Period prevalence of uveitis in human T-lymphotropic virus 1 carriers versus noncarriers in a highly endemic area: The Nagasaki Islands Study.

The magnitude of the effect of human T-lymphotropic virus 1 (HTLV-1) infection on uveitis remains unclear. We conducted a cross-sectional study in a highly endemic area of HTLV-1 in Japan. The study included 4265 residents (men, 39.2%), mostly middle-aged and older individuals with a mean age of 69.9 years, who participated in our surveys between April 2016 and September 2022. We identified HTLV-1 carriers by screening using chemiluminescent enzyme immunoassays and confirmatory tests, and the proportion of carriers was 16.1%. Participants with uveitis were determined from the medical records of all hospitals and clinics where certified ophthalmologists practiced. We conducted logistic regression analyses in an age- and sex-adjusted model to compute the odds ratio (OR) and 95% confidence interval (CI) of uveitis according to HTLV-1 infection status. Thirty-two (0.8%) participants had uveitis. For HTLV-1 carriers, the age- and sex-adjusted OR (95% CI) of uveitis was 3.27 (1.57-6.72) compared with noncarriers. In conclusion, HTLV-1 infection was associated with a higher risk of uveitis among mostly middle-aged and older Japanese residents in a highly endemic HTLV-1 area. Our findings suggest that physicians who treat HTLV-1 carriers should assess ocular symptoms, and those who diagnose patients with uveitis should consider HTLV-1 infection.

Profile of Nagasaki Islands Study (NaIS): A Population-Based Prospective Cohort Study on Multi-disease.

In an aging society, it is important to visualize the conditions of people living with diseases or disabilities, such as frailty and sarcopenia, and determine the environmental and genetic factors underlying such conditions. Atherosclerosis and arterial stiffness are key conditions between these factors and noncommunicable diseases. In 2014, we launched a population-based prospective open-cohort study, the Nagasaki Islands Study (NaIS), which was conducted in Goto City, located in the remote islands of Nagasaki Prefecture, Japan, mostly involving middle-aged and older residents. We conducted our own health checkups along with the annual standardized checkups organized by the municipality; recruited study participants; and started to follow-up with them for vital status (death), migration, and occurrence of diseases such as myocardial infarction, stroke, fracture, and human T-cell leukemia virus type 1 (HTLV-1) -associated uveitis. Our checkups were conducted as baseline surveys in different areas of Goto City during the fiscal years 2014-2016, secondary surveys during 2017-2019, and tertiary surveys since 2021, consisting of medical interviews, physical examinations, blood and urine tests, body composition measurements, osteoporosis screening, arterial stiffness measurements, carotid ultrasonography, and dental examination. A total of 4,957 residents participated in either the baseline or secondary surveys and were followed-up; and 3,594 and 3,364 residents (aged 27-96 and 28-98 years) participated in the baseline and secondary surveys, respectively. In conclusion, the NaIS has been undertaken to reveal the influence of aging and risk factors of noncommunicable diseases and disabilities, with an aim to contribute towards better healthcare in the future.

Diagnostic value of deep learning reconstruction for radiation dose reduction at abdominal ultra-high-resolution CT.

