Left atrial circumferential ablation （LACa） and box ablation （BOXa） are two common treatments for paroxysmal atrial fibrillation （PAF）. However, only a few studies have compared these two approaches. This study aimed to compare the clinical outcomes of these two therapeutic modalities. Patients with PAF who underwent catheter ablation were randomly assigned to either the LACa or BOXa groups and were followed up for 6 months. The primary outcomes were the rate of atrial fibrillation （AF） recurrence after 6 months and changes in the left atrial ejection fraction （LAEF） measured via magnetic resonance imaging from baseline to follow-up. The secondary outcomes included the frequency of supraventricular premature beats （SPBs） and short supraventricular runs （SVRs） on a 24-h electrocardiogram at follow-up. A total of 40 patients were randomly assigned to the LACa （n＝21） or BOXa group （n＝19）. No significant between-group differences were observed in the patient characteristics and LAEF at baseline or the rate of AF recurrence at 6 months （LACa, 4.8％ ［1/21］ vs. BOXa, 5.3％ ［1/19］; P＝0.94） as well as changes in the LAEF at 3 and 6 months. However, the frequency of SPB and SVR at 6 months was significantly lower in the LACa group than in the BOXa group （0.2 ［−0.2, 0.50］/24h vs. 0.8 ［0.5, 1.2］/24h, P＝0.01; 2.2 ［−4.2, 8.7］/24h vs. 11.9 ［4.8, 18.9］/24h, P＝0.04, respectively）. Although the rates of AF recurrence and changes in the LAEF were comparable between the LACa and BOXa groups, the higher incidence of SPBs and SVRs at 6 months in the BOXa group suggests that BOXa provided no advantage in the treatment of PAF patients.

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The precise measurement and detection of a tumor is indispensable in establishing the regular use of minimally invasive procedures for breast cancer treatment. We, herein, focused on ultrasonography （US） and magnetic resonance imaging （MRI）, and evaluated their effectiveness in measuring the tumor size of ductal carcinoma in situ （DCIS）. Furthermore, we assessed the DCIS subtype and its relationship with the accuracy of the imaging modalities and some critical histopathological characteristics. A total of 102 DCIS cases （that were diagnosed from 2018 to 2021） were retrospectively analyzed. The tumor sizes measured by US and MRI were compared with those obtained by the postoperative histological examination of the tumors. The DCIS subtypes were classified based on the nuclear grade and immunohistochemical （IHC） pattern; namely, estrogen/progesterone receptor expressing status, human epidermal growth factor receptor 2 （HER2） expressing status, and Ki-67 index. Tumors classified as HER2-enriched DCIS exhibited a high nuclear grade and a high Ki-67 index （Ki-67＞20％） when compared with the luminal DCIS tumors （p＜0.05）. The tumor size measured by US was smaller than the actual tumor size in all DCIS subtypes, while MRI systematically overestimated the tumor size with the exception of the triple-negative DCIS. The median tumor size differences identified between MRI and histopathology were smaller than those identified between US and histopathology, especially in HER2-enriched DCIS cases （p＝0.01）. The HER2-enriched DCIS tumors were more accurately measured by MRI than by US. MRI could measure the DCIS tumor size more accurately than US, especially in HER2-enriched DCIS cases （p＝0.01）. These results might be particularly useful in developing a more tailored DCIS management strategy.

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Cognitive challenge is a late effect of childhood cancer survival. This study examined the effectiveness of CogEvo （Total Brain Care ［TBC］, Kobe, Japan）, a computerized evaluation system, in assessing neuropsychological dysfunctions that are difficult to identify among children who have experienced therapeutic exposure, radiation therapy, chemotherapy, surgical therapy, and hematopoietic cell transplantation. In all, 30 childhood survivors who attended a long-term follow-up clinic at the Children’s Cancer Center between April 2017 and December 2019 were assessed using CogEvo software, and 23 were assessed using the Wechsler Intelligence Scale for Children, Fourth Edition （WISC-IV）. Basic profile information （diagnosis and treatment） was also obtained. In all, 18 participants received central nervous system-directed therapies （CNS group）, and 12 did not （non-CNS group）. We found that in these childhood survivors, the spatial cognition and memory scores registered by CogEvo were significantly correlated with the scores on the WISC-IV perceptual reasoning index （PRI） in terms of spatial cognition （r＝0.52） and memory （r＝0.48）. Furthermore, orientation （p＜0.01） and spatial cognition （p＝0.01） scores were lower in the CNS group than in age-matched control subjects in the TBC database. The CogEvo results were related to certain elements of the PRI in WISC-IV and may measure visuospatial cognition. Cognitive weakness assessed on the PRI in the CNS group can be detected using CogEvo. CogEvo may complement WISC-IV to measure sensitive outcomes of cognitive function in childhood survivors who have experienced therapeutic exposure.

