Purpose: This study aimed to identify predictors of lateral lymph node metastasis (LLNM) and assess prognostic factors in patients with locally advanced low rectal cancer (LALRC), with the goal of informing optimal treatment strategies for LALRC. Methods: We retrospectively analyzed clinicopathological data from patients with LALRC who underwent lateral lymph node dissection without preoperative treatment between 2014 and 2023. The radiological criterion for LLNM was a short-axis diameter of ≥6 mm on magnetic resonance imaging (MRI). Results: Of 163 patients, 27 (16.6%) had pathological LLNM (pLLNM). Among 130 patients preoperatively classified as LLNM-negative, 5 (3.8%) were found to have pLLNM. Univariate and multivariate analyses showed that meeting the radiological LLNM criterion independently predicted pLLNM (odds ratio, 53.000; P<0.001). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of this criterion were 90.2%, 81.5%, 91.9%, 66.7%, and 96.2%, respectively. In multivariate analyses, pLLNM was an independent risk factor for 3‑year relapse‑free survival. MRI‑detected extramural vascular invasion (mrEMVI) was independently associated with 3‑year relapse‑free survival, local recurrence‑free survival, and distant recurrence‑free survival. Conclusion These radiological criteria may help clinicians develop personalized treatment plans for patients with LALRC. The high negative predictive value and specificity of LLNM assessment can assist in avoiding overtreatment in appropriate patients. Further evaluation is needed to define optimal management for mrEMVI‑positive cases.

Introduction: Intracranial tumors cause various neurological symptoms and neuropathic pain, which are often refractory to opioids. In some of these cases, the combination of Kampo medicines can be effective. Case: The case was a 44-year-old patient who underwent surgery for a suspected papilloma. After resection, pathological examination revealed squamous cell carcinoma, positive for margins, and then, the left intraorbital metastasis was observed. Due to the intracranial invasion of the tumor, he had pain in the second and third branches of the trigeminal nerve in the left face and paresthesia in the second branch of the trigeminal nerve bilaterally (Numerical Rating Scale: NRS 10/10). Hydromorphone was introduced, and the pain was relieved, but the paresthesia remained (NRS 8/10). Both paresthesia and pain worsened during the course of chemotherapy, but MRI showed no tumor progression, thus, the cause of symptom aggravation was diagnosed edema of the tissue around the tumor. Therefore, Goreisan was started, and both paresthesia and pain were relieved. Discussion: Goreisan has been shown to be effective in cerebral edema due to its water-regulating effect by inhibiting aquaporin. In the present case, the reduction of edema in peritumoral tissues by Goreisan may have contributed to the symptomatic relief.

STUDY DESIGN: A retrospective cohort study. PURPOSE: This study aims to investigate postoperative shoulder imbalance (PSI) ≥5 years postoperatively in patients who underwent posterior spinal fusion using hooks at the upper instrumented vertebra (UIV) for Lenke type 1 adolescent idiopathic scoliosis (AIS). OVERVIEW OF LITERATURE: Studies have reported PSI due to excessive correction of the main thoracic curve. METHODS: We examined 56 patients with AIS who underwent a posterior spinal fusion with hooks at the UIV from 2004 to 2010. Of these, we enrolled 14 patients who underwent surgery, at least, 5 years ago. X-rays and Scoliosis Research Society-22 (SRS-22) questionnaire were administered. To evaluate the shoulder balance, T1 vertebral tilt angle (T1 tilt), clavicle angle, and radiographic shoulder height (RSH) were measured. PSI was considered as the absolute value of the postoperative RSH being ≥20 mm. Based on radiographs obtained immediately postoperatively, we divided patients into two groups as follows: the balanced group (absolute value of RSH <20 mm) and imbalanced group (absolute value of RSH ≥20 mm). RESULTS: The frequency of PSI was 28.6% immediately postoperatively, 0% 2 years postoperatively, and 7.1% at the last follow-up. In the balanced group, PSI did not occur even at 2 years postoperatively or at the last follow-up. In the imbalanced group, PSI was improved in all patients 2 years postoperatively and all patients, except one patient, at the last follow-up. No significant differences were noted in the frequency of distal adding-on at 2 years postoperatively or the last follow-up between the balanced group and the imbalanced group. We observed moderate negative correlations between the absolute value of T1 tilt and the SRS-22 pain and satisfaction at the last follow-up. CONCLUSIONS: Hooks at the UIV could adjust the shoulder balance to avoid long-term PSI in patients with AIS.

Objective:The objectives were to assess regional differences in the safety outcomes of telaprevir-based triple therapy(T/PR) in Japan and evaluate a suitable generalized linear mixed model for estimating regional differences.Design and Methods:This study targeted individuals infected with genotype 1 chronic hepatitis C virus registered in a nationwide Japanese interferon database from December 2009 to August 2015. The rate of dropout from treatmentattributable to adverse events was calculated in every prefecture where ≥ 20 cases were reported. We constructed the following four models and evaluated the best-fit model based on Akaike information criterion (AIC) and Bayesian information criterion (BIC):1)prefecture as a fixed-effect,2)prefecture and identified confounding factors as fixed-effects,3)prefecture as a random-effect,and 4)prefecture as a random-effect and identified confounding factors as fixed-effects.Results:A total of 25,989 individuals from 38 prefectures were registered during the study period;among them,1,591 from18 prefectures were included as the study population. The dropout rate ranged from 7.0 to 23.1%among 17 prefectures.The model considering prefecture as a random-effect and confounding factors as fixed-effects showed the best-fit for the databased on both the AIC (1,108.06)and BIC (1,113.41).Conclusion:It is difficult to determine if regional differences exist in the safety outcomes of T/PR in Japan because of the limited number of cases. However, the model using prefecture as a random-effect and other confounding factors as fixed-effects would be suitable for estimating parameters that reflect the influence of the prefecture. Further studies using the model would help inform chronic hepatitis C treatment.

