Objective

H. pylori is considered a carcinogenic factor for gastric cancer. However, gastric cancer patients infected with H. pylori have a better postoperative course than uninfected patients. These studies classified gastric cancer patients into two groups, H. pylori-negative and positive. In the present study, gastric cancer patients were classified according to H. pylori load, and then the relationship of H. pylori load with the postoperative course was examined.

Patients and Methods

A total of 403 gastric cancer patients were examined endoscopically in the Department of Upper Gastrointestinal Surgery prior to gastric surgery. H. pylori infection was determined using the culture method, and the results were classified into five levels: negative, scant, little, moderate, and abundant growth. Overall survival (OS) was then analyzed by the pathological findings and culture results.

Results

H. pylori infection was detected in 57.3% (231/403) of patients. H. pylori-positive cases showed significantly better survival than negative cases. The patients with high H. pylori load (strongly positive group) showed significantly better OS than the H. pylori-negative group (p = 0.02). In relation to other histopathological findings and OS, the H. pylori-infected patients who showed a better prognosis were those with diffuse type gastric cancer and those with stage II, lymph node metastasis-positive disease.

Conclusion

OS was high when H. pylori was present at the time of operation, and it was even better when H. pylori load was high. In addition, conditions associated with a good prognosis in H. pylori-positive patients were diffuse type adenocarcinoma and localized metastasis-positive cases.

Purpose: To estimate the clinical characteristics of obstructive hypertrophic cardiomyopathy (HOCM) and other diseases or conditions with left ventricular outflow tract obstruction (LVOTO).

Methods: Forty cases (mean age 71 years, 31 women) with LVOTO (LVOT pressure gradient ≥ 30 mmHg) on resting transthoracic echocardiography were investigated and divided into two groups: HOCM group and other conditions (non HOCM group), and their clinical characteristics were compared. The mean follow-up period was 41 ± 8 months.

Results: There were 17 patients (42.5%) in the HOCM group and 23 (57.5%) in the non HOCM group, with sigmoid septum being the most common (12 patients, 30%), followed by hypertensive heart (10%), takotsubo syndrome (7.5%). and small left ventricle with hyperkinetic wall motion (7.5%). Compared to the HOCM group, the non HOCM group was older (76 ± 10 vs. 67 ± 10 years, p = 0.006), had more frequent hypertension (HT) (78% vs. 47%, p = 0.041), and the mitral regurgitation severity at the first transthoracic echocardiography was significantly lower. Compared to the first LVOT velocity, the last LVOT velocity was significantly reduced in the HOCM group (4.6 ± 0.1 m/sec vs. 2.8 ± 1.8 m/sec, p = 0.001). However, there was no significant change in the non HOCM group (4.1 ± 1.0 m/sec vs. 3.3 ± 1.1 m/sec, p = 0.100). The frequency of cardiovascular events showed no significant difference between the 2 groups.

Conclusions: This study showed different clinical background and change of LVOT velocity during follow-up periods in both groups. As the population ages, the patients with various LVOTO will increase further. It is important to investigate factors causing LVOTO and comprehensive management are required individually.

Background and aim: The background of liver carcinogenesis has shifted from viral hepatitis to sustained virological response (SVR) of hepatitis C virus (HCV) due to the advent of direct-acting antiviral agents (DAAs). The aMAP score is useful for predicting liver carcinogenesis in HCV-SVR patients, but limitations remain, particularly in medium- and high-risk groups. This study aimed to identify the best factor to combine with the aMAP score to improve predictive accuracy.

Methods: We reviewed 286 patients who achieved HCV-SVR. Patients were divided into two groups based on cancer development. Clinical characteristics at 12 weeks post-SVR were compared using the paired Wilcoxon test, and the cut-off values for liver carcinogenesis were determined using the receiver-operating characteristic (ROC) curve. Patients were classified by the aMAP scores as follows: less than 50 for low-risk, 50 to 59 for medium-risk, more than 60 for high-risk for liver carcinogenesis.

