Objective: In recent years, repetitive transcranial magnetic stimulation (rTMS) has shown promise in treating aphasia. While previous reports used the Standard Language Test of Aphasia (SLTA) for evaluation of language functions, the difficulty level of each task in SLTA varies. To show the effects of rTMS in more detail, it is necessary to use weighted values for the SLTA scores. This study aimed to assess the impact of high-frequency rTMS on aphasia using the deviation values of the SLTA.Methods: Thirty-one post-stroke aphasic patients participated in this study [mean (SD) age 58.0 (10.1) years, 15 infarction and 16 hemorrhage] from 2017 to 2021. The average (SD) duration from the onset of stroke to the intervention was 41.1 (31.1) months. Prior to admission, brain sites for rTMS were determined by detecting activation during the word-repeat task using functional MRI. A two-week inpatient treatment, including daily high-frequency rTMS and speech language hearing therapy (excluding Sundays), was conducted. In statistical analysis, SLTA scores were converted into deviation values, with participants grouped by rTMS sites (frontal lobe, temporal lobe, left/right hemisphere) for pre- and post-treatment comparisons.Results: rTMS sites included right frontal lobe (6 cases), left frontal lobe (10 cases), right temporal lobe (5 cases), and left temporal lobe (10 cases). Pre- and post-treatment comparisons showed significant improvements in overall mean scores and speech items in all groups. Additionally, significant enhancements in auditory comprehension items were observed in the right hemisphere and frontal lobe stimulation groups.Conclusion: High-frequency rTMS shows promise that it can improve language function regardless of the stimulation site, and auditory comprehension may be improved specifically by the right hemisphere and left frontal lobe stimulation. This suggests its potential as a valuable therapeutic intervention.

Objective: In recent years, repetitive transcranial magnetic stimulation (rTMS) has shown promise in treating aphasia. While previous reports used the Standard Language Test of Aphasia (SLTA) for evaluation of language functions, the difficulty level of each task in SLTA varies. To show the effects of rTMS in more detail, it is necessary to use weighted values for the SLTA scores. This study aimed to assess the impact of high-frequency rTMS on aphasia using the deviation values of the SLTA.Methods: Thirty-one post-stroke aphasic patients participated in this study [mean (SD) age 58.0 (10.1) years, 15 infarction and 16 hemorrhage] from 2017 to 2021. The average (SD) duration from the onset of stroke to the intervention was 41.1 (31.1) months. Prior to admission, brain sites for rTMS were determined by detecting activation during the word-repeat task using functional MRI. A two-week inpatient treatment, including daily high-frequency rTMS and speech language hearing therapy (excluding Sundays), was conducted. In statistical analysis, SLTA scores were converted into deviation values, with participants grouped by rTMS sites (frontal lobe, temporal lobe, left/right hemisphere) for pre- and post-treatment comparisons.Results: rTMS sites included right frontal lobe (6 cases), left frontal lobe (10 cases), right temporal lobe (5 cases), and left temporal lobe (10 cases). Pre- and post-treatment comparisons showed significant improvements in overall mean scores and speech items in all groups. Additionally, significant enhancements in auditory comprehension items were observed in the right hemisphere and frontal lobe stimulation groups.Conclusion: High-frequency rTMS shows promise that it can improve language function regardless of the stimulation site, and auditory comprehension may be improved specifically by the right hemisphere and left frontal lobe stimulation. This suggests its potential as a valuable therapeutic intervention.

Purpose: The study aimed to compare the diagnostic performance of washout-parametric imaging (WOPI) with that of conventional contrast-enhanced ultrasound (cCEUS) in differentiating focal liver lesions (FLLs). Methods: A total of 181 FLLs were imaged with contrast-enhanced ultrasound using Sonazoid, and the recordings were captured for 10 minutes in a prospective setting. WOPI was constructed from three images, depicting the arterial phase (peak enhancement), the early portal venous phase (1-minute post-injection), and the vasculo-Kupffer phase (5 or 10 minutes post-injection). The intensity variations in these images were color-coded and superimposed to produce a single image representing the washout timing across the lesions. From the 181 FLLs, 30 hepatocellular carcinomas (HCCs), 30 non-HCC malignancies, and 30 benign lesions were randomly selected for an observer study. Both techniques (cCEUS and WOPI) were evaluated by four off-site readers. They classified each lesion as benign or malignant using a continuous rating scale, with the endpoints representing "definitely benign" and "definitely malignant." The diagnostic performance of cCEUS and WOPI was compared using the area under the receiver operating characteristic curve (AUC) with the DeLong test. Interobserver agreement was assessed using the intraclass correlation coefficient (ICC). Results: The difference in average AUC values between WOPI and cCEUS was 0.0062 (95% confidence interval, -0.0161 to 0.0285), indicating no significant difference between techniques. The interobserver agreement was higher for WOPI (ICC, 0.77) than cCEUS (ICC, 0.67). Conclusion The diagnostic performance of WOPI is comparable to that of cCEUS in differentiating FLLs, with superior interobserver agreement.

