Search

The molecular dynamics of regioregulated poly(3-hexylthiophene) P3HT is investigated using muon spin relaxation (μ SR). The response of the μ SR spectra to a longitudinal magnetic field (B LF , parallel to the initial muon spin direction) indicates that the implanted muons form both muonated radicals localized on the thiophene ring and diamagnetic states with comparable yields. Moreover, the unpaired electron in the radical undergoes hyperfine interactions with muon bound to thiophene and with neighboring protons, whose fluctuations can serve as a measure of the molecular dynamics. The B LF dependence of the longitudinal muon spin relaxation rate (1 / T 1 μ ) measured in detail at several temperatures is found to be well reproduced by the spectral density function J (ω) derived from the local susceptibility that incorporates the Havriliak–Negami (H–N) function used in the analysis of dielectric relaxation, χ (ω) ∝ 1 / [ 1 − i (ω / ν ~) δ ] γ (where ν ~ is the mean fluctuation rate and 0 < γ , δ ≤ 1). The magnitude of ν ~ and its temperature dependence deduced from the analysis of 1 / T 1 μ are found to be consistent with the motion of hexyl chains and thiophene rings suggested by 13 C-NMR. The present result marks a methodological milestone in the application of μ SR to the dynamics of complex systems with coexisting fluctuations over a wide range of time scales, such as polymers. [ABSTRACT FROM AUTHOR]

Defect generation and recovery at the interface of a silicon dioxide/silicon ( SiO 2 /Si) stack are studied in oxygen ( O 2) or argon (Ar) plasma processing and post-annealing. Defect generation is recognized to be dependent on the processing gas and the SiO 2 layer thickness. O 2 plasma processing shows a strong incident-ion energy dependence, where ion's implantation, diffusion, and reactions in the SiO 2 layer play important roles in defect generation. A similar dependence is observed for Ar plasma processing; however, it also shows the photon effects in defect generation for a thick SiO 2 layer. Defect recovery is demonstrated by annealing, where recovery depends on the annealing temperature as well as the amount of defects generated at the interface. [ABSTRACT FROM AUTHOR]

Visual object memory is a fundamental element of various cognitive abilities, and the underlying neural mechanisms have been extensively examined especially in the anterior temporal cortex of primates. However, both macroscopic large-scale functional network in which this region is embedded and microscopic neuron-level dynamics of top-down regulation it receives for object memory remains elusive. Here, we identified the orbitofrontal node as a critical partner of the anterior temporal node for object memory by combining whole-brain functional imaging during rest and a short-term object memory task in male macaques. Focal chemogenetic silencing of the identified orbitofrontal node downregulated both the local orbitofrontal and remote anterior temporal nodes during the task, in association with deteriorated mnemonic, but not perceptual, performance. Furthermore, imaging-guided neuronal recordings in the same monkeys during the same task causally revealed that orbitofrontal top-down modulation enhanced stimulus-selective mnemonic signal in individual anterior temporal neurons while leaving bottom-up perceptual signal unchanged. Furthermore, similar activity difference was also observed between correct and mnemonic error trials before silencing, suggesting its behavioral relevance. These multifaceted but convergent results provide a multiscale causal understanding of dynamic top-down regulation of the anterior temporal cortex along the ventral fronto-temporal network underpinning short-term object memory in primates. The source and network mechanisms underlying visual object memory are not fully understood. By combining chemogenetics with neuroimaging and electrophysiology in behaving macaques, here authors provided multi-scale causal evidence on the top-down regulation in the ventral fronto-temporal network for short-term visual object memory. [ABSTRACT FROM AUTHOR]

Background: ChatGPT is a free artificial intelligence (AI) language model developed and released by OpenAI in late 2022. This study aimed to evaluate the performance of ChatGPT to accurately answer clinical questions (CQs) on the Guideline for the Management of Blepharoptosis published by the American Society of Plastic Surgeons (ASPS) in 2022. Methods: CQs in the guideline were used as question sources in both English and Japanese. For each question, ChatGPT provided answers for CQs, evidence quality, recommendation strength, reference match, and answered word counts. We compared the performance of ChatGPT in each component between English and Japanese queries. Results: A total of 11 questions were included in the final analysis, and ChatGPT answered 61.3% of these correctly. ChatGPT demonstrated a higher accuracy rate in English answers for CQs compared to Japanese answers for CQs (76.4% versus 46.4%; p = 0.004) and word counts (123 words versus 35.9 words; p = 0.004). No statistical differences were noted for evidence quality, recommendation strength, and reference match. A total of 697 references were proposed, but only 216 of them (31.0%) existed. Conclusions: ChatGPT demonstrates potential as an adjunctive tool in the management of blepharoptosis. However, it is crucial to recognize that the existing AI model has distinct limitations, and its primary role should be to complement the expertise of medical professionals. Level of Evidence V: Observational study under respected authorities. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Horizontal and vertical moisture advection in the lower troposphere of the Arctic under progressing global warming is examined using a large‐scale ensemble model data set. Advection is decomposed into terms related to the basic state of the atmosphere and transient eddies and compared against a non‐warming experiment. During summer, horizontal moisture advection increases mainly by transient eddies advecting moisture from the lower latitudes. During winter, enhanced evaporation due to reduced sea ice becomes a source of moisture diminishing the role of transient eddies moistening the atmosphere. This effect intensifies under extreme global warming, turning the change in total horizontal advection in the lower troposphere negative. Diminished horizontal advection during winter is counteracted by vertical advection accompanied with enhanced evaporation and upper‐level horizontal advection maintaining the increase in column moisture. These results improve our understanding of how the water cycle in the Arctic responds via atmospheric processes under global warming. Plain Language Summary: This study uses a data set with a large number of members to investigate how the atmosphere is moistened in the Arctic (north of 70˚N) under various stages of global warming. The movement of moisture is summarized in terms of horizontal and vertical components of advection, a measure of how the atmosphere is moistened in a given specific humidity gradient and wind, which is decomposed into parts related to the average state of the atmosphere and parts related to high‐frequency phenomena, such as cyclones. It is found that (a) during summer, moisturization of the Arctic is mainly driven by horizontal movement of moisture from a remote source in the lower latitude, (b) during winter, this moisturization due to horizontal movement of moisture is suppressed and is driven more by vertical movement of moisture due to reduction of sea ice and increased evaporation. As global warming progresses, the role or horizontal movement of moisture is taken over by the local process of evaporation and vertical movement of moisture. This research helps us understand how the water cycle in the Arctic changes with severe global warming and improves our knowledge of the atmospheric processes that govern the climate system through various feedbacks. Key Points: Moisture advection in the Arctic under progressing global warming is examined using a large‐scale ensemble model simulation data setMoistening effect of horizontal advection in the lower troposphere is enhanced for summer and diminished for winter under extreme warmingEnhanced horizontal advection in the upper layer and surface evaporation are consistent with increased column moisture during winter [ABSTRACT FROM AUTHOR]

