Improving cognitively healthy survival is important for achieving healthy aging. Therefore, it would be valuable to estimate the future risk of either incident dementia or death in community-dwelling older adults. This study aimed to develop a set of risk prediction models for either incident dementia or death that can be applied according to data availability across diverse clinical settings, using longitudinal data from community-dwelling older Japanese adults. A total of 8,334 participants aged ≥65 years were prospectively followed up from 2016 to 2023. Logistic regression was used to develop multivariable prediction models. The developed models were translated into simplified scoring systems based on the β coefficients. The discrimination abilities of the models were assessed by C-statistics, and the calibration was assessed by calibration plots. During the follow-up period, 1,151 participants developed either dementia or death. In the multivariable model using potential predictors commonly available in the primary care setting, age, male sex, formal education ≤9 years, diabetes mellitus, use of lipid-lowering agents, leanness, history of stroke, history of heart disease, history of respiratory disease, history of cancer, current smoking, no regular exercise habit, and low frequency of social interactions were selected as predictors. Adding cognitive status, depressive symptoms, apolipoprotein E-ε4 carrier status, and brain MRI markers to the model further enhanced its predictive performance. The developed models and simplified scores showed good discrimination and calibration. Risk stratification with our models may be useful for assessing the risks of incident dementia and death and, consequently, for prolonging cognitively healthy survival.
This study investigates the ductile fracture mechanisms in as-quenched (As-Q) and quenched-and-tempered (Q-T) dual-phase steels. Using in-situ tensile testing combined with synchrotron X-ray tomography, we performed four-dimensional quantitative analysis of void evolution to reveal how heat treatment fundamentally alters damage behavior. The high-strength, low-ductility As-Q steel exhibited premature failure. Its significant phase-hardness mismatch between ferrite and martensite phases induced continuous and widespread void nucleation via martensite cracking after reaching the ultimate tensile strength. The subsequent rapid, isotropic growth and coalescence of these numerous voids led to early fracture. In contrast, tempering the Q-T steel reduced the hardness mismatch among phases, yielding superior ductility with lower strength. The Q-T steel, in particular, exhibited a two-stage damage process. Throughout most of the deformation, voids grew anisotropically by elongating along the tensile axis. This stable growth, however, gave way to a drastic change just before fracture, characterized by a rapid proliferation of voids oriented perpendicular to the loading direction. This final phase is attributed to damage in the martensite, suggesting the quantitative and qualitative differences in void evolution between the As-Q and Q-T steels.
To create a risk stratification model for biochemical recurrence by examining the relationship between the positive surgical margin status and biochemical recurrence in patients with prostate cancer after radical prostatectomy. This retrospective study included 3,010 patients who received radical prostatectomy. We analyzed the effect of postoperative pathological results using the Kaplan–Meier method and Cox model regression analysis in patients with no positive lymph node. A risk stratification model incorporating the total positive surgical margin length was constructed based on factors predicting biochemical recurrence. Among the total 1,865 patients, 346 (19
Nivolumab plus ipilimumab (NIVO + IPI) is a standard first-line therapy for intermediate-risk and poor-risk metastatic renal cell carcinoma (mRCC), but the long-term prognostic impact of prior primary tumor resection in this setting remains unclear. We retrospectively reviewed patients with mRCC that received NIVO + IPI as first-line therapy at eight Japanese institutions between October 2015 and May 2022. Patients were stratified into groups according to timing of metastasis and prior primary tumor resection (cytoreductive nephrectomy; CN): a metachronous group, a synchronous/CN(+) group, and a synchronous/CN(−) group. Progression-free survival, overall survival, and tumor responses were compared among groups, with a median follow-up of 54 months. Among 135 eligible patients, 40 were classified into the metachronous group (30
This study examined the feasibility and preliminary signals of change associated with PEACE, an intervention designed to reduce emotional distress and support emotional regulation in children with developmental disorders attending after-school care facilities in Japan. The program was delivered using narrated slides and worksheets, and staff members received training to support implementation. A total of 13 children were initially assigned to the intervention group, of whom 7 were included in the final analysis, and 32 children were included in the control group. The study employed a quasi-experimental design with pre-intervention, post-intervention, and three-month follow-up assessments. Outcome measures included caregiver and staff ratings of emotional problems, hyperactivity/inattention, and social skills. Caregiver ratings suggested a reduction in emotional problems, whereas no consistent changes were observed in staff ratings. Given the small and imbalanced sample, these findings should be interpreted as preliminary. Qualitative data indicated variability in children’s engagement and responses, suggesting that the program’s acceptability and usefulness may depend on individual characteristics such as developmental level and cognitive functioning. Overall, the findings support the feasibility of implementing the program in after-school care settings while highlighting the importance of adapting content and delivery to individual needs. Further research with larger samples and more detailed measures is needed to clarify the mechanisms underlying observed changes and to evaluate effectiveness more rigorously.
