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.

Background: In May 2023, Japan reclassified coronavirus disease 2019 (COVID-19) under the Infectious Disease Control Law. However, there have been insufficient examinations on how the change in classification has impacted citizens’ lives. This study examined the impact of revisions to the Infectious Disease Control Law in Japan on the social frailty and social life of older adults in the community. Methods: From mid-March to mid-April 2023, a self-administered survey targeting community-dwelling older adults aged 65 years and over was conducted by mail, before the revision of the Infectious Disease Control Law. From mid-February to mid-March 2024, after the revision of the law, a second survey was conducted among those who had responded to the first one. Ultimately, data from 240 cases were collected. The survey included social information such as mask-wearing when going out, status of long-term care insurance, presence of polypharmacy, sleep status, long outings, presence of COVID-19 infection, presence of post-COVID-19 syndrome (if infected), social frailty, and the Kihon Checklist, alongside basic demographic information. Results: After the revision of the Infectious Disease Control Law, there was an increase in the number of individuals receiving benefits from long-term care insurance and those identified as socially frail. However, no significant differences were observed in the other surveyed items. Conclusion The increase in socially frail individuals and those with long-term care insurance suggests that, despite the revision of the Infectious Disease Control Law, the connections within the local community that had once weakened due to the COVID-19 pandemic have not been fully restored.

Background: In May 2023, Japan reclassified coronavirus disease 2019 (COVID-19) under the Infectious Disease Control Law. However, there have been insufficient examinations on how the change in classification has impacted citizens’ lives. This study examined the impact of revisions to the Infectious Disease Control Law in Japan on the social frailty and social life of older adults in the community. Methods: From mid-March to mid-April 2023, a self-administered survey targeting community-dwelling older adults aged 65 years and over was conducted by mail, before the revision of the Infectious Disease Control Law. From mid-February to mid-March 2024, after the revision of the law, a second survey was conducted among those who had responded to the first one. Ultimately, data from 240 cases were collected. The survey included social information such as mask-wearing when going out, status of long-term care insurance, presence of polypharmacy, sleep status, long outings, presence of COVID-19 infection, presence of post-COVID-19 syndrome (if infected), social frailty, and the Kihon Checklist, alongside basic demographic information. Results: After the revision of the Infectious Disease Control Law, there was an increase in the number of individuals receiving benefits from long-term care insurance and those identified as socially frail. However, no significant differences were observed in the other surveyed items. Conclusion The increase in socially frail individuals and those with long-term care insurance suggests that, despite the revision of the Infectious Disease Control Law, the connections within the local community that had once weakened due to the COVID-19 pandemic have not been fully restored.

Background: In May 2023, Japan reclassified coronavirus disease 2019 (COVID-19) under the Infectious Disease Control Law. However, there have been insufficient examinations on how the change in classification has impacted citizens’ lives. This study examined the impact of revisions to the Infectious Disease Control Law in Japan on the social frailty and social life of older adults in the community. Methods: From mid-March to mid-April 2023, a self-administered survey targeting community-dwelling older adults aged 65 years and over was conducted by mail, before the revision of the Infectious Disease Control Law. From mid-February to mid-March 2024, after the revision of the law, a second survey was conducted among those who had responded to the first one. Ultimately, data from 240 cases were collected. The survey included social information such as mask-wearing when going out, status of long-term care insurance, presence of polypharmacy, sleep status, long outings, presence of COVID-19 infection, presence of post-COVID-19 syndrome (if infected), social frailty, and the Kihon Checklist, alongside basic demographic information. Results: After the revision of the Infectious Disease Control Law, there was an increase in the number of individuals receiving benefits from long-term care insurance and those identified as socially frail. However, no significant differences were observed in the other surveyed items. Conclusion The increase in socially frail individuals and those with long-term care insurance suggests that, despite the revision of the Infectious Disease Control Law, the connections within the local community that had once weakened due to the COVID-19 pandemic have not been fully restored.

Blunt traumatic rupture of the heart carries a high mortality rate. Anatomical injuries have included the atrium, appendage and ventricle but injury to the left appendage has been reported very rarely. We present the case of a 71-year-old female who was a driver in a motor collision with major front-end damage where air bags were deployed. After being intubated and receiving pericardiocentesis for cardiac tamponade at an advanced critical care and emergency medical center, the patient was taken to our hospital and emergently to the operating room for exploration. There was brisk bleeding coming from a 2 cm laceration on the left atrial appendage. The injury was repaired using 4-0 polypropylene felt pledget-supported horizontal mattress sutures on the beating heart with the assistance of cardiopulmonary bypass. The present report describes this patient and our findings from a literature review.