Introduction: The tongue plays an important role in mastication, swallowing, and articulation, but it cannot be directly observed because of its location inside the oral cavity. This study aimed to clarify detailed 3D tongue movements during chewing using electromagnetic articulography (EMA). Materials and Methods: The participants were 10 healthy, young volunteers (average age 26.8 ± 2.1 years; 5 males, 5 females). Tongue and jaw movement during gum chewing was measured and recorded using EMA. Four EMA sensors were attached to the anterior, posterior, left, and right surfaces of the tongue, and one sensor was also attached to the mandibular left incisor. The tongue motion during the chewing cycle was spatially and sequentially analyzed based on the motion trajectories of the tongue and mandible. Results and Discussion: The tongue moved downward and to the masticatory side in a manner similar to the movement of the jaw. The anterior tongue marker moved downward to a greater extent than the other tongue markers. However, the tongue moved forward as the jaw moved backward. The anterior marker reached the most anterior position during the jaw-opening phase and the posterior markers reached the most anterior position during the jaw-closing phase. Just before maximum jaw-opening, all markers on the tongue reached the bottom lowest position. During the jaw-closing phase, the tongue reached the dominant farthest position in the masticatory side. All the markers reached the most posterior position during the occlusal phase. Conclusion: These findings demonstrate the sequence of tongue motion patterns during gum chewing. [ABSTRACT FROM AUTHOR]

Real-world data (RWD) in the medical field, such as electronic health records (EHRs) and medication orders, are receiving increasing attention from researchers and practitioners. While structured data have played a vital role thus far, unstructured data represented by text (e.g., discharge summaries) are not effectively utilized because of the difficulty in extracting medical information. We evaluated the information gained by supplementing structured data with clinical concepts extracted from unstructured text by leveraging natural language processing techniques. Using a machine learning-based pretrained named entity recognition tool, we extracted disease and medication names from real discharge summaries in a Japanese hospital and linked them to medical concepts using medical term dictionaries. By comparing the diseases and medications mentioned in the text with medical codes in tabular diagnosis records, we found that: (1) the text data contained richer information on patient symptoms than tabular diagnosis records, whereas the medication-order table stored more injection data than text. In addition, (2) extractable information regarding specific diseases showed surprisingly small intersections among text, diagnosis records, and medication orders. Text data can thus be a useful supplement for RWD mining, which is further demonstrated by (3) our practical application system for drug safety evaluation, which exhaustively visualizes suspicious adverse drug effects caused by the simultaneous use of anticancer drug pairs. We conclude that proper use of textual information extraction can lead to better outcomes in medical RWD mining. [ABSTRACT FROM AUTHOR]

Background: Mega-aortic syndrome including aortic arch and descending aortic aneurysm is a challenging surgical case. Because the aorta continuously dilates, creating the distal anastomosis sites becomes an issue. Despite the developments in endovascular techniques including frozen elephant trunk, in the case of mega-aortic syndrome or mycotic aneurysm, extensive surgical repair is still a strong armamentarium. Our patient had a mega-aorta with chronic aortic dissection. Herein, we show tips regarding concurrent ascending, aortic arch, and descending aortic replacement via posterolateral thoracotomy for this relatively young patient. Case presentation: A 46-year-old man with chronic kidney disease had chronic type A aortic dissection with an extensively dilated thoracic aorta from the distal ascending to the descending aorta measuring 63 mm in diameter and abdominal aorta measuring 50 mm. The short segment of the distal descending aorta was narrowed to 36 mm. The patient underwent a concurrent replacement of the distal ascending aorta, aortic arch, and descending aorta via a posterolateral thoracotomy. The patient was extubated on postoperative day (POD) 1 and discharged home without serious complications such as stroke, respiratory failure, or renal failure on POD 18. The 1-year follow-up computed tomography did not find issues in the anastomosis sites; however, the abdominal aorta enlarged from 50 to 58 mm. The patient underwent a thoracoabdominal aortic replacement and recovered well without any complications. Conclusions: Good exposure and meticulous organ protection methods are key to a safe concurrent replacement of the ascending, aortic arch, and descending aorta via posterolateral thoracotomy. [ABSTRACT FROM AUTHOR]

Microbial cells serve as efficient and environmentally friendly biocatalysts, but their stability and reusability in practical applications must often be improved through immobilization. Acinetobacter sp. Tol 5 shows high adhesiveness to materials due to its large cell surface protein AtaA, which consists of 3630 amino acids (aa). Previously, we developed a method for immobilizing bacteria using AtaA. Herein, we investigated the cell immobilization ability of in-frame deletion (IFD) mutants of AtaA with different sizes in Tol 5. Mini-AtaA, which consists of 775 aa and is functional in Escherichia coli, was produced and present on the cell surface; however, mini-AtaA showed no immobilization ability in Tol 5. A cell immobilization assay was performed with cells expressing 16 IFD mutants of AtaA with different sizes, revealing that a length of at least 1417 aa was required for the sufficient immobilization of Tol 5 cells; thus, the minimum length needed to achieve the adhesive function of AtaA varies among bacterial species. The constructed mutant library of AtaA ranging from 3630 to 775 aa will allow researchers to quickly and easily explore the optimal size of AtaA, even for bacteria newly introduced to AtaA. [ABSTRACT FROM AUTHOR]

Stalagmites are useful archives in reconstructing paleoclimates: most paleoclimate studies used stalagmites that are distributed in specific locations and ages. We examined a stalagmite (GYM-1) collected from Nara Prefecture, central Japan, where limestone areas are limited. Applying 238U–234U method, the ages of GYM-1 were determined as 744 ± 70 to 677 ± 74 ka (based only on analytical uncertainties, 1σ). Even assuming a 10% uncertainty in the initial activity of 234U/238U, (234U/238U)0, this age could be still older than 460 ka. Temperatures calculated based on δD in the fluid inclusions and δ18O in the calcium carbonate ranged from 9.0 to 11.9 °C (10.8 ± 0.9 °C on average) or from 6.0 to 9.1 °C (7.9 ± 0.9 °C on average) depending on the equation. The estimated temperature suggests that GYM-1 formed during an interglacial period of the Middle Pleistocene. Synchronous behavior of isotopic values with lamination likely reflects seasonal temperature in a highly ventilated cave system. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that patients with immunosuppression tend to have longer-lasting SARS-CoV-2 infections and a number of mutations were observed during the infection period. However, these studies were, in general, conducted longitudinally. Mutation evolution among groups of patients with immunosuppression have not been well studied, especially among Asian populations. Methods: Our study targeted a nosocomial cluster of SARS-CoV-2 infection in a Japanese medical center during Delta surge (AY.29 sublineage), involving ward nurses and inpatients. Whole-genome sequencing analyses were performed to examine mutation changes. Haplotype and minor variant analyses were furtherly performed to detect the mutations on the viral genomes in detail. In addition, sequences of the first wild-type strain hCoV-19/Wuhan/WIV04/2019 and AY.29 wild-type strain hCoV- 19/Japan/TKYK15779/2021 were used as references to assess the phylogenetical development of this cluster. Results: A total of 6 nurses and 14 inpatients were identified as a nosocomial cluster from September 14 through 28, 2021. All were Delta variant (AY.29 sublineage) positive. 92.9% of infected patients (13 out of 14) were either cancer patients and/or receiving immunosuppressive or steroid treatments. Compared to AY.29 wild type, a total of 12 mutations were found in the 20 cases. Haplotype analysis found one index group of eight cases with F274F (N) mutation and 10 other haplotypes with one to three additional mutations. Furthermore, we found that cases with more than three minor variants were all cancer patients under immunosuppressive treatments. The phylogenetical tree analysis, including 20 nosocomial cluster-associated viral genomes, the first wild-type strain and the AY.29 wild-type strain as references, indicated the mutation development of the AY.29 virus in this cluster. Conclusion: Our study of a nosocomial SARS-CoV-2 cluster highlights mutation acquisition during transmission. More importantly, it provided new evidence emphasizing the need to further improve infection control measures to prevent nosocomial infection among immunosuppressed patients. [ABSTRACT FROM AUTHOR]

