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【Purpose】With a view to early diagnosis of pediatric urological diseases and early intervention, pediatric urological infant health check-ups were introduced as 10-month health check-ups in Nankoku City and Konan City, Kochi Prefecture. In this study, we investigated the usefulness of pediatric urological examinations. 【Methods】The subjects comprised 992 people who underwent a 10-month check-up for infants in Nankoku City and Konan City between April 2021 and March 2023. The subjects were interviewed regarding urination and defecation, and the vulva, inguinal region, and sacrococcygeal region were examined. Only in Nankoku City, the presence or absence of hydronephrosis was confirmed using a portable echo device. 【Results】In Nankoku City and Konan City combined, 41 out of the 992 infants (4.1%) examined were found to have a urological disease. The breakdown of diseases included labial fusion in 13, sacrococcygeal depression in 12, hydronephrosis in 5, balanus hypospadias in 3, cryptorchidism in 2, testicle migration in 2. One infant had edema, one had an atrophic kidney, one had a meatal cyst, and one had gross hematuria. According to the data for the past five years, 12 out of 2608 people (0.5%) were precision workers in Nankoku City and Konan City combined. 【Conclusion】After commencing pediatric urological check-ups, there has been a significant increase in the number of infants diagnosed with pediatric urological diseases (P<0.05). By performing a pediatric urological check-up at 10 months, we considered that it would be possible to diagnose patients early and thereby intervene at the appropriate time. [ABSTRACT FROM AUTHOR]

The incidence of cancer within a bladder diverticulum is 0.8-10 %, and early diagnosis and appropriate treatment options are important because of its early invasion. We herein report three cases of intradiverticular bladder cancer. (Case 1) A 75-year-old male. The chief complaint was gross hematuria. He had a 25 mm diverticular mass on the left wall. The initial transurethral biopsy (TU-biopsy) did not lead to a diagnosis, and two months later, TU-biopsy and percutaneous needle biopsy were performed again, and a diagnosis of invasive UC, high grade, cT3N0M0 was made. Radical cystectomy was performed after chemotherapy, but the left pelvic wall was infiltrated, and pelvic recurrence and peritoneal dissemination were observed early after the operation, and the patient died of cancer. (Case 2) A 50-year-old male. The chief complaint was gross hematuria. After the spontaneous passage of a bladder diverticulum stone, the patient had recurrent cystitis, and MRI revealed a 7 mm diverticular tumor. He was diagnosed with invasive UC, high grade, cT1N0M0 by TU-biopsy, and underwent laparoscopic bladder diverticulectomy after chemotherapy. The pathological diagnosis was pT0. The patient remains recurrence-free at 1 year postoperatively. (Case 3) A 57-year-old male. The chief complaint was gross hematuria. MRI showed a 15 mm tumor consistent with a left wall diverticulum. He underwent TURBT with a diagnosis of cTaN0M0 and presented with non-invasive UC, low grade. He has been recurrence-free 8 months after the operation. [ABSTRACT FROM AUTHOR]

Late-onset hereditary ATTR (ATTRv) amyloidosis in nonendemic areas takes long periods of time to diagnose in many cases because the clinical symptoms are varied and nonspecific with the family history often unidentifiable. In recent years, disease-modifying therapies have been available for ATTRv amyloidosis, and early diagnosis is increasingly needed. The diagnosis of ATTRv amyloidosis usually requires histological confirmation of the amyloid deposition, although the amyloid detection rate largely depends on the experience, knowledge, and skill of the physician who performs the biopsy. It is important to consider ATTRv amyloidosis as a differential disease in idiopathic polyneuropathy. If ATTRv amyloidosis is strongly suspected, it is acceptable to perform TTR genetic testing prior to histological examination after a thorough differential diagnosis has been made.

