Methods: In total, 306 patients who received L5 floating lumbar fusion were included in this study. Clinical L5–S1 ASD was defined as newly developed radiculopathy in relation to the L5–S1 segment. Patients’ medical records and imaging data were retrospectively analyzed. The risk factors for clinical ASD were assessed by an inverse probability of treatment weighting-adjusted logistic regression analysis. Results: Clinical L5–S1 ASD occurred in 17 patients (5.6%). The mean onset time of L5–S1 ASD was 12.9±7.5 months after the primary surgery. Among these patients, 10 (58.8%) presented with clinical L5–S1 ASD within 12 months. Reoperation was performed in three patients (1.0%). The severity of L5–S1 disk degeneration did not affect the occurrence of L5–S1 ASD. Logistic regression analysis showed that the number of fusion levels was a significant risk factor for clinical L5–S1 ASD. Conclusions The incidence and characteristics of clinical L5–S1 ASD after L5 floating lumbar fusion were retrospectively investigated. This study established that the number of fusion levels was a significant candidate factor for clinical L5–S1 ASD. Careful clinical follow-up is deemed necessary after L5 floating lumbar fusion surgery, especially for patients who received multiple-level fusions.

Objective: Lenvatinib is an oral multitarget tyrosine kinase inhibitor (mTKI) and is recommended for patients with advanced hepatocellular carcinoma (HCC) with Child-Pugh A liver function, who are not amenable to surgical resection, locoregional treatment, or transcatheter arterial chemoembolization. Hepatogastric fistula is a rare complication with a poor prognosis in patients with HCC. Previous reports on fistula formation during mTKI therapy for HCC were all associated with sorafenib. Here, we report the first case of recurrent hepatogastric fistula during lenvatinib therapy for advanced HCC managed using an over-the-scope clip (OTSC).Patient: We present the case of a 73-year-old man with alcoholic liver cirrhosis who was treated for multiple HCC for 7 years. HCC was treated using repetitive transcatheter arterial chemoembolization, radiofrequency ablation, and sorafenib. Owing to disease progression, lenvatinib treatment was started. During lenvatinib treatment, recurrent hepatogastric fistulas developed. An OTSC was useful for fistula closure and prevention of recurrence.Results: The major cause of fistula formation is considered to be the direct invasion of HCC; however, HCC treatment might also be a contributing factor in our case. In addition, OTSC was useful for fistula closure.Conclusion: Clinicians should be aware of the fatal complications during HCC treatment.

We have previously reported on a predictive model for deficiency-excess pattern diagnosis that was unable to predict the medium pattern. In this study, we aimed to develop predictive models for deficiency, medium,and excess pattern diagnosis, and to confirm whether cutoff values for diagnosis differed between the clinics. We collected data from patients' first visit to one of six Kampo clinics in Japan from January 2012 to February 2015. Exclusion criteria included unwillingness to participate in the study, missing data, duplicate data, under 20 years old, 20 or less subjective symptoms, and irrelevant patterns. In total, 1,068 participants were included. Participants were surveyed using a 153-item questionnaire. We constructed a predictive model for deficiency, medium, and excess pattern diagnosis using a random forest algorithm from training data, and extracted the most important items. We calculated predictive values for each participant by applying their data to the predictive model, and created receiver operating characteristic (ROC) curves with excess-medium and medium-deficiency patterns. Furthermore, we calculated the cutoff value for these patterns in each clinic using ROC curves, and compared them. Body mass index and blood pressure were the most important items. In all clinics, the cutoff values for diagnosis of excess-medium and medium-deficiency patterns was > 0.5 and < 0.5, respectively. We created a predictive model for deficiency, medium, and excess pattern diagnosis from the data of six Kampo clinics in Japan. The cutoff values for these patterns fell within a narrow range in the six clinics.

Many patients with mental disorders visit emergency departments (EDs). However, the majority of these patients do not receive psychiatric assessment. In the present study, we investigated the detailed proportion of patients with mental disorders visiting an urban ED in the largest northern city in Japan. A retrospective chart review study was performed at a University Hospital from January 2012 to December 2015. The reasons for psychiatric consultations made by ED staff, and the primary psychiatric diagnoses were investigated. Among all living patients, 20% of them received consultations. The most common reason for consultation was suicide attempt followed by agitation or insomnia. Of all diagnoses, organic mental disorder was the most frequent and the mean age was significantly higher than the other diagnostic groups. Our study indicated that the frequency of psychiatric consultation was high. This indicates the high demand for mental health services at the ED. A thorough psychiatric assessment can provide adequate psychiatric services to acute patients; thereby possibly preventing suicide attempters from later actually dying by suicide.
Diagnosis ; Dihydroergotamine ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Japan* ; Mental Disorders ; Mental Health Services ; Neurocognitive Disorders ; Referral and Consultation* ; Retrospective Studies ; Sleep Initiation and Maintenance Disorders ; Suicide

The purpose of this study is to considerate the prediction formula for marathon time based on 20-m shuttle run test and training indexes in recreational runners. 100 male and 111 female recreational runners who have experienced one or more marathon races were measured. Each participant was measured with regard to physical characteristics, 20-m shuttle run test, and answered questionnaires about his/her training (monthly running distance, frequency of training, and years of experience of running training). Moreover, participants self-reported their best marathon time. Additionally, to examine the validity of the prediction formula, 14 male and 13 female recreational runners were measured using the 20-m shuttle run test and they answered the questionnaires about his/her training. The marathon time was significantly correlated with the participant’s BMI, the times of 20-m shuttle run test, the monthly running distance, the frequency of training and the years of experience of running training for both male and female runners. Subsequently, multiple regression analysis generated the prediction model for marathon time by the measurement items. Furthermore, in the examination of the validity of the prediction formula, predicted marathon time was significantly highly correlated with measured marathon time. This study suggested that the marathon time can be predicted by the 20-m shuttle run test, the monthly running distance, and the years of experience of running training and the predicted marathon time may be useful for the marathon race and training in recreational runners.

