Myofunctional therapy (MFT) involves oropharyngeal exercise to improve oral hypofunction. Recently, the efficacy of mild-to-moderate obstructive sleep apnea syndrome has been reported. This is the first case report of MFT being effective for severe obstructive sleep apnea and oral hypofunction in an older adult patient. MFT is expected to gain more attention as an alternative treatment option for individuals intolerant to treatments such as continuous positive airway pressure and oral appliances.
Background: Yoga is one of the most popular activities for improving health worldwide. However, the investigation of scientific evidence has only just begun. Methods: This study investigated the effects of yoga using two psychological tests, the State-Trait Anxiety Inventory (STAI) and the Profile of Mood States (POMS), and gene expression analysis using quantitative real-time polymerase chain reaction (qPCR). Seven healthy individuals volunteered to participate in the yoga therapy program designed for this study. The participants' saliva was collected for gene expression analyses in a noninvasive manner. Results: No adverse events were observed. The participants were categorized by stress levels (low, normal, or high) based on their psychological tests before the intervention. Participants with normal stress levels experienced the most effective changes in their health, including decreased expression of an inflammatory gene or increased expression of anti-inflammatory genes, after three months of yoga intervention. Those with low and high stress levels retained their initial physical conditions. Conclusions: By using both psychological research and gene expression analysis in the same participants, our study revealed that yoga therapy has the potential to improve both psychological and physical health, especially among those with normal stress levels, with little physical discomfort. These effects should be carefully considered in future large-scale, long-term studies.
Background: Work engagement is an indicator of mental health. All previous studies on the relationship between job resources (i.e., job control, supervisor support, coworker support, and career opportunities) and work engagement among physicians have been conducted in Europe; no studies have been conducted exclusively among anesthesiologists. This cross-sectional study examined the association between job resources and work engagement among Japanese anesthesiologists. Methods: An online questionnaire was administered to anesthesiologists practicing in all certified hospitals in Japan. We analyzed data from 546 respondents (318 males, mean age 46.7 years) and assessed job resources and work engagement using the New Brief Job Stress Questionnaire and the Japanese version of the Utrecht Work Engagement Scale, respectively. We also performed hierarchical multiple regression analysis. Results: After adjusting for demographic characteristics, job control (β = 0.16, p < 0.001), supervisor support (β = 0.13, p = 0.006), and career opportunities (β = 0.37, p < 0.001) were significantly and positively associated with work engagement. In contrast, coworker support (β = 0.06, p = 0.19) was not associated with work engagement. Conclusions: Job control, supervisor support, and career opportunities were associated with higher work engagement among Japanese anesthesiologists, whereas coworker support was not.
In recent years, numerous molecular-targeted drugs have become available for the perioperative therapy of breast cancer, bringing about a revolution in breast cancer treatment. Based on comprehensive gene expression analysis, breast cancer is classified into four subtypes, and there are limitations regarding the drugs that can be used depending on the subtype and the cancer progression. Therefore, it is necessary to identify and select the appropriate drugs for each subtype. This review explores the expanded indications of four recently available molecular-targeted drugs in breast cancer treatment.
Background: This study aimed to analyze the characteristics and challenges of whole slide imaging (WSI) system guidelines in Japan, the United States, and Europe. Methods: Information disseminated by academic societies in Japan, the United States, and Europe was extracted from their websites, and the WSI system guidelines were identified. Based on the classification criteria, the guidelines were grouped into six categories, and their characteristics and issues were analyzed through comparison. Results: A total of 24 guidelines were identified: eight in Japan, 12 in the United States, and four in Europe. The first WSI system guidelines were issued in the United States, and only one was issued by a regulatory authority. While the guidelines in the United States and Europe cover all six categories, those in Japan lack coverage of funding strategies. Conclusions: WSI system guidelines in the United States contribute to establishing regulatory and technical requirements for the clinical use of the WSI system in Japan, the United States, and Europe. This study also suggests directions for funding strategies that could contribute to the widespread adoption of WSI systems in Japan, such as monetization through joint research with companies and the utilization of grants.
