The increase in the incidence of hip fractures over time disappeared in Northern European and North American Caucasians after 2000, while an increase was observed in Asian countries including Japan until 2010. However, a decrease in the incidence was observed after 2010. The prevalence of vertebral fractures in Asians, Europeans, and American Caucasians is similar, and the incidences of clinical and morphometric vertebral fractures are higher in Asians compared with European Caucasians. The decrease in the incidence of vertebral fractures over time has been observed in Japan. Although the stabilization or decrease over time in the incidence of hip and vertebral fractures have been observed, the number of patients with these fractures is expected to increase rapidly with increases in the elderly population. Multidisciplinary measures to prevent fragility fractures are an urgent issue in Asia at this time. This narrative review outlines the recent trends in incidence and future burdens of hip fracture and vertebral fracture in Asia.

Magnetic resonance imaging (MRI) is the preferred imaging technique for the sellar and parasellar regions. In this review article, we report our clinical experience with MRI for hypothalamic and pituitary lesions, such as pituitary adenomas, craniopharyngiomas, Rathke cleft cysts, germinoma, and hypophysitis with reference to the histopathological findings through a review of the literature. Our previous study indicated that three dimensional-spoiled gradient echo sequence is a more suitable sequence for evaluating sellar lesions on postcontrast T1 weighted image (WI). This image demonstrates the defined relationship between the tumor and its surroundings, such as the normal pituitary gland, cavernous sinus, and optic pathway. We demonstrated the characteristic MRI findings of functioning pituitary adenoma. In growth hormone-producing adenoma, signal intensity on T2WI is important to differentiate densely from sparsely granulated somatotroph adenomas. In prolactin-producing pituitary adenomas, distinct hypointense areas in early phase on T2WI, possibly owning to diffuse hemorrhage, indicate pronounced regressions of invasive macroprolactinomas during cabergoline therapy. The two histopathological subtypes, adamantinomatous and squamous papillary craniopharyngioma, differ in genesis. Calcified tumors are mostly adamantinomatous type. On MRI, these lesions have a heterogenous appearance with a solid portion and cystic components. The solid portions and cyst wall enhance heterogeneously. Although cyst fluid of Rathke cleft cysts show variable intensities on MRI, intracystic waxy nodule can be hypointense on T2WI. The enhancing cyst wall may contain the squamous metaplasia. Cystic lesions of the sellar and parasellar areas may be difficult to differentiate on a clinical, imaging, or even histopathological basis.

Background Cognitive flexibility is also referred to as set-shifting and is considered to be an important activity of the frontal lobe. The objective of this study was to produce a Cognitive Flexibility Test (CFT) that can evaluate cognitive flexibility in a short time and in a simple manner and to verify the usefulness of the test.

Methods The CFT, Mini Mental State Examination (MMSE), Verbal Fluency Test (VFT), and Geriatric Depression Scale 15 (GDS-15) were implemented among a total of 94 elderly people who live at home. An “A” version of CFT (CFT-A), which asked about the possible uses of a plastic bottle other than drinking and a “B” version (CFT-B), which asked about the possible uses of a ballpoint pen other than writing, were produced.

Results In the case of CFT-A, after adjusting the number of years of education, a significant correlation was found between CFT-A and the variables age, VFT, and MMSE. As for CFT-B, after adjusting the number of years of education, it was found to have a significant correlation with age and VFT. The number of responses for CFT-A and CFT-B were significantly lower than that of VFT. The number of responses for CFT-B was significantly lower than that of CFT-A.

Conclusion The CFT-A may be useful as a neuropsychological test to evaluate cognitive flexibility among elderly people that can be implemented easily in a short time.

Background As antithrombin III (AT-III) is produced in the hepatocytes, its serum activity decreases at the time of liver failure, in addition to ischemia reperfusion injury, vascular endothelial dysfunction, and disseminated intravascular coagulation (DIC). Here, we examined whether the serum AT-III value after hepatectomy could be a prognostic factor for hepatocellular carcinoma (HCC).

