Similar to motor function, swallowing function declines with age. Dysphagia in older adults has detrimental effects, including an increased risk of pneumonia and mortality, highlighting the importance of early detection and intervention at the community level. This review aims to comprehensively discuss the relationship between motor and swallowing functions in older adults through a narrative review, including existing limitations, with the goal of contributing to the early detection of dysphagia and the development of treatment strategies.Regarding the relationship between swallowing and whole-body skeletal muscle strength, associations between swallowing or tongue pressure and grip strength have been reported. A relationship between tongue pressure and respiratory muscles has been hypothesized, given the association between tongue pressure and walking function, which focuses on age-related changes in neural function, and the fact that certain swallowing-related muscles contract in coordination with respiratory movements.Detailed assessment of research, such as endoscopic swallowing studies, and verification of causal relationships through intervention and longitudinal studies are expected to contribute to the early detection and treatment of dysphagia.
BACKGROUND:Post-stroke spasticity may involve dynamic abnormalities that impair voluntary movement, such as muscle co-contraction during gait, which may be present even in patients without apparent spasticity at rest. This study aimed to identify brain lesion locations associated with abnormal lower-limb muscle co-contraction during walking using support vector regression lesion-symptom mapping. METHODS:Thirty-two ambulatory patients with first-ever supratentorial stroke were included. Lower-limb motor impairment was defined as a Fugl-Meyer Assessment lower-extremity score of < 34. Surface electromyography recorded activity of the tibialis anterior and medial gastrocnemius muscles during gait. The co-activation index (CoI) was calculated from the overlap of normalized electromyography waveforms during the swing phase. Lesions were delineated on magnetic resonance imaging and analyzed using support vector regression lesion-symptom mapping, followed by disconnectome analysis to identify involved white matter tracts. RESULTS:A higher CoI was associated with lesions in the premotor cortex, precentral gyrus, and superior longitudinal fasciculus, with a 100% probability of disconnection in the second and third branches of the superior longitudinal fasciculus. CONCLUSION:Lesions in regions involved in sensorimotor integration were associated with abnormal lower-limb muscle co-contraction during walking, supporting the importance of dynamic gait assessment and targeted rehabilitation after stroke.
Psychiatric-onset DLB refers to a prodromal presentation of DLB in which late-life psychiatric symptoms precede the characteristic cognitive and neurological features of DLB, often leading to an initial diagnosis of a primary psychiatric disorder. We report two women with psychiatric-onset DLB presentations who were followed longitudinally at a single institution. Case 1 presented with late-onset severe depression and anxiety, together with clinically suspected rapid eye movement sleep behavior disorder (RBD). Cognitive function was preserved, and dopamine transporter scintigraphy showed reduced striatal uptake, whereas myocardial metaiodobenzylguanidine scintigraphy and cerebral perfusion single-photon emission computed tomography showed no clinically meaningful abnormalities. A psychiatric-onset prodromal DLB presentation was suspected. Case 2 initially presented with depressive symptoms and mild cognitive impairment after cerebral aneurysm surgery and was first diagnosed with an organic mental disorder. Longitudinal follow-up revealed progressive cognitive decline, parkinsonism, autonomic dysfunction, and subsequent biomarker abnormalities approximately 9 years after the initial presentation, leading to a diagnosis of DLB. The total follow-up period to date is approximately 15 years. These cases highlight the heterogeneity of psychiatric-onset DLB and the importance of careful longitudinal reassessment in older adults with new-onset psychiatric symptoms.
Heart failure (HF) is a systemic syndrome in which myocardial remodeling and multiorgan dysfunction exacerbate each other. This review focuses on the hepatokine Fetuin-A and the post-translational modification N-myristoylation in HF. Regarding Fetuin-A, we first demonstrated that circulating Fetuin-A levels were significantly lower in HF patients than in control subjects without structural heart disease. This reduction was associated with hepatic hypoperfusion. In a prospective study of 202 HF patients who underwent cardiopulmonary exercise testing, the combination of lower Fetuin-A and impaired exercise tolerance was independently associated with increased risk of cardiac events, suggesting that Fetuin-A could serve as a novel mediator of cardiac-hepatic-peripheral interaction. Regarding N-myristoylation, expression of N-myristoyltransferase 2 (NMT2) was significantly reduced in failing hearts. Cardiac-specific NMT2 knockdown exacerbated cardiac dysfunction, whereas AAV9-mediated NMT2 gene transfer attenuated cardiac remodeling and HF. Click chemistry-based proteomics identified MARCKS as a crucial substrate, and N-myristoylation of MARCKS prevented pathological hypertrophy by promoting its membrane localization, thereby suppressing CaMKII-HDAC4 signaling. These findings indicate that Fetuin-A and NMT2-dependent N-myristoylation play important roles in HF pathophysiology and represent potential novel therapeutic targets.