Results: After excluding 30 patients due to insufficient follow-up, 256 patients were analyzed. During the observation period, 13 patients (5.1%) developed hepatocellular carcinoma (HCC). Alanine aminotransferase (ALT), α-fetoprotein, platelet count, shear wave velocity, and the FIB-4 index were identified as promising factors for combination with the aMAP score. The combination of the FIB-4 index (cut-off value 2.57) with the aMAP score was optimal for predicting liver carcinogenesis, increasing the HCC occurrence rate in medium- and high-risk groups compared to that in high-risk group of the aMAP score alone (13.6%, 12/88 vs. 9.2%, 11/119).

Conclusions: The FIB-4 index is the best factor to combine with the aMAP score for predicting liver carcinogenesis after HCV-SVR, especially in medium- and high-risk groups (aMAP score more than 50).

Epilepsy is a disorder characterized by recurrent seizures, and seizure prediction using electroencephalogram (EEG) and electrocorticogram (ECoG) signals is challenging. Conventional signal processing methods, which assume stationarity and linearity for the system considered, are inefficient at capturing the complex temporal structures of these signals; therefore, this study focused on dynamic mode decomposition (DMD), which has recently been used in fluid dynamics to extract the spatiotemporal dynamic features of non-stationary and nonlinear signals.

This study applied an advanced data-driven nonlinear time series analysis method that combines time-delay embedding, diffusion mapping, and Koopman operator analysis, to the nonlinear dynamics of epileptic ECoG data. We analyzed 5 min of ECoG data from an 11-year-old boy with refractory Rolandic epilepsy. The collected data were embedded into a high-dimensional time-delayed coordinate space, and then its dimensions were reduced by diffusion mapping. The Koopman operator was estimated using extended DMD (eDMD), yielding its eigenvalues, modes, and eigenfunctions that represent the underlying dynamics of brain activity.

We identified 11 of 32 Koopman eigenfunctions as significantly correlated with the occurrence of epileptic spikes, representing the temporal features of the ECoG data. We also found six Koopman modes that were significantly correlated with the spatial pattern of epileptic spike propagation, capturing the spatial features of the ECoG data.

Understanding the spatiotemporal brain dynamics underlying epileptic EEG and ECoG signals may provide new clues to seizure prediction in epilepsy.

We aimed to investigate whether chylous ascites is associated with enteral nutrition and postoperative complications in pancreaticoduodenectomy and assess perioperative management and treatment methods. This retrospective observational study included 98 patients who underwent pancreaticoduodenectomy between 2020 and 2022. The associations between enteral nutritional supplements and the occurrence of chylous ascites and between postoperative infectious complications and pancreatic leakage among patients with chylous ascites were compared. Chylous ascites occurred in 3/27 (11%), 5/5 (100%), and 18/66 (27%) of patients who received ELENTAL^®, ISOCAL Support^®, and HINEX^®, respectively (P < 0.05). The incidence of chylous ascites in the fat-containing (ISOCAL SUPPORT^® and HINEX^®) group was thrice that in the low-fat (ELENTAL^®) group (P = 0.006). Pancreatic leakage was observed in 1/26 (3.8%) of patients in Group A (with chylous ascites) and 16/72 (22.2%) in Group B (without chylous ascites). Infectious complications of CD > 3a were observed in 8/26 (30.7%) patients in Group A and 34/72 (47.2%) in Group B. Group A had a lower frequency of pancreatic leakage (P = 0.03) and a similar rate of infectious complications (P = 0.25). The time to improvement in milk and chylous ascites was similar in the groups using no food, ELENTAL^®, and octreotide (3 days [1-10 days]) and in the groups using a fat-restricted diet and ELENTAL^® (4.5 days [4-5 days]). Chylous ascites was not associated with any serious postoperative complications. Lipid intake is a risk factor for chylous ascites. Lipid restriction enabled treatment without special drugs and with continued oral intake and enteral nutrition.