We have developed and operated a browser-based questionnaire system for Kampo medicine based on conventional questionnaires and review of systems to reveal implicit Kampo wisdom both in patients' questionnaire data and in some Kampo specialists' examination data. However, the questionnaire data were found to be inaccurate because too many questions were included and cumbersome input steps were required. The purpose of the present study was to solve these problems and to develop a new patient-centered questionnaire system with fewer questions and an easier input method. After analyzing inquiry database from collaborating institutes and hospitals, we deleted, combined, and added questions. We changed the evaluation method of symptoms from a visual analogue scale to a simple staged evaluation, and introduced another method to evaluate the main symptoms in each time of visit using a visual analogue scale. At the same time, a tool for predicting Kampo pattern diagnoses based on the questionnaire data was implemented. We have already started collecting more accurate and reliable data using the new questionnaire system. It is expected to support routine practices and facilitate more precise clinical research on Kampo medicine.

In Kampo medicine, a tongue examination, whereby the shape and color of the tongue is observed, is thought to reveal the constitution and condition of the patient. In Japan, numerous books on this tongue examination have been published. However, tongue findings are expressed differently in these books, and a standard description for such findings has yet to be established. A standard description would be useful when examining the tongue, and when educating students of Kampo medicine. We therefore compared how tongue colors and shapes were expressed in the Japanese literature on tongue examinations (12 publications).
Using these results, we have arrived at a standardized description for tongue findings in accordance with Kampo specialists of tongue diagnoses at many facilities. In the process, we focused on easily recognizable findings that can be noted with short clinical examination times, and that can also be understood by beginners.

OBJECTIVE: Many studies have reported pre-processing effects for brain volumetry; however, no study has investigated whether non-parametric non-uniform intensity normalization (N3) correction processing results in reduced system dependency when using an atlas-based method. To address this shortcoming, the present study assessed whether N3 correction processing provides reduced system dependency in atlas-based volumetry. MATERIALS AND METHODS: Contiguous sagittal T1-weighted images of the brain were obtained from 21 healthy participants, by using five magnetic resonance protocols. After image preprocessing using the Statistical Parametric Mapping 5 software, we measured the structural volume of the segmented images with the WFU-PickAtlas software. We applied six different bias-correction levels (Regularization 10, Regularization 0.0001, Regularization 0, Regularization 10 with N3, Regularization 0.0001 with N3, and Regularization 0 with N3) to each set of images. The structural volume change ratio (%) was defined as the change ratio (%) = (100 x [measured volume - mean volume of five magnetic resonance protocols] / mean volume of five magnetic resonance protocols) for each bias-correction level. RESULTS: A low change ratio was synonymous with lower system dependency. The results showed that the images with the N3 correction had a lower change ratio compared with those without the N3 correction. CONCLUSION: The present study is the first atlas-based volumetry study to show that the precision of atlas-based volumetry improves when using N3-corrected images. Therefore, correction for signal intensity non-uniformity is strongly advised for multi-scanner or multi-site imaging trials.
Adult ; Atlases as Topic ; Brain Mapping/*methods ; Female ; Humans ; Image Enhancement/methods ; Image Processing, Computer-Assisted/*methods ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Software ; Statistics, Nonparametric

We experienced a case of post-operative complication and chronic pain due to left pyeloplasty and uterine myomectomy successfully treated with Kampo medicine. A 55-year-old woman underwent pyeloplasty for ureteropelvic junction obstruction, and ureteral stent for ureteral stenosis caused by synechia after uterine myomectomy. She suffered from post-operative complication and chronic pain, which was becoming severe, and had a depressed mood. She visited our outpatient clinic for Kampo therapy. We prescribed bukuryoingohangekobokuto on the diagnoses such as qi deficiency, qi stagnation, and water retention. Her symptoms disappeared with this formulation. This case suggests the importance of considering qi disturbance when we treat patients with chronic pain using Kampo medicine.

We investigated prescriptions and drug costs at admission and discharge for 35 patients hospitalized in Department of Japanese Oriental (Kampo) Medicine, Chiba University Hospital from September 2006 to October 2008. They recovered after Kampo therapy from various non-acute diseases. The number of western drugs decreased from 3.7 at admission to 2.7 at discharge, thus their drug costs per day significantly decreased from302.1yen to 227.6 yen. The cost of Kampo medicines themselves, on the other hand, did not decrease significantly. Total drug costs, however, were significantly reduced from 437.8 yen at admission to 348.0 yen at discharge, so patients' overall costs were reduced by 20%. These results indicated that the proper use of Kampo medicine for various diseases would reduce drug costs and the impact of treatment expenses on medical economics, with improvement in disease outcomes.