BACKGROUND:Depression in later life is associated with dopaminergic dysfunction and increased risk of neurodegenerative disorders, although the relationship between dopamine transporter (DAT) availability and tau accumulation remains unclear. Although previous studies have linked tau and DAT in neurodegenerative diseases, evidence related to depression is limited. Therefore, this study used positron emission tomography (PET) to investigate the association between tau pathology and DAT availability in elderly adults with depression. METHODS:Six patients diagnosed with depression according to ICD-10 criteria underwent PET scans with PET radioligands that enable accurate in vivo assessment, namely, florzolotau (18F) for tau and [18F]FE-PE2I for DAT. Clinical assessments using the Mini-Mental State Examination (MMSE) and Hamilton Depression Rating Scale (HAM-D) were performed for all patients. Tau standardized uptake value ratios (SUVR) in the striatal and cortical regions and DAT binding potentials (BPND) in the striatum were calculated. RESULTS:Tau SUVR in all regions was negatively correlated with DAT BPND in the striatum, suggesting that greater tau burden may be linked to dopaminergic dysfunction. Tau SUVR in the striatum was negatively correlated with MMSE, indicating that tau accumulation may be related to subtle cognitive decline. DAT BPND in the striatum was not correlated with HAM-D. CONCLUSIONS:These preliminary results suggest a link between tau pathology and dopaminergic dysfunction in elderly adults with depression.
BACKGROUND:Extracorporeal membrane oxygenation (ECMO) is a resource-intensive life support therapy associated with high complication rates. Blood products are a major cost driver, yet their impact on outcomes under the Japanese health insurance system remains unclear. This study investigated the association between transfusion burden and clinical outcomes in ECMO patients. METHODS:We retrospectively analyzed data from 112 adult patients who received ECMO at Nippon Medical School Hospital between 2014 and 2023. Baseline characteristics, laboratory findings, and transfusion volumes of red blood cells (RBCs), fresh frozen plasma (FFP), and platelets were compared in relation to survival and death. Sixty-day mortality was assessed using Kaplan-Meier analysis and Cox proportional hazards models. Predictors of transfusion burden were evaluated with multivariable regression. RESULTS:Transfusion of FFP (hazard ratio [HR] 2.00, 95% confidence interval [CI] 1.15-3.46) and RBCs (HR 2.37, 95%CI 1.14-4.93) were independently associated with increased 60-day mortality, whereas platelet transfusion was not. Nonsurvivors required significantly larger volumes of all blood products. Transfusion burden was primarily determined by longer ECMO duration and lower fibrinogen levels. Blood products accounted for 56.1% of drug-related expenditures during ECMO. CONCLUSIONS:Transfusion burden was a key determinant of mortality and cost in ECMO patients and was mainly affected by prolonged ECMO duration and low fibrinogen levels. These findings highlight the clinical and economic impact of transfusion practices and underscore the need for prospective multicenter validation to establish evidence-based transfusion strategies in Japan.
Used to treat type I allergies, allergen immunotherapy (AIT) can lead to sustained remission even after treatment cessation. In Japan, sublingual immunotherapy (SLIT) is the only therapeutic option for allergic rhinitis caused by Japanese cedar pollinosis (JCP) and house dust mite (HDM) allergies. Clinical studies have shown that SLIT tablets reduce symptom scores by approximately 30% while maintaining a high safety profile; serious adverse events are rare, and most reactions are mild, local irritations. Japanese multicenter studies have also confirmed the safety of concomitant administration of JCP and HDM SLIT tablets within a five-minute interval. Additionally, JCP SLIT shows cross-efficacy against Japanese cypress pollinosis. While a treatment period of 3-5 years is recommended for long-term efficacy, significant clinical benefits are often observed during the first pollen season. Japan maintains a high adherence rate of approximately 80%, underscoring the importance of proper patient selection and pretreatment education. Thanks to its efficacy, safety, and non-invasive nature, SLIT continues to play a central role in the management of allergic rhinitis in Japan.
