arch aneurysm 50mm in diameter. Steroid therapy gave symptomatic relief and improved laboratory findings, but hyperglycemia and hypertension developed. Two months later the thoracic aneurysm ruptured, and computed tomography revealed expansion of the aneurysm to 60mm in diameter and surrounding hematoma. Emergency total arch replacement was performed successfully with deep hypothermic cardiopulmonary bypass and selective cerebral perfusion. The steroid therapy was considered to be responsible for the rapid expansion and rupture of the thoracic aneurysm. When prescribing steroids for a patient who has a concomitant atherosclerotic cardiovascular disease, we should not only control the steroidal side effects strictly, but also carefully watch the course of the atherosclerotic lesion.

Objective: Most women with early stage endometrial cancer have a favorable prognosis. However, there is a subset of patients who develop recurrence. In addition to the pathological stage, clinical and therapeutic factors affect the probability of recurrence. Machine learning is a subtype of artificial intelligence that is considered effective for predictive tasks. We tried to predict recurrence in early stage endometrial cancer using machine learning methods based on clinical data. Methods: We enrolled 75 patients with early stage endometrial cancer (International Federation of Gynecology and Obstetrics stage I or II) who had received surgical treatment at our institute. A total of 5 machine learning classifiers were used, including support vector machine (SVM), random forest (RF), decision tree (DT), logistic regression (LR), and boosted tree, to predict the recurrence based on 16 parameters (age, body mass index, gravity/parity, hypertension/diabetic, stage, histological type, grade, surgical content and adjuvant chemotherapy). We analyzed the classification accuracy and the area under the curve (AUC). Results: The highest accuracy was 0.82 for SVM, followed by 0.77 for RF, 0.74 for LR, 0.66 for DT, and 0.66 for boosted trees. The highest AUC was 0.53 for LR, followed by 0.52 for boosted trees, 0.48 for DT, and 0.47 for RF. Therefore, the best predictive model for this analysis was LR. Conclusion The performance of the machine learning classifiers was not optimal owing to the small size of the dataset. The use of a machine learning model made it possible to predict recurrence in early stage endometrial cancer.

Objective: Most women with early stage endometrial cancer have a favorable prognosis. However, there is a subset of patients who develop recurrence. In addition to the pathological stage, clinical and therapeutic factors affect the probability of recurrence. Machine learning is a subtype of artificial intelligence that is considered effective for predictive tasks. We tried to predict recurrence in early stage endometrial cancer using machine learning methods based on clinical data. Methods: We enrolled 75 patients with early stage endometrial cancer (International Federation of Gynecology and Obstetrics stage I or II) who had received surgical treatment at our institute. A total of 5 machine learning classifiers were used, including support vector machine (SVM), random forest (RF), decision tree (DT), logistic regression (LR), and boosted tree, to predict the recurrence based on 16 parameters (age, body mass index, gravity/parity, hypertension/diabetic, stage, histological type, grade, surgical content and adjuvant chemotherapy). We analyzed the classification accuracy and the area under the curve (AUC). Results: The highest accuracy was 0.82 for SVM, followed by 0.77 for RF, 0.74 for LR, 0.66 for DT, and 0.66 for boosted trees. The highest AUC was 0.53 for LR, followed by 0.52 for boosted trees, 0.48 for DT, and 0.47 for RF. Therefore, the best predictive model for this analysis was LR. Conclusion The performance of the machine learning classifiers was not optimal owing to the small size of the dataset. The use of a machine learning model made it possible to predict recurrence in early stage endometrial cancer.

Two patients with post-traumatic diabetes insipidus (DI) are reported. One had suffered a fatal injury and the other a mild contusion without amnesia before DI developed. These two instances exemplify the wide spectrum of post-traumatic DI and, hence, the importance of ruling out DI even afer a mild closed-head injury.
Adult ; Case Report ; Central Nervous System/*injuries ; Desmopressin/therapeutic use ; Diabetes Insipidus/drug therapy/*etiology/physiopathology ; Diuresis/drug effects ; Female ; Human ; Male ; Middle Age ; Vasopressins/therapeutic use ; Wounds and Injuries/*complications/mortality

OBJECTIVEThe aim of this study is to clarify the long-term dynamics of the red tide occurring in Lake Kawaguchi.

METHODSThe measurement of environmental factors and water sampling were carried out monthly at a fixed station in Lake Kawaguchi's center basin from April 1993 to March 2004. On June 26, 1995, the horizontal distribution ofPeridinium bipes was investigated using a plastic pipe, obtaining 0∼1-m layers of water column samples at 68 locations across the entire lake.

