There are increasing reports of patients with refractory otitis media caused by anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), especially myeloperoxidase (MPO)-ANCA-positive middle ear disease.　However, making a definitive diagnosis can be difficult, which can adversely affect the outcome of treatment.　We reviewed the diagnostic features of MPO-ANCA-positive middle ear disease and here discuss the difficulties of timely diagnosis and treatment.　Seven cases were eligible (6 women, 1 man;aged 57-83 years), and all were MPO-ANCA positive and proteinase 3 (PR3)-ANCA negative.　The patients were referred to our institution for management of intractable otitis media (2/7), progressive hearing loss (7/7) with facial palsy (1/7), and/or a high MPO-ANCA titer (5/7).　All patients underwent tapering steroid therapy and their MPO-ANCA titer was monitored.　Refractory MPO-ANCA-positive otitis media was noted:5 of 7 cases showed improvement with tapering steroid therapy but cure was not achieved in the remaining 2 cases.　This study demonstrates the difficulties in the diagnosis and treatment of localized AAV.　Early diagnosis and treatment can improve the prognosis of patients with AAV but global diagnostic criteria for ear disease have not been established.　Additional cases should be prospectively examined to establish a treatment for MPO-ANCA-positive middle ear disease.

Background and Purpose: Mild cognitive impairment (MCI) is a predictor of future age-related dementia.　We herein investigated associations of MCI with higher-level functional capacities, as well as with subjective difficulty regarding these functions, in community-dwelling older people, to identify a simple method for early MCI detection.

Method: We administered a test battery to 118 community-dwelling older people living in an urban area.　The battery consisted of three tests;the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), the Touch Panel-type Dementia Assessment Scale (TDAS), and the Geriatric Depression Scale-15.　We then excluded participants with possible dementia or depression symptoms, and divided the remainder (n = 67) into an MCI group (n = 16) and a non-MCI group (n = 51), according to TDAS performance.

Results: Logistic regression analysis with the MCI and non-MCI groups as dependent variables indicated that TMIG-IC was a significant variable.　Male sex and the perception that preparing meals and filling out pension forms had become more difficult were significantly associated with MCI, each independently increasing the probability of MCI.

Conclusions: Subjective difficulty with higher-level functions and impairment in higher-level functional capacity may serve as indices for mass screening for MCI.

Introduction:Computer-aided design and manufacturing (CAD/CAM) methods have gained prominence in early orthotic provision.　This study introduces an innovative approach using compact three-dimensional (3D) printers and computed tomography data to generate segmented body models for traditional Damen corset orthoses.　The goals included evaluating the comfort and fit of orthoses and assessing the effectiveness of our approach for prosthetic companies with limited financial resources.

Materials and Methods:Lumbar and thoracolumbar orthoses were crafted via CAD/CAM.　Four healthy patients wore the orthoses, with whom immediate and 1-week comfort and fit assessments were conducted.　A prosthetist assessed fit, and the Japanese edition of OPUS-CSD, the Orthotics Prosthetics Users’ Survey-Client Satisfaction with Device, was used for subjective assessment of comfort and fit.

Results:The fit evaluations were satisfactory for all patients with positive predefined criteria.　Questionnaire responses confirmed high satisfaction and comfort, confirming a successful orthosis fit.

Conclusion:We established an orthotic fabrication method using CAD/CAM methods with 3D printers.　Additionally, we confirmed the comfort and fit of the corsets so produced.　The initial cost of 3D printers is lower than that of traditional carving machines, enabling even small-scale orthotic fabrication facilities to utilize CAD/CAM methods.　Further research and refinements of this manufacturing approach are expected to expand its applicability.

Background:White fiber dissection is essential for studying brain connections.　However, preparation protocols have not been validated.

Methods:We microstructurally analyzed Klingler’s brain preparation method and freezing process and assessed changes under two protocols:freeze-only and freeze-thaw.　The microstructure changes of these protocols were evaluated by measuring the ratio of the total gap area to the white matter area and determining the mean eccentricity value to assess the degree of anisotropy.

Results:Sixty hemispheres were allocated to ten different freezing protocols.　In the freeze-only protocols, the total gap area ratio was significantly higher compared to that of specimens fixed with only formaldehyde, particularly after continuous freezing for 3-4 weeks;however, the difference in eccentricity was not significant.　In the freeze-thaw protocols, both the area ratio and eccentricity were significantly higher compared to the freeze-only.　The optimum degree of fiber separation in the freeze-thaw protocols reached its peak with four cycles of 1-week freezing periods interrupted by six hours of thawing.

Conclusion:The Klingler method assists in the separation of the white fibers through the gaps formed by ice crystals, but an appropriate degree of anisotropy is reached when the freezing protocol is interrupted by at least four thawing cycles.

Although uterine sarcoma is a rare disease, its prognosis is extremely poor;thus, it is important to differentiate it from uterine leiomyoma.　In this retrospective study, we examined the association between preoperative MRI findings and postoperative pathology results in 170 patients with uterine tumors who underwent preoperative MRI examination at Fukushima Red Cross Hospital.　In 4 cases of sarcoma / smooth muscle tumor of unknown malignant potential (STUMP), abnormal findings were found at a high frequency with T1-weighted imaging (T1WI) (75%), T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and contrast enhancement (CE) (100%).　In cases of ordinary leiomyoma, on the other hand, abnormal findings were less frequent.　The rates of high DWI signal intensity for degenerated and cellular leiomyoma were 31% and 64%, respectively, and the CE-positive rates were 31% and 57%, respectively.　Apparent Diffusion Coefficient (ADC) values appeared to be useful in differentiating degenerated leiomyoma from sarcoma.　The relatively characteristic findings of uterine sarcoma on MRI images may overlap with those of degenerated leiomyoma and cellular leiomyoma, making it difficult to diagnose sarcoma on imaging alone.　However, findings that distinguish sarcoma from ordinary, degenerated, and cellular leiomyoma cases are worthy of attention, to avoid overlooking sarcoma.

Changing perceptions of schizophrenia is crucial for both medical professionals and students.　This study examined negative attitudes toward schizophrenia among medical students, psychiatrists, psychiatric staff, physicians, and non-medical workers.　We created an 18-item survey using a web-based tool to assess attitudes toward schizophrenia, focusing on three factors:stigma, underestimation of patients’ abilities, and skepticism about treatment.　To compare scores among the five participants’ groups, we used analysis of covariance, adjusting for age and sex.　The study included 237 medical students, 10 psychiatrists, 16 psychiatric staff, 26 physicians, and 98 non-medical workers.　After adjusting for age and sex, the overall discrimination score for psychiatrists was significantly lower than those of medical students, physicians, and non-medical workers.　Among medical students, a comparison of each score by grade revealed that underestimation of patients’ abilities scores was significantly higher in the fourth year than in the third year.　Furthermore, those aspiring to become psychiatrists had significantly lower adjusted mean and stigma scores than students with different career goals (p<0.05).　In conclusion, medical students, as well as physicians and non-medical workers, displayed higher levels of stigma towards schizophrenia than psychiatrists.　It is essential to explore modifying factors to improve medical students’ attitudes towards schizophrenia.