Modern diagnostic imaging often yields unexpected malignancy findings （UMFs）. If proper follow-up is not ensured, these findings pose a severe risk to patient safety due to a disconnect between reading the electronic report and taking clinical action. To guarantee appropriate clinical decision-making, our institution implemented a “closed-loop communication” system. In this system, the patient safety department actively tracks cases using a ledger, thereby complementing the communication between the radiologist and the ordering physician. This study retrospectively analyzed the effectiveness of this healthcare professional-driven active tracking system for UMFs, aiming to verify its consistency with international quality metrics and to clarify the effectiveness of third-party intervention in completing closed-loop communication. The analysis included 148 UMF cases from the registry （April 2022-July 2025）. The primary endpoints, which are consistent with American College of Radiology （ACR） metrics, included time to initial contact, the ordering physician’s acknowledgment status at the time of contact （documented in 117 cases）, and the final outcome. The median time to initial contact was 1 day, with 94％ of contacts made within 3 days. However, 60.7％ of the cases were unacknowledged and unaddressed at initial contact. Despite this, the system achieved successful final outcomes: 98％ of all patients accessed proper medical care, including surgery （38％） and consultation with other specialties （37％）. The study concludes that the active tracking system effectively achieves both rapid contact and appropriate, successful outcomes, despite a high initial rate of unacknowledged cases. This finding aligns with international studies on the management of actionable incidental findings （AIFs）. The system is considered a reproducible internal standard operating procedure for other facilities through technological integration （RIS/PACS） and stepwise escalation notification.

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Inhalation therapy is the primary treatment modality for asthma. Numerous inhaled formulations are available in different combinations of medications and devices. However, the appropriate inhalers for specific patient populations have not been clarified. This study aimed to investigate the 5-year trend in inhalation therapy for asthma in Japan. This retrospective study evaluated patients with asthma who regularly visited our clinic between January 2018 and December 2023. The patients were stratified by asthma treatment step, and the content of inhalation therapy and patient characteristics in 2018, 2021, and 2023 were investigated. Overall, 243 patients underwent inhalation therapy. In 2023, 64.2％ were female, and the mean age was 62.8±15.8 years. Dry powder inhalers （DPIs） were used more frequently than were pressurized metered-dose inhalers （pMDIs） in all treatment steps in all years. The use of pMDIs increased from 16.4％ in 2018 to 21.6％ in 2021 but decreased to 18.1％ in 2023. For inhaled medications, the combination of inhaled corticosteroid （ICS）/long-acting β2-receptor agonist （LABA） was the most frequently used. However, the number of patients using ICS/LABA significantly decreased in 2023 relative to that in 2021, whereas the number of patients using single-inhaler triple therapy （SITT） significantly increased. Although DPIs are used more frequently, certain patients require pMDIs, and it may be more useful for them. The approval of SITT has improved accessibility to long-acting muscarinic receptor antagonists. This study emphasizes the importance of understanding inhaler types and medication characteristics to enable personalized treatment based on each patient’s needs.

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Voxel-based regional analysis system for Alzheimer’s disease （VSRAD） can measure the volume of the hippocampus and parahippocampal gyrus in patients over 55 years of age, and support the early diagnosis of Alzheimer’s disease or mild cognitive impairment. The aim of this study is to validate the clinical usefulness of the VSRAD in the evaluation of cognitive function in elderly schizophrenia, comparing with those in elderly depression and Alzheimer’s disease. We included 19 elderly patients with schizophrenia, 18 elderly patients with depression, and 19 patients with Alzheimer’s disease at the National Hospital Organization Kikuchi Hospital over a 10-year period. The atrophy in hippocampal and parahippocampal gyrus was evaluated by using VSRAD Z-scores. The cognitive function was assessed by Mini-Mental State Examination. A Pearson product-moment correlation was used to analyze the correlation between the VSRAD Z-scores and MMSE scores. In the schizophrenia group, volumes of the hippocampal and parahippocampal gyrus tended to be smaller than those in the depression group, and the levels of cognitive function also tended to be lower than those in the depression group, even though the average age in the schizophrenia group was lower than in the depression group. In the schizophrenia group, the levels of cognitive function declined with the reduction in hippocampal and parahippocampal volumes （r＝−0.52, p＜0.05）, as did the Alzheimer’s disease group （r＝−0.63, p＜0.01）. In conclusion, we demonstrated the hippocampal atrophy related with cognitive impairment in elderly patients with schizophrenia as well as in patients with Alzheimer’s disease. We also suggested the possibility of structural and functional differences in brain pathology between schizophrenia and depression.