PURPOSE:To investigate morphological changes associated with lamellar macular hole (LMH). METHODS:We retrospectively reviewed data for all eyes with LMH, as determined by spectral-domain optical coherence tomography (OCT), from patients who had undergone vitrectomy and had at least 12 months of preoperative and 6 months of postoperative follow-up data. Eyes were classified as those with morphological changes in the epiretinal membrane (ERM), macular pseudohole (MPH), or ERM-foveoschisis (ERM-FS) that were observed before LMH formation (group A), and those in which LMH was present at the first visit and remained unchanged until surgery (group B). Follow-up time (from first visit to surgery), time from detection of diseases associated with LMH, and morphological changes were analyzed. RESULTS:Of 14 eyes of 14 patients, 9 were in group A and 5 were in group B, and mean follow-up time was 49.2 ± 23.5 months and 44.4 ± 25.4 months in groups A and B, respectively. In group A, LMH formed through ERM in 1 eye, MPH in 2 eyes, and ERM-FS in 6 eyes; 5 eyes maintained LMH morphology for longer than 12 months. The mean time from associated disease to LMH was 11.2 ± 13.8 months, and 30.3 ± 25.5 months from LMH to surgery. BCVA significantly improved in group A (p<0.05) but not in group B (p=0.0579). Neither time to surgery in group A nor follow-up time correlated with postoperative BCVA. CONCLUSION:LMH likely forms through progression of associated diseases, and time from LMH to surgery was not significantly associated with visual outcomes.
BACKGROUND:Selenium is an important trace element that helps maintain physiological functions. We calculated the incidence of selenium deficiency in enterally and parenterally fed patients with acute neurologic disorders. METHODS:We enrolled 39 consecutive patients who received enteral and/or parenteral nutrition for 14 days or longer (23 men, mean age 74.6 years). Serum selenium was recorded on admission and at 2 weeks and 1 month thereafter. Low selenium was defined as a level lower than 107 μg/L. A diagnosis of selenium deficiency was based on the clinical guidelines for selenium deficiency. RESULTS:The mean serum selenium level at admission was 119.9 μg/L in 38 patients but was lower in the 39th patient, who had undergone prolonged tube feeding. There was a weak negative correlation between selenium level and patient age, and when the age cutoff for detecting low selenium was set to 75 years, the sensitivity was 91.7% and the specificity was 53.8%. No selenium-deficient patients presented with clinical symptoms associated with selenium deficiency (all had subclinical low selenium). Selenium was normal in 26 patients, although 2 presented with low selenium 2 weeks post-admission. At 1 month after admission, no patient had a low selenium level. CONCLUSION:Our findings suggest that selenium measurement on admission may be advisable for patients aged 75 years or older and for those undergoing hemodialysis or prolonged tube feeding. Selenium deficiency is a concern when neurosurgery patients with acute neurologic disorders are fed enterally or parenterally.
BACKGROUND:Peripheral nerve injury induces neuroinflammation in the dorsal root ganglion (DRG), which is a major cause of neuropathic pain. Interferon regulatory factors (IRFs) are a family of transcription factors that regulate the expression of inflammatory genes. Although several IRFs affect nociceptive transmission in the spinal cord, their roles in the DRG remain largely unknown. METHODS:Spinal nerve ligation (SNL) was used to develop a rat neuropathic pain model. Pain-related behaviors were assessed by the von Frey test and Plantar test. Gene expression levels of IRF family members were examined using quantitative PCR or immunofluorescence. IRF8 expression was downregulated by intrathecal administration of small interfering RNA (siRNA). RESULTS:IRF1, IRF5, and IRF8 were upregulated 4 days after nerve injury, but their expression gradually declined thereafter. In contrast, IRF4 and IRF7 expression gradually increased during an observation period of 14 days. No significant changes were observed in the expression of IRF2, IRF3, IRF6, or IRF9 after injury despite a slight increase. IRF8, which exhibited the greatest change in expression, was expressed in DRG neurons of naïve rats, and its distribution was not altered by nerve injury. IRF8 knockdown alleviated mechanical allodynia but not thermal hyperalgesia in neuropathic pain. CONCLUSION:To our knowledge, these results are the first to show that multiple IRFs are upregulated in the DRG after peripheral nerve injury. The upregulated members of IRF family in the DRG after nerve injury may be involved in the pathophysiology of neuropathic pain.