YKL-40 (chitinase-3-like protein 1) has emerged as a biomarker associated with inflammation and tissue remodeling. YKL-40 is produced by multiple cell types, including macrophages, neutrophils, and airway structural cells, and has been implicated in chronic inflammatory and remodeling processes. While the exact biological role of YKL-40 remains unclear, it has been studied in various respiratory and systemic diseases, including obstructive airway diseases. Clinical investigations in asthma, chronic obstructive pulmonary disease (COPD), and asthma-COPD overlap have demonstrated that both serum and sputum YKL-40 levels correlate with sputum neutrophils and may reflect neutrophil-associated non-type 2 airway inflammation in these obstructive airway diseases. Specifically, serum YKL-40 levels are also associated with airflow limitation, disease severity, longitudinal lung function decline, and exacerbation risk. Sputum YKL-40 appears more closely related to symptom burden than to lung function indices. Overall, YKL-40 may represent an informative biomarker, supporting its potential clinical relevance. Future prospective studies incorporating standardized measurement and integrated biomarker approaches that combine YKL-40 with established type 2 indicators may improve inflammatory phenotyping and risk stratification, potentially supporting precision medicine strategies. In this review, we summarize the biological characteristics and clinical roles of YKL-40, with a particular focus on obstructive airway diseases.
BACKGROUND:Pregnancy after childhood hemipelvectomy is rare, and contemporary guidance on fertility, preconception counseling, and delivery planning remains limited. Altered pelvic anatomy may affect fetal descent and rotation ; however, the optimal mode and delivery timing should be individualized. CASE:A 30-year-old primigravida, with a history of right hemipelvectomy for osteosarcoma, conceived spontaneously after regular menstrual cycles. Fertility preservation was not performed during childhood treatment, and formal preconception counseling with an obstetric team was not provided. After antenatal assessment, a trial of labor was planned under close supervision. During induction at 38 weeks of gestation, vaginal examination and transabdominal ultrasonography revealed poor fetal head descent and deviation toward the pelvic defect, with suspected rotational failure. Cesarean delivery was performed after persistently poor progress and non-reassuring fetal heart rate patterns. Intraoperatively, uterine rotation with rightward cervical deviation and leftward fundal deviation was observed. CONCLUSION:After hemipelvectomy, delivery planning should consider the pelvic anatomy, maternal functional status, anesthetic issues, and risk of prolonged labor. Intrapartum ultrasonography may help identify fetal head deviation and malrotation ; however, timely transition to cesarean delivery should be considered when poor descent persists.
Recent advances in surgical techniques and perioperative management have significantly improved the outcomes of cardiac and/or thoracic aortic surgery compared with earlier decades. However, redo procedures remain particularly challenging, with surgical results still inferior to those of primary operations. The complexity arises from altered anatomy, dense adhesions, and increased risks of injury to vital structures. Careful surgical planning is therefore indispensable, and four strategic steps are especially critical. First, meticulous preoperative assessment with contrast-enhanced computed tomography is required to delineate the spatial relationship between the heart, great vessels, and sternum. Second, the optimal approach to intrapericardial access must be determined, including whether cardiopulmonary bypass should be instituted prior to median sternotomy. Third, safe and deliberate dissection of adhesions surrounding the heart and great vessels is essential to avoid catastrophic complications. Finally, effective organ protection strategies, particularly for the brain and myocardium, are paramount to ensure favorable outcomes. This review highlights common pitfalls encountered in redo cardiac and/or thoracic aortic surgery and discusses practical strategies to overcome them, aiming to provide surgeons with a structured framework for improving safety and results in these high-risk procedures.