A 32-year-old male presented with unilateral orbital-temporal pulsatile headache, followed by fever in the 38°C range and nausea. The patient experienced two episodes of transient dysarthria and tinnitus, each lasting several minutes. MRI revealed swelling of the left cerebral cortex, enhancement of the leptomeninges, dilation of the left middle cerebral artery, and subcortical FLAIR hypointensity. The clinical presentation and MRI findings raised suspicions of myelin oligodendrocyte glycoprotein (MOG) antibody-associated cortical encephalitis. After two courses of steroid pulse therapy, the patient's headache subsided, and there was a significant improvement in the swelling of the left cerebral cortex. Subsequently, serum MOG antibody positivity was confirmed. While unilateral cortical FLAIR hyperintensity and increased blood flow can be observed in various diseases, MOG antibody-associated cortical encephalitis is notably characterized by subcortical FLAIR hypointensity, a finding more frequently observed in this condition compared to other diseases. In this case, the findings were useful for early diagnosis and intervention.

The advent of lecanemab is a hope not only for people with dementia and their families but also for society as a whole. However, the effectiveness of lecanemab is limited, and the need to inform patients of their dementia may emphasize negative aspects more than ever as "early diagnosis leads to early despair." In this situation, it is important to provide post-diagnostic support to make the "time spent living with dementia," which is prolonged by lecanemab, as meaningful as possible. In this review, the authors introduce the "Peer Support Activities for people with mild dementia and their families," a post-diagnosis support program for those diagnosed early in the course of the disease.

Longitudinal studies using neuropsychological tests have reported that cognitive changes may be observed up to 20 years before diagnosis of dementia. These findings suggest that neuropsychological tests may serve as potential screening tools during the preclinical phase of Alzheimer's disease. However, routine cognitive screening tests show limited sensitivity for prediction of dementia. Therefore, careful selection of appropriate neuropsychological tests is essential for effective screening of dementia during the preclinical stages.

The advent of pathology-specific diagnostic methods such as amyloid positron emission tomography (PET) and tau PET has enabled early and pre-symptomatic diagnosis of Alzheimer's disease. Imaging biomarkers in nuclear medicine play a key role in elucidating the pathogenesis of Alzheimer's disease and accelerating the development of disease-modifying drugs. In this study, we describe the current status and future prospects of nuclear medicine diagnostics aimed at early detection of Alzheimer's disease to delay and prevent disease progression.

MR imaging is often used in assessing patients with dementia, including Alzheimer's disease. Assessment is done through quantitative imaging analysis in addition to visual assessment using structural MRI. Advanced MRI techniques, such as diffusion MRI, functional MRI, arterial spin labeling (ASL), and MR spectroscopy, are also potential imaging biomarkers. In this article, we will outline the current status in the early diagnosis of Alzheimer's disease using these techniques.

Early diagnosis of Alzheimer's disease (AD) relies on imaging and fluid biomarkers to objectively detect and quantitatively evaluate brain AD pathologies. Amyloid- and tau-PET scans recently enabled clinicians to make definitive diagnoses based on abnormal amyloid/tau deposition in the human brain. Since PET scans and blood-based biomarkers are mutually complementary, the identification of suitable blood-based biomarkers is essential for screening brain AD pathologies. According to the National Institute on Aging and Alzheimer's Association (NIA-AA) Research Framework published in 2018, AD is defined by its underlying pathologic processes, which can be diagnosed in vivo using suitable biomarkers. These biomarkers are categorized under the ATN classification system, including β amyloid deposition (A), pathologic tau (T), and neurodegeneration (N). Originally, all the ATN fluid biomarkers were assessed using cerebrospinal fluid, but currently these biomarkers can be quantified using blood samples. Among those blood-based ATN biomarkers, the plasma levels of Aβ42/40 ratio, p-tau, and neurofilament light chain (NfL) representing "A," "T," and "N" biomarkers, respectively, are useful in the early diagnosis of AD. However, further studies and additional data are required before utilizing these blood-based biomarkers as stand-alone diagnostic markers for AD.