Narratives posted on the internet by patients contain a vast amount of information about various concerns. This study aimed to extract multiple concerns from interviews with breast cancer patients using the natural language processing (NLP) model bidirectional encoder representations from transformers (BERT). A total of 508 interview transcriptions of breast cancer patients written in Japanese were labeled with five types of concern labels: "treatment," "physical," "psychological," "work/financial," and "family/friends." The labeled texts were used to create a multi-label classifier by fine-tuning a pre-trained BERT model. Prior to fine-tuning, we also created several classifiers with domain adaptation using (1) breast cancer patients' blog articles and (2) breast cancer patients' interview transcriptions. The performance of the classifiers was evaluated in terms of precision through 5-fold cross-validation. The multi-label classifiers with only fine-tuning had precision values of over 0.80 for "physical" and "work/financial" out of the five concerns. On the other hand, precision for "treatment" was low at approximately 0.25. However, for the classifiers using domain adaptation, the precision of this label took a range of 0.40–0.51, with some cases improving by more than 0.2. This study showed combining domain adaptation with a multi-label classifier on target data made it possible to efficiently extract multiple concerns from interviews. [ABSTRACT FROM AUTHOR]

Stiff knee gait (SKG) occurrence after a stroke is associated with various abnormal muscle activities; however, the interactions among these muscles are unclear. This study aimed to elucidate the muscle synergy characteristics during walking in patients with SKG after a stroke. This cross-sectional study included 20 patients with poststroke SKG (SKG group), 16 patients without poststroke SKG (non-SKG group), and 15 healthy adults (control group). Participants walked a 10-m distance at a comfortable speed, and electromyographic data were recorded from six lower-limb muscles. Non-negative matrix factorization was employed to derive time-varying activity (C), muscle weights (W), and the percentage of total variance accounted for (tVAF) for muscle synergies. The SKG group showed a higher tVAF than the control group. The initial stance module (including knee extensors) showed increased activity during the swing phase. The initial swing module (including hip flexors and ankle dorsiflexors) exhibited a higher activity during the single-support phase but a lower activity during the swing phase. The synergy structure in patients with SKG after stroke was simplified, with specific abnormalities in synergy activities. SKG may arise from several synergy alterations involving multiple muscles, indicating that approaches focused on controlling individual muscle activities are unsuitable. [ABSTRACT FROM AUTHOR]

Simple Summary: The pathophysiology of leukemia has been studied in the most detailed manner among all human cancers. In this review, acute promyelocytic leukemia (APL), chronic myeloid leukemia (CML), and acute myeloid leukemia (AML) with RUNX1-RUNX1T1 were selected to consider minimal requirements for cancer initiation based on a simplified model. Even if its completed form is complex, cancer originates from one or two events that happened to a single cell. A simplified model can play a role in understanding how cancer initiates at the beginning. The pathophysiology of leukemia has been studied in the most detailed manner among all human cancers. In this review, based on milestone papers and the latest research developments in hematology, acute promyelocytic leukemia (APL), chronic myeloid leukemia (CML), and acute myeloid leukemia (AML) with RUNX1-RUNX1T1 are selected to consider minimal requirements for cancer initiation. A one-hit model can be applied to the initiation of APL and CML whereas a two-hit model is more suitable to the initiation of AML with RUNX1-RUNX1T1 and other AMLs. Even in cancer cells with multiple genetic abnormalities, there must be a few mutant genes critical for the mutant clone to survive and proliferate. Such genes should be identified and characterized in each case in order to develop individualized target therapy. [ABSTRACT FROM AUTHOR]

The fern independent gametophytes that can maintain populations by vegetative reproduction without conspecific sporophytes have been considered an unusual phenomenon found in some epiphytic or epilithic species of Hymenophyllaceae, Pteridaceae, Lomariopsidaceae, and Polypodiaceae. By chance, the discovery of mysterious strap-like gametophytes on Izu-Oshima Island, Japan, has led to the hypothesis that Hymenasplenium murakami-hatanakae, a fern species belonging to Aspleniaceae, can also form independent gametophytes. Our investigation revealed gametophyte populations of H. murakami-hatanakae on three islands in the Izu Islands. Based on chloroplast DNA analysis of the gametophyte and sporophyte populations, the gametophytes were found to be maintained by vegetative reproduction without a new supply of spores from sporophytes. A comparison of the surrounding vegetation at the collection sites showed that environmental factors such as light and humidity may influence the maintenance of gametophyte populations. These results clearly show that H. murakami-hatanakae is one of the ferns capable of forming independent gametophytes. This is the first report of independent gametophytes from the suborder Aspleniineae (eupolypod II). The discovery of the independent gametophyte within a phylogenetic lineage previously thought not to form independent gametophytes will provide important insights into the morphological and functional evolution of gametophytes in ferns. [ABSTRACT FROM AUTHOR]

Objectives: To compare the efficacy and safety of dose‐dense methotrexate, vinblastine, doxorubicin, and cisplatin (dd‐MVAC) with gemcitabine‐based regimens for neoadjuvant chemotherapy (NAC) in muscle‐invasive bladder cancer (MIBC) patients treated in Japan. Methods: Data for MIBC patients who received NAC‐dd‐MVAC followed by a radical cystectomy from June 2019 to May 2023 performed at our hospital were analyzed. For comparisons, data for MIBC patients who received NAC gemcitabine and cisplatin (GC) or gemcitabine and carboplatin (GCarbo) therapy between January 2010 and March 2019 were also obtained. Rates of ypT1N0 or less, progression‐free survival (PFS), overall survival (OS), and NAC adverse effects were compared between the GC/GCarbo and dd‐MVAC regimens. Results: Results for 32 patients who received dd‐MVAC and 30 who received GC/GCarbo NAC therapy were analyzed. ypT1N0 or less was noted in 40.7% of the dd‐MVAC and 40.0% of the GC/GCarbo groups, while ypT0N0 rates were 25% and 10%, respectively, with no statistical differences noted. However, Kaplan–Meier analysis of the total cohort demonstrated that dd‐MVAC was associated with significantly better PFS and OS rates than GG/GCarbo (hazard ratios: 0.33, p = 0.0237, and 0.23, p = 0.0127, respectively). Propensity‐matched models also showed similar results for both PFS and OS. Adverse effects of dd‐MVAC were acceptable and the incidence of hematologic toxicity was lower as compared with GC/GCarbo therapy. Conclusion: The present study is the first to show that dd‐MVAC as NAC can provide better survival as compared with a gemcitabine‐based regimen for patients with MIBC treated in Japan. [ABSTRACT FROM AUTHOR]

