Decreased Hepatic Functional Reserve Increases the Risk of Piperacillin/Tazobactam-Induced Abnormal Liver Enzyme Levels: A Retrospective Case-Control Study.

BACKGROUND: Piperacillin/tazobactam (PIPC/TAZ), which is a combination of a beta-lactam/beta-lactamase inhibitor, often causes liver enzyme abnormalities. The albumin-bilirubin (ALBI) score is a simple index that uses the serum albumin and total bilirubin levels for estimating hepatic functional reserve. Although patients with low hepatic reserve may be at high risk for drug-induced liver enzyme abnormalities, the relationship between PIPC/TAZ-induced abnormal liver enzymes levels and the ALBI score remains unknown. OBJECTIVE: This study aimed to elucidate the relationship between PIPC/TAZ-induced abnormal liver enzyme levels and the ALBI score. METHODS: This single-center retrospective case-control study included 335 patients. The primary outcome was PIPC/TAZ-induced abnormal liver enzyme levels. We performed COX regression analysis with male gender, age (≥75 years), alanine aminotransferase level (≥20 IU/L), and ALBI score (≥-2.00) as explanatory factors. To investigate the influence of the ALBI score on the development of abnormal liver enzyme levels, 1:1 propensity score matching between the ≤-2.00 and ≥-2.00 ALBI score groups was performed using the risk factors for drug-induced abnormal liver enzyme levels. RESULTS: The incidence of abnormal liver enzyme levels was 14.0% (47/335). COX regression analysis revealed that an ALBI score ≥-2.00 was an independent risk factor for PIPC/TAZ-induced abnormal liver enzyme levels (adjusted hazard ratio: 3.08, 95% coefficient interval: 1.207-7.835, P = 0.019). After 1:1 propensity score matching, the Kaplan-Meier curve revealed that the cumulative risk for PIPC/TAZ-induced abnormal liver enzyme levels was significantly higher in the ALBI score ≥-2.00 group (n = 76) than in the <-2.00 group (n = 76) (P = 0.033). CONCLUSION AND RELEVANCE: An ALBI score ≥-2.00 may predict the development of PIPC/TAZ-induced abnormal liver enzyme levels. Therefore, frequent monitoring of liver enzymes should be conducted to minimize the risk of severe PIPC/TAZ-induced abnormal liver enzyme levels in patients with low hepatic functional reserve.

Validation of the Diagnostic Criteria for IgG4-Related Periaortitis/Periarteritis and Retroperitoneal Fibrosis (IgG4PA/RPF) 2018, and Proposal of a Revised 2023 Version for IgG4-Related Cardiovascular/Retroperitoneal Disease.

BACKGROUND: In 2018, diagnostic criteria were introduced for IgG4-related periaortitis/periarteritis and retroperitoneal fibrosis (PA/RPF). This study assessed the existing criteria and formulated an improved version.Methods and Results: Between August 2022 and January 2023, we retrospectively analyzed 110 Japanese patients diagnosed with IgG4-related disease (IgG4-RD) involving cardiovascular and/or retroperitoneal manifestations, along with 73 non-IgG4-RD patients ("mimickers") identified by experts. Patients were stratified into derivation (n=88) and validation (n=95) groups. Classification as IgG4-RD or non-IgG4-RD was based on the 2018 diagnostic criteria and various revised versions. Sensitivity and specificity were calculated using experts' diagnosis as the gold standard for the diagnosis of true IgG4-RD and mimickers. In the derivation group, the 2018 criteria showed 58.5% sensitivity and 100% specificity. The revised version, incorporating "radiologic findings of pericarditis", "eosinophilic infiltration or lymphoid follicles", and "probable diagnosis of extra-PA/-RPF lesions", improved sensitivity to 69.8% while maintaining 100% specificity. In the validation group, the original and revised criteria had sensitivities of 68.4% and 77.2%, respectively, and specificities of 97.4% and 94.7%, respectively. CONCLUSIONS: Proposed 2023 revised IgG4-related cardiovascular/retroperitoneal disease criteria show significantly enhanced sensitivity while preserving high specificity, achieved through the inclusion of new items in radiologic, pathological, and extra-cardiovascular/retroperitoneal organ categories.

Deep-Seated Fluids in Thermal Waters Before and After the 2016 Kumamoto Earthquakes.