Recently, increase in the prevalence of Autistic Spectrum Disorder (ASD) has become a focus of wide-spread attention, prompting many studies on the etiology, early diagnosis and early intervention for ASD throughout the world. Discussed here will be the current state and issues surrounding the Health Check-up for 5-year-old children in Japan. Browsing through literature on early detection and diagnosis worldwide, it is seen that while studies abroad report intensively on epidemiological research and biomarkers to detect ASD on one hand, problems such as the presence of an endophenotype that fails to meet diagnostic criteria for ASD in the later stages of development have been revealed. In our country, health checks for pregnant women and infants based on the 1965 Maternal and child Health Act are being conducted as standard practice. However, it is as yet difficult to pick up developmental disabilities, such as Attention Deficit-Hyperactivity Disorder (ADHD) and Specific Learning Disorder (SLD), and ASD without Intellectual Disabilities. To this end, efforts aimed at the early detection and early intervention for developmental disorders have been incorporated into national policy, recommending implementation of Health Check-ups for 5-year-old children by local government. However, many problems exist regarding this check-up for 5-year-olds. For example, implementation has not been unifrom across all regions as it is not a legal requirement like the medical checkups for 18-month-olds and 3-year-olds. Additionally, even where implemented, assessments have not been standardized, calling for further scientific validation. Scientific clarification should bring about needed change in the recognition and concrete aid for developmental disorders including ASD. Just as infant health checkups were instrumental in reducing infant mortality rates historically, it is hoped they will similarly contribute to the early diagnosis and support of developmental disorders in future. [ABSTRACT FROM AUTHOR]

< MRI for stress fracture > Early diagnosis and treatment for stress fractures are important to enable a return to full athletic activities as soon as possible. We investigated the early diagnostic efficacy of MRI for stress fractures. Subjects were 38 patients (39 limbs)whose ages ranged from 12 to 27 years(mean, 20 years). Each patient was examined by MRI, plain radiography, and bone scintigraphy during the same period. The signal change was more evident in the femur and lateral malleolus and tarsal navicular bone, but, signal changes of tibia stress fractures were varied. The subjects examined by MRI within 2 weeks from onset showed obvious signal change, but their plain radiograms at the same time revealed no abnormalities. These subjects diagnosed in the early stage by MRI could return to sports earlier than those diagnosed 4 or more weeks after onset. < Bone metabolism markers(BMM)and bone mineral density(BMD)for stress fracture > We investigated the bone metabolism markers(BMM)and bone mineral density(BMD)in female long-distance runners of a university. Subjects were 14 female runners. As BMM, we investigated PICP, osteocalcin, AL-P(bone), DPD, and NTx. As BMD, femoral neck, knee and lumber vertebrae were investigated at the stage between rest and hard training. In runners with amenorrhea or with stress fracture, NTx was markedly higher and BMD was lower than in female runners with normal menstruation. These factors are good markers for studying the condition of female runners. [ABSTRACT FROM AUTHOR]

Orthostatic hypotension (OH) is a common non-motor symptom that occurs in Parkinson's Disease (PD) patients. Typical symptoms of OH are lightheadedness, visual disturbance, and fainting; however, nonspecific symptoms such as dizziness, headache, and fatigue are observed in mild cases. Although OH is prevalent in PD patients, it is often overlooked. Further, after diagnosis, the causative drug should be discontinued and non-pharmacological therapy should be performed,; however, if it is ineffective, additional pharmacological therapy should be administered depending on the symptom severity. The symptoms are usually progressive without proper intervention, and motor functions are affected leading to an increased risk of fainting and falls. Early diagnosis and intervention for OH improves the quality of life and prevents complications in PD patients.