The physiological impacts of polysaccharides and lipids in seaweed on human health are becoming clearer, but the behavior of the protein components, especially lectins, after ingestion remains poorly understood. In this study, we examined the resistance of edible red algae-derived lectins to digestive enzymes. We found that a lectin extracted from Meristotheca papulosa (MPL-1), belonging to the Jacalin-related lectin family, was relatively stable when subjected to both peptic and tryptic digestion and retained its hemagglutination activity after 24 h of digestion. The activity of MPL-1 was also maintained without a large change for 24 h following exposure to enzymes such as papain, Actinase E, and proteinase K, suggesting that MPL-1 possesses a strong resistant property against proteolytic digestion. We examined the anti-proliferation activity of the MPL fraction from the algal body against HT-29, a human colon cancer-derived cell line, and found that it showed a strong inhibitory activity with a half-maximal inhibitory concentration of 4.5 μg/mL. This activity was nullified in the presence of yeast mannan, an inhibitory sugar compound of lectin, demonstrating that MPL expressed its activity through binding to the glycan moieties on HT-29. This study indicates that this proteinase-resistant lectin could play a vital role after ingestion and is expected to have an inhibitory effect against colorectal cancer. [ABSTRACT FROM AUTHOR]

People living in coastal areas have the advantage of accessing a high level of ecosystem services, but are also exposed to the dangers inherent in living by the sea in an area prone to natural disasters. To achieve sustainable utilization of the high ecosystem services of coastal areas, establishment of an effective marine policy based on regional characteristics of human–nature interactions is essential. We compared the structure of perceived satisfaction for five components of human well-being ('Security', 'Basic material for a good life', 'Good social relations', 'Health', and 'Freedom of choice and action') derived from coastal ecosystem services among three sites in Japan (Wakasa, Sanriku, and Shima) that share the same natural and social backgrounds: highly dependent on fisheries industry, located in the same climate regime (temperate zone), and have similar topographical features (ria coast). Structural equation modeling using the results from questionnaire surveys showed that the three sites shared a common basic structure of the interactions among the five components of human well-being. However, the intensity of interactions among components differed among the three sites. Questionnaire surveys on anxiety about natural disasters and future access to marine ecosystem services were simultaneously conducted at the three sites. The site-specific anxieties were responsible for the difference in the interactions among the five components of human well-being. We propose a method that quantitatively evaluates both positive (satisfaction) and negative (anxiety) aspects of respondents' subjective assessment as a useful tool for understanding the diversity of human–nature interactions caused by the region-specific natural and social backgrounds of coastal areas. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the effect of plasma‐activated Ringer's lactate solution (PAL) on oral squamous cell carcinoma (OSCC) cells and carcinogenic processes with a particular focus on iron and collagenous matrix formation. Materials and Methods: We used three OSCC cell lines, one keratinocyte cell line, and two fibroblast lines, and cell viability assays, immunoblotting, flow cytometry, and transmission electron microscopy were performed to evaluate the effect and type of cell death. The effect of PAL treatment on lysyl oxidase (LOX) expression was investigated in vitro and in vivo. Tamoxifen‐inducible Mob1a/b double‐knockout mice were used for the in vivo experiment. Results: PAL killed OSCC cells more effectively than the control nontumorous cells and suppressed cell migration and invasion. Ferroptosis occurred and the protein level of LOX was downregulated in cancer cells in vitro and in vivo. Additionally, PAL improved the survival rate of mice and suppressed collagenous matrix formation. Conclusions: We demonstrated that PAL specifically kills OSCC cells and that ferroptosis occurs in vitro and in vivo. Furthermore, PAL can prevent carcinogenesis and improve the survival rate of oral cancer, especially tongue cancer, by changing collagenous matrix formation via LOX suppression. [ABSTRACT FROM AUTHOR]

Background: Maintenance avelumab is currently recommended for patients with unresectable and/or metastatic (mUC) achieving at least stable disease (SD) on first-line platinum-based chemotherapy (1L-CT). Pembrolizumab is an alternative therapeutic avenue for this patient cohort in clinical practice. We investigated real-world data, focusing on the correlation between response to 1L-CT and oncological efficacy of subsequent immune checkpoint inhibitor (ICI) therapy with avelumab or pembrolizumab. Methods: A multicenter database registered 626 patients with mUC diagnosed from 2008–2023; among these, 175 receiving 2–6 cycles of 1L-CT followed by ICI therapy. Patients were categorized based on response to 1L-CT using the Response Evaluation Criteria in Solid Tumors (v1.1). Objective response rate on ICI, progression to ICI-free survival (ICI-PFS), and overall survival from start of 1L-CT were compared between avelumab-treated and pembrolizumab-treated patients in each response subgroup. Results: ICI-PFS was significantly longer in patients achieving partial response on 1L-CT and subsequently receiving pembrolizumab compared to those receiving avelumab. Notably, patients achieving SD on 1L-CT and subsequently receiving pembrolizumab manifested significantly higher objective response rate (14% and 41%, respectively) and prolonged ICI-PFS relative to those receiving avelumab. In contrast, overall survival did not delineate difference between patients treated with avelumab versus pembrolizumab. Similar findings were discerned in the subanalysis of patients having favorable SD (tumor shrinkage, from − 29 to 0%) and unfavorable SD (tumor enlargement, from + 1 to + 19%) on 1L-CT. Conclusions: Our study provides real-world evidence regarding difference of oncological efficacy between maintenance avelumab and subsequent pembrolizumab in patients with mUC who achieved partial response or SD on 1L-CT. [ABSTRACT FROM AUTHOR]

