Preoperative percutaneous transhepatic portal vein embolization is used to induce future liver remnant hypertrophy before major hepatectomy in perihilar cholangiocarcinoma. We report a patient who developed peritoneal nodules along the suspected transhepatic puncture route after right-sided percutaneous transhepatic portal vein embolization. Histopathology showed adenocarcinoma consistent with the primary tumor. The spatial distribution and timing were considered more suggestive of tract-related seeding from bile leakage rather than hematogenous spread. This rare but serious complication warrants preventive strategies, including careful route planning, strict avoidance of bile contamination, minimization of puncture attempts, and secure tract closure.

PURPOSE:Preventive transarterial embolization (TAE) for splenic artery aneurysm (SAA) is recommended in high-risk cases owing to the high mortality after rupture. This study evaluated the cost effectiveness of preventive TAE for SAAs smaller than guideline-recommended threshold of 30 mm. MATERIALS AND METHODS:A Markov model with 6 states (well without treatment, well after treatment, TAE for aneurysm growth, recanalization, rupture, and death) was developed to compare preventive TAE with the watch-and-wait strategy using 1-year cycles over a lifetime. Model parameters were derived from prior studies and a national administrative claims database in Japan. The base case was a 60-year-old female with SAA measuring 20 mm. The incremental cost-effectiveness ratio (ICER) was evaluated against Japan's willingness-to-pay threshold of 5 million yen per quality-adjusted life year (QALY). Deterministic and probabilistic sensitivity analyses incorporated scenarios varying multiple parameters. RESULTS:Analysis of 2,870 patients undergoing preventive TAE for SAAs from the database revealed an ICER of 3,522,204 yen/QALY (22,724 USD/QALY) in the base case, below the threshold. The ICER exceeded the threshold at 71.4 years in females and 65.9 in males. Quality-of-life (QOL) improvement by treatment (12-24 months and longer), time to QOL difference resolution, age at discovery, and costs of preventive TAE were the key ICER influencers. Without QOL improvement, preventive TAE was not cost-effective. CONCLUSIONS:Preventive TAE for SAA may be cost-effective but only when treatment leads to improvements in QOL. These findings highlight the importance of patient selection and can guide cost-conscious clinical decision-making and reimbursement policy.

Transarterial radioembolization (TARE) is effective for unresectable hepatocellular carcinoma; however, it awaits approval in Japan. This study aimed to simulate the cost-effectiveness of TARE over chemoembolization when TARE is approved in Japan and identify the requirements for cost-effectiveness. A Markov model was constructed to analyze the costs and effectiveness associated with TARE and transarterial chemoembolization with drug-eluting beads (DEB-TACE) for 2-month cycles over 5 years. In the primary analysis, the intention-to-treat survival data were used to calculate transition probabilities, whereas the ancillary analysis assessed the per-protocol survival data. DEB-TACE costs were calculated using the Japanese nationwide claims Diagnosis Procedure Combination database between April 2018 and March 2022, whereas TARE costs were estimated using database and international sources. The incremental cost-effectiveness ratio (ICER) was determined based on the payer’s perspective and compared with the Japanese willingness-to-pay threshold of 5 million Japanese yen (JPY) (31,250 USD) per quality-adjusted life years (QALY). From the claims database, 6,986 patients with hepatocellular carcinoma who received DEB-TACE were identified. In the primary analysis, the ICER was 5,173,591 JPY (32,334 USD)/QALY, surpassing the Japanese willingness-to-pay threshold. However, the ancillary analysis showed a lower ICER of 4,156,533 JPY (25,978 USD)/QALY, falling below the threshold. The one-way deterministic sensitivity analysis identified progression-free survival associated with TARE and DEB-TACE, DEB-TACE costs, and radioactive microsphere reimbursement price as key ICER influencers. The primary analysis suggested that setting the reimbursement price of radioactive microspheres below 1.399 million JPY (8,744 USD), approximately 2.8