Spinal dural arteriovenous fistulas (SDAVF) are rare and most commonly affect men aged >50 years. Patients with SDAVF develop an abnormal vascular dural shunt between the dural branch of a segmental artery and a subdural radicular vein that drains the perimedullary venous system, leading to venous hypertension and secondary congestive myelopathy. Most SDAVFs are located in the thoracolumbar region, and usually patients present with slowly progressive paraparesis and urinary disturbances. SDAVF is diagnostically challenging; this condition may be misdiagnosed as lumbar spinal stenosis or myelitis. Clinicians should be aware of fluctuating symptoms in the early stages to avoid misdiagnosis of SDAVF. Claudication is associated with various activities including walking, bathing, drinking, and singing. On T2-weighted magnetic resonance imaging of the spinal cord, SDAVFs show a high signal intensity with a low signal intensity peripherally and dilated spinal cord veins in the subarachnoid space.

The incidence of postoperative pulmonary torsion is not frequent but it has a high mortality rate once it occurs, and prompt diagnosis and treatment are required. From past reports, it is considered effective to point out disruption of pulmonary blood flow by contrast-enhanced computed tomography (CT) examination for diagnosis. However, the comparison of pre- and post-operative plain CT images is considered to be useful in diagnosing lung torsion, and postoperative CT lung window setting sagittal images were examined in three cases of postoperative lung torsion. Results indicate that pulmonary torsion of the middle lobe after right lower lobectomy and the middle lobe after right upper lobectomy can be diagnosed by the present method.

As one of the strategies for the early detection and treatment of osteoporosis, we have recommended visiting a hospital, based on the Fracture Risk Assessment Tool (FRAX ® ) and evaluation questionnaire for osteoporotic fracture risk. In this study, we evaluated the impact of intervention by community pharmacists by integrating our data for the FRAX ® and questionnaire. The measurement of FRAX ® and the questionnaire survey were conducted through participation in health seminars organized by a community general support center from June 2018 to December 2019. Participants with a FRAX ® score more than 15% and at least one item in the questionnaire were considered to have "suspected osteoporosis" were recommended medical consultation. The medical treatment status for the participants considered to have "suspected osteoporosis" aged 40-90 years were analyzed. Of the 84 participants, 54 had a FRAX ® score more than 15%, and 44 participants fulfilled at least one item in the questionnaire. Medical consultation was recommended to 26 of these 44 participants, excluding 18 under treatment. Of the 25 participants, six (excluding one who disagreed) received consultation, and medical treatment was started for four of them (66.7%). However, consultation with the attending physician was recommended to five of the 18 participants who were initially on treatment but discontinued it at the time of the survey. Consequently, two participants resumed their osteoporosis treatment. Our data suggest advantages of community pharmacists' intervention using FRAX ® and a questionnaire for osteoporotic fracture risk measurement for early detection and medical treatment.

Propofol infusion syndrome (PRIS) is one of the severe complications which occur during continuous venous infusion of propofol, and has a high mortality rate. It is featured by high fever, oliguria, myogloblin urine, acute renal failure, hepatomegaly, fatty liver, and so on. We have experienced a case of PRIS who was saved by prompt changing of sedatives from propofol to midazolam and dexmedetomidine. The patient was an 82-year-old man, who underwent off-pump coronary bypass grafting due to effort angina pectoris. After the operation, he suffered from continuous high fever over 38 ℃, acute renal impairment, and high level of creatine kinase (CK) without CK-MB increment, suggesting PRIS. We promptly changed sedatives from propofol to midazolam and dexmedetomidine, then the patient recuperated from these abnormalities. It is strongly suggested that meticulous observation is necessary during propofol infusion.

