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Abstract We aimed to develop a new artificial intelligence software that can automatically extract and measure the volume of white matter hyperintensities (WMHs) in head magnetic resonance imaging (MRI) using only thick-slice fluid-attenuated inversion recovery (FLAIR) sequences from multiple centers. We enrolled 1092 participants in Japan, comprising the thick-slice Private Dataset. Based on 207 randomly selected participants, neuroradiologists annotated WMHs using predefined guidelines. The annotated images of participants were divided into training (n = 138) and test (n = 69) datasets. The WMH segmentation model comprised a U-Net ensemble and was trained using the Private Dataset. Two other models were trained for validation using either both thin- and thick-slice MRI datasets or the thin-slice dataset alone. The voxel-wise Dice similarity coefficient (DSC) was used as the evaluation metric. The model trained using only thick-slice MRI showed a DSC of 0.820 for the test dataset, which is comparable to the accuracy of human readers. The model trained with the additional thin-slice dataset showed only a slightly improved DSC of 0.822. This automatic WMH segmentation model comprising a U-Net ensemble trained on a thick-slice FLAIR MRI dataset is a promising new method. Despite some limitations, this model may be applicable in clinical practice.

Abstract Background Malignant hyperthermia (MH) is a rare, life-threatening disorder of calcium homeostasis in skeletal muscle cells that is triggered by volatile anesthetics and succinylcholine, leading to a hypermetabolic reaction. The pathogenic ryanodine receptor 1 (RYR1) gene variant is critical. Patients susceptible to MH should avoid triggering agents, and total intravenous anesthesia (TIVA) is preferred. Remimazolam is safe in patients with suspected MH. Case presentation We present the first case of remimazolam treatment in a genetically confirmed patient with MH without MH development. A 72-year-old man with a family history of MH underwent remimazolam-based TIVA. After informed consent was obtained, a muscle biopsy and genetic testing were performed. Intraoperatively and postoperatively, the patient exhibited no signs of MH. An enhanced function of the RYR1 channel into releasing calcium was indicated, and the genetic testing revealed a pathogenic variant of RYR1. Conclusions Remimazolam-based TIVA is safe in patients confirming the diagnosis of MH.

Percutaneous treatments, including thoracic duct embolization (TDE) and thoracic duct disruption (TDD), are reportedly effective and safe alternatives to surgical thoracic duct ligation for refractory chylothorax. When catheterization of the thoracic duct is impossible, TDD can be performed as long as the thoracic duct can be opacified by lymphangiography. However, no report has described percutaneous treatment when the thoracic duct cannot be visualized. In this case, TDE was not feasible because intranodal lymphangiography failed to opacify the thoracic duct: cannulation was not achieved. Therefore, we aimed to disrupt the thoracic duct by puncturing the retrocrural area where it was anatomically suspected to be located. Chylothorax improved thereafter. In cases without lymphangiographic thoracic duct visualization, TDD by puncturing the retrocrural space might improve refractory chylothorax.

Abstract Background Tumor-to-tumor metastasis is a rare phenomenon in which primary tumor cells metastasize hematogenously into another tumor. Herein, we report an extremely rare case of a renal cell carcinoma metastasis into a pancreatic neuroendocrine tumor exhibiting a tumor-to-tumor metastasis. Ours is the third reported case worldwide. Case presentation The patient, a 72-year-old male, was referred to our hospital for further examination and treatment due to high levels of prostate-specific antigen. A left renal tumor and pancreatic head tumor were revealed incidentally on screening computed tomography. There were suspected to be a renal cell carcinoma and primary pancreatic neuroendocrine tumor or pancreatic metastasis from the renal cell carcinoma according to preoperative examination. The left nephrectomy and subtotal stomach-preserving pancreaticoduodenectomy were performed because of the pancreatic tumor indicated for operation in either case of diagnosis. Postoperative pathological examination showed a diagnosis of clear cell renal cell carcinoma for the left renal tumor. The pancreatic tumor was diagnosed with clear cell renal cell carcinoma metastasis into the pancreatic neuroendocrine tumor, that is to say tumor-to-tumor metastasis. Conclusion In some cases, conservative approach is selected for pancreatic neuroendocrine tumor patients who meet some requirements. However, if such patients exhibit tumor-to-tumor metastasis which combines with renal cell carcinoma and pancreatic neuroendocrine tumor as this case, conservative approach leads to progression of renal cell carcinoma. Therefore, conceiving the possibility of tumor-to-tumor metastasis, it is necessary to carefully choose a treatment plan for pancreatic neuroendocrine tumor patients associated with renal cell carcinoma, not easily choosing conservative approach.

