Background/Aims: Colorectal polyp detection during colonoscopy is influenced by the lesion location, size, morphology, and histology. However, no studies have systematically assessed the difficulty of detection along the short axis of the intestinal lumen. This study aimed to evaluate the colorectal polyp detection rates on this axis during colonoscopy. Methods: This retrospective study analyzed 1,169 polyps in 513 patients who underwent colonoscopy at Showa University Hospital between November 2022 and February 2023. The short-axis lumen was divided into: upper right, lower right, lower left, and upper left. Each polyp detected was assigned to a quadrant. Detection rates were compared across quadrants and analyzed for associations with clinicopathological factors including lesion size, location, macroscopic type, and examiner experience. Results: The lesion detection rates varied significantly by quadrant. The upper left quadrant had the lowest detection rate (17.5%) compared with the expected 25.0% per quadrant. Subgroup analyses consistently confirmed the lower detection rates in this quadrant across most lesion types and patient groups, except for lesions in the cecum and rectum. Conclusions The lower detection rate in the upper left quadrant suggests that this orientation poses a challenge and may increase the number of missed lesions. Enhanced examination of this area may improve detection; however, further prospective studies are required.

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.

The purpose of this study was to investigate the injury patterns and risk factors of injuries among high school handball players in Japan. A total of 1299 (709 male and 590 female) subjects who played in the 2018 Japanese National High School Handball Championship participated in this study. The questionnaire on injury experience was distributed two weeks before the championship and was collected at the representation meeting the day before the championship. The main results were as follows: 1) The subjects (n=625, 48.1%) reported experiences of injuries in the previous year. Female had significantly more suffer injuries than male. 2) The main body parts of injuries were the ankle, knee, and finger in traumatic injuries and the lower leg, lumber spine/lower back, and knee in overuse injuries. The main types of injuries were sprain, ligamentous rupture, and fracture in traumatic injuries and stress fracture, other bone injuries, and lesion of meniscus or cartilage in overuse injuries. The main cause of injuries was “contact with another athlete”. 3) Age, female players, and back players were associated with increased the occurrences of injuries. Goalkeepers were associated with decreased the occurrences of injuries. These results indicated that a high prevalence of injuries in high school handball players, and it is important to take preventive measures based on age, gender, and player position.

Background/Aims: The adenoma detection rate (ADR) of screening colonoscopies performed by trainees is often lower than that of colonoscopies performed by experts. The effcacy of cap-assisted colonoscopy (CAC) in adenoma detection is well documented, especially that of CACs performed by trainees. Endocuff, a new endoscopic cap, is reportedly useful for adenoma detection; however, no trials have compared the effcacy of Endocuff-assisted colonoscopy (EAC) and CAC conducted by trainees. Therefore, the present study retrospectively compared the effcacy between EAC and CAC in trainees. Methods: This was a single-center, retrospective study involving 305 patients who underwent either EAC or CAC performed by three trainees between January and December 2018. We evaluated the ADR, mean number of adenomas detected per patient (MAP), cecal intubation rate, cecal intubation time, and occurrence of complications between the EAC and CAC groups. Results: The ADR was significantly higher in the EAC group than in the CAC group (54.3% vs. 37.3%, p=0.019), as was the MAP (1.36 vs. 0.74, p=0.003). No significant differences were found between the groups with respect to the cecal intubation rate or cecal intubation time. No major complications occurred in either group. Conclusions Our results suggest that EAC exhibits increased ADR and MAP compared to CAC when performed by trainees.

The purpose of this study was to clarify feasibility of a booklet for families of children dying with incurable cancer. Of 267 pediatric oncology specialists, 76 (28%) participated in this cross-sectional survey. Ninety-three percent of participants answered that they were “likely to use” the booklet, and 86% percent answered that they believed the booklet was “helpful” for families. Some participants described various advantages of its use as follows: “able to communicate something that is difficult to put into words,” “easy to understand for families,” “families can read whenever they choose to,” and “able to grasp the direction of dying.” In contrast, other participants described points of attention of use as follows: “optimal timing to bring out,” “acceptance of families,” “direction as interdisciplinary team,” “confidential relationship between families and interdisciplinary team,” “disinclination among health care providers,” and “information volume of the booklet.” Thus, our results validated feasibility of the booklet. In conclusion, pediatric oncology specialists should provide their support of utilizing the booklet for families and assessing each family condition and advantage/attention of using the booklet.

Case : A 75-year-old man was brought to our hospital by ambulance with dorsal pain. Contrast-enhanced computed tomography (CT) revealed acute communicating aortic dissection (Stanford type B) complicated by an aberrant right subclavian artery (ARSCA). Under a diagnosis of type B dissection, conservative treatment by hypotensive therapy and resting was performed. One month after onset, contrast-enhanced CT showed the expansion of the false lumen, and intermittent abdominal pain persisted. To close the entry of the distal arch and reconstruct the ARSCA route, right common carotid artery-right axillary artery bypass, thoracic endovascular aortic repair (TEVAR), and coil embolization of the ARSCA were performed. Five days after surgery, contrast-enhanced CT revealed the expansion of a false abdominal lumen. Abdominal endovascular aortic repair (EVAR) was additionally conducted, leading to the disappearance of false lumen blood flow. ARSCA is a congenital arch vessel abnormality. It may cause obstruction of the esophagus/trachea, aortic aneurysm/dissection of an adjacent area, or aneurysmal changes/rupture of the ARSCA. Various techniques have been reported ; reconstruction of the ARSCA route and closure of the false lumen by de-branch TEVAR may be effective for acute communicating aortic dissection with an ARSCA.