Objectives: In recent years, efforts made by cancer patients to balance their work schedules and treatment regimens have gained increasing attention. Such workers tend to resign when diagnosed with cancer. A particularly prominent issue is that many of these employees resign immediately after diagnosis. This study aimed to clarify factors influencing continuation of employment from the period immediately after diagnosis up to the first treatment., Methods: Study aims were explained to 68 employees, who were 20‒64 years and had received a definitive diagnosis of cancer in the last two years. After obtaining informed consent, structured interviews were conducted., Result: Informed consent was obtained from 61 patients, of which 60 (98.4%) wished to continue working after diagnosis. Of these 60 patients, 15 (25.0%) had not been working (including those on leave) and 45 (75.0%) had continued employment. The latter comprised the continuation group. There were no significant differences in attributes, company type and size, nor in employment status between the two groups. Subjects in the continuation group sought significantly more consultation for the questionnaire item "Disease, treatment, and symptoms," whereas significantly less consultation was sought for the item "Concerning expenses such as medical bills and living costs." The number of those who had disclosed their illness to colleagues was significantly higher in the continuation group, while the number of those hoping for a "Probationary period for returning to work" and complaining of "Prejudice and misunderstanding of cancer patient's continuation of work" was significantly smaller in the continuation group. The number of those who had undergone surgery and who received a score of 0 to 1 (light work acceptable) on the Eastern Cooperative Oncology Group performance status was significantly higher in the continuation group. As for other factors that had influenced subjects' decision to continue working or not, subjects described two situational attitudes: first, "Gratitude for understanding, consideration, and encouragement of superiors and colleagues" and second, "Impossibility of thinking about work immediately after diagnosis.", Conclusion: Results revealed that continuation of work immediately after diagnosis was related to the stage of the patient's cancer, their general condition, and whether they had undergone surgery or not. Support from superiors and/or colleagues at the workplace was also beneficial. Medical staff should therefore provide patients with support in overcoming the crisis in which they feel the continuation of work immediately after diagnosis to be an impossibility, and to assist them in making an informed choice regarding their employment status.

Although progressive multifocal leukoencephalopathy (PML) is known as a fatal disease, some recent cases have shown favorable prognosis with early diagnosis. Therefore, detection of early PML lesions using magnetic resonance imaging (MRI) is important. PML lesions are divided into 4 groups based on distinct developing patterns: A)cerebral lesion, B)central lesion including deep gray matter, C)infratentorial lesion of the brain stem and cerebellum, and D)punctate lesions in the deep white matter. These lesions develop in 3 steps: 1)initiation of a small demyelinating lesion, 2)extension/expansion, and 3)fusion. It is likely that the viruses first reach the brain via the bloodstream and form small demyelinating foci (initiation). Second, the demyelinating foci spread along nerve fibers or expand at the sites (extension/expansion). Finally, the foci fuse with one another to form larger demyelinating lesions (fusion). Understanding the spreading patterns of the virus could help early MRI diagnosis of PML, which is important for favorable prognosis. (Received May 7, 2020; Accepted May 11, 2020; Published September 1, 2020).

A 79-year-old man presented with chest and back pain on the right side but with no cutaneous lesions. He had received oral corticosteroids and immunosuppressants for systemic lupus erythematosus. He had spastic paraplegia, sensory disturbance in the lower limbs, and dysfunction of the bladder and bowel. He showed mononuclear-dominant pleocytosis and elevated proteins in the cerebrospinal fluid (CSF), and a decreased CSF/blood glucose ratio. Although polymerase chain reaction techniques found no varicella-zoster virus (VZV) DNA, VZV IgG antibodies were elevated in both the serum and CSF, and the VZV IgG index was dramatically elevated. MRI revealed no lesions in the brain or spine. However, somatosensory evoked potentials in the tibial nerve showed abnormal prolongation of the central sensory conduction time. We diagnosed the patient with acute myelitis associated with zoster sine herpete (ZSH). He received acyclovir and intravenous methylprednisolone pulse therapy in the early stage, and his symptoms and CSF findings completely recovered. We conclude that acute myelitis associated with ZSH should be treated as soon as possible because VZV infection may induce necrotizing myelitis if the treatment is delayed.