Abstract Purpose To evaluate the clinical outcome of ultraselective transcatheter arterial embolization (TAE) with small-sized microcoils for acute lower gastrointestinal bleeding (LGIB). Materials and methods The subjects were 17 consecutive patients (mean age, 69 years) with LGIB who were treated with ultraselective TAE using small-sized microcoils between December 2013 and December 2019. Ultraselective TAE was defined as embolization of one or both of the long or short branches of the vasa recta. The etiologies of bleeding were colonic diverticulosis in 16 patients (94%) and malignancy in one patient (6%). The bleeding foci were in the ascending colon in 11 patients (65%), transverse colon in 2 patients (12%), and sigmoid colon in 4 patients (23%). A total of 18 branches (diameter: range 0.5–1.5 mm, mean 1.1 mm) of the vasa recta in 17 patients were embolized with small-sized microcoils (size range 1–3 mm, mean combined lengths of all microcoils 7.6 cm). The mean follow-up period was 19 months (range 1–80 months). The technical and clinical success rate, recurrent bleeding rate, major complications and long-term clinical outcomes were retrospectively evaluated. Results Technical and clinical success was achieved in all patients (17/17). The rates of early recurrent bleeding (within 30 days of TAE) and major complications were 0% (0/17). Recurrent bleeding occurred in one patient at 2 months after TAE, but was stopped with conservative treatment. There were no other bleeding episodes or complications in the follow-up period. Conclusion Ultraselective TAE with small-sized microcoils is a highly effective and safe treatment modality for LGIB.

Aim To support decision‐making for early interventional radiology, this study aimed to derive and validate a novel and simple scoring system for predicting the necessity of interventional radiology therapies in trauma patients. Methods This retrospective study used data derived from the medical records of patients with severe traumatic injuries treated at a tertiary‐level emergency institution. The score was derived from 168 patients treated between April 2015 and October 2016 and validated using data from 68 patients treated between November 2016 and July 2017. Logistic “least absolute shrinkage and selection operator (LASSO)” regression was used to select predictors. In order to compose the score, odds ratios derived from the logistic model were simplified to integer score coefficients. The score was evaluated using the area under the receiver operating characteristic curve. The best cut‐off point for the score was determined using Youden’s index, and sensitivity and specificity were calculated. Results The derived score comprised three predictors (systolic blood pressure, positive findings in abdominal ultrasound assessment, and pelvic fracture) and ranged from 0 to 30. On validation, the area under the receiver operating characteristic curve for the score was 0.86 (95% confidence interval, 0.64–1.00). The sensitivity and specificity were 80% and 89%, respectively, with a cut‐off point of 3. Conclusion This simple score, requiring variables obtainable immediately after hospital arrival, could aid in facilitating early interventional radiology team activation.

We present the results of ALMA-ACA 7 m array observations in ^12 CO( J = 2–1), ^13 CO( J = 2–1), and C ^18 O( J = 2–1) line emission toward the molecular-gas disk in the Local Group spiral galaxy M33 at an angular resolution of 7.″31 × 6.″50 (30 × 26 pc). We combined the ACA 7 m array ^12 CO( J = 2–1) data with the IRAM 30 m data to compensate for emission from diffuse molecular-gas components. The ACA+IRAM combined ^12 CO( J = 2–1) map clearly depicts the cloud-scale molecular-gas structure over the M33 disk. Based on the ACA+IRAM ^12 CO( J = 2–1) cube data, we cataloged 848 molecular clouds with a mass range from 10 ^3 –10 ^6 M _⊙ . We found that high-mass clouds (≥10 ^5 M _⊙ ) tend to associate with the 8 μ m bright sources in the spiral arm region, while low-mass clouds (

A 78-year-old man presented with lymphatic fluid collections in bilateral inguinal area after bilateral inguinal lymph node dissections. Because no inguinal or popliteal lymph nodes were observed under ultrasound examination, intranodal lymphangiography was not applicable. Although traditional pedal lymphangiography was required, it was difficult to perform this procedure owing to the decreasing frequency over the past 20 years and being unavailable in not only our institution, but also other in institutions. Therefore, we performed catheterization using the 29-guage Argyle PI catheter into the lymphatic duct in lower legs under a microscope and achieved successful percutaneous embolization using N-butyl cyanoacrylate for inguinal lymphatic leakage.