Noble gases, oxygen-hydrogen isotope ratios, and ion compositions were measured at three sampling points (KUM, OTN, and ASO) from December 2013 to July 2021. The 3 He/4 He values at the three sampling points remained stable in the range of 3-4 Ra throughout the observation period, suggesting that the supply of deep-seated gases to the aquifer was stable. The 4 He/20 Ne values of KUM and OTN indicate that the supply of surface-source fluids to the aquifer decreased relative to that of deep-seated fluids at KUM and OTN. In contrast, in the ASO site, both the surface- and deep-seated fluids supplied to the aquifer were stable. The δD-δ18 O relationship indicated the supply of deep-seated water to the KUM and OTN aquifers but not to the ASO aquifer. Nevertheless, the δD-δ18 O relationship remained stable throughout the observation period, suggesting that the supply of deep-seated water to the three stations was stable. The Li/Cl and 1/Cl relationships for the three sampling points were plotted within a narrow range throughout the observation period, suggesting that the groundwater recharge was stable. Neither spikes nor step changes owing to the 2016 Kumamoto earthquake were observed in any of the data. These results indicate that the KUM and OTN aquifers are constantly supplied with deep fluids from the fluid-rich zone beneath the Kumamoto region, and that only deep-seated gas was supplied to the ASO aquifer. We also confirmed that these supply conditions were unaffected by the 2016 Kumamoto earthquake or the subsequent aftershock activity.

Origin of an orbiting star around the galactic supermassive black hole.

The tremendous tidal force that is linked to the supermassive black hole (SMBH) at the center of our galaxy is expected to strongly subdue star formation in its vicinity. Stars within 1'' from the SMBH thus likely formed further from the SMBH and migrated to their current positions. In this study, spectroscopic observations of the star S0-6/S10, one of the closest (projected distance from the SMBH of ≈0''.3) late-type stars were conducted. Using metal absorption lines in the spectra of S0-6, the radial velocity of S0-6 from 2014 to 2021 was measured, and a marginal acceleration was detected, which indicated that S0-6 is close to the SMBH. The S0-6 spectra were employed to determine its stellar parameters including temperature, chemical abundances ([M/H], [Fe/H], [α/Fe], [Ca/Fe], [Mg/Fe], [Ti/Fe]), and age. As suggested by the results of this study, S0-6 is very old (≳10 Gyr) and has an origin different from that of stars born in the central pc region.

Effect of Ceftriaxone Dosage and Albumin-Bilirubin Score on the Risk of Ceftriaxone-Induced Liver Injury.

The albumin-bilirubin (ALBI) score is an index of hepatic functional reserve and is calculated from serum albumin and total bilirubin levels. However, the relationship between ceftriaxone (CTRX)-induced liver injury and ALBI score remains unknown. Therefore, we aimed to elucidate the risk of CTRX-induced liver injury based on the ALBI scores and CTRX dosage. This was a single-center, retrospective, case-control study of 490 patients and the primary outcome was CTRX-induced liver injury. We performed a COX regression analysis using age ≥75 years, male sex, alanine aminotransferase levels, ALBI score, and CTRX dosage regimen (4 ≥2 or 1 g/d) as explanatory factors. We also performed 1 : 1 propensity score matching between non-liver injury and liver injury groups. The incidence of liver injury was 10.0% (49/490). In COX regression analysis, CTRX 4 g/d was an independent risk factor for liver injury (95% coefficient interval: 1.05-6.96, p = 0.04). Meanwhile, ALBI score ≥-1.61 was an independent factor for liver injury (95% coefficient interval: 1.03-3.22, p = 0.04) with the explanatory factor of ≥2 and 1 g/d. The Kaplan-Meier curve indicated that the cumulative risk for CTRX-induced liver injury was significantly higher in the ALBI score ≥-1.61 group than in the ALBI score <-1.61 group before propensity score matching (p = 0.032); however, no significant differences were observed after propensity score matching (p = 0.791). These findings suggest that in patients treated with CTRX with ALBI score ≥-1.61, frequent liver function monitoring should be considered.

Effect of pharmacist-led intervention protocol on preventing postoperative delirium after elective cardiovascular surgery.

