We investigated the safety and utility of endoscopic removal of common bile duct stones (CBDS) in the elderly. In all, 253 patients with CBDS who underwent endoscopic retrograde cholangiopancreatography (ERCP) between January 2007 and December 2011 at Showa University Hospital were evaluated retrospectively. The median age of the patients was 75 years; thus, we divided patients into two groups, those aged ≥ 75 years (Group A; n = 134) and those aged < 75 years (Group B; n = 119). Patients in Group A had significantly higher rates of endoscopic sphincterotomy in palliative ERCP (24.8% vs. 10.7%; p = 0.008) and palliative removal of CBDS (34.8% vs. 20.9%; p = 0.015) than patients in Group B. However, the median dose of flunitrazepam was significantly lower for patients in Group A than Group B (1 vs. 1.4mg, respectively; p < 0.001). The rate of use of pentazocine (18.5% vs. 54.7%; p < 0.001) and scopolamine butylbromide (6.2% vs. 23.9%; p < 0.01) was significantly lower in Group A patients, whereas the use of glucagon was significantly higher in this group (43.8 vs. 15.4%; p < 0.001). There were no significant differences in the rate of successful endoscopic removal of CBDS, treatment time, complications, and the recurrence of CBDS between the two groups. Endoscopic removal of CBDS in the elderly is a safe procedure with good outcomes if the appropriate treatment is selected.

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Pulmonary vein isolation (PVI) via catheter ablation has been shown to be a highly effective option for patients with symptomatic paroxysmal atrial fibrillation (AF). The recurrence of AF within 3 months after PVI is not considered a failure of the ablation procedure because early recurrence of AF is not always associated with late recurrence. We examined the usefulness of an external loop recorder with auto-trigger function (ELR-AUTO) to detect AF following PVI to characterize early recurrence and determine the implication of AF within 3 months after PVI. The study included 53 consecutive patients with symptomatic paroxysmal AF (age, 61.6 ± 12.6 years; 77% male) who underwent PVI, and were fitted with an ELR-AUTO for 7 ± 2 days within 3 months after PVI. Of the 33 patients (62.2%) who did not have AF within the 3-month period, only 1 patient had AF recurrence at 12 months. Seven of 20 patients (35%) who experienced AF within 3 months had symptomatic AF recurrence at 12 months. The sensitivity, specificity, positive predictive value, and negative predictive value of early AF recurrence for late recurrence was 87.5%, 71.1%, 35.0%, and 96.9%, respectively. Thus, AF recurrence detected by ELR-AUTO within 3 months after PVI can predict late AF recurrence. Freedom from AF in the first 3 months following ablation significantly predicts long-term freedom from AF. An ELR-AUTO is useful for detecting symptomatic and asymptomatic AF.

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Accumulating evidence from animal studies shows that the administration of mesenchymal stem cells (MSCs) from adult bone marrow ameliorates tissue damage after ischemic injury. In the present study we investigated the efficacy of MSC implantation into a hindlimb ischemia model over a short-term period to elucidate the effects conferred within the early phase after treatment. MSCs from rats expressing green fluorescence protein (GFP) were injected into rat ischemic limbs. Laser Doppler perfusion imaging revealed significantly higher blood perfusion recovery in the MSC group than in the control group on days 3 and 7 after the treatment. The capillary/muscle fiber ratio in ischemic muscle was also significantly higher in the MSC group than in the controls in a histological study. In spite of these benefits, we found no evident engraftment of the GFP-positive cells, and instead, the MSC treatment induced a proliferation of resident stromal cells in the perivascular area of the ischemic muscle, some of which produced vascular endothelial growth factor. The present study suggested that MSC therapy promotes neovascularization even in the early phase, both directly through endothelial proliferation and indirectly through activation of the resident stromal cells.

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Selecting the appropriate operation for gallbladder cancer depends on the depth of cancer invasion, which remains difficult to determine preoperatively, especially with respect to the subserosal layer (pT2). We devised a laparoscopic cholecystectomy with gallbladder bed dissection (LC with GBD) as a new total biopsy method for suspected gallbladder cancer. We retrospectively reviewed the medical records of 19 patients who underwent LC with GBD to assess the usefulness of this procedure and the pathological findings. No severe morbidity or recurrence was encountered. LC with GBD could be performed easily and safely, and the patients' postoperative course was almost equal to that of patients treated by conventional LC. Histologically, gallbladder cancer was diagnosed in five cases (pT1a, 3; pT2, 2). We believe that LC with GBD could play an important role in the potential treatment strategy for pT2 gallbladder cancer.