Introduction Conventional antipsychotic drugs that attenuate dopaminergic neural transmission are ineffective in approximately one-third of patients with schizophrenia. This necessitates the development of non-dopaminergic agents. Methods A systematic search was conducted for completed phase II and III trials of compounds for schizophrenia treatment using the US Clinical Trials Registry and the EU Clinical Trials Register. Compounds demonstrating significant superiority over placebo in the primary outcome measure in the latest phase II and III trials were identified. Collateral information on the included compounds was gathered through manual searches in PubMed and press releases. Results Sixteen compounds were identified; four compounds (ulotaront, xanomeline/trospium chloride, vabicaserin, and roluperidone) were investigated as monotherapy and the remaining 12 (pimavanserin, bitopertin, BI 425809, encenicline, tropisetron, pregnenolone, D-serine, estradiol, tolcapone, valacyclovir, cannabidiol, and rimonabant) were examined as add-on therapy. Compared to the placebo, ulotaront, xanomeline/trospium chloride, vabicaserin, bitopertin, estradiol, cannabidiol, rimonabant, and D-serine showed efficacy for positive symptoms; roluperidone and pimavanserin were effective for negative symptoms; and encenicline, tropisetron, pregnenolone, tolcapone, BI 425809, and valacyclovir improved cognitive function. Discussion Compounds that function differently from existing antipsychotics may offer novel symptom-specific therapeutic strategies for patients with schizophrenia. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this randomized controlled trial was to evaluate whether early urinary catheter removal is feasible during epidural anesthesia during gastrointestinal surgery in male patients at high risk for urinary retention. Methods: Male patients who underwent radical surgery for gastric or colon cancer were enrolled in this randomized controlled trial. Patients were randomized 1:1 into 2 groups: the early group, in which the urinary catheter was removed before removal of the epidural catheter on the second or third postoperative day, and the late group, in which the urinary catheter was removed after removal of the epidural catheter. The randomization adjustment factors were age (≥ 65 or < 65 years) and operative site (gastric or colon). The primary endpoint was urinary retention. The secondary endpoints were the incidence of urinary tract infection and length of postoperative hospital stay. Results: Seventy-three patients were enrolled between March 2020 and February 2024 and assigned to the Early (n = 37) and Late (n = 36) groups. Four patients withdrew their consent after randomization. The intention-to-treat analysis showed that urinary retention occurred in 4 patients (11.1%) in the early group and 1 patient (3.0%) in the late group (P = 0.20). Urinary tract infection occurred in 1 patient (3.0%) in the late group. The median postoperative hospital stay was 9 days in both groups. Conclusion: Early urinary catheter removal in male patients undergoing gastrointestinal surgery with epidural anesthesia could increase urinary retention within the expected acceptable range. Trial registration number: UMIN000040468, Date of registration: May 21, 2020. [ABSTRACT FROM AUTHOR]

We report an Arase‐all sky imager (ASI) conjugate event in which the pulsating aurora (PsA) has a one‐to‐one correspondence with chorus bursts. Wavelet analysis displayed three peaks at ∼0.3 Hz, 4 Hz, and >10 Hz, corresponding to the main pulsation, internal modulation, and fast modulation, respectively. These correspond to the old terms of ∼5–15 s pulsations, chorus risers/elements and subelements/subpackets, respectively. Electron "microbursts" correspond to the 4‐Hz peak. The internal and fast modulations are further verified by the analysis based on fast Fourier transform analyses. Moreover, the spatial distributions of the Fourier spectral amplitude show that the internal and fast modulations are well‐structured within auroral patches. The above results indicate a paradigm shift away from quasilinear theory which implicitly assumes diffuse wave generation. The three time‐scale modulations are consistent with coherent chorus which has been theoretically argued to lead to pitch angle transport three orders of magnitude faster. Plain Language Summary: Pulsating aurora exhibit irregular patches of brightness with quasiperiodic on‐off transitions (∼2–20 s). More rapid modulations, such as internal modulation (∼3–4 Hz) or fast modulation (>10 Hz), have been detected within the pulsation "on" time. However, due to the measurement limitations, the simultaneous observation of three time‐scale modulations has never been reported. In this study, we analyze the conjugate observations of the pulsating aurora (PsA) and chorus recorded by the ground‐based Arase‐all sky imager and the Arase satellite, which demonstrates the coexistence of three time‐scale modulations in the PsA. The spatial distributions of Fourier spectral amplitude show that the internal and fast modulations are well‐structured within the aurora patches. The three time scales of chorus modulation have been previously called chorus 5–15 s pulsations, risers/elements and subelements/subpackets corresponding to the three aurora peaks. This study verifies the existence of internal and fast modulations in PsA, implying an extremely rapid electron loss mechanism. Quasilinear theory cannot explain any of the three time‐scale modulations. The discovery that chorus is coherent and will lead to pitch angle transport 1,000 times faster than diffuse waves is consistent with the fast modulations shown in this paper. A new theory of chorus generation is needed to update that of quasilinear theory. Key Points: We report a conjugate event in which the pulsating aurora (PsA) has a one‐to‐one correspondence with chorus burstsThe frequency spectra of auroral intensities obtained by wavelet analysis and fast Fourier transform (FFT) show the coexistence of ∼0.3 Hz, 4 Hz, and >10 Hz modulationsSpatial distributions show that the internal and fast modulations are well‐structured within aurora patches [ABSTRACT FROM AUTHOR]

Temporal discounting, in which the recipient of a reward perceives the value of that reward to decrease with delay in its receipt, is associated with impulsivity and psychiatric disorders such as depression. Here, we investigate the role of the serotonin 5-HT4 receptor (5-HT4R) in modulating temporal discounting in the macaque dorsal caudate nucleus (dCDh), the neurons of which have been shown to represent temporally discounted value. We first mapped the 5-HT4R distribution in macaque brains using positron emission tomography (PET) imaging and confirmed dense expression of 5-HT4R in the dCDh. We then examined the effects of a specific 5-HT4R antagonist infused into the dCDh. Blockade of 5-HT4R significantly increased error rates in a goal-directed delayed reward task, indicating an increase in the rate of temporal discounting. This increase was specific to the 5-HT4R blockade because saline controls showed no such effect. The results demonstrate that 5-HT4Rs in the dCDh are involved in reward-evaluation processes, particularly in the context of delay discounting, and suggest that serotonergic transmission via 5-HT4R may be a key component in the neural mechanisms underlying impulsive decisions, potentially contributing to depressive symptoms. [ABSTRACT FROM AUTHOR]

The prompt initiation of stroke treatment significantly influences patient outcomes, highlighting the crucial role of prehospital triage. This study aimed to assess the implementation of the 7-Item Japan Urgent Stroke Triage (JUST-7) score by emergency medical services (EMS) in our region and its effect on emergency transportation for suspected stroke patients. Data were collected from patients suspected of having an acute stroke with a Cincinnati Prehospital Stroke Scale (CPSS) score of 1 or more who were transferred by ambulance within 24 h of symptom onset. Two prehospital stroke scales were employed during different periods: period 1 with CPSS alone (January to December 2020) and period 2 with both CPSS and JUST-7 (January 2021 to March 2023). On-scene time data were obtained from the EMS crews, and data regarding the final diagnosis of patients and their outcomes were obtained from the respective hospitals to which the patients were transferred. These data were compared between periods 1 and 2 and between the CPSS and JUST-7. The results revealed that additional evaluation with JUST-7 did not affect ambulance transport time. The CPSS+JUST-7 approach demonstrated higher specificity in identifying stroke and major artery occlusion than with the CPSS alone; however, an appropriate cut-off value needs to be considered. The JUST-7 achieved a diagnostic concordance rate of 35.9% for the most likely stroke type and 64.0% for the first two most likely types. This research emphasizes the potential of JUST-7 as a valuable addition to prehospital stroke diagnosis protocols. Its flexibility in adapting cut-off values based on regional factors and available medical resources optimizes its utility in diverse healthcare settings. The JUST-7 score is a promising tool for improving patient outcomes through prompt and accurate prehospital assessments. [ABSTRACT FROM AUTHOR]