Postoperative delirium (PD) is an acute brain dysfunction, with a particularly high incidence after cardiovascular surgery. Pharmacist-led interventions show limited evidence in attenuating PD in cardiovascular surgery. In this retrospective cohort study, we aimed to clarify the risk factors of PD for cardiovascular surgery focused on pharmacotherapy and elucidate the effect of pharmacist-led intervention on the PD attenuation rate based on protocol-based pharmaceutical management (PBPM). This study included 142 adult patients who underwent elective valve replacement or valvuloplasty. The risk factors for PD were investigated using multivariate logistic regression analysis. Taking risk factors into consideration, a protocol was developed to discontinue benzodiazepines prescriptions by ward pharmacists, and replace with ramelteon and suvorexant if all the following factors apply: 1) number of medications ≥ 6 drugs, 2) number of doses to take ≥ 4 times, and 3) regular use of benzodiazepines or insomnia. Subsequently, the PD rate was compared during a period of two years and 6 months between the pre-PBPM (n = 39) and post-PBPM (n = 62). The PD rate for elective valve replacement or valvuloplasty was 25% (35/142). The adjusted odds ratio for polypharmacy was 3.3 (95% confidence interval: 1.2-8.9, p = 0.016), suggesting that preoperative risk assessment may be essential for patients with polypharmacy. The PD rate significantly decreased to 13% (8/62) in the post-PBPM group compared with 33% (13/39) in the pre-PBPM group (p = 0.014). There was a significant decrease in benzodiazepines use in post-PBPM compared with pre-PBPM (p = 0.026); however, the rate of ramelteon and orexin receptor antagonists use increased by PBPM introduction (p < 0.001). Although the present PBPM still requires further modification, it is simple and potentially useful for pharmacists to assess the risk of patients undergoing any elective cardiovascular surgery.

Interval walking training in type 2 diabetes: A pilot study to evaluate the applicability as exercise therapy.

There are few established easy-to-perform exercise protocols with evidence-based effects for individuals with type 2 diabetes (T2D). A unique exercise regimen, interval walking training (IWT), has been reported to be beneficial for improving metabolic function, physical fitness and muscle strength in adults of overall health. This pilot study aims to demonstrate descriptive statistics of IWT adherence and changes in various data before and after the intervention of IWT in adults with T2D, perform statistical hypothesis testing, and calculate effect sizes. We performed a single-arm interventional pilot study with IWT for 20 weeks. We enrolled 51 participants with T2D aged 20-80 years with glycohemoglobin (HbA1c) levels of 6.5-10.0% (48-86 mmol/mol) and a body mass index of 20-34 kg/m2, respectively. The target was 60 min/week of fast walking for 20 weeks. The participants visited the hospital and were examined at 4-week intervals during this period. Between the start of IWT and after 20 weeks, we measured and evaluated changes in glucose and lipid metabolism data, body composition, physical fitness, muscle strength, dietary calorie intake, and daily exercise calories. All included participants completed IWT, with 39% of them reaching the target length of fast walking over 1,200 minutes in 20 weeks. In the primary outcome, HbA1c levels, and in the secondary, lipid metabolism and body composition, no significant changes were observed except for high-density lipoprotein cholesterol (HDL-C) (from 1.4 mmol/L to 1.5 mmol/L, p = 0.0093, t-test). However, in the target achievement group, a significant increase in VO2 peak by 10% (from 1,682 mL/min to 1,827 mL/min, p = 0.037, t-test) was observed. Effect sizes were Cohen's d = 0.25 of HDL-C, -0.55 of triglyceride, and 0.24 of VO2 peak in the target achievement group, which were considered to be of small to medium clinical significance. These results could be solely attributed to IWT since there were no significant differences in dietary intake and daily life energy consumption before and after the study. IWT could be highly versatile and was suggested to have a positive effect on lipid metabolism and physical fitness. In future randomized controlled trial (RCT) studies, the detailed effects of IWT, focusing on these parameters, will be examined. Trial registration: This trial was registered with the Japanese University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR: Usefulness on interval walking training in patients with type 2 diabetes. 000037303).

Radiation dosimetry and pharmacokinetics of the tau PET tracer florzolotau (18F) in healthy Japanese subjects.

