Ken Kondo

Age- and cognitive-related changes in visual search behavior may affect driving performance, particularly during complex road maneuvers requiring continuous steering adjustments. The aim of this study was to clarify the characteristics of visual search behavior in elderly drivers during S-curve driving. Seven elderly drivers with a high prevalence of mild cognitive impairment (MCI) and ten expert drivers working as professional driving instructors performed crank and S-curve driving tasks. Their visual search behavior toward reference points and surrounding reference areas was monitored using an eye tracker (Tobii Pro Glasses 2). Linear mixed-effects model analysis revealed a significant Group × Area of Interest interaction: elderly drivers allocated significantly longer gaze dwell percentages to inner reference areas (specifically, Reference Areas 11 and 13) during the second half of the S-curve compared to expert drivers (p < 0.001). These findings imply that expanded gaze allocation toward reference areas may serve as a potential compensatory mechanism in elderly drivers with MCI features to construct spatial awareness under dynamic driving demands, representing one of several plausible interpretations alongside cognitive and task-related factors. These preliminary insights could contribute to understanding visual search mechanisms in elderly clinical populations.

Background/Aims: The aim of the present study was to examine the potential association between a specific gaze behavior, “overstay fixations,” observed during the Trail Making Test, and cognitive functional independence after stroke. Methods: This study was a cross-sectional, observational study. Hospitalized patients with mild stroke (n = 12) and healthy young adults (n = 19) performed the electronic version of Trail Making Test. The number of overstay fixations and the total completion time were measured. In the patients with mild stroke, the total time in conventional Japanese version of Trail Making Test and the cognitive scores in Functional Independence Measure were measured. Findings: The mild stroke group showed significantly more overstay fixations as task difficulty increased ( p = 0.005). A significant correlation existed between the overstay fixations during the electronic version of Trail Making Test part A and the cognitive Functional Independence Measure scores for Comprehension ( r = -0.643) and Memory ( r = -0.610). Multiple regression revealed that the total time and overstay fixations in the electronic version of the Trail Making Test were more strongly associated with the Comprehension score (R² = 0.850) compared with the total time in the paper-based Trail Making Test (R² = 0.397). Similarly, the Memory score showed stronger associations with the total time and overstay fixations in the electronic version of the Trail Making Test (R² = 0.684) than with the total time in the paper-based version (R² = 0.391). Conclusions: The overstay fixation was associated with specific domains of cognitive functional independence in patients with mild stroke.

Introduction: The prospective, historically controlled study evaluated whether a collaborative practice (CP) model between nurses and occupational therapists improves activities of daily living (ADLs) and reduces the use of disposable absorbent products and physical restraints in hospitalized older patients. Methods: Data from the historical control group ( n = 72), who received usual care, were collected from medical records, and the intervention group ( n = 46), who participated in the CP‐based intervention, was recruited in a community‐based care ward in a regional hospital. The CP model was designed to facilitate collaborative planning for improving ADLs between nurses and occupational therapists. Outcome measures included disposable absorbent product use, physical restraint use, and the functional independence measure (FIM). Assessments were conducted at admission and discharge. Propensity score matching was applied to balance baseline characteristics between groups and to reduce potential confounding factors. Results: Propensity score matching generated 45 pairs (“historical controls,” n = 45, and “interventions,” n = 45). Although physical restraint use was reduced in both groups ( p ≤ 0.007), the use of disposable absorbent products in the intervention group was significantly reduced compared to the historical control group ( p = 0.020). Additionally, significant interaction effects were observed between time and group for all FIM scores, indicating greater improvements in ADLs in the intervention group, with moderate to large effect sizes ( p ≤ 0.013, partial η ² ≥ 0.068). Conclusions: This study demonstrated the positive impact of a CP model between nurses and occupational therapists in improving ADLs and reducing disposable absorbent product use in older patients. These findings suggest that this model of CP enhances the quality of geriatric care. Trial Registration: UMIN Clinical Trials Registry number: UMIN000047072.