OBJECTIVES: We evaluated lower dose (LD) hepatic dynamic ultra-high-resolution computed tomography (U-HRCT) images reconstructed with deep learning reconstruction (DLR), hybrid iterative reconstruction (hybrid-IR), or model-based IR (MBIR) in comparison with standard-dose (SD) U-HRCT images reconstructed with hybrid-IR as the reference standard to identify the method that allowed for the greatest radiation dose reduction while preserving the diagnostic value. METHODS: Evaluated were 72 patients who had undergone hepatic dynamic U-HRCT; 36 were scanned with the standard radiation dose (SD group) and 36 with 70% of the SD (lower dose [LD] group). Hepatic arterial and equilibrium phase (HAP, EP) images were reconstructed with hybrid-IR in the SD group, and with hybrid-IR, MBIR, and DLR in the LD group. One radiologist recorded the standard deviation of attenuation in the paraspinal muscle as the image noise. The overall image quality was assessed by 3 other radiologists; they used a 5-point confidence scale ranging from 1 (unacceptable) to 5 (excellent). Superiority and equivalence with prespecified margins were assessed. RESULTS: With respect to the image noise, in the HAP and EP, LD DLR and LD MBIR images were superior to SD hybrid-IR images; LD hybrid-IR images were neither superior nor equivalent to SD hybrid-IR images. With respect to the quality scores, only LD DLR images were superior to SD hybrid-IR images. CONCLUSIONS: DLR preserved the quality of abdominal U-HRCT images even when scanned with a reduced radiation dose. KEY POINTS: • Lower dose DLR images were superior to the standard-dose hybrid-IR images quantitatively and qualitatively at abdominal U-HRCT. • Neither hybrid-IR nor MBIR may allow for a radiation dose reduction at abdominal U-HRCT without compromising the image quality. • Because DLR allows for a reduction in the radiation dose and maintains the image quality even at the thinnest slice section, DLR should be applied to abdominal U-HRCT scans.

Utility of Radial Scanning for the Identification of Arterial Hypervascularity of Hepatocellular Carcinoma on Gadoxetic Acid-Enhanced Magnetic Resonance Images.

OBJECTIVES: This study aimed to compare the accuracy of assessing the arterial hypervascularity of hepatocellular carcinoma (HCC) on dynamic computed tomography (CT) scans and gadoxetic acid (EOB)-enhanced magnetic resonance imaging (MRI) scans performed with radial sampling. METHODS: We studied the images of 40 patients with hypervascular HCC. A radiologist recorded the standard deviation of the attenuation (or the signal intensity [SI]) in subcutaneous fat tissue as the image noise (N) and calculated the contrast-to-noise ratio (CNR) as follows: (CNR) = (n-ROIT - n-ROIL)/N, where n-ROIT is the mean attenuation (or SI) of the tumor divided by the mean attenuation (or SI) of the aorta and n-ROIL is the mean attenuation (or SI) of the liver parenchyma divided by the mean attenuation (or SI) of the aorta. RESULTS: The CNR was significantly higher on EOB-enhanced MRI than on dynamic CT scans. CONCLUSIONS: For the assessment of HCC vascularity, EOB-enhanced MRI scans acquired with radial sampling were more accurate than dynamic CT images.

Tumor contact length of prostate cancer determined by a three-dimensional method on multiparametric magnetic resonance imaging predicts extraprostatic extension and biochemical recurrence.

OBJECTIVE: To evaluate the clinical benefit of tumor contact length as a predictor of pathological extraprostatic extension and biochemical recurrence in patients undergoing prostatectomy. METHODS: A total of 91 patients who underwent 3T multiparametric magnetic resonance imaging before prostatectomy from April 2014 to July 2019 were included. A total of 94 prostate cancer foci were analyzed retrospectively. We evaluated maximum tumor contact length, which was determined to be the maximum value in the three-dimensional directions, as a predictor of pathological extraprostatic extension and biochemical recurrence. RESULTS: A total of 19 lesions (20.2%) had positive pathological extraprostatic extension. Areas under the curves showed maximum tumor contact length to be a significantly better parameter to predict pathological extraprostatic extension than the Prostate Imaging Reporting and Data System (P = 0.002), tumor maximal diameter (P = 0.001), prostate-specific antigen (P = 0.020), Gleason score (P < 0.001), and clinical T stage (P < 0.001). Multivariate analysis showed maximum tumor contact length (P = 0.003) to be an independent risk factor for predicting biochemical recurrence. We classified the patients using preoperative factors (prostate-specific antigen >10, Gleason score >3 + 4 and maximum tumor contact length >10 mm) into three groups: (i) high-risk group (patients having all factors); (ii) intermediate-risk group (patients having two of three factors); and (iii) low-risk group (patients having only one or none of the factors). Kaplan-Meier curves showed that the high-risk group had significantly worse biochemical recurrence than the intermediate-risk group (P = 0.042) and low-risk group (P < 0.001). CONCLUSIONS: Our findings suggest that maximum tumor contact length is an independent predictor of pathological extraprostatic extension and biochemical recurrence. A risk stratification system using prostate-specific antigen, Gleason score and maximum tumor contact length might be useful for preoperative assessment of prostate cancer patients.

