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Kidney organoids are connected to the host circulation and mature after transplantation. However, they are still immature compared to the adult kidneys, and their precise maturation stages remain unclear. By transplanting the mouse embryonic kidney as a model system for organoid transplantation, we report here the maturation defects of the graft, especially in the medulla. Single cell profiling of the developing kidneys in vivo identified gene sets associated with the maturation of the collecting duct epithelium and medullary stroma. These data revealed an upregulation of genes associated with channel/transporter functions and immune defense, as well as a downregulation of neuronal genes. Using these marker genes, we found that the maturation of the collecting duct and medullary stroma in the grafts barely corresponds to the perinatal stage, which was confirmed histologically by using representative genes. Thus, the gene sets obtained serve as maturation coordinates for the renal medulla and will be helpful in analyzing its maturation defects after transplantation. They will also provide a useful basis for further maturation of transplanted kidney organoids. [ABSTRACT FROM AUTHOR]

Although methamphetamine (METH) and other addictive substance use disorders are a major social problem worldwide, appropriate pharmacotherapies have not yet been discovered. Subtype‐nonselective opioid receptor antagonists, such as naltrexone (NTX), have been reported to suppress METH addiction, but unclear are the opioid receptor subtypes that are involved in this beneficial effect. To clarify the role of μ‐opioid receptors (MOPs), we examined effects of the novel nonpeptidic MOP‐selective antagonist UD‐030 on the acquisition and expression of METH‐induced conditioned place preference (CPP) using behavioral tests in C57BL/6J mice. UD‐030 was found to inhibit both the acquisition and expression of METH‐induced CPP in a dose‐dependent manner, with effects comparable to those observed with NTX. These findings suggest that UD‐030 has the potential to mitigate METH‐related reward mechanisms and may serve as a promising candidate for MOP‐selective pharmacotherapy targeting METH addiction. [ABSTRACT FROM AUTHOR]

The implementation of home-care robots is sometimes unsuccessful. This study aimed to explore factors explaining people's willingness to use home-care robots, particularly among care recipients and caregivers. Surveys were conducted in Japan, Ireland, and Finland. The survey questionnaire comprised four categories (familiarity with robots, important points about home-care robots, functions expected from home-care robots, and ethically acceptable uses), with 48 items assessing users' willingness to use home-care robots. The responses from 525 Japanese, 163 Irish, and 170 Finnish respondents were analyzed to identify common and distinct factors influencing their willingness to use these robots. Common factors across the countries included "willingness to participate in research and development," "interest in robot-related news," and "having a positive impression of robots". The distinct factors for each country were: "convenience" in Japan; "notifying family members and support personnel when an unexpected change occurs in an older person" in Ireland; and "design" in Finland. Therefore, developers should determine potential users' willingness to participate in the research and development of home-care robots and consider a system that involves them in the development process. [ABSTRACT FROM AUTHOR]

Ion mobility‐mass spectrometry (IM‐MS) has recently contributed to the structural analysis of molecules, including supramolecules and proteins, by determining the ion arrival time distributions correlated with the collision cross sections (CCSs), as well as the mass‐to‐charge ratios. However, its application range is still limited owing to the lack of general CCSs simulation methods based on possible molecular conformations. Here, a molecular dynamics‐based conformational search method for simulating CCS distributions using projection approximation is reported. As a case study, the gas‐phase conformations of the sodium adducts of conformationally flexible polyketones with 3,3‐dimethylpentane‐2,4‐dione as the monomer are analyzed. The sodium adduct of the hexamer (m/z 781.4 for [1 + Na]+) showed a monomodal arrival time distribution, but that of the octamer sodium adduct (m/z 1033.5 for [2 + Na]+) is multimodal. The conformational analysis indicated an unimodal CCS distribution of simulated [1 + Na]+ conformations in which the sodium cation is mainly bound at the chain terminal. Conversely, four clusters of conformations are obtained for [2 + Na]+ based on the Na+‐coordination sites, which qualitatively reproduced the observed CCS distribution. This approach will extend the utility of IM‐MS for the conformational analysis of flexible molecules in the gas phase. [ABSTRACT FROM AUTHOR]

We develop a methodology to compile an objective tremor catalog by utilizing distinctive event features that differentiate tectonic tremors from non‐tremor events, and combining the envelope cross‐correlation method with clustering technique and neural network. This approach enables tremor extraction without subjective criteria, allowing for the detection of previously overlooked short‐duration tremors. The event features employed to distinguish tremors and non‐tremor events are depth, the mean amplitudes at high and low frequencies, the ratio of these two amplitudes, and event duration. The duration is defined as the minimum period that contains 50% of the seismic energy. The application of this method to western Japan detects 1.7 times more tremors than the previous studies, with the durations of 0.3–∼100 s. The events with short durations are considered low‐frequency earthquakes. The relationship between seismic moment and duration of the detected tremors is consistent with the scaling law of slow earthquakes. Plain Language Summary: Slow earthquakes are characterized by very slow underground deformation compared with regular (fast) earthquakes and are important for understanding the preparation period prior to large earthquakes. Tectonic tremors, which are a type of slow earthquakes, radiate tiny seismic waves with frequencies of several Hz, occur episodically and densely in space and time, and may last for long durations of up to several hundred seconds, which is much longer than the durations of fast earthquakes of equivalent magnitude. In this study, we detect and differentiate tectonic tremors from fast earthquakes and anthropogenic events. We do this using a set of event features, without relying on subjective criteria. The durations of the detected tremors range from 0.3 to ∼100 s, and they appear consistent with a previously proposed scaling relationship for slow earthquakes. This result suggests that fast earthquakes and slow earthquakes have different physical mechanisms. Key Points: We compile a more complete tectonic tremor catalog for western Japan using a clustering method based on event featuresEvent duration, newly defined using energy radiation, clearly separates tectonic tremors from fast earthquakesTectonic tremors, ranging in duration from 0.3 to 100 s, are consistent with the scaling law of slow earthquakes [ABSTRACT FROM AUTHOR]

Upper extremity injuries in baseball pitchers cause significant time loss from competing and decreased quality of life. Although shoulder range of motion (ROM) is reported as a key factor to prevent potential injury, it remains unclear how limited glenohumeral ROM affects pitching biomechanics which may contribute to upper extremity injuries. To investigate how pitchers with decreased total arc glenohumeral ROM of the throwing arm differed in upper extremity pitching kinematics and kinetics as well as ball velocity compared with pitchers with greater levels of glenohumeral ROM. Cross-sectional study. Laboratory. Fifty-seven baseball pitchers (ages 18–24) were divided into either control (≥160° total arc) or lower ROM (<160° total arc) groups. The mean glenohumeral ROM deficits, pitching kinematic and kinetic outcomes, and ball velocity were compared between groups. The control group demonstrated significantly less deficit in total arc ROM between arms than the lower ROM (control: −1.5° ± 10.0°; lower ROM: −12.4° ± 13.9°; P <.001). While the lower ROM group displayed less maximal shoulder external rotation (ER) while pitching, the control group had significantly less difference in ROM between maximal shoulder ER while pitching and clinically measured ER (lower ROM: 64.4° ± 12.1°; control: 55.8° ± 16.6°; P =.025). The control group had significantly faster ball velocity than the lower ROM group (control: 85.0 ± 4.3 mph; lower ROM: 82.4 ± 4.8 mph; P =.024). Pitchers with decreased total arc glenohumeral ROM (<160° total arc) may undergo overstretching toward ER in the shoulder during the late cocking phase. Pitchers with higher total arc ROM can pitch the same or faster ball without increasing loading in the upper extremity. Total arc glenohumeral ROM measurement can be a clinical screening tool to monitor shoulder condition over the time, and pitchers with limited total arc ROM might be at higher risk of shoulder injury. [ABSTRACT FROM AUTHOR]