The patient was a 78-year-old man who had been attending another medical institution for management of diabetes and hypertension. He began to notice dyspnea on exertion about a month early. Chest computed tomography performed at that institution revealed diffuse ground-glass opacities in the lungs bilaterally, leading to his referral to our department. The patient was from Oita Prefecture and had no fever, rash, superficial lymphadenopathy, or hepatosplenomegaly, but was positive for human T-cell leukemia virus type-1 (HTLV-1) antibodies. A transbronchial lung cryobiopsy (TBLC) of the pulmonary lesions was performed, revealing cellular infiltrates primarily composed of small lymphocytes in the interalveolar septum and vascular walls. Histologically, the findings were consistent with HTLV-1-associated bronchiolo-alveolar disorder (HABA). Here, we report this case of HABA, which demonstrated the diagnostic utility of HTLV-1 antibody testing and TBLC.

A 68-year-old man presented with a chronic headache, without signs of meningeal irritation, at the age of 67. Diffusion-weighted and FLAIR MRI of the head revealed hyperintense signal areas in the white matter of the right parietal lobe and the subarachnoid space within the falx cerebri, with enhancement of the pia mater. Serum and cerebrospinal fluid (CSF) anti-cyclic citrullinated peptide antibody (ACPA) levels, as well as the intrathecal ACPA antibody titer index (ACPA index), were elevated. Although serum IgG4 levels were normal, brain biopsy demonstrated an IgG4-positive cellular infiltrate exceeding 40% in the cerebral pia mater. Steroid treatment led to an improvement in meningitis, along with a reduction in CSF ACPA levels and the ACPA index. These findings suggest a shared pathogenic mechanism between rheumatic meningitis and IgG4-associated leptomeningitis.

A 13-year-old female was presented with vision impairment and ptosis, along with general fatigue. Elevated acetylcholine receptor antibodies, and positive findings in Tensilon and repetitive nerve stimulation tests were noted, leading to a diagnosis of generalized myasthenia gravis (gMG). Despite treatments with anticholinesterase drugs, methylprednisolone pulse therapy, immunosuppressants, and plasma exchange, the disease was refractory and a thymectomy was scheduled. The operation was performed under CO₂ insufflation with three ports from the right side as much as possible, followed by two ports from the left side to complete the extended procedure. Following a good postoperative course, the patient was discharged on postoperative day 10 without onset of an MG crisis, with treatment continued thereafter. The present case of childhood MG was treated in a safe and effective manner with a bilateral thoracoscopic thymectomy.

A 1-year-old girl with no underlying medical conditions developed bloody stools after antibiotic treatment and was diagnosed with Clostridioides difficile infection (CDI). The possibility of developing CDI should be considered even in healthy children.

The incidence of CDI among healthy children has increased in recent years. A history of antimicrobial therapy for children with gastrointestinal symptoms is important. Longer durations of antimicrobial therapy, more types of antimicrobials, and third-generation cephems have been cited as risk factors for CDI development. Above all, antimicrobial stewardship is essential.

We report the case of a 79-year-old man with locally advanced rectal cancer (LARC) who underwent total neoadjuvant therapy (TNT). Treatment consisted of chemoradiotherapy (CRT) delivered to the pelvic region (including the lateral lymph nodes) with a total dose of 30 Gy in 10 fractions of 3 Gy each. Concurrently with radiation therapy, S-1 (80 mg) was administered orally twice daily on all days of radiotherapy. Following CRT, systemic chemotherapy with the SOX regimen (S-1 and oxaliplatin) was administered for two cycles. Eight weeks after completion of radiation therapy, evaluation revealed no evidence of distant metastasis. Colonoscopy showed complete macroscopic disappearance of the tumor, and biopsy specimens revealed no evidence of residual cancer, confirming a complete clinical response (cCR). Although surgery was initially planned after TNT, the patient strongly preferred non-operative management (NOM). The patient has maintained cCR for two years following NOM, making this a valuable case to report.