Advanced CT techniques for assessing hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the sixth-most common cancer in the world, and hepatic dynamic CT studies are routinely performed for its evaluation. Ongoing studies are examining advanced imaging techniques that may yield better findings than are obtained with conventional hepatic dynamic CT scanning. Dual-energy CT-, perfusion CT-, and artificial intelligence-based methods can be used for the precise characterization of liver tumors, the quantification of treatment responses, and for predicting the overall survival rate of patients. In this review, the advantages and disadvantages of conventional hepatic dynamic CT imaging are reviewed and the general principles of dual-energy- and perfusion CT, and the clinical applications and limitations of these technologies are discussed with respect to HCC. Finally, we address the utility of artificial intelligence-based methods for diagnosing HCC.

Impact of radiological morphology of clinical T1 renal cell carcinoma on the prediction of upstaging to pathological T3.

OBJECTIVES: Previous studies have reported that cases with clinical T1 renal cell cancer upstaging to pathological T3 are a risk factor to predicting postoperative recurrence after partial nephrectomy. The aim of our study was to investigate the impact of the radiological morphology of the enhanced CT scan of clinical T1 renal cell cancer on predicting upstaging to pathological T3. METHODS: Three hundred sixty-seven cases with clinical T1 renal cell cancer diagnosed from enhanced CT scans were enrolled in this study. Based on the findings from the enhanced CT scan, the cases were classified into 'round', the margins of which were smooth and round; 'lobular', one or more findings of smooth dent and no spiky dent were identified on the margin of the tumor; and 'irregular', one or more spiky dent were identified on the margin of the tumor. The association of postoperative upstaging with these radiological morphology and other clinical characteristics of each case was analyzed. RESULTS: Eighteen cases (4.9%) pathologically upstaged to T3a. Two round case (0.7%), 3 lobular cases (10.0%) and 13 irregular cases (22.0%) pathologically upstaged (P < 0.001, round + lobular versus irregular). Four of 17 cases (23.5%) with hilar tumors pathologically upstaged, while 14 of 350 cases (4%) with tumors pathologically upstaged in other sites (P < 0.001). Multivariate analysis revealed that irregular case was an independent factor in predicting upstaging to pathological T3a (P < 0.001). CONCLUSIONS: Evaluation of the radiological morphology of clinical T1 renal cell cancer based on enhanced CT scans is useful for predicting pathological upstaging.

Possibility of Deep Learning in Medical Imaging Focusing Improvement of Computed Tomography Image Quality.

Deep learning (DL), part of a broader family of machine learning methods, is based on learning data representations rather than task-specific algorithms. Deep learning can be used to improve the image quality of clinical scans with image noise reduction. We review the ability of DL to reduce the image noise, present the advantages and disadvantages of computed tomography image reconstruction, and examine the potential value of new DL-based computed tomography image reconstruction.

The role of mental disease on the association between multimorbidity and medical expenditure.

BACKGROUND: Multimorbidity is the presence of two or more chronic diseases and is associated with increased adverse outcomes, including hospitalization, mortality and frequency of use of medical institutions. OBJECTIVE: This study aimed to describe multimorbidity patterns, determine whether multimorbidity was associated with high medical expenditure, and determine whether mental diseases had an interaction effect on this association. METHODS: We conducted a claims data-based observational study. Data were obtained for 7526 individuals aged 0-75 years from a medical claims data set for Goto, Japan, over a 12-month period (2016-17). Annual medical expenditure was divided into quintiles; the fifth quintile represented high medical expenditure. Multimorbidity status was defined as the occurrence of two or more health conditions from 17 specified conditions. Odds ratios (OR) and 95% confidence intervals (CI) for high medical expenditure were calculated by number of comorbidities. RESULTS: In total, 5423 (72.1%) participants had multimorbidity. Multimorbidity was significantly associated with high medical expenditure, even after adjustment for age, sex and income category (OR: 10.36, 95% CI: 7.57-14.19; P < 0.001). Mental diseases had a significant interaction effect on the association between multimorbidity and high medical expenditure (P = 0.001). CONCLUSIONS: Multimorbidity is associated with high medical expenditure in Japan. Mental diseases may contribute to increased medical costs.