As a laminar flow control device for delaying the crossflow-induced transition of a three-dimensional boundary layer, sinusoidal roughness elements (SREs) are placed in a Falkner-Skan-Cooke boundary layer, and the resultant laminarizing effect is numerically investigated in comparison with discrete roughness elements (DREs). Because SREs are elongated in the streamwise direction and designed to avoid flow tripping, the critical height of SREs is much higher than that of DREs. Moreover, the wake flow behind SREs efficiently generates and sustains crossflow vortices that are not dangerously unstable against secondary instabilities but able to strongly distort the mean crossflow profile into a less unstable one. By measuring this mean flow distortion by SREs and DREs, the laminarizing effect is compared among them. It is shown that the effect of SREs is higher than that of DREs and can be enhanced by choosing the appropriate height, angle, and wavelength depending on the local boundary-layer profile. [ABSTRACT FROM AUTHOR]

Genomic information must be faithfully transmitted into two daughter cells during mitosis. To ensure the transmission process, interphase chromatin is further condensed into mitotic chromosomes. Although protein factors like condensins and topoisomerase IIα are involved in the assembly of mitotic chromosomes, the physical bases of the condensation process remain unclear. Depletion attraction/macromolecular crowding, an effective attractive force that arises between large structures in crowded environments around chromosomes, may contribute to the condensation process. To approach this issue, we investigated the "chromosome milieu" during mitosis of living human cells using an orientation-independent-differential interference contrast module combined with a confocal laser scanning microscope, which is capable of precisely mapping optical path differences and estimating molecular densities. We found that the molecular density surrounding chromosomes increased with the progression from prophase to anaphase, concurring with chromosome condensation. However, the molecular density went down in telophase, when chromosome decondensation began. Changes in the molecular density around chromosomes by hypotonic or hypertonic treatment consistently altered the condensation levels of chromosomes. In vitro, native chromatin was converted into liquid droplets of chromatin in the presence of cations and a macromolecular crowder. Additional crowder made the chromatin droplets stiffer and more solid-like. These results suggest that a transient rise in depletion attraction, likely triggered by the relocation of macromolecules (proteins, RNAs, and others) via nuclear envelope breakdown and by a subsequent decrease in cell volumes, contributes to mitotic chromosome condensation, shedding light on a different aspect of the condensation mechanism in living human cells. [ABSTRACT FROM AUTHOR]

In this theoretical study, we apply a method based on the complex ray theory (CRT) for the first time to the stability analysis of a roughness-induced boundary layer at a sub- but near-critical condition and use it to investigate the linear behavior of slit-excited localized disturbances (wave packets). Base flows past a cylindrical roughness element and their stabilities are, respectively, solved using an in-house high-fidelity direct numerical simulation code and a two-dimensional partial-differential equation-based stability code (two-dimensional linear stability theory; 2DLST). First, a detailed spatial analysis treating conventional vibrating ribbon-excited waves is conducted to obtain overall stability characteristics. Then, to demonstrate the potential applicability of the CRT-based 2DLST method, the satisfiability of a realization condition is investigated to determine whether each wave packet of the representative dominant modes (in-wake/far-wake/varicose/sinuous modes) can be observed in physical space. As a result, our analyses clarified that only wave packets within a limited range of wave parameters can satisfy the realization condition. [ABSTRACT FROM AUTHOR]

Foot and ankle alignment plays a pivotal role in human gait and posture. Traditional assessment methods, relying on 2D standing radiographs, present limitations in capturing the dynamic 3D nature of foot alignment during weight-bearing and are prone to observer error. This study aims to integrate weight-bearing CT (WBCT) imaging and advanced deep learning (DL) techniques to automate and enhance quantification of the 3D foot and ankle alignment. Thirty-two patients who underwent a WBCT of the foot and ankle were retrospectively included. After training and validation of a 3D nnU-Net model on 45 cases to automate the segmentation into bony models, 35 clinically relevant 3D measurements were automatically computed using a custom-made tool. Automated measurements were assessed for accuracy against manual measurements, while the latter were analyzed for inter-observer reliability. DL-segmentation results showed a mean dice coefficient of 0.95 and mean Hausdorff distance of 1.41 mm. A good to excellent reliability and mean prediction error of under 2 degrees was found for all angles except the talonavicular coverage angle and distal metatarsal articular angle. In summary, this study introduces a fully automated framework for quantifying foot and ankle alignment, showcasing reliability comparable to current clinical practice measurements. This operator-friendly and time-efficient tool holds promise for implementation in clinical settings, benefiting both radiologists and surgeons. Future studies are encouraged to assess the tool's impact on streamlining image assessment workflows in a clinical environment. • Traditionally, plain weightbearing radiographs are used to quantify our foot and ankle. • These 2D radiographs are impeded by bony superposition and errors in patient positioning. • Technical advances have introduced 3D weightbearing CT imaging to overcome these shortcomings. • At present weightbearing CT creates a large image stack, which is time consuming to process. • A fully automated 3D alignment tool with a high reliability and short processing time is presented. [ABSTRACT FROM AUTHOR]

The article describes the case of a 59-year old Japanese man diagnosed with cerebellar cognitive affective syndrome (CCAS) caused by cerebellar atrophy associated with Wallerian degeneration after pontine haemorrhage. The patient demonstrated psychiatric symptoms, slow gait, configuration apraxia, cognitive and motor decline, decline in intelligence quotient and function. Symptoms of CCAS include motor deficits, decreased blood flow in the posterior cerebellar lobes and functional impairment.

Improvements in spinal fusion devices and techniques have enabled stronger spinal fusion, resulting in excellent clinical outcomes. Nevertheless, complications associated with implants, such as screw misalignment, screw lubrication, cage dislocation, and skin issues, might occur. This study aimed to investigate the characteristics and symptoms of sacral fractures after spinal instrumented fusion. This case series retrospectively examined the medical records of eight patients (one man and seven women; mean age: 74 years) diagnosed with sacral fractures after undergoing posterior spinal instrumented fusion from February 2015 to March 2022. The average number of fusion levels in all patients was 3.5 (range, 1–10). The lowest instrumented vertebrae (LIV) ranged from L5 to the ilium. Sacral fractures were diagnosed at 18.8 (range, 0.5–84) months postoperatively. The average time from consultation to diagnosis was nine days (range, 0–25 days). Two patients had subclinical fractures, two had H-shaped fractures with the LIV at L5, and four had U-shaped fractures, including screw holes. Buttock pain and lower extremity pain, the most commonly reported symptoms, were observed in seven patients each. There were also instances of leg numbness, muscle weakness, and unilateral leg pain that may be related to L5 or S1 radiculopathy. In all patients, leg and buttock pain were worse during movement and in the sitting position, and better while resting and in the supine position. Three patients were treated conservatively, and five were treated with extended fixation to the ilium. Sacral fractures following posterior spinal fusion can cause radiculopathy and buttock pain. Symptoms are especially severe when instability occurs in the pelvic region, such as during movements or sitting. As atypical radiculopathy may lead to delays in diagnosis, spine surgeons should recognize the symptoms of this condition. [ABSTRACT FROM AUTHOR]

Jetted astrophysical phenomena with black hole engines, including binary mergers, jetted tidal disruption events, and X-ray binaries, require a large-scale vertical magnetic field for efficient jet formation. However, a dynamo mechanism that could generate these crucial large-scale magnetic fields has not been identified and characterized. We have employed three-dimensional global general relativistic magnetohydrodynamical simulations of accretion discs to quantify, for the first time, a dynamo mechanism that generates large-scale magnetic fields. This dynamo mechanism primarily arises from the non-linear evolution of the magnetorotational instability (MRI). In this mechanism, large non-axisymmetric MRI-amplified shearing wave modes, mediated by the axisymmetric azimuthal magnetic field, generate and sustain the large-scale vertical magnetic field through their non-linear interactions. We identify the advection of magnetic loops as a crucial feature, transporting the large-scale vertical magnetic field from the outer regions to the inner regions of the accretion disc. This leads to a larger characteristic size of the, now advected, magnetic field when compared to the local disc height. We characterize the complete dynamo mechanism with two time-scales: one for the local magnetic field generation, |$t_{\rm gen}$|⁠ , and one for the large-scale scale advection, |$t_{\rm adv}$|⁠. Whereas the dynamo we describe is non-linear, we explore the potential of linear mean field models to replicate its core features. Our findings indicate that traditional |$\alpha$| -dynamo models, often computed in stratified shearing box simulations, are inadequate and that the effective large-scale dynamics is better described by the shear current effects or stochastic |$\alpha$| -dynamos. [ABSTRACT FROM AUTHOR]

