Objectives: In a mouse model, aldehyde dehydrogenase 2 (ALDH2) knockout resulted in lower bone mineral density; however, higher parathyroid hormone receptor expression than wild-type mice. This study aimed to investigate whether ALDH2 polymorphisms influence efficacy of intermittent parathyroid hormone therapy and bone mineral density changes in humans. Methods: Eighty-two patients with primary osteoporosis treated with parathyroid hormone for > 1 year were divided into wild-type ALDH2 (ALDH2*1) and variant (ALDH2*2) groups. Bone mineral densities were measured by dual-energy X-ray absorptiometry. Changes in bone mineral density, treatment response, bone turnover markers, and new fracture incidence were evaluated. Furthermore, bone mineral density was analyzed using a mixed-effects model. Results: Femoral neck bone mineral density increased by 1.0 ± 7.4% in the ALDH2*1 group and 4.3 ± 8.1% in the ALDH2*2 group (P < 0.05), whereas lumbar spine bone mineral density increased by 5.7 ± 8.2% and 9.4 ± 9.1% without significance. Treatment success rates were higher in ALDH2*2 group (femoral neck 38.7%, lumbar spine 68.8%) compared with ALDH2*1 (16.3%, 51.0%). Statistical significance was observed only at the femoral neck. Bone turnover markers and fracture incidence were comparable between groups. Mixed-effects analysis adjusting for confounders showed a significant ALDH2 genotype × duration interaction for femoral neck, indicating genotype-related differences in the rate of bone mineral density increase over time. For lumbar spine, the genotype main effect was significant, whereas the interaction was not. Conclusions These findings suggest that ALDH2 polymorphisms may influence the therapeutic response to PTH treatment and highlight the need for larger future studies.

Methods: Lateral radiographs were obtained from 100 healthy adults in standing and seated postures at 25°, 35°, and 45° recline angles. Spinal parameters (cervical lordosis, thoracic kyphosis, thoracolumbar kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and T1 spinopelvic inclination) and seat belt metrics (X-value, Z-value, and lap belt angle) were measured. Multivariate regression was used to assess associations with sex, age, height, and body mass index (BMI). Results: Reclining reduced cervical/lumbar lordosis and sacral slope, while thoracic kyphosis and pelvic tilt increased. Higher BMI was associated with a cranially shifted and more horizontal lap belt. Taller individuals showed greater T1 spinopelvic inclination and pelvic parameters. Females exhibited more pronounced thoracic kyphosis and pelvic retroversion across reclining angles. Conclusions Car seat recline significantly alters spinal alignment and seat belt positioning, with changes influenced by age, height, and BMI. These findings support ergonomic improvements in seat design and may inform surgical planning for ASD.

Background/Aims: In patients undergoing endoscopic extraction of common bile duct stones (CBDs) and subsequent cholecystectomy, CBDs sometimes recur during the preoperative and perioperative periods. In this study, the incidence and risk factors for CBDs recurrence were investigated. Methods: A total of 245 patients (mean age: 66 years; 138 men) who underwent cholecystectomy within 180 days of CBDs extraction between October 2017 and June 2023 were included. Recurrence was defined as the detection of the CBDs during the preoperative or perioperative period using imaging modalities such as computed tomography or re-endoscopic retrograde cholangiopancreatography, regardless of the presence of cholangitis. Results: CBDs recurrence occurred in 4.1% of the patients (10/245). The median time to recurrence was 40 days. Preoperative recurrence was observed in nine patients, and only one patient had postoperative recurrence. Multivariate analysis identified cystic duct stones as the only significant risk factor for CBDs recurrence (hazard ratio, 15.6; 95% confidence interval, 3.7–66; p<0.001). Conclusions The risk of CBDs recurrence after endoscopic extraction during the pre and perioperative periods is high in patients with cystic duct stones. Prophylactic biliary stenting may be considered in high-risk patients.

Background/Aims: The factors affecting the detection rate of lymphoplasmacytic sclerosing pancreatitis (LPSP) using endoscopic ultrasound-guided tissue acquisition (EUS-TA) in patients with type 1 autoimmune pancreatitis (AIP) have not been thoroughly studied. Therefore, we conducted a retrospective study to identify the predictive factors for histologically detecting level 1 or 2 LPSP using EUS-TA. Methods: Fifty patients with AIP were included in this study, and the primary outcome measures were the predictive factors for histologically detecting level 1 or 2 LPSP using EUS-TA. Results: Multivariate analysis identified the use of fine needle biopsy (FNB) needles as a significant predictive factor for LPSP detection (odds ratio, 15.1; 95% confidence interval, 1.62–141; ¬¬p=0.017). The rate of good-quality specimens (specimen adequacy score ≥4) was significantly higher for the FNB needle group than for the fine needle aspiration (FNA) needle group (97% vs. 56%; p<0.01), and the FNB needle group required significantly fewer needle passes than the FNA needle group (median, 2 vs. 3; p<0.01). Conclusions The use of FNB needles was the most important factor for the histological confirmation of LPSP using EUS-TA in patients with type 1 AIP.

Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of autoimmune diseases characterized by muscle involvement and various extramuscular manifestations. Interstitial lung disease (ILD) is one of the most common extramuscular manifestations of IIM and is associated with significant mortality and morbidity. The clinical phenotypes, treatment responses, and prognosis of IIM-ILD are significantly related to myositis-specific antibody (MSA) profiles, with some racial differences. The features associated with MSA in IIM-ILD could also be relevant to cases of ILD where MSA is present but does not meet the criteria for IIM. The anti-melanoma differentiation-associated gene 5 antibody is highly associated with rapidly progressive ILD (RP-ILD), especially in Asian populations, and with characteristic cutaneous manifestations, such as skin ulcers. Radiologically, ground-glass opacities, consolidations, and nonsegmental linear opacities were more predominant than reticular opacities and honeycombing. While the mortality rate is still around 30%, the prognosis can be improved with early intensive therapy with corticosteroids and multiple immunosuppressants. In contrast, anti-aminoacyl-tRNA synthetase (ARS) antibodies are associated with chronic ILD, although RP-ILD is also common. Patients with anti-ARS antibodies often show lung-predominant presentations, with subtle muscle and skin involvement. Radiologically, reticular opacities, with or without consolidation, are predominant and may progress to honeycombing over time. Combination therapy with corticosteroids and a single immunosuppressant is recommended to prevent relapses, which often lead to a decline in lung function and fatal long-term outcomes. Significant advances in immunology and genetics holds promise for fostering more personalized approaches to managing IIMILD.

We report a case of performing a 4-stage operations, including TEVAR through the descending aorta as an access route, for multiple aortic aneurysms complicated by severe COPD. The patient was a 71-year-old woman. A chest X-ray suggested a thoracic aortic aneurysm (TAA). CT scans revealed significant aortic tortuosity and six aortic aneurysms, including a TAA with a maximum diameter of 65 mm. However, due to severe mixed ventilatory impairment with an FEV1 of 39% and a %VC of 64%, a multi-stage surgery including TEVAR was chosen from the perspective of surgical tolerance. Additionally, due to severe calcification and stenosis extending from both iliac arteries to the femoral arteries and significant aortic tortuosity, careful planning for endovascular access was necessary. In the first stage, TEVAR was performed through the descending aorta as the access route for the TAA. In the second stage, a prosthetic graft replacement (abdominal four-branched reconstruction) was performed for the thoracoabdominal aortic aneurysm. In the third stage, TEVAR was performed using a prosthetic graft branch as the access route for the remaining TAA. In the fourth stage, additional TEVAR was performed for the endoleak, and EVAR was performed for the abdominal aortic aneurysm and common iliac artery aneurysm, completing the treatment in four stages. By carefully designing treatment strategies, such as access routes for endovascular stent-graft insertion with a focus on minimal invasiveness, severe postoperative complications, including respiratory issues, were successfully avoided.

Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of autoimmune diseases characterized by muscle involvement and various extramuscular manifestations. Interstitial lung disease (ILD) is one of the most common extramuscular manifestations of IIM and is associated with significant mortality and morbidity. The clinical phenotypes, treatment responses, and prognosis of IIM-ILD are significantly related to myositis-specific antibody (MSA) profiles, with some racial differences. The features associated with MSA in IIM-ILD could also be relevant to cases of ILD where MSA is present but does not meet the criteria for IIM. The anti-melanoma differentiation-associated gene 5 antibody is highly associated with rapidly progressive ILD (RP-ILD), especially in Asian populations, and with characteristic cutaneous manifestations, such as skin ulcers. Radiologically, ground-glass opacities, consolidations, and nonsegmental linear opacities were more predominant than reticular opacities and honeycombing. While the mortality rate is still around 30%, the prognosis can be improved with early intensive therapy with corticosteroids and multiple immunosuppressants. In contrast, anti-aminoacyl-tRNA synthetase (ARS) antibodies are associated with chronic ILD, although RP-ILD is also common. Patients with anti-ARS antibodies often show lung-predominant presentations, with subtle muscle and skin involvement. Radiologically, reticular opacities, with or without consolidation, are predominant and may progress to honeycombing over time. Combination therapy with corticosteroids and a single immunosuppressant is recommended to prevent relapses, which often lead to a decline in lung function and fatal long-term outcomes. Significant advances in immunology and genetics holds promise for fostering more personalized approaches to managing IIMILD.

In mass casualty incidents, effective triage, treatment, and transport are critical for efficient management but often deviate from practices and ethical standards. In terms of resource allocation, decentralized transport is the predominant transport method; however, it is not standardized. This report retrospectively analyzed the response to a mass casualty incident at a university emergency center. By centralizing patient transport from the scene, the time to patient transport could be shortened, the burden on the scene related to transport could be reduced, and undertriage at the scene could be avoided. No trauma-related deaths occurred. This case provides a valuable contribution to the understanding of situations in which critical patients may concentrate in emergency centers during future mass-casualty incidents.