Magnetic resonance imaging/transrectal ultrasonography fusion targeted prostate biopsy finds more significant prostate cancer in biopsy-naïve Japanese men compared with the standard biopsy.

OBJECTIVE: To assess the clinical benefits of magnetic resonance imaging/transrectal ultrasound fusion-targeted biopsy for biopsy-naïve Japanese men. METHODS: Between February 2017 and August 2018, 131 biopsy-naïve men who underwent targeted biopsy together with 10-core systematic biopsy at Hiroshima University Hospital were retrospectively investigated. Multiparametric magnetic resonance imaging findings were reported based on Prostate Imaging Reporting and Data System version 2. RESULTS: The overall cancer detection rates per patient were 69.5% in systematic biopsy + targeted biopsy cores, 61.1% in systematic biopsy cores and 61.1% in targeted biopsy cores. The detection rates for clinically significant prostate cancer were 43.5% in targeted biopsy cores and 35.9% in systematic biopsy cores (P = 0.04), whereas the detection rates for clinically insignificant prostate cancer were 17.6% and 25.2% respectively (P = 0.04). Lesions in the peripheral zone were diagnosed more with clinically significant prostate cancer (54.8% vs 20.7%, P < 0.001) and International Society of Urological Pathology grade (3.2 vs 2.7, P = 0.02) than that in the inner gland. Just 4.2% (3/71) of Prostate Imaging Reporting and Data System category 2 and 3 lesions in the middle or base of the inner gland were found to have clinically significant prostate cancer. The cancer detection rate per core was 42.3% in targeted biopsy cores, whereas it was 17.9% in systematic biopsy cores (P < 0.001). CONCLUSIONS: Targeted biopsy is able to improve the diagnostic accuracy of biopsy in detection of clinically significant prostate cancer by reducing the number of clinically insignificant prostate cancer detections compared with 10-core systematic biopsy in biopsy-naïve Japanese men. In addition, the present findings suggest that patients with Prostate Imaging Reporting and Data System category 2 or 3 lesions at the middle or base of the inner gland might avoid biopsies.

Breastfeeding and offspring's compassion and empathy in adulthood: A study with an over 30-year follow-up.

This study investigated whether breastfeeding predicts offspring's dispositional compassion and empathy from early adulthood to middle age. The parents of the participants (N = 1,394) of the Young Finns study answered questions about breastfeeding in 1983, and the participants' compassion and empathy were evaluated in 1997-2012 (participants were aged 20-50 years). Breastfeeding did not predict the course of compassion or empathy in adulthood at the age of 20-50 years. The associations remained non-significant, when adjusted for age, gender, socioeconomic factors, and a wide range of characteristics of the family environment (including mother's gestational age; premature birth; birth weight; number of other children at home; parental mental disorder; parental relationship status; parental postnatal smoking; parental postnatal alcohol use; parenting behavior; and child's externalizing behavior). In conclusion, breastfeeding seems not to predict offspring's compassion or empathy in adulthood. The findings may present a hopeful perspective for children growing up with non-breastfeeding caregivers.

Deep learning reconstruction improves image quality of abdominal ultra-high-resolution CT.

