Clinical Validation of Computer-Aided Diagnosis Software for Preventing Retained Surgical Sponges.

BACKGROUND: We previously reported the successful development of a computer-aided diagnosis (CAD) system for preventing retained surgical sponges with deep learning using training data, including composite and simulated radiographs. In this study, we evaluated the efficacy of the CAD system in a clinical setting. STUDY DESIGN: A total of 1,053 postoperative radiographs obtained from patients 20 years of age or older who underwent surgery were evaluated. We implemented a foreign object detection application software on the portable radiographic device used in the operating room to detect retained surgical sponges. The results of the CAD system diagnosis were prospectively collected. RESULTS: Among the 1,053 images, the CAD system detected possible retained surgical items in 150 images. Specificity was 85.8%, which is similar to the data obtained during the development of the software. CONCLUSIONS: The validation of a CAD system using deep learning in a clinical setting showed similar efficacy as during the development of the system. These results suggest that the CAD system can contribute to the establishment of a more effective protocol than the current standard practice for preventing the retention of surgical items.

Nonlocal Spin Correlation as a Signature of Ising Anyons Trapped in Vacancies of the Kitaev Spin Liquid.

In the Kitaev chiral spin liquid, Ising anyons are realized as Z_{2} fluxes binding Majorana zero modes, which, however, are thermal excitations with finite decay rates. On the other hand, a lattice vacancy traps a Z_{2} flux even in the ground state, resulting in the stable realization of a Majorana zero mode in a vacancy. We demonstrate that spin-spin correlation functions between two vacancy sites exhibit long-range correlation arising from the fractionalized character of Majorana zero modes, in spite of the strong decay of bulk spin correlations. Remarkably, this nonlocal spin correlation does not decrease as the distance between two vacancy sites increases, signaling Majorana teleportation. Furthermore, we clarify that the nonlocal correlation can be detected electrically via the measurement of nonlocal conductance between two vacancy sites, which is straightforwardly utilized for the readout of Majorana qubits. These findings pave the way to the measurement-based quantum computation with Ising anyons trapped in vacancies of the Kitaev spin liquid.

A comparative, randomised MRI study of the physiological and appetitive responses to gelling (alginate) and non-gelling nasogastric tube feeds in healthy men.

Inclusion in nasogastric tube feeds (NGTF) of acid-sensitive, seaweed-derived alginate, expected to form a reversible gel in the stomach, may create a more normal intragastric state and modified gastrointestinal responses. This may ameliorate NGTF-associated risk of diarrhoea, upper gastrointestinal symptoms and appetite suppression. In a randomised, crossover, comparison study, undertaken in twelve healthy males, an alginate-containing feed (F + ALG) or one that was alginate-free (F-ALG) (300 ml) was given over 1 h with a 7-14-d washout period between treatments. Baseline and for 4-h post-feed initiation, MRI measurements were made to establish small bowel water content (SBWC), gastric contents volume (GCV) and appearance, and superior mesenteric artery blood flux. Blood glucose and gut peptides were measured. Subjective appetite and upper gastrointestinal symptoms scores were obtained. Ad libitum pasta consumption 3-h post-feeding was measured. F + ALG exhibited a gastric appearance consistent with gelling surrounded by a freely mobile water halo. Significant main effects of feed were seen for SBWC (P = 0·03) and peptide YY (PYY) (P = 0·004) which were attributed to generally higher values for SBWC with F + ALG (max difference between adjusted means 72 ml at 210 min) and generally lower values for PYY with F + ALG. GCV showed a faster reduction with F + ALG, less between-participant variation and a feed-by-time interaction (P = 0·04). Feed-by-time interactions were also seen with glucagon-like-peptide 1 (GLP-1) (P = 0·02) and glucose-dependent insulinotropic polypeptide (GIP) (P = 0·002), both showing a blunted response with F + ALG. Apparent intragastric gelling with F + ALG and subsequent differences in gastrointestinal and endocrine responses have been demonstrated between an alginate-containing and alginate-free feed.

[A Challenge of Digitalizing the X-ray Film Image, and the Recent Technical Trends].

Fuji Photo Film (then), a chemical manufacturer that manufactures film, succeeded in digitizing X-ray photographs for the first time in the world, and commercialized Computed Radiography (CR) in 1983. In addition to eliminating darkroom work from X-ray work and improving the efficiency of X-ray work and diagnosis, this CR also played a role in paving the way for networking of image information in hospitals and for computer-added diagnostic support. Nowadays, the mechanism of digital X-rays has been established and is known to many people, but there was no precedent in the latter half of the 1970s when the development of CR was started. In this paper, we will look back on the development process of such CR first, then we will outline the evolution of digital X-ray detectors and image processing technology, and introduce the technology we have challenged to estimate scattered X-rays in the human body.

