Osaka University Hospital (大阪大学医学部附属病院, Ōsaka daigaku igakubu fuzoku byōin) is a university hospital located in Suita, Osaka, Japan, affiliated with Osaka University.
Objectives To evaluate whether a modified sleep stage sequence (SSS) method based on a single epoch immediately preceding each rapid eye movement (REM) sleep period during nocturnal polysomnography (nPSG) could help identify candidates for further narcolepsy workup. Methods This study retrospectively analyzed 204 participants: 39 with narcolepsy type 1 (NT1), 63 with narcolepsy type 2 (NT2), 62 with idiopathic hypersomnia (IH), and 40 healthy controls (HC). In nPSG, REM periods were classified by the single 30-s epoch immediately preceding their onset, excluding sleep-onset REM periods (SOREMPs). The participant-level SSS(W/N1) ratio was the proportion of remaining REM periods preceded by wakefulness or N1. Decision trees distinguished NT1/NT2 from IH/HC using REM sleep latency (REML) alone or with this ratio, with 50 stratified 70/30 hold-out splits for internal validation. Results In pooled multiple sleep latency test SOREMPs, the proposed method showed the same between-group ordering as conventional SSS. In pooled nocturnal REM periods excluding SOREMPs, the frequency of SSS(W/N1) was highest in NT1 and showed a stepwise numerical gradient across NT1, NT2, IH, and HC. Adding the SSS(W/N1) ratio to REML increased the median validation area under the receiver operating characteristic curve from 0.64 [interquartile range, 0.63–0.67] to 0.70 [0.68–0.74]. Two rounded high-specificity rules were derived: Rule A (REML-based), REML < 40 min; and Rule B (SSS-enhanced), SSS(W/N1) ratio ≥ 0.4 with REML < 125 min. Median sensitivity/specificity were 23%/98% and 37%/97%, respectively. Conclusions A modified pre-REM SSS measure derived from routine nPSG may help prioritize patients for further narcolepsy workup.
Background: Fully automated Gram staining systems integrating staining, microscopy, image acquisition, and artificial intelligence (AI)-assisted interpretation have the potential to reduce laboratory workload and standardize workflows. However, their diagnostic performance in routine clinical practice remains unclear. We evaluated a fully automated Gram staining system using clinical urine specimens from multiple institutions. Methods: In this prospective multicenter study, residual urine specimens from two Japanese university hospitals were evaluated using Mycrium, a fully automated system integrating Gram staining, microscopy, image acquisition, and AI-assisted interpretation. The standalone performance of the initial and updated AI models and the performance of manual microscopy were compared with a consensus reference standard established by three experienced clinical microbiology technologists. Results: Among 892 collected specimens, 882 were eligible for analysis. Manual microscopy demonstrated a sensitivity of 93.4%, specificity of 89.9%, and Cohen's kappa of 0.83 for overall Gram stain interpretation. The initial AI model achieved a sensitivity of 91.0%, specificity of 49.3%, and kappa of 0.41, whereas the updated model showed a sensitivity of 88.3%, specificity of 59.0%, and kappa of 0.48. Model updating resulted in category-specific trade-offs between sensitivity and specificity. Most false-negative results occurred in 1+ specimens. Conclusions: The automated Gram staining system demonstrated high sensitivity but moderate specificity. Although its diagnostic performance remained inferior to experienced technologists, it enabled a fully automated workflow integrating staining, microscopy, image acquisition, and AI-assisted interpretation. These findings support the feasibility of integrated Gram stain workflow automation and provide a benchmark for further refinement of automated microscopy and AI algorithms.