Background: The Kidney Disease Improving Global Outcomes guidelines recommend nephrology referral for patients with chronic kidney disease (CKD) stages 4 to 5, significant proteinuria and persistent microscopic haematuria. However, the recommendations are opinion‐based and which patients with CKD benefit more from nephrology referral has not been elucidated. Methods: In this retrospective cohort study, patients referred to our nephrology outpatient clinic from April 2017 to March 2019 were included. We excluded patients considered to have an acute decline in kidney function (annual decline in estimated glomerular filtration rate [eGFR] >10 mL/min/1.73 m2). The slopes of eGFR before and after nephrology referral were estimated and compared by linear mixed effects models. Interaction between time and referral status (before or after referral) was assessed and effect modifications by the presence of diabetes, proteinuria (defined by urine dipstick protein 2+ or more), urine occult blood, hypoalbuminemia (defined by albumin levels less than 3.5 g/dL) and anaemia (defined by haemoglobin levels less than 11.0 g/dL) were evaluated. Results: The eGFR slope significantly improved from −2.05 (−2.39 to −1.72) to −0.96 (−1.36 to −0.56) mL/min/1.73 m2/year after nephrology referral (p <.001). The improvement in eGFR slope was more prominent among those with diabetes mellitus, anaemia, and hypoalbuminemia (all p‐values for three‐way interaction <.001 after adjustment for covariates). Further adjustments for time‐dependent haemoglobin levels, the use of erythropoiesis‐stimulating agents, iron supplementation, anti‐hypertensives and anti‐diabetic medications did not change the significance of the interactions. Conclusions: Nephrology referral slows CKD progression, especially among those with hypoalbuminemia, diabetes or anaemia. Patients with hypoalbuminemia, diabetes or anaemia might benefit more from specialized care and lifestyle modifications by nephrologists. The inclusion of anaemia and hypoalbuminemia in nephrology referral criteria should be considered. [ABSTRACT FROM AUTHOR]

This study aimed to determine which instrumental activities of daily living (IADL) are associated with health deterioration from the "support level" to the "care level" among users of the long-term care insurance system in Japan. From April 2017 to March 2020, we conducted a retrospective follow-up survey on 178 Japanese community-dwelling older adults (64 men, 114 women) newly certified as support level. Independent variable was 8 IADL items and the outcome defined as the "support level maintenance time." Cox models were used to assess the risk of health deterioration, with adjustments for age group, family composition, dementia status, and frailty status by gender. Dependence on 5 items, "laundry" (hazard ratio [HR] =2.5; 95% confidence interval [CI]: 1.1-5.8), "cooking" (HR = 3.7; 95% CI: 1.1-12.2), "telephone use" (HR = 2.4; 95% CI: 1.2-4.7), "financial management" (HR = 2.5; 95% CI: 1.2-5.0), and "medication management" (HR = 2.4; 95% CI: 1.2-4.8), was independently associated with a worse outcome among men, whereas dependence on "financial management" (HR = 2.6; 95% CI: 1.5-4.7) and "medication management" (HR = 2.0; 95% CI: 1.1-3.5) was independently associated with a worse outcome among women. These findings suggest that difficulties in "financial management" and "medication management" are common factors associated with health deterioration from the support to the care level among both genders. An association with household tasks was also seen among men, indicating that a paradigm shift is needed to increase the participation of men in household tasks. [ABSTRACT FROM AUTHOR]

Background: The International Committee of Medical Journal Editors (ICMJE) has published Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals. These provide a global standard for writing and editing medical articles, including research integrity. However, no study has examined the research integrity-related content of Japanese medical journals' Instructions for Authors. We therefore compared research integrity content in ICMJE member journals with those in the English- and Japanese-language journals of the Japanese Association of Medical Sciences (JAMS). Materials and methods: This was a descriptive literature study. We obtained Instructions for Authors from English- and Japanese-language journals listed on the JAMS website and the ICMJE member journals listed on the ICMJE website as of September 1, 2021. We compared the presence of 20 topics (19 in the ICMJE Recommendations plus compliance with ICMJE) in the Instructions for Authors, and analyzed the content of the conflict of interest disclosure. Results: We evaluated 12 ICMJE member journals, and 82 English-language and 99 Japanese-language subcommittee journals. The median number of topics covered was 10.5 for ICMJE member journals, 10 for English-language journals, and three for Japanese-language journals. Compliance with ICMJE was mentioned by 10 (83%) ICMJE member journals, 75 (91%) English-language journals, and 29 (29%) Japanese-language journals. The ICMJE Conflicts of Interest Disclosure Form was requested by seven (64%) ICMJE member journals, 15 (18%) English-language journals, and one (1%) Japanese-language journal. Conclusions: Although the topics in the JAMS English-language journals resembled those in the ICMJE member journals, the median value of ICMJE-related topic inclusion was approximately one-third lower in JAMS Japanese-language journals than in ICMJE member journals. It is hoped that Japanese-language journals whose conflict of interest disclosure policies differ from ICMJE standards will adopt international standards to deter misconduct and ensure publication quality. [ABSTRACT FROM AUTHOR]

Background: New platforms for robotic surgery have recently become available for clinical use; however, information on the introduction of new surgical robotic platforms compared with the da Vinci™ surgical system is lacking. In this study, we retrospectively determined the safe introduction of the new "hinotori™" surgical robot in an institution with established da Vinci surgery using four representative digestive organ operations. Methods: Sixty-one patients underwent robotic esophageal, gastric, rectal, and pancreatic operations using the hinotori system in our department in 2023. Among these, 22 patients with McKeown esophagectomy, 12 with distal gastrectomy, 11 with high- and low-anterior resection of the rectum, and eight with distal pancreatectomy procedures performed by hinotori were compared with historical controls treated using da Vinci surgery. Results: The console (cockpit) operation time for distal gastrectomy and rectal surgery was shorter in the hinotori group compared with the da Vinci procedure, and there were no significant differences in the console times for the other two operations. Other surgical results were almost similar between the two robot surgical groups. Notably, the console times for hinotori surgeries showed no significant learning curves, determined by the cumulative sum method, for any of the operations, with similar values to the late phase of da Vinci surgery. Conclusions: This study suggests that no additional learning curve might be required to achieve proficient surgical outcomes using the new hinotori surgical robotic platform, compared with the established da Vinci surgery. [ABSTRACT FROM AUTHOR]

Dersimelagon is an orally administered selective melanocortin‐1 receptor agonist being investigated for treatment of erythropoietic protoporphyria, X‐linked protoporphyria, and diffuse cutaneous systemic sclerosis. Dersimelagon is extensively metabolized in the liver, and potential recipients may have liver dysfunction. Further, effects of renal impairment on pharmacokinetic properties should be established in drugs intended for chronic use. Two separate studies (ClinicalTrials.gov: NCT04116476; NCT04656795) evaluated the effects of hepatic and renal impairment on dersimelagon pharmacokinetics, safety, and tolerability. Participants with mild (n = 7) or moderate (n = 8) hepatic impairment or normal hepatic function (n = 8) received a single oral 100‐mg dersimelagon dose. Participants with mild (n = 8), moderate (n = 8), or severe (n = 8) renal impairment or normal renal function (n = 8) received a single 300‐mg dose. Systemic exposure to dersimelagon was comparable with mild hepatic impairment but higher with moderate hepatic impairment (maximum observed plasma concentration, 1.56‐fold higher; area under the plasma concentration‐time curve from time 0 extrapolated to infinity, 1.70‐fold higher) compared with normal hepatic function. Maximum observed plasma concentration and area under the plasma concentration‐time curve from time 0 extrapolated to infinity were similar with moderate renal impairment but higher with mild (1.86‐ and 1.87‐fold higher, respectively) and severe (1.17‐ and 1.45‐fold higher, respectively) renal impairment versus normal renal function. Dersimelagon was generally well tolerated. [ABSTRACT FROM AUTHOR]