OBJECTIVE: Abnormal aggregation of tau in the brain is a major contributing factor in various neurodegenerative diseases. Florzolotau (18F) (florzolotau, APN-1607, PM-PBB3) has been shown to be a probe for tau fibrils in an animal model and patients with Alzheimer's disease and those with non-Alzheimer's disease tauopathies. The objective of this study is to evaluate the safety, pharmacokinetics, and radiation dose following a single intravenous administration of florzolotau in healthy Japanese subjects. METHODS: Three healthy male Japanese subjects aged between 20 and 64 were enrolled in this study. Subjects were determined to be eligible based on the screening assessments at the study site. Subjects received a single intravenous dose of 195.0 ± 0.5 MBq of florzolotau and underwent the whole-body PET scan 10 times in total to calculate absorbed doses to major organs/tissues and effective dose. Radioactivities in whole blood and urine were also measured for pharmacokinetic evaluation. Absorbed doses to major organs/tissues and effective dose were estimated using the medical internal radiation dose (MIRD) method. Vital signs, electrocardiography (ECG), and blood tests were done for safety evaluation. RESULTS: The intravenous injection of florzolotau was well tolerated. There were no adverse events or clinically detectable pharmacologic effects related to the tracer in any subjects. No significant changes in vital signs and ECG were observed. The highest mean initial uptake at 15 min after injection was in the liver (29.0 ± 4.0%ID), intestine (4.69 ± 1.65%ID), and brain (2.13 ± 0.18%ID). The highest absorbed dose was 508 µGy/MBq of the gallbladder wall, followed by the liver of 79.4 µGy/MBq, the pancreas of 42.5 µGy/MBq, and the upper large intestine of 34.2 µGy/MBq. The effective dose was calculated as 19.7 µSv/MBq according to the tissue weighting factor reported by ICRP-103. CONCLUSION: Florzolotau intravenous injection was well tolerated in healthy male Japanese subjects. The effective dose was determined as 3.61 mSv when 185 MBq florzolotau was given.

Pharmacist's interventions in factors contributing to medication errors reduces medication errors in self-management of patients in the rehabilitation ward.

BACKGROUND: The number of medications, number of administrations per day, dosing frequency on indicated day, and medication from multiple prescriptions are the medication factors prone to medication errors in self-management that have been previously reported. However, whether pharmacists actually intervene in medication factors that affect medication error occurrences in self-management is unclear. Therefore, we conducted this study to clarify these issues. METHOD: This study included patients who underwent self-management in the rehabilitation ward of Higashinagoya National Hospital. From April 2019 to March 2020, a one-pharmacist period existed, and from April 2020 to March 2021, a two-pharmacist period existed. The number of patient instructions and interventions were expected to increase with an increase in the number of pharmacists. Considering this to be an environment of differential interventions by pharmacists, a pre-post-test design was conducted with all self-managed patients in both the time periods. The primary and secondary endpoints were the proportion of medication error occurrences and proportion of pharmacist's interventions in medication factors, respectively. RESULT: The proportions of medication error occurrences during the one-pharmacist and two-pharmacist periods were 41% (71/173) and 28% (51/180) (relative risk 0.690, 95% confidential interval 0.515-0.925), respectively. The proportion of pharmacist's interventions in medication factors in the one-pharmacist period was 13% (22/173) and 22% (40/180) in the two-pharmacist period; there was an increase in the proportion of pharmacist's interventions in medication factors in the two-pharmacist period. CONCLUSION: The proportion of medication error occurrences was significantly lower in the two-pharmacist period than that in the one-pharmacist period. This can be attributed to the increase in the proportion of pharmacist's interventions in medication factors. Therefore, an environment in which pharmacists could intervene in the medication factors to prevent medication errors in advance is necessary.

Analysis of medication and prescription background risk factors contributing to oral medication administration errors by nurses: A case-control study.