Purpose: To identify anatomical variations in the left adrenal vein (LAV) and to evaluate the role of preprocedural contrast-enhanced computed tomography (CT) planning. Methods: The length of the left adrenal central vein (LACV), the vessel that receives blood from all tributaries of the left adrenal gland, was measured using venograms of patients who had undergone adrenal venous sampling (AVS) for the diagnosis of primary aldosteronism between October 2017 and December 2019. The anatomical variants of the LAV were described and classified. Contrast-enhanced CT was used to evaluate the detection rate of the following: (a) confluence of the left inferior phrenic vein and the LAV and (b) the last tributary flowing into the LAV. Results: In total, 311 patients (143 men, 168 women; mean age: 49.3 years +/- 11.0) were enrolled. Of them, 9 (2.9%) patients had anatomical variants lacking a LACV. In patients with a LACV (n = 302), the venographic LACV length was 9.0 mm +/- 3.9 (<1 mm in 9 patients). The detection rate of the confluence of the left inferior phrenic vein and LAV, as determined using contrast-enhanced CT, was high (96.2%), whereas that of the last tributary flowing into the LAV was low (0.8%). In 4 of 18 patients with short or absent LACV, the variant was visualized using contrast-enhanced CT. Conclusions: In some patients, the LACV is absent or short, which is an anatomical variation. Understanding venographic anatomical variations can help avoid misleading results resulting from a suboptimal sampling site in AVS. For some subtypes, contrast-enhanced CT may also help in planning the AVS procedure.

Objective: This study evaluated the differences in the appearance of COVID-19 pneumonia on chest computed tomography (CT) images of outpatient and cases that developed during hospitalisation. Method: Chest CT images of 66 patients (median age, 76 years; range, 29-94 years) who underwent the severe acute respiratory syndrome coronavirus-2 reverse-transcription polymerase chain reaction (RT-PCR) test were included in this retrospective study. The chest CT appearance was categorised as "typical," "indeterminate," "atypical," or "negative" in accordance with the recommendations of the Radiological Society of North America for COVID-19 pneumonia and compared among the following four subgroups: PCR-positive outpatient (n = 14); PCR-positive hospitalised (n = 7); PCR-negative outpatient (n = 9); and PCR-negative hospitalised (n = 36). Findings: The frequency of "typical" findings in the PCR-positive outpatient cases (13/14, 92.9%) was significantly higher than that of those in the PCR-positive hospitalised cases (2/7, 28.6%, P = 0.022). There was no significant difference between the frequency of the "typical" appearance in PCR-positive hospitalised cases and that of those in the PCR-negative hospitalised cases (1/36, 2.8%, P = 0.192). Conclusions: When COVID-19 patients acquire infections while hospitalised, their chest CT images are less likely to show typical findings than those of outpatient cases. Comprehensive and careful assessments of CT findings and consideration of the possibility of concomitant infections with other pathogens and clinical information, such as underlying diseases, background lung structure, and time course of the infection, are required for the management of such cases.

Azadirachtin (1), which was isolated from the Indian neem tree in 1968, exhibits potent antifeedant and growth inhibitory activities against many insects. Because of its complicated structure, only the Ley group has completed the synthesis of 1. In this article, we describe the second synthesis of 1. The Diels-Alder reaction-decarboxylation-Claisen rearrangement approach was used to construct the basic structure of the left-hand segment. The correct stereochemistry at C4 was established by an oxidative ring-opening reaction and a subsequent aldol reaction. The right-hand segment was prepared from the known cyclopentenone derivative. After a coupling of both segments, the key tandem radical cyclization reaction was performed to elaborate the full carbon framework of 1. The cyclized product could be converted into Ley’s intermediate in 9 steps, resulting in the formal synthesis of 1. Our synthesis with a longest linear sequence of 39 steps is highly efficient.