Background: Neuralgic amyotrophy (NA) typically develops with neuralgia in the upper limbs and causes localized muscle atrophy after pain subsides. NA is not well known; thus, many patients face delayed diagnosis and treatment. Methods: We evaluated the initial symptoms, symptom duration, neurological findings, impaired nerves, treatment, and sequelae in patients with NA in our department between 2010 and 2020. Results: Ten patients had upper-limb NA. The suprascapular nerve was the most commonly affected nerve (n = 9). Needle electromyography revealed abnormal findings in all patients, and fibrillations/positive sharp waves at rest were observed in seven patients. Nerve conduction studies showed reduced motor or sensory nerve action potential amplitudes in six patients. Brachial plexus magnetic resonance imaging (MRI) revealed abnormalities in five patients. The mean duration from symptom onset to diagnosis was 142 days (median: 130 days), and the mean duration from the first visit to our department to diagnosis was 41 days (median: 20 days). Sequelae were observed in patients diagnosed 200 days after symptom onset. Conclusion: A combination of needle electromyography of the affected muscles, nerve conduction studies, and a special MRI technique (short tau inversion recovery MRI) may support the diagnosis of NA lesions, even in the subacute to chronic phase.
Background: The head-down position used in laparoscopic surgery considerably influences cardiac function. However, few studies have examined systolic and diastolic functions, such as the ejection fraction (EF), mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE), and early diastole/atrial kick ratio, in the head-down position. Methods: This study was registered at the University Hospital Medical Information Network (UMIN; Registration No.: 46067; Date: November 13, 2021). We used transthoracic echocardiography to examine the systolic and diastolic functions of the left and right ventricles after maintaining first horizontally and next head-down positions (30°) for 5 min in 31 adult volunteers. Results: Mean blood pressure increased by 6.4%, while left ventricular EF decreased from 70% to 63%. Similarly, MAPSE, which is strongly correlated with left ventricular EF, decreased by 11.3%. TAPSE, which correlated with right ventricular EF, increased by 8.7%. No change was observed in the early diastole/atrial kick ratio or E/E´, which reflects left ventricular diastolic function. Conclusions: In the head-down position, the EF, percentage fractional shortening, and MAPSE, which reflect contractility, decreased, whereas TAPSE increased. No significant differences were found in the measurement items reflecting diastolic capacity.
Background: Acinetobacter species are environmental microorganisms that inhabit the skin and can become opportunistic pathogens in immunocompromised hosts. This study investigated the pathogenicity of proteins released extracellularly by Acinetobacter radioresistens (A. radioresistens), isolated from the small intestine of two patients with severe Kawasaki disease, in a mouse model. Methods: The sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis of culture supernatants derived from Acinetobacter species showed large variations in protein compositions among species and strains. The biological effects of soluble proteins secreted by A. radioresistens were evaluated in mice by intraperitoneal injection of culture supernatants. Results: The administration of culture supernatant derived from A. radioresistens caused weight loss, electrolyte imbalance, and decreased aldosterone levels. The sustained infiltration of the inflammatory mononuclear cells was observed in the liver of mice 6 weeks after the last administration. Conclusions: A. radioresistens expressed virulence through its extracellular proteins, leading to acute adrenal gland insufficiency and chronic inflammation of the livers.
Background: Some patients with immunoglobulin A (IgA) vasculitis develop severe disease, with severe abdominal symptoms that necessitate prolonged fasting. Moreover, no biomarkers that can predict severe disease have been clearly established. Methods: We analyzed the data of 65 children with IgA vasculitis who were admitted to our department between 2010 and 2015. Seven patients with severe abdominal symptoms who required fasting for at least one week were classified into the fasting group, and the remaining 58 patients were classified into the non-fasting group. The clinicopathological factors were compared between the two groups. Results: Significant differences in peripheral blood neutrophil-to-lymphocyte ratio (NLR), plasma D-dimer levels, and coagulation factor XIII activity at admission were observed between the two groups. Logistic regression analysis revealed that the NLR showed the highest odds ratio for severe abdominal symptoms (odds ratio, OR: 1.67; 95% confidence interval, CI: 1.14-2.45). The results of receiver operating characteristic (ROC) curve analysis revealed an area under the curve (AUC) of 0.89 for the NLR, and an optimum cutoff value of 2.8 was associated with a sensitivity of 100% and specificity of 72.5%. Conclusion: The NLR at diagnosis is a useful marker for predicting the severity of abdominal symptoms in patients with IgA vasculitis.