Background: Visual search supports action planning and target selection in daily life. Despite toileting being frequent yet high-risk in rehabilitation, gaze analyses specific to toileting remain limited. This study quantified visual search behavior during the approach phase of toileting. Methods: Twenty inpatients aged 65 years or older in a convalescent rehabilitation ward participated in the study. At the time of hospital admission, their gaze behavior from toilet room entry to arrival at the bowl was recorded using an eye tracker (Tobii Pro Glasses 2). Moreover, we evaluated a toilet-functional independence measure (toilet-FIM), comprising toileting, toilet transfer, and locomotion at discharge. Results: In multiple regression, a longer total gaze time directed towards the toilet seat was associated with a greater toilet-FIM independence (β = 0.446), whereas prolonged gaze to the toilet rim (β = −0.839) and to the right handrail (β = −0.621) were related to lower independence (adjusted R² = 0.715). Conclusions: A toilet seat-oriented gaze implies effective action planning for safe sit-down, whereas toilet rim- or handrail-oriented gazes may reflect responses to visual salience or compensatory visual strategies related to reduced independence. These observations could improve our understanding of older patients’ motor planning and spatial perception in toileting.

The aim of this study was to assess the characteristics of visual search behavior in elderly drivers in reverse parking. Fourteen healthy elderly and fourteen expert drivers performed a perpendicular parking task. The parking process was divided into three consecutive phases (Forward, Reverse, and Straighten the wheel) and the visual search behavior was monitored using an eye tracker (Tobii Pro Glasses 2). In addition, driving-related tests and quality of life were evaluated in elderly drivers. As a result, elderly drivers had a shorter time of gaze at the vertex of the parking space both in direct vision and reflected in the driver-side mirror during the Forward and the Reverse phases. In contrast, they had increased gaze time in the passenger-side mirror in the Straighten the wheel phase. Multiple regression analysis revealed that quality of life could be predicted by the total gaze time in the Straighten the wheel phase (β = −0.45), driving attitude (β = 0.62), and driving performance (β = 0.58); the adjusted R² value was 0.87. These observations could improve our understanding of the characteristics of visual search behavior in parking performance and how this behavior is related to quality of life in elderly drivers.

Objective: It is important to improve caregiving skills to help reduce the strain on inexperienced caregivers. Previous studies on quantifying caregiving skills have predominantly relied on expensive equipment, such as motion-capture systems with multiple infrared cameras or acceleration sensors. To overcome the cost and space limitations of existing systems, we developed a simple evaluation system for transfer care skills that uses capacitive sensors composed of conductive embroidery fibers. The proposed system can be developed with a few thousand US dollars. Method: The developed evaluation system was used to compare the seating position and velocity of a care recipient during transfers from a nursing-care bed to a wheelchair between groups of inexperienced and expert caregivers. To validate the proposed system, we compare the motion data measured by our system and the data obtained from a conventional three-dimensional motion-capture system and force plate. Results: We analyze the relationship between changes in the center of pressure (CoP) recorded by the force plate and the center of gravity (CoG) obtained by the developed system. Evidently, the changes in CoP have a relation with the CoG. We show that the actual seating speed (vz) measured by the motion-capture system is related to the speed coefficient calculated from our sensor output. A significant difference exists in Vz between the inexperienced group and the physical therapists/occupational therapists’ group. Conclusions: The proposed system can effectively estimate a caregiver’s skill level in transferring patients from a bed to a wheelchair in terms of the seating position and velocity.

The purpose of this study was to assess the influence of ageing on reaching motion using a simple and quantitative method. An Electronic Evaluation System of Upper Extremity Function incorporating a motion sensor was used to monitor kinematic changes during a whack-a-mole type task. Sixteen healthy elderly adults (3 males and 13 females, mean age 78.8±6.0 years) and nineteen young adults (3 males and 16 females, mean age 22.1±2.8 years) participated in this study. The participants were asked to continue tapping 16 targets randomly presented on the screen. Based on the kinematic data, the tremor value, spatial travel distance, tapping time, and maximal spatial acceleration were calculated. Differences between elderly and young adults were tested using unpaired-t test. Significant differences were observed in all kinematic parameters, suggesting decreased reaching motion in elderly adults. Moreover, overall positive correlations between parameters were found. Our results suggest that kinematic parameters calculated from the motion sensor technology could be useful to evaluate reaching motion quantitatively and simply.