Methods Of 141 patients who underwent hepatectomy for HCC, data for 101 patients in whom serum AT-III activity was measured on the first postoperative day were extracted. Patients with serum AT-III activity > 50% and ≤ 50% were assigned to high value (72 cases) and low value (29 cases) groups, respectively. We examined the clinical and prognostic differences between these two groups.

Results The average age of enrolled patients (83 men and 18 women) was 68.0 years. The 5-year overall survival rate was 88% and 60% in the high and low value groups, respectively (P < 0.01). Furthermore, the 2-year relapse-free survival rate was 71% and 54% in the high and low value groups, respectively (P = 0.03).

Conclusion This is the first study to demonstrate that serum AT-III levels on the first postoperative day may serve as a prognostic factor in HCC patients.

Background The efficacy of adjuvant chemotherapy in stage II colorectal cancer (CRC) patients has not been clearly demonstrated. Therefore, identification of robust prognostic factors is crucial for the assessment of recurrence risk in stage II CRC and appropriate adjuvant treatment, in clinical practice.

Methods We enrolled 135 colorectal adenocarcinoma patients who underwent proctocolectomies and had histologically diagnosed stage II CRC.

Results Receiver operating characteristic (ROC) analysis, to evaluate the predictive ability of certain serum factors for CRC recurrence, indicated that the prognostic nutritional indicator (PNI), followed by serum carcinoembryonic antigen (CEA) level, were the strongest predictive metrics. Based on cutoff values from ROC analyses, patients were divided as follows; CEA^High (≥ 4.55 ng/mL), CEA^Low (< 4.55 ng/mL), PNI^High (≥ 47.72), and PNI^Low (< 47.72). The recurrence rates of patients with CEA^High and PNI^Low, CEA^High and PNI^High, CEA^Low and PNI^Low, and CEA^Low and PNI^High were 34.3%, 0%, 6.8%, and 2.6%, respectively (a significant difference at P < 0.0001). Logistic regression analysis revealed that the combination of serum CEA level and PNI was an independent predictive indicator of tumor recurrence after operation in stage II CRC patients. The 5-year disease specific survival rates of patients with CEA^LowPNI^High, CEA^HighPNI^High, CEA^LowPNI^Low, CEA^HighPNI^Low were 100%, 100%, 97.4%, and 77.5%, respectively (P < 0.0001).

Conclusion The combination of CEA and PNI was useful in predicting postoperative recurrence in stage II CRC patients.

Background We evaluated the influence of prior abdominal surgery on perioperative outcomes in patients who underwent robot-assisted partial nephrectomy in initial Japanese series.

Methods We reviewed patients with small renal tumors who underwent robot-assisted partial nephrectomy from October 2011 to September 2020 at our institution. Patients with prior abdominal surgery were compared with those without prior surgery based on perioperative outcomes. The chi-square test and Mann–Whitney U test were used for statistical analyses of variables.

Results Of 156 patients who underwent robot-assisted partial nephrectomy, 90 (58%) had no prior abdominal surgery, whereas 66 patients (42%) underwent prior abdominal surgery. No significant differences in perioperative outcomes were observed between with and without prior abdominal surgery groups. In transperitoneal approach robot-assisted partial nephrectomy, 31 patients (80.4%) had prior abdominal surgery. Trocar insertion time in the with prior abdominal surgery group took longer than the without prior abdominal surgery group (32 vs. 28.5 min, P = 0.031). No significant difference was observed in the conversion rate between the two groups (P = 0.556).

Conclusion Robot-assisted partial nephrectomy appears to be a safe approach for patients with prior abdominal surgery. In transperitoneal approach robot-assisted partial nephrectomy with prior abdominal surgery, trocar insertion time was longer, but no significant differences were found in other outcomes. Transperitoneal approach robot-assisted partial nephrectomy is thus considered a safe procedure for patients with prior abdominal surgery.

Background Self-compassion has been considered beneficial in overcoming negative self-assessment due to inadequate coping that increases vulnerability to significant distress among undergraduate students in emerging adulthood.