Background: The effect of parity on adverse pregnancy outcomes is well established in healthy pregnant women; however, the influence of parity on pregnancy outcomes in women with diabetes remains poorly understood. Therefore, we examined the association between parity and glycemic control, as well as pregnancy outcomes, in women with pregestational diabetes. Methods: A retrospective observational study was conducted on 59 women with diabetes, including 43 with type 1 diabetes and 16 with type 2 diabetes, who had a second pregnancy. Maternal clinical characteristics and pregnancy outcomes were compared between the first and second pregnancies. Results: The second pregnancy was characterized by higher pre-pregnancy body weight, increased insulin requirements, and poorer glycemic control during the third trimester. The first pregnancy was associated with a higher prevalence of diabetic retinopathy deterioration and hospitalization for glycemic control. No significant differences were observed in the perinatal or neonatal complications between the first and second pregnancies, except for hypertensive disorders of pregnancy, which were more common in the first pregnancy. Conclusions: Our findings emphasize the need for increased vigilance for maternal complications during the first pregnancy, weight control between pregnancies, and appropriate adjustment of insulin dosage during subsequent pregnancies in women with diabetes.
Background: Heterotaxy syndrome associated with functional single ventricle and extracardiac total anomalous pulmonary venous connection (TAPVC) is characterized by high operative risks and has high mortality rate. Treatment strategies to address these risks remain uncertain. Methods: This retrospective study included 16 patients with heterotaxy syndrome and functional single ventricle and TAPVC who underwent TAPVC repair between 2003 and 2023. The patients were divided into two groups according to the time of TAPVC repair and the type of repair technique Used. The actuarial survival and freedom from reoperation for pulmonary venous obstruction were compared. Results: Actuarial survival differed significantly between the two groups (early group: 38.5% vs. late group: 100% at 1 year, p < 0.05). A comparison of TAPVC repair techniques revealed higher freedom from reoperation for pulmonary venous obstruction in the primary sutureless technique group (n = 6) than in the conventional repair technique group (100% vs. 63 % at 1 year, p = 0.15). Conclusion: Improved surgical outcomes by delaying surgical TAPVC repair and using primary sutureless technique for initial TAPVC repair, if possible.
Background: Statins are effective in reducing cardiovascular events. However, statin-associated adverse muscle events, often associated with falls, remain a concern. We investigated the association between statin use and risk of falls in older individuals with diabetes. Methods: This cross-sectional study included 1,896 Japanese individuals with diabetes aged ≥65 years. The risk of falls was evaluated using a self-administered questionnaire. Multivariable logistic regression models were used to examine the association between statin use and fall risk. The subgroup analysis was limited to patients with a history of cerebral infarction or ischemic heart disease. Results: The percentage of individuals with type 2 diabetes, body mass index, and glycated hemoglobin A1c was higher, whereas the percentage of men and mean low-density lipoprotein cholesterol levels was lower in statin users (n = 953) than that in non-users (n = 943). The percentages of individuals at high risk of falls were higher in statin users than those in non-users (p < 0.001). Multivariable analysis showed no associations between statin and risk of falls in overall (odds ratio [OR] 1.17, 95% confidence interval [CI] 0.95-1.44) or subgroup (OR 1.22, 95% CI 0.72-2.06). Conclusions: This study did not provide evidence of an increased risk of falls in statin-using older individuals with diabetes.
Purpose: We screened patients admitted for coronavirus disease 2019 (COVID-19) via lung computed tomography (CT) using our own five-level categorization of imaging findings. We postulated that natural language processing (NLP) and machine learning (ML) could predict categorization using Japanese radiology reports. Methods: We screened 528 patients, including 40 polymerase chain reaction (PCR) test-positive patients. We built ML models to predict these categories and the results of PCR tests using a CoreML 3 framework. Results: When categories 1-3 were considered positive predictions, the precision of the probability of PCR results predicted by radiologists was 0.24 with recall of 0.65; specificity of 0.83; accuracy of 0.82; and F1 score of 0.35. The precision of the ML models was 0.62 with recall if 0.53; specificity of 0.88; accuracy of 0.78; and F1 score of 0.57. The macro-averaged accuracy of the reproducibility of the ML models for classification was 0.47. The area under the curve of receiver operating curve for PCR tests was 0.644, whereas that for categories 1-3 was 0.680. Conclusion: Although the understanding of Japanese radiology reports by NLP is still limited, the use of categorization may increase its usefulness in screening for COVID-19.