Purpose: The study aimed to compare the diagnostic performance of washout-parametric imaging (WOPI) with that of conventional contrast-enhanced ultrasound (cCEUS) in differentiating focal liver lesions (FLLs). Methods: A total of 181 FLLs were imaged with contrast-enhanced ultrasound using Sonazoid, and the recordings were captured for 10 minutes in a prospective setting. WOPI was constructed from three images, depicting the arterial phase (peak enhancement), the early portal venous phase (1-minute post-injection), and the vasculo-Kupffer phase (5 or 10 minutes post-injection). The intensity variations in these images were color-coded and superimposed to produce a single image representing the washout timing across the lesions. From the 181 FLLs, 30 hepatocellular carcinomas (HCCs), 30 non-HCC malignancies, and 30 benign lesions were randomly selected for an observer study. Both techniques (cCEUS and WOPI) were evaluated by four off-site readers. They classified each lesion as benign or malignant using a continuous rating scale, with the endpoints representing "definitely benign" and "definitely malignant." The diagnostic performance of cCEUS and WOPI was compared using the area under the receiver operating characteristic curve (AUC) with the DeLong test. Interobserver agreement was assessed using the intraclass correlation coefficient (ICC). Results: The difference in average AUC values between WOPI and cCEUS was 0.0062 (95% confidence interval, -0.0161 to 0.0285), indicating no significant difference between techniques. The interobserver agreement was higher for WOPI (ICC, 0.77) than cCEUS (ICC, 0.67). Conclusion The diagnostic performance of WOPI is comparable to that of cCEUS in differentiating FLLs, with superior interobserver agreement.

Purpose: The study aimed to compare the diagnostic performance of washout-parametric imaging (WOPI) with that of conventional contrast-enhanced ultrasound (cCEUS) in differentiating focal liver lesions (FLLs). Methods: A total of 181 FLLs were imaged with contrast-enhanced ultrasound using Sonazoid, and the recordings were captured for 10 minutes in a prospective setting. WOPI was constructed from three images, depicting the arterial phase (peak enhancement), the early portal venous phase (1-minute post-injection), and the vasculo-Kupffer phase (5 or 10 minutes post-injection). The intensity variations in these images were color-coded and superimposed to produce a single image representing the washout timing across the lesions. From the 181 FLLs, 30 hepatocellular carcinomas (HCCs), 30 non-HCC malignancies, and 30 benign lesions were randomly selected for an observer study. Both techniques (cCEUS and WOPI) were evaluated by four off-site readers. They classified each lesion as benign or malignant using a continuous rating scale, with the endpoints representing "definitely benign" and "definitely malignant." The diagnostic performance of cCEUS and WOPI was compared using the area under the receiver operating characteristic curve (AUC) with the DeLong test. Interobserver agreement was assessed using the intraclass correlation coefficient (ICC). Results: The difference in average AUC values between WOPI and cCEUS was 0.0062 (95% confidence interval, -0.0161 to 0.0285), indicating no significant difference between techniques. The interobserver agreement was higher for WOPI (ICC, 0.77) than cCEUS (ICC, 0.67). Conclusion The diagnostic performance of WOPI is comparable to that of cCEUS in differentiating FLLs, with superior interobserver agreement.

Purpose: The study aimed to compare the diagnostic performance of washout-parametric imaging (WOPI) with that of conventional contrast-enhanced ultrasound (cCEUS) in differentiating focal liver lesions (FLLs). Methods: A total of 181 FLLs were imaged with contrast-enhanced ultrasound using Sonazoid, and the recordings were captured for 10 minutes in a prospective setting. WOPI was constructed from three images, depicting the arterial phase (peak enhancement), the early portal venous phase (1-minute post-injection), and the vasculo-Kupffer phase (5 or 10 minutes post-injection). The intensity variations in these images were color-coded and superimposed to produce a single image representing the washout timing across the lesions. From the 181 FLLs, 30 hepatocellular carcinomas (HCCs), 30 non-HCC malignancies, and 30 benign lesions were randomly selected for an observer study. Both techniques (cCEUS and WOPI) were evaluated by four off-site readers. They classified each lesion as benign or malignant using a continuous rating scale, with the endpoints representing "definitely benign" and "definitely malignant." The diagnostic performance of cCEUS and WOPI was compared using the area under the receiver operating characteristic curve (AUC) with the DeLong test. Interobserver agreement was assessed using the intraclass correlation coefficient (ICC). Results: The difference in average AUC values between WOPI and cCEUS was 0.0062 (95% confidence interval, -0.0161 to 0.0285), indicating no significant difference between techniques. The interobserver agreement was higher for WOPI (ICC, 0.77) than cCEUS (ICC, 0.67). Conclusion The diagnostic performance of WOPI is comparable to that of cCEUS in differentiating FLLs, with superior interobserver agreement.