Objective: This study aimed to confirm whether the methods for assessing the reported causal relationship between dietary supplement intake and adverse events are reliable in the clinical setting.
Design: The relationships between supplement intake and adverse events were assessed using two algorithms proposed in our previous report, and causal relationships were evaluated.
Methods: Twelve raters with a high probability of handling adverse event information examined 200 records of dialogues with supplement users.  Each rater independently assessed the causal relationship using the two algorithms.  The relationships between supplement intake and adverse events were assessed for all 200 cases.  Variability in the evaluation among raters was analyzed for each occupation and the whole group of raters.  The distributions of evaluation were analyzed, and inter-rater reliability was evaluated using the intraclass correlation coefficient (ICC) and Fleiss’ kappa coefficient.
Results: All events of 200 cases seemed to be slight and within the range of variation in daily life.  Almost all cases were classified into two categories as “Possible” and “Lack of Information” by each rater.  The ICC values for all raters, pharmacists, dieticians, and health care workers were 0.644, 0.573, 0.678, and 0.694, respectively, and the kappa coefficients using the two algorithms were 0.466, 0.426, 0.468, and 0.519 and 0.481, 0.478, 0.465, and 0.517, respectively.  There were moderate levels of agreement based on the kappa coefficients and ICC values.
Conclusion: The two algorithms proposed in our previous report may be reliable in the clinical setting.  Their reliability could be enhanced by establishing a unified method of accumulation and recording adverse events for supplement intake, which should be evaluated by more raters using more cases of adverse events.

STUDY DESIGN: Retrospective cohort study. PURPOSE: To assess bone mineral density (BMD) and bone metabolism ≥27 years after surgery in female patients who underwent spinal fusion for adolescent idiopathic scoliosis (AIS) during adolescence and to determine their associations with physical performance. OVERVIEW OF LITERATURE: There are no studies investigating postsurgical BMD in middle-aged AIS patients. METHODS: This study included 23 patients who provided informed consent among 229 female patients with AIS who underwent spinal fusion from 1968 until 1988. Average age at the time of observation was 48.8 years. BMD was measured at the left femoral neck, and the levels of two bone metabolism markers–procollagen type 1 N-terminal propeptide (P1NP) and tartrate-resistant acid phosphatase 5b (TRACP-5b)–were measured from blood samples. Physical performance was measured using grip strength, sit-ups, sit-and-reach, side step, and standing long jump. RESULTS: Mean BMD was 0.784 g/cm2. According to the World Health Organization diagnostic criteria, one subject (4.3%) had osteoporosis, whereas nine subjects (39.1%) had osteopenia. In patients with osteoporosis or osteopenia, P1NP and TRACP-5b levels were high, and BMD loss was because of high metabolic turnover. All calculated standard scores for physical performance were lower in the study cohort than in healthy individuals. There was a positive correlation between BMD and the standard score for grip strength, whereas there were weak positive correlations between BMD and the standard scores for side step and standing long jump. CONCLUSIONS: In female AIS patients who underwent spinal fusion in adolescence, 4.3% and 39.1% had osteoporosis and osteopenia, respectively, ≥27 years after surgery. Exercise performance of these patients was poor compared with the national standards. In these patients, increased physical activity should be encouraged to prevent BMD loss in middle age.
Acid Phosphatase ; Adolescent* ; Bone Density* ; Bone Diseases, Metabolic ; Cohort Studies ; Female* ; Femur Neck ; Hand Strength ; Humans ; Informed Consent ; Metabolism ; Middle Aged ; Motor Activity ; Osteoporosis ; Retrospective Studies ; Scoliosis* ; Spinal Fusion ; World Health Organization

The changes of skin surface hydration state were measured in vivo to evaluate the efficacy of bath preparations and their common use raw materials, following five samples, from a view point of moisturizing effect using High Frequency Impedance Measurment (3.5MHz.) as an empirical approach previously adopted by Tagami et al.
The temparature of water immersion was 41°C and the duration was 5min. Five kinds of samples used in this survey, 15 and 30g of sodium hydrogencarbonate, bath preparations containing 85% of sodiumu hydrogen carbonate, 2% of JOJOBA OIL, and 5% of dextrin were dissolved into plain water equipped with the maintenance of water temparature at 41°C, respectively.
As the result of this examination, these five samples enhanced the hydration state of stratum corneum after immersion and the value of skin surface hydration state showed high significant difference comparing to plain water. Especially, sample A immersion (containing 2% of JOJOBA OIL; Fig. 1) showed clear cut difference to compare to plain water immersion. (P<0.01 at 30, 60, 90, and 120min, after immersion)
These data suggested that JOJOBA OIL, dextrin and sodium hydrogen carbonate can be utilized effectively as a moisturizing factor for various types of bath preparations. It was proved that JOJOBA OIL, dextrin, and sodium hydrogen carbonate as raw materials of bath preparations possess the moisturizing effect after immersion through this survey.
We suppose that these raw materials might be concerned in the quantity of secondary bound water which is necessary to retain the suppleness and smoothness of stratum corneum, and propose that High Frequency Impedance Measurement (3.5MHz) is a suitable method to evaluate the hydration state of stratum corneum after water immersion.