Purpose: To analyze the effect of use of tractography of the critical brain white matter fibers created from diffusion tensor magnetic resonance imaging on reduction of morbidity associated with radiosurgery.Methods and Materials: Tractography of the pyramidal tract has been integrated since February 2004 if lesions are adjacent to it, the optic radiation since May 2006, and the arcuate fasciculus since October 2007. By visually con.. firming the precise location of these fibers, the dose to these fiber tracts was optimized. One hundred forty-four consecutive patients with cerebral arteriovenous malformations who underwent radiosurgery with this technique between February 2004 and December 2009 were analyzed.Results: Tractography was prospectively integrated in 71 of 155 treatments for 144 patients. The pyramidal tract was visualized in 45, the optic radiation in 22, and the arcuate fasciculus in 13 (two tracts in 9). During the follow-up period of 3 to 72 months (median, 23 months) after the procedure, 1 patient showed permanent worsening of pre-existing dysesthesia, and another patient exhibited mild transient hemiparesis 12 months later but fully recovered after oral administration of corticosteroid agents. Two patients had transient speech disturbance before starting integration of the arcuate fasciculus tractography, but no patient thereafter.Conclusion: Integrating tractography helped prevent morbidity of radiosurgery in patients with brain arteriovenous malformations. (C) 2012 Elsevier Inc.

PURPOSE:To evaluate whether the use of diffusion-tensor tractography (DTT) of the corticospinal tract could reduce motor complications after stereotactic radiosurgery (SRS). METHODS AND MATERIALS:Patients with arteriovenous malformation (AVM) in the deep frontal lobe, deep parietal lobe, basal ganglia, and thalamus who had undergone radiosurgery since 2000 and were followed up for more than 3 years were studied. DTT of the corticospinal tract had been integrated into treatment planning of SRS since 2004, and the maximum dose received by the corticospinal tract was attempted to be less than 20 Gy. Treatment outcomes before (28 patients, Group A) and after (24 patients, Group B) the introduction of this technique were compared. RESULTS:There were no statistical differences between the two groups (Group A vs. Group B) in patients' age (34 years vs. 33 years, p = 0.76), percentage of patients with hemorrhagic events before treatment (50% vs. 29%, p = 0.12), or percentage of AVM involving the basal ganglia and thalamus (36% vs. 46%, p = 0.46). Obliteration rates were 69% and 76% at 4 years in Groups A and B, respectively (p = 0.68), which were not significantly different. Motor complications were observed in 5 patients in Group A (17.9%) but only in 1 patient in Group B (4.2%), which was significantly less frequent (p = 0.021). CONCLUSION:Integrating DTT of the corticospinal tract into treatment planning contributed to reduction of motor complications without compromising the obliteration rate for AVM adjacent to the corticospinal tract.

Recently, high-albedo materials and products have been developed to lower the surface temperatures of urban building roofs and roads. In this paper, outdoor exposure experiments and a numerical simulation are conducted to identify the effectiveness of reflective paint. The optical and thermal properties of 137 kinds of reflective paint are measured according to JIS (Japan Industrial Standard) method. In addition, sensible heat emission and heat load are calculated considering a change in the paint performance deteriorated by outdoor exposure.

BACKGROUND:The reported cumulative risk of post-angiographic obliteration (post-AO) hemorrhage from arteriovenous malformations (AVMs) following gamma knife radiosurgery (GKRS) over 10 years is 2.2%.OBJECTIVE:To identify the warning signs of post-AO hemorrhage by analyzing the characteristics of enhancement on contrast-enhanced MRI magnetic resonance imaging (MRI) of AVMs with post-AO hemorrhage.METHODS:We performed a retrospective analysis of 121 patients whose AVMs were angiographically obliterated within 5 years of GKRS without hemorrhage and who received at least 1 contrast-enhanced MRI after GKRS (group 1), and 7 patients who experienced post-AO hemorrhage (group 2). We analyzed the enhancement persistence ratio (the percentage of AVMs with persisting enhancement on contrast-enhanced T1-weighted image after obliteration) and the change in size of the enhanced region over time in each patient.RESULTS:The enhancement persistence ratio showed no significant difference between the 2 groups (89.4% vs 100% for groups 1 and 2, respectively; P=.401). While most cases in group 1 showed a tendency to decrease in size and gradually stabilize following GKRS, there were significantly more cases in group 2 with obvious increment of the enhanced regions within 1 year of angiographic obliteration compared with the previous measurement (4.96% vs 71.4% for groups 1 and 2, respectively; P<.0001).CONCLUSION:Our results suggest that AVMs that show an increase in the size of the enhanced region within 1 year of angiographic obliteration should be followed up with caution for post-AO hemorrhage. Persisting enhancement itself is not positively associated with subsequent hemorrhage.