Seizures are increasingly being recognized as the hallmark of Alzheimer's disease (AD). Neuronal hyperactivity can be a consequence of neuronal damage caused by abnormal amyloid β (Aß) depositions. However, it can also be a cell-autonomous phenomenon causing AD by Aß-independent mechanisms. Various studies using animal models have shown that Ca2+ is released from the endoplasmic reticulum (ER) via type 1 inositol triphosphate receptors (InsP3R1s) and ryanodine receptors (RyRs). To investigate which is the main pathophysiological mechanism in human neurons, we measured Ca2+ signaling in neural cells derived from three early-onset AD patients harboring Presenilin-1 variants (PSEN1 p.A246E, p.L286V, and p.M146L). Of these, it has been reported that PSEN1 p.A246E and p.L286V did not produce a significant amount of abnormal Aß. We found all PSEN1-mutant neurons, but not wild-type, caused abnormal Ca2+-bursts in a manner dependent on the calcium channel, Ryanodine Receptor 2 (RyR2). Indeed, carvedilol, an RyR2 inhibitor, and VK-II-86, an analog of carvedilol without the β-blocking effects, sufficiently eliminated the abnormal Ca2+ bursts. In contrast, Dantrolene, an inhibitor of RyR1 and RyR3, and Xestospongin c, an IP3R inhibitor, did not attenuate the Ca2+-bursts. The Western blotting showed that RyR2 expression was not affected by PSEN1 p.A246E, suggesting that the variant may activate the RyR2. The RNA-Seq data revealed that ER-stress responsive genes were increased, and mitochondrial Ca2+-transporter genes were decreased in PSEN1A246E cells compared to the WT neurons. Thus, we propose that aberrant Ca2+ signaling is a key link between human pathogenic PSEN1 variants and cell-intrinsic hyperactivity prior to deposition of abnormal Aß, offering prospects for the development of targeted prevention strategies for at-risk individuals. [ABSTRACT FROM AUTHOR]

Background: The respiratory adjusted shock index (RASI) is a risk score whose usefulness in patients with sepsis and trauma has previously been reported. However, its relevance in elderly emergency patients with medical diseases is yet to be clarified. This study assessed the usefulness of the RASI, which can be evaluated without requiring special equipment, to provide objective and rapid emergency responses. Methods: In this retrospective study, we recruited patients with medical diseases, aged 65 years or older, who were transported to the emergency room from Tokushima Prefectural Kaifu Hospital and underwent arterial blood gas testing from 1 January 2022 to 31 December 2023. We investigated the association of the RASI with other indices, including the lactate level, National Early Warning Score 2 (NEWS2), Shock Index (SI), Sequential Organ Failure Assessment (SOFA) score, quick SOFA (qSOFA) score, and systemic inflammatory response syndrome (SIRS). Results: In this study, we included 260 patients (mean age, 86 years), of whom 234 were admitted to the hospital; 27 and 49 patients died within 7 and 30 days of admission, respectively. The RASI was positively correlated with the lactate level, NEWS2, SI, and increase in the SOFA score (p < 0.001). The RASI was higher in patients with a SIRS or qSOFA score ≥ 2 than in those without (p < 0.001). It predicted death within 7 and 30 days of admission with an area under the curve (AUC) of 0.80 (95% confidence interval [CI]: 0.73–0.87), sensitivity of 96.3%, and specificity of 53.6% when the cutoff value was set to 1.58 and with an AUC of 0.73 (95% CI: 0.66–0.81), sensitivity of 69.4%, and specificity of 70.6% when the cutoff value was set to 1.83, respectively. Conclusions: The RASI is a simple indicator that can be used for predicting in-hospital outcomes in elderly emergency patients with medical diseases. Larger prospective studies based on this study are needed. [ABSTRACT FROM AUTHOR]

Elevated temperatures persisted for an anomalously protracted interval following pulsed volcanic carbon release associated with the end-Permian mass extinction, deviating from the expected timescale of climate recovery following a carbon injection event. Here, we present evidence for enhanced reverse weathering--a CO2 source--following the end-Permian mass extinction based on the lithium isotopic composition of marine shales and cherts. We find that the average lithium isotopic composition of Lower Triassic marine shales is significantly elevated relative to that of all other previously measured Phanerozoic marine shales. Notably, the record generated here conflicts with carbonate-based interpretations of the lithium isotopic composition of Early Triassic seawater, forcing a re-evaluation of the existing framework used to interpret lithium isotopes in sedimentary archives. Using a stochastic forward lithium cycle model, we demonstrate that elevated reverse weathering is required to reproduce the lithium isotopic values and trends observed in Lower Triassic marine shales and cherts. Collectively, this work provides direct geochemical evidence for enhanced reverse weathering in the aftermath of Earth's most severe mass extinction. [ABSTRACT FROM AUTHOR]

The present study introduces a rapid and accurate customized solver on the OpenFOAM platform for large-scale industrial computations. Specifically, a sparse analytical Jacobian approach utilizing the SpeedCHEM library was implemented to enhance the efficiency of the ordinary differential equation solver. The dynamic load balancing code was used to distribute computational workloads uniformly across multiple processes. Optimization continued with open multi-processing to improve parallel computing efficiency and the local time stepping scheme to maximize individual cell time steps. The effectiveness and robustness of the customized solver were first validated using Sandia flames D–F as benchmarks. The results showed that the customized solver exhibited better strong scaling characteristics and led to a speed increase of up to 30 times for two-dimensional Sandia flame D calculations. The numerical predictions for temperature and species distribution closely matched the experimental trends, confirming the accuracy of the solver. Subsequently, a three-dimensional numerical study on a 10 kW ammonia co-combustion furnace was conducted, exploring the performance of the solver in large-scale reactive simulations. Results analysis indicated that the acceleration capability was reduced due to increased communication overhead between processors, achieving up to 7.06 times speed-up. However, as the size of the reaction mechanism increases, better acceleration capabilities can be demonstrated. The numerical predictions could closely replicate experimental trends, effectively predicting NO emission trends within the combustion furnace. This study offers one viable solution for rapid and accurate calculations in the OpenFOAM platform, which could be applied in the subsequent ammonia industrial combustion processes. [ABSTRACT FROM AUTHOR]