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Sports drinks are an effective means of rapidly replenishing fluids and nutrients, such as electrolytes, lost during exercise. However, the frequent consumption of sports drinks lowers oral pH, and the subsequent use of a sports mouthguard （SMG） reduces saliva contact with the tooth surfaces, decreasing acid buffering capacity and potentially increasing the risk of dental caries. Wearing an SMG is essential for safety and comfort in sports, as it prevents or mitigates damage to the teeth and oral mucosa and reduces the risk of concussion. This study aimed to investigate the acid buffering capacity of sports mouthguards containing surface pre-reacted glass-ionomer （S-PRG） filler （S-SMGs）. The study included 11 rugby players. Tooth surface pH was measured after the consumption of a sports drink under three conditions: without an SMG, with an SMG, and with an S-SMG. There was no significant difference between the control group and the S-SMG group; however, a significant difference was observed between the control group and the SMG group, indicating that the SMG delayed pH recovery. The findings of this study suggest that the S-SMG is suitable for situations involving the consumption of sports drinks.

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There is currently no unified understanding of the mechanism underlying the commonly observed malposition （buccal inclination of the maxillary second molar） in the maxillary molar region. The aim of this study was to clarify the factors associated with the buccal inclination of the maxillary second molar. Thirty-two participants with skeletal Class Ⅰ or Ⅱ malocclusion were classified into four groups according to the presence or absence of buccal inclination of the maxillary second molars. Cone-beam computed tomography in centric occlusion was used to evaluate the horizontal relationship between the upper and lower alveolar bones in the molar region. Statistical analysis was performed using an analysis of covariance and a mixed-effects model analysis, with tooth inclination and skeletal classification serving as explanatory variables. The buccal inclination of the maxillary second molars was defined according to the buccolingual positional relationship between the first and second molars. Compared to the Class Ⅰ group with buccal inclination, the Class Ⅱ group with buccal inclination had a pronounced lingual inclination of the first molars, and the lingual cancellous bone width at the level of the first molar showed a significant difference in the main effect of tooth inclination （p＝0.002） and the interaction effect between tooth inclination and skeletal classification （p＝0.041）. A significant main effect of tooth inclination was observed for the overlap width between the upper and lower alveolar bones （p＝0.035）. No significant difference was observed between the groups regarding the alveolar distance posterior to the maxillary first molar. This study suggests that the positional relationship between the upper and lower alveolar bones and the associated change in the degree of inclination of the first molar are involved in the buccal inclination of the maxillary second molar.

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Adrenal venous sampling （AVS） is essential for diagnosing subtypes of primary aldosteronism （PA）; however, its interpretation can be compromised by anatomical and physiological factors. This study aims to clarify how venous dilution and drainage variability obscure lateralization in technically successful AVS procedures. We analyzed five patients with AVS-confirmed unilateral PA who exhibited discordant radiological and hormonal findings. All patients underwent superselective AVS and a detailed imaging review. Anatomical variations and hormone gradients were examined to identify the root causes of these discordances. Three patients demonstrated the collecting dilution effect （CDE）, wherein tumor drainage merged with non-tumor-related venous flow. Nonrepresentative hormonal adrenal central veins （NRH-ACVs） were suspected in cases where the sampled central veins did not align with the functional laterality confirmed by superselective sampling and surgical outcomes. Even when catheterization is technically successful, lateralization may fail due to venous dilution or atypical drainage patterns. Recognizing these anatomical pitfalls can significantly improve diagnostic accuracy. An integrative analysis that combines venous anatomy with hormone gradients enhances clinical confidence in surgical planning.

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Orthodontic treatment with clear aligners is attracting attention, and various mechanical analyses are being conducted to improve simulation accuracy. Molar distalization in this type of treatment is considered highly predictable. However, methods for determining the regions that receive orthodontic force from the aligner are currently insufficient. Therefore, the objective of this study was to employ a two-dimensional birefringence measurement system using the optical phase difference proposed by Shimada et al. to visualize the area and distribution of orthodontic force during molar distalization in clear aligner orthodontic treatment. In addition, we quantitatively evaluated the impact of molar distalization. Four types of clear aligners were prepared: a control aligner, second molar aligners only （#27）, and first-and-second molar aligners （#26 and #27）, with distalization distances of 0.25mm and 0.50mm. Subsequently, we compared the orthodontic forces applied by the clear aligners to the models. A two-dimensional birefringence measurement system （WPA-200-NIR） was used to calculate the mechanical strain energy from the generated optical phase difference. When the first and second molars （#26 and #27） were distalized, greater movement distance resulted in a lower load on the terminal molar. Furthermore, although the load decreased on the canines, the load on the anterior teeth increased. These results suggest that during molar distalization in clear aligner orthodontics, careful consideration must be given to the distalization distance and the number of teeth to be distalized.

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