Recently, post-set solar shading techniques for existing windows have been developed for reducing the air conditioning load. The optical and thermal properties of sixty-nine samples are measured according to JIS (Japan Industrial Standard) method. In addition, heat load calculations are carried out for the cases of office and house in Tokyo and Osaka.The optimum solar shading techniques can be derived from the load reduction performance curves obtained by the numerical simulation results.

Purpose: The objective of this study was to examine the frequency of high signal intensity in the dural sinuses of normal subjects upon magnetic resonance (MR) angiography using 3.0-T scanners. Methods: A total of 748 consecutive healthy subjects underwent three-dimensional time-of-flight MR angiography at 3.0 T. Sixteen subjects were excluded. MR angiographic source images were retrospectively reviewed for the presence of high signal intensity in the inferior petrosal sinus, pterygoid sinus, or sigmoid sinus. Results: Of the 732 examinations, 10 (1.3%) showed high signal intensity in the dural sinuses (left inferior petrosal sinus, n=4; left pterygoid sinus, n=3; left sigmoid sinus, n=6). High signal intensity in the dural sinuses was observed only on the left side. The minimum diameter of the left brachiocephalic vein was significantly smaller in subjects with high signal intensity than in the control group. Conclusion: In our study with healthy subjects at 3.0 T, the frequency of high signal intensity in the dural sinuses is as low as 1.3%. Retrograde flow due to physiological stenosis of the left brachiocephalic vein may be one of the causes of this phenomenon. (C) 2010 Elsevier Inc. All rights reserved.

In recent years, high-albedo materials and products have been utilized for urban building roofs and roads to lower their surface temperatures. These high-albedo materials and products include those with spectral selectivity. Accordingly, a numerical simulation was conducted to investigate the spectral dependency and characteristics of the urban albedo. The distribution of the spectral albedo relative to the albedo over the entire spectrum agreed well between the experimental (Itoh & Ashie 2008) and numerical investigations. The effects of the spectral selectivity of urban materials on the urban albedo are discussed using the results from the numerical simulation.

In recent years, high-albedo materials and products have been utilized for urban building roofs and roads to lower their surface temperatures. These high-albedo materials and products include those with spectral selectivity. Accordingly, a scale model experiment and a numerical simulation were conducted to investigate the spectral dependency and characteristics of the urban albedo. The experimental results suggest that the spectral albedo is high in the near-infrared region especially in hours with low solar altitudes. The distribution of the spectral albedo relative to the albedo over the entire spectrum agreed well between the experimental and numerical investigations. The effects of the spectral selectivity of urban materials on the urban albedo are discussed using the results from the numerical simulation.