OBJECTIVESThe effect of dampness on sick building syndrome (SBS) symptoms has not been fully investigated in Japan. The purpose of this study is to elucidate the possible effects of dampness on SBS symptoms among residents in Japanese public apartment houses.

METHODSA questionnaire was used to investigate the degree of dampness in public apartment houses in Asahikawa, Japan, and its effect on SBS symptoms, involving 480 residents in 64 buildings. Dampness indicators were as follows: condensation on the windowpanes, condensation on the walls and/or closets, visible mold in the bathrooms, visible mold on the walls, window frames, and/or closet, moldy odor, slow drying of the wet towels in bathrooms, water leakage, and bad drainage in bathrooms.

RESULTSAll dampness indicators except for visible mold in bathrooms had significantly higher odds ratios (ORs) for all or any SBS symptoms after adjustment. The dampness index, the number of positive dampness indicators, was significantly related to all SBS symptoms after adjustment.

CONCLUSIONSThere are serious problems relating to dampness in Japanese public housing, which affects the health of residents. There is a need to educate the residents about the relationship between dampness and SBS, and building problems should be rectified.

OBJECTIVETwo simple, commercially available and semiquantitative dust mite allergen tests, namely, the Acarex test(®) and Mitey Checker(®), were compared using 2 and 10 μg of Der 1 allergen per gram of dust, as evaluated by enzyme-linked immunosorbent assay (ELISA), to clarify which method is better suited for practical use.

METHODSMite allergen exposure levels of 106 floor, bed and sofa surfaces were evaluated by the Acarex test(®), Mitey Checker(®), and ELISA. A template of 100 cm×100cm was placed on the same surfaces to identify the examined areas. A dust collection filter was attached to a vacuum cleaner, and the area in the template (1 m(2)) was vacuumed. Then, to evaluate the other two tests, samples from the two other areas in the template (1 m(2)) that neighbored each other and did not overlap were vacuumed.

RESULTSTo predict Der 1 levels of 2 μg/g dust or higher, the sensitivity and specificity of the Acarex test(®) were 100% and 13.3%, and those, of Mitey Checker(®) were 91.8% and 71.1%, respectively. To predict Der 1 levels of 10 μg/g dust or higher, the sensitivity and specificity of the Acarex test(®) were 50.0% and 96.2%, and those of Mitey Checker(®) were 85.7% and 79.5%, respectively. Compared with Der 1<2.0, 2.0-9.9.≥10.0 (μg/g dust), the percent agreement and kappa of the Acarex test(®) were 47.2% and 0.234, and those of Mitey Checker(®) were 70.0% and 0.505, respectively.

CONCLUSIONTo evaluate mite allergen exposure level for practical use in Japanese living environments, Mitey Checker(®) is better than the Acarex test(®) because of its higher sensitivity and specificity.

We analyzed the scores of objective structured clinical examinations (OSCEs) and written examinations administered to fourth-year medical students after practical training in clinical skills and to fifth-year medical students after clinical training and scores of graduation examinations taken by sixth-year medical students. Correlations were analyzed among the scores of 96 students who had taken all 3 examinations during a 3-year period. Mean scores on examinations in the fourth, fifth, and sixth years were compared between sixth-year students who did or did not graduate and between graduating students who did or did not pass the national examination for medical practitioners in Japan. Significant correlations in the scores were found between 1) OSCEs and written examinations for fourth-year students versus those for the fifth-year students; 2) OSCE and written examinations for fourth-year students versus graduation examination scores for the sixth-year students; and 3) OSCE and written examinations for fifth-year students versus graduation examination scores for sixth-year students. In addition, the mean scores in the fourth and fifth years were significantly higher for sixth-year students who graduated and passed the national examination than for students who did not graduate or who graduated but failed the national examination. These results suggest that the practical training in clinical skills given to fourth-year students and the clinical training given to fifth-year students strongly affect the overall evaluation of the ability of sixth-year students and success on the national examination.

Medical students at Kurume University begin practical training in clinical skills in their fourth year. At that time, students use the skills laboratory to improve their clinical skills. Medical education resources in the skills laboratory include simulators for emergency resuscitation and heart diseases, wireless stethoscopes, and videotapes. All students use the skills laboratory for 2 months, and its usefulness was evaluated with questionnaires after practical training. More than 50 % of students approved of their practice in the skills laboratory. However, some students were unsatisfied because they were unable to make effective use of the simulators. In the future, an improved skills laboratory will be necessary to improve practical training in the clinical skills for medical students.