Hemorheology deals with the flow properties of blood. Research has primarily focused on analyzing the state of blood flow and the characteristics of blood in the microcirculation, such as in capillaries. In studies on blood fluidity, the ektacytometry method, which uses a laser-assisted optical rotational cell analyzer, has been the mainstream approach. In contrast, the microchannel method, which uses a microchannel array flow analyzer, was developed in Japan, and is characterized by the ability to analyze samples without any pretreatment and visualize the flow of blood under conditions that closely approximate physiological reality. This review focuses on the microchannel method and provides an overview of blood fluidity, covering the fundamentals of analytical methods, diurnal variations in blood fluidity, factors that impair blood fluidity, exercise-induced disturbances under high-intensity conditions, and the prevention of exercise-induced impairment of blood fluidity.

Objective: Stereotactic radiotherapy (SRT) and stereotactic radiosurgery (SRS) are useful treatments for arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs). In this study, 320-row four-dimensional (4D) computed tomography angiography (CTA) was used to determine the irradiation range before SRT/SRS, and the treatment effect was retrospectively evaluated.

Methods: Five patients with an AVM and two with an AVF who underwent 4D CTA were included. Treatment was planned and performed based on the 320-row CTA images. Treatment efficacy was evaluated using magnetic resonance imaging and CTA.

Results: Shrinkage was observed in four of the five AVMs and both AVFs. Additional irradiation was performed in one AVM patient and one AVF patient. One AVM patient experienced seizures 6 years after treatment. No other adverse neurological events or cerebral hemorrhages occurred.

Conclusion: 320-row 4D CTA image fusion was useful for lesion identification in determining radiation treatment plans for AVMs and AVFs. It also was able to demonstrate post-treatment shrinkage and disappearance of lesions.

Objectives: In East Asia, the incidence of gastric cancer is high, and Helicobacter pylori (HP) infection is strongly implicated. China has a high incidence rate of gastric cancer and high prevalence of HP infection. We conducted a survey on the current status of HP infection in China.

Methods: HP antibodies were measured in 496 Chinese nationals who visited our clinic. Participants were classified into groups based on a medical questionnaire: HP infection unknown; HP non-infected; and HP infected. Results of HP antibody tests were examined for each group. A comparative analysis was also conducted among 35 Japanese examinees.

Results: The overall HP antibody positivity rate in Chinese patients was 39.9% (age group 20s: 14.3%, 30s: 40.0%, 40s: 45.0%, 50s: 35.8%, 60s: 32.6%, 70+: 57.1%). HP antibody positivity rates in the HP infection unknown, HP non-infected, and HP-infected groups were 39.0%, 23.3%, and 62.0%, respectively. In the HP-treated group, the HP antibody positivity rate was 52.3% in the eradication-confirmed group and 69.6% in the non-confirmed group. The overall HP antibody positivity rate among Japanese examinees was 17.1%, significantly lower than that among Chinese examinees (p=0.0074).

Conclusion: The HP antibody positivity rate in Chinese participants was higher among younger age groups, compared with Japanese participants, and tended to be higher when eradication confirmation was not performed after HP eradication therapy. Combining the group with unclear HP infection status and the group who did not undergo HP eradication confirmation, approximately half of Chinese participants had an unclear HP infection status.

Objectives: This study examined the feasibility of patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) performing gaming tasks.

Methods: Ten patients with MCI and nine patients with AD participated. Gaming and tabletop tasks were the two types of interventions designed for this study. Following a randomized crossover design, the two interventions were conducted at a rate of 1 hour per week for 4 weeks. The Genki! Ha•tsu•ra•tsu Trepachi-table (TOYOMARU INDUSTRY CO., LTD., Aichi, Japan) device was used for the gaming intervention. Using this table-shaped gaming device with cognitive training components, one to four players can compete in various gaming challenges on a touchscreen mounted on the top of the table. For the tabletop task intervention, patients completed arithmetic and spot-the-difference exercises as cognitive training activities. A visual analog scale was used to quantify mood before and after each intervention session, and a reaction scale measuring the “autonomy” and “degree of participation” of patients was completed after each intervention.

Results: The gaming intervention significantly increased the visual analog scale score of the AD group (p=0.031). The MCI group had significantly higher autonomy reaction scale scores during the gaming intervention than the AD group (p=0.007).

Conclusions: Activities using gaming technology may enhance the willingness and mood of senior citizens with diminished cognitive capabilities and could potentially support ongoing brain training.

Objective: This study examines the dietary intake and eating habits of female university students and compares key nutritional indicators according to the body mass index (BMI) categories and adequacy of estimated energy requirements.