Medication errors, including overdose and underdose, have a significant impact on patients and the medical economy. We need to prevent or avoid recurring medication errors. Therefore, we conducted a survey to identify medication and prescription background risk factors contributing to the administration of medication by nurses. This study surveyed cases of medication administration errors. This study was conducted at Higashinagoya National Hospital from April 1, 2018, to October 31, 2019. Patients' backgrounds and medication and prescription background risk factors were investigated. Three control cases were randomly selected for each medication error case. We defined the group of medication error cases as the medication error group and the group of control cases as the no-medication-error group. A logistic regression analysis was performed for factors related to medication errors. A total of 202 patients were included in the medication error group. The median age and number of medications were 78 years and 7, respectively. A total of 606 cases were included in the no-medication-error group. The median age and number of medications were 77 years and 6, respectively. The factors that exhibited a relationship with the medication error group were the number of administrations per day, dosing frequency on indicated days, prescription and start dates were the same, medications from multiple prescriptions, and continuous use of a medication received prior to admission. This study identified existing medication and prescription background risk factors. Overlapping risk factors from these groups might contribute to medication administration errors. Therefore, reviewing these factors is necessary to avoid recurring medication administration errors.

Analysis of factors contributing to medication errors during self-management of medication in the rehabilitation ward: a case control study.

BACKGROUND: In the rehabilitation ward, many elderly patients require continuous use of medication after a stroke or bone fracture, even after discharge. They are encouraged to self-manage their medications from the time of admission. Medication errors, such as a missed dose or incorrect administered medication can worsen conditions, resulting in recurrent strokes, fractures, or adverse effects. The study was aimed to identify risk factors, such as medication and prescription, contributing to errors in self-management of medication. METHODS: This study was conducted on patients who self-managed their medication in the rehabilitation ward of Higashinagoya National Hospital from April 2018 to March 2020. The patient background including age and sex were investigated. The medication factors examined include the number of medications and administrations per day, dosing frequency on indicated days, prescription and start date are the same, medications from multiple prescriptions, and one package or one tablet at each dosage. The group of medication error cases were defined as the medication error group and that of control cases as the no-medication error group. A logistic regression analysis was performed for factors related to medication errors. RESULTS: A total of 348 patients were included in the study, of which 154 patients made medication errors, with 374 total medication error cases. The median number of medications in the medication error group was six, and that in the no-medication error group was five. Statistically significant factors correlated with errors made during self-management of medication were the number of medications, number of administrations per day, dosing frequency on indicated days, and medication from multiple prescriptions. CONCLUSIONS: When a patient is self-managing their medications, errors are likely to occur due to a high number of medicines they are taking and the complexity of the dosage regimen. Therefore, to prevent medication errors, reviewing the prescribed medications and devise ways to simplify the dosage regimens is crucial.

Risk factors and prognosis of humeral head inferior subluxation in proximal humeral fractures after osteosynthesis.

BACKGROUND: Humeral head inferior subluxation often occurs immediately after osteosynthesis for proximal humeral fracture; however, the underlying cause remains largely unknown. In addition, the prognosis of postoperative inferior subluxation has not been fully investigated. This study aimed to clarify the predictive factors that affected the onset of postoperative inferior subluxation using multivariate analysis and examine the postoperative course of inferior subluxation and its influence on postoperative outcomes. METHODS: We retrospectively reviewed 212 patients who underwent osteosynthesis for Neer 2- or 3-part proximal humeral fractures. In the multivariate analysis, the dependent variable was set as the inferior subluxation observed 1 week after the surgery. The explanatory variables included age, sex, affected side, body mass index, smoking, local osteoporosis, preoperative axillary nerve injury, time from injury to surgery, fracture dislocation, fracture pattern, preoperative inferior subluxation, surgical procedure, surgical approaches, blood loss, operative time, and postoperative drainage. Baseline variables, which were observed to be significant in the univariate analysis, were included in multivariate models. Furthermore, based on the presence of inferior subluxation at 1 week after the surgery, we divided the patients into two groups: with inferior subluxation (+IS group) and without inferior subluxation (-IS group). We compared the postoperative outcomes (incidence of postoperative complications and range of motion) between these two groups. RESULTS: Of 212 patients, 64 (30.7%) experienced inferior subluxation at 1 week after the surgery. On multivariate analyses, preoperative inferior subluxation (odds ratio = 4.69; 95% confidence interval = 2.45-9.76; P < .001) and longer operative time (odds ratio = 1.01; 95% confidence interval = 1.00-1.02; P = .049) were the risk factors for postoperative inferior subluxation. In the +IS group, inferior subluxation resolved at 1 year after the surgery in 89.5% of patients. There was no significant difference in the postoperative outcome between the +IS and -IS groups. However, four of six patients with persistent inferior subluxation, more than 6 months after the surgery, experienced complications, such as varus angulation of the humeral head or screw joint perforation. CONCLUSIONS: This study provides new information on the risk factors for and prognosis of postosteosynthesis inferior subluxation in patients with proximal humeral fracture. Longer operative time and presence of preoperative inferior subluxation was associated with an increased risk of postoperative inferior subluxation, although it was temporary in most cases, and had no significant influence on the postoperative outcomes. However, in patients with persistent inferior subluxation of more than 6 months duration, inferior subluxation may be related to postoperative complications.

