OBJECTIVE:To evaluate the feasibility and perceived utility of mixed-reality-assisted navigation using patient-specific 3-dimensional holographic models derived from computed tomography in transvaginal surgery for stress urinary incontinence and pelvic organ prolapse. METHODS:Patient-specific computed tomography imaging data were converted into 3-dimensional holographic models using the HoloEyes MD system. The holograms were projected using HoloLens 2 for intraoperative guidance. The study included 24 transvaginal surgeries (tension-free vaginal tape, transobturator tape, transvaginal mesh, and sacrospinous ligament suspension), involving 46 surgeons and assistants. Surgical tools were modeled as spatial reference markers using kneadable erasers and integrated into the mixed-reality visualization system. RESULTS:The mixed-reality system was perceived to improve surgeons' spatial understanding of pelvic anatomy and surgical workflow, particularly in anatomically complex regions such as the sacrospinous ligament and obturator foramen. Most participants reported enhanced anatomical comprehension and perceived usefulness of the system during preoperative planning and intraoperative confirmation. Familiarity with the technology improved with repeated use. CONCLUSION:Mixed-reality-assisted navigation using patient-specific holographic models is feasible in transvaginal procedures and may support surgeons' spatial understanding and confidence during surgery. This technology shows potential as a useful educational and intraoperative support tool in urology and gynecology.
Context:The association of iodine nutritional status with thyroid function in iodine-replete countries is controversial and more sensitive biomarkers than urinary iodine concentration is required. Objective:To evaluate the use of scalp hair and serum iodine concentration as measure of iodine status through their association with thyroid indices. Methods:A nationwide survey was conducted between 2016 and 2023. Iodine concentration in serum (SIC), hair (HIC), urine (UIC) and estimated 24-hour urinary iodine excretion (eUIE), dietary iodine intake (DII) as well as serum TSH, FT4, and FT3 concentrations, thyroid antibody (ThAb) was measured in Japanese adults. Results:The median UIC in 2771 adults was 295.0 μg/L and within the WHO's adequacy range of iodine intake. The high iodine intake assessed by UIC, eUIE and SIC was associated with higher TSH and lower thyroid hormone levels. Urinary iodine concentration, eUIE and DII were higher in the group with a high TSH level. The subjects with positive ThAbs had significantly higher SIC, DII, TSH and slightly lower FT4 levels. The median HIC correlated positively but weakly with SIC, eUIE and DII, while SIC correlated modestly with eUIE, UIC and weakly with DII. The 5th percentile of the SIC reference (49.9 μg/L) coincided with the threshold value of median UIC (<100 μg/L) for iodine deficiency by WHO. Conclusion:Higher iodine intake results in changes of TSH and thyroid hormones within their referenced range. Serum and hair iodine concentrations might be feasible indicators for a population's iodine intake and further research is needed to validate their availability.
Background Primary small intestinal lymphoma (PSIL) is a rare disease, and its clinical characteristics and prognostic factors remain insufficiently defined because of limited large-scale data. Methods We conducted a nationwide multicenter retrospective study of 686 patients diagnosed with PSIL between January 2008 and December 2017 at 44 institutions in Japan. Clinical characteristics, histological subtypes, and overall survival were analyzed. Results B-cell lymphoma was the predominant immunophenotype (n = 623, 91%), whereas T-cell lymphoma was uncommon (n = 50, 7%). Diffuse large B-cell lymphoma (DLBCL) was the most frequent histological subtype (n = 330, 48%), followed by follicular lymphoma (FL) (n = 224, 33%). Compared with other B-cell lymphomas, FL was more common in women and more frequently involved the jejunum (P < 0.001). The 5-year overall survival rate was significantly higher in patients with B-cell lymphoma than in those with T-cell lymphoma (81% vs. 23%, P < 0.001). Multivariate Cox regression analysis identified age > 60 years and T-cell lymphoma as independent adverse prognostic factors, whereas FL was an independent predictor of favorable overall survival. Conclusions This nationwide multicenter analysis delineates the clinicopathological features and survival outcomes of PSIL in Japan. FL represents the second most common subtype after DLBCL and is associated with a favorable prognosis among PSIL subtypes.
BACKGROUND AND AIMS:Chronic background mucosal inflammation contributes to colorectal cancer (CRC) development in ulcerative colitis (UC), but its prognostic impact is unclear. We evaluated whether background mucosal inflammation documented at cancer diagnosis is associated with oncologic outcomes. METHODS:This retrospective study analyzed 1189 UC patients diagnosed with CRC using a nationwide, multicenter database in Japan. Patients were classified as CRC within the UC-involved area (within-area) or outside the UC-involved area (outside-area), based on tumor location relative to the UC disease extent documented endoscopically at cancer diagnosis. The primary end point was 5-year recurrence-free survival (RFS), and the secondary end point was 5-year cancer-specific survival (CSS). In within-area cases, inflammation severity was assessed using the Mayo Endoscopic Score (MES), stratified as Inactive, Mild-Moderate, and Severe. RESULTS:Of the 723 eligible patients, 683 had within-area and 40 outside-area CRC. Five-year RFS was significantly lower in within-area than outside-area CRCs (75.1% vs 87.6%, P = 0.022). Multivariable Cox regression analysis of RFS revealed this classification as an independent prognostic factor (hazard ratio = 2.99, 95% confidence interval: 1.09-8.18, P = 0.030). A significant difference was also observed in 5-year CSS (P = 0.038). Among within-area cases, higher MES was associated with stepwise declines in RFS (P = 0.150), and a similar, statistically significant gradient in CSS (P = 0.048). CONCLUSIONS:Background mucosal inflammation at cancer diagnosis is associated with significantly worse prognosis of CRC in UC patients. Systematic endoscopic assessment at cancer diagnosis may aid prognostic stratification and inform management.