Novel Computer-Aided Diagnosis Software for the Prevention of Retained Surgical Items.

BACKGROUND: Retained surgical items are a serious human error. Surgical sponges account for 70% of retained surgical items. To prevent retained surgical sponges, it is important to establish a system that can identify errors and avoid the occurrence of adverse events. To date, no computer-aided diagnosis software specialized for detecting retained surgical sponges has been reported. We developed a software program that enables easy and effective computer-aided diagnosis of retained surgical sponges with high sensitivity and specificity using the technique of deep learning, a subfield of artificial intelligence. STUDY DESIGN: In this study, we developed the software by training it through deep learning using a dataset and then validating the software. The dataset consisted of a training set and validation set. We created composite x-rays consisting of normal postoperative x-rays and surgical sponge x-rays for a training set (n = 4,554) and a validation set (n = 470). Phantom x-rays (n = 12) were prepared for software validation. X-rays obtained with surgical sponges inserted into cadavers were used for validation purposes (formalin: Thiel's method = 252:117). In addition, postoperative x-rays without retained surgical sponges were used for the validation of software performance to determine false-positive rates. Sensitivity, specificity, and false positives per image were calculated. RESULTS: In the phantom x-rays, both the sensitivity and specificity in software image interpretation were 100%. The software achieved 97.7% sensitivity and 83.8% specificity in the composite x-rays. In the normal postoperative x-rays, 86.6% specificity was achieved. In reading the cadaveric x-rays, the software attained both sensitivity and specificity of >90%. CONCLUSIONS: Software with high sensitivity for diagnosis of retained surgical sponges was developed successfully.

Electric Probe for the Toric Code Phase in Kitaev Materials through the Hyperfine Interaction.

The Kitaev model is a remarkable spin model with gapped and gapless spin liquid phases, which are potentially realized in iridates and α-RuCl_{3}. In the recent experiment of α-RuCl_{3}, the signature of a nematic transition to the gapped toric code phase, which breaks the C_{3} symmetry of the system, has been observed through the angle dependence of the heat capacity. We here propose a mechanism by which the nematic transition can be detected electrically. This is seemingly impossible because J_{eff}=1/2 spins do not have an electric quadrupole moment (EQM). However, in the second-order perturbation, the virtual state with a nonzero EQM appears, which makes the nematic order parameter detectable by nuclear magnetic resonance and Mössbauer spectroscopy. The purely magnetic origin of the EQM is different from conventional electronic nematic phases, allowing the direct detection of the realization of Kitaev's toric error-correction code.

Histopathological Finding of Microdamage Accumulation in Atypical Subtrochanteric Femoral Fracture.

Atypical femoral fracture is a low-energy stress fracture in the subtrochanteric region or the femoral shaft and is a complication of the long-term use of bisphosphonates. Histopathological findings of atypical femoral fractures have not been clarified. Herein, we report the case of a 61-year-old woman who fell while walking, which prompted her to visit our facility. She had a 7-year history of alendronate use to treat osteoporosis. A radiograph showed an atypical subtrochanteric femoral fracture, following which she underwent a primary surgery, where an intramedullary femoral nail was used. Implant breakage was discovered 8 weeks after the primary surgery. The patient underwent a revision surgery in which the entry point for the revised intramedullary hole was created to prevent varus position. The lag screw was successfully inserted into the center of the femoral head. Cancellous bone, isolated from the right ilium, was autogenously implanted into the fracture site. Fracture healing was promoted using low-intensity pulse ultrasonography. Callus formation was detected on a radiograph, and full weight-bearing was advised 12 weeks after the revision surgery. The fracture had healed completely at 13 months after the revision surgery. The patient was able to walk without support and could independently perform activities of daily life. Laboratory findings suggested that the concentrations of her bone formation markers were normal, while those of bone resorption markers were elevated. Iliac bone histomorphometry did not reveal severely suppressed bone turnover. In the cortex of fracture site, the lacunar density was markedly lower than the osteocyte density, and microcracks were detected, suggesting impaired osteocyte function and a low potential for fracture healing. This case is notable because it helps to clarify the histopathological findings of atypical femoral fractures.