OBJECTIVES: Deep learning reconstruction (DLR) is a new reconstruction method; it introduces deep convolutional neural networks into the reconstruction flow. This study was conducted in order to examine the clinical applicability of abdominal ultra-high-resolution CT (U-HRCT) exams reconstructed with a new DLR in comparison to hybrid and model-based iterative reconstruction (hybrid-IR, MBIR). METHODS: Our retrospective study included 46 patients seen between December 2017 and April 2018. A radiologist recorded the standard deviation of attenuation in the paraspinal muscle as the image noise and calculated the contrast-to-noise ratio (CNR) for the aorta, portal vein, and liver. The overall image quality was assessed by two other radiologists and graded on a 5-point confidence scale ranging from 1 (unacceptable) to 5 (excellent). The difference between CT images subjected to hybrid-IR, MBIR, and DLR was compared. RESULTS: The image noise was significantly lower and the CNR was significantly higher on DLR than hybrid-IR and MBIR images (p < 0.01). DLR images received the highest and MBIR images the lowest scores for overall image quality. CONCLUSIONS: DLR improved the quality of abdominal U-HRCT images. KEY POINTS: • The potential degradation due to increased noise may prevent implementation of ultra-high-resolution CT in the abdomen. • Image noise and overall image quality for hepatic ultra-high-resolution CT images improved with deep learning reconstruction as compared to hybrid- and model-based iterative reconstruction.

Correction to: Deep learning reconstruction improves image quality of abdominal ultra-high-resolution CT.

The original version of this article, published on 11 April 2019, unfortunately, contained a mistake. The following correction has therefore been made in the original: The image in Fig. 3c was wrong. The corrected figure is given below. The original article has been corrected.

Utility of radial reformation of three-dimensional fat-suppressed multi-echo gradient-recalled-echo images for the evaluation of acetabular labral injuries and femoroacetabular impingement.

OBJECTIVES: To assess the utility of the radial reformation of three-dimensional fat-suppressed multi-echo gradient-recalled-echo (3D FS me-GRE) for evaluating acetabular labral injuries and femoroacetabular impingement (FAI). MATERIALS AND METHODS: A total of 25 patients with suspected acetabular labral injuries were examined using 3D FS me-GRE and radial 2D T2*-weighted imaging (T2*WI) on a 3-T magnetic resonance imaging (MRI) scanner. The range of acetabular labral injuries was evaluated by radial reformation through the center of the acetabulum perpendicular to the plane across the entire acetabular rim (type 1 radial reformation) of 3D FS me-GRE and radial 2D T2*WI. To evaluate the FAI morphology, we performed radial reformation perpendicular to the central axis of the femoral head and neck (type 2 radial reformation) of 3D FS me-GRE. RESULTS: Acetabular labral injuries were identified in 23 patients, and no acetabular labral injury was seen in two patients on type 1 radial reformation of 3D FS me-GRE and radial 2D T2*WI. The diagnostic concordance rate for the range of acetabular labral injuries between the two imaging methods was 76.0%, and there was excellent agreement for the injured angles (r = 0.977, p < 0.001). FAI morphology could be evaluated in all patients (no FAI, n = 8; cam, n = 10; pincer, n = 4; combined cam and pincer, n = 3) using type 2 radial reformation of 3D FS me-GRE. CONCLUSIONS: Type 1 and type 2 radial reformations of 3D FS me-GRE imaging were useful for evaluating acetabular labral injuries and determining whether patients with acetabular labral injuries have FAI, respectively.

Clinical staging of upper urinary tract urothelial carcinoma for T staging: Review and pictorial essay.

Upper urinary tract urothelial carcinoma is staged using the TNM classification of malignant tumors. Preoperative TNM is important for treatment planning. Computed tomography urography is now widely used for clinical survey of upper urinary tract carcinoma because of its diagnostic accuracy. Computed tomography urography is recommended as the first-line imaging procedure in several guidelines. Several reports stated that computed tomography urography is also useful for staging. However, no educational and practical reviews detailing the T staging of upper urinary tract urothelial carcinomas using imaging are available. We discuss the scanning protocol, T staging using computed tomography urography, limitations, magnetic resonance imaging, computed tomography comparison and pitfalls in imaging of upper urinary tract urothelial carcinoma. A recent study reported the high diagnostic accuracy of computed tomography urography with respect to T3 or higher stage tumors. To date, images that show a Tis-T2 stage have not been reported, but various studies are ongoing. Although magnetic resonance imaging has lower spatial resolution than computed tomography urography, magnetic resonance imaging can be carried out without radiation exposure or contrast agents. Magnetic resonance imaging also offers the unique ability of diffusion-weighted imaging without contrast agent use. Some researchers reported that diffusion-weighted imaging is useful not only for detecting lesions, but for predicting the T stage and tumor grade. We recommend the appropriate use of computed tomography and magnetic resonance while considering the limitations of each modality and the pitfalls in upper urinary tract urothelial carcinoma imaging.