BACKGROUND:Oncotype DX is an important tool for guiding perioperative treatment in estrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative breast cancer. Real-world retrospective studies are essential for validating its clinical utility. METHODS:We retrospectively evaluated the association of Oncotype DX Recurrence Score (ODRS) with clinical and pathological characteristics, chemotherapy regimen, and recurrence-free survival (RFS) in consecutive patients with ER-positive/HER2-negative primary breast cancer. RESULTS:A total of 133 patients underwent Oncotype DX testing to determine the need for adjuvant chemotherapy. Mean age was 49.2 years, 67.7% of the patients were premenopausal, and 50.4% had nodal metastases. Mean ODRS was 19.5. Patients were categorized into three risk groups: low (ODRS 0-15, 40.6%), intermediate (16-25, 36.1%), and high (≥26, 23.3%). ODRS was significantly correlated with histologic grade, ER, PgR, and Ki-67. Endocrine therapy alone was administered to all low-risk patients. Chemotherapy was administered to 20.8% of patients at intermediate risk and 67.7% of patients at high risk. Multivariate analysis confirmed that ODRS was the strongest predictor of chemotherapy administration. During a median follow-up of 30.4 months, three distant recurrences occurred (in two intermediate-risk patients and one high-risk patient). No recurrence was observed in the low-risk group. RFS was worse in higher ODRS categories. CONCLUSIONS:Real-world data demonstrate that ODRS correlates with key pathological characteristics and can guide adjuvant therapy selection, independent of menopausal status or nodal involvement. This suggests that ODRS is useful in tailoring chemotherapy decisions in ER-positive/HER2-negative breast cancer.
Background: Comprehensive genomic profiling (CGP) tests have been covered by insurance in Japan since 2019, and their use in cancer genomic medicine (CGM) has expanded since then. Although extensive data are available from core hospitals, real-world data from community-based cooperative hospitals are limited. Methods: Using data from 514 consecutive patients with advanced cancer who underwent CGP testing at our institution between June 2019 and March 2025, we investigated the proportion of cases receiving therapeutic recommendations, the rate of drug administration based on CGP test results, and the prevalence and management of presumed germline pathogenic variants (PGPVs). Results: The most common cancer sites were the pancreas (18.7%), breast (16.9%), bowel (14.6%), lung (12.8%), and prostate (12.5%). An expert panel made up of molecular oncologists recommended 360 targeted therapies for 311 patients (60.5% of the total cohort). Ultimately, 80 patients (15.6%) received matched therapy, among whom 56 received medication under health insurance coverage, 22 through clinical trials, and 2 via the patient-requested medical treatment system. PGPVs were identified in 68 patients (13.2%). After discussion by the expert panel, confirmatory germline testing was offered to patients with PGPVs, and subsequent germline testing confirmed pathogenic variants in 18 patients (3.5% of the total cohort). Conclusion: The proportion of patients who received targeted therapy at our cooperative hospital was comparable to proportions reported from core hospitals. However, disease progression was a significant barrier to accessing targeted therapies and genetic counseling. To maximize the benefits of CGM, the timing of CGP testing must be optimized and collaboration across departments and institutions must be strengthened.
Patients with acquired idiopathic generalized anhidrosis (AIGA) present with reduced sweating and impaired thermoregulation, which causes body temperature to increase quickly during exercise or in a hot environment. A 14-year-old girl was admitted with a variety of symptoms and prolonged fever of unknown origin. AIGA was diagnosed because of a discrepancy between deep body temperature (tympanic membrane) and body surface temperature (axillary), and she was treated. Careful history taking and physical examination are essential for patients with fever of unknown origin.
BACKGROUND:Students and junior residents often rely on subjective methods and evaluations to learn medical interviewing. Although facial expressions correlate with therapeutic outcomes, no study has systematically analyzed facial expressions in medical education. This study aimed to investigate the differences in facial expressions between senior physicians and junior residents during medical interviews using an artificial intelligence (AI)-based facial expression analysis tool. METHODS:Healthcare professionals at the Dokkyo Medical University Saitama Medical Center were recruited between November 2017 and October 2018. The medical interview duration was compared between junior and senior physicians. Facial emotions were analyzed using "Kokoro Sensor," an AI-based tool that classifies facial expressions into seven emotions-anger, contempt, disgust, fear, joy, sadness, and surprise-based on the proportion of frames classified as each emotion. RESULT:Thirteen physicians participated, resulting in 20 video recordings from 8 junior residents and 19 from 5 senior physicians. The mean interview time was 18.95 ± 8.959 minutes for junior residents and 11.79 ± 8.073 minutes for senior physicians (p = 0.004). The percentage of time physicians' faces were recognized by the Kokoro Sensor (indicating when doctors looked at patients) was 9.4% for junior residents and 21.6% for senior physicians (p = 0.012). Emotional analysis showed a significant difference in the expression of surprise: 4.9% for junior residents and 15.9% for senior physicians (p = 0.011). CONCLUSION:Facial emotion analysis revealed differences in facial expressions between junior residents and senior physicians during medical interviews. The findings suggest that an AI-based facial expression analysis tool can be used in education for both students and residents.