Seronegative Oligoarthritis Preceding Psoriasis by 9.5 Years.

We report a case of psoriatic arthritis where oligoarthritis preceded the skin lesions. A 57-year-old man complained of left third-finger pain. Laboratory examinations were negative for anti-cyclic citrullinated peptide antibodies and rheumatoid factor; he was treated for suspected rheumatoid arthritis. Six years later, X-ray revealed enthesitis of his fingers and wrist joint. At 9.5 years after the initial visit, skin lesions appeared in the left auricular region and buttock and dermatopathology findings indicated psoriasis vulgaris. The final diagnosis was psoriatic arthritis. In cases of seronegative oligoarthritis, psoriatic arthritis must be considered because some patients demonstrate osteoarticular lesions preceding skin lesions.

Inheritance of susceptibility to bacterial spot (Xanthomonas arboricola pv. pruni) in peach offspring populations derived from Brazilian and Japanese cultivars/selections.

Bacterial spot (caused by Xanthomonas arboricola pv. pruni) is a serious disease and difficult to control in peach cultivation, and inheritance manner of susceptibility is unclear. Five hundred and fourteen offspring and their parents from 27 peach full-sib families were evaluated for susceptibility to bacterial spot by evaluating lesion length value (LLV) after artificial inoculation to shoots from trees growing in the field. Brazilian cultivars including 'Chimarrita' and selections derived from them had notably lower LLVs ranging from 0.302 to 0.490 than those from Japanese cultivars/selections ranging from 0.514 to 1.295. Family means in offspring crossed between Brazilian cultivars/selections (low LLVs) and other cultivars/selections (high LLVs) showed rather low LLVs, whose values were close to Brazilian cultivar/selection parents. These results suggested that the susceptibility was controlled by single major gene and that the Brazilian and Japanese cultivar/selection parents showed dominant and recessive homozygotes, respectively. In contrast, the LLVs of family means were very high ranging from 0.719 to 1.194 in offspring population derived from crosses among Japanese cultivars. Repeated backcrosses of Brazilian cultivars/selections with Japanese cultivars/selections having high fruit quality are proposed as an effective method for developing new cultivars combining bacterial spot resistance and fruit quality in Japan.

Deep Sylvian Meningioma without Dural Attachment - A Case Report.

Deep Sylvian meningiomas are rare, accounting for 0.3-0.4% of all meningiomas, and mostly present in young adults and children. We report on a 32-year-old man who presented with headache but had no neurological deficits. Computed tomography of brain revealed a 24 × 19 × 21 mm3 mass lesion in the right Sylvian fissure with calcification. Magnetic resonance imaging showed that the lesion was isointense on T1- and T2-weighted images (WI), with homogenous enhancement on post-gadolinium T1WI. The lesion was surgically removed via right fronto-temporal craniotomy. The tumor was located in deep Sylvian fissure and had no dural attachment. Histopathological examination of the lesion revealed both meningothelial and fibroblastic features, thereby suggesting the diagnosis of transitional meningioma (WHO grade I), with Ki-67 labeling index of 6.9%. Thus, meningioma should be considered as a differential diagnosis of enhancing mass lesions in the Sylvian fissure even in the absence of dural tail sign, especially in young adults and children.

Emergent SU(4) Symmetry in α-ZrCl_{3} and Crystalline Spin-Orbital Liquids.

While the enhancement of spin-space symmetry from the usual SU(2) to SU(N) is promising for finding nontrivial quantum spin liquids, its realization in magnetic materials remains challenging. Here, we propose a new mechanism by which SU(4) symmetry emerges in the strong spin-orbit coupling limit. In d^{1} transition metal compounds with edge-sharing anion octahedra, the spin-orbit coupling gives rise to strongly bond-dependent and apparently SU(4)-breaking hopping between the J_{eff}=3/2 quartets. However, in the honeycomb structure, a gauge transformation maps the system to an SU(4)-symmetric Hubbard model. In the strong repulsion limit at quarter filling, as realized in α-ZrCl_{3}, the low-energy effective model is the SU(4) Heisenberg model on the honeycomb lattice, which cannot have a trivial gapped ground state and is expected to host a gapless spin-orbital liquid. By generalizing this model to other three-dimensional lattices, we also propose crystalline spin-orbital liquids protected by this emergent SU(4) symmetry and space group symmetries.

Designing Kitaev Spin Liquids in Metal-Organic Frameworks.