A 51-year-old man was referred to our hospital with pain and coldness of the upper left extremity. Contrasted computed tomography revealed a silhouette protruding into the aortic arch. Peripheral embolism in upper left extremity by tumor or thrombosis was suspected. Magnetic resonance imaging revealed a mobile mass in the aortic arch. To prevent recurrent embolization, the mass and the aortic arch to which the mass was attached were excised and partial arch replacement was performed under cardiopulmonary bypass. Histologically, the mass was a fibrin thrombus with no malignancy. The aortic wall showed only mild atherosclerosis of the intima. No thrombotic predisposition such as protein S or C deficiency or antiphospholipid antibody syndrome was observed. Anticoagulant therapy was started and the patient was discharged on postoperative day 10 without recurrent thromboembolism. Three years have passed since the operation and there is no recurrence of thromboembolism.

Primary aldosteronism (PA) is the most common cause of secondary hypertension, and is associated with an increased incidence of cardiovascular events. PA itself is clinically classified into the following two types: unilateral PA, mostly composed of aldosteroneproducing adenoma (APA); and bilateral hyperaldosteronism, consisting of multiple aldosterone-producing micronodules (APMs) and aldosterone-producing diffuse hyperplasia. Histopathologically, those disorders above are all composed of compact and clear cells. The cellular morphology in the above-mentioned aldosterone-producing disorders has been recently reported to be closely correlated with patterns of somatic mutations of ion channels including KCNJ5, CACNA1D, ATP1A1, ATP2B3, and others. In addition, in non-pathological adrenal glands, APMs are frequently detected regardless of the status of the renin-angiotensin-aldosterone system (RAAS). Aldosterone-producing nodules have been also proposed as non-neoplastic nodules that can be identified by hematoxylin and eosin staining. These non-neoplastic CYP11B2-positive nodules could represent possible precursors of APAs possibly due to the presence of somatic mutations. On the other hand, aging itself also plays a pivotal role in the development of aldosterone-producing lesions. For instance, the number of APMs was also reported to increase with aging. Therefore, recent studies indicated the novel classification of PA into normotensive PA (RAAS-independent APM) and clinically overt PA.

An 87-year-old man underwent a transcatheter aortic valve implantation (TAVI) for severe aortic stenosis. Approximately 8 months later, he was readmitted to our institution because of a cerebral infarction. Viridans Streptococcus was identified from the blood culture, and transesophageal echocardiography revealed a mobile mass on the leaflet. Prosthetic valve endocarditis (PVE) was diagnosed and we initially administered intravenous antibiotic therapy for 4 weeks, after which the patient underwent surgical aortic valve replacement. Herein, we report on the surgical AVR in the patient using a pericardial valve after successful removal of the infected prosthetic valve, and discuss some issues related to this rare complication after TAVI.

Background: In Japan, in 2016, the School Health and Safety Act was revised and examination of extremities in addition to scoliosis became mandatory. Musculoskeletal examinations were subsequently started using a mark sheet-type questionnaire. In the present study, we aimed to analyze the relationship between physical findings and musculoskeletal problems and propose a preventive strategy for musculoskeletal injuries.Methods: In 2017, a total of 4,073 elementary and middle school students underwent direct musculoskeletal examination. In a direct examination, the following elements were included: torticollis; scoliosis; stiffness of the shoulder, elbow, hip, knee, and ankle; flexion and extension in standing position; flat foot; hallux valgus; and alignment of the upper and lower extremities. Of the 4,073 students who underwent direct examination in early 2017, only 3,754 were able to complete the mark sheet-type questionnaires in early 2018. A prospective longitudinal analysis of the data gathered was performed.Results: A total of 396 (11%) students had injuries. The ankle sprain/non-ankle sprain group comprised 119 (3%)/3,635 (97%) students, while the fracture/non-fracture group comprised 105 (2.8%)/3,650 (97.2%) students, respectively. Comparing the sprain group with the non-sprain group, ankle stiffness significantly correlated with ankle sprain in the univariable and multivariable analyses. Injuries occurred more frequently among boys, older students, students with stiff bodies, and students who were involved in sports activities of longer duration.Conclusion: Ankle stiffness was assumed to be a risk factor for ankle sprain. Stretching of the ankle might be effective for preventing ankle sprain. However, further interventional studies are needed to confirm this finding.

The patient was a 34-year-old woman who had been routinely monitored after receiving a childhood diagnosis of partial anomalous pulmonary venous connection, but unilaterally discontinued follow-up examinations after the age of 18. At 33 years of age, she was admitted to our hospital after a physical examination revealed an abnormal shadow on a chest X-ray. Transthoracic echocardiography detected an atrial septal defect (ASD), and contrast-enhanced computed tomography showed that the right lower pulmonary vein drained to the inferior vena cava. The patient was diagnosed with scimitar syndrome with ASD. Cardiac catheterization showed a pulmonary/systemic flow ratio (Qp/Qs) of 2.48 and a left-to-right shunt rate of 59.7%. Surgical treatment was deemed to be indicated. The right lower pulmonary vein was anastomosed to the anterolateral wall of the right atrium, and an intra-atrial baffle repair was performed from the orifice within the right atrium to the left atrium through the existing ASD using untreated fresh autologous pericardium. Two years after the operation, good blood flow was maintained within the baffle with no stenosis at the anastomotic site. This report describes a rare case of scimitar syndrome with ASD in an adult woman, and provides a review of the existing literature.