Objective As Japan's aging population increases, local initiatives are required to prevent frailty and malnutrition. In FY2024, Chiyoda City implemented a high-risk and population-wide approach focused on malnutrition prevention as part of health services and long-term care prevention for older adults. This report evaluates the implementation and outcomes of the RE-AIM framework to identify its effectiveness and future challenges.Methods A steering committee and working group facilitated cross-departmental and community collaborations. Health and welfare staff received data utilization training to support evidence-based policymaking (EBPM). For the high-risk approach, 43 older adults with a body mass index (BMI) ≤20.0 and recent weight loss were identified using the KDB system. After setting individual goals with registered dietitians, the participants underwent four home visits. The pre- and post-intervention outcomes were assessed using body weight, BMI, WHO-5, CNAQ-J, and CO-DVS. The population approach involved distributing pamphlets and conducting community lectures. Quantitative and qualitative data were analyzed using the RE-AIM model.Results In the high-risk approach, 25 of the 43 identified individuals participated and 20 completed the program (retention rate; 80%). Although there were no statistically significant changes in health indicators, 30% of the participants gained >1 kg of body weight and approximately 75% reported positive behavioral changes, suggesting significant support was provided. Collaboration with community support centers has led to additional services, such as long-term care applications and assistance for isolated individuals. In the population approach, 2,940 copies of promotional and educational pamphlets were distributed, and 271 residents received information via lectures and individual consultations; >90% of the participants found the content useful. This project collaborated with the Community Life Support Coordination Program. Data utilization training confirmed the increased awareness of KDB system utilization in business operations and policy planning based on data.Conclusion This initiative has shown promising results as a community-based integrated care model through data-driven targeting, multi-sector collaboration, and individual- and population-level interventions. Building a sustainable system requires personalized support, ICT utilization, outreach to middle-aged and harder-to-reach groups, and further integration with existing services.
These guidelines aim to support magnetic resonance imaging (MRI) diagnosis in patients receiving anti-amyloid β (Aβ) antibody treatment without restricting treatment eligibility. These guidelines were collaboratively established by Japan Radiological Society, The Japanese Society of Neuroradiology, and Japanese Society for Magnetic Resonance in Medicine by reviewing existing literature and the results of clinical trials. Facility standards should comply with the “Optimal Use Promotion Guidelines” of Japan, and physicians should possess comprehensive knowledge of amyloid-related imaging abnormalities (ARIA) and expertise in brain MRI interpretation. The acquisition of knowledge regarding amyloid-related imaging abnormalities, brain MRI, anti-Aβ antibody introduction, and post-treatment diagnosis are also recommended. These guidelines facilitate the accurate diagnosis and effective management of ARIA; ensure the safe administration of anti-Aβ drugs; and provide a framework for MRI facilities, includes staffing requirements and the use of MRI management systems.
We previously reported a clinicopathological examination in the Sagamihara family, familial PD with LRRK I2020T mutation, highlighting the most common neuropathological finding as pure nigral degeneration without Lewy bodies (LBs). We applied immunohistochemical analysis to seven previously reported cases and evaluated five additional cases for a full neuropathological examination (altogether 12 cases). All cases exhibited nigral degeneration with a relatively preserved locus coeruleus (LC). Synuclein pathology was found in four cases, one of which showed multiple system atrophy pathology, and three showed LB pathology. Tau pathology in the brainstem mostly comprised a few neurofibrillary tangles and fell within the range of age-related changes. We found phosphorylated transactivation response element DNA-binding protein 43 kDa (pTDP-43) positive structures in five cases. Four of the five cases were observed in the substantia nigra (SN) but not limbic regions. The distribution pattern of pTDP-43 clearly differed from that in LB disease and older adults, suggesting that nigral degeneration is the primary lesion in the Sagamihara family. TDP-43 pathology in the Sagamihara family was different from those observed in TDP-43 proteinopathy that causes parkinsonism, which could be a secondary change; however, it may influence the course of the disease. Degeneration of the SN with relative preservation of the LC is a consistent finding in Sagamihara families, with or without LBs. These findings suggest that members of the Sagamihara family harbor a synuclein-independent neurodegenerative pathway and exhibit differential vulnerabilities depending on the brain region.
Background: Allogeneic hematopoietic stem cell transplantation (HSCT) is the only potentially curative treatment option for patients with refractory and relapsed acute myeloid leukemia (R/R AML) not in complete remission. Many studies investigating the prognosis of patients with R/R AML not in remission focused on patients who received myeloablative conditioning regimen (MAC). Conversely, reduced intensity conditioning regimen (RIC) could be a considerable conditioning regimen for some patients because of the high frequency of R/R AML in older patients who are not candidates for MAC. Objective: This study aimed to evaluate the prognosis and identify factors associated with outcomes in patients with R/R AML who underwent allogeneic HSCT with RIC. Study Design: This study included 707 adult patients with AML not in complete remission who had received RIC. The primary endpoint was progression-free survival (PFS), which was estimated using the Kaplan-Meier method. Prognostic factors were identified using a Cox proportional hazards model with multiple imputations using a chained equation approach. Results: The 5-year PFS, overall survival, relapse, and nonrelapse mortality were 18.8% (95% confidence interval [CI]: 15.6-22.2), 22.0% (95% CI: 8.5-25.7), 53.6% (95% CI 49.7-57.4%) and 27.5% (95% CI: 24.0-31.2), respectively. Multivariable analysis revealed that male sex, poor performance status, karyotype risk, and blasts in the peripheral blood were significantly associated with PFS. Conclusions: This study identified prognostic factors in patients with R/R AML not in complete remission. These results can help to develop a transplant strategy for the treatment of R/R AML. (c) 2024 International Society for Cell & Gene Therapy. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Umbilical cord blood transplantation (CBT) is accepted as an effective treatment for acute myeloid leukemia (AML), and reduced-intensity conditioning (RIC), rather than myeloablative conditioning (MAC) regimens allowed elderly patients to be treated safely. However, appropriate intensities of conditioning regimens are still unclear, especially for middle-aged patients. To compare outcomes after RIC and MAC regimens, we analyzed AML patients aged 16 years or older in the Japanese registry database, who underwent single cord unit CBT between 2010-2019. Median ages of the RIC group (n = 1353) and the MAC group (n = 2101) were 59 and 51 years (P < 0.001), respectively. 5-year overall survival (OS) after MAC was superior to that of RIC (38.3% vs 27.7%, P < 0.001) with lower incidence of relapse (33.9% vs 37.4%, P = 0.029) and better neutrophil engraftment (84.7% vs 75.9%, P < 0.001). Detailed subgroup analysis revealed that age at transplantation is the most important factor affecting 5-year OS in RIC and MAC. This analysis identified a threshold of 55 years, beyond which the superiority of MAC disappeared, irrespective of other factors such as disease status or performance status. In conclusion, RIC may be preferable for patients aged 56 or older in CBT for AML due to higher potential toxicities.