An intraosseous pneumatocyst is a gas-containing cystic bone lesion that is not associated with infection or bone necrosis due to vertebral compression fracture. The most common sites are the pelvis and spine, but it is reported rarely in other sites. To our knowledge, only two cases of intraosseous pneumatocyst in the scapula have been reported. Herein, we report two cases of intraosseous pneumatocyst of the scapula, in a 41-year-old woman and a 51-year-old man. Neither patient had shoulder symptoms, and the lesions were found incidentally during imaging studies. Plain X-rays revealed cystic lesions with sclerotic rims, located from the scapular neck to the glenoid, adjacent to the shoulder joint. Plain X-rays of the 51-year-old male patient showed osteoarthritis of the shoulder, including joint space narrowing and osteophyte formation. CT was used for diagnosis in both cases. The patients remained pain-free throughout the follow-up period (10 years and 6 months, respectively). Their lesion sizes were unchanged, and radiolucency was reduced at the final follow-up. The shoulder joint has the largest range of motion in the human body; thus, the vacuum phenomenon may occur when the shoulder is elevated or externally rotated. We speculate that gas was produced in an intraosseous ganglion or subchondral cyst, the likely pre-existing lesions, after the vacuum phenomenon occurred in the shoulder joints of these patients.
BACKGROUND:Postoperative delirium (POD) is a common complication that is associated with adverse outcomes. However, differences between surgical patients in intensive care unit (ICUs) and non-ICUs are unclear. This study investigated POD incidence, prognostic significance, and risk factors in ICU and non-ICU settings. METHODS:We retrospectively analyzed data from 20,338 adults who underwent general anesthesia at Nippon Medical School Hospital between July 2021 and March 2025. Patients were classified as ICU (n=2,451) and non-ICU patients (n=17,887). POD was defined by an Intensive Care Delirium Screening Checklist score of ≥4 or prescription of antipsychotics. Logistic regression was used to identify risk factors, and Kaplan-Meier analysis assessed 180-day mortality. Subgroup analysis evaluated differences between early (≤2 days) and late (3-7 days) POD. RESULTS:The overall incidence of POD was 4.4% (889/20,338) and was higher in ICU patients (19.1%) than in non-ICU patients (2.3%; p<0.001). POD was positively associated with 180-day mortality in both groups (p<0.001). Among non-ICU patients, survival was worse among patients with late POD than among those with early POD (p<0.001), whereas onset timing had no impact in ICU patients. Risk profiles differed: advanced age, higher American Society of Anesthesiologists class, and cerebrovascular disease were associated with POD in non-ICU patients, while male sex and dialysis were significant factors for ICU patients. Excessive positive fluid balance and prolonged operative time increased POD risk in both groups, but gradients were steeper in non-ICU patients. CONCLUSIONS:POD was independently positively associated with excess mortality across settings, but the risk factors and prognostic implications varied. These findings highlight the need for ward-specific preventive strategies and tailored perioperative management.
BACKGROUND:Pregnancy-related breast cancer is relatively rare, but its incidence is increasing as the age of childbearing advances. The impact of placenta-specific microRNAs (miRNAs) derived from the chromosome 19 miRNA cluster (C19MC) on pregnancy-associated breast cancer is unclear. Nuclear protein high mobility group box 3 (HMGB3) plays a role in cancer progression. This study examined the effects of placenta-specific C19MC miRNAs on the cancer-related gene HMGB3 in the human breast cancer cell line MCF-7. METHODS:We used target gene prediction programs to identify C19MC miRNAs that modulate HMGB3 and then validated them using analytical procedures (i.e., quantitative PCR, Western blot, and luciferase reporter assay). We investigated how inhibition of HMGB3 by C19MC miRNAs affects the invasive and proliferative ability of MCF-7 cells and explored the downstream effectors of this axis. RESULTS:C19MC miRNA miR-515-3p targeted HMGB3. In MCF-7 cells, reduction of HMGB3 expression by miR-515-3p increased cell invasion and proliferation. Furthermore, miR-515-3p-mediated HMGB3 inhibition led to the upregulation of CTNNB1 and GRB2, implicating invasion- and proliferation-related signaling pathways (e.g., WNT/β-catenin, Ras/MAPK, and PI3K/AKT/mTOR) in MCF-7 cells. CONCLUSIONS:The impact of C19MC miRNA miR-515-3p on the cancer-related gene HMGB3 in MCF-7 cells suggests a potential tumor-suppressive role for HMGB3 that contrasts with previous reports of oncogenic activity. The present findings raise the possibility that placenta-specific C19MC miRNAs play a role in pregnancy-related breast cancer during pregnancy.