Methods Subjects were 552 Indonesian undergraduate students from Diponegoro University, Indonesia (M_Age = 20.03; SD_Age = 1,022). Sex and age category were identified for further analysis. The measurements used the Self-Compassion Scale (SCS) and General Health Questionnaire-12 (GHQ-12). The GHQ-12 also measures psychological morbidity in three dimensions, i.e. social dysfunction, anxiety and depression symptoms, and loss of confidence. Data were analyzed using Spearman’s rho. Additional analyzes using the Mann-Whitney U Test and descriptive statistics were also performed.

Results Self-compassion had a significant negative relation with distress. Self-compassion was significantly related to all dimensions of distress, i.e. loss of confidence, anxiety and depression symptoms, and social dysfunction (from largest to smallest respectively). The correlation between self-compassion and distress in men was higher than women, both were significant. The correlation between those two constructs in late adolescence and early adulthood were also significant. Both sex and age did not significantly predict self-compassion and distress.

Conclusion The existence of self-compassion could predict a lower level of distress both in general and based on its dimensions, as well as correlations based on sex and age categories. A higher correlation in men may be of concern, while the absence of a marked difference in the correlation by age category could be due to the effect of small age variation in both age categories that was still in the emerging adult period. This was also supported by a non-significant difference of each variable across sex and age category. Discussions based on cultural values were also considered.

Background Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma in Asia and Indonesia. DLBCL could be further classified according to cell of origin as the germinal center B-cell (GCB) subtype or the non-germinal center B-cell (non-GCB) subtypes; of these, the non-GCB subtype usually has poorer prognosis. The purpose of this study is to determine the relationship between the cell-origin subtype and 3-year overall survival of patients with DLBCL at Kariadi General Hospital Semarang.

Methods This research represents an observational analytical study of 36 patients with DLBCL who visited Kariadi General Hospital between January and August 2017. Data on age of diagnosis, tumor location, disease stage, and 3-year overall survival were collected. DLBCL subtype was determined via immunohistochemical examination of CD10, BCL6, and MUM1 protein expression. Data analyses, including the chi squared test and Kaplan-Meier curves, were conducted.

Results The study population included 18 patients with GCB-subtype DLBCL and 18 patients with non-GCB-subtype DLBCL. No significant difference (P = 0.171) between disease stage and cell-origin subtype was noted between groups. Patients with the non-GCB subtype had a 3-year overall survival that was significantly worse than that of patients with the GCB subtype (P = 0.026). Moreover, the 3-year survival rate of patients with the non-GCB subtype of the disease was 38.9% while that of patients with the GCB subtype was 77.8%. Patients with advanced stages of DLBCL also had a 3-year overall survival that was significantly worse than those of patients with early stages of the disease (P < 0.001), with the 3-year survival rate of patients with advanced stage was 14.3%.

Conclusion Patients with non-GCB-subtype DLBCL or advanced stages of the disease have a lower 3-year overall survival rate and poorer prognosis compared with those with other subtypes or earlier stages of the disease.

Accessory and Cavitated Uterine Mass (ACUM) is a condition defined by the presence of a non-communicating uterine mass close to the insertion of the round ligament. ACUM is a rare Müllerian anomaly found in young women and is diagnosed by the presents of a central cavity in the uterus, lined by functional endometrium, and surrounded by a ring of smooth muscle. In most cases, surgical treatment is recommended due to severe dysmenorrhea. Herein, we present a case of a woman with severe dysmenorrhea since adolescence which was not relieved with any form of hormonal treatment. ACUM was suspected preoperatively based on MRI findings, and she was treated with total laparoscopic hysterectomy. A uterine mass was found at the insertion of the right round ligament during surgery. All her symptoms improved after resection.