Purpose: The study aimed to compare the diagnostic performance of washout-parametric imaging (WOPI) with that of conventional contrast-enhanced ultrasound (cCEUS) in differentiating focal liver lesions (FLLs). Methods: A total of 181 FLLs were imaged with contrast-enhanced ultrasound using Sonazoid, and the recordings were captured for 10 minutes in a prospective setting. WOPI was constructed from three images, depicting the arterial phase (peak enhancement), the early portal venous phase (1-minute post-injection), and the vasculo-Kupffer phase (5 or 10 minutes post-injection). The intensity variations in these images were color-coded and superimposed to produce a single image representing the washout timing across the lesions. From the 181 FLLs, 30 hepatocellular carcinomas (HCCs), 30 non-HCC malignancies, and 30 benign lesions were randomly selected for an observer study. Both techniques (cCEUS and WOPI) were evaluated by four off-site readers. They classified each lesion as benign or malignant using a continuous rating scale, with the endpoints representing "definitely benign" and "definitely malignant." The diagnostic performance of cCEUS and WOPI was compared using the area under the receiver operating characteristic curve (AUC) with the DeLong test. Interobserver agreement was assessed using the intraclass correlation coefficient (ICC). Results: The difference in average AUC values between WOPI and cCEUS was 0.0062 (95% confidence interval, -0.0161 to 0.0285), indicating no significant difference between techniques. The interobserver agreement was higher for WOPI (ICC, 0.77) than cCEUS (ICC, 0.67). Conclusion The diagnostic performance of WOPI is comparable to that of cCEUS in differentiating FLLs, with superior interobserver agreement.

Although cardiac rehabilitation (CR) has been shown to improve exercise tolerance and prognosis in patients with cardiovascular diseases, there remains low participation in outpatient CR. This may be attributed to the patients’ busy schedules and difficulty in visiting the hospital due to distance, cost, avoidance of exercise, and severity of coronary disease. To overcome these challenges, many countries are exploring the possibility of remote CR. Specifically, there is increasing attention on the development of remote CR devices, which allow transmission of vital information to the hospital via a remote CR application linked to a wearable device for telemonitoring by dedicated hospital staff. In addition, remote CR programs can support return to work after hospitalization. Previous studies have demonstrated the effects of remote CR on exercise tolerance. However, the preventive effects of remote CR on cardiac events and mortality remain controversial. Thus, safe and effective remote CR requires exercise risk stratification for each patient, telenursing by skilled staff, and multidisciplinary interventions. Therefore, quality assurance of telenursing and multi-disciplinary interventions will be essential for remote CR. Remote CR may become an important part of cardiac management in the future. However, issues such as costeffectiveness and insurance coverage still persist.

A 2-month-old male infant was transferred to our hospital for suspected cardiomyopathy because he had livedo reticularis and peripheral coldness. An electrocardiogram showed ischemic change and an echocardiogram showed a dilated, poorly functioning left ventricle. Therefore, we performed urgent cardiac catheterization. The coronary artery was not visualized by aortography, but the single coronary artery arising from the pulmonary artery was depicted by pulmonary angiography. Therefore, we performed emergent surgery. The whole coronary arteries traveled directly inferiorly from the left side of the pulmonary trunk. A patent ductus arteriosus (PDA) was closed at the operation. We established cardiopulmonary bypass using two arterial cannulae through both ascending aortas and pulmonary trunk to maintain coronary blood flow. Direct implantation is difficult because the coronary ostium is far from the ascending aorta. Therefore, we chose to perform the Takeuchi procedure using an intrapulmonary artery tunnel. The patient's postoperative course was good, and he was discharged on postoperative day 22. A case of an anomalous origin of a single coronary artery from the pulmonary artery without any other heart disease is extremely rare. Management of cardiopulmonary bypass and myocardial protection in this abnormality is discussed.

Objective：This study was aimed at investigating the acquirement of socks-handling ability with hip flex, abduction, and external rotation position (hip open position) in 5 months after the posterior approach to total hip arthroplasty (THA), with consideration of the functional goals by conducting a multicenter cooperative study.Methods：The study included 101 patients (104 hip joints) with hip osteoarthritis. We evaluated patient attribution；ranges of motion of the hip, knee and ankle；hip pain in socks-handling；and upper extremity length, which were evaluated before the operation, upon hospital discharge and at 5 months after the posterior approach to THA. The patients were classified into those who attained and did not attain socks-handling ability in open hip position until 5 months after THA. We investigated the factors for acquiring socks-handling ability by using a multiple logistic regression analysis.Results：We identified three factors that significantly correlated to socks-handling ability as follows：(1) socks-handling ability before the operation, (2) range of hip external rotation before operation, and (3) range of hip abduction before discharge. The goal to acquire socks-handling ability is 27.5°hip external rotation and 17.5°hip abduction.Conclusion：We suggest that socks-handling ability must be acquired before THA and that the target range of hip abduction and external rotation must be attained during the early post-THA stage.