Preoperative risk classification using neutrophil-lymphocyte ratio and hydronephrosis for upper tract urothelial carcinoma.

BACKGROUND: To improve the prediction of outcomes in patients who will undergo radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC), we examined the preoperative prognostic factors and established a risk classification model. METHODS: A total of 148 patients who underwent RNU without history of neo-adjuvant chemotherapy between 1999 and 2016 in Hiroshima University Hospital were retrospectively reviewed. Associations between preoperative/clinicopathological factors and outcomes including cancer-specific survival (CSS) and recurrence-free survival (RFS) were assessed. We specifically looked at neutrophil-lymphocyte ratio (NLR) due to growing evidence on its predictive role in cancer prognosis prediction. RESULTS: Preoperative elevated neutrophil-lymphocyte ratio (pre-op NLR, ≥3.0) and hydronephrosis (≥grade 2) were associated with advanced pathological stage; and were identified as independent predictive factors of shorter CSS and RFS in univariate and multivariate analysis. We classified the patients in three groups using preoperative factors and found that the 5-year CSS was 94.5, 75.9 and 44.7% and the 5-year RFS was 74.3, 57.6 and 28.7% in the low-risk group (neither pre-op NLR nor hydronephrosis), intermediate-risk group (either pre-op NLR or hydronephrosis) and high-risk group (pre-op NLR and hydronephrosis), respectively. High-risk group had significantly worse CSS (P = 0.0172) and RFS (P = 0.0014) than intermediate-risk group and low-risk group (CSS (P < 0.0001) and RFS (P < 0.0001)). CONCLUSIONS: Elevated pre-op NLR and hydronephrosis were identified as independent prognostic factors in patients with UTUC. These simple preoperative factors can stratify three prognostic groups and may help urologists in clinical decision-making before RNU.

Preliminary Results of High-Precision Computed Diffusion Weighted Imaging for the Diagnosis of Hepatocellular Carcinoma at 3 Tesla.

OBJECTIVE: To compare the utility of high-precision computed diffusion-weighted imaging (hc-DWI) and conventional computed DWI (cc-DWI) for the diagnosis of hepatocellular carcinoma (HCC) at 3 T. METHODS: We subjected 75 HCC patients to DWI (b-value 150 and 600 s/mm). To generate hc-DWI we applied non-rigid image registration to avoid the mis-registration of images obtained with different b-values. We defined c-DWI with a b-value of 1500 s/mm using DWI with b-value 150 and 600 s/mm as cc-DWI, and c-DWI with b-value 1500 s/mm using registered DWI with b-value 150 and 600 s/mm as hc-DWI. A radiologist recorded the contrast ratio (CR) between HCC and the surrounding hepatic parenchyma. RESULTS: The CR for HCC was significantly higher on hc- than cc-DWIs (median 2.0 vs. 1.8, P < 0.01). CONCLUSION: The CR of HCC can be improved with image registration, indicating that hc-DWI is more useful than cc-DWI for the diagnosis of HCC.

Temporal dynamics of neural activity in motor execution and inhibition processing.

Although many neuroimaging studies using functional magnetic resonance imaging have shown the neuronal networks for motor execution and inhibition processing, the precise activation timing of each brain region is not yet well understood. In the present study, we investigated the temporal dynamics of neural activities in multiple brain regions using magnetoencephalography (MEG) and electroencephalography (EEG) simultaneously during somatosensory Go/No-go paradigms. The results of MEG showed that neural activities in the bilateral premotor area at approximately 150 ms and in the primary motor cortex at approximately 250 ms were only detected in Go trials, while brain responses in the bilateral prefrontal cortex at approximately 170 ms were only observed in No-go trials. In addition, the amplitudes of the N140 and P300 components in EEG was significantly larger in No-go trials than in Go trials, and the latencies of N140 and P300 were significantly later in No-go trials than in Go trials. Our results indicated the time courses of neural processing in response execution and inhibition processing, and revealed differences in their underlying neural mechanisms.