Background: To compare the efficacy and safety of pemafibrate with those of fenofibrate in a real-world setting in patients with hypertriglyceridemia and type 2 diabetes (T2D). Methods: This study included 155 patients with hypertriglyceridemia (>175 mg/dL) and T2D. Adjusted least square mean changes in the serum levels of triglycerides (TG), transaminases, γ-glutamyl transpeptidase (γGTP), and estimated glomerular filtration rates (eGFRs) were compared before and after a 3-month therapy with pemafibrate (0.2 mg), fenofibrate (160 mg), or bezafibrate (400 mg). Multivariate logistic regression analyses were performed to examine the association between fibrates, achievement of target TG levels, and deterioration of liver and renal function. Results: Pemafibrate therapy greatly reduced TG levels, which was three times better than fenofibrate therapy in achieving the target range for TG levels. The administration of pemafibrate, not fenofibrate, was significantly associated with a lower risk of increasing γGTP levels. Similarly, a lower risk of eGFR reduction was observed in the pemafibrate group than in the fenofibrate group. Conclusions: Pemafibrate achieved a greater reduction in TG levels toward the desired target range than did fenofibrate. Moreover, pemafibrate was associated with a lower risk profile for elevated γGTP and reduced eGFR than fenofibrate.
Background: This study clarifies the effects of adding a glucagon-like peptide-1 receptor agonist (GLP-1RA) to sodium-glucose cotransporter 2 inhibitor (SGLT2i) therapy on glycated hemoglobin (HbA1c) and body weight in Japanese patients with type 2 diabetes (T2D). Methods: This historical cohort study, part of the Diabetes Study from the Center of Tokyo Women's Medical University, included 80 adults with T2D (registered April 2014-July 2020) prescribed SGLT2i for ≥3 months before adding GLP-1RA. HbA1c and weight changes to 12 months after GLP-1RA prescription were assessed, overall and in subgroups based on previous dipeptidyl peptidase-4 inhibitor use, body mass index (BMI), baseline HbA1c levels, and insulin use. Results: HbA1c was significantly reduced from baseline (mean ± SD: 8.9 ± 1.6%) at all times, including 6 months (primary endpoint: 8.2 ± 1.3%; change: −0.76%, P = 0.002). At 12 months, 21.4% of individuals achieved HbA1c levels <7%. Results were similar in most subgroups. In the BMI ≥30 kg/m2 subgroup, HbA1c was significantly reduced only at 3 months; 15.2% of individuals achieved HbA1c <7% at 12 months. Significant weight changes were observed only in insulin non-users. Conclusions: Adding GLP-1RA to SGLT2i therapy reduced HbA1c levels in Japanese people with T2D; obese individuals may require more intensive treatment.
Cell-surface antigens, cytokines, receptors, and signal transduction molecules that are central in the pathogenesis of rheumatic diseases have been elucidated, and therapeutic targets have been identified. Molecular-targeted drugs are now available for the treatment of rheumatoid arthritis and other diseases, including psoriatic arthritis, ankylosing spondylitis, and juvenile idiopathic arthritis. These targeted drugs have shown the potential for achieving clinical remission in many rheumatic diseases. Tumor necrosis factor and interleukin-6 (IL-6) play major roles in rheumatoid arthritis, whereas IL-17 and IL-23 play crucial roles in spondyloarthritis. Biological disease-modifying anti-rheumatic drugs that specifically inhibit the actions of these cytokines and targeted synthetic disease-modifying anti-rheumatic drugs, such as Janus kinase inhibitors, have been approved, increasing the available treatment options. Molecular-targeted drugs also hold promise for the treatment of collagen diseases, including systemic lupus erythematosus, systemic sclerosis, and vasculitis. However, drawbacks related to their use persist, including high drug costs and the risk of adverse events, such as infectious diseases. Therefore, the criteria for selecting patients who are most likely to benefit from these drugs should be developed.
