The Woven EndoBridge (WEB) device has emerged as a promising alternative to endovascular coiling. This case report demonstrates the use of stent-assisted WEB deployment for the embolization of multiple wide-neck posterior cerebral artery (PCA) aneurysms. A middle-aged patient was diagnosed with 3 unruptured aneurysms in the P3 and P4 segments of the right PCA, with sizes ranging from 2.5 mm to 6.6 mm. Given the small vessel diameter and distal location of the aneurysms, a combined approach was adopted. Coil embolization was performed for the most distal aneurysm, while stent-assisted WEB deployment was used for the proximal and middle aneurysms. The “flower bud” technique facilitated the safe positioning of the WEB device in challenging anatomical conditions. The procedure was successfully completed without complications, and the patient was discharged on postoperative day 7 with no neurological deficits. Follow-up at 3 months confirmed adequate embolization of all aneurysms, with in-stent stenosis managed conservatively.

The Woven EndoBridge (WEB) device has emerged as a promising alternative to endovascular coiling. This case report demonstrates the use of stent-assisted WEB deployment for the embolization of multiple wide-neck posterior cerebral artery (PCA) aneurysms. A middle-aged patient was diagnosed with 3 unruptured aneurysms in the P3 and P4 segments of the right PCA, with sizes ranging from 2.5 mm to 6.6 mm. Given the small vessel diameter and distal location of the aneurysms, a combined approach was adopted. Coil embolization was performed for the most distal aneurysm, while stent-assisted WEB deployment was used for the proximal and middle aneurysms. The “flower bud” technique facilitated the safe positioning of the WEB device in challenging anatomical conditions. The procedure was successfully completed without complications, and the patient was discharged on postoperative day 7 with no neurological deficits. Follow-up at 3 months confirmed adequate embolization of all aneurysms, with in-stent stenosis managed conservatively.

The Woven EndoBridge (WEB) device has emerged as a promising alternative to endovascular coiling. This case report demonstrates the use of stent-assisted WEB deployment for the embolization of multiple wide-neck posterior cerebral artery (PCA) aneurysms. A middle-aged patient was diagnosed with 3 unruptured aneurysms in the P3 and P4 segments of the right PCA, with sizes ranging from 2.5 mm to 6.6 mm. Given the small vessel diameter and distal location of the aneurysms, a combined approach was adopted. Coil embolization was performed for the most distal aneurysm, while stent-assisted WEB deployment was used for the proximal and middle aneurysms. The “flower bud” technique facilitated the safe positioning of the WEB device in challenging anatomical conditions. The procedure was successfully completed without complications, and the patient was discharged on postoperative day 7 with no neurological deficits. Follow-up at 3 months confirmed adequate embolization of all aneurysms, with in-stent stenosis managed conservatively.

The Woven EndoBridge (WEB) device has emerged as a promising alternative to endovascular coiling. This case report demonstrates the use of stent-assisted WEB deployment for the embolization of multiple wide-neck posterior cerebral artery (PCA) aneurysms. A middle-aged patient was diagnosed with 3 unruptured aneurysms in the P3 and P4 segments of the right PCA, with sizes ranging from 2.5 mm to 6.6 mm. Given the small vessel diameter and distal location of the aneurysms, a combined approach was adopted. Coil embolization was performed for the most distal aneurysm, while stent-assisted WEB deployment was used for the proximal and middle aneurysms. The “flower bud” technique facilitated the safe positioning of the WEB device in challenging anatomical conditions. The procedure was successfully completed without complications, and the patient was discharged on postoperative day 7 with no neurological deficits. Follow-up at 3 months confirmed adequate embolization of all aneurysms, with in-stent stenosis managed conservatively.

The Woven EndoBridge (WEB) device has emerged as a promising alternative to endovascular coiling. This case report demonstrates the use of stent-assisted WEB deployment for the embolization of multiple wide-neck posterior cerebral artery (PCA) aneurysms. A middle-aged patient was diagnosed with 3 unruptured aneurysms in the P3 and P4 segments of the right PCA, with sizes ranging from 2.5 mm to 6.6 mm. Given the small vessel diameter and distal location of the aneurysms, a combined approach was adopted. Coil embolization was performed for the most distal aneurysm, while stent-assisted WEB deployment was used for the proximal and middle aneurysms. The “flower bud” technique facilitated the safe positioning of the WEB device in challenging anatomical conditions. The procedure was successfully completed without complications, and the patient was discharged on postoperative day 7 with no neurological deficits. Follow-up at 3 months confirmed adequate embolization of all aneurysms, with in-stent stenosis managed conservatively.

We devised IMADOKO as a tool to confirm the current status of terminal cancer patients and are using it in the home care team. In this study, we retrospectively investigated the actual state of end-of-life care to clarify the impact of IMADOKO on decision-making support for terminal cancer patients and their families. The subjects were 64patients (male/female, 38/26) before IMADOKO introduction, and 140 patients (male/female, 78/62) after the introduction, with an average age of 74 years in both cases and the primary lesions were the pancreas, lung, and the gastrointestinal tract. The rate of death at home increased significantly after the introduction of IMADOKO, compared to before. In the IMADOKO introduced group, IMADOKO was used in 108 patients and all their families. The use of IMADOKO for the patient was not related to the location of death, but it significantly improved communication between the patient and family, and between patient/patient's family and medical staff. It was shown that IMADOKO may be useful for decision-making support in choosing a better place of recuperation.