BACKGROUND:Ischemic stroke remains a leading cause of death and long-term disability worldwide, and effective neuroprotective therapies applicable to a broad patient population are still limited. Although mesenchymal stromal cell-derived exosomes (MSC-EXO) have emerged as promising cell-free therapeutic agents, evidence regarding exosomes derived from human amnion-derived mesenchymal stromal cells (AMSC-EXO) in cerebral ischemia remains scarce. METHODS:Human AMSC-EXO were isolated from conditioned media of cultured human amnion-derived mesenchymal stromal cells and characterized by nanoparticle tracking analysis and exosomal marker expression. Male mice were subjected to middle cerebral artery occlusion and randomly assigned to receive intravenous AMSC-EXO or vehicle 24 h after ischemia. Neurological function, motor coordination, and spatial working memory were assessed at 3 and 14 days. Post-ischemic neuroinflammation, neuronal degeneration, and endothelial cell proliferation were evaluated by immunohistochemistry and enzyme-linked immunosorbent assay in a blinded manner. RESULTS:Systemic administration of AMSC-EXO significantly improved neurological outcomes and motor performance after cerebral ischemia and enhanced spatial working memory. AMSC-EXO treatment markedly suppressed microglial activation and reduced the expression of pro-inflammatory cytokines, including tumor necrosis factor-α, interleukin-1β, and interleukin-6, in the ischemic brain. In addition, neuronal degeneration in the cortical infarct border zone was significantly attenuated. At later stages, AMSC-EXO significantly increased the number of proliferating endothelial cells, suggesting a potential involvement in neurovascular remodeling. CONCLUSION:Human AMSC-derived exosomes exert neuroprotective and neurovascular restorative effects after cerebral ischemia by suppressing post-ischemic neuroinflammation, reducing neuronal cell death, and promoting endothelial cell proliferation. AMSC-EXO represents a promising, scalable, and cell-free therapeutic strategy for ischemic stroke.
BACKGROUND:The numerous studies of the effects of intravenous anesthetics on cancer have suggested potential effects on cell migration and postoperative outcomes. This study compared the direct effects of midazolam and dexmedetomidine on A549 human lung adenocarcinoma cells. METHODS:A549 cells were exposed for 2 hr to midazolam (5, 10, 15, 20 μM), dexmedetomidine (1, 10, 100 nM), or medium alone as a naïve control. Cell viability changes were assessed with a wound healing assay, adenosine triphosphate (ATP) analysis, and cell counting kit-8 (CCK) assay. Tumor metastasis-related gene expression was assessed by a polymerase chain reaction (PCR) array and qRT-PCR. Hypoxia-inducible factor (HIF-1α), angiotensin-converting enzyme 2 (ACE2), matrix metalloproteinase (MMP9), and β-catenin expressions were assessed by immunofluorescence staining. RESULTS:Midazolam treatments promoted cell migration and metabolism but suppressed cell proliferation, whereas D treatments promoted cell migration only and had no effect on metabolism or cell proliferation. The PCR array of cancer-related genes revealed that five genes were upregulated by midazolam treatment relative to naïve controls: Frizzled-1 (FZD1), AKT serine/threonine kinase 2 (AKT2), E2F transcription factor 1 (E2F1), Fos proto-oncogene, AP-1 transcription factor subunit (FOS), and tumor protein p53 (TP53). Two genes were upregulated in the dexmedetomidine group: the CRK proto-oncogene, adaptor protein (CRK) and FZD1. CONCLUSIONS:These findings clarify how dexmedetomidine and midazolam treatments affect lung cancer prognoses. Our data suggest that midazolam rather than dexmedetomidine should be recommended for lung cancer surgery.