Osteosynthesis Using the Anatomical Plate With Grasping Arms for Unstable Distal Clavicle Fractures: A Technical Trick and Clinical Experience.

SUMMARY: Plate fixation is an established method of treating distal clavicle fractures. However, it is often difficult to maintain the reduction of distal fragments with conventional plates, especially in cases where the distal fragments are small or comminuted. This study aimed to introduce a technical trick and clinical experience of osteosynthesis using an anatomical nonlocking plate with grasping arms (SCORPION NEO plate) for unstable distal clavicle fractures. During fixation, distal fragments are grasped by the plate arms and fixed with 2 screws. We retrospectively reviewed 41 patients who underwent osteosynthesis for unstable distal clavicle fractures (Neer type 2 and 5) using a SCORPION NEO plate. Patients were divided into 2 groups: type unstable 1, where the trapezoid ligament adhered to a distal fragment, and type unstable II (UII), where the trapezoid ligament adhered to a third fragment detached from a distal fragment. Although delayed union, plate loosening, plate-related pain, infection, and stiffness were observed in 2 (4.9%), 2 (4.9%), 3 (7.3%), 1 (2.4%), and 1 patient (2.4%), respectively; all fractures united at the time of final follow-up. Operating time for the UII group was significantly longer than that for the UI group. There were no significant differences between the 2 groups in postoperative complications and coracoclavicular distance ratios at the time of bone union. Our results demonstrated that osteosynthesis with the anatomical plate with grasping arms could be a viable option in the treatment of unstable distal clavicle fractures, especially in cases where distal fragments are not contiguous with the trapezoid ligament.

Physiologically decreased F-18 fluorodeoxyglucose uptake in the lower vertebrae associated with daily drinking habit in Japanese men with alcohol flushing reaction.

Alcohol flushing reaction (AFR) is known as one of the risks for esophageal squamous cell cancer, and scientists have been elucidating this issue. However, little attention has been given to relevant imaging features. This study aims to investigate whether physiological 18F-fluorodeoxyglucose (FDG) uptake patterns in vertebrae are associated with drinking habits or AFR. Japanese male patients who underwent FDG positron emission computed tomography for evaluation of their known or suspected malignancies or inflammatory diseases were asked about their drinking habits and AFR. Altogether, 192 patients, 139 every-day drinkers and 53 non-drinkers were evaluated. Comparing the FDG uptake between that in the thoracic region and that in the lumbar region, vertebral uptake was visually classified into four patterns: Ld, dominant in lumbar region; TL, almost equal in both regions; BL, slightly higher in thoracic region (borderline pattern); Td, dominant in thoracic region. The uptake patterns were evaluated according to drinking habit (every-day drinker or non-drinker), AFR (flusher or non-flusher), and the combination of these two factors (habit/reaction: every-day drinker/flusher, every-day drinker/non-flusher, non-drinker/flusher, or non-drinker/non-flusher). There were 95 flushers (51 every-day drinkers and 44 non-drinkers) and 97 non-flushers (88 every-day drinkers and 9 non-drinkers). Ld, TL, BL, and Td patterns were observed in 0, 109 (56.8%), 31 (16.1%), and 52 (27.1%) patients, respectively. Td and BL patterns were more frequently observed in every-day drinkers compared with non-drinkers (p = 0.0467). Though the uptake patterns did not differ between flushers and non-flushers (p = 0.116), the Td pattern was more frequently observed in every-day drinkers/flushers (51%) compared with every-day drinkers/non-flushers (20.5%), non-drinkers/flushers (13.6%), and non-drinkers/non-flushers (22.2%) (p = 0.0014). The Td pattern was observed in patients with various diseases, with higher frequency in esophageal cancer, head and neck cancer, and lung cancer compared with other diseases. In conclusion, drinking habits and AFR were related to the vertebral uptake pattern with decreased uptake in the lumbar region in Japanese male patients.