Magnetic resonance imaging (MRI) is the imaging modality of choice for patients with multiple sclerosis (MS). The roles of MRI in MS include diagnosis, imaging biomarkers, and safety monitoring for patients receiving disease-modifying drugs (DMDs). In terms of diagnosis, MRI plays a pivotal role in the international diagnosis criteria (McDonald criteria). MRI is also useful for differential diagnosis. The rate of MS misdiagnosis might be as high as 10%, and careful interpretation of MRI may reduce rates of misdiagnosis. Quantified MRI data have been widely used as primary and secondary outcomes in clinical trials of DMDs. MRI is also a powerful tool for monitoring the efficacy of DMDs in individual patients (i.e., determination of responder status for each drug). MRI assists with early detection of the side effects of DMDs. MRI can detect lesions of natalizumab-induced progressive multifocal leukoencephalopathy (PML) before symptoms occur. This review summarizes our current understanding of the utility of MRI in the diagnosis and treatment of patients with MS.

A 62-year-old woman was transported to our hospital for management of generalized clonic seizures. Cerebrospinal fluid examination showed an increased monocyte-dominant cell count, high protein concentration, and low glucose concentration that was 17% of the plasma glucose concentration. Contrast-enhanced cranial magnetic resonance imaging revealed diffuse leptomeningeal enhancement with multiple nodular lesions. She underwent examinations that ruled out the following conditions: tuberculous meningitis, systemic sarcoidosis, malignant lymphoma, carcinomatous meningitis, and central nervous system vasculitis. On hospital day 13, dural and brain biopsies revealed neurosarcoidosis, for which steroid therapy was administered. Thereafter, imaging examinations showed marked improvement. Because isolated neurosarcoidosis is difficult to diagnose, early pathologic diagnosis may be essential.

More accurate and early diagnoses of neurodegenerative diseases are required to establish disease-modifying therapies. Obtaining a clear diagnosis of multiple system atrophy (MSA), a neurodegenerative disease, can be challenging because MSA has a number of clinical subtypes and many other diseases, known as mimics, are characterized by symptoms that are similar to those of MSA. This paper discusses the factors that make the clinical diagnosis of MSA difficult. Additionally, this paper introduces an attempt at the new clinical diagnostic criteria establishment in accord with recent clinical trials.

After the discovery of a series of autoantibodies against neuronal cell surface antigens (NSAs) of the CNS in the past 10 years, the concept of encephalitis has changed dramatically. Accordingly, a practical, syndrome-based diagnostic approach to autoimmune encephalitis was proposed in 2016. These autoantibodies have also been identified in a subset of overlapping encephalitis and demyelinating syndrome, epilepsy, first episode psychosis, movement disorders, post-herpes simplex encephalitis, progressive dementia, postpartum psychosis, stiff-person spectrum disorders, or non-REM/REM sleep behavior disorder. Although not all neuronal antibody tests are available in Japan, we have entered a new era that we have to make a correct diagnosis and start appropriate immunotherapy based on initial neurological assessment and conventional tests, without being constrained by conventional fixed ideas or normal-appearing brain MRIs while waiting for neuronal antibody test results. Although many issues need to be resolved in Japan in terms of diagnosis and treatment in autoimmune encephalitis, this review focusses on recent progress in autoimmune encephalitis and its related disorders closely related to clinical practice, including Hashimoto encephalopathy and new-onset refractory status epilepticus (NORSE).

The purpose of this study is to evaluate the collaboration system between Muscat Pharmacy and community general support center by verifying the results of tests for early detection of dementia, and the early support response for the participants with suspected dementia by the center. From December 2016 to November 2018, we conducted measurement sessions using a touch panel-type test, MSP-1100 at 23 events that included health promotion classes and local community events directed by community general support center. At a later date, a visit survey was administered by the center to the participants with suspected dementia those who received a score lower than 12, and their individual records of early support responses and follow-ups were evaluated and analyzed. During the period, 597 participants had measurements taken with the touch panel-type test. Among them, 89 (14.9% of total) participants received a score lower than 12. The contents of the support by the center for the low-scoring participants were classified into nine categories. Forty of the 89 low-scoring participants were judged to have no problems. Others were cooperatively followed up with medical consultation recommendation, receiving home care management, and/or having their information provided physicians by the Muscat pharmacy and the center. The results of our study indicate that the cooperation between community pharmacy and community general support centers could allow for the early detection of dementia and follow-ups for suspected dementia.