Introduction Uretero‐arterial fistula is a rare life‐threatening condition. Its diagnosis and management remains a challenge for urologists. Case presentation A 64‐year‐old man presented to our hospital with gross hematuria. He had history of rectal cancer treated with neoadjuvant chemoradiotherapy followed by low anterior resection and chronic ureteral stenting for bilateral ureteral strictures. He developed recurrent hemorrhagic shocks due to sudden massive gross hematuria. Repeated computed tomography and angiography could not identify the source of bleeding. After prophylactic embolization of the right renal artery and right nephrectomy, angiography finally revealed a uretero‐arterial fistula from the right external iliac artery. Percutaneous balloon‐expandable covered stent graft was used to successfully treat the fistula. Conclusions Urologists should consider possible uretero‐arterial fistula in patients with recurrent hematuria along with several risk factors and convincing medical history.

Anomalous retro-psoas artery is an extremely rare congenital anomaly of the iliac arteries reported in the English-language literature. Using contrast-enhanced computed tomography, we incidentally diagnosed an anomalous retro-psoas artery in a 60-year-old male patient with right renal cancer. Although anomalous retro-psoas artery is extremely rare and mostly asymptomatic, knowledge of it is needed to avoid severe vascular complications in the event of vascular intervention and surgery.

The nucleus of oocytes (germinal vesicle) is unusually large and its nuclear envelope (NE) is densely packed with nuclear pore complexes (NPCs) that are stockpiled for embryonic development. We showed that breakdown of this specialized NE is mediated by an Arp2/3-nucleated F-actin ‘shell’ in starfish oocytes, in contrast to microtubule-driven tearing in mammalian fibroblasts. Here, we address the mechanism of F-actin-driven NE rupture by correlated live-cell, super-resolution and electron microscopy. We show that actin is nucleated within the lamina, sprouting filopodia-like spikes towards the nuclear membranes. These F-actin spikes protrude pore-free nuclear membranes, whereas the adjoining stretches of membrane accumulate NPCs that are associated with the still-intact lamina. Packed NPCs sort into a distinct membrane network, while breaks appear in ER-like, pore-free regions. We reveal a new function for actin-mediated membrane shaping in nuclear rupture that is likely to have implications in other contexts, such as nuclear rupture observed in cancer cells.

The engagement of DNA-binding drugs to their target is difficult to study, particularly in vivo. Here the authors develop an in vivo fluorescence lifetime imaging confocal laparo/endomicroscope to show intra- and inter-tumor heterogeneity in doxorubicin binding to peritoneal metastases, which depends on the route of administration.

Background: Among pediatric cases of moyamoya disease (MMD), cerebral ischemic symptoms often progress and worsen rapidly in infants under one year of age; therefore, it is important to treat them as early as possible. However, direct bypass surgery is often technically difficult for infants due to their small blood vessels. Here, we describe our technique to resolve the technical challenges encountered during superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass surgery in infants aged <1 year with MMD, focusing on specific procedures. Case Description: We performed bilateral STA-MCA and indirect bypass in a 1-year-old girl with MMD and cerebral infarction. Before treatment, a peripherally inserted central venous catheter (PICC) was placed to avoid ischemic attacks associated with crying, dehydration, and malnutrition. All examinations and procedures that would be stressful to the patient, such as blood examinations, were performed using PICC or under sedation. The STA-MCA diameters were 0.8 and 1.2 mm, respectively. After suturing the planned anastomosis with one stitch using an 11-0 monofilament nylon thread, the thread was lifted upward, and the arterial wall was incised. Anastomosis was performed using an 11-0 monofilament nylon thread with 2-4 stitches on each side. The operation was completed without patency problems. Postoperative blood flow improved, and the patient had a good treatment course. Conclusion: Direct bypass for MMD patients aged <1 year is technically challenging; however, the vessels can be connected if the procedure is carefully performed with consideration of the characteristics of the infant's vessels. [ABSTRACT FROM AUTHOR]