Background: Uncertainty about disproportionate impact on health care budgets limits implementation of early highly effective treatment (EHT) in multiple sclerosis (MS). Objective: To estimate cost-effectiveness of escalation versus EHT disease-modifying treatment (DMT) sequences. Methods: Using a health-economic approach, we analysed health benefits (relapse rate reduction, disability prevention), direct/indirect DMT and societal costs of escalation versus EHT DMT sequences. In scenario analyses, we allowed (1) earlier use of alemtuzumab (ALE) and (2) a single retreatment with cladribine (CLA). Results: In our model, we showed that the ratio between costs and quality-adjusted life years (QALYs) for the most cost-effective EHT and escalation sequence results into a similar net health benefit with higher costs and also higher QALYs associated with an EHT versus escalation strategy. Earlier use of ALE is more cost-effective than in later lines, even when aggravating the impact of its side-effects tenfold. Retreatment with CLA was more cost-effective in both escalation and EHT sequences. Conclusions: Certain EHT sequences are equally cost-effective to escalation sequences and are likely to result in more health at uncertain additional costs. The favourable cost–benefit ratio of CLA and ALE suggests that a wider application of affordable highly effective therapies could promote the cost-effectiveness both EHT and escalation approaches. [ABSTRACT FROM AUTHOR]

The species composition of the strawberry anthracnose pathogen population in Saga Prefecture was investigated through phylogenetic analysis of the nucleotide sequences of the intergenic regions of the apn2 and MAT1-2–1 genes. Here, 77 out of the 80 Colletotrichum isolates used were classified as C. fructicola, and the remaining three were classified as C. siamense. The 77 C. fructicola isolates were tested for sensitivity to fludioxonil, which is widely used as the main fungicide in rotational programs in Saga Prefecture. High levels of resistance to fludioxonil were observed in 14 C. fructicola isolates tested for sensitivity to mycelial growth in fludioxonil-containing media. Furthermore, two inoculation assays using strawberry seedlings treated with fludioxonil were performed on five of the 14 isolates that showed high levels of resistance. The effectiveness of fludioxonil was significantly low in these isolates. To our knowledge, this is the first study to report fludioxonil resistance in a C. fructicola population. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Accurately identifying fulminant demyelinating diseases is important for sudden onset of asymmetric cerebral white matter lesions with mass effect. Initially, immunotherapy should be administered; however, surgical intervention should be performed with poor response to medical management and evident signs of cerebral herniation. A case of fulminant demyelinating disease of the central nervous system that required decompressive craniectomy 8 days after symptom onset is presented. The patient recovered without sequelae after a combination of neurosurgery and immunotherapy with steroids and has remained relapse‐free for 4 years. [ABSTRACT FROM AUTHOR]

Reflexivity is acknowledged as a crucial concept and is pivotal in the methodology of qualitative research. Various practices of reflexivity are adopted in the social science disciplines. However, the concept is difficult to pin down and the challenge for researchers is to address how to become reflexive and do reflexivity in research practice. In social work, reflexivity has further been developed and applied in practice contexts. The practice terms, critical reflection and reflection or reflectivity are interrelated in ways that aim to explain reflexivity in the profession which, in turn, can offer an enhanced understanding of reflexivity applied in research. This exploratory article promotes practising reflection – questioning, analysing and evaluating oneself in employing reflexivity in all the research stages: methodological construction, data collection and data analysis by undertaking three key self-focused activities: (1) thinking about one's own thinking; (2) observation of emotions/thoughts, role boundaries and power dynamics in research relationships; and (3) exploration of perceptual experiences. Maintaining the reflexive stance is achieved through reflectivity. The article is largely descriptive but draws on experience in a doctoral study of cultural competence and promotes the effective use of reflexivity in qualitative social work research. [ABSTRACT FROM AUTHOR]

AbstractIncluding women into their ranks offers non-state armed groups advantages in terms of mobilisation, intelligence gathering, and establishing ties with civilians. However, especially in conservative societies, this inclusion of could also cause backlash from group members and supporters. While several previous studies analyse why rebels choose to recruit female combatants, limited attention has been paid to women in non-combat roles. I address this gap by studying the drivers of women’s inclusion into rebel groups as non-fighting members, hence contributing to wider efforts to bring gender-sensitive approaches to research on security and violence. Specifically, I conduct a qualitative comparative analysis (QCA) of 118 groups in the period 1989–2015. The results indicate that a conjunction of supply-side factors (female unemployment, gender inequality) and demand-side factors (leftist ideology, territorial control, military strength) drive female non-combat participation in rebel groups. The causal impact of women’s marginalisation is highly context-dependent: Leftist rebels’ calls for gender equality are appealing to (particularly poor and excluded) women. Yet, rebels with high demand for skilled labour prefer to recruit non-marginalised women that received at least some job training. [ABSTRACT FROM AUTHOR]

In the present study, anatomical assessment of zygomaticofacial foramina (ZFFs) and zygomatic canals communicating with ZFFs were performed using cadaver micro-computed tomography images. It was suggested that all ZFFs were located above the jugale (Ju)-zygomaxillare (Zm) line, which is the reference line connecting the Ju and Zm, and most were located in the zygomatic body area (ZBA). The anteroposterior position of the ZFF in the ZBA was within a middle to posterior region and was most often located slightly posteriorly in males and closer to the middle of the region in females. The mean distance from the Ju-Zm line to the ZFF in the ZBA was 12.36 mm (standard deviation [SD] 1.52 mm) in males and 11.48 mm (SD 1.61 mm) in females. In zygomatic canals communicating with ZFFs, most zygomatic canals were type I canals, communicating from the zygomaticoorbital foramen and harboring the zygomaticofacial nerve, and the others were type II canals, communicating from the zygomaticotemporal foramen and located near the posterior margin of the frontal process. These results provide useful anatomical information for preventing nerve injury during surgical procedures for zygomatic implant treatment. [ABSTRACT FROM AUTHOR]