Although novel drug development and clinical trials are ongoing, bisphosphonates remain the standard treatment of osteogenesis imperfecta (OI). This study aimed to evaluate clinical effects of bisphosphonate therapy across clinical subtypes and genetic variants of OI, and to explore treatment outcomes of sequential bisphosphonate therapy in patients with severe disease. This retrospective analysis was conducted using clinical data from patients with genetically confirmed OI. Bone mineral density (BMD), trabecular bone score (TBS), height, and fracture incidence were analyzed in patients undergoing pamidronate (PAM) treatment and in those who switched from PAM to zoledronate (ZOL). A total of 83 patients with OI were included, of whom 51 (type I: n = 36; type III: n = 9; type IV: n = 5; type V: n = 1) with a history of PAM treatment were selected for subgroup analysis. Analysis of up to 5 years of PAM treatment demonstrated a significant overall increase in BMD accompanied by a reduction in the annualized fracture rate. However, BMD improvement was significantly attenuated in patients with type III compared with those with other types (years 2–4, p < 0.001). Although BMD significantly increased in both groups following PAM initiation, the glycine-substitution group showed lower BMD than the haploinsufficiency group. Type III patients who switched from PAM to ZOL demonstrated increased BMD Z-scores and reduced fracture incidence. Switching from PAM to ZOL appears to be associated with improved outcomes in severe cases. These results suggest that clinical classification, alongside genotype information, may help inform prognosis and guide treatment strategies.
Robot-assisted minimally invasive esophagectomy (RAMIE) has become increasingly prevalent due to its ability to provide a magnified, three-dimensional operative field and articulate instrumentation. However, the narrow and fixed field of view creates peripheral blind zones. Assistant maneuvers and instrument movements frequently occur outside the console view, potentially affecting intraoperative situational awareness and workflow. These factors can lead to inadvertent injuries to adjacent organs such as the aorta, pulmonary vein, trachea, or lungs. This dynamic manuscript illustrates a practical visualization strategy using a 5-mm flexible sub-scope to address blind zones during robot-assisted esophagectomy. This manuscript presents synchronized intraoperative footage from the main robotic camera and a 5-mm flexible sub-scope used during the thoracic phase of RAMIE. Representative operative scenes were selected to demonstrate how the sub-scope provides complementary visualization of areas outside the console field of view. Quantitative assessment of visual coverage was performed in a representative case to illustrate the proportion of assistant activity occurring within and outside the robotic camera view. Additional illustrative scenarios highlight sub-scope utilization during port insertion, instrument exchange, vascular division, and assistant-led background tasks. Video analysis demonstrated that a substantial proportion of assistant forceps activity occurred outside the robotic camera’s field of view during the thoracic phase. The sub-scope enabled continuous visualization of these blind zones, allowing assistants to monitor instrument trajectories, surrounding structures, and spatial relationships without requiring repositioning of the main camera. Dynamic intraoperative examples illustrate how this complementary visualization supports safe confirmation during critical steps, facilitates autonomous assistant actions, and enables parallel task execution while preserving uninterrupted console workflow. This video-based report demonstrates a practical technique for dynamic visualization of peripheral blind zones during robot-assisted esophagectomy. A 5-mm flexible sub-scope may support intraoperative awareness and coordinated workflow while preserving the stability of the primary console view.
After a median study follow-up of 36.6 months, first-line pembrolizumab plus chemotherapy numerically improved overall survival (OS) and progression-free survival (PFS) versus placebo plus chemotherapy in Japanese participants with advanced esophageal cancer in the phase 3 KEYNOTE-590 study. The 5-year follow-up is presented. Participants with previously untreated advanced esophageal cancer were randomly assigned 1:1 to pembrolizumab 200 mg or placebo every 3 weeks up to 35 cycles plus chemotherapy (cisplatin 80 mg/m2 and 5-fluorouracil 800 mg/m2/day). Primary end points were OS and PFS per RECIST v1.1 by investigator; objective response rate (ORR) and safety were secondary. The data cutoff date was July 10, 2023. In total, 141 of 794... participants were enrolled in Japan. Median study follow-up was 60.6 months (range, 53.8–69.7). Median OS was 17.7 months (95