Methods: Dietary surveys were conducted among 50 female nursing students using the brief-type self-administered diet history questionnaire (BDHQ). Participants were classified into BMI categories (underweight group, n=7; normal-weight group, n=41) and energy-intake adequacy groups based on estimated energy requirements (inadequate energy intake group, n=43; adequate/excess energy intake group, n=7). Nutrient intake status was examined between energy intake adequacy groups, with additional consideration of the BMI categories.

Results: No significant differences in energy or macronutrient intake were observed between BMI-based groups (p>0.05). In contrast, when comparing energy intake adequacy, 88.4% of the participants in the inadequate energy intake group had insufficient carbohydrate intake, and their intakes of protein, vitamin C, iron, and folate were lower than those in the adequate/excess energy intake group (all p<0.05).

Discussion: Among female university students, no group differences were detected based on BMI alone. However, in the inadequate energy intake group, marked inadequacies were observed in the intake of nutrients. These findings indicate that dietary problems cannot be captured solely by BMI and require individualized nutritional counseling.

Conclusion: Nutritional assessment of female university students should incorporate BMI and adequacy of energy intake relative to estimated energy requirements, with individualized approaches tailored to each student.

A challenge in patients with terminal cancer is that serum creatinine–based estimates of renal function often deviate from true renal function because cachexia-related loss of muscle mass leads to abnormally low serum creatinine levels. Serum cystatin C is a useful marker of renal function in patients with decreased muscle mass; however, there are limited data on its use in patients with terminal cancer. In this study, we present a detailed assessment of renal function, incorporating muscle mass measurement by bioelectrical impedance analysis, in a patient with terminal rectal cancer who developed respiratory depression while receiving a stable dose of morphine hydrochloride injections.

Objective: The use of bioelectrical impedance analysis (BIA) has enabled measurement of the amounts of body components. Terminal cancer patients often experience excessive fluid retention. In this study, we investigated the effect of cell-free and concentrated ascites reinfusion therapy (CART) on fluid retention in terminal cancer patients using BIA.

Methodology: Of the 676 patients, 176 underwent CART, with 6 patients having measured total body water (TBW), extracellular water (ECW) and body fluid balance (ECW/TBW) using BIA before and after CART.

Results: Body composition measurements were obtained a total of 45 times before and after CART. The median (quartile) drained fluid volume by CART was 3000 mL (800–6000). After CART, the ECW/TBW improved to 0.413 (0.408–0.420) in patients with ascites. Correlation with pre-CART anthropometric analysis showed a positive correlation between water loss and TBW and ECW/TBW (R=0.415 and 0.528, P<0.001 and 0.001, respectively). A strong correlation was also observed between body weight and TBW and BCM (R=0.892 and 0.897, P<0.001 and 0.001, respectively). Furthermore, in cases with a large amount of fluid removal, BCM decreased by approximately 9 kg, from 32.3 kg to 23.2 kg. ECW/TBW, a measure of edema, was 0.465 before the start of the study, indicating severe fluid retention, but eventually improved to 0.404.

Conclusion: In terminal cancer patients having refractory fluid retention, CART ameliorated edema. It was suggested that fluid retention may affect measurements of somatic cell volume, potentially hindering accurate assessment of these values.

Introduction: Ectopic pregnancy is a typical obstetric emergency, and serum and urine human chorionic gonadotropin (hCG) measurements are important for its diagnosis. However, qualitative urine hCG tests sometimes give false-negative results. We herein report a case in which pregnancy was ruled out due to a negative qualitative urine hCG test, and surgery was performed based on a preoperative diagnosis of ovarian hemorrhage. However, the pregnancy was ultimately diagnosed as ectopic.

Case Presentation: The patient was a 19-year-old woman, gravida 0, para 0. She presented to a local clinic for lower abdominal pain that occurred 28 days after her last menstrual period. She was then transferred to our hospital following confirmation of peritoneal irritation signs and abdominal computed tomography (CT) findings revealing ascites. She presented with severe tenderness and rebound tenderness around the umbilicus, and transvaginal ultrasonography revealed an 83-mm hematoma in the Douglas pouch. Since her qualitative urine hCG test was negative and contrast-enhanced CT scans revealed contrast leakage around the left adnexa, a diagnosis of left ovarian hemorrhage was made. Subsequently, emergency laparoscopic surgery was performed. However, the intraoperative finding of left fallopian tube enlargement led to suspicion of an ectopic pregnancy, prompting a change in the surgical procedure to left salpingectomy. Preoperative serum hCG level was elevated at 314 mIU/mL, and pathological examination confirmed chorionic villi, confirming a left fallopian tubal pregnancy.

Conclusion: We experienced a case of ectopic pregnancy with a negative urine pregnancy test. In women of reproductive age presenting with an acute abdomen, the possibility of ectopic pregnancy should always be considered, even if the qualitative urine hCG test is negative, and careful informed consent is required.