Unresectable, metastatic, advanced urothelial carcinoma (aUC) is an aggressive disease and is treated with platinum-containing first-line chemotherapy, followed by immune checkpoint inhibitors and antibody–drug conjugates. Response to first-line chemotherapy is a vital priority in sequential treatment strategies because a better response to first-line chemotherapy is associated with a better response to subsequent therapies. Gemcitabine plus carboplatin chemotherapy is conventionally recommended for cisplatin-ineligible patients. This multicenter, single-arm prospective trial will investigate whether dose-dense methotrexate, vinblastine, doxorubicin, and carboplatin (DD-MVACarbo) chemotherapy is superior to gemcitabine plus carboplatin chemotherapy in terms of efficacy in platinum-naïve, cisplatin-ineligible patients with aUC. After screening and registration, a total of 46 patients will be treated with this novel chemotherapy regimen. The primary endpoint is the objective response rate. The secondary endpoints include disease control rate, patient-reported outcomes, and adverse events. No evidence of this novel intervention is available as of July 2024. The results are expected to change the standard of care and improve the management of patients with aUC. [ABSTRACT FROM AUTHOR]

Background: Hypopharyngeal carcinoma is likely to spread to the lymph nodes, but there is no established strategy for management in transoral surgery. Methods: We compared oncologic and functional outcomes in a retrospective multicenter study of patients who underwent transoral surgery for hypopharyngeal carcinoma between 2015 and 2021. Results: Two‐hundred and thirty‐two patients were included. Comparing patients with and without adjuvant radiotherapy, 3‐year regional recurrence‐free survival (RRFS) was not significantly different in pN2b and pN2c, but was significantly worse in pN3b without adjuvant radiotherapy. In patients without neck dissection, the 3‐year RRFS was 85.6%, 76.8%, and 70.0% for T1, T2, and T3 primary lesions, respectively, and was significantly worse for T2 or higher (p = 0.035). Conclusions: In the absence of extracapsular invasion, regional control did not deteriorate without adjuvant therapy. If prophylactic neck dissection is not performed, careful follow‐up is necessary if the primary lesion is T2 or greater. [ABSTRACT FROM AUTHOR]

Recent advances in treating colorectal cancer (CRC) have increased the importance of multidisciplinary treatment. This study aimed to clarify trends in the treatment and survival of CRC using population‐based cancer registry data in Japan. We analyzed the survival of CRC cases diagnosed from 1995 through 2015 from a population‐based cancer registry of six prefectures. The year of diagnosis was classified into five periods, and the trends in the detailed categorization of treatments and survival were identified. We calculated net survival and excess hazard of death from cancer using data on 256,590 CRC patients. The use of laparoscopic surgery has been increasing since 2005 and accounts for the largest proportion of treatment types in the most recent period. Net survival of CRC patients diagnosed after 2005 remained high for laparoscopic surgery and endoscopic surgery (endoscopic mucosal resection or endoscopic submucosal dissection). There was an upward trend in treatment with chemotherapy in addition to open and laparoscopic surgery. Using the excess hazard ratio at the regional stage since 2005, there has been a significant improvement in survival in the younger age group and the rectum cancer group. By type of treatment, there was a tendency toward significant improvement in the open surgery + chemotherapy group. We clarified the trends in treating CRC and the associated trends in survival. Continuous survey based on population‐based data helps monitor the impact of developments in treatment. [ABSTRACT FROM AUTHOR]

Killip classification has been used to stratify the risk of patients with acute myocardial infarction (AMI). There were many reports that Killip class 3 or 4 is closely associated with poor clinical outcomes. In other words, Killip class 1 or 2 is associated with favorable clinical outcomes in patients with AMI, especially when patients received primary percutaneous coronary intervention (PCI). However, some patients with Killip class 1/2 suffer from serious in-hospital complications. This study aimed to identify factors associated with serious in-hospital complications of ST-segment elevation myocardial infarction (STEMI) in patients with Killip class 1/2. The primary endpoint was serious in-hospital complications defined as the composite of in-hospital death and mechanical complications. We included 809 patients with STEMI, and divided them into the non-complication group (n = 791) and the complication group (n = 18). In-hospital death was observed in 14 patients (1.7%), and mechanical complications were observed in 4 patients (0.5%). Final TIMI flow ≤ 2 was more frequently observed in the complication group (33.3%) than in the non-complication group (5.4%) (p < 0.001). Multivariate logistic regression analysis revealed that serious in-hospital complication was associated with final TIMI flow grade ≤ 2 (Odds ratio 6.040, 95% confidence interval 2.042–17.870, p = 0.001). In conclusion, serious in-hospital complication of STEMI was associated with insufficient final TIMI flow grade in patients with Killip class 1/2. If final TIMI flow grade is suboptimal after primary PCI, we may recognize the potential risk of serious complications even when patients presented as Killip class 1/2. [ABSTRACT FROM AUTHOR]

Chronic psychological stress has been reported to decrease circulating iron concentrations and impair hematopoiesis. However, the underlying mechanisms remain unclear. This study aimed to investigate the effects of psychological stress on biological iron metabolism by using the social defeat stress (SDS) model, a widely used model of depression. Compared with control mice, mice subjected to SDS (SDS mice) had lower social interaction (SI) behavior. The SDS mice also showed impaired hematopoiesis, as evidenced by reduced circulating red blood cell counts, elevated reticulocyte counts, and decreased plasma iron levels. In the SDS mice, the iron contents in the bone marrow decreased, whereas those in the spleen increased, suggesting dysregulation in systemic iron metabolism. The concentrations of plasma hepcidin, an important regulator of systemic iron homeostasis, increased in the SDS mice. Meanwhile, the concentrations of ferroportin, an iron transport protein negatively regulated by hepcidin, were lower in the spleen and duodenum of the SDS mice than in those of the control mice. Treatment with dalteparin, a hepcidin inhibitor, prevented the decrease in plasma iron levels in the SDS mice. The gene expression and enzyme activity of furin, which converts the precursor hepcidin to active hepcidin, were high and positively correlated with plasma hepcidin concentration. Thus, furin activation might be responsible for the increased plasma hepcidin concentration. This study is the first to show that psychological stress disrupts systemic iron homeostasis by activating the hepcidin–ferroportin axis. Consideration of psychological stressors might be beneficial in the treatment of diseases with iron‐refractory anemia. [ABSTRACT FROM AUTHOR]

Sarcopenic dysphagia is the term for swallowing difficulty associated with loss of mass, strength, and physical performance, which leads to increased pharyngeal residues. Unlike sarcopenia, presarcopenia is characterized by low muscle mass without decreased muscle strength or physical performance and can develop into dysphagia due to low skeletal muscle mass. This retrospective study investigated the impact of presarcopenic dysphagia (PSD) on 1-year mortality in patients with cancer and dysphagia who underwent a videofluoroscopic swallowing study (VFSS). An operational definition of PSD based on presarcopenia and pharyngeal residues was adopted. The psoas muscle mass index (cm2/height [m2]), calculated by the psoas muscle area at the third lumber vertebra via abdominal computed tomography (CT) and related to height, was used to assess presarcopenia with cutoff values of 4.62 for men and 2.66 for women. Pharyngeal residues were assessed using a VFSS to evaluate dysphagia. Patients' medical charts were analyzed to investigate 1-year mortality after a VFSS. Out of 111 consecutive patients with cancer, 53 (47.7%) were defined as having PSD. In a forward-stepwise Cox proportional regression analysis, PSD (HR 2.599; 95% CI 1.158–5.834; p = 0.021) was significantly associated with 1-year mortality after a VFSS, even after adjusting for the factors of operation, Functional Oral Intake Scale (FOIS) scores at discharge, and modified Barthel Index (BI) scores at discharge. PSD, defined as CT-based presarcopenia and pharyngeal residues observed during a VFSS, is associated with increased 1-year mortality in patients with cancer and dysphagia. [ABSTRACT FROM AUTHOR]