BACKGROUND:Inferior shoulder dislocation (luxation erecta) is a rare condition, accounting for approximately 0.5% of all shoulder dislocations, typically resulting from high-energy trauma, such as falls or motor vehicle accidents. CASE PRESENTATION:This case involved a man in his late 50s who sustained an inferior left shoulder dislocation with a greater tuberosity fracture after falling 2 m during work-related activities. Due to the patient's elevated BMI and absence of an anesthesiologist, general anesthesia was not feasible and local anesthesia led to inadequate pain relief and complicated reduction. We employed an interscalene brachial plexus block, enhanced by a modified approach involving positional adjustment and elastic taping, to address the abducted arm position and potential cervical spine concerns. Reduction was successfully performed without complications, such as neurovascular injury and respiratory issues. CONCLUSIONS:This report describes a modified interscalene block technique that may serve as a practical alternative in selected cases where general anesthesia is unavailable.
BackgroundTo improve the management of premenstrual disorders, it is important to understand the prevalence of symptoms and their relationship with age among patients seeking treatment.MethodsIn this retrospective cross-sectional study, we investigated the prevalence of 31 premenstrual symptoms among 199 patients (aged 20-49 years) who visited a gynecology clinic seeking treatment for premenstrual symptoms between November 2022 and May 2023. We also compared symptom prevalence across age groups.ResultsWomen in their 20s comprised the largest group, with 89.9% reporting dysmenorrhea. Fatigue (71.9%) and mood swings (70.9%) were the most prevalent moderate-to-severe symptoms, with psychological symptoms reported more frequently than physical symptoms. Multivariable logistic regression analysis showed that, compared with women in their 20s (reference group), those in their 40s had significantly lower odds of experiencing changes in appetite (adjusted odds ratio [aOR]:0.10), overeating (aOR:0.19), and specific food cravings (aOR:0.09), independent of potential confounders.ConclusionsPsychological symptoms were the most common among gynecological patients seeking treatment for premenstrual disorders. Eating-related symptoms differed by age group. Future longitudinal studies using validated prospective symptom records are warranted.
BACKGROUND:Post-traumatic stress disorder (PTSD) has been reported among both survivors and response workers following large natural disasters. The Japan Disaster Rehabilitation Assistance Team (JRAT) provides rehabilitation-focused support;however, few studies have examined post-traumatic stress symptoms (PTSS) among JRAT members. This study investigated the relationship between PTSS and the physical and mental conditions of JRAT members during support activities. METHODS:A questionnaire on job type, activity location, sleep quality, meal quality, fatigue, physical symptoms, and psychological symptoms was distributed among 23 JRAT members one month after deployment. PTSS were assessed using the Impact of Event Scale-Revised (IES-R), a self-report screening questionnaire. RESULTS:Overall, 27.3% of participants were classified into the probable PTSS group. Compared with the non-probable group, they reported significantly poorer sleep quality, more physical symptoms, and greater fatigue, whereas psychological symptoms were more common in the non-probable group. CONCLUSION:Our findings suggest that limited disaster relief experience, discrepancies between expectations and reality, and stress responses during relief activities may be associated with higher PTSS levels among JRAT members, underscoring the importance of comprehensive management of both physical and mental health across deployment phases.
BACKGROUND:Heart-liver metabolic crosstalk contributes to heart failure pathophysiology. Metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed as a new disease entity based on positive metabolic criteria. However, the clinical implications of MAFLD in heart failure remain to be fully elucidated. METHODS AND RESULTS:We enrolled 457 hospitalized patients with symptomatic stage C/D heart failure who underwent abdominal ultrasonography for liver assessment. MAFLD was diagnosed based on the presence of hepatic steatosis and metabolic dysfunction. Overall, 20.1% of patients met the criteria for MAFLD. Patients with MAFLD were younger, had higher tricuspid annular plane systolic excursion (TAPSE), and lower B-type natriuretic peptide levels compared to those without MAFLD. In multivariate logistic regression analysis, TAPSE remained independently associated with MAFLD. During a median follow-up period of 1127 days, Kaplan-Meier analysis demonstrated that patients with MAFLD showed a higher event-free survival from all-cause mortality, but not from composite cardiac events. In multivariable Cox proportional hazards analysis, MAFLD was not independently associated with all-cause mortality. CONCLUSIONS:MAFLD was common among the hospitalized patients with heart failure. Although MAFLD appeared to be associated with lower overall mortality, MAFLD was not independently associated with mortality from any cause or future cardiac events.