Kitaev's honeycomb lattice spin model is a remarkable exactly solvable model, which has a particular type of spin liquid (Kitaev spin liquid) as the ground state. Although its possible realization in iridates and α-RuCl_{3} has been vigorously discussed recently, these materials have substantial non-Kitaev direct exchange interactions and do not have a spin liquid ground state. We propose metal-organic frameworks (MOFs) with Ru^{3+} (or Os^{3+}), forming the honeycomb lattice as promising candidates for a more ideal realization of Kitaev-type spin models, where the direct exchange interaction is strongly suppressed. The great flexibility of MOFs allows generalization to other three-dimensional lattices for the potential realization of a variety of spin liquids, such as a Weyl spin liquid.

Enhanced gap junction intercellular communication inhibits catabolic and pro-inflammatory responses in tenocytes against heat stress.

Elevation of tendon core temperature during severe activity is well known. However, its effects on tenocyte function have not been studied in detail. The present study tested a hypothesis that heat stimulation upregulates tenocyte catabolism, which can be modulated by the inhibition or the enhancement of gap junction intercellular communication (GJIC). Tenocytes isolated from rabbit Achilles tendons were subjected to heat stimulation at 37 °C, 41 °C or 43 °C for 30 min, and changes in cell viability, gene expressions and GJIC were examined. It was found that GJIC exhibited no changes by the stimulation even at 43 °C, but cell viability was decreased and catabolic and proinflammatory gene expressions were upregulated. Inhibition of GJIC demonstrated further upregulated catabolic and proinflammatory gene expressions. In contrast, enhanced GJIC, resulting from forced upregulation of connexin 43 gene, counteracted the heat-induced upregulation of catabolic and proinflammatory genes. These findings suggest that the temperature rise in tendon core could upregulate catabolic and proinflammatory activities, potentially leading to the onset of tendinopathy, and such upregulations could be suppressed by the enhancement of GJIC. Therefore, to prevent tendon injury at an early stage from becoming chronic injury, tendon core temperature and GJIC could be targets for post-activity treatments.

Advances in table grape breeding in Japan.

In Japan, few grape cultivars related to Vitis vinifera existed 200 years ago, on account of Japan's high rainfall. Many V. labruscana and vinifera cultivars were introduced to Japan in the 19th century. Labruscana was grown instead of vinifera, mainly because of severe disease problems and a high incidence of berry cracking. Grape breeding for table use started in the 20th century, with the goal of combining the berry quality of vinifera with the ease of cultivation of labruscana. By 1945, three strategies were used: 1) crossing among introduced diploid vinifera and vinifera-related cultivars of Japanese origin, 2) interspecific crossing in tetraploid cultivars, and 3) interspecific crossing in diploid cultivars, resulting in 'Neo Muscat', 'Kyoho', and 'Muscat Bailey A'. Later, tetraploid interspecific crossing over generations developed many 'Kyoho'-related cultivars, including 'Pione', many of which have large berries, intermediate flesh texture between the two species, a labruscan or neutral flavor, and moderate disease resistance. Interspecific diploid crossing over generations developed 'Shine Muscat' in 2006, with large berries, crispy flesh, a muscat flavor, no cracking, seedless fruit by gibberellin application, and moderate resistance to downy mildew and ripe rot.

Persimmon breeding in Japan for pollination-constant non-astringent (PCNA) type with marker-assisted selection.

Oriental persimmon (Diospyros kaki) originated in Eastern Asia, and many indigenous cultivars have been developed in China, Japan, and Korea. These cultivars are classified into four groups based on their natural astringency loss on the tree and seed formation: pollination-constant non-astringent (PCNA), pollination-variant non-astringent (PVNA), pollination-constant astringent (PCA), and pollination-variant astringent (PVA). PCNA is the most desirable type because the fruit can be eaten without any postharvest treatment; therefore, one of the goals of our persimmon breeding programs is to release superior PCNA cultivars. The PCNA genotype is recessive to the other three non-PCNA genotypes, and PCNA-type F1 offspring are obtained exclusively from crosses among PCNA genotypes. Moreover, the number of superior PCNA cross-parents have been limited. In the late 1980s, inbreeding depression became obvious, especially in terms of fruit size, tree vigor, and productivity. To mitigate the inbreeding, a backcross program using PCNA [(non-PCNA × PCNA) × PCNA] was started in 1990. This process, however, was inefficient because only 15% of the offspring were PCNA, and all offspring had to be grown to the fruiting stage. Therefore, molecular markers linked to the PCNA locus were developed for discriminating PCNA offspring. A molecular marker linked to Chinese PCNA has also been developed.