Here we report a case of a 12-year-old girl who was referred to our department because of marked short stature of more than -5 SD below the median. Although her growth failure began suddenly at 6 years of age, she never had an examination because she had no other symptoms. Brain MRI examination suggested a tumor in the suprasellar region, and endocrine examination revealed combined pituitery hormone deficiency due to the tumor. Before surgery, the supplementation with hydrocortisone and levothyroxine was initiated. The pathological diagnosis of the surgically removed tumor was xanthogranuloma. The pattern of her growth curve showed a growth failure with sudden onset, which is a typical pattern of short stature secondary to pituitary disfunction including growth hormone deficiency associated with brain tumors. This case suggests that growth failure could be the only symptom in pediatric cases with brain tumors. Improved awareness regarding the association of growth failure with brain tumors is needed for earlier diagnosis and treatment. Furthermore, the growth curves should be carefully evaluated in regular health examinations at school.

Fragility fractures associated with osteoporosis can have a major impact on a person's "activities of daily living" (ADL) and life span. Therefore, osteoporosis and its complications must be addressed by early screening and prompt intervention. A Fracture Risk Assessment Tool (FRAX) has been developed by the WHO. FRAX allows the calculation/estimation of absolute fracture risk over a 10-year period. The FRAX can be completed using a free application form, accessible online. The relationship between FRAX and the young adult mean (YAM) was investigated in order to calculate the cut-off value of FRAX for each age group. FRAX can be used by both physicians and other healthcare professionals to pre-screen patients for more detailed subsequent work-ups. Using FRAX in clinical practice has proven to be simple, inexpensive and useful.

Early detection and treatment are important for the successful eradication of various cancers; therefore, the development of economical, noninvasive novel cancer screening systems is critical. Previous reports using canine scent detection have demonstrated the existence of cancer-specific odors. However, it is difficult to introduce canine scent recognition into clinical practice because of the need to maintain accuracy. In this study, we developed a Nematode-Nose (N-NOSE) test using Caenorhabditis elegans to provide a novel, highly accurate cancer detection system that is economical, painless, rapid, and convenient. We demonstrated that wild-type C. elegans displayed attractive chemotaxis toward human cancer cell secretions, cancer tissues, and urine from cancer patients but avoided control urine. In parallel, C. elegans olfactory neurons showed a significantly stronger response to urine from cancer patients than to control urine. In contrast, G protein α mutants and animals with ablated olfactory neurons were not attracted to urine from cancer patients, suggesting that they sense odors in urine. We tested 242 samples to measure the performance of the N-NOSE test and found that the sensitivity was 95.8%, which is markedly higher than that of other existing tumor markers. Furthermore, the specificity was 95.0%. Importantly, this test could detect various cancer types tested at the early stage (stage 0 or 1). C. elegans scent-based analyses therefore might provide a new strategy for the detection and study of disease-associated scents.

We focused on diseases causing both neurological and intestinal disorders and introduce representative cases with a case based review. We frequently encountered chronic constipation in patients with schizophrenia, dementia, and Parkinson's disease, and treated them with commonly used conservative management approaches. However, some serious diseases that require early diagnosis and treatment may also be present and should be identified. We discuss the pathophysiology and image features of these serious diseases.