RESULTSP. bipes showed an explosive growth and formed a freshwater red tide in the early summer of 1995, when the nutrient level was higher than those in the other years, particularly the phosphate concentration in the surface layer. The dissolved total phosphorus (DTP) concentration was sufficient forP. bipes growth in that year. In the study of its horizontal distribution,P. bipes was found at all the locations. The numbers of cells per milliliter ranged from 67 to 5360, averaging 1094±987 cells/ml, with particularly high densities along the northern shore. Since then,P. bipes has annually averaged about 25 cells/ml in Lake Kawaguchi.

CONCLUSIONWe observed that the red tide caused byP. bipes correlates with a high DTP concentration in Lake Kawaguchi.

AIMIn 11 congenital hypogonadal men, the bone mineral density (BMD) values were determined to assess the effect of long-term androgen replacement therapy (ART) on skeletal integrity.

METHODSEleven congenital hypogonadal men, including 8 isolated gonadotropin deficiency patients, 2 Kallmann's syndrome and 1 vanishing testes syndrome were recruited and treated with 250 mg of testosterone enanthate intramuscularly every 4 weeks for 7-43 years (mean+/-SD: 21.5 +/-13 years). In these patients and a group of 10 healthy young men (controls), the whole and trabecular BMDs were examined at the distal end of radius by means of a peripheral quantitative computerized tomography device.

RESULTSThe whole radial BMD in hypogonadal men was significantly less in the patients than in the healthy men (498+/-115 and 725+/-134 mg/cm(3), respectively; P<0.01); the trabecular BMD was also lower in the hypogonadal men (199+/-80 and 375+/-89 mg/cm(3); P< 0.01). The whole radial BMD values in 10 of 11 hypogonadal men were at least 1 SD below the mean value for healthy young men; 2 hypogonadal men had BMD values more than 2.5 SD lower than the healthy mean. Additionally, the whole radial BMD showed a significant negative correlation with the patient's age at the initiation of ART (r = 0.748, P<0.01). The serum level of bone-specific alkaline phosphatase and the urinary level of deoxypyridinoline were not significantly different between the two groups.

CONCLUSIONOsteopenia persists in the hypogonadal men after long-term ART, suggesting that such patients have a persistent defect in bone development not alleviated by androgen replacement.

Adult ; Age Factors ; Bone Density ; drug effects ; Cryptorchidism ; drug therapy ; Hormone Replacement Therapy ; Humans ; Hypogonadism ; congenital ; drug therapy ; physiopathology ; Injections, Intramuscular ; Kallmann Syndrome ; drug therapy ; Male ; Middle Aged ; Reference Values ; Testosterone ; administration & dosage ; analogs & derivatives ; therapeutic use

Background: and Purpose Differences in measurement of the extent of acute ischemic stroke using the Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) by non-contrast computed tomography (CT-ASPECTS stratum) and diffusion-weighted imaging (DWI-ASPECTS stratum) may impact the efficacy of endovascular therapy (EVT) in patients with a large ischemic core. Methods: The RESCUE-Japan LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan–Large IscheMIc core Trial) was a multicenter, open-label, randomized clinical trial that evaluated the efficacy and safety of EVT in patients with ASPECTS of 3–5. CT-ASPECTS was prioritized when both CT-ASPECTS and DWI-ASPECTS were measured. The effects of EVT on the modified Rankin Scale (mRS) score at 90 days were assessed separately for each stratum. Results: Among 183 patients, 112 (EVT group, 53; No-EVT group, 59) were in the CT-ASPECTS stratum and 71 (EVT group, 40; No-EVT group, 31) in the DWI-ASPECTS stratum. The common odds ratio (OR) (95% confidence interval) of the EVT group for one scale shift of the mRS score toward 0 was 1.29 (0.65–2.54) compared to the No-EVT group in CT-ASPECTS stratum, and 6.15 (2.46–16.3) in DWI-ASPECTS stratum with significant interaction between treatment assignment and mode of imaging study (P=0.002). There were significant interactions in the improvement of the National Institutes of Health Stroke Scale score at 48 hours (CT-ASPECTS stratum: OR, 1.95; DWIASPECTS stratum: OR, 14.5; interaction P=0.035) and mortality at 90 days (CT-ASPECTS stratum: OR, 2.07; DWI-ASPECTS stratum: OR, 0.23; interaction P=0.008). Conclusion Patients with ASPECTS of 3–5 on MRI benefitted more from EVT than those with ASPECTS of 3–5 on CT.