We report the case of a 65-year-old male who presented with a 1-week history of right periorbital pain and progressive visual loss. He had a history of ulcerative colitis and was taking oral corticosteroids and mesalazine. Neurological and radiological examination demonstrated a rare case of invasive fungal rhinosinusitis that began with orbital apex syndrome. Initial endoscopic sinus surgery was performed and fungal culture identified Aspergillus fumigatus. Although antifungal treatment was started empirically before the operation, the patient had improved orbital pain but continued to have decreased right vision. Five months after the first surgical procedure, his condition deteriorated, including loss of consciousness, and a right temporal lobe abscess was found and surgically drained. Since then, the patient received antifungal treatment for 4 years without recurrence. Invasive fungal rhinosinusitis with orbital apex syndrome should be treated with long-term postoperative antifungal medication. It should be noted that even in immunosuppressive individuals such as ulcerative colitis, fungal rhinosinusitis with orbital apex syndrome may become severe.

Lichen nitidus and morphea are common diseases, but an associated localization of both lesions is rare. Here, we describe the first case of lesions distributed along Blaschko’s lines. A 24-year-old Japanese woman was referred to our clinic for evaluation of band-like plaques of 18-months history on the right lateral side of her abdomen. In addition, multiple milky-white papules were seen within the plaques. Histopathological examination showed there was sclerosis in the lower half of the dermis and well-circumscribed, dense, papillary dermal lymphohistiocytic aggregations showing a so-called “claw clutching a ball.” Immunohistochemical analysis revealed that the morphea and lichen nitidus had similar characteristics. We speculated that unique immunologic events led to the development of lichen nitidus and morphea in our patient.

A 49-year-old Japanese man presented with a rare case of sinonasal leiomyosarcoma with left nasal bleeding for 12 months. He had no history of irradiation or malignancies, including retinoblastoma. Preoperative histological examination suggested vascular leiomyoma. Complete resection with endoscopic surgery was performed. Histological examination during the operation suggested that the tumor was a leiomyoma. However, immunohistochemical staining for α smooth muscle actin and desmin were helpful in establishing a definitive diagnosis of sinonasal leiomyosarcoma. The resection margins were positive for tumor cells. Staging with CT of the neck and thorax, ultrasound of the abdomen, and MRI of the head ruled out metastases. Second endoscopic tumor resection surgery was performed for positive resection margins. The patient’s condition was successfully managed with additional excision, and he remains well with no evidence of recurrence and metastasis 36 months after treatment. Endoscopic management should be considered in suitable cases.

Superficial siderosis is a disease in which iron from hemoglobin is deposited in the central nervous system, resulting in conditions such as progressive sensorineural hearing loss, cerebellar ataxia, dementia, and pyramidal signs. A 30-year-old man with superficial siderosis received a cochlear implant in the left ear, which had shown complete hearing loss. Good auditory responses were obtained at 14 days after implantation. The postoperative average hearing level with the cochlear implant was 56.7 dB at 3 months and 55.0 dB at 6 months. However, the patient showed gradual hearing loss, and the dynamic range changed each time the electrode parameters were adjusted. To assess residual hearing ability, single-photon emission computed tomography was performed together with an assessment of electrical auditory brainstem response, which showed a good response and increased blood flow in both the temporal lobes. Based on this result, we asked the patient to continue using the cochlear implant to see whether a perception of speech response would be obtained. However, the patient discontinued using the cochlear implant because he could not hear satisfactorily. Hearing outcomes after cochlear implant surgery for patients with superficial siderosis are not necessarily good. Therefore, the possibility of unsatisfactory results should be fully explained before recommending this surgery to patients.

Ventilation in the prone position improves the prognosis of patients with severe acute respiratory distress syndrome (ARDS). Contraindications to ventilation in this position include unstable systemic circulation. Only a few reports exist on the effects of prone ventilation in respiratory failure on systemic circulation. This animal study compared systemic hemodynamic changes between supine and prone positions in anesthetized rabbits under acute systemic hypoxia (breathing 15% O₂). Cardiac output and the systemic O₂ extraction ratio increased under the hypoxia, but only in the supine group. Besides, the rate pressure product was higher in the prone group than in the supine group. This study showed that prone ventilation increases myocardial O₂ consumption and suppresses compensatory mechanisms to maintain aerobic metabolism during systemic hypoxia. First of all, it will be necessary to examine the effect of prone ventilation on the O₂ supply-demand balance in the ARDS model.