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In recent years, good outcomes have been reported using transparent and removable orthodontic appliances known as aligners. However, unpredicted tooth movement that contradicted 3-dimensional image simulations was observed in some cases. These anomalies could relate to biomechanical factors; in particular, the characteristics of mechanical loading applied to the periodontal ligament and the tooth crown by aligners remain unclear. This study examines the biomechanical characteristics of aligners by a new method as follows: 1) development of an experimental model using artificial teeth and plastic aligners; 2) finite element (FE) modeling and analysis using computed tomography (CT) images of the experimental model; and, 3) comparison among observations of this actual model and standard FE analysis results. Roots of two artificial teeth were covered by silicone material at 1.0mm intervals for each coronal proximal surface and plastic clear aligners were manufactured based on another model in which the interval was reduced to 0.0mm to simulate bodily movement. An FE analysis model of this 1.0mm teeth interval was reconstructed from the CT images. A virtual aligner based on the FE model was also generated with a 0.0mm interval. Changes in space between the root surface and silicone in both the actual and FE model were compared with the aligner fitted in the initial model. Identical tendencies of movement were observed in both experimental results - the artificial teeth and computational results of FE analysis. Our method using an experimental and computational approach proved useful to examine aligner characteristics; the use of such a biomechanical approach could further our understanding of aligner treatments.

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Biometric identification techniques are widely used as individual identification methods in security systems. We have studied the high frequency component of electrocardiogram (HFECG) as a new biometric modality. In this technique, a HFECG segment containing individual characteristics is extracted and used for identification. Identification performance depends greatly on extraction accuracy, but the current extraction method using the peak point on R waves as fiducial points can result in unsatisfactory performance. In this study, we propose a new fiducial point determination technique utilizing waveforms transformed from ECGs. The algorithm is based on differential calculus and produces sufficient performance despite having less complexity than other signal detection techniques. Comparative evaluation established that identification performance was improved using the new method.

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The reverse redistribution phenomenon (RR) on ²⁰¹Tl SPECT has been focused mainly on ischemic improvement regions after reperfusion therapy or vasospastic angina pectoris. However, RR analysis has not been used in the context of non-ischemic disease. The aim of this study was to evaluate the clinical role of RR on ²⁰¹Tl SPECT in patients without a history of myocardial ischemia. We retrospectively enrolled 86 patients showing RR by myocardial perfusion SPECT and studied 75 other patients as a control group. For quantitative analysis, each ²⁰¹Tl SPECT polar map was divided into 13 segments. Differences between the RR and control group were assessed with respect to patient characteristics and cardiac event-free survival using the Kaplan-Meier method. RR was detected frequently in the inferoposterior wall, septal portion of the anterior wall, and septum. The two groups showed significant differences in rates of heart failure (P < 0.01), hypertrophic cardiomyopathy (P < 0.05), and wall motion abnormality (P < 0.05), but not in the rate of event occurrence. The study demonstrated that RR on ²⁰¹Tl SPECT could indicate the existence of myocardial damage; however, it would not be a factor that determines the prognosis.

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An 85-year-old man was referred to the Department of Gastroenterological and General Surgery after complaining of abdominal pain and distention. Abdominal computed tomography (CT) revealed intra-abdominal free air, mimicking perforated peritonitis, with air collection within the jejunum bowel wall. On the basis of these findings, we made a diagnosis of pneumatosis cystoides intestinalis (PCI) with intra-abdominal free air. The PCI signs had disappeared completely by Day 7 of hospitalization. The patient was discharged from hospital after 15 days. At the time of writing, the patient's PCI has not reappeared. This case highlights the clinical importance of PCI, and that the lung window settings of abdominal CT are useful tools to enable an accurate diagnosis of PCI.

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A 60-year-old man with diabetes mellitus (DM) had a continuous fever and complained of pollakisuria and general fatigue during his hospitalization to establish glycemic control. He was diagnosed with a prostatic abscess by computed tomography and immediately transferred to our hospital. Transrectal, ultrasound-guided, needle aspiration of the prostatic abscess was performed as the initial surgical treatment, but the fluid could not be completely evacuated due to its high viscosity. Aspiration was not sufficient to improve his symptoms, therefore, antibiotics were administered intravenously along with strict control of his DM. Transurethral resection of the prostate (TURP) was carried out to resolve the abscess cavities while the patient awaited improvement of his general condition and inflammatory findings. After TURP, the patient's lower urinary tract symptoms improved, and the abscess in the prostate did not recur.

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