Background: Anticholinergic burden is associated with adverse events in the older adults. However, there is a lack of evidence regarding its effect on urinary independence in stroke patients. Aim: This study examined the association between increased anticholinergic burden during hospitalization and urinary independence in post-stroke patients undergoing rehabilitation. Method: This observational cross-sectional study included stroke patients admitted to a post-acute rehabilitation hospital between 2020 and 2022 who were not independently urinating. The degree of urinary independence was assessed using the Functional Independence Measure-Bladder (FIM-Bladder), a subscale of the motor domain of the FIM, and urinary independence was defined as FIM-Bladder ≥ 6. Anticholinergic burden was assessed using the anticholinergic risk scale (ARS), and changes in ARS during hospitalization were calculated by subtracting the value at admission from the value at discharge. The study outcome was urinary independence at discharge. Logistic regression analysis was used to examine whether change in ARS score was independently associated with the outcome. Statistical significance was set at P < 0.05. Results: Of the 573 patients enrolled, 312 patients (mean age 77.5 years, 51.9% male) were included in the analysis. ARS increased during hospitalization in 57 patients (18.3%). Change in ARS score was independently associated with urinary independence (odds ratio: 0.432, 95% confidence interval: 0.247–0.756, P = 0.003). Conclusion: Increased anticholinergic burden in post-stroke patients who require assistance with urination is significantly associated with less independent urination. Anticholinergic agents may need to be introduced cautiously in patients who require assistance with urination. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) in the caudate lobe presents surgical challenges due to the lack of distinct anatomical landmarks. This case report introduces a novel surgical approach combining Takasaki's classification and indocyanine green negative counterstaining for precise anatomical caudate lobectomy. A 78-year-old patient with hepatocellular carcinoma in the caudate lobe underwent surgery following preoperative volumetric assessment. The method involved a glissonian approach for both left and right pedicles, coupled with meticulous dissection of hepatic pedicles of the caudate lobe guided by taping of left and right glissonian pedicles, followed by indocyanine green administration for improved visualization of caudate lobe boundaries. The procedure enabled complete tumor resection with minimal blood loss. At 50 months postsurgery, the patient maintains favorable liver function and performance status. This innovative approach offers a promising solution for precise resection of caudate lobe hepatocellular carcinoma, potentially improving surgical outcomes and long-term prognosis. [ABSTRACT FROM AUTHOR]

Background: Coordination among lip, cheek and tongue movements during swallowing in patients with mandibular prognathism remains unclear. Objectives: This study aimed to identify the temporal sequences of tongue pressure and maxillofacial muscle activities during swallowing in patients with mandibular prognathism and compared characteristics with those of healthy volunteers. Methods: Seven patients with mandibular prognathism (mandibular prognathism group) and 25 healthy volunteers with individual normal occlusion (control group) were recruited. Tongue pressures and masseter, orbicularis oris, mentalis and supra‐ and infrahyoid muscle activities while swallowing gel were measured simultaneously using a sensor sheet system with five measurement points and surface electromyography, respectively. Onset time, offset time and durations of tongue pressure and muscle activities were analysed. Results: In the mandibular prognathism group, tongue pressure was often produced first in more peripheral parts of the palate. Offset of tongue pressure in the posteromedian and peripheral parts of the palate and maxillofacial muscle activities except for orbicularis oris were delayed. Duration of tongue pressure in the anteromedian part of the palate was significantly shorter and durations of masseter, mentalis and suprahyoid muscle activities were significantly longer. Times to onset of orbicularis oris and suprahyoid muscle activities based on first onset of tongue pressure were significantly shorter. Conclusion: These results suggest that patients with mandibular prognathism may exhibit specific patterns of tongue pressure production and maxillofacial muscle activities during swallowing. [ABSTRACT FROM AUTHOR]

Objective: The current longitudinal study examined how (1) cognitive measures, including episodic memory, executive function, and global cognition, predict later healthcare access and how (2) healthcare access predicts later cognition. Methods: Drawing a sample (n = 9920) from the Health and Retirement Study dataset, we created a cross-lagged panel model to examine the longitudinal association between cognitive measures and healthcare access from 2012 to 2018. Results: Results revealed that cognitive measures significantly predict later healthcare access, with effects increasing across waves. However, within sub-domains, memory was more predictive of later healthcare access over time compared to executive function. Discussions: Our study suggested an increased link between cognition and healthcare access during aging. Even outside of the context of AD, there are likely both policy-based and practical implications to ensure those experiencing cognitive decline continue to maintain access to care. [ABSTRACT FROM AUTHOR]

Background. Photodynamic diagnosis‐assisted transurethral resection of bladder tumors (PDD‐TURBT) enhances detection of elusive lesions compared to standard white light‐transurethral resection of bladder tumors (WL‐TURBT). If minimal light exposure during PDD‐TURBT induces the accumulation of reactive oxygen species (ROS), potentially resulting in phototoxicity in small lesions, apoptosis may be triggered in residual small tumors, allowing them to escape resection. We investigated the hypothesis of a potential photodynamic therapeutic effect during PDD‐TURBT. Methods and Materials. Our study, conducted between January 2016 and December 2020 at Nara Medical University Hospital, focused on a specific emphasis on ROS production. Immunohistochemical analysis for thymidine glycol and Nε‐hexanoyl‐lysine was performed on 69 patients who underwent 5‐aminolevulinic acid‐mediated PDD‐TURBT and 28 patients who underwent WL‐TURBT. Additionally, we incrementally applied the minimal irradiation energy to T24 and UM‐UC‐3 cells treated with 5‐aminolevulinic acid using instruments similar to those used in PDD‐TURBT and evaluated intracellular ROS production and phototoxicity. Results. Immunohistochemical analysis revealed a significant increase in production of thymidine glycol and Nε‐hexanoyl‐lysine within the PDD‐TURBT group. In T24 and UM‐UC‐3 cells treated with 5‐aminolevulinic acid and light exposure, immunofluorescent staining demonstrated a dose‐dependent increase in intracellular ROS production. In addition, higher irradiation energy levels were associated with a greater increase in ROS production and phototoxicity, as well as more significant decrease in mitochondrial membrane potential. Conclusion. Although the irradiation energy used in PDD‐TURBT did not reach the levels commonly used in photodynamic therapy, our findings support the presence of a potential cytotoxic effect on bladder lesions during PDD‐TURBT. [ABSTRACT FROM AUTHOR]