The Field Trip to Fukushima Course (Harvard T.H. Chan School of Public Health, GHP549, Winter Session 2026) built on the inaugural 2025 course to offer an educational experience for graduate students across Harvard, examining ongoing recovery challenges in Fukushima following Japan's 2011 triple disaster of an earthquake, tsunami, and nuclear meltdown. Students learned directly from stakeholders spanning local, prefectural, and national levels across a range of sectors, mainly in Fukushima and Tokyo. Organized into three groups (Radiation and Environmental Health, Disaster Preparedness and Health Systems Resilience, and Community Recovery and Social Impact), students presented their results at Fukushima Medical University on January 20, 2026. The Radiation and Environmental Health group proposed establishing a Japan-led task force on nuclear disaster response and preparedness, presented in a theater-style format. The Disaster Preparedness and Health Systems Resilience group applied a social capital framework and recommended community strengthening through Disaster Welfare Assistance Teams in the acute phase and community buckwheat farming in long-term recovery. The Community Recovery and Social Impact group designed a LINE account for information dissemination and community building among young people. Building on its inaugural year, the course offered insights into how field-based, interdisciplinary learning can contribute to graduate education in disaster preparedness, recovery, and community resilience.
AIM:To clarify the change in characteristics and body mass index standard deviation (BMI-SD) after guanfacine extended-release (GXR) administration for attention-deficit/hyperactivity disorder (ADHD) children, we undertook a clinical survey of ADHD children. Methods:Among 209 pediatric patients with ADHD, two groups were selected:those who patients were received GXR monotherapy (Group 1) and those who were treated with non-pharmacological therapy alone (Group 2). Results:1) BMI-SD scores before and after treatment were 0.56±1.05, 0.76±1.21, respectively, in Group 1 and 0.33±1.18, 0.46±1.15, respectively, in Group 2. The frequency of patients with a BMI-SD score more than 2.0 SD before and at about 2 years after treatment were 7.8% and 13.7%, respectively, in Group 1 and 4.1% and 8.2%, respectively, in Group 2. There were no significant differences between these values before and after treatment. 2) ADHD Rating Scale (ADHD-RS) scores and the improvement rate for each score in Group 1 were higher than those in Group 2. 3) In Group 1, the ADHD-RS scores at the most recent follow-up were significantly lower than those before treatment. Conclusion:GXR administration did not affect obesity in ADHD patients and reduced the characteristics of ADHD, suggesting its usefulness in managing ADHD patients.
INTRODUCTION:Adequate vascular access is essential for stable hemodialysis treatment. Several clinical factors have been reported to affect arteriovenous fistula (AVF) patency;however, data focusing on Japanese patients remain limited. This study aimed to evaluate one-year AVF patency rates and associated clinical factors in Japanese patients. METHODS:We retrospectively analyzed 580 patients who underwent AVF creation at a single center between July 2013 and December 2020. One-year AVF patency rates were estimated using the Kaplan-Meier method, and factors associated with AVF failure were examined using Cox proportional hazards regression. RESULTS:The overall one-year primary, assisted primary, and secondary AVF patency rates were 15.4%, 78.3%, and 79.1%, respectively. In multivariate analyses, older age (adjusted HR 1.02, 95% CI 1.00-1.04), reduced preoperative cardiac function (ejection fraction ≤50%;adjusted HR 1.98, 95% CI 1.20-3.26), and catheter use at dialysis initiation (adjusted HR 1.51, 95% CI 1.02-2.22) were associated with an increased risk of AVF failure. CONCLUSIONS:In Japanese patients undergoing hemodialysis, older age, reduced cardiac function, and catheter use at dialysis initiation were factors associated with one-year AVF failure. These findings highlight the importance of minimizing catheter use and assessing cardiovascular status when planning vascular access.
PURPOSE:This study investigated the prognostic significance of perioperative changes in diastolic function in patients with heart failure with preserved ejection fraction (HFpEF) and severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). METHODS:A total of 123 HFpEF patients (left ventricular ejection fraction ≥50%) with severe AS were evaluated using echocardiography before and within one week after TAVI. Based on changes in diastolic function, patients were classified into the control group with unchanged or improved function (n=105;85.4%) and the worsened group (n=18;14.6%). We compared patient characteristics and prognosis between the two groups. RESULTS:There were no significant differences in age or sex between the groups. The worsened group exhibited lower preoperative peak aortic jet velocity and lower mean aortic valve pressure gradient compared with the control group. Lower preoperative values in these parameters were associated with a higher risk of a worsened diastolic function after TAVI. Eleven major adverse cardiovascular and cerebrovascular events occurred after TAVI. Worsened diastolic function was associated with major adverse cardiovascular and cerebrovascular events (hazard ratio 5.163;p=0.007). CONCLUSION:Perioperative worsening of diastolic function was associated with poor prognosis in patients with HFpEF and severe AS undergoing TAVI.