OBJECT:Although conventional catheter angiography is commonly used in the evaluation of intracranial arteriovenous malformations (AVMs), less invasive tools are more suitable for screening or follow-up. Older MR angiography techniques cannot provide high enough temporal and spatial resolution for assessing AVMs. Threetesla time-resolved imaging of contrast kinetics (TRICKS)-a time-resolved, contrast-enhanced 3D MR angiography technique-achieves subsecond time resolution without sacrificing spatial resolution. The purpose of this study was to assess the accuracy of TRICKS at 3 T in the evaluation of AVMs.METHODS:Between November 2006 and November 2007, 31 patients who were known to have AVMs underwent evaluation in a 3-T unit with the TRICKS technique. The TRICKS images were then evaluated independently by 2 radiologists for nidus detection, early venous filling detection, and Spetzler-Martin classification, and these results were compared with the results of catheter angiography.RESULTS:Time-resolved imaging of contrast kinetics achieved 96% sensitivity and 100% specificity both in nidus detection and early venous filling detection. The Spetzler-Martin grades also showed excellent correlation with catheter angiography findings (kappa= 0.89).CONCLUSIONS:Although this is a preliminary study, the authors' results indicate that time-resolved contrast-enhanced 3D MR angiography at 3 T is a good tool to assess AVMs, and has the potential to replace catheter angiography in screening or follow-up examinations of patients with AVMs.

BACKGROUND AND PURPOSE: Although neuroembolization has recently spread quickly, sufficient attention has not been focused on the associated radiation exposure. The purpose of this research was to evaluate the patient's entrance skin dose (ESD) during neuroembolizations in 6 institutions.MATERIALS AND METHODS: This study was approved by all of the 6 institutional review boards, and all of the patients gave informed consent. This study included a total of 103 consecutive neuroembolizations in the 6 institutions. Patient ESDs during the procedures were evaluated by using caps that had 44 radiosensitive indicators adherent to the surface. The patient ESDs were calculated from the color difference of the indicators. To check for effects on the scalp, clinical follow-up was performed at 1-2 days, 2 weeks, and 3 months after the procedure.RESULTS: The averages of total fluoroscopic time, total number of digital subtraction angiography frames, and dose area product were 67.1 +/- 41.6 minutes, 883 +/- 626, and 257 +/- 150 Gy x cm(2), respectively. The average maximum ESD for each patient was 1.9 +/- 1.1 Gy (range, 0.4-5.6 Gy; median, 1.5 Gy). The average maximum ESDs of each institution ranged from 1.0 to 2.4 Gy. Epilation was observed in 6 patients.CONCLUSIONS: The maximum ESDs during neuroembolizations exceed the thresholds for radiation skin injuries in some cases.

Purpose: To minimize the morbidity of radiosurgery for critically located lesions, we integrated diffusion-tensor tractography into treatment planning for gamma-knife radiosurgery. We calculated the refined tolerance of the pyramidal tract (PT) after prospective application of the technique to additional patients.Methods and Materials: The relationship between the dosimetry during treatment planning and the development of subsequent motor complications was investigated in 24 patients, 9 studied retrospectively and 15 studied prospectively. The maximal dose to the PT and the volumes of the PT that received >= 20 Gy (20-Gy volume) and >= 25 Gy (25-Gy volume) were calculated. Univariate logistic regression analyses were used to produce dose-response curves. Differences in the tolerable dose according to the PT location were calculated.Results: Univariate logistic regression analysis of the motor complications revealed a significant independent correlation with the maximal dose to the PT and the 20- and 25-Gy volumes. The maximal dose to the PT with a 5% risk of motor complications was 23 Gy compared with 15 Gy in our previous report. The risk of motor complications was significantly greater in the internal capsule than in the corona radiata for the 20- and 25-Gy volumes in generalized Wilcoxon tests (p = 0.031), although no significant difference was observed for the maximal dose.Conclusion: The tolerable dose of the PT was greater than that previously reported. The internal capsule was more sensitive to high-dose irradiation over a wide area of the PT, probably owing to the dense concentration of motor fibers. (c) 2008 Elsevier Inc.

The solar-optical properties of the adhesive films for glazings are measured according to JIS (Japan Industrial Standard) method to clarify the spectral characteristics of them. The measured samples are classified by cluster analysis and the spectral characteristics of clusters are discussed. In addition, the performances of adhesive films for glazings are compared with those of various glazing to find the practical utilization of the adhesive films for glazings.