Introduction: Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is typically associated with mature cystic teratomas. We report a case of anti-NMDA receptor encephalitis associated with an immature ovarian teratoma, which is a malignant tumor.

Case: A 16-year-old girl who presented with impaired consciousness and abnormal behavior was referred to our hospital. After evaluation upon admission, she was diagnosed with anti-NMDA receptor encephalitis associated with an ovarian mature cystic teratoma, and laparoscopic right salpingo-oophorectomy was performed. The postoperative pathological diagnosis confirmed the presence of an immature ovarian teratoma. The patient subsequently underwent immunoglobulin therapy, steroid pulse therapy, and plasma exchange for the treatment of encephalitis. Bleomycin, etoposide, and cisplatin chemotherapy was administered after her symptoms improved.

Conclusions: In this case, early collaboration among the departments of neurology, obstetrics and gynecology, and emergency medicine enabled a prompt diagnosis and effective treatment. The patient’s symptoms were successfully ameliorated through early removal of the tumor and pharmacotherapy. Although anti-NMDA receptor encephalitis generally has a favorable prognosis, early diagnosis and initiation of treatment considerably affect the outcome. Clinicians should suspect anti-NMDA receptor encephalitis when a young patient presents with impaired consciousness or abnormal behavior and consider the possibility of underlying malignant tumors.

A 64-year-old Chinese man visited our clinic’s health-screening center. The patient tested negative for Helicobacter pylori (HP) infection in his home country, but at this visit, anti-HP antibodies of 5 U/mL and a urea breath test (UBT) result of 48.6‰ were detected. Upper gastrointestinal endoscopy showed no atrophic gastritis, and a regular arrangement of collecting venules was observed. Since a false-positive UBT was also considered, Smart Gene testing was performed, which confirmed the HP positivity. As no clarithromycin resistance mutation was detected, Japan’s first-line eradication regimen was prescribed. The eradication test result was a UBT of 0.1‰, confirming successful HP eradication.

Amivantamab, a bispecific antibody targeting epidermal growth factor receptor (EGFR) and mesenchymal–epithelial transition factor, has shown clinical efficacy in patients with EGFR-mutated non-small cell lung cancer. Although infusion-related reactions (IRRs) are common adverse events associated with this drug, cardiac events such as bradycardia have rarely been reported. We report the case of a 53-year-old Japanese man with advanced EGFR exon 19-deleted lung adenocarcinoma who was treated with amivantamab plus lazertinib as eighth-line therapy. On the first day, he experienced dyspnea, chills, and headache 30 min after amivantamab administration, so the infusion flow was reduced to 25 mL/h. After the symptoms resolved, the flow rate was set to 50 mL/h. On the second day, 2 h after initiating amivantamab infusion (700 mg) at 50 mL/h, his heart rate decreased to <50 beats per minute (bpm) and subsequently to <40 bpm. His blood pressure remained stable and he had no symptoms. The infusion was interrupted and intravenous methylprednisolone, chlorpheniramine, and atropine were administered. Bradycardia persisted for approximately 24 h but gradually resolved. On rechallenge with amivantamab 10 days later, bradycardia did not recur, suggesting that bradycardia is an IRR. Clinicians should be aware of this potential reaction and closely monitor cardiac rhythm during and after amivantamab infusion.

Lambl’s excrescences (LEs) are filiform extensions arising on the closing surface of cardiac valves, typically occurring at coaptation lines of left-sided valves. LEs are more commonly reported in adults and pediatric cases remain rare, with no previously documented cases in Japan. A 9-year-old Japanese boy initially presented with a fever and sore throat but developed right-sided neck pain several days later. Blood tests showed a white blood cell count of 33,900/mL and C-reactive protein concentration of 9.95 mg/dL. Contrast-enhanced computed tomography showed a right peritonsillar abscess, and cefotaxime and clindamycin were administered. The patient’s symptoms persisted for 4 days. Therefore, he was transferred to our hospital. Transthoracic echocardiography showed trivial aortic regurgitation and a 4.4×1.0-mm filamentous structure attached to the aortic valve. The patient improved with antibiotic treatment alone, which was continued because infective endocarditis was suspected. However, transesophageal echocardiography showed no shape-like vegetations, papillary fibroelastomas, or thrombi, and repeated blood cultures were all negative, which led to a diagnosis of LEs. After completing a 3-week antibiotic course, the patient was discharged and remained asymptomatic with no structural changes in the LE in 2 years. To the best of our knowledge, this is the first report of a pediatric case of LEs associated with aortic regurgitation in Japan, highlighting that LEs should be considered in children with aortic regurgitation.