Producing a polarized lanthanum (La) target with high polarization and long relaxation time is crucial for realizing time-reversal violation experiments using polarized neutron beams. We use a LaAlO3 crystal doped with a small amount of Nd3+ ions for the polarized lanthanum target. Optimizing the amount of Nd3+ ions is considerably important because the achievable polarization and relaxation time strongly depend on this amount. We established a fundamental method to grow single crystals of Nd3+:LaAlO3 using an optical floating zone method that employs halogen lamps and evaluated the crystals with the dynamic nuclear polarization (DNP) method for polarizing nuclear spins. Two crystal samples were grown by ourselves and evaluated with the DNP at 1.3 K and 2.3 T for the first time, except for the target materials of protons. The enhancement of nuclear magnetic resonance signals for 139La and 27Al was successfully observed, and the enhancement factors were eventually 3.5 ± 0.3 and 13 ± 3 for the samples with Nd3+ ions of 0.05 and 0.01 mol. %, respectively. These enhancement factors correspond to absolute vector polarizations of 0.27% ± 0.02% (Nd3+ 0.05 mol. %) and 1.4% ± 0.3% (Nd3+ 0.01 mol. %). Although the obtained polarizations are still low, they are acceptable as a first step. The combination scheme of the crystal growth and the evaluation of the crystals is found to be effectively applicable for optimizing the amount of Nd3+ ions for improving the performance of the polarized target. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the diagnostic value of T1-weighted 3D fast spin-echo sequence (CUBE) with deep learning-based reconstruction (DLR) for depiction of pituitary adenoma and parasellar regions on contrast-enhanced MRI. Methods: We evaluated 24 patients with pituitary adenoma or residual tumor using CUBE with and without DLR, 1-mm slice thickness 2D T1WI (1-mm 2D T1WI) with DLR, and 3D spoiled gradient echo sequence (SPGR) as contrast-enhanced MRI. Depiction scores of pituitary adenoma and parasellar regions were assigned by two neuroradiologists, and contrast-to-noise ratio (CNR) was calculated. Results: CUBE with DLR showed significantly higher scores for depicting pituitary adenoma or residual tumor compared to CUBE without DLR, 1-mm 2D T1WI with DLR, and SPGR (p < 0.01). The depiction score for delineation of the boundary between adenoma and the cavernous sinus was higher for CUBE with DLR than for 1-mm 2D T1WI with DLR (p = 0.01), but the difference was not significant when compared to SPGR (p = 0.20). CUBE with DLR had better interobserver agreement for evaluating adenomas than 1-mm 2D T1WI with DLR (Kappa values, 0.75 vs. 0.41). The CNR of the adenoma to the brain parenchyma increased to a ratio of 3.6 (obtained by dividing 13.7, CNR of CUBE with DLR, by 3.8, that without DLR, p < 0.01). CUBE with DLR had a significantly higher CNR than SPGR, but not 1-mm 2D T1WI with DLR. Conclusion: On the contrast-enhanced MRI, compared to CUBE without DLR, 1-mm 2D T1WI with DLR and SPGR, CUBE with DLR improves the depiction of pituitary adenoma and parasellar regions. [ABSTRACT FROM AUTHOR]

The war on terror as a discourse assumes that terrorism is an essential threat of global proportions, is mostly perpetuated by Islamist networks, and requires a strong international response. This discourse had tremendous impacts on both domestic and international politics. Consequentially, a large number of studies analyse the assumptions underlying and the policies legitimised by the war on terror discourse. However, existing work mostly focusses on one or a few cases, predominantly in the global north. This article introduces a novel dataset containing information on the war on terror discourse in the school textbooks of 36 countries, representing around 64% of the world's population, for the period 2003–2014. Based on this dataset, I present the first comprehensive analysis of the global diffusion of the war on terror discourse. The study finds that the discourse has by no means globalised but is mostly limited to wealthy countries in Europe and North America. There are hence clear limits to the USA's soft power and the hyper-globalisation of terrorism discourses. Factors like terrorism intensity, armed conflict and authoritarian regime have little predictive power. This is despite clear incentives for challenged (authoritarian) regimes to adapt the war on terror discourse. Contrary to common assumptions in critical security and terrorism studies, the war on terror discourse is hardly associated with an emphasis on terrorists' irrationality and hatred or with the marginalisation of socio-political grievances. [ABSTRACT FROM AUTHOR]

Background: In Japan, Alzheimer's disease dementia (AD) is the most common cognitive disease, and the most widely used dementia screening tests are the Revised Hasegawa Dementia Scale (HDS‐R) and Mini‐Mental State Examination (MMSE). This study sought to elucidate the relationships of the individual domains of these tests with age and duration of school education in a large group of patients with AD. Methods: Participants were 505 new outpatients diagnosed with AD who completed the HDS‐R and MMSE at the first visit. We investigated the relationships of total and individual domains of these tests with age and duration of school education using the least squares method. Next, we plotted regression lines of the individual domain scores against the total test scores. Results: Younger age and longer duration of school education were significantly associated with higher total HDS‐R and MMSE scores in AD. Domain‐specific results indicated that younger age was significantly associated with a higher immediate memory score on both the HDS‐R and MMSE and with a higher orientation (time), repetition score on the MMSE. Longer duration of school education was significantly associated with a higher working memory score on the HDS‐R and with higher serial 7, repetition and writing scores on the MMSE. In addition, shorter duration of school education was significantly associated with higher naming score on the MMSE. The regression lines of orientation of time, remote memory, visual memory, and verbal frequency hit the bottom on the HDS‐R (4/30, 8/30, 4/30, and 6/30, respectively) and of orientation of time, serial 7, remote memory, and writing also hit the bottom on the MMSE (8/30, 9/30, 11/30, and 8/30, respectively). Conclusions: We should pay attention to age, duration of school education, and the individual domains when using the HDS‐R or MMSE to assess patients with AD. [ABSTRACT FROM AUTHOR]

The incidence of rod fracture after corrective surgery for adult spinal deformity (ASD) is high. Although many reports have investigated the effects of rod bending considering postoperative body motion, and countermeasures, there are no reports investigating the effects during intraoperative correction. The purpose of this study was to investigate the effect of ASD correction on rods by using finite element analysis (FEA) based on the rod shape changes before and after spinal corrective fusion. Five ASD patients (mean age 73 years, all female) who underwent thoracic to pelvic fusion were included in this study. A 3D rod model was created using computer-aided design software from digital images of the intraoperatively bended rod and intraoperative X-ray images after corrective fusion. The 3D model of the bent rod was meshed by dividing each of the screw head intervals into 20 sections and cross-section of the rod into 48 sections. Two surgical fusion methods of stepwise fixation as the cantilever method and parallel fixation as the translational method were simulated to evaluate stress and bending moments on the rods during intraoperative correction. The stresses on the rods were 1500, 970, 930, 744, and 606 MPa in the five cases for stepwise fixation and 990, 660, 490, 508, and 437 MPa for parallel fixation, respectively, with parallel fixation having lower stresses in all cases. In all cases, maximum stress was found around the apex of the lumbar lordosis and near L5/S1. The bending moment was high around L2-4 in most cases. The external forces of intraoperative correction had the greatest effect on the lower lumbar region, especially around the apex of the lumbar lordosis. [ABSTRACT FROM AUTHOR]

Allergic rhinitis (AR) is caused by type I hypersensitivity reaction in the nasal tissues. The interaction between CD300f and its ligand ceramide suppresses immunoglobulin E (IgE)-mediated mast cell activation. However, whether CD300f inhibits the development of allergic rhinitis (AR) remains elusive. We aimed to investigate the roles of CD300f in the development of AR and the effectiveness of intranasal administration of ceramide liposomes on AR in murine models. We used ragweed pollen-induced AR models in mice. Notably, CD300f deficiency did not significantly influence the ragweed-specific IgE production, but increased the frequency of mast cell-dependent sneezing as well as the numbers of degranulated mast cells and eosinophils in the nasal tissues in our models. Similar results were also obtained for MCPT5-exprssing mast cell-specific loss of CD300f. Importantly, intranasal administration of ceramide liposomes reduced the frequency of sneezing as well as the numbers of degranulated mast cells and eosinophils in the nasal tissues in AR models. Thus, CD300f–ceramide interaction, predominantly in mast cells, alleviates the symptoms and progression of AR. Therefore, intranasal administration of ceramide liposomes may be a promising therapeutic approach against AR by targeting CD300f. [ABSTRACT FROM AUTHOR]