BACKGROUND:This pilot study aimed to evaluate early outcomes of a composite graft constructed from two saphenous veins (SVs) with a single inflow source in coronary artery bypass grafting (CABG) for patients with an atherosclerotic ascending aorta. The analysis focused on prevention of embolic events and early graft patency. METHODS:The analysis included 17 patients who underwent CABG using the left internal thoracic artery (LITA) to the left anterior descending artery (LAD), combined with a composite graft constructed from two saphenous veins (SVs) with a single inflow source. The SV composite graft was anastomosed to non-LAD coronary territories. RESULTS:Intraoperative flow and pulsatility index values of the SV grafts were satisfactory. No major complications, including new cerebrovascular embolic events, were observed. The early patency rate of SV anastomoses was 90%; all four occlusions among the total 40 anastomoses occurred in the Y-shaped composite graft. CONCLUSIONS:A composite graft constructed from two SVs with a single inflow source appears to reduce the risk of embolic events by minimizing manipulation of the atherosclerotic ascending aorta. However, the configuration of the proximal SV anastomoses may affect early graft patency. Specifically, the risk of early failure appears to be higher in the Y-shaped configuration than in the V-shaped configuration.
INTRODUCTION:Hemoglobin (Hb) monitoring is essential for perioperative management, particularly for detecting anemia and guiding transfusion decisions. Conventional invasive methods provide accurate results but are limited by delays, intermittent sampling, and iatrogenic blood loss. Noninvasive spot-check Hb (SpHb) monitoring offers rapid assessment, but its accuracy is unclear. This study thus evaluated agreement between SpHb obtained with the Rad-67 and invasive Hb measurements in anesthetized patients. METHODS:This single-center, prospective, observational study enrolled 25 adults who underwent gastrointestinal surgery under general anesthesia between June 2023 and March 2024. After induction and stabilization, SpHb was recorded simultaneously with arterial blood sampling. Reference Hb was measured with an automated hematology analyzer (XN-9100), an arterial blood gas analyzer (LC-661), and a portable spectrophotometric device (HemoCue). Correlation was assessed by Pearson's coefficient, and agreement by Bland-Altman analysis. RESULTS:The cohort comprised 18 men (72.0%) with a mean (±SD) age of 66.8 ± 13.4 years and body mass index of 22.9 ± 3.2 kg/m2. Mean Hb was 12.6 ± 1.7 g/dL (SpHb), 11.1 ± 1.8 g/dL (XN-9100), 11.4 ± 1.8 g/dL (LC-661), and 11.4 ± 1.8 g/dL (HemoCue). Strong correlations were observed (r = 0.931, 0.930, 0.841; p < 0.001 for all). Bland-Altman analysis showed fixed positive biases of +1.47 g/dL (XN-9100) and +1.19 g/dL (LC-661, HemoCue), without proportional error. CONCLUSIONS:SpHb correlated strongly with invasive Hb but consistently overestimated values by 1-1.5 g/dL. While unsuitable as a direct substitute, SpHb may serve as a bias-aware screening tool that reduces unnecessary phlebotomy.
BACKGROUND:Sleep-related eating disorder (SRED) is a parasomnia characterized by involuntary nocturnal eating with amnesia, which can result in serious injuries, weight gain, and metabolic complications. Reports implicate the use of ultra-short-acting benzodiazepine receptor agonists (USBZRAs)-especially zolpidem-in SRED, but the magnitude of this risk in psychiatric patients remains unclear. METHODS:We performed a cross-sectional observational survey at two Japanese hospitals of 157 psychiatric outpatients receiving one of four USBZRAs (triazolam, zopiclone, zolpidem, or eszopiclone) for ≥7 days. High-dose USBZRA therapy was defined as the maximum recommended dose per package insert. SRED was assessed using an International Classification of Sleep Disorders-based checklist. A Firth bias-reduced logistic regression model with four prespecified clinically relevant variables was employed due to the limited number of events. RESULTS:Fourteen patients met SRED criteria (8.9%; 95% CI, 4.9-14.4). Zolpidem use (adjusted odds ratio [aOR] 5.98; 95% CI, 1.57-33.58) and high-dose USBZRA therapy (aOR 4.87; 95% CI, 1.56-17.51) were independently associated with SRED. Age (aOR 0.98; 95% CI, 0.94-1.02) and female sex (aOR 0.75; 95% CI, 0.22-2.87) were not significant. CONCLUSIONS:The observed prevalence aligns with earlier reports, confirming that nearly one in eleven psychiatric outpatients receiving USBZRAs experiences SRED. Our study extends prior work by showing that SRED risk is highest at the maximum recommended dose, and especially with zolpidem. The wide confidence intervals reflect the small number of events and should be interpreted as hypothesis generating rather than definitive. These findings support limiting USBZRA dosage, favoring lower-risk hypnotics, and actively screening for nocturnal eating. This pilot study warrants validation in larger cohorts.
