Objectives: We evaluated the clinical outcomes of transumbilical single-incision laparoscopic appendectomy with extracorporeal hand-sewn stump closure in adults.

Methods: One-hundred-and-thirty-one consecutive adults with acute appendicitis were treated with the intention of performing transumbilical single-incision laparoscopic appendectomy with extracorporeal hand-sewn stump closure from July 2012 to December 2017. The procedure completion rate and outcomes were examined. To evaluate the risk factors for conversion, the background data were compared between the patients in whom the procedure was completed versus those in whom the procedure was uncompleted.

Results: The procedure was completed in 113 of 131 patients (86.3%). Single-site surgery was completed in 117 patients (89.3%). The median operation time was 79 (range 30–270) minutes and median intraoperative blood loss was 10 (range 0–394) ml. Postoperative complications occurred in 17 patients (13.0%). Postoperative hospital stay was 6 (range 1–27) days. The 18 patients in whom the procedure could not be completed comprised four patients in whom the stapler was used for intraabdominal stump closure, and 14 patients who were converted to multiport laparoscopic surgery or open surgery. Multivariate analysis showed that the independent risk factors for conversion were age, preoperative abscess, and peri-appendiceal fat density. Receiver operating characteristic curve analysis showed that the cutoff value of peri-appendiceal fat density for conversion was –40.51 Hounsfield units.

Conclusions: Transumbilical single-incision laparoscopic appendectomy with extracorporeal hand-sewn stump closure was safe in adults with acute appendicitis. The risk factors for conversion were age ≥60 years, preoperative abscess, and peri-appendiceal fat density ≥–40.51 Hounsfield units.

Objectives: The aim of this study was to determine whether age correlates with amplitude and latency, when full-field electroretinography (ERG) is performed using skin electrodes. The ability of pulse reference power line noise reduction (PURE) to dampen the noise associated with the use of skin electrodes, was also investigated.

Methods: ERG was performed on 77 eyes in 77 healthy subjects (mean age: 55.6±19.0 years; age range: 9 to 86 years). Subjects with –5D or higher myopia, Emery-Little grade III or higher cataracts, retinal disease, uveitis, glaucoma, ≤5 mm mydriasis, or a history of intraocular surgery other than cataract surgery, were excluded. The active, reference, and ground electrodes were placed on the lower eyelid, outer canthus, and earlobe, respectively. Responses were averaged 10 times for dark-adapted (DA) ERGs, and 32 to 64 times for light-adapted (LA) ERGs. Noise was removed using the PURE method.

Results: The DA ERGs without PURE were so noisy that the amplitude or latency could not be determined, whereas those with PURE were comparatively quieter. ERG with PURE demonstrated a significant negative correlation between age and amplitude and a significant positive correlation between age and latency.

Conclusions: We could record the measurable ERG waveforms with skin electrodes by using the PURE method, especially in fewer averaged conditions. It is suggested that skin electrode with PURE is suitable to examine the pathological ERGs, and other types of electrodes. It is recommended that the aging effect should be taken into consideration when pathological ERGs are evaluated.

Objectives: We conducted a finger tapping movement test using a finger tapping device with magnetic sensors (UB-2) and performed multiple regression analyses using a number of finger movements parameters to estimate the severity of cognitive impairment.

Methods: The subjects of this study were 64 patients, including 44 diagnosed with Alzheimer’s disease (AD) (mean age: 73.8±7.0 years) and 20 diagnosed with mild cognitive impairment (MCI) (mean age: 76.7±4.2 years). For the finger-tapping movement tasks, we tested single-hand (left and right) tapping, simultaneous tapping of both hands, and alternate tapping between hands. After measurement, multiple regression analysis adjusted for age and sex was performed to predict the Mini-Mental State Examination (MMSE) score from the calculated hand parameters.

Results: Relatively high standardized partial regression coefficients were observed for the following two parameters: standard deviation (SD) of distance rate of velocity peak in extending movement and the SD of contact duration. The coefficients of determination (R²) ranged between 0.1 to 0.28.

Conclusions: Our results suggest the possibility that these parameters may be used to assess cognitive function. We shall obtain large-scale data from older people to examine the possibility of these parameters to be used as an early diagnostic tool for dementia patients.

Objectives: The prognostic significance of the progesterone receptor (PR) has been widely investigated in luminal A and luminal B [human epidermal growth factor receptor 2 (HER2)–] breast cancer subtypes, both of which are estrogen receptor (ER)-positive and HER2-negative. In contrast, few studies have focused on PR status in luminal B (HER2+) tumors. The aim of this study was to evaluate the impact of positive PR status on outcomes in patients with luminal B (HER2–) or luminal B (HER2+) breast cancer.

Methods: Survival analysis was performed to estimate the likelihood of distant recurrence and death in 469 breast cancer patients with the luminal B (HER2–) or luminal B (HER2+) subtype. The relationship between PR and HER2 status was also assessed.

Results: Of 387 luminal B (HER2–) and 82 luminal B (HER2+) cancers, PR+ was significantly more frequent in the former than the latter (86.3% vs. 61.0%, respectively; P<0.001). In univariate analysis, PR was identified as a significant favorable prognostic factor for distant disease–free survival and overall survival in both subtypes, but in multivariate analysis PR was not an independent prognostic factor.

Conclusions: After patients with luminal B subtype were divided into two subgroups according to HER2 status, there was evidence of a relatively good prognosis in the PR+ subgroup. Further studies with a larger number of patients are recommended to validate these findings.

Objectives: Vascular calcification is common in patients with advanced chronic kidney disease (CKD) and contributes to cardiovascular disease. Accumulating evidence indicates that CKD patients often acquire subclinical vitamin K deficiency, which is associated with vascular calcification.

Methods: This prospective, randomized, parallel group, multicenter trial (UMINID000011490) will include 200 dialysis patients in an open-label, two-arm design. After baseline computed tomography of the abdominal aorta, patients will be randomized to two groups that will either (1) continue receiving standard care or (2) receive additional oral supplementation with menatetrenone (45 mg/day). The treatment duration will be 24 months, and the computed tomography scan will be repeated after 12 and 24 months. The primary endpoint is the progression of abdominal aortic calcification, which is calculated as absolute changes based on the Agatston score. The secondary endpoints are the decrease in bone mineral density (measured by dual-energy X-ray absorptiometry), the biomarkers associated with vitamin K, vitamin K intake (evaluated by the food frequency questionnaire), and the biomarkers associated with vascular calcification.

Conclusions: This study aims to confirm whether vitamin K has inhibitory effects on calcification that can be clinically determined.

Trial registration: UMINID000011490.

We reported here four cases presenting with disturbance of consciousness over long periods of time and hyperammonemia. Two patients were on maintenance hemodialysis. Contrast-enhanced computed tomography (CT) of abdomen and balloon-occluded retrograde contrast venography revealed existence of a non-cirrhotic portosystemic shunt. Conservative treatment such as intravenous branched-chain amino acid administration and oral lactulose administration had only a modest effect in all patients. Improvements in symptoms were observed following the occlusion of the shunt path in three patients. Measurements of ammonia values would be the most important test for screening, but changes in Fischer’s ratio or indocyanine green (ICG) test values were also correlated with clinical symptoms. Neurologists should keep in mind the possibility of non-cirrhotic portosystemic shunts when they encounter patients with disturbance of consciousness. They should also remember that occlusion of the shunt pathway is an effective treatment.