Background: Osteoarthritis (OA) is a major cause of chronic pain. Non-steroidal anti-inflammatory drugs (NSAIDs) are analgesics commonly used for musculoskeletal pain; however, NSAIDs can increase the risk of certain adverse events, such as gastrointestinal bleeding, edema, heart failure, and hypertension. Objective: The objective of this study was to characterize existing comorbidities among patients with OA. For patients with OA with and without a coexisting medical condition of interest (CMCOI), we estimated the prevalence of prescribing and dispensing NSAIDs pre-OA and post-OA diagnosis. Methods: Data from three large administrative claims databases were used to construct an OA retrospective cohort. Databases leveraged were IBM MarketScan Medicare Supplemental Database (MDCR), IBM MarketScan Commercial Database (CCAE), and Optum's de-identified Clinformatics® Data Mart Database (Optum CDM). The OA study population was defined to be those patients who had an OA diagnosis from an inpatient or outpatient visit with at least 365 days of prior observation time in the database during January 2000 through May 2021. Asthma, cardiovascular disorders, renal impairment, and gastrointestinal bleeding risks were the CMCOI of interest. Patients with OA were then classified as having or not having evidence of a CMCOI. For both groups, NSAID dispensing patterns pre-OA and post-OA diagnosis were identified. Descriptive analysis was performed within the Observational Health Data Sciences and Informatics framework. Results: In each database, the proportion of the OA population with at least one CMCOI was nearly 50% or more (48.0% CCAE; 74.4% MDCR; 68.6% Optum CDM). Cardiovascular disease was the most commonly observed CMCOI in each database, and in two databases, nearly one in four patients with OA had two or more CMCOI (23.2% MDCR; 22.6% Optum CDM). Among the OA population with CMCOI, NSAID utilization post-OA diagnosis ranged from 33.0 to 46.2%. Following diagnosis of OA, an increase in the prescribing and dispensing of NSAIDs was observed in all databases, regardless of patient CMCOI presence. Conclusions: This study provides real-world evidence of the pattern of prescribing and dispensing of NSAIDs among patients with OA with and without CMCOI, which indicates that at least half of patients with OA in the USA have a coexisting condition. These conditions may increase the risk of side effects commonly associated with NSAIDs. Yet, at least 32% of these patients were prescribed and dispensed NSAIDs. These data support the importance of shared decision making between healthcare professionals and patients when considering NSAIDs for the treatment of OA in patients with NSAID-relevant coexisting medical conditions. [ABSTRACT FROM AUTHOR]

• Anti-donor T-cell responses are not necessarily attenuated during cytomegalovirus infection. • Anti-third-party T-cell responses are attenuated before cytomegalovirus infection. • Caution is exercised in reducing the dose of immunosuppressants in cytomegalovirus infection. Cytomegalovirus (CMV), the most common opportunistic infection of kidney transplantation (KT), is preventable by prophylactic and preemptive antiviral drugs in CMV-immunoglobulin (Ig)G–positive donors. Our preemptive therapy optimized immunosuppressive doses based on mixed lymphocyte response (MLR) results, regardless of preoperative CMV-IgG serostatus pairing. This study used the MLR to compare the anti-donor T-cell responses between CMV antigenemia-positive and -negative cases. One hundred patients underwent KT using a cyclosporine (CsA)-based immunosuppressive regimen at Hiroshima University Hospital. CMV antigenemia-positive cells were defined as 4/50,000 CMVpp65-positive cells. T-cell responses to allo-antigens were measured using MLR assays to evaluate patients' anti-donor immune reactivity. After analyzing the proliferation of CD4+ and CD8+ T-cell subsets, the stimulation indices of CD4+ or CD8+ T cells were quantified. The study used no prisoners, and the participants were neither coerced nor paid. The manuscript was created in compliance with the Helsinki Congress and the Declaration of Istanbul. Forty-three patients tested positive for CMV antigenemia within 3 months after KT. No significant differences were found between the CMV antigenemia-positive and -negative groups in the stimulation indices for CD4+ and CD8+ T-cell responses to anti-donor stimulation. However, T-cell responses to third-party stimuli during the postoperative month 1 were significantly less in the CMV antigenemia-positive than -negative group. Anti-donor T-cell responses are not necessarily attenuated during CMV infection in KT recipients. In CMV-infected KT recipients, caution should be exercised against inadvertent dose reduction of immunosuppressants. [ABSTRACT FROM AUTHOR]

(1) Background: The incidence of congenital cholesteatoma (CC) has rarely been discussed, particularly from a demographic viewpoint. Therefore, we conducted an epidemiological study of CC using local medical characteristics. (2) Methods: The participants were 100 patients (101 ears) who underwent initial surgical treatment at university hospitals in two rural prefectures between 2006 and 2022. A total of 68% of the patients were males and 32% were females, with a median age of 5 years. We reviewed the medical records for the date of birth, date of surgery, stage of disease, and first symptoms of the disease. (3) Results: The total incidence of CC was calculated to be 26.44 per 100,000 births and tended to increase. No significant difference was found between the incidences in the two prefectures. The number of surgeries performed was higher in the second half of the study period. No difference in the stage of progress was observed based on age. (4) Conclusions: The incidence of CC was estimated to be 26.44 per 100,000 newborn births. The number of patients with CC tended to increase; however, this can be attributed to an increase in the detection rate rather than the incidence. [ABSTRACT FROM AUTHOR]

Background and Objective: Fluid biomarkers have the potential to improve the accuracy of diagnosis and prognosis in children with mild traumatic brain injury. Our primary objective was to assess the diagnostic and prognostic utility of acute blood and fluid biomarkers in children with mild traumatic brain injury. Methods: We performed a systematic review of the published literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Fluid biomarker studies assessing pediatric mild traumatic brain injury diagnosis or prognosis were included if blood or fluids were sampled within 24 h of injury. Results: Thirty-two studies involving 4743 patients were included comprising 25 diagnostic studies and ten prognostic studies with three studies assessing both diagnosis and prognosis. Sixteen of the 25 diagnostic studies reported the area under the receiver operating characteristic curve (AUC) for predicting abnormal computed tomography scans of the head; S100 calcium binding protein B (S100B, N = 6 studies, AUC range 0.67–1.00), glial fibrillary acidic protein (N = 5, AUC range 0.41–0.85), ubiquitin C-terminal hydrolase (N = 3, AUC 0.59 and 0.83), neuron specific enolase (N = 1, AUC 0.99), total tau (N = 1, AUC 0.65), and interleukin-6 (N = 1, AUC 0.61). In four of the ten prognostic studies, increased acute serum S100B levels, tumor necrosis factor-α, or interleukin-8 were associated with post-concussive symptoms or fatigue from 3 to 12 months post-injury. Conclusions: The largest amount of evidence supported the potential use of S100B, glial fibrillary acidic protein, and UCH-L1, but there was mixed accuracy for diagnosis and prognostication for all biomarkers in pediatric mTBI. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Pulmonary resection in patients with severe emphysema may impact postoperative respiratory complications. Low-attenuation areas evaluated using three-dimensional computed tomography to assess emphysematous changes are strongly associated with postoperative respiratory complications. Herein, we investigated the relationship between low-attenuation area, the surgical procedure and resected lung volume, which has not been explored in previous studies. METHODS We retrospectively evaluated patients with primary or metastatic lung cancer who underwent surgical resection. The low-attenuation area percentage (low-attenuation area/total lung area × 100) and resected lung volume were calculated using three-dimensional computed tomography software, and the relationship with postoperative respiratory complications was analysed. RESULTS Postoperative respiratory complications occurred in 66 patients (17%) in the total cohort (n  = 383). We set the median value of 1.1% as the cut-off value for low-attenuation area percentage to predict postoperative respiratory complications, which occurred in 24% and 10% of patients with low-attenuation area >1.1% and <1.1%, respectively (P < 0.001). Postoperative respiratory complications occurred in approximately one-third of the patients with low-attenuation area >1.1%, whose resected lung volume was ≥15.8% or ≥5 resected subsegments. Multivariable analysis revealed that sublobar resection was associated with a significantly lower risk of postoperative respiratory complications in patients with low-attenuation area >1.1% (odds ratio 0.4, 95% confidence interval 0.183–0.875). CONCLUSIONS Emphysema is a risk factor for postoperative respiratory complications, and lobectomy is an independent predictive risk factor. Preserving more lung parenchyma may yield better short-term prognoses in patients with emphysematous lungs. [ABSTRACT FROM AUTHOR]

