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In triple A (Allgrove) syndrome, motor neuron disease is a co-morbid condition. We herein report a 38-year-old Japanese man with triple A (Allgrove) syndrome and novel tandem mutations a novel c.881delT deletion mutation and c.835C>T localized to the AAAS gene. A nerve conduction study revealed marked axonal damage in several motor nerves. Tandem mutations in the AAAS gene may be involved in co-morbid motor neuron disease and aberrant electrophysiological findings.Objective Although a number of studies have shown that both short and long sleep durations were associated with the risk of metabolic disorders related to obesity, the underlying mechanism is still not fully understood. In this study, we analyzed the association of sleep duration with metabolic, anthropometric, and lifestyle factors in patients with type 2 diabetes. Methods The subjects were 279 patients with type 2 diabetes 63 (52-70) years old (median and interquartile range) with a body mass index of 25.0 (22.2-28.3) kg/m2 and HbA1c levels of 8.7% (7.6-10.3%). Patients with advanced complications were excluded from the study. Diets were evaluated by registered dietitians using a software program. Body composition was assessed by the multifrequency bioelectrical impedance method. Results The mean self-reported nightly sleep duration was 6.4 hours with no marked gender difference. Sleep duration was inversely correlated with the HbA1c levels, total energy intake, and intakes of carbohydrate, protein, and fat. The body fat ratio and skeletal muscle mass were correlated positively and negatively, respectively, with sleep duration. When the subjects were divided into three groups based on sleep duration, the intakes of total energy, carbohydrates, and fat tended to be high in those with 7 hours of sleep. Conclusion The observation that sleep duration is distinctly associated with excessive eating and a sedentary lifestyle may provide a basis for effective lifestyle management of patients with type 2 diabetes.Objective Classic Hodgkin lymphoma (CHL) has been regarded as a curable disease when treated appropriately, especially in younger patients, and ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) has been regarded as the standard regimen. However, a relatively poor prognosis has been reported in older patients with CHL, and the efficacy and tolerability of the ABVD regimen has not been fully elucidated. We retrospectively investigated the outcomes in patients with CHL treated with ABVD at our institute. Methods Twenty-five patients were evaluated; 14 were ≤60 years of age, and 11 were >60 years of age (older group). Results The ABVD doses were reduced in all patients in the older group; the median average relative dose intensity was 0.58. In the older group, the 5-year overall survival (OS) and median OS were 100% and not reached, respectively, for patients with early-stage CHL and 66.7% and not reached, respectively, for those with advanced-stage CHL. No patients died of CHL, and only one treatment-related death was observed in the older group. Conclusion ABVD with dose attenuation may represent a feasible and effective strategy for the treatment of older patients with CHL in clinical practice, particularly in those with early-stage disease, although the optimal degree of attenuation remains unclear.

Cervical anastomotic leakage (CAL) is one of the most common complications that occur minimally invasive esophagectomy (MIE). It is associated with high postoperative mortality. Some risk factors still remained controversial and so accurate prediction of risk groups for CAL remained very difficult. This study aimed to identify the risk factors of CAL after McKeown MIE to predict the accuracy of the technique as early as possible.

A total of 129 patients with esophageal cancer who underwent McKeown MIE at the Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, between January 2018 and June 2019 were retrospectively reviewed. Multivariate logistic regression analysis was used to identify the risk factors for CAL and receiver operating characteristic (ROC) curve analysis was used to predict the accuracy for each quantitative data variable and determine the cutoff value.

There were statistically significant differences between Group CAL and Group NCAL in FEV

(p = 0.031), neoadjuvant chemotherapy (p = 0.001), intraoperative minimum PaCO

(p = 0.002), and hospital stays (p <0.001). In multivariate logistic regression, FEV

(OR = 0.440, p = 0.047), neoadjuvant chemotherapy (OR = 4.425, p = 0.003), and intraoperative minimum PaCO

(OR = 1.14, p <0.001) were identified to be three risk factors of CAL. The ROC curve analysis showed that FEV

<2.18L (p = 0.029) and intraoperative minimum PaCO

>45.5 mmHg (p = 0.002) demonstrated good accuracy.

FEV

, neoadjuvant chemotherapy, and intraoperative minimum PaCO

in arterial blood gas (ABG) were considered as risk factors of CAL after McKeown MIE for esophageal cancer. Preoperative FEV

<2.18L and intraoperative minimum PaCO

>45.5 mmHg in ABG showed good accuracy in predicting risk factors for CAL.

45.5 mmHg in ABG showed good accuracy in predicting risk factors for CAL.

We investigated the clinical utility of a radiological technologist's (RT)'s reports (RRs) as a second opinion by the free-response receiver operating characteristic (FROC) observer study that compared the performance of medical doctors' (MDs') reading of digital mammogram with and without consulting the RR.

One hundred women (39 malignant, 61 benign or normal) who underwent diagnostic mammography were selected from among 1674 routine clinical images classified by the degree of difficulty and categories for inclusion in the FROC study. The first FROC study performed by three RTs (RT 1-3) was conducted to collect the data for RR utilized in the second FROC study. The second FROC study was performed by five MDs, and the statistical significance of MDs' performances with and without reference to the RR was investigated by figure of merit (FOM).

The FOM values of three RTs obtained in the first FROC study were 0.529, 0.576, and 0.539, respectively. Pyrvinium In the second FROC study, RT 2 had the highest FOM, RT 1 the lowest false positives/case, and RT 3 the highest sensitivity.

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