T categorization of urothelial carcinomas of the ureter with CT: preliminary study of new diagnostic criteria proposed for differentiating T2 or lower from T3 or higher.

OBJECTIVE: The purposes of this study were to propose and evaluate new diagnostic criteria for the differentiation of category T2 or lower from T3 or higher ureteral urothelial carcinomas on contrast-enhanced CT (CECT) images and to investigate the diagnostic applicability of the criteria. MATERIALS AND METHODS: The study included 30 patients with ureteral urothelial carcinoma who underwent CECT before surgery. For all patients, unenhanced and contrast-enhanced images (nephrographic and excretory phases) were acquired with a 16- or 64-MDCT scanner. The slice thickness of axial images was 5 mm. A grading system was devised that focused on spiculation and mass formation along the ureter on CECT images to differentiate T2 or lower from T3 or higher tumors. Three radiologists not specialized in abdominal radiology participated in an observer performance study to investigate the diagnostic utility of the criteria. Jackknife ROC analysis was used to compare the radiologists' diagnostic performance without and with the proposed diagnostic criteria. In addition, two board-certified radiologists used consensus to determine the CT grade, and the correlation between CT and pathologic findings was assessed. RESULTS: The mean AUCs for the three radiologists without and with the proposed criteria were 0.54 (SD, 0.09) and 0.73 (SD, 0.08), indicating a statistically significant difference (p<0.01). For the CT-pathologic correlation, the diagnostic sensitivity and specificity of the proposed criteria with respect to pT3 and higher tumors were 87.5% (14/16) and 92.9% (13/14). CONCLUSION: The proposed CT grading system was accurate for differentiating T2 or lower from T3 or higher ureteral urothelial carcinoma.

The short and long-term efficacy of nurse-led interventions for improving blood pressure control in people with hypertension in primary care settings: a systematic review and meta-analysis.

BACKGROUND: Previous systematic reviews suggest that nurse-led interventions improve short-term blood pressure (BP) control for people with hypertension. However, the long-term effects, adverse events, and appropriate target BP level are unclear. This study aimed to evaluate the long-term efficacy and safety of nurse-led interventions. METHODS: We conducted a systematic review and meta-analysis. We searched the Cochrane Central Register of Controlled Trials, PubMed, and CINAHL, as well as three Japanese article databases, as relevant randomized controlled trials from the oldest possible to March 2021. This search was conducted on 17 April 2021. We did an update search on 17 October 2023. We included studies on adults aged 18 years or older with hypertension. The treatments of interest were community-based nurse-led BP control interventions in addition to primary physician-provided care as usual. The comparator was usual care only. Primary outcomes were long-term achievement of BP control goals and serious adverse events (range: 27 weeks to 3 years). Secondary outcomes were short-term achievement of BP control goals and serious adverse events (range: 4 to 26 weeks), change of systolic and diastolic BP from baseline, medication adherence, incidence of hypertensive complications, and total mortality. RESULTS: We included 35 studies. Nurse-led interventions improved long-term BP control (RR 1.10, 95%CI 1.03 to 1.18). However, no significant differences were found in the short-term effects of nurse-led intervention compared to usual care about BP targets. Little information on serious adverse events was available. There was no difference in mortality at both terms between the two groups. Establishing the appropriate target BP from the extant trials was impossible. CONCLUSIONS: Nurse-led interventions may be more effective than usual care for achieving BP control at long-term follow-up. It is important to continue lifestyle modification for people with hypertension. We must pay attention to adverse events, and more studies examining appropriate BP targets are needed. Nurse-led care represents an important complement to primary physician-led usual care.