Atmospheric response to high-resolution topographical and radiative forcings in a general circulation model of Venus: Time-mean structures of waves and variances.

Thermal tides, stationary waves, and general circulation are investigated using a T63 Venus general circulation model (GCM) with solar and thermal radiative transfer in the presence of high-resolution surface topography, based on time average analysis. The simulated wind and static stability are very similar to the observed ones (e.g., Horinouchi et al., 2018; Ando et al., 2020). The simulated thermal tides accelerate an equatorial superrotational flow with a speed of ~90 m s-1 around the cloud-heating maximum (~65 km). The zonal-flow acceleration rates of 0.2-0.5 m s-1 Earth day-1 are produced by both horizontal and vertical momentum fluxes at low latitudes. In the GCM simulation, strong solar heating above the cloud top (>69 km) and infrared heating around the cloud bottom (~50 km) modify the vertical structures of thermal tides and their vertical momentum fluxes, which accelerate zonal flow at 103 Pa (~75 km) and 104 Pa (~65 km) at the equator and around 103 Pa at high latitudes. Below and in the cloud layer, surface topography weakens the zonal-mean zonal flow over the Aphrodite Terra and Maxwell Montes, whereas it enhances the zonal flow in the southern polar region. The high-resolution topography produces stationary fine-scale bow structures at the cloud top and locally modifies the variances in the geographical coordinates (i.e., the activity of unsteady wave components). Over the high mountains, vertical spikes of the vertical wind variance are found, indicating penetrative plumes and gravity waves. Negative momentum flux is also locally enhanced at the cloud top over the equatorial high mountains. In the solar-fixed coordinate system, the variances (i.e., the activity of waves other than thermal tides) of flow are relatively higher on the nightside than on the dayside at the cloud top. Strong dependences of the eddy heat and momentum fluxes on local time are predominant. The local-time variation of the vertical eddy momentum flux is produced by both thermal tides and solar-related, small-scale gravity waves.

Seasonal variation in the onset of acute calcific tendinitis of rotator cuff.

BACKGROUND: Calcific tendinitis of the rotator cuff is a disorder that causes acute onset of shoulder pain when spontaneous resorption of the calcification occurs. However, factors that trigger calcium resorption have not been clarified. The present study aimed to investigate the association between the onset of calcium resorption in calcific tendinitis and the season of onset. METHODS: We retrospectively reviewed 195 patients (female, 116; male, 79; mean age, 62.6 ± 14.2 years; median age, 62 [52, 73] years) diagnosed with the postcalcification stage of calcific tendinitis, which was defined as acute calcific tendinitis in this study, between 2006 and 2018. The onset date of acute calcific tendinitis for each patient was collected from clinical notes. We evaluated the incidence of acute calcific tendinitis in each season and month. Furthermore, we investigated the correlation between the incidence of acute calcific tendinitis and the mean monthly temperature or humidity levels for each year. RESULTS: The most common season of acute calcific tendinitis onset was summer (35.4%), followed by spring (24.6%), autumn (24.1%), and winter (15.9%) (P = 0.002). Monthly analyses showed the highest peak of onset was in July (15.4%) and the lowest peak was in February (3.1%) (P = 0.022). The incidence of acute calcific tendinitis had a weak association with mean monthly temperature (R2 = 0.066; P = 0.001) but was not associated with mean monthly humidity levels (R2 = 0.018; P = 0.099). CONCLUSIONS: This study provides new information on seasonal variation of acute calcific tendinitis onset. The results of this study indicated that the onset of calcium resorption occurs most frequently in the summer in Japan; however, the reasons for seasonal variation remain unclear, and further studies will be needed. LEVEL OF EVIDENCE: Level III.

Diagnostic imaging guide for autoimmune pancreatitis.