Background: This study explores the working generation's attitudes and needs regarding advance care planning and the factors associated with its practice. Methods: This cross-sectional study was conducted through a questionnaire survey with adults working in Kakegawa City, Japan. Logistic regression was used to assess the relationships between advance care planning practices and potential related factors. Results: Of the 182 participants whose data were analyzed, 49.5%, 17.6%, and 2.7% reported having considered, discussed, and documented advance care planning, respectively. The logistic regression analysis showed that advance care planning consideration was associated with three factors: experience of serious accidents/diseases, presence of agencies/persons to consult about medical treatment and care, and willingness to learn about it. Discussion about advance care planning was significantly associated with the following factors: female, experience of serious accidents/diseases, and willingness to learn about it. Due to limited completion rates, documented advance care planning was excluded from the relevant statistics. Conclusions: Incidence of advance care planning among the working generation is low. It might be necessary to create a foundation of related knowledge as well as opportunities for consideration or discussion by which people can understand the need for advance care planning.
Background: The objective of this study was to investigate the association of the recognition of the importance and the effectiveness of clinical practice guidelines with the use of them among doctors in charge of medical education. Methods: A cross-sectional questionnaire survey was conducted on doctors in charge of medical education at Tokyo Women's Medical University. Multiple logistic regression adjusted for sex, age, and position was used to assess the association between the recognition and use of clinical practice guidelines for education among the participants. Results: Data from 89 respondents (response rate: 72.4%) were analyzed. The odds ratios (ORs) for using the guidelines in lectures (OR = 4.19, p < 0.05) and clinical clerkships (OR = 4.26, p < 0.05) were significantly greater among doctors who thought that "clinical practice guidelines are important in medical education" compared with those who did not. The OR for using the guidelines in clinical clerkships was also significantly greater among doctors who thought that "clinical practice guidelines are effective in medical education" compared with those who did not (OR = 6.46, p < 0.05). Conclusion: The results of this study suggest that doctors who recognize the importance and effectiveness of clinical practice guidelines tend to use them more frequently in medical education.
Background: Spinal muscular atrophy (SMA) is a lower motor neuron disease caused by SMN1. Several clinical trials have indicated that valproic acid (VPA) benefits a limited number of SMA patients. To clarify the difference in VPA responsiveness and elucidate the mechanism, we analyzed gene expression changes by VPA treatment in Japanese pediatric patients using data from clinical trials. Methods: To identify VPA responders, we correlated the changes in motor function and survival motor neuron (SMN) protein levels. To determine the effects of VPA on gene expression profiles, a microarray analysis was performed. The Gene Ontology (GO) analysis evaluated statistically overexpressed GO terms within a group of genes. Results: The group with significant improvement showed elevated SMN protein levels following VPA administration, whereas that with the highest SMN levels at baseline did not improve immediately. GO analysis suggested that specific factors contributed to the correlation between changes in motor function and the SMN protein levels, including splicing factors HNRNPC and SNRNP70. Conclusions: This is the first study to indicate that the time for VPA effectiveness varies among individuals and is associated with SMN protein levels at baseline and expression changes in splicing factor genes. Clinical Trials Registry of the Center for Clinical Trials, Japan Medical Association, a registry of the Japan Primary Registries Network certified by the World Health Organization as a primary registry (registration numbers: SMART01 trial, JMA-II A00190; SMART02 trial, JMA-II A00231; SMART03 trial, JMA-II A00259).
Background: Amphiregulin (AREG) and epiregulin (EREG), which are ligands of epidermal growth factor receptor (EGFR), are associated with the prognosis of patients with unresectable colorectal cancer (CRC). The objective of this study was to determine whether the expressions of these genes are useful as prognostic markers for stage III CRC patients who received curative surgery.Methods: From 2007 to 2014, consecutive CRC patients (stage III and IV who underwent primary tumor resection in our institute were analyzed. AREG and EREG mRNA expressions in surgically resected specimen were analyzed by real-time reverse transcription polymerase chain reaction (RT-PCR).Results: AREG and EREG expressions tended to be higher in stage IV patients than stage III patients. Among stage III patients, there were no significant differences in disease-free survival (DFS) or overall survival (OS) between patients with high AREG or EREG expression and low expression. In stage IV patients, those with high AREG or EREG expression tended to have better OS than those with low expression.Conclusion: We found no association between AREG and EREG expression and prognosis in stage III CRC. Our data may suggest that the role of the EGFR pathway in tumor cell growth is mainly in advanced phase but not in the early phase.