The purpose of this study was to examine aging and bimanual effects on finger spatial stability during precision grip. Twenty-one older and 21 younger adults performed precision grip tasks consisting of a single task (grip and lift an object with the thumb and index finger) and a dual task (the grip-lifting task with one hand and a peg board task with the other hand). The center of pressure (COP) trajectory and the grip force were evaluated using a pressure sensor with a high spatial resolution. In the COP trajectory, the main effects of age for the thumb (F_1,140 = 46.17, p < 0.01) and index finger (F_1,140 = 22.14, p < 0.01) and task difficulty for the thumb (F_1,140 = 6.47, p = 0.01) were significant based on ANCOVA. The COP trajectory was statistically decreased in the older adults. The COP trajectory was also decreased in the dual task, regardless of age. The results suggest the existence of a safety strategy to prioritize the spatial stability in the elderly group and in the dual task. This study provides new insights into the interpretation of the COP trajectory.

Objective: Biliary brush cytology is an important diagnostic tool in the evaluation of pancreatobiliary malignancies. However, it is difficult to distinguish between malignant and benign cells. The present study evaluated the utility of immunocytochemical expression of Claudin‐18 and Maspin in brushing cytology specimens of pancreatobiliary lesions in the diagnosis of pancreatobiliary malignancies.Methods: The study retrospectively assessed biliary and pancreatic duct brushing cytology specimens of 43 patients whose pancreatobiliary lesions were histologically diagnosed at the University of Miyazaki Hospital. Scanty cellularity slides and cases with no histological confirmation were excluded. Alcohol‐fixed and Papanicolaou‐stained slides were immunostained with monoclonal antibodies to Claudin‐18 and Maspin.Results: Of the 43 patients, 35 (81.4%) were finally histologically diagnosed with invasive adenocarcinomas. The sensitivity of routine cytology for the detection of malignancy was 63%, and the specificity was 100%. The sensitivity of cytology in combination with immunocytochemical expression of Claudin‐18 (89%) or Claudin‐18 and/or Maspin (97%) was significantly higher than that of cytology alone (P < 0.01).Conclusion: Immunocytochemical staining for Claudin‐18 and Maspin improved the diagnostic sensitivity for pancreatobiliary adenocarcinomas.

大腸癌肝転移H3の2例に5-FU持続肝動注を行い,腫瘍縮小を見たため肝切除施行し,Ibの組織学的化学療法効果を認あた.両者とも肝動注開始から2年6カ月,4年5カ月で肝肺転移をきたし死亡したが,残肝再発部位は切除端が1例,それ以外が1例であった.CT画像にて腫瘍陰影が消失した部分にも残肝再発が認められたので,画像上腫瘍が消失しても必ずしもviable cellが消失したことを意味せず,肝切除後のさらなる肝動注化学療法の必要性が示唆された. 索引用語:大腸癌肝転移,肝動注化学療法,肝切除療法 大腸癌の肝転移はHlで切除可能であれば必ずしも予後は悪くはない.しかし,H3(両葉に5ケ以上の転移巣を有する)ともなれば,その扱いは難しく,また予後はきわあて悪い.肝転移に対しては肝動注化学療法の効果が良いことは最近では広く受け入れられている.近年,われわれはこのような摘除不能肝転移でも可及的に肝動注を行い,腫瘍摘除をめざす治療方針を取っている,これまで当科で扱った大腸癌肝転移51例中H3は19例であるが,肝動注を施行し,動注後に肝切除を行い得たのは2例である.これらにっき大腸癌研究会の大腸癌取扱規約に沿った臨床病理学的検討を行い,その問題点を検討する.