Objectives: One of the important risk factors of falling is decreased muscle mass and muscle strength. Recently, there has been an increasing concern on the role of vitamin D in muscle strength and physical activity. Aim of our study is to examine the relationships between vitamin D status and muscle mass and muscle strength in middle-aged healthy adults. Methods: Subjects were 40 healthy volunteers aged 42.0 ± 10.6 years old. Evaluation was made for serum vitamin D3 metabolites including 25-hydroxyvitamin D3 [25(OH)D3] and 24,25-dihydroxyvitamin D3 [24,25(OH)2D3] concentrations, lower limb muscle strength, and dietary intake by food frequency questionnaire. Body composition was measured by dual-energy X-ray absorptiometry (DXA), and appendicular skeletal mass index (ASMI) was calculated as skeletal muscle mass/squared height. Results: 70% of the subjects had vitamin D insufficiency/deficiency (serum total 25(OH)D

We describe a new approach to effective embolization of Rasmussen aneurysm by simultaneous devascularization of the pseudoaneurysm and systemic artery-to-pulmonary artery anastomoses. In our patient, a radiologic workup for hemoptysis revealed a Rasmussen aneurysm. A bronchial arteriogram revealed a pseudoaneurysm via bronchopulmonary artery shunting. A left pulmonary arteriogram did not demonstrate the pseudoaneurysm. A superior lingular pulmonary arteriogram with balloon occlusion showed the pulmonary artery branch, pseudoaneurysm, and bronchial artery via bronchopulmonary artery shunting with retrograde flow. An n-butyl cyanoacrylate injection with balloon occlusion achieved complete embolization. This approach may be an effective technique for the treatment of peripheral pulmonary artery pseudoaneurysm.

Diagnostic and interventional radiology (IR) techniques have recently shown significant efficacy in trauma care when combined with surgical procedures. A multifaceted approach to traffic accidents has reduced the number of trauma patients in Japan, which has necessitated simulation education to provide practical experience and ensure proficiency. The objective of this paper is to report the educational development of endovascular and hybrid workshops in Japan. The Japanese Society of Diagnostic and Interventional Radiology in Emergency, Critical care, and Trauma (DIRECT) was established in 2011 to maximize the benefit of diagnostic and IR in emergency or trauma settings. DIRECT conducts trauma endovascular workshops for emergency medicine physicians, acute care surgeons, and IR physicians. From July 2011 to June 2016, DIRECT has conducted 14 simulator workshops, six endovascular workshops using a porcine model, and four hybrid trauma management workshops, of which two were conducted with porcine models. The simulation workshop was designed for novice learners and included resuscitative endovascular balloon occlusion of the aorta (REBOA) deployment using a pressurized silicone model, catheter and guidewire manipulation with a three-dimensional (3D) vessel silicone model and virtual fluoroscopic simulator, and metallic coil deployment. Porcine simulations for intermediate-level physicians were conducted and endovascular tools included different occlusion materials. In the hybrid strategy model, by using a porcine model of injury, the participants combined both surgical and endovascular procedures such as REBOA, selective balloon occlusion, and N-butyl cyanoacrylate embolization. DIRECT is a vital bridge between emergency/trauma and IR, and workshops are essential for improved trauma care.

Previously, we have demonstrated that the transplantation of viable, structurally intact, respiration competent mitochondria into the ischemic myocardium during early reperfusion significantly enhanced cardioprotection by decreasing myocellular damage and enhancing functional recovery. Our in vitro and in vivo studies established that autologous mitochondria are internalized into cardiomyocytes following transplantation; however, the mechanism(s) modulating internalization of these organelles were unknown. Here, we show that internalization of mitochondria occurs through actin-dependent endocytosis and rescues cell function by increasing ATP content and oxygen consumption rates. We also show that internalized mitochondria replace depleted mitochondrial (mt)DNA. These results describe the mechanism for internalization of mitochondria within host cells and provide a basis for novel therapeutic interventions allowing for the rescue and replacement of damaged or impaired mitochondria.