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In 2018, oral hypofunction was registered officially as a disease in Japan. It is important to detect oral hypofunction symptoms early in patients, before frank oral dysfunction symptoms occur. Subjective evaluations of chewing function, which help to identify foods that cannot be chewed, might be useful in diagnosing oral hypofunction. Previous evaluations used to identify patients with oral hypofunction used varying standards, making it impossible to compare and integrate them without first developing a unified screening method. This study aimed to compare and integrate known evaluation methods that are useful for diagnosing oral hypofunction. A total of 76 elderly participants （aged ＞65 years） were enrolled after providing consent to participate in this study. The established subjective evaluation methods of chewing function investigated for this study included the Yamamoto denture performance judgment table, the Sato table for evaluation of chewing function in complete denture wearers, and the Hirai evaluation method for the masticatory function in complete denture wearers. As the Yamamoto method lacks scoring, the total number of circles was used as the score. A time study was performed on the time taken for the description, entry, and analysis of these tables. There was a strong correlation between the Sato and Hirai methods （r＝0.71） and between the Sato and Yamamoto （r＝0.68） and Hirai and Yamamoto （r＝0.60） methods. During the time study, the description time was the shortest with the Yamamoto method, and the entry and analysis times were the shortest with the Sato method. The total time was significantly shorter with the Sato method than with the Yamamoto method. Three evaluation methods showed correlation, but the examination times varied. In future studies, we plan to clarify the selection criteria, including the relevance of objective evaluation and usability.

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Incidental gallbladder cancers （IGBCs） refer to gallbladder cancers （GCs） that are not preoperatively diagnosed but are diagnosed only after cholecystectomy for benign gallbladder diseases. This exploratory study aimed to investigate the diagnostic performance of bile cytology with percutaneous transhepatic gallbladder drainage （PTGBD） and tumor markers in preoperatively detecting IGBC. Data on consecutive acute cholecystitis cases between January 2018 and March 2020 at the Showa University Hospital in Tokyo, Japan, were retrospectively analyzed. Patient characteristics, bile cytology results, collection date, and blood test results were assessed. Concerning the bile cytology results, classes I–III were categorized as negative, whereas classes IV and V were positive. Bile cytology was performed in 102 patients; of these, 2 cases were diagnosed as GC. The bile cytology results were as follows: class I in 15 cases; class II in 84; class III in 2; class IV in 1; and class V in 0. Therefore, 101 and 1 cases were judged as negative and positive, respectively. Bile cytology had a sensitivity of 50％, specificity of 100％, positive predictive value of 100％, and negative predictive value of 99％. Among 47 patients in whom carcinoembryonic antigen （CEA） and carbohydrate antigen 19-9 （CA19-9） levels were measured, 3 and 12 patients exhibited elevated CEA and CA19-9 levels, respectively. Tumor markers were elevated in IGBC cases; however, several false-positive results were present in cases without GC. Bile cytology from PTGBD may be useful for the preoperative diagnosis of IGBC with acute cholecystitis. Measurement of CEA and CA19-9 levels as tumor markers should be performed with caution, as false-positive results due to inflammation would be included.

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Patients with septic acute kidney injury （AKI） often require continuous renal replacement therapy （CRRT）, but factors that predict their prognosis have been insufficiently established. Thus, this study aimed to evaluate the associations of the Sequential Organ Failure Assessment （SOFA） score, SOFA-sub scores, and SOFA sub-score components with mortality in patients with AKI on CRRT. A total of 231 patients with AKI who required CRRT were enrolled in this retrospective, cohort study. Associations between the SOFA-sub scores on days 1 or 4 of CRRT and all-cause death within 30 days were assessed. The respiratory SOFA sub-score in patients with sepsis on day 1 was associated with mortality. However, this association disappeared on day 4, and coagulation and renal SOFA-sub scores were significantly associated with mortality in patients with sepsis. These findings differed from patients without septic AKI. The baseline respiratory SOFA sub-score was significantly associated with mortality in patients with septic AKI, whereas the coagulation SOFA sub-score became a prognostic factor on day 4. The evaluation of SOFA-sub scores and changes in the factors after CRRT initiation may be useful for predicting prognosis in patients with septic AKI.

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Herein, we evaluated the effectiveness of assessing “wetness” of sound extracted from ordinary Japanese utterances to detect dysphagia. Forty-five patients experiencing dysphagic symptoms after undergoing treatment for head and neck cancer were included as participants. We extracted “a” sound from the Japanese word for “month” （“gatsu”）, which was recorded before videofluoroscopic swallowing study （VFSS）. Forty-five “a” sounds were used for perceptual assessments. The recorded VFSS images were classified into the following groups based on the penetration-aspiration scale （PAS）: acceptable （PAS 1 or 2） and PA （PAS 3–8）. The speech samples were evaluated by 16 clinicians associated with dysphagia management. The degree of “wetness” of speech samples was perceptually assessed using a 5-point scale blinded to VFSS data. Average sensitivity and specificity of the first and the second perceptual evaluations were 69.8％ and 32.8％, respectively. Intraevaluator reliability between the first and second perceptual evaluations was 0.82, and interevaluator reliabilities of the first and second perceptual evaluations were 0.90 and 0.91, respectively. Our results suggested that solely relying on abnormal vocal quality is not useful. However, perceptual evaluation of continuous utterances appears promising as a valuable screening method for dysphagia.

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