[A case of ischemic colitis induced by hypereosinophilic syndrome].

A 58-year-old man came to our hospital, complaining of diarrhea and bloody stool of about 2 weeks' duration. Colonoscopic examination showed mucosal edema and bleeding, and irregular ulcer in the transverse colon and sigmoid colon. Laboratory data indicated elevated WBC (22300/mm(3)) and CRP (11.93mg/dl), and hypereosinophilia (30%). We diagnosed ischemic colitis with thrombosis due to hypereosinophilic syndrome. He started medication with prednisolone and heparin. However, after 15 days, he underwent emergency surgery because of perforation of the sigmoid colon. Thrombosis is associated with a high incidence of hypereosinophilia. It is important to consider the possibility of ischemic colitis associated with hypereosinophilic syndrome.

[Extranodal marginal zone lymphoma of the dura: a case report].

The authors present the case of a 65-year-old woman who initially was diagnosed as having intracranial dural B-cell malignant lymphoma. She survived more than 9 years after surgery and radiation. We re-examined the specimens pathologically. Histological findings confirmed an extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) that showed numerous IgG4-positive plasma cells. MALT lymphomas are already recognized as a distinct clinico-pathological entity. A primary dural MALT lymphoma is very rare and has a favorable clinical outcome, and patients are expected to have an excellent long-term survival with local therapy alone.

Primary T-cell/histiocyte-rich B-cell lymphoma arising in the trigeminal ganglion in a patient with rheumatoid arthritis.

We report a cased of a 68-year-old man with primary T-cell/histiocyte-rich B-cell lymphoma (T/HRBCL) that arose in the trigeminal ganglion. He had a 30-year history of rheumatoid arthritis and presented with progressive left facial pain that had started 3 weeks earlier. Magnetic resonance imaging (MRI) revealed an enhanced mass in the trigeminal ganglion and swelling of the distal part of the trigeminal root. The tumor, subtotally resected via the left anterior petrosal approach, was composed of proliferating CD30- and CD79-positive atypical large polygonal cells with hyperchromatic single or multiple nuclei. CD3-positive small lymphoid cells and CD68-positive histiocytic cells were intermingled with the neoplastic cells. These findings were compatible with T/HRBCL. After whole-brain radiation, his facial pain improved and he was discharged. Postoperatively, he developed transient left sixth nerve paresis. This is the first report of this rare type of B-cell lymphoma arising from the trigeminal ganglion. We posit that his prolonged immunosuppressive treatment for rheumatoid arthritis contributed to its development.

A phantom study comparing ultrasound-guided liver tumor puncture using new real-time 3D ultrasound and conventional 2D ultrasound.

OBJECTIVE: The purpose of this study is to compare the accuracy of ultrasound-guided puncture using new real-time 3D (4D) ultrasound and conventional 2D ultrasound for focal hepatic masses using a liver phantom. MATERIALS AND METHODS: A 4D ultrasound system equipped with a 5-MHz 4D probe displayed both axial and orthogonal images parallel to a puncture line plane. We used a liver phantom that contained four simulated spherical masses in an acrylic box (length × width × height, 300 × 299 × 150 mm) with two different sizes (15 and 30 mm in diameter) in two different positions (30 and 80 mm from the surface). Four inexperienced and four experienced physicians attempted punctures on these four simulated masses twice using 2D and 4D ultrasound guidance in a total of 128 punctures (eight operators, two techniques, and eight punctures per session). The error distance of the puncture was defined as the perpendicular distance from the center of a target mass (sphere) to the line of the puncture needle in the coronal plane of the target center, which was measured manually on the basis of the 3D volume data on off-line analysis. RESULTS: On each tumor model, the average error distance with 4D ultrasound was significantly smaller than that with 2D ultrasound, except for one tumor model that was 15 mm in diameter and 30 mm in depth. The average error distances for the experienced group tended to be smaller than those for the inexperienced group, with both techniques and on each tumor model, and there was a statistically significant difference between the two groups on one tumor model (30 mm in diameter and 80 mm in depth) on 4D ultrasound (p < 0.05). CONCLUSION: Four-dimensional ultrasound-guided puncture for liver tumors can markedly improve puncture accuracy for both experienced and inexperienced physicians compared with conventional 2D ultrasound guidance.