Taiwan offers a distinctive tectonic setting as a collisional orogen, ideal for studying tectonic tremors and the slow deformation process in the mountain‐building process. Using continuous seismic data at many stations, which have become available recently, and employing the envelope correlation method, we detected ∼7,000 tremor events from 2012 to 2022, with waveform characteristics similar to tectonic tremors worldwide. Beyond the previously known tremor zone beneath the southern Central Range, where newly detected tremors align along a low‐angle thrust plane, we identified several new tremor "hotspots" spanning 200 km along the mountain belt. These hotspots are situated at the termination of the subducting slabs and around the deep (25–50 km) extension of the Central Range fault, where repeating earthquakes occur at a depth of 10–25 km. Our findings suggest a strong linkage between the tremor generation mechanism and the mountain‐building process, potentially influenced by underground fluid and temperature anomalies. Plain Language Summary: Since around 2000, tectonic tremors have been discovered worldwide as geophysical phenomena strongly related to slow deformation and fluid movement inside the Earth. While a small cluster of tremors has been identified in Taiwan, where a rapid mountain‐building process occurs, the comprehensive distribution of tremors has remained unknown. Utilizing recently released seismic network records for all of Taiwan, we have clarified a broader pattern of tremor activity, previously unknown, in the region. The tremors are distributed planarly, corresponding to the mountain‐building processes and deep underground deformation in Taiwan. Key Points: Using newly available continuous seismograms, we identified ∼7,000 tectonic tremors in TaiwanSeveral tremor hotspots spanning 200 km were newly identified along the mountain beltTremor distribution suggests planer structures that are contributing to the rapid mountain‐building process [ABSTRACT FROM AUTHOR]

Exophiala is a black fungi of the family Herpotrichiellaceae that can be found in a wide range of environments like soil, water and the human body as potential opportunistic pathogen. Some species are known to be extremophiles, thriving in harsh conditions such as deserts, glaciers, and polluted habitats. The identification of novel Exophiala species across diverse environments underlines the remarkable biodiversity within the genus. However, its classification using traditional phenotypic and phylogenetic analyses has posed a challenges. Here we describe a novel taxon, Exophiala chapopotensis sp. nov., strain LBMH1013, isolated from oil-polluted soil in Mexico, delimited according to combined morphological, molecular, evolutionary and statistics criteria. This species possesses the characteristic dark mycelia growing on PDA and tends to be darker in the presence of hydrocarbons. Its growth is dual with both yeast-like and hyphal forms. LBMH1013 differs from closely related species such as E. nidicola due to its larger aseptate conidia and could be distinguished from E. dermatitidis and E. heteromorpha by its inability to thrive above 37°C or 10% of NaCl. A comprehensive genomic analyses using up-to-date overall genome relatedness indices, several multigene phylogenies and molecular evolutionary analyzes using Bayesian speciation models, further validate its species-specific transition from all current Exophiala/Capronia species. Additionally, we applied the phylophenetic conceptual framework to delineate the species-specific hypothesis in order to incorporate this proposal within an integrative taxonomic framework. We believe that this approach to delimit fungal species will also be useful to our peers. [ABSTRACT FROM AUTHOR]

Objectives: A computer‐aided detection (CAD) system was developed to support the detection of colorectal lesions by deep learning using video images of lesions and normal mucosa recorded during colonoscopy. The study's purpose was to evaluate the stand‐alone performance of this device under blinded conditions. Methods: This multicenter prospective observational study was conducted at four Japanese institutions. We used 326 videos of colonoscopies recorded with patient consent at institutions in which the Ethics Committees approved the study. The sensitivity of successful detection of the CAD system was calculated using the target lesions, which were detected by adjudicators from two facilities for each lesion appearance frame; inconsistencies were settled by consensus. Successful detection was defined as display of the detection flag on the lesion for more than 0.5 s within 3 s of appearance. Results: Of the 556 target lesions from 185 cases, detection success sensitivity was 97.5% (95% confidence interval [CI] 95.8–98.5%). The "successful detection sensitivity per colonoscopy" was 93% (95% CI 88.3–95.8%). For the frame‐based sensitivity, specificity, positive predictive value, and negative predictive value were 86.6% (95% CI 84.8–88.4%), 84.7% (95% CI 83.8–85.6%), 34.9% (95% CI 32.3–37.4%), and 98.2% (95% CI 97.8–98.5%), respectively. Trial registration: University Hospital Medical Information Network (UMIN000044622). [ABSTRACT FROM AUTHOR]

Amniotic fluid embolism (AFE) and placental abruption (PA) are typical obstetric diseases associated with disseminated intravascular coagulation (DIC). AFE is more likely to be complicated with enhanced fibrinolysis than PA. AFE may have an additional mechanism activating fibrinolytic cascade. We aimed to compare the coagulation/fibrinolysis factors among AFE, PA, and peripartum controls. We assessed AFE cases registered in the Japanese AFE Registry, and PA cases complicated with DIC (severe PA) and peripartum controls recruited at our hospital. The following factors in plasma were compared: prothrombin fragment 1 + 2 (PF1 + 2), plasmin α2-plasmin inhibitor complex (PIC), tissue factor (TF), tissue plasminogen activator (tPA), annexin A2 (AnnA2), total thrombin activatable fibrinolysis inhibitor (TAFI) including its activated form (TAFIa), and plasminogen activator inhibitor-type 1 (PAI-1). PF1 + 2 and PIC were markedly increased in both AFE (n = 27) and severe PA (n = 12) compared to controls (n = 23), without significant difference between those disease groups; however, PIC in AFE showed a tendency to elevate relative to PF1 + 2, compared with severe PA. AFE had significantly increased tPA and decreased total TAFI levels compared with severe PA and controls, which might be associated with further plasmin production in AFE and underlie its specific fibrinolytic activation pathway. [ABSTRACT FROM AUTHOR]

Background: Pneumothorax (PTX) and pneumomediastinum (PM) have been reported as potential complications in patients with coronavirus disease 2019 (COVID-19); however, their risk factors and etiology remain unknown. Herein, we investigated the clinical characteristics of mechanically ventilated patients with COVID-19 with PTX or PM. Methods: We examined patients with severe COVID-19 requiring mechanical ventilation who were admitted to the intensive care unit of a tertiary-level emergency medical center in Tokyo, Japan between April 1, 2020. and October 31, 2021. We collected and analyzed the clinical characteristics of the patients who presented with either PTX or PM during mechanical ventilation. Results: During the study period, a total of 165 patients required mechanical ventilation, and 15 patients with PTX/PM during mechanical ventilation were selected. Three patients with obvious causes were excluded, and the remaining 12 patients were analyzed (7.3%). The mortality rate in these patients was as high as 50%, demonstrating the difficulty of treatment in the presence of PTX/PM. PTX/PM occurred 14.5 days after intubation. A peak pressure of > 30 cmH2O was only apparent in one patient, suggesting that high positive pressure ventilation may be less involved than mentioned in the literature. In addition, the inspiratory effort was not strong in our group of patients. (P0.1 was 2.1 cm H2O [1.0–3.8]). Conclusion: Various factors are associated with the development of PTX/PM in patients on mechanical ventilation for COVID-19. We did not find a strong correlation between PTM/PM and barotrauma or strong inspiratory efforts, which have been identified as potential causes in previous studies. [ABSTRACT FROM AUTHOR]

Aim: Tongue strength plays an important role in the process of food intake, and low tongue pressure has been associated with aspiration pneumonia, cognitive decline, and mortality. However, special equipment for tongue pressure measurement is uncommon in general practice. Recently, the serum creatinine‐to‐cystatin C (Cr/CysC) ratio has been validated as a marker of muscle volume mass. Thus, we aimed to investigate the association of the serum Cr/CysC ratio with tongue pressure in a cross‐sectional study. Methods: This single‐center, cross‐sectional study enrolled 73 participants (mean age, 71.7 years; men, 49.3%) who regularly attended the hospital for treatment of chronic disease. A tongue pressure of <30 kPa was defined as low tongue pressure. We evaluated the relationships between the serum Cr/CysC ratio and tongue pressure using multiple regression analysis. Results: The serum Cr/CysC ratio was correlated with tongue pressure (R2 = 0.25, P < 0.0001). In multiple regression analyses adjusted for confounders including age, sex, body mass index, and serum albumin, the association remained significant (P = 0.0001). In logistic analyses, the multivariable‐adjusted odds ratios of the Cr/CysC ratio for tertiles 1 and 2 compared with tertile 3 for low tongue pressure were 7.81 (95% confidence interval, 1.45–51.73) and 2.71 (95% confidence interval, 0.60–13.19), respectively. Conclusions: We demonstrated that a decreased serum Cr/CysC ratio was associated with a higher risk of low tongue pressure. Our findings suggest that this simple serum surrogate marker may be a first step toward an intervention for oral function by general practitioners. Geriatr Gerontol Int 2024; 24: 102–108. [ABSTRACT FROM AUTHOR]