OBJECTIVE: The purpose of the present study was to clarify the relationship between white matter tracts and cognitive symptoms in children with high-functioning autism spectrum disorder (ASD). METHODS: We examined the cognitive functions of 17 children with high-functioning ASD and 18 typically developing (TD) controls and performed diffusion tensor imaging (DTI) tractography. We compared the results between the groups and investigated the correlations between the cognitive scores and DTI parameters within each group. RESULTS: The Comprehension scores in the ASD group exhibited a positive correlation with mean diffusivity (MD) in the forceps minor (F minor). In the TD group, the Comprehension scores were positively correlated with fractional anisotropy (FA) in the right inferior fronto-occipital fasciculus (IFO) and left anterior thalamic radiation (ATR), and negatively correlated with MD in the left ATR, radial diffusivity (RD) in the right IFO, and RD in the left ATR. Additionally, a positive correlation was observed between the Matching Numbers scores and MD in the left uncinate fasciculus and F minor, and RD in the F minor. Furthermore, the Sentence Questions scores exhibited a positive correlation with RD in the right inferior longitudinal fasciculus. Relative to TD controls, the specific tract showing a strong correlation with the cognitive scores was reduced in the ASD group. CONCLUSION: Our findings indicate that white matter tracts connecting specific brain areas may exhibit a weaker relationship with cognitive functions in children with ASD, resulting in less efficient cognitive pathways than those observed in TD children.
Anisotropy ; Autism Spectrum Disorder ; Autistic Disorder ; Brain ; Child ; Cognition ; Comprehension ; Diffusion Tensor Imaging ; Humans ; Neurobehavioral Manifestations ; Surgical Instruments ; White Matter

Introduction: Number of palliative care team increase every year, but the quality of team might differ from each other. We developed “Self-Check Program for Palliative Care Team” to assess and improve the quality of palliative care team. We report the result of the multi-center study to assess the feasibility of this program. Methods: We underwent the “Self-Check Program” as a trial at seven hospitals in Japan in February 2016. We took a questionnaire survey to team leaders and participants to assess the feasibility of this program. Results: Fifty-two medical staffs in six hospitals accomplished this program. Time scheduling and the integration of opinions from each team members were the difficulties came up from questionnaire survey. All team leaders and 87.8% of the participants answered that this program was effective to extract and improve the problem of the team. Also 83.3% of the team leaders were satisfied with the process of planning. Conclusion: Despite some difficulties, majority of the participants considering useful, this program is considered feasible.

　　Yuri Kumiai General Hospital is a community-based core hospital that treated approximately 14,000 patients in the emergency outpatient clinic in 2014, with approximately 7,800 walk-in patients on Saturdays, Sundays, and holidays. In April 2014, we incorporated an inhospital triage system for walk-in patients on weekends and holidays to quickly diagnose the conditions of patients in a crowded waiting room and promptly treat those requiring urgent care. Furthermore, in April 2015, we introduced the Japanese Triage and Acuity Scale (JTAS) to standardize the quality of triage care. Evaluation and analysis of 7,454 triage forms to identify future challenges revealed that the triage rate was 88% immediately after the incorporation of the JTAS, with 93 incomplete triage forms, 13 undertriage cases, and 18 overtriage cases. This showed that the severity of emergency was determined based only on subjective symptoms and complaints, with no application of objective physical assessment. We presented a list of analysis results to triage staff, further assessed undertriage cases, and provided feedback in monthly workshops. At 1 year after introduction, the rate of triage increased to 95%, with 12 incomplete forms, 9 undertriage cases, and 21 overtriage cases, and the number of cases increased where the severity of emergency was determined accurately from the entire clinical picture including vital signs and the cause of injury. These findings suggest that use of the JTAS enabled a standardized triage system to be established and that the assessment of undertriage cases and organization of continuous workshops improved the quality of triage and the skill of triage nurses.

OBJECTIVE: Rikkunshito, an herbal medicine, is widely prescribed in Japan for the treatment of anorexia and functional dyspepsia, and has been reported to recover reductions in food intake caused by cisplatin. We investigated whether rikkunshito could improve chemotherapy-induced nausea and vomiting (CINV) and anorexia in patients treated with cisplatin. METHODS: Patients with uterine cervical or corpus cancer who were to receive cisplatin (50 mg/m² day 1) and paclitaxel (135 mg/m² day 0) as first-line chemotherapy were randomly assigned to the rikkunshito group receiving oral administration on days 0–13 with standard antiemetics, or the control group receiving antiemetics only. The primary endpoint was the rate of complete control (CC: no emesis, no rescue medication, and no significant nausea) in the overall phase (0–120 hours). Two-tailed p<0.20 was considered significant in the planned analysis. RESULTS: The CC rate in the overall phase was significantly higher in the rikkunshito group than in the control group (57.9% vs. 35.3%, p=0.175), as were the secondary endpoints: the CC rate in the delayed phase (24–120 hours), and the complete response (CR) rates (no emesis and no rescue medication) in the overall and delayed phases (63.2% vs. 35.3%, p=0.095; 84.2% vs. 52.9%, p=0.042; 84.2% vs. 52.9%, p=0.042, respectively), and time to treatment failure (p=0.059). Appetite assessed by visual analogue scale (VAS) appeared to be superior in the rikkunshito group from day 2 through day 6. CONCLUSION: Rikkunshito provided additive effect for the prevention of CINV and anorexia.
Administration, Oral ; Anorexia* ; Antiemetics ; Appetite ; Cisplatin* ; Drug Therapy ; Dyspepsia ; Eating ; Herbal Medicine* ; Humans ; Japan ; Nausea* ; Paclitaxel* ; Time-to-Treatment ; Vomiting*