The epilepsy syndrome of autoimmune etiology, namely, autoimmune epilepsy has attracted attention in recent years, as was reflected in the new etiology of "immunity" in the Epilepsy Classification of the International League Against Epilepsy (2017). However, no specific tests other than neuronal antibodies have been established. We proposed a diagnostic algorithm for autoimmune epilepsy and preliminarily investigated its clinical utility. We applied this algorithm to 70 patients who were suspected as having autoimmune epilepsy from clinical symptoms and laboratory findings in our institute. At least one of the three neuronal antibodies (antibodies to N-methyl-D-aspartic acid receptor (NMDAR), glutamic acid decarboxylase (GAD), and voltage-gated potassium channels (VGKC) complex) was evaluated. In this two-step algorithm, the patients were initially screened by clinical features and then evaluated by laboratory findings (neuronal antibodies, cerebrospinal fluid (CSF), MRI, FDG-PET). The results of preliminary application of the algorithm are described. One of the three neuronal antibodies was positive in 13 patients. In this preliminary investigation, it was suggested that two or more abnormal findings in the diagnostic tests (CSF, MRI, FDG-PET) favors the diagnosis of autoimmune epilepsy. On the other hand, two patients with a positive neuronal antibody test failed the first step (clinical features), partly because epilepsy was not the major manifestation of autoimmune encephalitis (VGKC complex antibody) or due to a relatively low titer of the antibody (GAD antibody). Recruitment of the patient cohort with comprehensive neuronal antibody testing and multivariate analysis of laboratory findings is warranted for validation and modification of the proposed algorithm.

We report two cases of patients who developed cervical epidural hematoma while receiving oral anti-platelet agents and achieved satisfactory outcomes following early diagnosis and treatment. Both patients attained decompression within 12 hours of symptom onset and achieved independent gait at an early stage. Decompression was attained in a shorter amount of time(<6 hours)in case 1, and neurological symptoms rapidly and fully improved immediately following surgery. In contrast, sensory abnormality remained in case 2 despite early decompression(<12 hours.)Although there is a tendency to focus on improving motor function with regards to this condition, we found that the persistence of sensory abnormality affects the patient activities of daily living(ADL)more than expected. Based on these findings, we postulate that the reduction in the time until treatment completion is associated with better functional prognosis in patients who are receiving anti-platelet agents or have advanced motor paralysis.

A 41-year-old man left for Mexico in May 2015. Right pulmonary nodule was detected at a health examination in May 2016, and he subsequently showed headache and slight fever. Contrast-enhanced magnetic resonance imaging of the brain revealed basilar meningitis, so he was admitted to our hospital. We considered imported mycosis due to his travel history to Mexico. We diagnosed histoplasmosis based on the presence of antibodies against Histoplasma in both serum and cerebrospinal fluid. Symptoms almost completely recovered with a liposomal formulation of amphotericin B. Central nervous system histoplasmosis is very rare in Japan. Immunocompetent hosts can develop histoplasmosis, and this pathology is important to consider in patients presenting with basilar meningitis and a positive travel history.

Acquired hemophilia A (AHA), a bleeding disorder caused by autoantibodies against FVIII, has the potential for life-threatening bleeding. The annual onset rate is said to be one in 4 million people, but diagnosis examples increase in adults because a disorder concept penetrated. AHA is quite rare in children, with an incidence rate of 0.045 per 1 million, but early detection is crucial because serious bleeding can happen, as in adults. We report a pediatric case who received an early diagnosis of AHA by an activated partial thromboplastin time (APTT) cross-mixing test. The 12-year-old girl had neither a past history nor a family history of bleeding episodes. She presented with intramuscular bleeding and epistaxis without trauma or medication. At diagnosis, her blood test showed prolonged APTT. Other hemostatic tests, such as the platelet count, prothrombin time and fibrinogen concentration, were within the normal range. We administered an APTT cross-mixing test that detected an inhibitor pattern and inhibitory antibodies against factors VIII. As a result, we administered prednisolone and the inhibitor disappeared after 1.5 months. In conclusion, AHA is a bleeding disorder which should be considered even in children due to the potential for life-threatening bleeding. Furthermore, the APTT cross-mixing test is useful for screening coagulation factor deficiencies and inhibitors.