Mass media as an important element of mass communication influence the formation of public opinion, the perception of security challenges in society. In an effort to fulfil its statutory role of informing the people, the radio media reports security issues so as to arm residents with the needed information. To this end, this study investigated the public perception of radio reports on security issues in Bayelsa State, Nigeria. Agenda-setting and perception theories served as the theoretical foundation of the study. A mixed-methods research design was employed. From the population of 2,277,961, a sample size of 384 was drawn for the study using the Wimmer and Dominick online sample size calculator. Meanwhile, a qualitative population was drawn from security operatives within the state as well as staff from the two private radio stations and two public radio stations. Questionnaire and interview guide were used as the instruments for data collection. Multistage and purposive sampling techniques were used in the study. Findings revealed that, on average, 62% of Bayelsa residents are exposed to radio reports on security issues within the state to a large extent. The qualitative data revealed similar findings. Further findings revealed that, at an average mean score of 3.1 (N = 377), respondents have positive perceptions. They are of the view that radio reports on security issues are objective. Also, the qualitative findings are in tandem with the quantitative findings. [ABSTRACT FROM AUTHOR]

This letter, published in the International Journal of Surgical Pathology, discusses a previously undescribed retraction artifact in ameloblastoma, a type of tumor that affects the jaw. The artifact can mimic vascular invasion or pseudoinvasion, leading to potential misdiagnosis of malignancy. The authors describe a case where an ameloblastoma nest appeared to be situated in a thick-walled muscular vessel, but further examination revealed that it was a retraction artifact. The letter emphasizes the importance of pathologists being aware of these pseudomalignant artifactual patterns to avoid misdiagnosis. [Extracted from the article]

Key Clinical Message: When seeing patients who present with atypical lymphocytes and abdominal pain without accompanying symptoms of pharyngitis or lymphadenopathy, acalculous cholecystitis caused by CMV infection should be considered as a differential diagnosis. A teenage man presented with a fever and epigastric pain. The patient tested positive for cytomegalovirus IgG and IgM. Abdominal ultrasonography and contrast‐enhanced CT revealed hepatosplenomegaly and gallbladder wall thickening. MRI did not identify gallstones or tumorous lesions. He was diagnosed with infectious mononucleosis and acalculous cholecystitis caused by cytomegalovirus. [ABSTRACT FROM AUTHOR]

• Abdominal aortic calcification (AAC) is associated with renal dysfunction after liver transplantation. • Higher AAC is associated with a higher cumulative incidence of postoperative chronic kidney disease. • Aging, low baseline estimated glomerular filtration rate, and high AAC are risk factors for chronic kidney disease in liver transplants. With improved graft and patient survival after liver transplantation (LT), the onset of late complications, such as renal dysfunction, has become a problem. In this study, we aimed to investigate abdominal aortic calcification (AAC), a potential indicator of systemic atherosclerosis, and evaluate the relationship between preoperative AAC and postoperative chronic kidney disease (CKD), as the latter might be a long-term complication after LT. Among the 184 LTs performed at our center between 2008 and 2021, 110 LTs with normal renal function (estimated glomerular filtration rate [eGFR] 60 mL/min per 1.73 m2) before surgery were included. These were divided into high- (≥100 mm3) and low-AAC groups (<100 mm3) consisting of 51 and 59 patients, respectively. The AAC volume was automatically calculated for calcifications located in the abdominal aorta using the Agatston method. The high-AAC group was older, consisted of more men, and had lower preoperative creatinine and eGFR levels. No significant difference in the onset of postoperative CKD was found between the 2 groups. However, the cumulative incidence of postoperative CKD was significantly higher in the high-AAC group compared with the low-AAC group. Multivariate analysis of postoperative CKD using the Cox proportional hazards model showed significant differences in preoperative AAC ≥100 mm3, recipient age ≥50 years, and preoperative eGFR <75 mL/min per 1.73 m2. The development of postoperative CKD should be monitored in liver transplant recipients despite normal preoperative renal function. Our study suggests that preoperative AAC may influence postoperative renal dysfunction. [ABSTRACT FROM AUTHOR]

• Efforts to minimize rewarming during vascular anastomosis improve graft outcomes. • A thermal barrier bag keeps the graft cooler even with prolonged anastomosis. • In long anastomosis time, the thermal barrier bag is preferred. In kidney transplantation (KT), efforts to minimize rewarming and optimize anastomosis time during vascular anastomosis improve graft outcomes. We recently reported the safety and efficacy of a pouch-type thermal barrier bag (TBB) made of elastomer gel to reduce second-warm ischemic injury during vascular anastomosis. We aimed to examine the usefulness of the TBB in prolonged vascular anastomosis in KT performed by young transplant fellows. Young transplant fellows performed KT under the supervision of certified transplant surgeons. The kidney graft was placed inside the TBB with an outlet for vessels and preserved during vascular anastomosis. A non-contact infrared thermometer measured the graft surface temperature before and after vascular anastomosis. After completion of the anastomosis, the TBB was manually slid out of the transplanted kidney and removed before graft reperfusion. Clinical data, including patient characteristics and perioperative variables, were collected. The primary endpoint was the median graft surface temperature at the end of the anastomosis. Ten living-donor kidney transplant recipients with a median age of 56.5 years (range, 40–69 years) underwent KT procedures performed by young transplant fellows. The median anastomosis time was 53 (43–67) min. At the end of anastomosis, the median graft surface temperature was 17.7°C (16.3–18.3°C); no serious adverse events or delayed graft function were observed. The TBB can keep transplanted kidneys at a low temperature even with prolonged vascular anastomosis time, thus contributing to the functional preservation of transplanted kidneys and stable transplant outcomes. [ABSTRACT FROM AUTHOR]

Solving complex problems is critical to educational leaders' ability to achieve improvement in schools. Much of this problem-solving is carried out in conversations with staff. This paper draws on theories of collaborative problem-solving and interpersonal effectiveness to examine the behavior of leaders in such conversations – in Norway and New Zealand. Analyses of conversation transcripts of 17 Norwegian and 18 New Zealand leaders revealed that only half of the leaders overall engaged in advocacy, inquiry, and collaborative planning behaviors. Slightly less Norwegian leaders tended to engage in open and collaborative problem-solving behaviors compared to their New Zealand colleagues. New Zealand leaders, however, seemed less open and more directive in proposing solutions. Overall, we observed a lack of deep, critical inquiry and discussion of problems and their causes, which is likely to stand in the way of effective problem-solving and school improvement. [ABSTRACT FROM AUTHOR]

Insect galls, which often have complex external and internal structures, are believed to have adaptive significance for the survival of insects inside galls. A unique internal structure was discovered in the gall of a new cynipid species, Belizinella volutum Ide & Koyama, sp. nov., where the larval chamber could roll freely in the internal air space of the gall. Observations of the live galls using micro-computed tomography (micro-CT) revealed its formation process. The larval chamber becomes isolated from the internal parenchyma soon after the gall reaches the maximum diameter and is able to roll as the internal air space is expanding from the surrounding parenchyma to the outer gall wall. The enemy hypothesis could partly explain the adaptive significance of the unique structure of the gall of B. volutum. [ABSTRACT FROM AUTHOR]