Clonal hematopoiesis, characterized by the age-related expansion of hematopoietic stem cell clones harboring somatic mutations, has emerged as an essential contributor to cardiovascular disease. Accumulating evidence indicates that clonal hematopoiesis driven by myeloproliferative neoplasm-associated driver mutations, particularly JAK2, is associated with an increased risk of vascular and cardiac complications, even at low variant allele frequencies. Experimental models and clinical studies demonstrate that mutant hematopoietic cells promote inflammation and pathological remodeling, thereby contributing to cardiovascular disorders such as pulmonary hypertension and aortic aneurysm. In addition, advances in circulating biomarker research have enabled less invasive assessment of cardiovascular diseases. Biomarkers, including cell-free DNA, reflect ongoing cardiac damage, while the extracellular matrix protein of collagen triple helix repeat-containing protein 1 (CTHRC1) provides insights into cardiac fibrosis. Clonal hematopoiesis and circulating biomarkers may enhance risk stratification and improve mechanistic understanding of cardiovascular pathology. This review summarizes current evidence of clonal hematopoiesis and circulating biomarkers in cardiovascular diseases.
In response to the Fukushima Daiichi Nuclear Power Plant accident caused by the Great East Japan Earthquake, the Fukushima Health Management Survey (FHMS) has been conducted to provide long-term follow-up for the physical and mental health of Fukushima residents and to maintain and improve their health in the future. Fukushima Medical University organizes annual International Symposiums on the FHMS to share up-to-date survey findings with people in Fukushima Prefecture and other interested individuals. This year, the 7th International Symposium was held with the theme of "Fukushima's lessons for the future : promoting health and responding to disasters." In addition to the usual style of presenting results of the FHMS, we introduced "Open Lecture" elements to provide information that residents need in an easier-to-understand manner. Seven experts from Japan and overseas gave presentations on their knowledge of related fields and took part in lively discussions about the future.
On April 3, 2024, Fukushima Medical University hosted the China-Japan Joint Symposium on Disasters and Public Health Crises, welcoming public health professors from Fudan University in China to share and discuss disaster medicine and public health challenges in the two countries. The attendees addressed various topics such as strategies for managing infectious disease epidemics, environmental changes caused by public works initiatives, and the various health-related impacts of the Fukushima nuclear accident on residents near the Fukushima Daiichi Nuclear Power Plant.
Many countries have adopted the use of helicopter emergency medical services (HEMS). One such system in Japan is called "Doctor Heli" (Doctor Helicopter), which is sometimes used as a means of maternal transport. Since 2008, there have been 18 cases of Doctor Heli maternal transport to Fukushima Medical University Hospital, the ultimate referral center of Fukushima Prefecture. Reasons for transport included umbilical cord prolapse (UCP), placental abruption, traffic accident, and fetal bradycardia. There were two cases of intrauterine fetal death upon arrival at the hospital. Although there is no specific requirement for an obstetrician to be on board, we encountered a case of UCP in which an obstetrician examined a patient and then traveled with her via helicopter ; the baby was successfully delivered at a tertiary care facility. In cases such as UCP, where immediate assessment of fetal condition is critical, involvement of an obstetrician prior to or during transport can be vital. Because aeromedical dispatch can connect doctors and patients more quickly, it may improve perinatal outcomes.
Leukocytoclastic vasculitis (LCV) is a disease secondary to infections, malignancies, or drug exposure, although its pathogenesis remains unclear. Secondary LCV from different causes in the same patient has been rarely reported. We present a case of LCV secondary to pancreatic cancer that remained in remission for one year post-surgery, after which the patient suffered from a subdiaphragmatic abscess caused by Escherichia coli, followed by recurrence of LCV. This case suggests that patients with acquired hyposplenism may be susceptible to developing LCV as a manifestation of underlying disease. Careful evaluation of the underlying disease is important to avoid inappropriate immunosuppressive treatment.