The International Consensus Diagnosis Criteria for autoimmune pancreatitis (AIP) has been published internationally for the diagnosis of AIP. However, since the revisions in 2006 and 2011, the Clinical Diagnostic Criteria for Autoimmune Pancreatitis 2018 have been published. The criteria were revised based the Clinical Diagnostic Criteria 2011, and included descriptions of characteristic imaging findings such as (1) pancreatic enlargement and (2) distinctive narrowing of the main pancreatic duct. In addition, pancreatic duct images obtained by magnetic resonance cholangiopancreatography as well as conventional endoscopic retrograde pancreatography were newly adopted. The guideline explains some characteristic imaging findings, but does not contain descriptions of the imaging methods, such as detailed imaging parameters and optimal timings of dynamic contrast-enhanced computed tomography/magnetic resonance imaging. It is a matter of concern that imaging methods can vary from hospital to hospital. Although other characteristic findings have been reported, these findings were not described in the guideline. The present paper describes the imaging methods for obtaining optimal images and the characteristic imaging findings with the aim of standardizing image quality and improving diagnostic accuracy when radiologists diagnose AIP in actual clinical settings.

Treatment of distal clavicle fractures using a Scorpion plate and influence of timing on surgical outcomes: a retrospective cohort study of 105 cases.

BACKGROUND: Plate fixation is an established method for treating unstable distal clavicle fractures. However, the appropriate timing of surgery for acute distal clavicle fractures remains unclear. The present study aimed to evaluate the clinical outcomes of osteosynthesis using a Scorpion plate and to assess the influence of surgery timing on the surgical outcomes for acute unstable distal clavicle fractures. METHODS: We retrospectively reviewed 105 patients who underwent fixation for acute unstable distal clavicle fractures (Neer type II and V) using the Scorpion plate between 2008 and 2018. Patients were divided into early (45 patients) and delayed (60 patients) treatment groups based on the timing of the surgical intervention (within or after 7 days). The outcomes were postoperative complications (nonunion, peri-implant fracture, plate loosening, plate-related pain, and stiffness). We evaluated the outcomes from X-ray radiographs and clinical notes. RESULTS: Among the 105 patients, nonunion, plate loosening, plate-related pain, and stiffness were observed in six patients (5.7%), four patients (3.8%), seven patients (6.7%), and one patient (1.0%), respectively. The nonunion rate was significantly higher in the delayed treatment group than that in the early treatment group (P = 0.036). Although the difference was not significant, plate loosening and stiffness were only observed in the delayed treatment group. CONCLUSION: Our results demonstrated that osteosynthesis using Scorpion plates achieved satisfactory surgical outcomes for unstable distal clavicle fractures. In addition, this study suggested that performing surgery within 6 days after injury is recommended to reduce postoperative complications.

Predominance and homogeneity patterns of physiological FDG accumulation in thoracic and lumbar vertebrae: suspected mechanism of "bone pseudometastasis" on FDG-PET in Japanese patients with esophageal cancer.

OBJECTIVE: False-positive bone lesions (bone pseudometastases) have been often reported in patients with esophageal cancer (EsoC). This study aimed to evaluate the vertebral 2-deoxy-2-[18F] fluoro-D-glucose (FDG) accumulation pattern in patients with newly diagnosed esophageal cancers and other malignancies (OtherT) to elucidate the possible mechanism that causes bone pseudometastasis. METHODS: FDG positron emission tomography/computed tomography performed for 90 patients with EsoC, and 112 patients with OtherT was retrospectively evaluated. The uptake pattern in the thoracic (Th) and lumbar (L) vertebrae was visually assessed regarding predominance (TL, Th ≒ L; Td, Th > L; Ld, L > Th), main intensity compared with the uptake in the blood pool (BP) (Grade 1 < BP, Grade 2 ≒ BP, or Grade 3 > BP), and homogeneity (homogeneous, heterogeneous, marginal, or spotty). The patterns between EsoC and OtherT and between Th and L were compared. RESULTS: TL, Td, and Ld patterns were observed in 51.1%, 48.9%, and 0% in EsoC and 79.7%, 20.3%, and 0% in OtherT. Though Grade 2 was most frequently observed in both groups, the ratio of Grade 3 in Th and Grade 1 in L was significantly higher in EsoC than in OtherT. Heterogeneous and spotty patterns were more frequently observed in L and in EsoC, and these were strongly associated with Td pattern. CONCLUSION: Td pattern was frequently seen, especially in EsoC, and was strongly associated with a heterogeneous or marginal pattern in the L. Heterogeneous marrow distribution with declined lumbar uptake is suspected as the mechanism of bone pseudometastasis.